Introducing infants to a reduced protein Nordic diet may set better eating habits

A Nordic diet with a reduced protein content, when introduced in infancy before initiation of complementary feeding, appears to lead to healthier eating habits, according to results of the OTIS trial presented at ESPGHAN 2022.

“A Nordic diet with reduced protein introduced to infants naïve to this model of eating, increased the intake of fruit, berries, vegetables, and roots, establishing a preferable eating pattern lasting over a 12-month period,” said lead researcher Dr Ulrica Johansson from the University of Umeå, Umeå, Sweden.

This diet was safe and feasible, had no negative effects on growth, iron status, and duration of breastfeeding, and “may contribute to sustainable and healthy eating during infancy and early childhood,” she added.

In the OTIS trial, researchers from Sweden and the US identified 250 healthy infants who were randomized 1:1 to receive either a protein-reduced Nordic diet or a conventional diet initiated at age 4–6 months. To be included, the infants needed to have been exclusively breastfed and/or formula-fed with no complementary feeding.

Infants on the conventional diet were fed according to the current Swedish dietary recommendations for infants. Infants randomized to the Nordic diet began the trial by following a taste portion schedule for 24 days with repeated exposure (total of 72 exposures) to Nordic fruit, berries, vegetables, and roots. Parents or caregivers of the infants were then supplied with Nordic homemade baby food recipes, protein-reduced (30 percent reduction) baby food products, and parental support from nurses and dietitians through social media for infants from age 6–18 months.

At age 12 and 18 months, infants in the Nordic diet group consumed 42–45 percent more fruits and vegetables than those in the conventional diet group. Specifically, at 12 months, fruit intake was 172 vs 122 g/day in the Nordic vs conventional group and vegetable intake was 131 vs 92 g/day (p<0.001). At 18 months, fruit intake was 157 vs 125 g/day in the Nordic vs conventional group and vegetable intake was 109 vs 58 g/day (p<0.001)*. [ESPGHAN 2022, abstract N-O-007]

In the conventional diet group, fruit intake was consistent between age 12–18 months though vegetable intake reduced by 36 percent. In the Nordic diet group, daily vegetable intake was 46 percent higher than in the conventional diet group at age 18 months.

Plasma folate levels were higher in the Nordic vs the conventional diet group at age 12 months (p<0.001) and 18 months (p=0.003).

Daily mean protein intake (g) was 29 and 17 percent lower in the Nordic vs conventional diet group at 12 and 18 months, respectively (p<0.001). Overall protein intake (g/kg) was lower in the Nordic vs conventional diet group. This reduction was accompanied by lower blood urea nitrogen (BUN) levels at age 12 and 18 months (p<0.001).

Growth, total energy intake, iron status, and duration of breastfeeding did not significantly differ between infants in the Nordic and conventional diet groups between baseline and age 18 months.

“Nordic foods are possible to use when exposing infants to a variety of flavours which may contribute to long-lasting food preferences,” Johansson said. “Parental support and the systematic introduction with repeated exposure of taste portions may have impacted the infants’ dietary intake in the Nordic group,” she noted.

According to Johansson, avenues for research following this study include the long-term health effects of this type of diet on dietary intake, body composition, and metabolic processes.