Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

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Ecophysiology of novel intestinal butyrate-producing bacteria
Bui, Thi Phuong Nam - \ 2016
Wageningen University. Promotor(en): Willem de Vos, co-promotor(en): Caroline Plugge. - Wageningen : Wageningen University - ISBN 9789462577015 - 202
butyrates - butyric acid bacteria - intestines - microbial interactions - faecal examination - mice - man - infants - genomics - intestinal physiology - microbial physiology - biochemical pathways - lysine - sugar - butyraten - boterzuurbacteriën - darmen - microbiële interacties - fecesonderzoek - muizen - mens - zuigelingen - genomica - darmfysiologie - microbiële fysiologie - biochemische omzettingen - lysine - suiker

The human intestinal tract harbours a trillion on microbial cells, predominantly anaerobes. The activity and physiology of these anaerobes is strongly associated with health and disease. This association has been investigated for a long time.However, this has not been fully understood. One of the reasons is the limited availability of cultured representatives. It is estimated that there may be more than 3000 species colonised in the gut of healthy individuals, however, only a bit over 1000 species have been isolated and characterised. Among the intestinal microbes, butyrate-producing bacteria are of special interest as the butyrate produced, is crucial to maintain a healthy gut. In addition, butyrate-producing bacteria have shown a reverse correlation with several intestinal diseases. In Chapter 2 we described a novel species Anaerostipes rhamnosivorans 1y2T isolated from an infant stool. This strain belonged to genus Anaerostipes within Clostridium cluster XIVa. A. rhamnosivorans had a capability of converting rhamnose into butyrate that is unique within intestinal butyrate-producing bacteria. The genomic analysis also revealed the entire rhamnose fermentation pathway as well as the acetyl-CoA pathway for butyrate production. This bacterium is able to produce butyrate from a wide range of sugars as well as lactate plus acetate. In Chapter 3, we described the microbial interactions between A. rhamnosivorans and Bacteriodes thetaiotaomicron in dietary pectins; Blautia hydrogenotrophica in lactate and small amount of acetate; Methanobrevibacter smithii in glucose. We observed that A. rhamnosivorans was able to benefit from its partners in all cocultures for butyrate production. This is likely due to its high metabolic flexibility. While the interaction between A. rhamnosivorans and B. thetaiotaomicron appeared as syntrophy, the interaction between A. rhamnosivorans and hydrogenotrohic microbes were cross-feeding type where hydrogen was transferred between two species. The latter resulted in an increase in butyrate level. In Chapter 4 we described a novel species Intestinimonas butyriciproducens SRB521T representing a novel genus Intestinimonas from a mouse caecum within Clostridium cluster IV. This bacterium produced butyrate and acetate as end products from Wilkins-Chalgren-Anaerobe broth.

Butyrate production is assumed to derive from carbohydrate employing acetyl-CoA pathway. No gut bacterium is known to convert proteins or amino acids to butyrate although butyrogenic pathways from amino acid degradation have been detected in the human gut using metagenomic approach. In Chapter 5 we discovered a novel butyrate synthesis pathway from the amino acid lysine and the Amadori product fructoselysine in Intestinimonas butyriciproducens AF211 that was isolated from human stool. This strain appeared to grow much better in lysine as compared to sugars although lysine and acetyl-CoA pathways were both detected in its complete genome. Moreover, the strain AF211 was able to metabolise efficiently fructoselysine into butyrate, and acetate was found to affect the fructoselysine fermentation, representing the impact of the environmental conditions where acetate is abundant in the gut. While the lysine pathway was found in the gut of many individuals, the fructoselysine pathway was present in only half of those samples. The finding that strain I. butyriciproducens AF211 is capable of the butyrogenic conversion of amino acid lysine and fructoselysine, an Amadori product formed in heated foods via the Maillard reaction, indicated a missing link that coupling protein metabolism and butyrate formation. As this Amadori product has been implicated to play a role in aging process, the use of strain AF211 as fructoselysine clearance in the gut needs further investigation. In Chapter 6 we performed genomic and physiological comparison between the I. butyriciproducens strain AF211 (human isolate) and SRB521T (mouse isolate). I. butyriciproducens was the most abundant species within the Intestinimonas genus and highly prevalent in humans based on metadata analysis on 16S amplicons. We confirmed that the butyrogenesis from lysine was a shared characteristic between the two I. butyriciproducens strains. We also observed the host specific features including tolerance to bile, cellular fatty acid composition, more efficient capability of converting sugars into butyrate, especially galactose and arabinose, in the human strain AF211. In addition, genomic rearrangements as well as variations in bacteriophages differed among strains.

'Mum, can I have Brussels sprouts again?’ : development of vegetable preferences during the first 2 years of life
Barends, C. - \ 2015
Wageningen University. Promotor(en): Kees de Graaf, co-promotor(en): Jeanne de Vries; Jos Mojet. - Wageningen : Wageningen University - ISBN 9789462573505 - 187
voedselvoorkeuren - voedselopname - zuigelingen - spenen - eten - smaakgevoeligheid - groenten - food preferences - food intake - infants - weaning - eating - taste sensitivity - vegetables


Background and aim

Most children do not eat the recommended amount of vegetables. Their low vegetable intake may be attributed to their low preference for vegetables. Since the first years of life is a sensitive period in the development of taste preferences, and since taste preferences track over time, we started a longitudinal intervention study to investigate the effect of starting weaning with repeated exposure to vegetable purées on vegetable intake and liking during the first 2 years of life. The primary aim of this thesis was to investigate whether starting weaning with vegetables compared to weaning with fruit had an effect on the intake and liking of vegetables on the short and on the long term. The secondary aim was to investigate whether starting weaning with vegetables compared to weaning with fruit, influenced the preferences for sweet taste and daily intake of sugar.


First, we conducted an intervention study (n = 101) that investigated the effects of repeated exposure to either vegetable purées (vegetable groups) or fruit purées (fruit groups) on infants’ acceptance of vegetable or fruit purées during the first 18 days of weaning. Intake of the purées and mothers’ rated liking were measured in the lab. From a subsample (n = 60), we also measured liking by analysing the infants’ facial expressions and behaviour after consuming green beans purée in the lab. In two follow-up studies, when the infants were 12 (n = 84) and 23 months of age (n = 81), the long-term effect of the intervention was measured on intake and mothers’ rated liking of the purées in the lab. Additionally, infants’ daily vegetable intake was assessed with 3-day food records at both follow-ups. At the second follow-up, also the influence of starting with vegetables or fruits on children’s preferences for sweet and salty tastes (n = 81), were measured with sweetened and salted water solution and by calculating their daily mono- and disaccharides intake from the 3-day food records. Additionally, a systematic review investigated the current status of knowledge about effective strategies to increase vegetable intake in children younger than 3 y.


The studies showed that the group of children who were repeatedly exposed to vegetables increased their vegetable intake from 24 ± 28 g to 45 ± 44g (p < 0.001), while the children who were repeatedly exposed to fruit increased their fruit intake from 46 ± 40 g to 66 ± 42 g (p < 0.05) . Interestingly, the first vegetable intake in the fruit group, which was directly after the 18 days of exposure to fruit purées, was as low as the first vegetable intake of the children in the vegetable group at day 1. This indicates that the repeated exposure to fruit did not influence the children’s vegetable intake. These results were confirmed by the results of the facial expressions, showing a decrease in negative facial expressions after repeated exposure to green beans.

At the follow-ups, when the infants were 12 and 23 months of age, no differences between the vegetable and fruit groups in green beans or apple purée were found in the lab. Daily intake of vegetables at 12 months of age, was 38% higher (p = 0.02) in the vegetable group (75 ± 43 g) than in the fruit group (54 ± 29 g). At 23 months of age, no significant difference in daily vegetable intake was found between the groups. Also the 23 month olds’ preference for sweet water solutions and their daily mono- and disaccharides intake did not differ between groups.

Finally, the systematic review of literature showed that counselling of the parents on healthy eating and nutrition did have a positive long-term effect on their children’s’ vegetable intake, although the effect was relatively small. The review further showed that repeated exposure was the most studied and also the most effective strategy, since all studies reported an increase in intake after repeated exposure to a vegetable. Also exposure to a variety of vegetables showed to have a positive effect on the intake of a new vegetable.


Weaning with repeated exposure to vegetables has a positive influence on vegetable intake until at least 12 months of age.

Control of iron deficiency in the first 1000 days in life: prevention of impaired child development
Chang, S. - \ 2012
Wageningen University. Promotor(en): Frans Kok, co-promotor(en): Inge Brouwer; J. Chen; -- Guansheng Ma. - S.l. : s.n. - ISBN 9789461733825 - 125
ijzergebrekanemie - peuters en kleuters - zuigelingen - kindervoedering - aanvullende voedingsprogramma's - bijvoeding - voedselsupplementen - fortificatie - china - kinderontwikkeling - cognitieve ontwikkeling - iron deficiency anaemia - preschool children - infants - child feeding - supplemental feeding programs - supplementary feeding - food supplements - fortification - china - child development - cognitive development

Evidence indicates that the first 1000 days of life (the period from the woman’s pregnancy continuing into the child’s second year) is the most critical period. This is where nutritional deficiencies have a significant and often irreversible adverse impact on child survival and growth affecting their ability to learn in school and productivity in later life. Sufficient iron supply and intake during pregnancy and in children under two years of age are an important component for nutrition interventions during these critical 1000 days. A causal relationship between iron deficiency and poorer brain function has not been demonstrated yet. In addition, there is ample evidence that the high frequency of iron deficiency anemia (IDA) in the developing world has substantial health and economic costs. It is therefore of public health significance to explore effective and optimal approaches for iron supplementation and iron fortification among high risk populations (i.e., pregnant women, infants and young children).

This thesis addresses some of the above outstanding areas, aiming at i) exploring the long-term effect of IDA in pregnancy and IDA in children under 2 years on cognitive and psychomotor function and social emotional behaviour, ii) understanding the impact of prenatal multiple micronutrient supplementation on health outcomes of newborns, and iii) investigating iron absorption from a complementary food fortified with a mixture of FeSO4 and NaFeEDTA.

The human brain is vulnerable during critical periods of development, including the last trimester of fetal life and the first 2 years of childhood - a period of rapid brain growth termed the “brain growth spurt”. We found that iron deficiency anemia in the third trimester of pregnancy is associated with impaired mental development of the child before 24 months of age. The children whose mothers had iron deficiency anemia showed a significantly lower Mental Development Index (MDI) at 12, 18 and 24 months of age. The adjusted mean difference was 5.8 (95% Confidence interval [CI] 1.1 to 10.5), 5.1 (95% CI 1.2 to 9.0) and 5.3 (95% CI 0.9 to 9.7) respectively. Further analysis showed MDI in the prenatal IDA and non-prenatal IDA groups were similar with supplementation of iron-folic acid (60 mg iron), but significantly lower in the prenatal IDA group with supplementation of folic acid or multiple micronutrients. Prenatal iron supplementation with sufficient iron protects child development even when women’s IDA was not properly corrected during pregnancy (chapter 2).

In a second study, we compared social emotional affect and behavior of three groups of non-anemic 4-year-old children: children with IDA in infancy whose anemia was not corrected before 24 months (chronic IDA, n=27); children with IDA in infancy whose anemia was corrected before 24 months (corrected IDA, n=70), and children who were non-IDA in infancy and at 24 months (n=64). Children’s social referencing, wariness, frustration tolerance behavior and affect were observed in a laboratory setting. The whole procedure was videotaped. Child affective and behavioral display was coded using a time-sampling (5-second segments) coding scheme. Preschool aged children whohad chronic IDA in the first 2 years of life showed affected social emotional behavior. In contrast, children whose anemia was corrected before 24 months were comparable to children who were non-iron deficient and anemic throughout the first 2 years of life in terms of behavior and affect (chapter 3).

Overall, our results indicate that adverse effects can be reduced and/or prevented with iron supplementation during critical periods of brain development.WHO recommends universal distribution of iron-folic acid supplements to pregnant women in developing countries to prevent and treat iron deficiency anemia. However, pregnant women are often deficient in several other nutrients concurrently, all of which can negatively affect their own health as well as their infants’ health, growth and development across the life course. Multiple micronutrient supplements containing iron and other micronutrients should be more efficient to help to reduce anemia, because other nutrients often lacking in the diets of pregnant women in poor populations, including vitamin A, riboflavin and vitamin B6 and B12, are also needed for hemoglobin synthesis. Improving maternal status of multiple micronutrients could also benefit pregnancy outcome, infant micronutrient stores at birth and breast milk content of micronutrients.

In a randomized double blind controlled trial described in chapter 4, we examined the impact of prenatal supplementation with multiple micronutrients or iron-folic acid compared to folic acid alone on birth weight, duration of gestation and maternal hemoglobin concentration in the third trimester. In total 5828 pregnant women were involved. The results suggest multiple micronutrients are as effective as iron folic acid in increasing maternal hemoglobin concentration, birth weight and mean duration of gestation. Our study also shows good adherence can be achieved with multiple micronutrients during pregnancy.

Using 2000 and 2005 Food and Nutrition Surveillance data, we found that complementary feeding practices are suboptimal in both rural and poor rural areas in China, although significant improvements in practices have been made from year 2000 to year 2005. The percentage of consuming meat/eggs more than 4 times a week among 6-9 months children was only 30%, for other age groups only around 50% or less. The high energy and nutrient requirements relative to body size, the capacity to only consume small amounts of foods indicate that nutrient-dense foods must be provided from 6 months until the second and third year of life. Inclusion of animal products can meet the energy and nutrients gap in some cases, but this increases costs and may not be feasible for the lowest-income groups. Furthermore, the amount of animal products that can feasibly be included are generally not sufficient for iron, calcium and sometimes zinc. Thus strategies to optimize nutrient intake from locally available foods may need to be combined with other approaches such as complementary food fortification in order to fully address the problems of micronutrient malnutrition (chapter 6).

In-home fortification of complementary food is an effective approach to provide additional iron and other nutrients to infants and young children in developing countries. To determine whether iron absorption is enhanced with a mixture of FeSO4 and NaFeEDTA, we conducted an iron absorption study with a crossover design in two groups with children aged 24 to 31 months. A complementary food consisting of millet porridge with cabbage, tofu, and pork-filled wheat flour dumplings was fortified with 2 mg iron as either FeSO4 or NaFeEDTA (study 1) or 4 mg iron as FeSO4 or a mixture of 2 mg each of FeSO4 and NaFeEDTA (study 2). Iron absorption was determined based on erythrocyte incorporation of stable iron isotopes. In study 1, the geometric mean iron absorption(±SD) was 8.0% (3.1, 20.8) and 9.2% (3.1, 27.0) from food fortified with FeSO4 and NaFeEDTA, respectively. In study 2, iron absorption was significantly higher from food fortified with 4 mg iron as 1:1 mixture of FeSO4/NaFeEDTA than from food fortified with FeSO4 only; the geometric mean iron absorption was 6.4% (3.0, 13.5) and 4.1% (1.9, 8.9), respectively. We concluded that the equal mixture of FeSO4 and NaFeEDTA significantly enhanced iron absorption and can be a strategy to ensure adequate iron absorption from phytate-containing complementary foods (Chapter 5).

The studies in this thesis provide further evidence on the association between IDA during the first critical 1000 days of live and the long-term impact on child development. Our research results and the meta-analysis of 12 randomized controlled trials (including our trial in China) suggest that the daily provision of multiple micronutrients is an optimal approach for pregnant women in developing countries including China in terms of the health outcome of newborns. The benefits of giving at least 30 mg iron daily to pregnant women shown in our study as well as by others can provide guidance to policy makers on the development of a prenatal nutrient supplementation standard in China. Moreover, enhanced iron absorption from a mixture of FeSO4 and NaFeEDTA as a fortificant supports China’s current practice on the use of NaFeEDTA for in-home fortification of complementary food.Considering our study findings and research by others, the following research is proposed for the near future. 1) Continuing research into the causal relationship of iron deficiency and child behaviour; 2) Developing of better measurement tools to assess child development; 3) Exploring the causality of anemia in the region.

Gastrointestinal-active oligosaccharides from human milk and functional foods
Albrecht, S.A. - \ 2011
Wageningen University. Promotor(en): Harry Gruppen; Fons Voragen, co-promotor(en): Henk Schols. - [S.l.] : S.n. - ISBN 9789085859871 - 200
oligosacchariden - moedermelk - spijsverteringskanaal - zuigelingen - borstvoeding - koolhydraatmetabolisme - oligosaccharides - human milk - digestive tract - infants - breast feeding - carbohydrate metabolism

Keywords: human milk oligosaccharides (HMOs), galacto-oligosaccharides (GOS), konjac glucomannan (KGM), breast milk, baby feces, gastrointestinal metabolization, blood-group specific conjugates, CE-LIF-MSn

Oligosaccharides, as present in human milk or supplemented to food, are renowned for their biological activity in the gastrointestinal tract. So far, little is known about the implication of oligosaccharide structures on their gastrointestinal fate. The influence of diet-related oligosaccharides on the postnatal gastrointestinal development and on the establishment of a balanced microflora is of special interest. Therefore, the present research aimed at an advanced understanding of the gastrointestinal metabolization of diet-related oligosaccharides, focusing on infant nutrition.

Capillary electrophoresis with laser-induced fluorescence detection (CE-LIF) was introduced as a sensitive, qualitative and quantitative method for the analysis of individual galactooligosaccharides (GOS) from complex food matrices. The method also showed to be useful for the monitoring and characterization of complex konjac glucomannan (KGM) oligosaccharides, resulting from enzymatic digestion of the KGM polysaccharide andin vitro fermentation with human gut flora. The analysis and identification of human milk oligosaccharides (HMOs) in breast milk and the characterization of oligosaccharides as present in the feces of breast-, formula- and mixed-fed babies was performed by CE-LIF coupled to a mass spectrometer (CE-LIF-MSn). The type of feeding determines the presence of diet-related oligosaccharides in baby feces. For breast-fed babies a gradual change in fecal oligosaccharide profile was found during the first six months postpartum. Three continuous stages of fecal oligosaccharide profiles were defined, comprising the presence of the genetically determined HMO-profile of the breast milk consumed (stage 1), the presence of HMO-units conjugated to blood group determinants from gastrointestinal mucins (stage 2) and predominantly oligosaccharides characteristic for follow-up feeding when solid food is introduced (stage 3). In total, sixteen fecal oligosaccharides, which pointed to the degradation and gastrointestinal metabolization of diet-related oligosaccharides and which were not present in human milk or infant formula, were identified in this research.

Monitoring the gastrointestinal fate of diet-related oligosaccharides pointed to an individual-dependent gastrointestinal adaptation to enteral food during the postnatal period.

Exploring the functionality of intestinal Bifidobacteria: a post-genomics approach
Klaassens, E.S. - \ 2007
Wageningen University. Promotor(en): Willem de Vos, co-promotor(en): E.E. Vaughan. - [S.l.] : S.n. - ISBN 9789085047148 - 175
darmmicro-organismen - bifidobacterium - activiteit - zuigelingen - moedermelk - zuigelingenmelk - genexpressieanalyse - intestinal microorganisms - bifidobacterium - activity - infants - human milk - humanized milk - genomics
Following birth, the human gastrointestinal tract is rapidly colonized by microorganisms that profoundly impact the physiology and health of the host by contributing to host nutrition and natural defense, amongst other activities. In the large intestine, bifidobacteria are especially predominant in infants, where they can comprise up to 90% of the total microbiota, and in adults still account for a significant several percent. In this thesis, we applied post-genomic technologies, including metaproteomics and bifidobacterial community transcript profiling, to deepen our understanding of the activity of commensal bifidobacteria in the human intestine. Proteins were extracted from total infant fecal microbiota that was dominated by bifidobacteria, and two-dimensional gel electrophoresis was used to visualize the metaproteomes. The succession of the proteins was studied in fecal microbiota of two infants during 40 days. This revealed that the number and intensity of protein spots changed in time, but the patterns remained similar and specific for each infant. In-gel digestion of protein-spots and sequencing of the peptides, revealed the presence of a bifidobacterial transaldolase supporting the future application of this approach. Global transcript profiling of the infant fecal bifidobacteria was also performed. Total RNA from the fecal microbiota of infants that were solely breast-fed or formula-fed was hybridized to a DNA microarray comprising clones covering the genomes of several bifidobacterial species. Significantly hybridizing clones were sequenced and compared with those in the public databases. While some sequences were found to be bifidobacterial ribosomal RNA, the majority showed similarity to protein-encoding genes predicted to be involved in carbohydrate metabolism, processing of information and housekeeping functions. Remarkably, significant similarity was observed to an operon involved in the utilization of specifically human milk oligosaccharides and mucin sugars, supporting the functionality of bifidobacteria in the infant intestine. Overall, transcript profiling revealed significant differences between breast-fed and formula-fed infants, which was also reflected in the diversity of fecal bifidobacterial species measured with quantitative real time PCR. In another study, a specific prebiotic mixture showed a shift in the dominant adult fecal microbiota as well as abundance of the different bifidobacterial species. Subsequent transcriptomics using the same bifidobacterial-targeted microarrays showed the activity of genes in a wide range of functional groups, the majority being involved in metabolism of carbohydrates of plant origin, house keeping functions, and membrane transport of a wide variety of substrates including sugars and metals. Furthermore, the transcriptome of Bifidobacterium longum was studied in vitro in human and formula milk and semi-synthetic medium with galactooligosaccharides which showed quite some differentially expressed genes for sugar utilization. Overall, the transcription of genes involved in carbohydrate metabolism and uptake were specifically induced. In conclusion, post-genomics studies of fecal bifidobacteria and batch cultures of B. longum resulted in enhanced understanding of the life style and generated important leads for further investigation of genes for metabolism and colonization of intestinal bifidobacteria within the human host.
Validation of Monte Carlo models for estimating presticide intake of Dutch infants
Voet, H. van der; Boon, P.E. ; Klaveren, J.D. van - \ 2003
Wageningen : DLO, Rikilt, Analyse & Ontwikkeling (Report / RIKILT 2003.002)
monte carlo-methode - pesticiden - dieetstudies - zuigelingen - nederland - monitoring - gegevens verzamelen - waarschijnlijkheidsmodellen - blootstelling - opname (intake) - monte carlo method - pesticides - diet studies - infants - netherlands - data collection - probabilistic models - exposure - intake
Effects of Micronutrients during Pregnancy and Early Infancy on Mental and Psychomotor Development
Verhoef, H. ; West, C.E. ; Bleichrodt, N. ; Dekker, P.H. ; Born, M.P. - \ 2003
In: Micronutrient Deficiencies in the First Months of Life / Delange, F.M., West, K.P. Jr, Basel : Karger (Nestlé Nutrition workshop series 52) - ISBN 3805575599 - p. 327 - 357.
zwangerschap - zuigelingen - maternale voeding - zuigelingenvoeding - sporenelementen - jodium - ijzer - voedingsstoffentekorten - cognitieve ontwikkeling - psychomotorische ontwikkeling - pregnancy - infants - maternal nutrition - infant nutrition - trace elements - iodine - iron - nutrient deficiencies - cognitive development - psychomotor development
The questions that are addressed in this chapter concern the extent to which a shortage of iodine and iron during fetal and infant development impairs mental development and the extent to which this impairment can be redressed by increasing the intake of these micronutrients
Mum to mum : an evaluation of a community based health promotion programme for first-time mothers in the Netherlands
Hanrahan-Cahuzak, M.H. - \ 2002
Wageningen University. Promotor(en): C.M.J. van Woerkum; C.M.H. Hosman; M.A. Koelen. - S.l. : S.n. - ISBN 9789058086389 - 175
gezondheidsbevordering - gezondheidseducatie - sociaal welzijn - moeders - ziektepreventie - voorlichting - zuigelingen - gezondheidszorg - nederland - baby's - health promotion - health education - health care - disease prevention - extension - social welfare - mothers - infants - netherlands - babies

Background This study evaluated the Dutch Mothers Inform Mothers (MIM) programme. In that programme a visiting mother meets with a first-time mother in her home on a monthly basis to discuss the caring and rearing of her infant. The first-time mothers went also to the well-baby clinics in their locality where they discussed topics in the areas of psychosocial, cognitive and physical development, language, play and safety. The programme lasted for 18 months.

Aim/objectives To evaluate the MIM programme with the view to:

- provide information and, where appropriate, recommendations concerning the positioning of the programme in the Dutch public infant health services;

- integrate appropriate theoretical perspectives into the MIM programme;

- determine outcomes in relation to maternal mental health, maternal and infant general health, maternal competence with parenting and satisfaction with the well-baby clinic.

Study design/ A literature review on parenting support programme focused on infant health.

Instruments A cohort-study using a pre-test - post-test design with one experimental and two control groups. This was used to develop and test a model for the programme and to determine its effects. The mothers' progress was followed for 15 months, which covers the period of infancy. (After 15 months is the toddler period). Validated instruments were used to gather information.

- An infant food consumption survey using 24 hour recall and questions on feeding practices (breast feeding or feeding bottle). For maternal fat consumption a popular questionnaire of the National Food Centre was used.

Timing The pre-tests for mental health, social support and breastfeeding were administrated when the infants were approximately 6 weeks old (T1). Infant temperament, maternal and infant general health, maternal competence with parenting and satisfaction with the well-baby clinic were measured at 10 months, as was the nutritional survey. The post-tests were administrated when the infants were approximately 15 months old (T3).

- A qualitative study was carried out to gain insights in the way MIM co-ordinators perceive visiting mothers and visa versa.

Study population Total number of mothers was 346. In control group 1 (no MIM but using the

same well-baby clinics as the experimental mothers) N = 221, control group II (no MIM and not the same well-baby clinics), experimental group (MIM plus attending well-baby clinic) N = 42.

Results The visiting mothers visit on average two first-time mothers. This is very not enough for developing expertise as a visiting mother. The workload of co-ordinators was on average 25 visiting mothers / 50% FTE. Some mothers needing the programme were not accommodated due to illness of the programme's co-ordinator, absence of MIM co-ordinator, or because the caseload of visiting mothers are the co-ordinator were felt to be to high.

    • A first attempt was made to develop a theoretical framework for the MIM using maternal and infant characteristics together with social support factors. The boundaries of the model were set by Bronfenbrenner's theory on human ecology. Social support and infant temperament are important factors when caring and rearing a child. These factors are present in the maternal and infant health and maternal competence models. Partners' support with caring and household activities is especially important when a baby arrives. The factor lack of support is also present on numerous occasions.

Unexpected was the importance of the factor life events during pregnancy and complicated delivery, which remained so in the development of maternal general health, even after 15 months.

    • MIM had no impact on maternal mental and general health, although maternal general health scores of the experimental mothers increased over time and those of the control mothers decreased. MIM also had no impact on infant general health. The administration of the last inoculation of the Mumps, Measles and Rubella vaccines coincided with the post-test. This may have influenced the infant health score. MIM had a significant impact on maternal competence with parenting. The lower score for maternal competence for MIM mothers measured at baseline had disappeared by T3 relative to the two control groups. The most important influence on maternal competence with parenting seems to be infant temperament. Satisfaction with the well-baby clinic increased over time for all groups. Participation in the MIM programme was not significant in the final longitudinal model, but was significant at baseline and T3. This means that there was no further deterioration in satisfaction with the well-baby clinic of MIM mothers relative to the other two groups in the last six months of the study.

Given that lack of support has an important relationship with maternal mental health in T1, T3 and longitudinal regression models, it means that the factors identified by this regression indirectly contribute to the mother's state of mind.

Conclusions The evaluation has shown positive programme effects, but these effects need to be improved for the programme to be cost-effective. The programme is instrumental in enhancing the quality of health promotion activities of well-baby clinic members; it plays a role in the quality assurance process and it has an effect on enhancing mothers' competence with parenting. There are no indications that MIM had an influence on the mediating variables. This may be influenced by the fact that variables not included in the study, such as maternal attitudes, locus of control, or self-efficacy, play a role in the theoretical MIM model. Making healthy choices the easy choices through MIM is a strategy for helping people to accept responsibility for healthiness of their own lives, recognising health as a resource to be protected and actively enhanced. In line with the nurses' scope of practice their role as facilitator and coach could be strengthened, giving more responsibilities to the visiting mothers and making MIM a truly community based and community-led programme.

Mouthing behaviour of children aged between 3 and 36 months in the Netherlands
Steenbekkers, L.P.A. ; Groot, M.E. ; Lekkerkerk, M.C. - \ 1999
In: Proceedings of the 7th international conference on product safety research, September 30-October 1, 1999, Washington D.C.. - - p. 161 - 170.
peuters en kleuters - zuigelingen - gedrag - gedragspatronen - mond - nederland - preschool children - infants - behaviour - behaviour patterns - mouth - netherlands
Aim of this study (part of a larger project to determine if PVC softened toys with phthalates could possibly cause health risks for children due to mouthing) was to quantify duration of mouthing in infants of 3 to 36 months, to specify on what products they mouth and to determine differences between age groups
Risk analysis in relation to exposure of children to pesticide residues
Kloet, D.G. ; Dooren, M.M.H. van; Klaveren, J.D. van - \ 1998
Wageningen : RIKILT-DLO - 50
gewasbescherming - pesticiden - pesticidenresiduen - persistentie - voedingswaarde - voedsel - voedingsmiddelen - voedselsamenstelling - kwaliteit - eigenschappen - kinderen - zuigelingen - risicoschatting - plant protection - pesticides - pesticide residues - persistence - nutritive value - food - foods - food composition - quality - properties - children - infants - risk assessment
Jongeren in Friesland
Goede, M.P.M. de; Jansma, L.G. ; Ophem, J.A.C. van; Verhaar, C.H.A. - \ 1994
Ljouwert : Fryske Akademy - 171
sociale structuur - generaties - leeftijd - leeftijdsgroepen - menselijke relaties - sociale interactie - sociale systemen - adolescenten - kinderen - zuigelingen - nederland - sociale relaties - friesland - social structure - generations - age - age groups - human relations - social interaction - social systems - adolescents - children - infants - netherlands - social relations
Een keuze maken in kinderopvang : een onderzoek naar de mogelijkheden voor kinderopvang in de Westlandse glastuinbouw
Meer, C.J.D.M. van; Mulkens, L.E. - \ 1992
Wageningen : Wetenschapswinkel (Rapport / Wetenschapswinkel 61) - ISBN 9789067542067 - 82
dagopvang voor kinderen - kinderen - dagverblijven - zuigelingen - Nederland - kleuterscholen - child day care - children - day care centres - infants - Netherlands - nursery schools
Een keuze maken in kinderopvang.
Meer, C.J.D.M. van; Mulkens, L.E. - \ 1992
Wageningen : Wetenschapswinkel (Rapport / Wetenschapswinkel 62) - ISBN 9789067542074 - 15
dagopvang voor kinderen - kinderen - dagverblijven - zuigelingen - kleuterscholen - Nederland - zuid-holland - child day care - children - day care centres - infants - nursery schools - Netherlands
Acute effects of ambient air pollution episodes on respiratory health of children
Hoek, G. - \ 1992
Agricultural University. Promotor(en): E.H. Adema; D.W. Dockery; B. Brunekreef. - S.l. : Hoek - 239
atmosfeer - aërosolen - samenstelling - stof - luchtverontreiniging - luchtkwaliteit - lucht - hygiëne - ademhalingsziekten - kinderen - zuigelingen - atmosphere - aerosols - composition - dust - air pollution - air quality - air - hygiene - respiratory diseases - children - infants

In this thesis the acute effects of air pollution episodes on respiratory health of seven to eleven year old children living in non-urban communities in the Netherlands are discussed. Repeated measurements of pulmonary function (spirometry) and the occurrence of acute respiratory symptoms using a daily diary, were conducted to detect health effects. Exposure to air pollution was characterized by the ambient concentration of several pollutants, including ozone, PM 10 and acid aerosol, measured at fixed sites. Data were collected for a period of three and a half year, including two summer and three winter periods, from 1851 children.

In the summer of 1989 several photochemical episodes occurred with one hour maximum ozone concentrations between 160 and 240 μg/m 3. During these episodes small decrements of pulmonary function persisting for at least one day were found. No evidence of increased respiratory symptoms was found during these episodes. No major winter air pollution episode occurred, but significant associations of pulmonary function with the concentration of particles smaller than 10 μm (PM 10 ) were found. These associations were not explained by exposure to acid aerosol, because concentration levels of acid aerosol were low during both the winter and the summer periods. For the general population samples of children, respiratory symptom prevalence was not associated with air pollution levels. For a panel of children with chronic respiratory symptoms, prevalence of wheeze and bronchodilator use was associated with the PM 10 concentration. For all study populations differences in pulmonary function response between individual children were found. However, determined characteristics of the children (age, gender, presence of chronic respiratory symptoms) did not explain the magnitude of the response to air pollution.

The findings of the present study in combination with other recent studies support a revision of present guidelines for ozone and particulate matter.

Nutritional status and growth of children on macrobiotic diets : a population-based study
Dagnelie, P.C. - \ 1988
Agricultural University. Promotor(en): J.G.A.J. Hautvast; W.A. van Staveren. - S.l. : Dagnelie - 144
kindervoeding - zuigelingenvoeding - biologische voedingsmiddelen - kinderen - zuigelingen - child nutrition - infant nutrition - organic foods - children - infants

This thesis reports on the relationship between diet, growth, blood chemistry, psychomotor development, and clinical findings in the Dutch population of children on macrobiotic diets.- The macrobiotic diet mainly consisted of cereals, pulses and vegetables with small additions of seaweeds, fermented foods, nuts and seeds. meat and dairy products were avoided, whereas fish was occasionally being eaten but not by young children. The total Dutch macrobiotic population was invited to join the study; the refusal rate was below 5 per cent. A cross- sectional anthropometric study in macrobiotic children between birth and 8 years of age (n = 243) revealed that the age curves declined from the P50 of the Dutch standard mainly between 6 and 18 months of age. A partial return towards the P50 was observed after 2 years of age for weight and arm circumference, but not for height. A subsequent mixedlongitudinal study in macrobiotic infants aged 4 - 18 months and a matched omnivorous control group showed that growth of the macrobiotic infants was slowest between 8 and 14 months. This was attributed to a lack of both energy and protein in the macrobiotic weaning diet. The observed growth retardation was associated with retardation in gross motor and language development. For calcium, vitamin D, vitamin B12 and riboflavin, a low intake in combination with biochemical evidence of deficiency was found. Rickets was present in 28 per cent of macrobiotic infants in summer and 55 per cent in winter. AS a favourable aspect, lower levels of contaminants were found in the breast-milk of macrobiotic mothers. It is concluded that nutritional deficiencies are present in a high proportion of macrobiotic infants. Continued marginal deficiencies in older macrobiotic children seem to prevent catch-up growth in height. It is advised to adapt the macrobiotic diet as to include fatty fish (100 - 150 g/week), oil (20 - 25 g/day) and dairy products (one serving per day).

Xerophthalmia and post-measles eye lesions in children in Tanzania : a study of nutritional, biochemical and ophthalmological aspects
Pepping, F. - \ 1987
Agricultural University. Promotor(en): J.G.A.J. Hautvast, co-promotor(en): S. Franken. - S.l. : Pepping - 171
kinderen - zuigelingen - mazelen - voedingsstoornissen - retinol - rode hond - tanzania - oogheelkunde - children - infants - measles - nutritional disorders - retinol - rubella - tanzania - ophthalmology
From 1983 until 1986 a number of studies were carried out in collaboration with the Tanzania Food and Nutrition Centre on vitamin A deficiency and post-measles nutritional blindness.

Prevalence surveys were carried out in four regions in Tanzania in order to estimate the magnitude of xerophthalmia where it was found to be a problem in certain clusters of villages. The retinol and carotenoid content of certain food products were analysed and the results subsequently used in a study to estimate the nutrient intake of children suffering from xerophthalmia. The intake of vitamin A in these children was low.

In children with measles, serious eye lesions which may easily result in blindness, were observed in 3-4% of the children admitted to a number of hospitals. Serum retinol levels in these children were extremely low while in children with measles and not developing such lesions levels were somewhat higher although they were still rather low. These findings confirm the role of vitamin A in the aetiology of post-measles eye lesions.

The relationship between environmental lead and blood lead in children : a study in environmental epidemiology
Brunekreef, B. - \ 1985
Landbouwhogeschool Wageningen. Promotor(en): K. Biersteker; R.L. Zielhuis; J.P. Vandenbroucke. - Wageningen : Brunekreef - 185
bloed - chemische eigenschappen - chemicaliën - kinderen - zuigelingen - lood - fysiologie - toxische stoffen - milieuhygiëne - blood - chemical properties - chemicals - children - infants - lead - physiology - toxic substances - environmental hygiene

This study deals with the relationship between environmental lead and blood lead in children.
Chapter 1 provides a summary of the environmental health aspects of lead. The occurrence of lead in the environment and in man is described; children are discussed as a population at risk for undue lead absorption, and the exposure-response system is briefly outlined.
Chapter 2 discusses a number of methodological issues in studies on the relationship between environmental lead and blood lead in children. Lead is present in various environmental media like air, soil and dust. From all these media, lead intake by children may occur, by inhalation or ingestion. The inhalation rate per kg body weight is larger in children than in adults, due to a higher metabolism. The ingestion of dust and dirt cannot be easily quantified; at present, measurement of the lead concentration in dust and dirt usually serves as a surrogate. The concentration of lead in blood has been the major dependent variable in studies on the relationship between environmental lead exposure and internal lead exposure. The concentration of lead in blood does not only depend on intake but also on the fractional absorption of lead from the gut, and on distribution and excretion patterns within the body. All of these vary with age. Nutritional factors are important as well, for example dietary calcium, iron, phosphorus and fat. Lead is not only present in the general environment but also in food and drinking water, both of which may act as predominant sources of lead intake. Lead in food originates in part from environmental pollution, and it is still debated how large this part actually is. Lead in drinking water usually originates from pipes or storage facilities. In the United States especially, lead from crumbling paint is an important source for children; paint lead does not seem to be of general importance in The Netherlands, however.
The relationship between total lead intake and the concentration of lead in blood is usually given as a curvilinear downward function. The implication of this is that at low levels of exposure, a given increase of intake is expected to result in a stronger increase in blood lead concentrations than at high levels of exposure. In some studies, it has been customary to adjust relationships between air lead and blood lead for lead in other media. As lead in the air and lead in other media like soil and dust often originate from the same source or sources, such a procedure may under-estimate the impact of environmental lead on children's blood lead.
It is difficult to measure the intake of lead from the environment by children exactly. Instead, the concentration of lead in one or more environmental media is usually measured as an index of exposure.
Apart from being only approximations of actual lead intake from the environment, these concentrations also tend to have large temporal and spatial variations. A decomposition of total variation into within-subjects and between- subjects variation is a weans to estimate the reliability of exposure indicators. If the within-subjects variation of exposure indicators is large compared to the between- subjects variation, the impact of environmental lead exposure on blood lead will usually be underestimated in a regression analysis.
Chapter 3 reviews a number of studies from which estimates of relationships between environmental lead and children's blood lead can be obtained. Aggregate relationships are emphasized, i.e. it is not attempted to estimate the separate contributions of inhalation, ingestion of soil, dust etc. as the available data usually do not permit such an analysis. Aggregate relationships are relationships in which different indicators of lead exposure are thought to represent all environmental exposure. When the concentration of lead in air is taken as an indicator, a blood lead/air lead slope of about 3-5 μg/100 ml per μg/m 3 is obtained. When the concentration of lead in soil, street dust or house dust is taken as an indicator, most blood lead/soil (dust) lead slopes are in the order of 5.0 - 10.0 μg/100 ml per g/kg.
Although the ranges of the different types of estimates are wide, the review suggests that for children, lead intake from the environment constitutes a major part of total lead intake in quite a number of situations.
Chapter 4 is a description of our study on environmental lead and blood lead in children living in Rotterdam, The Hague and Zoetermeer which was performed in 1981.
Blood lead concentrations in children were different between city centers and suburbs. After adjustment for a number of confounders, more than half of the difference remained. Most probably, this was caused by differences in environmental lead pollution as most indicators of lead exposure were clearly different between city centers and suburbs. In a multiple regression analysis, most exposure indicators were significantly associated with the concentration of lead in blood, after adjustment for a number of confounders. Further analysis of the origins of lead in the environment suggested that in the area under investigation, vehicular traffic was the main source.
When our study results were compared with those of others, the estimated impact of environmental lead on children's blood lead was somewhat higher than in most other studies, but the difference was not great, considering the wide range in estimates which was reported in chapter 3. Theoretically, the differences can be explained by the low level of exposure which was studied, and by the use of repeated exposure measurements. As indicated in chapter 2, a given exposure difference is expected to result in a larger blood lead difference at low overall levels of PbB than at a high overall level of PbB. Also, repetition of exposure measurements leads to a more precise estimate of exposure, and can theoretically be expected to result in a higher exposure impact estimate than when exposure is only measured once, as was the case in most studies reviewed in chapter 3.

Bindt Binder? : een lezersonderzoek onder de leden van het agrarisch jongerenwerk
Dohmen, M. - \ 1985
Wageningen : Wetenschapswinkel (Rapport / IMGO-Landbouw 10) - 79
lezen - landbouw - kinderen - zuigelingen - nederland - reading - agriculture - children - infants - netherlands
Rotterdam, alternatieve leefgemeenschap verdacht
Kesler, B.E.Th.A. - \ 1985
Gewoon anders 8 (1985)2. - ISSN 0166-4336 - p. 2 - 4.
kinderen - communes - coöperatieve woningbouw - gezinsstructuur - huishoudens - zuigelingen - children - cooperative housing - family structure - households - infants
Beschouwing over kommunes met kinderkollektieven
Young children and supplementary feeding programmes
Hiel, A.M.M. ; Hautvast, J.G.A.J. ; Hartog, A.P. den - \ 1984
Wageningen : NIVV - ISBN 9789070840075 - 104
kindervoeding - zuigelingenvoeding - voedselhygiëne - voedingstoestand - consumptiepatronen - wereldvoedselproblemen - melkpoeder - afrika - zogende vrouwen - vrouwen - zwangerschap - kinderen - zuigelingen - child nutrition - infant nutrition - food hygiene - nutritional state - consumption patterns - world food problems - dried milk - africa - lactating women - women - pregnancy - children - infants
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