Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
Arsenic in Rice Products for Children
A recent CBC Marketplace program reported on the testing of the levels of arsenic in rice cereals and snacks for infants and children. For an in-depth examination and analysis of the evidence on the topic of arsenic in the diets of infants and children, see the 2018 PEN Trending Topic: Do New Parents or Parent-to-be Need to be Concerned About Dietary Arsenic Exposure?. For further information on rice and arsenic, see: PEN's Food Safety - Arsenic in Rice Background.
The Bottom Line
Limit or avoid giving infants and young children cereals made from brown rice flour and products with brown rice syrup, since they have more arsenic. Some rice is okay for young children, but it is best to give infants and children a variety of grains and use infant rice cereals and rice-based products, such as wafers and crackers, in moderation.
Malnutrition in Infants Fed Plant-based Beverages
Cases (n=34) of protein-energy malnutrition have been described in France among infants who were fed plant-based beverages/drinks (age at diagnosis 8.8 + 3.8 months) (1). These cases were discovered when pediatricians were asked to see these children because of fatigue or a growth deficit. One of these infants died, one-third had malnutrition, 29% (10/34) had a seizure, one suffered from respiratory distress and one had a bone fracture. Among the children who had blood work done, 60% (12/20) had anemia, 55% (11/20) had hypoalbuminemia, and 40% (8/20) had hyponatremia. The children were all fed plant-based drinks, mostly almond, chestnut and rice drinks. Previous reports involved smaller numbers of children (2).
The infants’ health improved after resuming a normal infant diet (which was not described), although one-third of the parents were not happy about the change in diet (1). The parents stated that their main influencers to give the plant-based drinks to their infants were the media (44%) and “alternative medical professionals” (38%). The researchers attributed the malnutrition to the low protein and energy contents of these drinks.
Although it is not possible to state with certainty that the malnutrition was caused by the plant-based drinks, the fact that 30 children (who were assessed) overcame their illnesses when placed on a normal infant diet suggests that this was the case. These cases may represent the health halo, a belief that these drinks are healthier than other choices.
For information on the recommendations for the use of plant-based beverages in infants, see PEN® Practice Question: What are the recommendations for the use of plant-based beverages (e.g. soy, rice, almond, coconut and oat milk/beverage) during the complementary feeding period in infants?
- Lemale J, Salaun JF, Assathiany R, Garcette K, Peretti N, Tounian P. Replacing breastmilk or infant formula with a nondairy drink in infants exposes them to severe nutritional complications. Acta Paediatr. 2018 Jun 20. doi: 10.1111/apa.14437. [Epub ahead of print]. Citation available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=29923219.
- Dietitians of Canada. Trending Topics: Plant-based Beverages – Are They Really Healthier for Young Children? In: Practice Based Evidence in PEN® [PEN]. 2017 Aug 29. Available from: http://www.pennutrition.com/resourcestools.aspx?trcatid=496&trid=26285&sr=plant-based#. Access only by subscription.
Introduction of Allergenic Food to Infants, Especially Peanuts: Interim Guidelines for Canadian Dietitians
This interim DC communication provides DC members with information on the scientific evidence regarding the introduction of peanuts to infants and how the current dietetic practice recommendations agree and differ from NIAID recommendations published in January 2017. In brief, the key differences between these new NIAID guidelines and current Canadian Nutrition for Healthy Term Infant (NHTI) recommendations are in the different definitions of “at risk” infants, the strength of wording for introducing peanut containing food early, and the recommendation to undergo physician supervised testing/feeding before introduction for a small subset of very high-risk infants . Refer to the full document for more information. See also the PEN Evidence Clip : Food Allergy Prevention in Infants.