Breastfeeding duration and its relation to weight gain, eating behaviours and positive maternal feeding practices in infancy

Eating behavior profiles in infancy and their associations with parental feeding practices and rapid weight gain

Childhood overweight and obesity are significant public health concerns. Eating behavior profiles using person-centered analysis have been utilized to understand patterns of commonly co-occurring eating behaviors within subgroups of individuals. However, eating behavior profiles, particularly in infancy, remain largely unexplored. Therefore, the aims of this study were to investigate person-centered eating behavior profiles in infants and their associations with infant and parental factors and rapid weight gain (RWG). Online survey included validated measures of infant eating behaviors and parental feeding practices. Infant height/length and weight were reported by parents and used to calculate RWG. Latent profile analysis was used to identify eating behavior profiles. Multiple regression analysis was performed to investigate the associations between parental feeding practices, RWG and eating behavior profiles. Chi-square was used to examine associations between demographics, milk type and eating behavior profiles. A total of 1092 parents of infants under 4 months of age (540 boys, 552 girls) completed the survey. Three unique eating behavior profiles were identified: Food Avoidance (24%, n = 263), Balanced Eating (58%, n = 633), and Food Approach (18%, n = 196). Use of food (milk) to calm was positively associated with the Food Approach profile (p < 0.001) and parental-led feeding with the Food Avoidance profile (p < 0.05). RWG was not associated with eating behavior profiles (p > 0.05). This study indicates that eating behavior profiles emerge in infants under four months old. The findings of this study will advance our knowledge of heterogeneity in infant eating and development and the environmental influences by parental feeding practices.

Maternal Well-Being and Child Appetitive Traits at 5 Years Old: Findings from the ROLO Longitudinal Birth Cohort Study

Background: Maternal depression has been linked with increased risk of childhood obesity. Furthermore, maternal negative affectivity in early childhood has been associated with food fussiness. We explored the relationship between longitudinal maternal well-being mid-pregnancy, at 2 years and 5 years postpartum and children's appetitive traits at 5 years of age. Methods: This is a secondary analysis of the ROLO (randomized control trial of low glycemic diet in pregnancy) longitudinal birth cohort study including pregnancy (n = 279), 2 years (n = 168), and 5 years (n = 295) postpartum. Maternal well-being was measured using the World Health Organization-Five Well-Being Index. Children's appetitive traits were measured at 5 years of age using the Children's Eating Behavior Questionnaire. Bivariate correlation and then linear regression, adjusted for potential confounders, were used to determine relationships between maternal well-being at each timepoint and offspring's appetitive traits at 5 years old. Results: Mean maternal well-being was higher at 5 years postpartum (63.3%) than mid-pregnancy (58.2%) or at 2 years postpartum (61.0%) (p = 0.001). No relationships were observed between maternal well-being mid-pregnancy and child's appetitive traits at 5 years. In adjusted regression, at 2 years postpartum, maternal well-being was negatively associated with "Emotional Overeating" (B = -0.029, p = 0.024), "Satiety Responsiveness" (B = -0.040, p = 0.014), "Slowness Eating" (B = -0.072, p = <0.001), and "Emotional Undereating" (B = -0.054, p = 0.010) and positively associated with "Enjoyment of Food" (B = 0.050, p = 0.007). Maternal well-being at 5 years postpartum was negatively associated with "Satiety Responsiveness" (B = -0.025, p = 0.033) and "Slowness Eating" (B = -0.031, p = 0.024). Conclusion: Maternal well-being in early childhood may influence children's appetitive traits; however, further research is required to fully explore this relationship.

Validation of Variables for Use in Pediatric Obesity Risk Score Development in Demographically and Racially Diverse United States Cohorts

OBJECTIVE

To evaluate the performance of childhood obesity prediction models in four independent cohorts in the United States, using previously validated variables obtained easily from medical records as measured in different clinical settings.

STUDY DESIGN

Data from four prospective cohorts, Latinx, Eating, and Diabetes; Stress in Pregnancy Study; Project Viva; and Center for the Health Assessment of Mothers and Children of Salinas were used to test childhood obesity risk models and predict childhood obesity by ages 4 through 6, using five clinical variables (maternal age, maternal prepregnancy body mass index, birth weight Z-score, weight-for-age Z-score change, and breastfeeding), derived from a previously validated risk model and as measured in each cohort's clinical setting. Multivariable logistic regression was performed within each cohort, and performance of each model was assessed based on discrimination and predictive accuracy.

RESULTS

The risk models performed well across all four cohorts, achieving excellent discrimination. The area under the receiver operator curve was 0.79 for Center for the Health Assessment of Mothers and Children of Salinas and Project Viva, 0.83 for Stress in Pregnancy Study, and 0.86 for Latinx, Eating, and Diabetes. At a 50th percentile threshold, the sensitivity of the models ranged from 12% to 53%, and specificity was ≥ 90%. The negative predictive values were ≥ 80% for all cohorts, and the positive predictive values ranged from 62% to 86%.

CONCLUSION

All four risk models performed well in each independent and demographically diverse cohort, demonstrating the utility of these five variables for identifying children at high risk for developing early childhood obesity in the United States.

Birth weight, slowness in eating and feeding practices as independent determinants of rapid weight gain

AIM

Our aim was to identify independent determinants of rapid weight gain in infants at 3-4, 6, and 12 months of age.

METHODS

A cohort study was conducted on Mexican term infants in public and private settings between March 2021 and May 2023. Rapid weight gain was defined as a ≥0.67 SD change in weight-for-age-Z-score from birth to 3-4, 6, and 12 months of age. Maternal and infant characteristics were described, and infant feeding practices, appetitive traits, weight, and length were analysed at 3-4, 6, and 12 months of age. Rapid weight gain predictors were determined using generalised linear regression models.

RESULTS

In total, 168 infants were recruited (55% boys). Small-for-gestational-age status increased rapid weight gain risk 1.5 times, whereas large-for-gestational-age status represented a 20%-30% decrease. Slowness in eating decreased the risk by 10%. Protective factors were older maternal age and higher educational level, whereas formula feeding, early complementary feeding, greater food enjoyment, and satiety responsiveness increased the risk.

CONCLUSIONS

Small for gestational age, slowness in eating, and feeding practices can be rapid weight gain predictors across the first year of life.

Can Breastfeeding Prevent Long-Term Overweight and Obesity in Children? A Population-Based Cohort Study

The aims of this study were to assess the impact of exclusive breastfeeding up to 6 months of age on reducing the incidence of overweight and obesity in children up to 10 years of age and to estimate the annual incidence of obesity and overweight in the study population. Our retrospective cohort analysis using electronic health records included children from zero to ten years old, born between 1 January 2006 and 31 December 2022, followed up at the Unidade Local de Saúde de Matosinhos (ULSM). Information on their comorbidity history was collected, and positive or negative control results were defined. In the first year of life, around 29% of the children on exclusive breastfeeding were obese and 20% were overweight. This trend was reversed by the age of 9. Asthma and allergic rhinitis were used as positive control outcomes and allergic dermatitis as a negative control outcome. There seems to be no relationship between exclusive and non-exclusive breastfeeding and the development of overweight or obesity at the age of 10. The results showed that breastfeeding is associated with a lower risk of asthma in the future.

Pediatric obesity in the United States: Age-period-cohort analysis

The rates of obesity among American children aged 2-5 years has reached a historic high. It is crucial to identify the putative sources of population-level increases in obesity prevalence among preschool-aged children because early childhood is a critical window for obesity prevention and thus reduction of future incidence. We used the National Health and Nutrition Examination Survey data and hierarchical age-period-cohort analysis to examine lifecycle (i.e., age), historical (i.e., period), and generational (i.e., cohort) distribution of age- and sex-specific body mass index z-scores (zBMI) among 2-5-year-olds in the U.S. from 1999 to 2018. Our current findings indicate that period effects, rather than differences in groups born at a specific time (i.e., cohort effects), account for almost all of the observed changes in zBMI. We need a broad socioeconomic, cultural, and environmental strategy to counteract the current obesogenic environment that influences children of all ages and generations in order to reach large segments of preschoolers and achieve population-wide improvement.

The mediation effect of breastfeeding duration on the relationship between maternal preconception BMI and childhood nutritional risk

BACKGROUND

Higher maternal preconception body mass index (BMI) is associated with lower breastfeeding duration, which may contribute to the development of poor child eating behaviours and dietary intake patterns (components of nutritional risk). A higher maternal preconception BMI has been found to be associated with higher child nutritional risk. This study aimed to determine whether breastfeeding duration mediated the association between maternal preconception BMI and child nutritional risk.

METHODS

In this longitudinal cohort study, children ages 18 months to 5 years were recruited from The Applied Research Group for Kids (TARGet Kids!) in Canada. The primary outcome was child nutritional risk, using The NutriSTEP®, a validated, parent-reported questionnaire. Statistical mediation analysis was performed to assess whether total duration of any breastfeeding mediated the association between maternal preconception BMI and child nutritional risk.

RESULTS

This study included 4733 children with 8611 NutriSTEP® observations. The mean (SD) maternal preconception BMI was 23.6 (4.4) and the mean (SD) breastfeeding duration was 12.4 (8.0) months. Each 1-unit higher maternal preconception BMI was associated with a 0.081 unit higher nutritional risk (95% CI (0.051, 0.112); p < 0.001) (total effect), where 0.011(95% CI (0.006, 0.016); p < 0.001) of that total effect or 13.18% (95% CI: 7.13, 21.25) was mediated through breastfeeding duration.

CONCLUSION

Total breastfeeding duration showed to mediate part of the association between maternal preconception BMI and child nutritional risk. Interventions to support breastfeeding in those with higher maternal preconception BMI should be evaluated for their potential effect in reducing nutritional risk in young children.

Evaluating Childhood Overweight- and Obesity-Related Food Marketing Policies in China Using the Food-Environment Policy Index (Food-EPI)

OBJECTIVE

Addressing the increasing global health issue of childhood obesity, exacerbated by pervasive food marketing, this study critically evaluated China's food marketing policies in comparison with international best practices, aiming to uncover policy content and implementation gaps and inform policy enhancement strategies.

METHOD

Three key indicators were utilized from the Healthy Food-Environment Policy Index (Food-EPI)'s food promotion domain. A panel of experts (n = 13) from academic institutions, China Centers for Disease Control and Prevention, and the food industry assessed the Chinese government's policy scores and implementation levels concerning food marketing. Benchmarked against international best practices using the Food-EPI process, this evaluation encompassed context analysis, data collection, evidence-based policy action, government validation, policy rating, scoring, and results translation for government and stakeholders. The three chosen indicators specifically addressed childhood overweight- and obesity-related food marketing in broadcast media (Indicator 1), non-broadcast media (Indicator 2), and child gathering settings (Indicator 3).

RESULTS

Specifically, Indicator 1, the Single Food Marketing Indicator Score was measured at 2.31 ± 0.38, with an accompanying Food Marketing Policy Implementation Percentage of 46.2%, and Low Implementation Level. For non-broadcast mediums (Indicator 2), these metrics were gauged at 1.77 ± 0.27, 35.4%, and Low Implementation Level, respectively. In child gathering settings (Indicator 3), for efforts curbing unhealthy food promotion, a score of 2.77 ± 0.27, an implementation percentage of 55.4%, and Medium Implementation Level was obtained. Cumulatively, the overarching efficacy of food marketing policy enforcement was determined to be suboptimal, with the consolidated figures being Total Food Marketing Score as 2.28 ± 0.97, Total Food Marketing Policy Implementation Percentage as 45.6%, and Total Food Marketing Policy Implementation Level as Low.

CONCLUSION

Like many countries, China's food marketing policies and implementation have room for improvement when compared to international best practices. Recommendations include emphasizing nutritional legislation, fostering stakeholder collaboration, bolstering public health campaigns, and leveraging technology for stringent enforcement.

Appetitive traits from childhood to adolescence: Analysis of their stability, derivation of trajectory profiles, and associated characteristics

This study aimed to assess the potential stability of appetitive traits from childhood to early adolescence, identify groups of individuals with distinct trajectories for these traits, and explore their association with other child and family characteristics. Participants were 5040 children from the Generation XXI cohort. Appetitive traits were assessed with the Children's Eating Behaviour Questionnaire (CEBQ) at ages seven, 10, and 13 (eight subscales). Mixed-effect models estimated individual trajectories of appetitive traits and Gaussian mixture models identified groups following different trajectories (appetitive trait trajectory profiles). Appetitive traits showed moderate-to-high stability across the three ages (intra-class correlation coefficients:0.66-0.83); most of the variance observed across time were due to persistent individual differences rather than age-related changes. Six appetitive trait trajectory profiles were identified: 'Moderate appetite' (scores close to the average) (29% of children), 'Small to moderate appetite' (lowest food approach and emotional eating) (26%), 'Increasing appetite' (increasing food approach) (15%), 'Avid appetite' (highest food approach and lowest food avoidance) (12%), 'Smallest appetite' (highest food avoidance and low food approach) (10%), and 'Small appetite but increasing' (decreasing high food avoidance and Desire to Drink) (8%). In multinomial logistic regression, these profiles were associated with different child and family characteristics. Compared to children with a 'Moderate appetite' profile, those with higher BMI, who desired a thinner body, whose mothers were younger, had lower education, higher pre-pregnancy BMI (OR = 1.07; 95%CI:1.04,1.09), smoked during pregnancy (OR = 1.51; 95%CI:1.21,1.90), and used more restrictive feeding practices (OR = 1.79; 95%CI:1.57,2.03) had increased odds of belonging to the 'Avid Appetite'. In conclusion, distinct appetitive trait trajectory profiles emerged, differentiating individuals with avid and small appetites. These findings have implications for identifying children at higher risk for obesogenic profiles.

Utility of the capability, opportunity, and motivation behaviour (COM-B) model in explaining the negative association between pre-pregnancy body mass index and exclusive breastfeeding at six weeks postpartum

The mechanisms underlying the negative associations between pre-pregnancy body mass index (BMI) and exclusive breastfeeding remain poorly understood. Thus, the study aimed to determine whether the negative associations between high pre-pregnancy BMI and exclusive breastfeeding at six weeks postpartum are mediated by components of the capability, opportunity, and motivation behaviour (COM-B) model. In this prospective observational study, we assigned 360 primiparous women to a pre-pregnancy overweight/obese group (n = 180) and a normal-BMI group (n = 180). A structural equation model was designed to study how capabilities (onset of lactogenesis II, perceived milk supply, breastfeeding knowledge, and postpartum depression), opportunities (pro-breastfeeding hospital practices, social influence, social support), and motivations (breastfeeding intention, breastfeeding self-efficacy, and attitudes towards breastfeeding) affected exclusive breastfeeding at six weeks postpartum in groups of women with different pre-pregnancy BMIs. In all, 342 participants (95.0%) possessed complete data. Women with high pre-pregnancy BMI were less likely to exclusively breastfeed at six weeks postpartum than women with a normal BMI were. We observed a significant negative direct effect of high pre-pregnancy BMI on exclusive breastfeeding at six weeks postpartum and a significantly negative indirect effect of high pre-pregnancy BMI via the explanatory mediating variables of capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy) on exclusive breastfeeding at six weeks postpartum. Our findings support certain capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy), partially explaining the negative association between high pre-pregnancy BMI and exclusive breastfeeding outcome. We suggest that interventions aimed at promoting exclusive breastfeeding among women with high pre-pregnancy BMI should address the capacity and motivation factors specific to this population.

Breastfeeding Duration and Timing of Bottle Supplementation: Associations with Body Mass Index from Childhood to Young-Adulthood

Evidence for the association between breastfeeding (BF) duration and later body mass index (BMI) is inconsistent. We explored how BF duration and BF type (exclusive or partial) related to BMI from childhood to young adulthood in a Chilean cohort. Infants were recruited at 6 months between 1994 and 1996 in Santiago, Chile (n = 821). Mothers reported date of first bottle and last BF; anthropometry was measured at 1, 5, 10, 16, and 23 years. We tested whether: (1) type of BF at 6 months (none, partial, exclusive) and (2) duration of exclusive BF (<1 month, 1 to <3 months, 3 to <6 months, and ≥6 months) related to BMI. At 6 months, 35% received both breastmilk and formula ("partial BF") and 38% were exclusively breastfed. We found some evidence of an association between longer BF and lower BMI z-scores at young ages but observed null effects for later BMI. Specifically, BF for 3 to <6 months compared to <1 month related to lower BMI z-scores at 1 and 5 years (both p < 0.05). Our results are in partial accordance with others who have not found a protective effect of longer BF for lower BMI.

Associations of parent feeding behaviors and early life food exposures with early childhood appetitive traits in an observational cohort study

PURPOSE

Child appetitive traits, eating styles that reflect responsiveness to external influences and internal hunger and satiety signals, are associated with eating behaviors and susceptibility to excess weight gain. However, relatively little is known about early life influences on child appetitive traits. This study investigated relations of early life maternal feeding behaviors and food exposures with appetitive traits at age 3.5 years.

METHODS

Participants of the Pregnancy Eating Attributes Study (PEAS) and follow-up study were enrolled in early pregnancy and followed prospectively. This analysis included data collected from baseline through child aged 3.5-years (n = 160). Child appetitive traits at age 3.5 years were measured using the Child Eating Behavior Questionnaire. Age at introduction to fruit, vegetables, discretionary sweets, and discretionary savory foods was assessed, along with intake frequency at infant ages 6, 9, and 12 months, and 2 years. Maternal feeding to soothe was assessed at child aged 3, 6, and 12 months. Maternal permissive feeding was assessed at child aged 2 years. Multiple linear regressions estimated relations of maternal feeding behaviors and infant food exposures with child appetitive traits at age 3.5 years, controlling for sociodemographics and breastfeeding duration.

RESULTS

Maternal feeding to soothe at 6 (r = 0.39, p < 0.001) and 12 months (r = 0.39, p < 0.001) was positively associated with permissive feeding at 2 years. Maternal feeding to soothe at 12 months and permissive feeding at 2 years were associated with greater child emotional overeating, emotional undereating, and desire to drink. Older age at introduction to fruit (β = 0.20±0.08, p = 0.01) and younger age at introduction to discretionary sweet foods (β = -0.07±0.04, p = 0.06) were associated with greater emotional overeating. Older age at introduction to vegetables (β = 0.22±0.11, p = 0.04) and less frequent feeding of fruit (β = -0.20±0.08, p = 0.01) were associated with greater food fussiness.

CONCLUSIONS

Associations of emotional eating with parent feeding behaviors and early life food exposures suggest the potential for interventions targeting early life feeding to have long-term impact on child appetitive traits and diet quality.

Associations of maternal food addiction, dietary restraint, and pre-pregnancy BMI with infant eating behaviors and risk for overweight

Maternal food addiction, dietary restraint, and pre-pregnancy body mass index (BMI) are associated with high-risk eating behaviors and weight characteristics in children and adolescents. However, little is known about how these maternal factors are associated with individual differences in eating behaviors and risk for overweight in infancy. In a sample of 204 infant-mother dyads, maternal food addiction, dietary restraint and pre-pregnancy BMI were assessed using maternal self-report measures. Infant eating behaviors (as measured by maternal report), objectively measured hedonic response to sucrose, and anthropometry were measured at 4 months of age. Separate linear regression analyses were used to test for associations between maternal risk factors and infant eating behaviors and risk for overweight. Maternal food addiction was associated with increased risk for infant overweight based on World Health Organization criteria. Maternal dietary restraint was negatively associated with maternal report of infant appetite, but positively associated with objectively measured infant hedonic response to sucrose. Maternal pre-pregnancy BMI was positively associated with maternal report of infant appetite. Maternal food addiction, dietary restraint, and pre-pregnancy BMI are each associated with distinct eating behaviors and risk for overweight in early infancy. Additional research is needed to identify the mechanistic pathways driving these distinct associations between maternal factors and infant eating behaviors and risk for overweight. Further, it will be important to investigate whether these infant characteristics predict the development of future high-risk eating behaviors or excessive weight gain later in life.

Maternal Feeding Beliefs and Behaviors Relate to Infant Diet and Appetite

INTRODUCTION

Maternal feeding practices may be linked to infant obesogenic outcomes, but research to date has focused primarily on infant growth as an outcome of maternal feeding practices rather than exploring additional obesogenic outcomes like infant appetite and diet. Therefore, the current study examined the association between maternal feeding practices and beliefs and infant growth, diet, and appetite simultaneously at a critical timepoint for obesity risk development (i.e., 3-months-old).

METHODS

Thirty-two 3-month-old infants and their mothers participated in this cross-sectional study. Infant anthropometrics were collected by trained staff and mothers completed questionnaires regarding maternal feeding practices and beliefs and infant diet and appetite. The data were analyzed by Spearman correlations.

RESULTS

Statistically significant correlations were identified between maternal feeding practices (e.g., using food to calm, concern about infant weight) and infant satiety, appetite, food responsiveness, slow eating, and kilocalories consumed. Infant weight-for-length was related to maternal concern about infant underweight and mother-infant social interaction during feeding.

DISCUSSION

These findings highlight the importance of the mother-infant feeding relationship and how these associations may influence responsive feeding practices and infant weight-related outcomes.

Ten-Year Differences in Nutritional Status and Obesity-Related Risk Factors in Polish Preschool Children

The aim of this study was to assess ten-year differences in nutritional statuses and obesity prevalences between populations of preschool children from Katowice, Poland, examined in 2007 and 2017, and to determine factors associated with overweight and obesity in preschool children. A cross-sectional questionnaire was conducted among parents and legal guardians of 276 preschool children in 2007 and 259 preschool children in 2017. Basic anthropometric measurements were performed. Overall, the prevalence of overweight and obesity among our sample of Polish preschool children (median age 5.25 year) was 16.82%, whereas 4.49% of children were obese. No significant differences in the number of overweight and obese children were observed when comparing the years 2017 to 2007. Overall body mass index (BMI) z-score was significantly lower in this group of children from 2017. However, median values of the BMI z-score were higher in two of the weight categories (overweight and obesity) in 2017. The child’s BMI z-score was positively correlated with birth weight (r = 0.1, p < 0.05). The BMI z-score was positively correlated with maternal BMI, paternal BMI, and maternal pregnancy weight gain, r = 0.24 p < 0.01; r = 0.16 p < 0.01; r = 0.12 p < 0.05, respectively. A decrease in overweight and obesity prevalence over the past decade and higher median values of BMI z-scores in the group of children with excessive weight in 2017 were observed. Birth weight, maternal BMI, paternal BMI, and maternal pregnancy weight gain all correlate positively with a child’s BMI z-score.

Early life exposures are associated with appetitive traits in infancy: findings from the BiTwin cohort

PURPOSE

To determine the stability of appetitive traits during infancy and their association with early life exposures.

METHODS

Participants were from the BiTwin birth cohort (longitudinal study of Portuguese infants). Appetitive traits at 3 months were measured using the Baby Eating Behaviour Questionnaire (n = 347) and at 12 months with the Children's Eating Behaviour Questionnaire for toddlers (n = 325). Stability was assessed with multi-level models. The association of early life exposures (weight for gestational age, mode of feeding, prematurity, smoking during pregnancy, maternal pre-pregnancy BMI, gestational weight gain, and diabetes mellitus diagnosis) with infant appetitive traits was estimated by multivariable linear regression models.

RESULTS

Appetite traits showed limited stability (ICCs: 0.25-0.34). Associations with early life exposures varied by age. At 3 months, infants of mothers with higher pre-pregnancy BMI and excessive gestational weight gain had low Satiety Responsiveness. In contrast, infants small for gestational age scored high in this trait (β̂ = 0.241; 95% CI 0.056-0.425). Exclusively formula-fed infants presented weak food approach traits at this age, namely low Enjoyment of Food (β̂ = - 0.145; 95% CI - 0.270 to - 0.019) and Food Responsiveness (β̂ = - 0.415; 95% CI - 0.618 to - 0.212). At 12 months, infants who were small for gestational age had low Food Responsiveness (β̂ = - 0.297; 95% CI - 0.523 to - 0.072), in contrast, infants of mothers who gained excessive gestational weight had high scores in this trait. Formula feeding was related to rapid eating (Slowness in Eating: β̂ = - 0.252; 95% CI 0.451 to - 0.054).

CONCLUSION

Early life exposures may play a role in the development of infants' appetitive traits, which then change during the first year of life. Interventions focussed on maternal and infant health may have the potential to shape appetite in infancy.

Impact of the COVID-19 pandemic on the digitization of routine pediatric practice in Spain: A nationwide survey study

Introduction

The COVID-19 pandemic forced a change in the working dynamics of all healthcare professionals, leading to the sudden introduction of telemedicine. Although until that moment telemedicine applications had been described in the paediatric age, their use was anecdotal.

Objective

To analyse the experience of Spanish paediatricians after the forced digitization of consultations due to the pandemic.

Methods

A cross-sectional survey-type study was designed to obtain information from Spanish paediatricians about the changes that took place in the usual clinical practice.

Results

306 health professionals participated in the study Most of them agreed on the use of the internet and social networks during the pandemic, referring to mail or WhatsApp® as usual channels of communication with their patients' families. There was a great agreement among paediatricians that the evaluation of newborns after hospital discharge and establishing methodologies that allow childhood vaccination and the identification of subsidiary patients for face-to-face evaluation were necessary although the limitations of the lockdown. The idea that telephone and digital consultations have optimized the consultation time and that they will probably continue after the end of the pandemic was generally accepted. No changes in adherence to breastfeeding or the start of complementary feeding were referred to, but an increase in the duration of breastfeeding and the appearance of frequent hoaxes in social networks concerning infant feeding were found.

Conclusions

It is necessary to analyse the impact of telemedicine in paediatric consultations during the pandemic to evaluate its effectiveness and quality to maintain it in routine paediatric practice.

Parental Feeding Practices and Children's Eating Behaviours: An Overview of Their Complex Relationship

Several studies have found an association between eating behaviours and weight status and obesity risk in childhood. Children's eating behaviours arise from a combination of genetic and environmental factors. Parents appear to play a central role in their development as the main responsible for shaping children's feeding environment and eating experiences. The purpose of this paper is to review the literature on parental influences on eating behaviours across childhood, mainly focusing on parental feeding practices. The associations between parental feeding practices and children's eating behaviours have been extensively studied. However, most of the findings come from cross-sectional studies, so the possibility of reverse causality cannot be ruled out (i.e., children's behaviours influencing parents). Most recently, a few longitudinal studies with a cross-lagged design have shown that the relationship between children's eating behaviours and parental feeding practices seems to be bidirectional, where it is not straightforward whether parental feeding practices are a predictor or a consequence of children's eating behaviours. Children's eating behaviours influence parents to adopt certain feeding practices, but these practices also influence children's behaviours over time. Parental feeding practices may have the potential to shape children's eating behaviours and should be targeted to promote the development of non-obesogenic traits. However, parent-child interactions are complex and therefore both parent and child characteristics and the family dynamics should be considered.

Prospective relations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits

Background

Infant appetitive traits including eating rate, satiety responsiveness, food responsiveness, and enjoyment of food predict weight gain in infancy and early childhood. Although studies show a strong genetic influence on infant appetitive traits, the association of parent and infant appetite is understudied. Furthermore, little research examines the influence of maternal pregnancy dietary intake, weight indicators, and feeding mode on infant appetite. The present study investigated relations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits.

Methods

Mothers in the Pregnancy Eating Attributes Study (458 mothers enrolled, 367 retained through delivery) completed self-report measures of reward-related eating, and principal component analysis yielded two components: (1) food preoccupation and responsiveness and (2) reinforcing value of food. Mothers completed 24-h dietary recalls across pregnancy, and the standardized NOVA (not an acronym) system categorized recalled foods based on processing level. Maternal anthropometrics were measured across pregnancy. At infant age 6 months, mothers reported on feeding mode and infant appetitive traits. Linear regressions were conducted predicting infant appetitive traits from household income-poverty ratio (step 1); maternal reward-related eating components (step 2); pregnancy ultra-processed food intake (% of energy intake), early pregnancy body mass index, and gestational weight gain (step 3); and exclusive breastfeeding duration (step 4).

Results

A 1-SD greater maternal food preoccupation and responsiveness was associated with 0.20-SD greater infant satiety responsiveness (p = .005). A 1-SD greater % energy intake from ultra-processed foods during pregnancy was associated with 0.16-SD lower infant satiety responsiveness (p = .031). A 1-SD longer exclusive breastfeeding duration was associated with 0.18-SD less infant food responsiveness (p = .014). Other associations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits were non-significant.

Conclusions

Proximal early-life environmental factors including maternal pregnancy dietary intake and feeding mode may facilitate or protect against obesogenic infant appetitive traits, whereas infant appetite may not parallel maternal reward-related eating. Further investigation into the etiology of appetitive traits early in development, particularly during solid food introduction, may elucidate additional modifiable risk factors for child obesity.

Trial registration

Clinicaltrials.gov. Registration ID – NCT02217462. Date of registration – August 13, 2014.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01334-9.

Infant appetite traits, feeding practices and child obesity in low-income Hispanic families

BACKGROUND

Appetite traits and feeding practices are important determinants of child weight and obesity.

OBJECTIVES

This study examined whether: (1) infant appetite traits were associated with feeding practices and (2) feeding practices mediated the link between appetite traits and weight-for-age z-scores at age 3 years.

METHODS

We conducted a secondary data analysis from the 'Starting Early Program' of low-income, Hispanic mother-child pairs. Appetite traits were assessed using the Baby Eating Behaviour Questionnaire. Infant feeding practices were collected using 24-h dietary recalls and surveys: (1) breastfeeding exclusivity, intensity and duration; (2) early introduction to complementary foods/liquids and (3) any 100% fruit juice consumption at age 10 months. Regression and mediation analyses were used to explore associations between appetite, feeding and weight.

RESULTS

Higher infant Slowness in Eating scores were associated with greater breastfeeding exclusivity, intensity and duration, compared to lower Slowness in Eating. Infants with higher Slowness in Eating and Satiety Responsiveness had lower odds of early introduction to complementary foods/liquids. Infants with higher Enjoyment of Food had greater odds of 100% juice consumption. Breastfeeding duration mediated the relationship between higher infant Slowness in Eating and lower weight-for-age z-scores.

CONCLUSIONS

Appetite traits represent potential targets for early life infant feeding interventions.

Early Feeding Factors and Eating Behaviors among Children Aged 1–3: A Cross-Sectional Study

Early nutrition plays a crucial role not only in providing essential nutrients for proper child development, but may also be an important step in creating desirable eating behaviors, which can be transmitted into adulthood. The aim of this study was to assess possible links between early feeding factors, such as breastfeeding, complementary feeding (timing and method) as well as types of complementary foods and mealtime environment during the first three months of complementary feeding and eating behaviors in children aged 1–3 years old. This cross-sectional, online survey involved 467 mothers of toddlers aged 1–3 years old from the whole of Poland. The questionnaire consisted of questions about early feeding and the Children’s Eating Behavior Questionnaire (CEBQ). The adjusted linear regression model revealed that longer duration of any breastfeeding was negatively related to enjoyment of food (EF), desire to drink (DD) and positively related to satiety responsiveness (SR) and slowness in eating (SE) subscales. Moreover, offering homemade complementary foods more often than commercial may be related to higher SR. Eating meals during distraction seems to be negatively associated with EF, and positively with DD and SE subscales. Our study highlights possible links between early feeding factors and toddlers’ eating behaviors, so further investigation, also including dietary factors, is needed.

Infant feeding practices associated with adiposity peak and rebound in the EDEN mother-child cohort

BACKGROUND/OBJECTIVE

High magnitude of adiposity peak and early adiposity rebound are early risk markers of later obesity. Infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the association between infant feeding practices and age and magnitude of adiposity peak and rebound.

SUBJECTS/METHODS

Analyses were based on data from the French EDEN mother-child cohort. Data on breastfeeding and complementary feeding were collected at birth and 4, 8, and 12 months. From clinical examinations and measurements collected in the child's health booklet up to 12 years, individual growth curves were modeled, and ages and magnitudes of adiposity peak and rebound were estimated. Associations between infant feeding practices and growth were investigated by multivariable linear regression in children after testing a child-sex interaction.

RESULTS

In the studied population (n = 1225), adiposity peak occurred at a mean of 9.9 ± 2 months and adiposity rebound at 5.5 ± 1.4 years. Associations between infant feeding practices and adiposity peak or rebound were moderated by child sex. For girls, each additional month of breastfeeding was related to a 2-day increase in the age at adiposity peak (p < 0.001), and an 18-day increase in the age at adiposity peak (p = 0.004). Whereas for boys, each additional month for the age at complementary food introduction was associated with a 29-day increase in the age at adiposity rebound (p = 0.02). For boys, long breastfeeding duration was only related to reduced body mass index at adiposity peak.

CONCLUSIONS

Child sex has a moderating effect on the association between infant feeding practices and adiposity peak or rebound. The well-known association between breastfeeding duration and early growth seems stronger in girls than boys. The association found for complementary feeding in boys may give new insights into preventing obesity.

Increased Gestational Weight Gain is Associated with a Higher Risk of Offspring Adiposity Before Five Years of Age: A Population-Based Cohort Study

OBJECTIVE

We aim to investigate the influence of weight gain during pregnancy on the risk of offspring adiposity before five years old.

METHODS

We retrospectively collected health information from the Tianjin mother-child cohort. Offspring outcome was BMI Z-score and prevalence of childhood adiposity from 0.5-5 years old. Gestational weight gain was analyzed using continuous and categorical variables evaluated by the IOM guidelines. Multivariate analysis adjusted maternal age, prepregnancy BMI, maternal height, smoking, cesarean section, gestational age at birth, birth weight, birth length, and mode of infant feeding during 0-6 months.

RESULTS

Gestational weight gain contributed to offspring's BMI Z-score from 1-5 years old, and the effect was most obvious in the first half of pregnancy (multivariate analysis, at 1, 2, 2.5, 3, 4, and 5 years of age: β 0.011, 95% CI 0.008-0.014; β 0.017, 95% CI 0.015-0.020; β 0.005, 95%CI 0.002-0.008; β 0.018, 95% CI 0.015-0.021; β 0.014, 95% CI 0.009-0.020; β 0.013, 95% CI 0.005-0.021). Excessive weight gain was associated with a higher prevalence of offspring adiposity before five years, even if prepregnancy BMI is normal. Multivariate regression analysis further confirmed that excessive weight gain during the first half of pregnancy significantly increased the risk of childhood obesity at aged one and three (AOR 1.083, 95% CI 1.003-1.169; AOR 1.158, 95% CI 1.036-1.293).

CONCLUSION

Offspring have a higher risk of preschool adiposity when gestational weight gain was excessive during the first half of pregnancy.

Relationships between feeding problems, eating behaviours and parental feeding practices in children with Down syndrome: A cross-sectional study

BACKGROUND

Research investigating feeding problems in children with Down syndrome is scarce. This study investigated feeding problems, eating behaviours and parental feeding practices in children with Down syndrome (n = 40), and typically developing (TD) children of the same age and sex (n = 40).

METHOD

Parents of children aged 6-months to 5-years in the UK completed questionnaires assessing their child's feeding problems and eating behaviours and parental feeding practices.

RESULTS

For children with Down syndrome, feeding problems were: significantly greater than for TD children; negatively associated with breast milk duration and appetite during exclusive milk feeding; and positively associated with drinking more slowly. For both groups, feeding problems were significantly correlated with more food avoidant eating behaviours.

CONCLUSIONS

This study provides new information about the relationships between feeding problems and eating behaviours in early development. Longitudinal research is needed to further investigate these relationships, so that effective support can be developed for families.

Infant eating behaviors and Milk feeding independently predict infant size

OBJECTIVES

This study investigates the association of infant eating behaviors with infant size, and if those associations are mediated by infant feeding.

METHODS

Mothers with infants less than 12 months of age and living in Central North Carolina were enrolled (N = 61). Data were collected at baseline and at 3- and 6-month follow up visits. Modified constructs from the Baby Eating Behavior Questionnaire (BEBQ) and Child Eating Behavior Questionnaire (CEBQ) measured parents' perceptions of infant eating behaviors related to food approach (enjoyment of food, and food responsiveness) and food avoidance (food fussiness, satiety responsiveness, and slowness in eating). Linear mixed effects models tested longitudinal associations among infant eating behavior ratings, infant feeding (breastfeeding intensity, timing of introduction of complementary foods), and anthropometry (weight, length, and weight-for-length z-scores). Path analyses were stratified by age and tested for direct and indirect effects of mothers' ratings of infant eating behaviors and infant feeding on infant anthropometry.

RESULTS

Linear mixed models showed that general appetite was associated with higher weight-for-age, and satiety responsiveness was associated with lower length-for-age. Path analyses showed that infant milk feeding did not mediate associations. Breastfeeding intensity was independently associated with lower weight- and length-for-age z-scores. Age at complementary feeding initiation was associated with lower length-for-age z-scores.

CONCLUSIONS

Associations between parental perceptions of general appetite, satiety responsiveness, and infant weight and length are observed early in life. These findings suggest that parental perceptions of infant eating behaviors may contribute to the early developmental programming of later health outcomes.

Evaluation of an e-Learning Breastfeeding Program for Postpartum Mothers of Moderately High-Risk Newborn Infants Admitted to the Special Care Nursery

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

Baby-Led Weaning: What Role Does It Play in Obesity Risk during the First Years? A Systematic Review

Childhood is a window of opportunity for the prevention of the obesity pandemic. Since “the first 1000 days of life” is a period in which healthy eating habits must be acquired, it should be the target for preventive strategies. Baby-led weaning (BLW) is an emergent way of weaning that could influence children’s health. The nutrition committees of the main pediatric societies affirm there is not enough evidence to support which is the best method of weaning. The aim was to determinate the influence of BLW on the infant’s weight gain compared to the traditional spoon-feeding, and to assess if it could decrease the risk of obesity in children. A systematic review was conducted, following the PRISMA method. Pubmed, Web of Science, Embase, and Cochrane Library were searched. Out of 747 articles, eight studies (2875 total infants) were included (two randomized control trials, 6 observational studies). Results were indecisive, while some studies seem to demonstrate lower weight gain in infants that apply BLW, others show inconclusive results. The risk of bias in all included studies was moderate or high. In conclusion, more clinical trials and prospective studies should be done prior to providing a general recommendation about the best method of weaning to reduce the risk of obesity.

Breastfeeding and maternal eating behaviours are associated with child eating behaviours: findings from the ROLO Kids Study

Background

Child eating behaviours can negatively contribute to the development of childhood obesity. This study investigated associations between breastfeeding habits, maternal eating behaviours and child eating behaviours, in 5-year-old children.

Methods

Secundigravida women were recruited to the ROLO dietary randomised controlled trial (Dublin, Ireland) and were followed up with their children to 5 years of age. Breastfeeding exposure and duration were obtained at postnatal and infant follow-up at 2 and 6 months and 2 and 5 years. At 5 years, maternal and child eating behaviours were measured using the Three Factor Eating Questionnaire and the Child Eating Behaviour Questionnaire, respectively. Regression determined associations between breastfeeding habits and maternal eating behaviours with child eating behaviours, controlling for RCT group, maternal education level, maternal BMI at 5 years, childcare exposure and child BMI centile at 5-year follow-up.

Results

There were 230 mother and child pairs analysed. One hundred and fifty-eight mothers had initiated breastfeeding. Median breastfeeding duration was 22 (IQR 33) weeks. Children who were never breastfed were more likely to express a desire to drink (B = −1.01, p = 0.022). Longer breastfeeding duration was associated with lower food responsiveness (B = −1.71, p = 0.003). Maternal uncontrolled eating was positively associated with child food responsiveness, emotional overeating and emotional undereating (B = 0.21, p < 0.001; B = 0.14, p = 0.005; B = 0.14, p = 0.005, respectively). Maternal emotional eating was associated with child emotional overeating and undereating (B = 0.27, p < 0.001, B = 0.29, p = 0.004, respectively).

Conclusion

Not breastfeeding and short breastfeeding duration may contribute to the development of obesogenic eating behaviours in children, alongside maternal eating behaviours including uncontrolled and emotional eating. These ‘food approach’ eating behaviours may increase risk of overweight/obesity as they are associated with increased energy intake, hence the importance of research surrounding eating behaviours.

Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort

OBJECTIVE

Maternal psychological distress in pregnancy has been associated with both breastfeeding duration and child weight at 24 months; however, the potential that breastfeeding duration partially mediates the risk of maternal mental health problems during pregnancy on child weight classification has not been examined. The current study investigated this proposed relationship.

METHODS

Data was taken from the All Our Families (AOF) cohort, an ongoing prospective pregnancy cohort located in Calgary, Canada. Psychological distress, defined as clinically significant symptoms of anxiety and depression, was assessed via self-report and measured between 34 and 36 weeks of gestation. Breastfeeding duration was assessed in the postpartum by self-report. Child overweight classification was defined as a weight-for-length/height z-score at or above the 97th percentile as per World Health Organization's child growth guidelines.

RESULTS

In this sample of 1582 mother-child pairs, there was no direct relationship between psychological distress and child overweight status. Both anxiety (B = - 5.40, p = 0.001) and depression (B = - 6.54, p = 0.008) were associated with decreased weeks breastfeeding. Breastfeeding duration mediated the association between maternal prenatal psychological distress and child overweight status at 24 months, for both anxiety (B(SE) = 0.10(0.05), CI 0.03-0.21) and depression (B(SE) = 0.11(0.07), CI 0.01-0.27). Covariates included maternal age, education, ethnicity, income, pre-pregnancy BMI, gestational weight gain, and infant birth weight.

CONCLUSIONS

The results of this longitudinal cohort analysis support an indirect relationship between maternal psychological distress in pregnancy and the childhood overweight/obesity at 24 months old, mediated through breastfeeding duration.

Maternal Infant-Feeding Attitudes, Infant Eating Behaviors, and Maternal Feeding Choice at 3 and 6 Months Postpartum: A Comparative Multicenter International Study

Objective: The aim of this study was to compare mothers' attitudes toward infant feeding and infant eating behavior in different countries, and their associations with infant feeding at 3 and 6 months. Methods: Data from 164 mothers with healthy term infants recruited for a randomized trial comparing breast pumps from the UK (n = 68), Russia (n = 51), and China (n = 45) were included in this analysis. Feeding practices were assessed using questionnaires at 3 and 6 months. Maternal attitudes toward infant feeding and infant eating behaviors were measured by Iowa Infant Feeding Attitudes Scale (IIFAS) and Baby Eating Behavior Questionnaire (BEBQ) at 5-6 weeks postpartum; scores were compared between countries and associations with infant feeding at 3 and 6 months were examined. Results: IIFAS score was significantly different between countries; mean scores in Chinese and Russian mothers (China 64.6 ± 4.88 and Russia 61.5 ± 6.15) lay in the range of "neutral breastfeeding attitudes," while British mothers had more positive attitudes (70.6 ± 6.47, post hoc p < 0.001). Russian infants had higher scores for "general appetite" (mean = 4.8 ± 0.41, p < 0.05) and "satiety responsiveness" (mean = 8.7 ± 1.08, p < 0.01) than Chinese or British infants. Longer duration of full-time education was associated with more positive attitudes toward breastfeeding in the whole sample (p < 0.001) and in the United Kingdom (p < 0.05). The majority of mothers were exclusively breastfeeding (EBF) at 3 months. Total IIFAS and BEBQ scores were not significant predictors of EBF at 3 and 6 months (p > 0.05), although greater agreement with the IIFAS statement "Formula feeding is more convenient than breastfeeding" was associated with lower EBF at 3 months (OR = 0.47, 95% CI: 0.29-0.78, p < 0.01). Conclusions: Maternal attitudes toward infant feeding and perceptions of infant eating behavior differed between countries, but were not associated with EBF at 6 months. Mothers with a greater baseline perception that formula feeding is more convenient than breastfeeding were less likely to EBF at 3 months; this could be a potential target for education.

Eating Disorders in Pregnant and Breastfeeding Women: A Systematic Review

Background: Pregnancy is a stage associated with various biopsychosocial changes. These changes, along with concerns about keeping an adequate weight, can modulate an individual's risk for psychological disorders, especially eating disorders (EDs). The aim of this review was to investigate the prevalence, associated risks, and consequences of eating disorders in pregnancy and in breastfeeding mothers. Materials and Methods: A systematic review was carried out following the PRISMA guidelines in the scientific databases: PubMed, Web of Science, Scopus, and PsycINFO. Search terms related to EDs, pregnancy, and breastfeeding were used. The evaluation of the methodological quality of the studies was carried out using different scales; CASP (Checklist for Cohort Study), NICE (Methodology Checklist for Cohort Study), ARHQ (Methodology Checklist for Cross-Sectional), and NOS (Newcastle-Ottawa Scale for Cohort). Results: From 2920 studies, 16 were selected to study EDs in pregnant women and 2 studies in nursing mothers. Most of the studies used questionnaires and scales as tools for the diagnosis of EDs. Binge eating, anxiety, and depression were the most common comorbidities of EDs, accompanied in most cases by excessive concern about weight gain. The consequences of EDs are diverse. The prevalence of EDs in this population is estimated to be 1 out of 20. Conclusions: Eating disorders are related to anxiety and depression and have negative consequences for both mothers and fetuses (cesarean, miscarriages, premature births). More research on the field to determine the risk factors for EDs in the population of pregnant and lactating women is needed.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

Is breastfeeding associated with later child eating behaviours?

Individual differences in children's eating behaviours emerge early. We examined the relationship between breastfeeding exposure and subsequent eating behaviours among children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Children (n = 970) were grouped according to their breastfeeding exposure: high (full breastfeeding ≥ 4 months with continued breastfeeding ≥ 6 months), low (any breastfeeding < 3 months or no breastfeeding) and intermediate (between low and high breastfeeding categories). Aspects of eating behaviour from ages 15 months to 6 years were captured using a combination of maternal reports (Child Eating Behaviour Questionnaire; Infant Feeding Questionnaire; Preschooler Feeding Questionnaire) and laboratory-based measures of meal size, oral processing behaviours (e.g. average eating speed and bite size) and tendency to eat in the absence of hunger. Most children had low (44%) or intermediate (44%) breastfeeding exposure; only 12% had high exposure. After adjusting for confounders, multivariable linear regression analyses indicated the high (but not intermediate) breastfeeding group was associated with significantly lower reported food fussiness at 3 years compared to low breastfeeding group (-0.38 [-0.70, -0.06]), with similar but non-significant trends observed at 6 years (-0.27 [-0.66, 0.11]). At 3 years, mothers in the high breastfeeding group also reported the least difficulty in child feeding compared to low breastfeeding group (-0.22 [-0.43, -0.01]). However, high breastfeeding was not associated with any other maternal-reports of child feeding or eating behaviours, and no significant associations were observed between breastfeeding exposure and any of the laboratory measures of eating behaviour at any of the time points. These results do not strongly support the view that increased breastfeeding exposure alone has lasting and consistent associations with eating behaviours in early childhood.

Spoonfeeding is associated with increased infant weight but only amongst formula-fed infants

Infant feeding experiences are important for the development of healthy weight gain trajectories. Evidence surrounding milk feeding and timing of introduction to solids is extensive; however, the impact of the method of introducing solids on infant growth has been relatively underexplored. Baby‐led weaning (where infants self‐feed family foods) is proposed to improve appetite regulation, leading to healthier weight gain and a reduced risk of obesity. However, the evidence is mixed and has methodological inconsistencies. Furthermore, despite milk being a large part of the infant diet during the period infants are introduced to solid foods, its influence and interaction with introductory style have not been considered. The aim of this study was to explore growth among infants aged 3–12 months according to both style of introduction to solid foods and milk feeding; 269 infants were weighed and measured, and body mass index (BMI) computed. The results showed that overall, infants who were spoon‐fed (compared with self‐fed) at introduction to complementary feeding (CF) had greater length (but not weight or BMI). However, when milk feeding was accounted for, we found that infants who were both spoon‐fed and fully formula fed had greater weight compared with spoon‐fed, breastfed infants. There was no significant difference in weight among self‐fed infants who were breastfed or formula fed. The results highlight the importance of considering infant feeding as a multicomponent experience in relation to growth, combining both milk feeding and method of CF. This relationship may be explained by differences in maternal feeding style or diet consumed.

Breastfeeding and the Development of Socio-Emotional Competencies: A Systematic Review

Aim: To assess the current scientific evidence about the relationship between breastfeeding and the development of infant's socio-emotional competencies. Materials and Methods: A systematic review of literature was conducted through PubMed, LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), and PsycINFO of population-based cohorts. Records were screened, data extracted, and a quality assessment performed by two authors independently. Results: Thirteen studies were included in the review with six finding a statistically significant association between breastfeeding and the development of socio-emotional competencies such as problem solving, agreeableness, and optimism. In five studies, no statistically significant association was found, and in three, a negative association existed. Regarding quality assessment, four studies had a strong global rating, four had a moderate rating, and five had a weak global rating. Conclusion: Almost half (6/13) of the studies found a positive association between breastfeeding and the development of social-emotional competencies in infants; however, a great heterogeneity was present in the quality of the included studies. There is a need for further and higher quality research into this field of study.

From conception to infancy - early risk factors for childhood obesity

Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.

Associations between Otitis media, taste sensitivity and adiposity: Two studies across childhood

BACKGROUND

Otitis media (OM), or middle ear infections, are one of the most common diseases during early childhood. OM has been linked to changes in food preferences through potential effects on taste signalling, and thereby, to increased weight.

OBJECTIVES

We investigated the associations between OM, taste sensitivity and adiposity across two studies in early childhood and conducted exploratory post-hoc analyses of sex differences.

METHODS

Study I assessed 101 children between 2 and 3 years old (59.0% boys). Children were weighed and their height was measured to estimate BMI centiles. Waist measurements were taken to calculate Waist-to-Height Ratio (WHtR). Child's taste sensitivity was assessed using Short Sensory Profile questionnaire. Study II included 95 children between 5 and 9 years old (52.9% boys). Children were weighed and their height was measured to calculate their BMI. Children took part in a Sucrose Detection Threshold (SDT) assessment to establish their taste sensitivity. In both studies parents reported child's history of OM.

RESULTS

In Study I OM was associated with higher WHtR (p=0.047), though this was observed among girls (p=0.011), but not boys (p=0.53). OM was not linked to BMI centiles or taste sensitivity (all p>0.05). In Study II children with OM history had higher BMI centiles (p=0.010), and this effect was stronger in boys (p=0.037) than girls (p=0.17). Multiple OM exposure increased the odds of overweight by 6.2 times (95%CI [1.46, 26.50]). Boys with multiple OM exposure had higher SDT (p=0.022) compared to boys not exposed to OM, akin to lower taste sensitivity. This was not observed in girls (p=0.67).

CONCLUSIONS

OM history was associated with higher BMI among 5-9 year old children and this may be linked to taste impairments. This association was not observed in 2-3 year old children. Potential sex differences in these associations require further investigation.

Duration of Breastfeeding and Early Growth: A Systematic Review of Current Evidence

Introduction: Growth patterns of breastfed and formula-fed infants differ, but the influence of breastfeeding duration on early growth remains unclear. The objective of this study is to evaluate current evidence on the association of exclusive and partial breastfeeding duration with different growth parameters during infancy. Materials and Methods: In this systematic review, we searched MEDLINE, EMBASE, and additional sources from January 2011 until March 2018 to identify relevant cohort studies and randomized controlled trials (RCTs). Results: Twenty studies that recruited infants from the general population were included. In the developed setting, exclusive breastfeeding duration was inversely associated with weight and length gain during infancy in observational studies. Longer duration of exclusive breastfeeding was also associated with an earlier peak in infant body mass index (BMI). Inconsistent results were observed for the associations of exclusive breastfeeding duration with other infant BMI characteristics. In an RCT conducted in Iceland, exclusive breastfeeding for 4 versus 6 months did not affect infant growth patterns. In the developing setting, conflicting findings on the associations of exclusive breastfeeding duration with infant weight and length parameters were shown in observational studies. Shorter partial breastfeeding duration was associated with higher weight gain during infancy, with limited or inconclusive data regarding other growth parameters. Conclusions: Longer duration of exclusive and partial breastfeeding tended to be associated with slower growth rates during infancy in the developed setting only. These associations seem to be dose dependent and more pronounced in exclusively versus partially breastfed infants.

Infant temperament, maternal feeding behaviours and the timing of solid food introduction

Despite guidance from the World Health Organization and the U.K. Department of Health, many mothers introduce solid food before their infant is 6 months old. The current study aimed to investigate relationships between maternal feeding behaviours (preintroduction and postintroduction to solids), infant temperament, and the timing of introduction to solid food. Eighty‐one women were recruited on low‐risk maternity units and were contacted at 1 week, 3, and 6 months postpartum. Mothers of infants (45 males, 36 females, mean birth weight 3.52 kg [SD 0.39]) completed the behaviours component of the Infant Feeding Style Questionnaire via telephone interview at 3 months. At 6 months, they were observed feeding their infant solid food at home and reported infant temperament using the Infant Behaviour Questionnaire‐Revised (short form). Partial correlations (covariates: birth weight, maternal age, breastfeeding duration, and postnatal depression) revealed negative associations between age of introduction to solid food and temperament (smiling and laughter) and laissez‐faire milk feeding behaviours; and positive associations between age of introduction to solid food and restrictive milk feeding behaviours and verbal involvement during an observed mealtime. Hierarchical multiple regression analysis revealed that an infant's birth weight and the degree to which their mothers perceive them to smile and laugh are key predictors of when they will be introduced to solid food, over and above other variables of interest (e.g., maternal milk feeding behaviours, breastfeeding duration, and postnatal depression).

Mode of infant feeding, eating behaviour and anthropometry in infants at 6-months of age born to obese women - a secondary analysis of the UPBEAT trial

BACKGROUND

Maternal obesity and rapid infant weight gain have been associated with increased risk of obesity in childhood. Breastfeeding is suggested to be protective against childhood obesity, but no previous study has addressed the potential benefit of breastfeeding as a preventive method of childhood obesity amongst obese women. The primary aim of this study was to assess the relationship between mode of feeding and body composition, growth and eating behaviours in 6-month-old infants of obese women who participated in UPBEAT; a multi-centre randomised controlled trial comparing a lifestyle intervention of diet and physical activity to standard care during pregnancy.

METHODS

Three hundred and fifty-three mother and infant pairs attended a 6-months postpartum follow-up visit, during which they completed the Baby-Eating Behaviour Questionnaire, a parent-reported psychometric measure of appetite traits. Measures of infant body composition were also undertaken. As there was no effect of the antenatal intervention on infant feeding and appetite the study was treated as a cohort. Using regression analyses, we examined relationships between: 1) mode of feeding and body composition and growth; 2) mode of feeding and eating behaviour and 3) eating behaviour and body composition.

RESULTS

Formula fed infants of obese women in comparison to those exclusively breastfed, demonstrated higher weight z-scores (mean difference 0.26; 95% confidence interval 0.01 to 0.52), higher rate of weight gain (0.04; 0.00 to 0.07) and greater catch-up growth (2.48; 1.31 to 4.71). There was also a lower enjoyment of food (p = 0.002) amongst formula fed infants, following adjustment for confounders. Independent of the mode of feeding, a measure of infant appetite was associated with sum of skinfold thicknesses (β 0.66; 95% CI 0.12 to 1.21), calculated body fat percentage (0.83; 0.15 to 1.52), weight z-scores (0.21; 0.06 to 0.36) and catch-up growth (odds ratio 1.98; 1.21 to 3.21).

CONCLUSIONS

In obese women, exclusive breastfeeding was protective against increasing weight z-scores and trajectories of weight gain in their 6-month old infants. Measures of general appetite in early infancy were associated with measures of adiposity, weight and catch up growth independent of cord blood leptin concentrations and mode of early feeding.

Baby-Led Weaning: The Evidence to Date

PURPOSE OF REVIEW

Infants are traditionally introduced to solid foods using spoon-feeding of specially prepared infant foods.

RECENT FINDINGS

However, over the last 10-15 years, an alternative approach termed 'baby-led weaning' has grown in popularity. This approach involves allowing infants to self-feed family foods, encouraging the infant to set the pace and intake of the meal. Proponents of the approach believe it promotes healthy eating behaviour and weight gain trajectories, and evidence is starting to build surrounding the method. This review brings together all empirical evidence to date examining behaviours associated with the approach, its outcomes and confounding factors.

SUMMARY

Overall, although there is limited evidence suggesting that a baby-led approach may encourage positive outcomes, limitations of the data leave these conclusions weak. Further research is needed, particularly to explore pathways to impact and understand the approach in different contexts and populations.

Maternal weight status and responsiveness to preterm infant behavioral cues during feeding

Background

Parental obesity is highly predictive of child obesity, and preterm infants are at greater risk of obesity, but little is known about obese and non-obese mothers’ responsiveness to preterm infant cues during feeding. The relationship between maternal weight status and response to preterm infant behavioral cues during feeding at 6-weeks corrected age was examined.

Methods

This secondary analysis used data from a randomized clinical trial. Maternal weight was coded during a play session. Mother-infant interaction during feeding was coded using the Nursing Child Assessment Satellite Training Feeding Scale (NCAST). We used multivariate linear regressions to examine NCAST scores and multivariate logistic regressions for the two individual items, satiation cues and termination of feeding.

Results

Of the 139 mothers, 56 (40.3%) were obese, two underweight women were excluded. Obese mothers did not differ from overweight/normal weight mothers for overall NCAST scores, but they had higher scores on response to infant’s distress subscale (mean = 10.2 vs. 9.6, p = 0.01). The proportion of infants who exhibited satiation cues did not differ by maternal weight. Obese mothers were more likely than overweight/normal weight mothers to terminate the feeding when the infant showed satiation cues (82.1% vs. 66.3%, p = 0.04, adjusted OR = 2.31, 95% CI = 0.97, 5.48).

Conclusions

Limitations include lack of BMI measures and small sample size. Additional research is needed about maternal weight status and whether it influences responsiveness to preterm infant satiation cues. Results highlight the need for educating all mothers of preterm infants regarding preterm infant cues.

Trial registration

NCT02041923. Feeding and Transition to Home for Preterms at Social Risk (H-HOPE). Registered 15 January 2014.