Has the WIC incentive to formula-feed led to an increase in overweight children?

Factors contributing to infant overfeeding in low-income immigrant Latina mothers

BACKGROUND

Approximately 10% of U.S. infants and toddlers are considered overweight. Hispanic infants persistently show higher prevalence rates for being overweight compared to other infants. Little is known about factors promoting excessive infant weight gain in Latinos.

PURPOSE

The aim of this study was to describe multidimensional factors and maternal feeding practices that may correlate with infant overfeeding in Latina mothers.

METHODS

Participants were 62 low-income immigrant Latina mothers and their infants. Study measures were: acculturation; maternal feeding beliefs and practices; food availability; temperament; 24-hour dietary recall; and infant's weight-for-height z score.

RESULTS

In regression models adjusted for infant's age, healthier feeding practices were significantly predicted by maternal education and infant's age. Most mothers preferred feeding their infants either formula or a combination of breast milk and formula. A significant proportion of the infants were overweight or obese and yet some mothers displayed difficulty recognizing this problem.

CONCLUSION

Future intervention efforts should focus primarily on the promotion of healthy feeding practices that discourage overfeeding and support exclusive breastfeeding among this ethnic group.

Global infant formula: monitoring and regulating the impacts to protect human health

Worldwide promotion of infant formula and other commercial baby foods is leading to increased use of these products, raising concerns about their impact on the health of infants. These products are made and marketed through a global system that extends beyond the control of separate nations. As the industry is increasingly globalized, there is a growing need for guidance, monitoring, and regulation. This study suggests a path toward achieving better control of infant formula and other baby foods to ensure that infants and young children everywhere are well nourished. The negotiation of a new Optional Protocol on Children's Nutrition, to be linked to the most relevant human rights treaty, the Convention on the Rights of the Child, would bring the major issues relating to infant formula and other baby foods to the attention of the global community and all national governments.

Food insecurity and obesogenic maternal infant feeding styles and practices in low-income families

OBJECTIVES

We explored the relationship between household food insecurity and maternal feeding styles, infant feeding practices, and perceptions and attitudes about infant weight in low-income mothers.

METHODS

Mothers participating in the Special Supplemental Food Program for Women, Infants, and Children with infants aged between 2 weeks and 6 months were interviewed. By using regression analyses, the following relationships were examined between food insecurity and: (1) controlling feeding styles (restrictive and pressuring); (2) infant feeding practices, including breastfeeding, juice consumption, and adding cereal to the bottle; and (3) perceptions and attitudes about infant weight. Path analysis was used to determine if perceptions and attitudes about infant weight mediated the relationships between food insecurity and controlling feeding styles.

RESULTS

The sample included 201 mother-infant pairs, with 35% reporting household food insecurity. Food-insecure mothers were more likely to exhibit restrictive (B [SE]: 0.18 [0.08]; 95% confidence interval [CI]: 0.02-0.34) and pressuring (B [SE]: 0.11 [0.06]; 95% CI: 0.001-0.22) feeding styles compared with food-secure mothers. No associations were found with feeding practices. Concern for their infant becoming overweight in the future was associated with food insecurity (adjusted odds ratio: 2.11 [95% CI: 1.02-4.38]). This concern mediated the relationship between food insecurity and both restrictive (P = .009) and pressuring (P = .01) feeding styles.

CONCLUSIONS

Increased concern about future overweight and controlling feeding styles represent potential mechanisms by which food insecurity could be related to obesity. Obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure.

Breastfeeding duration in relation to child care arrangement and participation in the special supplemental nutrition program for women, infants, and children

This study was conducted to examine associations among breastfeeding duration, child care arrangement, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The authors analyzed the nationally representative sample of infants born in 2001 who were enrolled in the Early Childhood Longitudinal Study-Birth Cohort (9 months). They estimated the risks of short breastfeeding duration (< 6 months of age) among infants according to the child care arrangement and WIC participation (n = 7515). Approximately 50% of US infants were enrolled in WIC, and 47% received child care on a regular basis. Both WIC participation and child care use were independently associated with short breastfeeding duration. Compared to those under parental care, WIC participants under relative care were more likely to discontinue breastfeeding before the age of 6 months. A breastfeeding support program targeted toward relative care users may be useful for WIC participants.

Food insecurity and weight status among U.S. children and families: a review of the literature

CONTEXT

Food insecurity disproportionately affects U.S. demographic groups of children and adult family members at the highest risk for obesity and may lead to weight gain through various pathways. This article reviews research regarding the relationship between food insecurity and weight status, and the potential role of federal food and nutrition assistance programs.

EVIDENCE ACQUISITION

A search for relevant peer-reviewed research studies among U.S. children and nonelderly adults, published between 2000 and March 2010, identified 42 studies regarding the relationship between food insecurity and weight status. There were 22 studies regarding the potential role of food and nutrition assistance programs.

EVIDENCE SYNTHESIS

Among children and men, support for an association between food insecurity and weight status has been mixed. Women who experience food insecurity are more likely to be overweight or obese compared to women with adequate household resources for food; however, there is little evidence that food insecurity promotes increased weight gain over time. Long-term participation in the Supplemental Nutrition Assistance Program may increase risk for excess weight gain.

CONCLUSIONS

Additional research addressing the limitations of current studies is needed to fully understand the observed linkages between food insecurity and risk for obesity. Nevertheless, there is substantial evidence these nutritional problems coexist, and it is critical that future efforts to eliminate hunger consider opportunities to promote healthy food choices and physical activity. Evaluations of policy changes and other intervention strategies are needed to determine the potential for food and nutrition assistance programs to more effectively reduce obesity among participants.

First- and second-trimester WIC participation is associated with lower rates of breastfeeding and early introduction of cow's milk during infancy

BACKGROUND

Existing literature suggests prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may reduce breastfeeding among low-income mothers. However, little is known about whether the timing of WIC entrance during pregnancy influences infant feeding decisions.

OBJECTIVE

This study assesses the association between the timing of prenatal participation in WIC and various infant feeding practices, including breastfeeding initiation, breastfeeding for at least 4 months, exclusive breastfeeding, formula feeding, and early introduction of cow's milk and solid food.

DESIGN

Cross-sectional survey matching of birth certificate data to mothers' interviews 9 months after the child's birth. Mothers provided information on participation in the WIC program, infant feeding practices, and sociodemographic characteristics.

SUBJECTS

A nationally representative sample of 4,450 births in 2001 from the Early Childhood Longitudinal Survey-Birth Cohort.

ANALYSES

Multivariate logistic regression techniques (using STATA 9.0 SE, Stata Company, College Station, TX) estimated the relationship between the timing of prenatal WIC participation and infant feeding practices.

RESULTS

Entry into the WIC program during the first or second trimester of pregnancy is associated with reduced likelihood of initiation of breastfeeding and early cow's milk introduction; and entry during the first trimester is associated with reduced duration of breastfeeding. WIC participation at any trimester is positively related to formula feeding.

CONCLUSIONS

Prenatal WIC participation is associated with a greater likelihood of providing babies infant formula rather than breastmilk after birth. Findings also indicate that there are critical prenatal periods for educating women about the health risks of early cow's milk introduction. Given the health implications of feeding infants cow's milk too early, WIC may be successful in educating women on the health risks of introducing complementary foods early, even if direct counseling on cow's milk is not provided.

Maternal behavior and infant weight gain in the first year

OBJECTIVE

To examine the relative contributions of maternal characteristics and behaviors in predicting infant weight gain over the first year of postpartum life.

DESIGN

Longitudinal study of maternal feeding style throughout infancy.

SETTING

A Special Supplemental Nutrition Program for Women, Infants, and Children center.

PARTICIPANTS

Ninety-six low-income, minority mother-infant dyads.

MAIN OUTCOME MEASURES

Infant weight gain at 3, 6, and 12 months.

ANALYSIS

Multiple linear and backward regressions.

RESULTS

None of the mother-infant perinatal measures predicted infant weight gain from birth to 3 months, nor did measures from birth to 3 months predict weight gain from 3 to 6 months. However, the number of feedings and lessened maternal sensitivity to infant cues predicted weight gain from 6 to 12 months.

CONCLUSIONS AND IMPLICATIONS

These results suggest that feeding plays an important role in promoting rapid weight gain in infants, since the maternal reports of feeding frequency, as well as their lessened sensitivity to the infants' cues, indicate that the infants in this study may have been regularly overfed. Nutrition educators who work with low-income populations should provide guidance to mothers in feeding their infants by helping them to recognize hunger signals and respond to satiety cues.

Breastfeeding duration and childhood overweight among low-income children in Kansas, 1998-2002

OBJECTIVES

We sought to determine whether increased duration of breast-feeding was associated with decreased risk of overweight among 4-year-old children in Kansas families with limited means.

METHODS

We linked data on Kansas families from the Pediatric Nutrition Surveillance System and Pregnancy Nutrition Surveillance System, 1998 to 2002, to determine breastfeeding duration and weight status at age 4 years. Overweight among 4-year-old children was defined as body mass index-for-age at the 95th percentile and above. Linked analysis included 3692 children. Logistic regression was applied to determine odds of being overweight at each duration of breastfeeding.

RESULTS

Breastfeeding duration considered independently showed a significant protective association with childhood overweight at age 4 years for all non-Hispanics (odds ratio [OR]=0.72; 95% confidence interval [CI]=0.55, 0.94) and for Whites only (OR=0.68; CI=0.50, 0.92). When we controlled for other significant risk factors for childhood overweight, the association diminished and was not statistically significant.

CONCLUSIONS

Although breastfeeding for longer duration appeared to be protective against overweight among 4-year-old non-Hispanic children, cultural and environmental factors may override this protective benefit.

Environmental influences on childhood obesity: ethnic and cultural influences in context

Ethnicity is associated with differences in food-related beliefs, preferences, and behaviors, and cultural influences may contribute to the higher than average risk of obesity among children and youth in U.S. ethnic minority populations. However, cultural attitudes and beliefs are not the only potential source of ethnic variation in childhood obesity prevalence and should not be studied in isolation. Demographic, socio-structural, and environmental variables must also be considered. Available evidence indicates ethnic differences along several pathways that may increase risks of obesity development during gestation, infancy, childhood and adolescence. These include above-average prevalence of obesity in adult females and of maternal diabetes during pregnancy, parental attitudes and practices that may lead to overfeeding children, above-average levels of consumption of certain high calorie foods and beverages, and inadequate physical activity. Environments with lower than average neighborhood availability of healthful foods and higher than average availability of fast food restaurants, along with exposure to ethnically targeted food marketing may contribute to reliance on high calorie foods and beverages, and these foods may be socially and culturally valued. Attitudes about and environmental contexts for physical activity are also relevant. Increasingly, it is acknowledged that individual behaviors and lifestyles, e.g. food choices or child feeding practices, are responsive to the ecological contexts in which they are practiced. Focusing attention on the fluid interactions of cultural influences with contextual factors, of recognized importance for the study of childhood undernutrition, can also lead to further understanding of how to address ethnic disparities in childhood obesity.

Breastfeeding is associated with lower body mass index among children of the Commonwealth of the Northern Mariana Islands

OBJECTIVE

To describe the prevalence of breastfeeding and overweight in the Commonwealth of the Northern Mariana Islands (CNMI), and the relationship between the two.

DESIGN AND METHODS

A random cluster survey of 420 children (aged 6 months to 10 years), was conducted in the CNMI in June and July of 2005. Children were measured for weight and height and caregivers were asked about past feeding habits by trained investigators.

RESULTS

Seventy-three percent of children were ever breastfed; 53% were still breastfed at 6 months, and 22% at 1 year of age. Five percent of children were found to be underweight (<5th percentile), while 15% were at risk for overweight (85th to <95th percentile) and 19% were overweight (>95th percentile), according to the Centers for Disease Control and Prevention body mass index for age reference data. Children who had been breastfed had a substantially lower body mass index than children who had not breastfed, after adjusting for age, sex, birthweight, and years of mother's education.

DISCUSSION

These findings will be used to guide program development in the CNMI.