Diet and growth in infancy: relationship to socioeconomic background and to health and development in the Avon Longitudinal Study of Parents and Children

Early-life family meal participation and anthropometric measures at 4 years of age

Early-life family meal participation has been associated with several aspects of nutritional health, but longitudinal associations with linear growth have not yet been investigated. The aim of this study was to investigate whether family meal participation at 12 months of age associates with anthropometric measures 3 years later. We used follow-up data from children born to mothers in the Norwegian Fit for Delivery trial (NFFD) and included 368 first-borns with dietary and anthropometric data at 12 months and 4 years of age. We treated the sample as a cohort and conducted subgroup analyses by randomization status. A family meal participation score was used as exposure, and weight, height, and body mass index (BMI) as outcomes in crude and multivariable linear regression models adjusted for maternal education, randomization status, and child sex.Higher family meal participation score at 12 months was positively associated with length at 12 months (B = 0.198, 95% CI 0.028, 0.367, p = 0.022) and 4 years (B = 0.283, 95% CI 0.011, 0.555, p = 0.042) in multivariable models. After additional adjustment for maternal height the associations attenuated and were no longer significant. An inverse association with BMI at 4 years of age was observed in children born to mothers that had been exposed to the NFFD intervention (B = -0.144, 95% CI -0.275, -0.014, p = 0.030), but attenuated after adjustment for maternal BMI.The longitudinal association observed between early family meal participation and child height was largely explained by maternal height. The relationship with BMI differed according to maternal participation in a lifestyle intervention trial during pregnancy.

Determinants of iron-rich food deficiency among children under 5 years in sub-Saharan Africa: a comprehensive analysis of Demographic and Health Surveys

BACKGROUND

Iron deficiency is a major public health problem that affects the physical and cognitive development of children under 5 years of age (under-5 children) in sub-Saharan Africa (SSA). However, the factors associated with the limited consumption of iron-rich foods in the region are poorly understood.

OBJECTIVE

This study examined the prevalence and determinants of iron-rich food deficiency among under-5 children in 26 SSA countries.

DESIGN

This nationally representative quantitative study employed pooled data from Demographic and Health Surveys conducted between 2010 and 2019.

METHODS

Representative samples comprising 296 850 under-5 children from the various countries were used. Bivariate and multivariate logistic regression models were used to determine the associations between the lack of iron-rich food uptake and various sociodemographic factors.

RESULT

The overall prevalence of iron-rich food deficiency among the children in the entire sample was 56.75%. The prevalence of iron-rich food deficiency varied widely across the 26 countries, ranging from 42.76% in Congo Democratic Republic to 77.50% in Guinea. Maternal education, particularly primary education (OR 0.62, 95% CI 0.57 to 0.68) and higher education (OR 0.58, 95% CI 0.52 to 0.64), demonstrated a reduced likelihood of iron-rich food deficiency in the sample. Likewise, paternal education, with both primary education (OR 0.69, 95% CI 0.63 to 0.75) and higher education (OR 0.66, 95% CI 0.60 to 0.73) showed decreased odds of iron-rich food deficiency. Postnatal visits contributed significantly to reducing the odds of iron-rich food deficiency (OR 0.90, 95% CI 0.83 to 0.95), along with antenatal visits, which also had a positive impact (OR 0.84, 95% CI 0.74 to 0.95). Finally, residents in rural areas showed slightly higher odds of iron-rich food deficiency (OR 1.12, 95% CI 1.10 to 1.28).

CONCLUSION

Based on the findings, interventions targeting iron-food deficiency in the SSA region should take into strong consideration the key determinants highlighted in this study.

Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV

OBJECTIVE

The aim of this study was to compare long-term growth between HIV-exposed uninfected children (CHEU) born to women with perinatally acquired HIV (CHEU-PHIV) and CHEU born to women with nonperinatally acquired HIV (CHEU-NPHIV).

DESIGN

A longitudinal analysis of anthropometric measurements from a U.S.-based multisite prospective cohort study enrolling CHEU and their mothers since April 2007.

METHODS

CHEU were evaluated for growth annually from birth through age 5 and again at age 7 years. Z-scores were calculated using U.S. growth references for weight (WTZ), height (HTZ), and weight-for-length or BMI-for-age (WLZ/BMIZ). Mid-upper arm circumference (MUACZ) and triceps skinfold thickness (TSFZ) Z-scores were obtained from ages 1 and 2, respectively, through age 7 years. Piecewise mixed-effects models, overall and stratified by race and sex, were fit to assess differential growth patterns across age by maternal PHIV status.

RESULTS

One thousand four hundred fifty-four singleton infants (286 CHEU-PHIV and 1168 CHEU-NPHIV) were included. CHEU-PHIV had slower growth rates than CHEU-NPHIV for WTZ and WLZ/BMIZ at earlier ages and continued to have lower mean WTZ [-0.27, 95% confidence interval (95% CI): -0.50, -0.04] and WLZ/BMIZ (-0.39, 95% CI: -0.67, -0.11) through age 7. Among non-Black boys, CHEU-PHIV had slightly lower WTZ and WLZ/BMIZ at birth than CHEU-NPHIV and these growth deficits persisted through age 7 years.

CONCLUSION

Compared with CHEU-NPHIV, CHEU-PHIV had diminished growth in early childhood with differences most pronounced among non-Black male children. Further longitudinal follow-up of CHEU-PHIV into young adulthood is needed to understand whether these early effects of maternal PHIV status on growth persist and have other health consequences.

Timing of rapid weight gain and its effect on subsequent overweight or obesity in childhood: findings from a longitudinal birth cohort study

BACKGROUND

Rapid weight gain (RWG) has been recognized as an important determinant of childhood obesity. This study aims to explore the RWG distribution among children at six-month intervals from birth to two years old and to examine the association of RWG in each interval with overweight or obesity development in preschool- and school-aged children.

METHODS

Data were obtained from the Taiwan Birth Cohort Study, which is a nationally representative sample of 24,200 children who participated in a face-to-face survey. A total of 17,002 children had complete data both for weight and height at each of the five measurement time periods. Multivariable logistic regression models quantified the relationship between RWG and childhood overweight or obesity.

RESULTS

A total of 17.5% of children experienced rapid weight gain in the first six months of age, compared to only 1.8% of children from 18-24 months. RWG was significantly associated with an increased risk of developing overweight or obesity at 36 months (RWG birth-6 months: OR = 2.6, 95% CI: 2.3-2.8; RWG 18-24 months: OR = 3.7, 95% CI: 2.9-4.6), 66 months (RWG birth-6 months: OR = 2.2, 95% CI: 2.0-2.4; RWG 18-24 months: OR = 2.3, 95% CI: 1.8-2.8), and 8 years of age (RWG birth-6 months: OR = 1.7, 95% CI: 1.6-1.9; RWG 18-24 months: OR = 2.4, 95% CI: 2.0-3.0).

CONCLUSIONS

Childhood RWG increased the risk of subsequent overweight or obesity, regardless of the specific time interval at which RWG occurred before the age of two years. The results reinforce the importance of monitoring childhood RWG continuously and show the risks of childhood RWG with respect to the development of overweight or obesity at preschool and school ages.

Iron-fortified formula use in young children and association with socioeconomic factors in the French nationwide ELFE cohort

AIM

To study the rate of iron-fortified infant formula (IFF) use in young children in France and its association with socioeconomic factors.

METHODS

The ELFE national birth cohort included, in 2011, 18 329 living births in 349 hospitals randomly selected. The present analyses were restricted to children with follow-up at age two years. Milk consumption was evaluated by parental telephone interview, and its association with socioeconomic factors was studied.

RESULTS

The 12 341 analysed children had a mean age of 26 months; 50% were girls. Rate of IFF use before two years old and at two years old was 65% and 43%, respectively. At age two years, use of IFF was lower with young age of the mother (adjusted OR [aOR] = 0.4, 95% CI: 0.3-0.5), low educational level (aOR = 0.7, 95% CI: 0.6-0.9), high parity (aOR = 0.3, 95% CI 0.2-0.4), and mother smoking (aOR = 0.8, 95% CI: 0.7-0.9) as well as low household income (aOR = 0.5, 95% CI: 0.4-0.7), and parents' unemployment (aOR = 0.7, 95% CI: 0.5-0.9).

CONCLUSION

In this national population-based study, the rate of implementation of the ID prevention strategy was much lower at two years old than before two years old, and significantly lower in disadvantaged populations.

Standard v. baby-led complementary feeding: a comparison of food and nutrient intakes in 6–12-month-old infants in the UK

Objective:

To compare food and nutrient intakes of infants aged 6–12 months following a baby-led complementary feeding (BLCF) approach and a standard weaning (SW) approach.

Design:

Participants completed an online questionnaire consisting of sociodemographic questions, a 28 d FFQ and a 24 h dietary recall.

Setting:

UK.

Participants:

Infants (n 134) aged 6–12 months (n 88, BLCF; n 46, SW).

Results:

There was no difference between weaning methods for the food groups ‘fruits’, ‘vegetables’, ‘all fish’, ‘meat and fish’, ‘sugary’ or ‘starchy’ foods. The SW group was offered ‘fortified infant cereals’ (P < 0·001), ‘salty snacks’ at 6–8 months (P = 0·03), ‘dairy and dairy-based desserts’ at 9–12 months (P = 0·04) and ‘pre-prepared baby foods’ at all ages (P < 0·001) more often than the BLCF group. The SW group was offered ‘oily fish’ at all ages (P < 0·001) and 6–8 months (P = 0·01) and ‘processed meats’ at all ages (P < 0·001), 6–8 months (P = 0·003) and 9–12 months (P < 0·001) less often than the BLCF group. The BLCF group had significantly greater intakes of Na (P = 0·028) and fat from food (P = 0·035), and significantly lower intakes of Fe from milk (P = 0·012) and free sugar in the 6–8 months subgroup (P = 0·03) v. the SW group. Fe intake was below the Reference Nutrient Intake (RNI) for both groups and Na was above the RNI in the BLCF group.

Conclusion:

Compared with the SW group, the BLCF group was offered foods higher in Na and lower in Fe; however, the foods offered contained less free sugar.

FACTORS ASSOCIATED WITH RAPID WEIGHT GAIN IN PRESCHOOL CHILDREN IN PUBLIC DAY CARE CENTERS

OBJECTIVE

To evaluate the prevalence, and identify factors associated with rapid weight gain in preschool children.

METHODS

A cross sectional study was carried out with 136 children between 24 and 35 months of age attending public daycare centers in Mogi das Cruzes between February and December 2014. Interviews were conducted with the mothers for clinical, sociodemographic and anthropometric characterizations of the children. It was considered to be rapid weight gain when the children presented a difference greater than 0.67 between the weight for age Z score from birth to evaluation. A logistic regression model was adjusted for factors associated with rapid weight gain.

RESULTS

Fifty children (36.8%) presented rapid weight gain and 36 (26.5%) were overweight. Of these, 22 children were in the rapid weight gain group. The logistic model showed that longest total breastfeeding time (OR 0.94, 95%CI 0.88-0.99; p=0.031) was a protection factor, and low socioeconomic level (OR 4.18, 95%CI 1.04-18.60; p=0.044) was a risk factor for rapid weight gain.

CONCLUSIONS

There was a high prevalence of rapid weight gain and being overweight among three year old preschoolers attending public day care centers in Brazil. Encouraging the practice of breastfeeding children in the first years of life, in addition to giving guidance about appropriate foods, especially for families with a low socioeconomic status, can potentially contribute to reduce rapid weight gain and, consequently, future metabolic complications of being overweight.

Changes of feeding patterns in Chinese city children under 2 years from 1985 to 2015: results from a series of national cross-sectional surveys

BACKGROUND

In China, as the social transformation and economic development from 1985 to 2015, children's feeding pattern has undergone some changes. So we aimed to analyze the secular trend on feeding patterns of city children in China.

METHODS

All data were from a series of national survey which implemented once every 10 years in China from 1985 to 2015. We use same indexes to evaluate the feeding pattern of children in these four surveys.

RESULTS

From 1985 to 2005, the exclusive breastfeeding rates in infants under 6 months of age decreased, especially in suburban areas decreased by 17.7%; the continuous breastfeeding rate of 1-year-old children in suburban area decreased from 60.1 to 27.6%. However, from 2005 to 2015, the exclusive breastfeeding rates under 6 months of age increased by 16.0% in urban areas and 5.9% in suburban areas; the continuous breastfeeding rate of 1-year-old children in urban increased from 17.0 to 36.0%. The overall feeding rate of complementary food in infants under 6 months of age declined from 1985 to 2015; the average age at introduction of all complementary foods was around 6 months of age in 2015.

CONCLUSIONS

There is an obvious trend on feeding pattern of Chinese children. From 1985 to 2005, the breastfeeding rate decreased, the duration time of breastfeeding was shortened and the age at introduction of complementary food was advanced. From 2005 to 2015, the breastfeeding rate increased, the duration time of breastfeeding was prolonged, and the age at introduction of complementary food was postponed.

Relative Validity of a 24-h Recall in Assessing Intake of Key Nutrients in a Cohort of Australian Toddlers

There is limited information concerning the dietary intake of toddlers in Australia. Consequently, there is a need for studies investigating toddler intake that use dietary assessment measures that are valid and place a low participant burden on caregivers. The aim of this study was to determine the relative validity of a single 24-h dietary recall (24HR) in measuring the intake of five nutrients in a cohort of Australian toddlers compared to a combined 24HR and 2-day estimated food record (2DFR). A single 24HR and a 2DFR were collected from a cohort of Australian toddlers (n = 699) at approximately 12 months of age as part of the Study of Mothers' and Infants' Life Events affecting oral health (SMILE) project. Relative validity of one day of dietary data (24HR) in assessing intake of energy, protein, calcium, iron, and added sugars was tested against three days of dietary data (24HR + 2DFR) using paired t-tests, Bland-Altman analysis, cross-classification, and weighted Kappa statistic. Classification analysis found good agreement between the 24HR and 24HR + 2DFR for all nutrients with the percentage classified in the same tertile at 57.9% and above. The weighted Kappa statistic found acceptable agreement for all nutrients. This study suggests that a 24HR is a valid assessment tool for estimating the relative intake of energy, protein, calcium, iron, and added sugars among Australian toddlers at the individual level.

Assessment of complementary feeding of Canadian infants: effects on microbiome & oxidative stress, a randomized controlled trial

BACKGROUND

The World Health Organization recommends exclusive breastfeeding until 6 months followed by introduction of iron-rich complementary foods (CFs). The aim of this study was to determine the impact of different iron-rich CFs on infant gut inflammation and microbiota.

METHODS

Eighty-seven exclusively breastfed infants were randomly assigned to receive one of the following as their first CF: iron-fortified cereal (Cer), iron-fortified cereal with fruit (Cer + Fr), or meat (M). Urine and stool samples were collected to assess reactive oxygen species (ROS) generation, gut microbiota and inflammation.

RESULTS

Fecal iron differed across feeding groups (p < 0.001); levels were highest in the Cer group and lowest in M group. A significant increase of fecal ROS formation (p < 0.002) after the introduction of CFs was observed, but did not differ across feeding groups. Fecal calprotectin increased within all groups after the introduction of CFs (p = 0.004). Gut microbiota richness increased after introduction of M or Cer + Fr. Regardless of feeding group, Coriobacteriaceae were positively correlated with ROS and Staphylococcaceae were negatively correlated with calprotectin.

CONCLUSIONS

Choice of first CF may influence gut inflammation and microbiota, potentially due to variations in iron absorption from different foods. Further research is warranted to fully characterize these associations and to establish implications for infant health. This study was registered in the ClinicalTrial.gov registry (Identifier No. NCT01790542 ).

TRIAL REGISTRATION

This study was registered in the ClinicalTrial.gov registry under the name "Assessment of Complementary Feeding of Canadian Infants" (Identifier No. NCT01790542 ) February 6, 2013.

Relationship Between Breastfeeding and Early Childhood Obesity: Results of a Prospective Longitudinal Study from Birth to 4 Years

AIM

To study a potential link between breastfeeding in infancy and obesity at age 4.

MATERIALS AND METHODS

A total of 30,508 infants born during 2002-2007 from the databases of the Preventive Child Health Services in two Swedish counties and from national registers were studied. The outcome variable was obesity at age 4. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations. Analyses were adjusted for child sex and maternal anthropometric and sociodemographic variables.

RESULTS

In unadjusted analyses, any breastfeeding up to 9 months was linked to successively decreasing odds ratios (ORs) for obesity at age 4 (ORs 0.78-0.33), however, not significantly for 1 week and 2 months of breastfeeding. In adjusted analyses, the same pattern remained statistically significant for breastfeeding for 4 (OR 0.51), 6 (OR 0.55), and 9 (OR 0.47) months. Child sex, maternal education, maternal body mass index, and maternal smoking additionally influenced child obesity.

CONCLUSION

Breastfeeding duration for at least 4 months may contribute independently to a reduced risk for childhood obesity at 4 years.

Infant Dietary Exposures to Sweetness and Fattiness Increase during the First Year of Life and Are Associated with Feeding Practices

BACKGROUND

Taste is a strong determinant of food intake. Previous research has suggested that early taste exposures could influence preferences and later eating behavior, but little is known about the factors related to this.

OBJECTIVES

The aims of this study were to describe infants' exposure to sweetness and fattiness and to examine whether maternal and infant characteristics and feeding practices are related to these exposures in participants from the OPALINE [Observatoire des Préférences Alimentaires du Nourrisson et de l'Enfant (Observatory of Infant and Child Food Preferences)] cohort study.

METHODS

Food consumption frequency was assessed with a 7-d food record completed monthly over the first year. Dietary taste exposure was defined by the consumption frequency of each food multiplied by the intensity of its taste, summed over all foods. The daily sweetness exposure (SweetExp) and fattiness exposure (FatExp) were calculated at 3-6, 7-9, and 10-12 mo of age for 268 infants from complementary feeding initiation (CFI) to 12 mo. Associations between taste exposure and potential factors were tested by multiple linear regressions.

RESULTS

Both FatExp and SweetExp increased from 3-6 mo to 10-12 mo (mean ± SD: 7.5 ± 2.3 to 12.2 ± 2.5 and 6.8 ± 2.8 to 14.7 ± 4.1, respectively). Breastfeeding duration ≥6 mo was associated with higher SweetExp at all ages, with a decreasing β [β (95% CI): 2.6 (1.8; 3.4) at 3-6 mo and 1.3 (0.1; 2.4) at 10-12 mo]. CFI at <6 mo was associated with higher SweetExp at all ages but with higher FatExp only at 3-6 mo. Higher SweetExp and FatExp were associated with a higher use of all complementary food types. Boys were more likely to be exposed to SweetExp at 10-12 mo and to FatExp at 3-6 mo and 10-12 mo than were girls. Maternal higher education attainment and return to work after 6 mo were linked with higher FatExp and higher FatExp and SweetExp, respectively.

CONCLUSION

SweetExp and FatExp increased from CFI until 12 mo and were associated with feeding practices in OPALINE infants. Studying early taste exposure longitudinally should provide new insights regarding the development of food preferences.

Novel application of statistical methods for analysis of multiple toxicants identifies DDT as a risk factor for early child behavioral problems

BACKGROUND

The aim of this study was to assess the association between postnatal exposure to multiple persistent organic pollutants (POPs) measured in breast milk samples and early behavioral problems using statistical methods to deal with correlated exposure data.

METHODS

We used data from the Norwegian HUMIS study. We measured concentrations of 24 different POPs in human milk from 612 mothers (median collection time: 32 days after delivery), including 13 polychlorinated biphenyls (PCB) congeners, 6 polybrominated diphenyl ethers (PBDE) congeners and five organochlorine compounds. We assessed child behavioral problems at 12 and 24 months using the infant toddler symptom checklist (ITSC). Higher score in ITSC corresponds to more behavioral problems. First we performed principal component analysis (PCA). Then two variable selection methods, elastic net (ENET) and Bayesian model averaging (BMA), were applied to select any toxicants associated with behavioral problems. Finally, the effect size of the selected toxicants was estimated using multivariate linear regression analyses.

RESULTS

p,p'-DDT was associated with behavioral problems at 12 months in all the applied models. Specifically, the principal component composed of organochlorine pesticides was significantly associated with behavioral problems and both ENET and BMA identified p,p'-DDT as associated with behavioral problems. Using a multiple linear regression model an interquartile increase in p,p'-DDT was associated with a 0.62 unit increase in ITSC score (95% CI 0.45, 0.79) at 12 months, corresponding to more behavioral problems. The association was modified by maternal education: the effect of p,p'-DDT was strongest in women with lower education (β=0.59; 95%CI: 0.38, 0.81) compared to the mother with higher education (β=0.14; 95%CI: -0.05, 0.34) (p-value for interaction=0.089). At 24 months, neither selection method consistently identified any toxicant associated with behavioral problems.

CONCLUSION

Within a mixture of 24 toxicants measured in breast milk, p,p'-DDT was the single toxicant associated with behavioral problems at 12 months using different methods for handling numerous correlated exposures.

Diet, growth, and obesity development throughout childhood in the Avon Longitudinal Study of Parents and Children

Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7-11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood.

Dietary patterns in the Avon Longitudinal Study of Parents and Children

Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The "health-conscious" and "traditional" patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the "processed" patterns. There was evidence of tracking in childhood diet, with the "health-conscious" patterns tracking most strongly, followed by the "processed" pattern. An "energy-dense, low-fiber, high-fat" dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology.

A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Does Breastfeeding Protect Against Childhood Obesity? Moving Beyond Observational Evidence

Human milk is the optimal feeding choice for infants, as it dynamically provides the nutrients, immunity support, and other bioactive factors needed for infants at specific stages during development. Observational studies and several meta-analyses have suggested that breastfeeding is protective against development of obesity in childhood and beyond. However, these findings are not without significant controversy. This review includes an overview of observational findings to date, then focuses on three specific pathways that connect human milk and infant physiology: maternal obesity, microbiome development in the infant, and the development of taste preference and diet quality. Each of these pathways involves complex interactions between mother and infant, includes both biologic and non-biologic factors, and may have both direct and indirect effects on obesity risk in the offspring. This type of integrated approach to examining breastfeeding and childhood obesity is necessary to advance research in this area beyond observational findings.

Obesogenic dietary intake in families with 1-year-old infants at high and low obesity risk based on parental weight status: baseline data from a longitudinal intervention (Early STOPP)

Purpose

To compare dietary intake in 1-year-old infants and their parents between families with high and low obesity risk, and to explore associations between infant dietary intake and relative weight.

Methods

Baseline analyses of 1-year-old infants (n = 193) and their parents participating in a longitudinal obesity intervention (Early STOPP) were carried out. Dietary intake and diet quality indicators were compared between high- and low-risk families, where obesity risk was based on parental weight status. The odds for high diet quality in relation to parental diet quality were determined. Associations between measured infant relative weight and dietary intake were examined adjusting for obesity risk, socio-demographics, and infant feeding.

Results

Infant dietary intake did not differ between high- and low-risk families. The parents in high-risk families consumed soft drinks, French fries, and low-fat spread more frequently, and fish and fruits less frequently (p < 0.05) compared to parents in low-risk families. Paternal intake of vegetables and fish increased the odds for children being consumers of vegetables (OR 1.7; 95 % CI 1.0–2.9) and fish, respectively (OR 2.5; 95 % CI 1.4–4.4). Infant relative weight was weakly associated with a high intake of milk cereal drink (r = 0.15; p < 0.05), but not with any other aspect of dietary intake, obesity risk, or early feeding patterns.

Conclusions

At the age of one, dietary intake in infants is not associated with family obesity risk, nor with parental obesogenic food intake. Milk cereal drink consumption but no other infant dietary marker reflects relative weight at this young age.