The neighborhood food environment modifies the association between infant feeding and childhood obesity

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) issues infant formula to infants who are not fully breastfed, and prior research found elevated obesity risk among children receiving lactose-reduced infant formula with corn syrup solids (CSSF) issued by WIC. This study was conducted to evaluate associations between a broader set of specialty infant formulas issued by WIC and child obesity risk, whether neighborhood context (e.g. neighborhood food environment) modifies associations, and whether racial/ethnic disparities in obesity are partly explained by infant formula exposure and neighborhood context.

METHODS

WIC administrative data, collected from 2013-2020 on issued amount (categorical: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and type of infant formula (standard cow's milk formula, and three specialty formulas: any CSSF, any soy-based formula, and any cow's milk-based formula with added rice starch) and obesity at ages 2-4 years (defined as a Body Mass Index z-score ≥ 95th percentile according to World Health Organization growth standard) were used to construct a cohort (n = 59,132). Associations of infant formula exposures and race/ethnicity with obesity risk were assessed in Poisson regression models, and modification of infant feeding associations with obesity by neighborhood context was assessed with interaction terms.

RESULTS

Any infant formula exposure was associated with significantly higher obesity risk relative to fully breastfeeding. Receipt of a CSSF was associated with 5% higher obesity risk relative to the standard and other specialty infant formulas (risk ratio 1.05, 95% confidence interval 1.02, 1.08) independent of breastfeeding duration and receipt of other specialty infant formulas. The association between CSSF and obesity risk was stronger in neighborhoods with healthier food environments (10% higher risk) compared to less healthy food environments (null). Racial/ethnic disparities in obesity risk were robust to adjustment for infant formula exposure and neighborhood environment.

CONCLUSIONS

Among specialty infant formulas issued by WIC, only CSSFs were associated with elevated obesity risk, and this association was stronger in healthier food environments. Future research is needed to isolate the mechanism underlying this association.

Third stage of the kangaroo method: exclusive breastfeeding and growth of preterm and/or low birth weight newborns

OBJECTIVE

To evaluate the rates of exclusive breastfeeding (EBF) and growth of preterm and/or low birth weight newborns during the third stage of the Kangaroo Method (TSKM), at discharge.

METHODS

Retrospective study in a reference public maternity hospital between Jan/2014 and Dec/2017, including the preterm (less than 37 weeks) and/or low birth weight (less than 2500 g) newborn infants. Information was collected from medical records. Statistics analysis was done in SPSS software.

RESULTS

482 infants were included and followed up at the TSKM ambulatory. The average gestational age was 33 weeks (variation: 24-39 weeks) and birth weight, 1715g (variation: 455-2830 g). EBF occurred in 336 (70.1%) infants at hospital discharge, and in 291 (60.4%) at TSKM discharge. Each additional day of hospital stay increased the chance of infant formula (IF) use by 9.3% at hospital discharge and by 10.3% at TSKM discharge. Staying in the Kangaroo Neonatal Intermediate Care Unit (KNICU) favored EBF at hospital discharge and TSKM discharge (p<0.001). Not performing the kangaroo position increased the chance formula administration to the newborn infant at hospital discharge by 11%. Weight gain and head circumference growth were higher in infants using formula (p<0.001).

CONCLUSIONS

The length of hospital stay and not performing the kangaroo position favored the use of infant formula at hospital and TSKM discharge. Staying in the KNICU favored exclusive breastfeeding at hospital and TSKM discharge. Weight gain and HC growth were higher in newborns receiving infant formula.

Type of Milk Feeding and Introduction to Complementary Foods in Relation to Infant Sleep: A Systematic Review

Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. This study aimed to systematically review the existing literature on infant sleep and its relation to the timing of introduction to complementary foods and type of milk feeding to better understand their role(s) in infant sleep. Cohort, longitudinal, cross-sectional studies, and controlled trials were identified using online searches of five databases up to April 2020. Twenty-one articles with a total of 6225 infants under 12 months-of-age were eligible. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies (67%) reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies (>65%) reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (<12 months-of-age). Future studies using standardized methodologies and definitions, transdisciplinary expertise, and longitudinal design are required to better understand the complex role of feeding on sleep.

Latin American Considerations for Infant and Young Child Formulae

Infant formula is the only acceptable substitute for breastmilk from 0 to 6 months old when human milk cannot be provided in sufficient amounts. Manufacturers have developed options that intend to meet the changing needs of the child aged from six to twelve months (follow-on formulae) and after the age of one year (young child formulae). The international code for marketing breast milk substitute stipulates standards for marketing practices of these products. In Latin America there are local variations of marketing practices. Novel marketing strategies such as advertising through social media and influencers pose new threats for breastfeeding success in Latin America. This review aims to examine variations in local regulations for marketing of infant formulae and to analyze the emerging phenomenon of influencer advertising. We reviewed the local norms for Latin American countries and examined differences and possible gaps. Emerging evidence of influencer marketing was explored. The results indicate that national regulations differ among Latin American countries, particularly with respect to product labelling and the requirement to use a local native language, highlighting the cost of the product, and different regulations prohibiting certain messages and illustrations. Regarding new marketing strategies, there is limited evidence on advertising infant formula through social media influencers, where different categories of marketing strategies can be described. More transparent reporting of social marketing by formula providers and more independent research on novel marketing strategies are needed.

Rates and time trends in the consumption of breastmilk, formula, and animal milk by children younger than 2 years from 2000 to 2019: analysis of 113 countries

BACKGROUND

Previous analyses of trends in feeding indicators of children younger than 2 years have been limited to low-income and middle-income countries. We aimed to assess time trends in the consumption of different types of milk (breastmilk, formula, and animal milk) by children younger than 2 years from 2000 to 2019 at a global level.

METHODS

In this time-series analysis, we combined cross-sectional data from 487 nationally representative surveys from low-income and middle-income countries and information from high-income countries to estimate seven infant and young child feeding indicators in up to 113 countries. Multilevel linear models were used in pooled analyses to estimate annual changes in feeding practices from 2000 to 2019 for country income groups and world regions.

FINDINGS

For the absolute average annual changes, we found significant gains in any breastfeeding at age 6 months in high-income countries (1·29 percentage points [PPs] per year [95% CI 1·12 to 1·45]; p<0·0001) and at age 1 year in high-income countries (1·14 PPs per year [0·99 to 1·28]; p<0·0001) and upper-middle-income countries (0·53 PPs per year [0·23 to 0·82]; p<0·0001). We also found a small reduction in low-income countries for any breastfeeding at age 6 months (-0·07 PPs per year [-0·11 to -0·03]; p<0·0001) and age 1 year (-0·13 PPs per year [-0·18 to -0·09]; p<0·0001). Data on exclusive breastfeeding and consumption of formula and animal milk were only available for low-income and middle-income countries, where exclusive breastfeeding in the first 6 months of life increased by 0·70 PPs per year (0·51-0·88; p<0·0001) to reach 48·6% (41·9-55·2) in 2019. Exclusive breastfeeding increased in all world regions except for the Middle East and north Africa. Formula consumption in the first 6 months of life increased in upper-middle-income countries and in east Asia and the Pacific, Latin America and the Caribbean, the Middle East and north Africa, and eastern Europe and central Asia, whereas the rates remained below 8% in sub-Saharan Africa and south Asia. Animal milk consumption by children younger than 6 months decreased significantly (-0·41 PPs per year [-0·51 to -0·31]; p<0·0001) in low-income and middle-income countries.

INTERPRETATION

We found some increases in exclusive and any breastfeeding at age 6 months in various regions and income groups, while formula consumption increased in upper-middle-income countries. To achieve the global target of 70% exclusive breastfeeding by 2030, however, rates of improvement will need to be accelerated.

FUNDING

Bill & Melinda Gates Foundation, through WHO.

Gestational Diabetes Is Uniquely Associated With Altered Early Seeding of the Infant Gut Microbiota

Gestational diabetes mellitus (GDM) is a worldwide public health problem affecting up to 27% of pregnancies with high predictive values for childhood obesity and inflammatory diseases. Compromised seeding of the infant gut microbiota is a risk factor for immunologic and metabolic diseases in the offspring; however, how GDM along with maternal obesity interact to alter colonization remains unknown. We hypothesized that GDM individually and in combination with maternal overweight/obesity would alter gut microbial composition, diversity, and short-chain fatty acid (SCFA) levels in neonates. We investigated 46 full-term neonates born to normal-weight or overweight/obese mothers with and without GDM, accounting for confounders including cesarean delivery, lack of breastfeeding, and exposure to antibiotics. Gut microbiota in 2-week-old neonates born to mothers with GDM exhibited differences in abundance of 26 microbial taxa; 14 of which showed persistent differential abundance after adjusting for pre-pregnancy BMI. Key pioneering gut taxa, including potentially important taxa for establishing neonatal immunity, were reduced. Lactobacillus, Flavonifractor, Erysipelotrichaceae, and unspecified families in Gammaproteobacteria were significantly reduced in neonates from mothers with GDM. GDM was associated with an increase in microbes involved in suppressing early immune cell function (Phascolarctobacterium). No differences in infant stool SCFA levels by maternal phenotype were noted; however, significant correlations were found between microbial abundances and SCFA levels in neonates. Our results suggest that GDM alone and together with maternal overweight/obesity uniquely influences seeding of specific infant microbiota in patterns that set the stage for future risk of inflammatory and metabolic disease.

Patterns and predictors of exclusive breastfeeding in Chinese Australian mothers: a cross sectional study

BACKGROUND

While exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers.

METHODS

Chinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression.

RESULTS

Almost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months.

CONCLUSIONS

While Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study

OBJECTIVE

The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids.

METHODS

Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks.

RESULTS

The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66).

CONCLUSIONS

Women who are younger, single mothers, those not working by the time of child's first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.

Trends in Food Consumption Patterns of US Infants and Toddlers from Feeding Infants and Toddlers Studies (FITS) in 2002, 2008, 2016

The Feeding Infants and Toddlers Study (FITS) is the largest survey of dietary intake among infants and young children in the United States. Dietary patterns in early childhood are a key component of prevention of diet-related chronic diseases, yet little is known about how food consumption patterns of infants and young children have changed over time. The objective of this study is to examine trends in food and beverage consumption among children ages 6–23.9 months using data from the FITS conducted in 2002, 2008, and 2016. A total of 5963 infants and young children ages 6–23.9 months were included in these analyses. Food consumption data were collected using a multiple-pass 24-h recall by telephone using the Nutrition Data System for Research. Linear trends were assessed using the Wald’s test in a multivariable linear regression model. Positive significant findings include increases in breast milk consumption and decreases in the consumption of sweets, sugar-sweetened beverages, and 100% fruit juice. More troubling findings include decreasing infant cereal consumption, stagnant or decreasing whole grain consumption, and stagnant consumption of vegetables. Our findings suggest some promising improvements in dietary intake among infants and toddlers in the United States over the past 15 years, but further policy, programmatic, and industry efforts are still needed.

Formula-feeding practice and associated factors among urban and rural mothers with infants 0-6 months of age: a comparative study in Jimma zone Western Ethiopia

BACKGROUND

Infants are in a state of rapid development and maturation; the growth rate is most rapid during the first 4 to 6 months of life. Few studies indicated that in developing countries including Ethiopia the prevalence and duration of breastfeeding is declining and being replaced by formula milk. Therefore, this study aimed to assess the formula-feeding practice and its associated factors among urban and rural mothers with infants 0-6 months of age in the Jimma Zone, Western Ethiopia.

METHODS

A community-based cross-sectional study was conducted from November 7, 2015, to January 10, 2016, in the Jimma Zone. The quantitative data were collected from a sample of 714 respondents using a multistage sampling technique. Data were collected through a structured questionnaire and the multivariate logistic regression model was used to show predictors of the formula-feeding practice among mothers with infants 0-6 months of age.

RESULT

The proportion of mothers who feed their baby formula-based was 47.2%, of which 34.5% were living in rural areas and 65.5% were living in urban areas. Among the mothers living in urban areas, the likelihood of formula-feeding was significantly associated with maternal educational status and attitude towards formula-feeding. On the other hand, being attended by relatives/friends and the traditional birth attendant was significantly associated with the formula-feeding practice among mothers who live in rural areas.

CONCLUSION

Nearly half of the mothers in the study area practice formula-feeding for their infant. Therefore, sustained community based nutritional health education is recommended for pregnant and lactating mothers to reduce the practice of formula-feeding for infants.

Dental Caries Status and its Associated Factors among 3- to 5-year-old Children in China: A National Survey

OBJECTIVE

To investigate the prevalence and severity of dental caries among pre-school children in China as part of the 4th National Oral Health Survey.

METHODS

The sampling process was conducted with a multistage stratified cluster method. A total of 40,360 children aged between 3 and 5 years were recruited for this study. Each participant was clinically assessed according to the 5th edition of the oral health survey's basic methods recommended by the World Health Organization (WHO) and their parents or grandparents completed a questionnaire at a face-to-face interview. The status of dental caries was shown in the form of the mean dmft and the prevalence of dental caries. The logistic regression analysis was performed to study the relationships between the prevalence of dental caries and the selected variables.

RESULTS

The prevalence of dental caries was 50.8%, 63.6% and 71.9% for 3-, 4- and 5-year-olds, respectively. The mean dmft was 2.28, 3.40 and 4.24, respectively. Logistic regression analysis showed that children who were mixed-fed had a higher chance of staying free of dental caries; children who had dessert before going to bed were associated with a higher probability of caries.

CONCLUSION

The status of dental caries among preschool children in China is on the increase. The preschoolers' dental caries status related to their breastfeeding conditions within the first 6 months of life and their snacking habits.

In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus

OBJECTIVE

To ascertain the rate of in-hospital supplementation as it relates to early breastfeeding (BF) and early formula feeding (FF) and its effects on BF (exclusive and partial) at the time of discharge for infants born to women with pregestational diabetes mellitus (PGDM).

METHODS

Retrospective cohort investigation of 282 women with PGDM who intended to BF and their asymptomatic infants admitted to the newborn nursery for blood glucose monitoring and routine care. Early feeding was defined by the initial feeding if given within four hours of birth.

RESULTS

Of the 282 mother-infant dyads, for 134 (48%) early feeding was BF and for 148 (52%) early feeding was FF. Times from birth to BF and FF (median 1 hr, 0.3-6) were similar, while the time to first BF for those who FF and supplemented was longer (median 6 hr., 1-24). Ninety-seven infants (72%) who first BF also supplemented. Of these, 22 (23%) BF exclusively, 67 (69%) BF partially and 8 (8%) FF at discharge. One hundred seventeen (79%) who first FF also supplemented. Of these, 21 (18%) BF exclusively, 76 (65%) BF partially and 20 (17%) FF at discharge.

CONCLUSION

Regardless of the type of first feeding, the majority of infants born to women with PGDM require supplementation. Even when medically indicated, in-hospital supplementation is an obstacle, albeit not absolute, to exclusive BF at discharge. Parents should be reminded that occasional supplementation should not deter resumption and continuation of BF.

Do Infant Formula Giveaways Undermine or Support Women's Choices?

Eliminating formula giveaways ("banning the bag") has been embraced as a way to reduce the influence of formula marketing in hospitals and to increase breastfeeding rates among new mothers, but the policy raises ethical concerns in the mind of some, notably because it denies a useful benefit to mothers who have trouble affording formula. Hospital policies to promote breastfeeding, including banning the bag, should be sensitive to the economic and other costs associated with breastfeeding and should be consciously designed to make breastfeeding easier and not just to make formula feeding more difficult. We recommend that hospitals evaluate the negative impacts of banning the bag on their patient population in order to ensure that families are not being negatively affected.

Milk feeding and first complementary foods during the first year of life in the TEDDY study

The aim was to describe milk feeding patterns and first weaning foods during the first year of life in a large prospective birth cohort of infants with increased genetic risk for Type 1 diabetes (T1D) recruited in 4 different countries: the United States, Finland, Germany, and Sweden. All enrolled children with dietary information (n = 8,673) were included in the analyses; 1,307 (15%) children who dropped out before the first birthday were excluded from some analyses. Supplementary milk feeding in the first 3 days of life was common in all the four countries, although the type of the supplementary milk differed by country and by maternal T1D. Donated human milk was commonly used only in Finland. In all the countries, the most common first supplementary food was cow's milk-based infant formula, especially among offspring of mothers with T1D. The use of specific types of infant formulas differed notably by country: Extensively hydrolysed formulas were most used in Finland, partially hydrolysed ones in the United States and in Germany, and soy formulas only in the United States. Infant formulas commonly included probiotics, prebiotics, and starches. During the first year of life, most of the infants received conventional cow's milk. Overall, milk feeding during the first 3 days of life and thereafter until the first birthday differed markedly by maternal T1D status and across countries. These descriptive data may be useful in understanding early infant feeding practices and in planning potential interventions, which affect infant feeding.

Outcomes Associated With Type of Milk Supplementation Among Late Preterm Infants

OBJECTIVE

To assess whether type of milk supplementation provided to breastfeeding late preterm infants was associated with hospital length of stay (LOS) or breastfeeding status at discharge.

DESIGN

Retrospective chart review.

SETTING

Tertiary care teaching hospital in the southern United States.

PARTICIPANTS

Late preterm infants 35 0/7 to 36 6/7 weeks gestational age (N = 183) admitted to the mother-baby unit between November 1, 2014, and October 31, 2016.

METHODS

The exposure of interest was type of milk supplementation, for example, expressed human milk, pasteurized donor human milk, and formula. Outcomes measured were LOS and breastfeeding status at discharge. Generalized Poisson regression models were used to compare LOS by type of milk supplementation. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals for associations with breastfeeding status at discharge.

RESULTS

The LOS for breastfed infants supplemented with expressed human milk and/or pasteurized donor human milk did not differ significantly from exclusively breastfed infants who received no supplement. Exclusively formula-fed infants had longer LOS of 3.2 days compared with 2.6 days for exclusively breastfed infants (p = .001). Breastfed infants who received any formula supplementation were 16% less likely to continue breastfeeding until day of discharge compared with breastfed infants who received human milk supplementation (risk ratio = .84, 95% confidence interval [.77, .92]).

CONCLUSION

The high prevalence of supplementation among breastfeeding late preterm infants underscores the potential effect of type of milk supplementation on LOS and breastfeeding outcomes. Our findings suggest that human milk supplementation discourages transition to formula feeding before hospital discharge without increasing LOS.

Early Breastfeeding Cessation Among HIV-Infected and HIV-Uninfected Women in Western Cape Province, South Africa

As part of the Mother-Infant Health Study, we describe infant feeding practices among HIV-infected and HIV-uninfected mothers over a 12-month period when the Western Cape Province prevention of mother-to-child transmission (PMTCT) program was transitioning from a policy of exclusive formula feeding to one of exclusive breastfeeding. Two hundred pairs of mother and HIV-uninfected infant were included in the analysis, among whom 81 women were HIV uninfected and breastfeeding. Of the 119 HIV-infected mothers, 50 (42%) were breastfeeding and 69 (58%) were formula feeding. HIV-infected mothers predominantly breastfed for 8.14 (7.71-15.86) weeks; HIV-uninfected mothers predominantly breastfed for 8.29 (8.0-16.0) weeks; and HIV-infected mothers predominantly formula fed for 50.29 (36.43-51.43) weeks. A woman's HIV status had no influence on the time to stopping predominant breastfeeding (P = 0.20). Our findings suggest suboptimal duration of breastfeeding among both HIV-infected and HIV-uninfected mothers. Providing support for all mothers postdelivery, regardless of their HIV status, may improve breastfeeding practices.

Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: a pilot study

BACKGROUND

The rising prevalence of childhood obesity in Asia has led to interest in potential risk factors such as infant health-related quality of life (HRQoL), temperament and eating behaviors. This pilot study evaluated the utility of administering parent-reported outcome measures (PROMs) to explore these factors in Filipino infants and examined the relationships between these factors and infant sex, formula intake and weight, over time.

METHODS

Forty healthy, 4-week-old, formula-fed infants (n = 20 males) were enrolled in this 6-week, prospective, uncontrolled study during which infants were exclusively fed a standard term infant formula enriched with alpha-lactalbumin. On Day-1 and 42, anthropometrics were measured and mothers completed a 97-item measure of HRQoL [Infant Toddler Quality of Life Questionnaire (ITQOL)] covering 6 infant-focused and 3 parent-focused concepts and a 24-item measure of infant temperament [Infant Characteristics Questionnaire (ICQ)]. At Day-42, mothers also completed an 18-item measure of infant appetite [Baby Eating Behaviour Questionnaire (BEBQ)]. A 3-day formula intake diary was completed before Day-42. Nonparametric statistics were used to evaluate correlations among outcomes and compare outcomes by visit and sex.

RESULTS

Thirty-nine infants completed the study; similar results were observed in males and females. Completion of PROMs was 100% with no missing responses, but Cronbach's α was low for many concept scales scores. ITQOL scores [range 0 (worst)-100 (best)] were generally high (median ≥ 80) except for Day-1 and Day-42 Temperament and Mood and Day-1 General Health Perceptions scores. ITQOL but not ICQ temperament scores improved significantly between Day-1 and Day-42 (P < 0.01). Mean ± standard deviation BEBQ scores (range 1-5) were high for Enjoyment of Food (4.59 ± 0.60) and Food Responsiveness (3.53 ± 0.81), and low for Satiety Responsiveness (2.50 ± 0.73) and Slowness in Eating (1.71 ± 0.60). Better HRQoL scores were significantly (P < 0.05) associated with high General Appetite scores (3 ITQOL concepts, r = 0.32 to 0.54), greater Enjoyment of Food (4 ITQOL concepts, r = 0.35 to 0.42) and low levels of Slowness in Eating (7 ITQOL concepts, r = - 0.32 to - 0.47).

CONCLUSION

Findings demonstrated the utility of the ITQOL, ICQ and BEBQ for measuring HRQoL, temperament and eating behavior, and the need for further adaptations for use in Filipino infants.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02431377; Registered May 1, 2015.

Iron deficiency, its epidemiological features and feeding practices among infants aged 12 months in Qatar: a cross-sectional study

OBJECTIVES

To estimate the magnitude of anaemia, iron deficiency (ID), iron deficiency anaemia (IDA) and to explore epidemiological features of ID and feeding practices among infants aged 12 months in Qatar.

SETTING

Well baby clinics in 14 randomly selected primary healthcare centres covering all geographical areas on the national level.

PARTICIPANTS

Three hundred and six (163 male and 143 female) infants of all nationalities were enrolled. Mothers were asked to complete a predesigned interview questionnaire and infants were blood tested for anaemia, ID and IDA.

OUTCOME MEASURES

Cut-off point used to diagnose anaemia was haemoglobin <11.1 g/dL, and to diagnose ID, serum ferritin <6 ug/L with normal C reactive protein.

RESULTS

Prevalence of anaemia was 23.5%, ID was 9.2% and IDA was 7.8%. ID was more prevalent among non-Qatari infants compared with Qatari (10.9% vs1.7%, p=0.029), more prevalent among infants born to housewives and to families of low income (p≤0.05). With regard to feeding practice, ID was higher in infants who continued breastfeeding until the age of 1 year and among those who never took infant formula milk (p≤0.05). Mothers who received infant feeding counselling had less ID occurrence among their infants compared with their counterparts who did not receive such counselling (4.2%vs13.4%, p=0.005).

CONCLUSION

Although ID and IDA among infants in Qatar are less prevalent compared with many developing countries, still further efforts are needed for improvement towards more developed countries. Efforts should be contextualised and should target the key epidemiological features with special emphasis on infant feeding and infant feeding counselling to mothers.

Personalized weight change prediction in the first week of life

BACKGROUND & AIMS

Almost all neonates show physiological weight loss and consecutive weight gain after birth. The resulting weight change profiles are highly variable as they depend on multiple neonatal and maternal factors. This limits the value of weight nomograms for the early identification of neonates at risk for excessive weight loss and related morbidities. The objective of this study was to characterize weight changes and the effect of supplemental feeding in late preterm and term neonates during the first week of life, to identify and quantify neonatal and maternal influencing factors, and to provide an educational online prediction tool.

METHODS

Longitudinal weight data from 3638 healthy term and late preterm neonates were prospectively recorded up to 7 days of life. Two-thirds (n = 2425) were randomized to develop a semi-mechanistic model characterizing weight change as a balance between time-dependent rates of weight gain and weight loss. The dose-dependent effect of supplemental feeding on weight gain was characterized. A population analysis applying nonlinear mixed-effects modeling was performed using NONMEM 7.3. The model was evaluated on the remaining third of neonates (n = 1213).

RESULTS

Key population characteristics (median [range]) of the whole sample were gestational age 39.9 [34.4-42.4] weeks, birth weight 3400 [1980-5580] g, maternal age 32 [15-51] years, cesarean section 26%, and girls 50%. The model demonstrated good predictive performance (bias 0.01%, precision 0.56%), and is able to accurately predict individual weight change (bias 0.15%, precision 1.43%) and the dose-dependent effects of supplemental feeding up to 1 week after birth based on weight measurements during the first 3 days of life, including birth weight, and the following characteristics: gestational age, gender, delivery mode, type of feeding, maternal age, and parity.

CONCLUSIONS

We present the first mathematical model not only to describe weight change in term and late preterm neonates but also to provide an educational online tool for personalized weight prediction in the first week of life.

Baby-Friendly Practices Minimize Newborn Infants Weight Loss

INTRODUCTION

It is accepted that newborns lose weight in the first few days of life. Baby-Friendly practices that support breastfeeding may affect newborn weight loss. The objective of this study were: 1) To determine whether Baby-Friendly practices are associated with term newborn weight loss day 0-2 in three feeding categories (exclusively breastfed, mixed formula fed and breastfed, and formula fed). 2) To determine whether Baby-Friendly practices increase exclusive breast feeding rates in different ethnic populations.

MATERIALS AND METHODS

This was a retrospective case-control study. Term newborn birth weight, neonatal weights days 0-2, feeding type, type of birth, and demographic information were collected for 1,000 births for the year before Baby-Friendly designation (2010) and 1,000 in 2013 (after designation). Ultimately 683 in the first group and 518 in the second met the inclusion criteria.

RESULTS

Mean weight loss decreased day 0-2 for infants in all feeding types after the initiation of Baby-Friendly practices. There was a statistically significant effect of Baby-Friendly designation on weight loss for day 0-2 in exclusively breastfed infants (p < 0.01) after controlling for birth weight. Exclusive breast feeding increased in all ethnic groups after Baby-Friendly practices were put in place.

CONCLUSION

There was a decrease in mean weight loss day 0-2 regardless of feeding type after Baby-Friendly designation. Exclusive breast feeding increased in the presence of Baby-Friendly practices.

Food Sources of Energy and Macronutrient Intakes among Infants from 6 to 12 Months of Age: The Growing Up in Singapore Towards Healthy Outcomes (GUSTO) Study

Adequate nutrition during complementary feeding is important for the growth, development and well-being of children. We aim to examine the energy and macronutrient intake composition and their main food sources in a mother-offspring cohort study in Singapore. The diets of infants were assessed by 24 h dietary recalls or food diaries collected from mothers when their offspring were 6 (n = 760), 9 (n = 893) and 12 (n = 907) months of age. Food sources of energy and macronutrients were determined using the population proportion methodology. Energy intakes per day (kcal; mean (standard deviation, SD)) of these infants were 640 (158) at 6 months, 675 (173) at 9 months, and 761 (208) at 12 months. Infant formula, breastmilk and infant cereals were the top three food sources of energy and macronutrient intakes in infants through the period 6 to 12 months. Other main energy and carbohydrate sources at 9 and 12 months of age were rice porridge, infant biscuits and fresh fruits, while fish, red meat and eggs were the other main protein and total fat sources. Breast-fed and mixed-fed infants had a more varied diet as compared to formula-fed infants. Formula-fed infants had consistently higher protein and lower total fat consumption compared to those who were breastfed. An understanding of these main food sources during complementary feeding can inform local dietary recommendations and policies.

Factors affecting breastfeeding adherence among Chinese mothers: A multicenter study

Breastfeeding is beneficial for both infant and mother, but discontinuation of breastfeeding is very common.To investigate maternal breastfeeding intention and the rate of breastfeeding based on the theory of reasoned action, and analyze the predominant factors associated with breastfeeding and breastfeeding problems.This observational study was conducted in 3 hospitals. Three researchers recruited women at 3 time points in the hospitals: initial documentation of pregnancy at the outpatient department, prenatal admission, and postpartum discharge. SPSS version 21 was used for statistical analyses. Significance was set at P < .05. In the multivariate analysis, binary logistic regression was used and odds ratios (ORs) with 95% confidence intervals (CI) were calculated.We recruited 1260 women, with 420 pregnant women at each time point. 55.1% of the infants were exclusively breastfed, 40.6% were mixed fed, and 4.3% were formula fed when discharged from hospital. A total of 53.8% of the mothers declared having breastfeeding problems. The multivariate analysis showed that nonsuccessful breastfeeding was associated with neonatal birth length, food intake before breastfeeding, infrequent sucking, the intention of breastfeeding, understanding level of the benefits of breastfeeding and that breastfeeding problems were related with the understanding level of the benefits of breastfeeding, neonatal birth length, normal vaginal delivery, breast size, the experience of breastfeeding, use of pacifier and the needs of family member's support in breastfeeding.Most mothers who intended to practice exclusive breastfeeding initially chose to add formula and had breastfeeding problems when discharged from hospital. Successful breastfeeding depends on antenatal and postnatal breastfeeding education and on support provided by healthcare professionals.

Breastfeeding initiation for Aboriginal and Torres Strait Islander women in Victoria: analysis of routinely collected population-based data

BACKGROUND

Increasing breastfeeding rates is one way of improving the short and long term health of Aboriginal and Torres Strait Islander children (hereafter referred to as Aboriginal). Despite the benefits of breastfeeding and recommendations for strategies to increase breastfeeding among Aboriginal people, there is a lack of available population data.

AIM

To use population-based data from Victoria, Australia to compare breastfeeding initiation for Aboriginal and non-Aboriginal women and to explore factors associated with breastfeeding initiation of Aboriginal women.

METHODS

Routinely collected infant feeding data obtained from the Victorian Perinatal Data Collection (VPDC) was used. The VPDC is a mandatory, population-based system where maternal and infant data on all Victorian births are collected.

FINDINGS

Compared with non-Aboriginal women, Aboriginal women were less likely to attempt to breastfeed their baby (87.2% vs 95.3%; p<0.001); more likely to give formula in hospital (39.6% vs 30.6%; p<0.001) and less likely to give the last feed prior to discharge exclusively from the breast (64.4% vs 75.0% p<0.001). For Aboriginal women, factors associated with not initiating breastfeeding were being single, multiparous, smoking and length of stay. Infant factors were gestation less than 37 weeks and low birthweight (<2,500g).

CONCLUSION

In Victoria, breastfeeding initiation is lower for Aboriginal women compared with non-Aboriginal women. Further research is needed to explore the effectiveness of interventions that may increase breastfeeding for Aboriginal women.

Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services

Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding.

The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-being Among Mothers of Late Preterm and Term Infants: A Secondary, Exploratory Analysis

BACKGROUND

Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth.

PURPOSE

The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being.

METHODS

Participants were 105 mother-infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012.

RESULTS

Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point.

IMPLICATIONS FOR PRACTICE

Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs.

IMPLICATIONS FOR RESEARCH

Prospective research is critical to document women's intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

Use of extensively hydrolysed formula for refeeding neonates postnecrotising enterocolitis: a nationwide survey-based, cross-sectional study

OBJECTIVE

To evaluate the prevalence of and reasons for using extensively hydrolysed formulas (EHFs) of cow's milk proteins in the French neonatal units as well as the modality of their prescription for refeeding infants recovering from necrotising enterocolitis (NEC).

METHODS

A multicentre nationwide cross-sectional study using a questionnaire to address the prevalence of use and the reasons for prescribing EHF in hospitalised neonates and to examine the protocols and the actual reasons for their use for refeeding infants in recovery from NEC. The questionnaire was sent to only 1 senior neonatologist in each neonatal unit included in the study.

RESULTS

More than half of the French neonatal units participated in the survey. 91% of the surveyed units used EHF. Of 1969 infants hospitalised on the day the survey was run, 12% were fed on an EHF. 11% of the EHF prescriptions were due to previous NEC. The main reasons for using an EHF to feed infants post-NEC were the absence of human milk (75%) and surgical management of NEC (17%). When given, EHF was mainly prescribed for a period varying between 15 days and 3 months. None of the involved units continued using the EHF after 6 months of age. More than half of the surveyed units acknowledged hospitalising infants for the initiation of weaning EHF but only 21% of them tested these infants for cow's milk allergy.

CONCLUSIONS

The prevalence of EHF use in the French neonatal units is high. Refeeding infants post-NEC is one of the main reasons for such a high prevalence. The main incentive for using an EHF is the absence of human breast milk, either maternal or donor.

Age at Introduction to Solid Foods and Child Obesity at 6 Years

BACKGROUND

Epidemiological evidence suggests that timing of introduction of solid foods may be associated with subsequent obesity, and the association may vary by whether an infant is breastfed or formula-fed.

METHODS

We included 1181 infants who participated in the Infant Feeding Practices Study II (IFPS II) and the Year 6 Follow Up (Y6FU) study. Data from IFPS II were used to calculate the primary exposure and timing of solid food introduction (<4, 4-<6, and ≥6 months), and data from Y6FU were used to calculate the primary outcome and obesity at 6 years of age (BMI ≥95th percentile). We used multivariable logistic regression to assess the association between timing of the introduction of solids and obesity at 6 years and test whether this association was modified by breastfeeding duration (breastfed for 4 months vs. not).

RESULTS

Prevalence of obesity in our sample was 12.0%. The odds of obesity was higher among infants introduced to solids <4 months compared to those introduced at 4-<6 months (odds ratio [OR] = 1.66; 95% CI, 1.15, 2.40) in unadjusted analysis; however, this relationship was no longer significant after adjustment for covariates (OR = 1.18; 95% CI, 0.79, 1.77). Introduction of solids ≥6 months was not associated with obesity. We found no interaction between breastfeeding duration and early solid food introduction and subsequent obesity.

CONCLUSIONS

Timing of introduction of solid foods was not associated with child obesity at 6 years in this sample. Given the inconsistency in findings with other studies, further studies in larger populations may be needed.

Soy-Based Infant Formula Feeding and Ultrasound-Detected Uterine Fibroids among Young African-American Women with No Prior Clinical Diagnosis of Fibroids

BACKGROUND

Early-life soy phytoestrogen exposure has been shown in Eker rats to increase uterine fibroid incidence in adulthood. Two large epidemiologic cohorts have provided some support for increased fibroid risk with infant soy formula feeding in women, but both cohorts relied on self-report of clinically diagnosed fibroids.

OBJECTIVE

We evaluated the relationship between infant soy formula feeding and ultrasound-detected fibroids.

METHODS

The Study of Environment, Lifestyle & Fibroids (SELF) is an ongoing cohort study of 1,696 African-American women ages 23-34 years with baseline ultrasound screening to detect and measure fibroids ≥ 0.5 cm in diameter. Questionnaire data on soy formula feeding during infancy was ascertained for 1,553 participants (89% based on mother's report), of whom 345 were found to have fibroids. We estimated the association between soy formula feeding and fibroid prevalence and tumor number using log-binomial regression. Among those with fibroids, we compared fibroid size between soy formula-exposed and unexposed women using multivariable linear regression.

RESULTS

We did not observe an association between soy formula feeding and fibroid prevalence [adjusted prevalence ratio (aPR) 0.9, 95% CI: 0.7, 1.3]. Nor were exposed women with fibroids more likely to have ≥ 2 tumors than unexposed women with fibroids (aPR 1.0, 95% CI: 0.7, 1.6). However, exposed women with fibroids had significantly larger fibroids than unexposed women with fibroids. On average, soy formula feeding was associated with a 32% increase in the diameter of the largest fibroid (95% CI: 6%, 65%) and a 127% increase in total tumor volume (95% CI: 12%, 358%).

CONCLUSIONS

Our observation that women fed soy formula as infants have larger fibroids than unexposed women provides further support for persistent effects of early life phytoestrogen exposure on the uterus.

CITATION

Upson K, Harmon QE, Baird DD. 2016. Soy-based infant formula feeding and ultrasound-detected uterine fibroids among young African-American women with no prior clinical diagnosis of fibroids. Environ Health Perspect 124:769-775; http://dx.doi.org/10.1289/ehp.1510082.

A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment

BACKGROUND

Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment.

METHODS

One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis.

RESULTS

Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours.

CONCLUSIONS

Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.

Types of Infant Formulas Consumed in the United States

We examined consumption of different types of infant formula (eg, cow's milk, soy, gentle/lactose-reduced, and specialty) and regular milk among a nationally representative sample of 1864 infants, 0 to 12 months old, from the National Health and Nutrition Examination Survey, 2003-2010. Among the 81% of infants who were fed formula or regular milk, 69% consumed cow's milk formula, 12% consumed soy formula, 5% consumed gentle/ lactose-reduced formulas, 6% consumed specialty formulas, and 13% consumed regular milk products. There were differences by household education and income in the percentage of infants consuming cow's milk formula and regular milk products. The majority of infants in the United States who were fed formula or regular milk consumed cow's milk formula (69%), with lower percentages receiving soy, specialty, gentle/sensitive, or lactose-free/reduced formulas. Contrary to national recommendations, 13% of infants younger than 1 year consumed regular milk, and the percentage varied by household education and income levels.

The Impact of Mailed Samples of Infant Formula on Breastfeeding Rates

INTRODUCTION

Decades of research supports the health benefits of breastfeeding. Prior studies have shown that hospital discharge bags containing free samples of infant formula are associated with decreased breastfeeding exclusivity. This study aims to determine if receiving a free sample of infant formula in the mail has an impact on breastfeeding duration and exclusivity.

MATERIALS AND METHODS

This was a cohort study analyzing data from the Infant Feeding Practices Study II. The main outcomes of interest were any breastfeeding through 12 months of age and exclusive breastfeeding through 6 months of age. The main predictor of interest was receipt of a free sample of infant formula in the mail around the time of the infant's birth. Logistic regression models were developed to evaluate the association between the outcomes and predictor of interest at each month.

RESULTS

This study included 3,031 infants; mothers of 1,741 (57.4%) received a sample of infant formula in the mail. There was no difference in the likelihood of any breastfeeding at each month among those who received formula in the mail compared with those who did not. There was also no difference in exclusive breastfeeding through 5 months; however, by 6 months of age infants whose mothers received formula in the mail were less likely to be exclusively breastfed (odds ratio = 0.57; 95% confidence interval, 0.37, 0.89).

CONCLUSIONS

Receiving infant formula in the mail decreases the likelihood of exclusive breastfeeding by 6 months of age while having no impact on the duration of any breastfeeding.

[Breastfeeding: health, prevention, and environment]

Recently, a great deal of research in the field of neuroscience and human microbiome indicates the primal period (from preconceptional up to the early years of a child's life) as crucial to the future of the individual, opening new scenarios for the understanding of the processes underlying the human health. In recent decades, the social representation of infant feeding moved in fact from the normality of breastfeeding to the normal use of artificial formulas and bottle-feeding. Even the scientific thinking and the research production have been influenced by this phenomenon. In fact, a clear dominance of studies aimed to show the benefits of breast milk compared to formula milk rather than the risks of the latter compared to the biological norm of breastfeeding. Mother milk affects infant health also through his/her microbiome. Microbial colonisation startes during intrauterine life and continues through the vaginal canal at birth, during skin to skin contact immediately after birth, with colostrum and breastfeeding. The microbial exposure of infants delivered by the mother influences the development of the child microbiota, by programming his/her future health. However, rewriting the biological normality implies also a health professional paradigm shift such as departing from the systematic separation mother-child at birth, sticking at fixed schedules for breastfeeding time and duration, as it still happens in many birth centres. Breastfeeding has economic implications and the increase of its prevalence is associated with significant reduction of avoidable hospital admissions and medical care costs, both for the child and for the mother. Success in breastfeeding is the result of complex social interactions and not simply of an individual choice. However, any successful strategy must be oriented to the mother empowerment. Therefore, health professionals and community stakeholders have to learn and practice the health promotion approach, particularly avoiding prescribing appropriate breastfeeding behaviours to the mothers, but emphasizing her needs and preferences and her values system.

Trends of US hospitals distributing infant formula packs to breastfeeding mothers, 2007 to 2013

OBJECTIVE

To examine trends in the prevalence of hospitals and birth centers (hereafter, hospitals) distributing infant formula discharge packs to breastfeeding mothers in the United States from 2007 to 2013.

METHODS

The Maternity Practices in Infant Nutrition and Care survey is administered every 2 years to all hospitals with registered maternity beds in the United States. A Web- or paper-based questionnaire was distributed and completed by the people most knowledgeable about breastfeeding-related hospital practices. We examined the distribution of infant formula discharge packs to breastfeeding mothers from 2007 to 2013 by state and hospital characteristics.

RESULTS

The percentage of hospitals distributing infant formula discharge packs to breastfeeding mothers was 72.6% in 2007 and 31.6% in 2013, a decrease of 41 percentage points. In 2007, there was only 1 state (Rhode Island) in which <25% of hospitals distributed infant formula discharge packs to breastfeeding mothers, whereas in 2013 there were 24 such states and territories. Distribution declined across all hospital characteristics examined, including facility type, teaching versus nonteaching, and size (annual number of births).

CONCLUSIONS

The distribution of infant formula discharge packs to breastfeeding mothers declined markedly from 2007 to 2013. Discontinuing the practice of distributing infant formula discharge packs is a part of optimal, evidence-based maternity care to support mothers who want to breastfeed.

Association of breast feeding with early childhood dental caries: Japanese population-based study

OBJECTIVES

We investigated the association between breastfeeding duration during the first half year of life and the risk of early childhood caries from the age of 30 to 66 months in Japan.

DESIGN

Observational study of a longitudinal survey.

SETTING

A secondary data analysis of the Japanese Longitudinal Survey of Babies in the 21st Century.

PARTICIPANTS

43,383 infants at the age of 6 months.

OUTCOME MEASURES

Early childhood caries--defined as a child's visit to a dentist for treatment of dental caries during the past 12 months--was ascertained from the caregiver from the age of 30 months in the survey. We estimated the risk of dental caries each year according to duration of breast feeding using logistic regression analyses. We controlled for a set of biological factors (birth weight, sex, parity and maternal age at delivery) and socioeconomic factors (maternal educational attainment and smoking status, marital status at delivery, family income and region of birth and residence).

RESULTS

We found that infants who had been breast fed for at least 6 or 7 months, both exclusively and partially, were at elevated risk of dental caries at the age of 30 months compared with those who had been exclusively formula fed. Adjusted ORs were 1.78 (95% CI, (1.45 to 2.17)) for the exclusively breastfed group and 1.39 (1.14 to 1.70) for the partially breastfed group. However, the associations became attenuated through the follow-up period and were no longer statistically significant beyond the age of 42 months for the partially breastfed group and beyond the age of 54 months for the exclusively breastfed group.

CONCLUSIONS

We found an association between breast feeding for at least 6 or 7 months and elevated risk of dental caries at age 30 months. However, the association became attenuated as children grew older.

Postpartum sexual function in women and infant feeding methods

OBJECTIVE

To assess postpartum sexual function in mothers using different infant feeding methods.

METHODS

The comparative cross-sectional study comprising women referred to health centres in Mashhad, Iran, was conducted from July 7 to December 11, 2011. Sexual function and infant-feeding method of the subjects were assessed four months after childbirth. Data was collected using the standard Female Sexual Function Index and baby's feeding method questionnaire. SPSS 11.5 was used for statistical analysis.

RESULTS

There were 366 women in the study with a mean age of 26.70±4.70 years who were using four methods of infant-feeding: exclusive breastfeeding, breastfeeding plus complementary feeding, formula milk, and breastfeeding plus formula. There was a significant difference between women's sexual function score and infant-feeding method (p=0.04). The highest score 6.23±3.5 belonged to women who had exclusive breastfeeding.

CONCLUSIONS

There was a difference in women's sexual function between different groups of infant feeding methods. The highest score of sexual function was found in breastfeeding women. Women need to be educated about exclusive breastfeeding and its positive effects on sexual function.

Polybrominated biphenyl ethers in breast milk and infant formula from Shanghai, China: temporal trends, daily intake, and risk assessment

To investigate the temporal trend of polybrominated diphenyl ethers (PBDEs) in breast milk and assess the risks to breast- and formula-fed infants, breast milk and infant formula samples were collected from Shanghai, China. The PBDE concentrations decreased from 14.8 to 4.85 pmol/g lipid weight during 2006-2012, with a rate of decrease by half approximately every four years. Although there were no significant correlations between the total PBDEs in breast milk and age, parity, and pre-pregnant BMI of mothers, there were significant differences between primiparous and multiparous mothers for tri- to hepta-BDEs. PBDEs in breast milk were much higher than those in infant formula (equivalent to 91.9 vs. 5.25 pg/mL). Among the different brand infant formulas, there were no significant differences in their PBDE concentrations. The estimated daily intake of PBDEs by breast- and formula-fed infants suggested that breast-fed infants are exposed to much more PBDEs than formula-fed ones (12.9 vs. 0.72 ng/kg-bw/day). However, the hazard quotient values were much smaller than one, indicating that the ingested PBDEs did not exert obvious adverse effects on both breast- and formula-fed infants considering non-carcinogenic effect endpoint. This is the first report on temporal trend of PBDEs in breast milk from China.

Infant breast-feeding and childhood caries: a nine-year study

PURPOSE

This study's purpose was to assess the association between infant breast-feeding and caries experience of primary second molars in a nine-year longitudinal cohort study.

METHODS

Study sample was 509 subjects recruited at birth. Information about breast-feeding duration and other factors was collected through parents' responses to periodic questionnaires. Primary teeth were examined for dental caries at five years old and nine years old by calibrated dentist examiners. Caries experience (yes/no) and number of decayed and/or filled surfaces (dfs) were determined for five- and nine-year-olds.

RESULTS

For primary second molars at five years old, 18 percent of children who were breast-fed less than six months had caries (mean dfs=0.55) while only 9 percent of children who were breast-fed at least six months had caries (mean dfs=0.33). From five to nine years old, caries incidence was 32 percent and 31 percent, respectively, for children breast-fed less than six months and at least six months. In multivariable regression analyses, shorter breast-feeding duration was positively associated with caries experience of primary second molars at five years old (P=.005), both before and after controlling for other important factors.

CONCLUSIONS

Shorter duration of breast-feeding is suggested to be associated with increased risk for early childhood caries, but its impact might diminish with age.

Dietary behaviours and dental fluorosis among Gaza Strip children

A high prevalence of dental fluorosis has been identified among children in the Gaza Strip. This study aimed to determine the history of breastfeeding and dietary behaviours among children in the Gaza Strip and to examine potential associations with the prevalence and severity of dental fluorosis. A cross-sectional study recruited a stratified cluster random sample of 350 children aged 12-18 years and their mothers. Data about dietary behaviours in the first 7 years of life were collected by interview questionnaire. Dental fluorosis was determined using the Thyllstrup-Fejerskov index. A majority of children were breastfed exclusively in the first 6 months (82.9%) but 98.1% were given tea in the first year of life. The prevalence of dental fluorosis was 78.0%. Both intake of animal proteins and plant proteins were negatively associated with the prevalence and severity of dental fluorosis. Further studies to investigate fluoride intake is required to plan preventive interventions.

Prevalence and reasons for introducing infants early to solid foods: variations by milk feeding type

OBJECTIVE

To examine the prevalence of, and mothers' self-reported reasons for, introducing solid foods to infants earlier than recommended (aged <4 months) and the variation in reasons for early introduction by milk feeding type.

METHODS

The study included 1334 mothers who participated in the national longitudinal Infant Feeding Practices Study II (2005-2007). Monthly 7-day food-frequency questions throughout infancy were used to determine infant age at solid food introduction and to classify infant's milk feeding at introduction as breast milk only, formula only, or mixed. Reasons for introducing solid foods at age <4 months were assessed through maternal responses to a list of 12 potential reasons. Analyses included descriptive statistics and multivariable logistic regression.

RESULTS

Overall, 40.4% of mothers introduced solid foods before age 4 months. Prevalence varied by milk feeding type (24.3%, 52.7%, and 50.2% for breastfed, formula-fed, and mixed-fed infants, respectively). The most commonly cited reasons for early introduction of solid food were as follows: "My baby was old enough," "My baby seemed hungry," "I wanted to feed my baby something in addition to breast milk or formula," "My baby wanted the food I ate," "A doctor or other health care professional said my baby should begin eating solid food," and "It would help my baby sleep longer at night." Four of these reasons varied by milk feeding type.

CONCLUSIONS

Our findings highlight the high prevalence of early introduction of solids and provide details on why mothers introduced solid foods early.

Breast-feeding vs formula-feeding for infants born small-for-gestational-age: divergent effects on fat mass and on circulating IGF-I and high-molecular-weight adiponectin in late infancy

CONTEXT

Fetal growth restraint, if followed by rapid weight gain, confers risk for adult disease including diabetes. How breast-feeding may lower such risk is poorly understood. OBJECTIVE, STUDY PARTICIPANTS, INTERVENTION, OUTCOMES: In infants born small-for-gestational-age (SGA), we studied the effects of nutrition in early infancy (breast-feeding vs formula-feeding; BRF vs FOF) on weight partitioning and endocrine markers in late infancy. Body composition (by absorptiometry), fasting glycemia, insulin, IGF-I, and high-molecular-weight (HMW) adiponectin were assessed at 4 and 12 months in BRF controls born appropriate-for-GA (N = 31) and in SGA infants receiving BRF (N = 48) or FOF (N = 51), the latter being randomized to receive a standard formula (FOF1) or a protein-rich formula (FOF2).

SETTING

The study was conducted in a University Hospital.

RESULTS

SGA-BRF infants maintained a low fat mass and normal levels of IGF-I and HMW adiponectin. In contrast, SGA-FOF infants normalized their body composition by gaining more fat; this normalization was accompanied by a marked fall in HMW adiponectinemia and, in FOF2 infants, by elevated IGF-I levels. In late infancy, SGA-BRF infants were most sensitive to insulin, even more sensitive than appropriate-for-GA-BRF controls.

CONCLUSIONS

Because the health perspectives are better for SGA-BRF than for SGA-FOF infants, the present results suggest that FOF for SGA infants should aim at maintaining normal IGF-I and HMW-adiponectin levels rather than at normalizing body composition. Nutriceutical research for SGA infants may thus have to be redirected.

Impact of policy changes on infant feeding decisions among low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

OBJECTIVES

We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes.

METHODS

We analyzed WIC data on more than 180,000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder.

RESULTS

Issuance rates of the "fully breastfeeding" package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model.

CONCLUSIONS

Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.

[Intervention for family feeding methods for nursling between 6 to 24 months in Zhouqu]

OBJECTIVE

To analyze the change of family feeding methods after nutrition intervention for nurslings between 6 to 24 months in Zhouqu .

METHOD

Choose 252 nurslings in basic survey and 239 in final survey by PPS sampling and obtain the change of feeding methods by questionnaire.

RESULTS

After the one year's intervention, the rate of pure breast feeding increases from 26.98% to 39.33%, the rate of breast feeding in one hour after the baby delivered increases from 17.06% to 38.09%. The rate of feeding formula powder increases from 27.28% to 61.51% and the status of feeding vegetable meat and bean are improved. The rate for early complementary feeding for special kings of food decreased.

CONCLUSION

After the one year's intervention, the feeding methods improves in total, but there are still some problems. It isrequired to enhance intervention and formulate and implement a kind of reasonable intervention method to attach the objective of scientific feeding for nurslings.

Infant feeding and obesity risk in the child

Early nutrition in infancy may influence later child health outcomes including overweight through 'programming'. Systematic reviews suggest that breastfeeding is associated with a modest reduction in the risk of later overweight and obesity. This commentary explores some of these mechanisms behind this association. Generally breastfed infants are leaner than artificially (formula)-fed infants and behavioural and hormonal mechanisms may explain this difference. The theory is that a high nutrient diet in infancy adversely programs the principal components of the metabolic syndrome in the child (body mass index, blood pressure and blood lipids) by promoting growth acceleration, whereas slower growth benefits later cardiovascular disease and its risk factors. Artificial-feeding stimulates a higher postnatal growth velocity with the adiposity rebound occurring earlier in those children who have greater fatness later, whereas breastfeeding has been shown to promote slower growth. The adverse long-term effects of early growth acceleration emerge as fundamental in later overweight and obesity. The higher protein content of artificial baby milk compared to the lower protein content in breastmilk is responsible for the increased growth rate and adiposity during the influential period of infancy of formula-fed infants. Breastfeeding, on the other hand, has a protective effect on child overweight and obesity by inducing lower plasma insulin levels, thereby decreasing fat storage and preventing excessive early adipocyte development. Plausible biological mechanisms underlying the protective effect of breastfeeding against obesity are based on the unique composition of human milk and the metabolic and physiological responses to human milk.

The economic burden of infant formula on families with young children in the Philippines

BACKGROUND

Infant formula usage places children at risk for illness and death. Studies in the United States demonstrated high economic burden, health care costs, and absenteeism of caregivers associated with formula usage. Despite high formula usage in developing countries, no economic studies were found. This study examines the financial burden of purchasing infant formula and increased health care expenditure in the Philippines, a developing country with a per capita income of $3930. The average exchange rate of the peso to the US dollar for 2003 was $1 to P52, according to Bangko Sentral ng Pilipinas (BSP).

METHODS

This is a secondary analysis of the 2003 Family Income and Expenditure Survey, a national cross-sectional multistage cluster survey of 42 094 households.

RESULTS

Almost half of Philippine families with a young child and one-third of families living on less than $2 per day purchase formula. Nationally, $260 million was spent on infant formula in 2003. Formula-buying families with young children had spent an aggregate of $143.9 million on medical care compared to $56.6 million by non-formula-buying families. After adjusting for income and nonmilk family expenditures, the average formula-purchasing Philippine family spent an additional $0.30 (95% CI: 0.24 - 0.36; r(2) = 0.08) on medical expenditure for every $1 spent on formula.

CONCLUSIONS

The economic burden from infant formula purchase and out-of-pocket medical expenditure exceeded $400 million in 2003. This cost was aside from other costs, such as absenteeism and the risk of childhood death and illness. These expenses caused an unnecessary burden on Filipino families and could instead have been invested in education and other social services.

Are fathers underused advocates for breastfeeding?

Fathers' knowledge base and attitudes influence breastfeeding practice. We aimed to evaluate if Irish fathers felt included in the breastfeeding education and decision process. 67 fathers completed questionnaires, which assessed their role in the decision to breastfeed, knowledge regarding the benefits of breastfeeding and attitude towards breastfeeding.Forty-two (62.7%) of their partners were breastfeeding. Antenatal classes were attended by 38 (56.7%); 59 (88.1%) discussed breastfeeding with their partners and 26 (38.8%) felt that the decision was made together. Twelve (48%) fathers of formula fed infants were unaware that breastfeeding was healthier for the baby. Most fathers (80.6%) felt that breastfeeding was the mother's decision and most (82.1%) felt that antenatal information was aimed at mothers only. Irish fathers remain relatively uninformed regarding the benefits of breastfeeding. This may contribute to their exclusion from the decision to breastfeed. Antenatal education should incorporate fathers more, and this may result in an improvement in our breastfeeding rates.

[Investigation on the feeding status of infants and young children in poor counties of Gansu Province]

OBJECTIVE

To understand the feeding status and the current situation of complementary food supplement of infants and young children aged 6-23 months in Yongjing County and Yuzhong County, two of poorer counties in Gansu Province.

METHODS

A study was conducted by cluster sampling. The status of breastfeeding and complementary food supplement was surveyed by using questionnaires.

RESULTS

A total of 836 infants and young children aged 6-23 months were investigated. The results showed that 18. 2% of infants received breastfeeding in the first hour after birth. The breastfeeding rate reached up to 84.1%, while the percentage of continuous breastfeeding for 12-15 months and 20-23 months was only 29.6% and 8.7%, respectively. The percentage of almost exclusive breastfeeding,mixed feeding and artificial feeding attained 42.7%, 41.4% and 15.9% ,respectively during the first 6 months after birth. Besides, the complementary food not supplemented in time was in 68.7% of infants, among which, 35.2% of infants were supplemented too early and 33.5% not in time. The diversity of complementary foods in 6-11 month-old infants was less than that in 12-17 and 18-23 month-old young children. The situation of complementary food supplement for meeting the minimum acceptable dietary level in breastfeeding infants was lower than that in non-breastfeeding infants.

CONCLUSION

The exclusive breastfeeding rate was relatively low. The inappropriate addition of complementary foods in time, category and frequency were the main issues to be concerned. It was suggested that publicizing knowledge on infant feeding should be strengthened.

Infant-feeding practices and associated factors of HIV-positive mothers at Gert Sibande, South Africa

AIM

To assess knowledge, infant-feeding education and practices, factors that affect choice of infant feeding option, determinants of mixed feeding, psychosocial challenges and attitudes of HIV-positive women with infants between ages 3-6 months who attended prevention of mother-to-child transmission of HIV services in Gert Sibande district.

METHODS

A cross-sectional study was conducted with 815 HIV-positive mothers at 47 postnatal clinics. Trained field workers collected data at health facilities, using structured questionnaires. HIV-infected women who were at least 18 years of age were interviewed.

RESULTS

The mean age was 27.7 years (SD 6.4). Seventy-eight percent agreed that HIV could be transmitted by breastfeeding. Fifty per cent were exclusively formula feeding, 35.6% breastfed exclusively and 12.4% mixed fed. In multivariate analysis, having a vaginal delivery, infant hospital admissions, and currently pregnant were associated with mixed feeding. Being older, knowing the HIV status of the infant and higher knowledge on HIV transmission through breastfeeding were associated with formula feeding.

CONCLUSION

The study identified gaps in prevention of mother-to-child transmission (PMTCT) knowledge and infant feeding policy which seem to affect appropriate infant feeding. Various determinants of mixed feeding and exclusive formula feeding in the context of PMTCT were identified that can guide infant feeding counselling and support services of PMTCT programmes.