Associations between Infant Feeding Practice Prior to Six Months and Body Mass Index at Six Years of Age

Rapid growth during infancy is associated with increased risk of overweight and obesity and differences in weight gain are at least partly explained by means of infant feeding. The aim was to assess the associations between infant feeding practice in early infancy and body mass index (BMI) at 6 years of age. Icelandic infants (n = 154) were prospectively followed from birth to 12 months and again at age 6 years. Birth weight and length were gathered from maternity wards, and healthcare centers provided the measurements made during infancy up to 18 months of age. Information on breastfeeding practices was documented 0–12 months and a 24-h dietary record was collected at 5 months. Changes in infant weight gain were calculated from birth to 18 months. Linear regression analyses were performed to examine associations between infant feeding practice at 5 months and body mass index (BMI) at 6 years. Infants who were formula-fed at 5 months of age grew faster, particularly between 2 and 6 months, compared to exclusively breastfed infants. At age 6 years, BMI was on average 1.1 kg/m² (95% CI 0.2, 2.0) higher among infants who were formula fed and also receiving solid foods at 5 months of age compared to those exclusively breastfed. In a high-income country such as Iceland, early introduction of solid foods seems to further increase the risk of high childhood BMI among formula fed infants compared with exclusively breastfed infants, although further studies with greater power are needed.     

Food consumption and feeding patterns of Czech infants and toddlers living in Prague

OBJECTIVE: To describe feeding patterns during first two years of life and their relation to sociodemographic factors. DESIGN: Longitudinal study. SETTING: Prague, Czech Republic. SUBJECTS: Ninety-seven full-term healthy singletons enrolled at maternity ward, of which 90.7% completed the study. METHODS: Diet was assessed at 9, 12 and 24 months of age using a structured 3-day dietary record. Additional information was obtained from questionnaires completed at birth and at 6 months. RESULTS: The median duration of exclusive breastfeeding was 5 months, and that of total breastfeeding 9 months. Breastfeeding rate 47.4% at 9 months declined to 4.5% at 24 months. Total duration of breastfeeding was positively associated with maternal education and marital status but not with maternal age, gender or birth order. Breastfeeding frequency at 9, 12 and 24 months was 4.8, 4 and 3.7, respectively. The complementary food feeding frequency increased significantly with age (4.5, 4.7 and 5.9 times per day, respectively). All children at any age point consumed fruits, cereal and milk products. The proportion of children consuming meat and vegetables had increased with age but between ages 9 and 24 months, at least 23-38% children did not consume vegetables daily and 28-40% did not consume foods from meat/fish/poultry/eggs group daily. The proportion of children consuming milk and foods associated with the early complementary feeding period had fallen with age while the consumption of cereal foods other than porridge had increased. Values of indicators of adequate complementary feeding practices tentatively suggested in the context of WHO expert consultation had closely reflected breastfeeding rates. CONCLUSIONS: Breastfeeding duration is shorter than WHO recommends. It is influenced by maternal education and marital status. Compliance with complementary feeding recommendations is relatively good. Continued promotion of healthy infant and young child feeding practices is needed. Indicators evaluating complementary feeding practices should assess breastfeeding separately from other aspects. SPONSORSHIP: Ministry of Health, 1st Faculty of Medicine, Charles' University of Prague.     

Complementary feeding practices in rural area of district Agra

The study was conducted to assess the prevailing complementary feeding practices. Strikingly 30.9 percent infants were not receiving complementary foods. 21.9 percent mothers initiated complementary feeding at the right age. This was significantly associated with the literacy status of the mothers (p<0.05). 87.1 percent infants were receiving family pot feeding. The complementary foods fed to the infants were mostly (88.6%) of semi-solid consistency. Demand feeding was being practiced by 66.7 percent mothers. The practice of cleaning hands before feeding was very poor with only 17.1%. Thus to conclude the complementary feeding practices were not satisfactory in the rural area of Agra and need to be improved.     

Relations between high ponderal index at birth, feeding practices and body mass index in infancy

OBJECTIVE: We compared feeding practices between infants of high ponderal index (PI) at birth (PI above the 90th percentile) and normal PI at birth (PI between 10th and 90th percentiles), and examined how birth size and infant feeding practices were related to body mass index (BMI) at 12 months. DESIGN: In a cohort of 3000 infants invited to participate in a national Norwegian dietary survey, 1825 participated both at 6 and 12 months of age, and the present study included those born full term and with a PI (weight/length3) at birth > or =10th percentile (n=1441). Data on feeding practices were collected by food-frequency questionnaires, and anthropometrical data were measured by health-care personnel. RESULTS: A lower proportion of infants born with high PI were exclusively breastfed for at least 4 months compared with infants born with normal PI (37 and 47%, respectively; P=0.03). Earlier introduction of solid foods and higher consumption of some foods were also observed among infants of high PI. In a multivariate analysis, adjusted mean BMI (kg/m2) at 12 months was higher for infants of high PI at birth than for infants of normal PI (17.6 and 17.0, respectively; P<0.001) and higher for infants exclusively breastfed <3 months than for infants exclusively breastfed > or =3 months (17.5 and 17.2, respectively; P=0.001). CONCLUSIONS: High PI at birth was associated with a shorter duration of exclusive breastfeeding. Furthermore, high PI at birth and short-term exclusive breastfeeding were both associated with higher BMI at 12 months.     

Commercial Baby Food Consumption and Dietary Variety in a Statewide Sample of Infants Receiving Benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children

Dietary variety and exposure to fruits and vegetables in infancy have been associated with nutritional benefits and later acceptance of these foods. The objective of this study was to examine the prevalence of fruit and vegetable commercial baby food consumption and its relation to dietary variety during infancy. A cross-sectional statewide telephone survey of 733 Maryland mothers and infants receiving benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was conducted between July 2004 and July 2005. A 24-hour dietary recall was examined to assess infant dietary variety. Among infants from birth to age 5 months, 54% had consumed complementary foods in the past 24 hours; 60% received commercial baby foods. Among infants aged 6 to 12 months, 98% had consumed complementary foods in the past 24 hours; 81% received commercial baby foods. In the latter age range, the average daily number of different types of fruits and vegetables consumed was 1.5±1.2, range 0 to 6). In a multivariate model, infants aged 6 to 12 months who received commercial baby foods consumed a greater variety of fruits and vegetables (β=.54, 95% confidence interval 0.26-0.84; P<0.001) than infants who did not, characterized by a diet that was lower in white potatoes (14% vs 22%) and higher in dark-green (6% vs 5%) and deep-yellow (35% vs 10%) vegetables. Commercial baby food is consumed by a majority of WIC infants, although many mothers introduce it before the recommended age of 6 months. Among infants aged 6 to 12 months, commercial baby food is associated with dietary variety in fruits and vegetables. By encouraging consumption of fruits and vegetables after 6 months of age, either through the provision of commercial baby foods and/or education and resources related to the preparation of fruits and vegetables for infants, WIC can increase dietary variety and appropriate introduction of complementary foods among infants.     

Preterm Infants on Early Solid Foods and Iron Status in the First Year of Life—A Secondary Outcome Analysis of a Randomized Controlled Trial

Introduction of solid foods and iron status in the first year of life of preterm infants are highly discussed topics. The aim of this study was to examine whether two timepoints of introduction of standardized solid foods in preterm infants have an impact on ferritin and other hematologic parameters important for iron status in the first year of life. This is a secondary outcome analysis of a prospective, randomized intervention trial in very low birth weight (VLBW) infants randomized to an early (10–12th week corrected age) or a late (16–18th week corrected age) complementary feeding group. Iron status was assessed with blood samples taken at 6 weeks, 6 months, and 12 months corrected age. In total, 177 infants were randomized (early group: n = 89, late group: n = 88). Ferritin showed no differences between study groups throughout the first year of life, as did all other parameters associated with iron status. At 12 months corrected age, the incidence of iron deficiency was significantly higher in the early feeding group. There is room for improvement of iron status in VLBW preterm infants, regular blood checks should be introduced, and current recommendations may need to be a reconsidered.     

Weaning practices and breast-feeding duration in Northern Thailand.

Current infant feeding guidelines recommend exclusive breast-feeding until the infant is about 4 months old to reduce the risks of early termination of breast-feeding, undernutrition and infection. In many societies, however, supplementary foods are given well before 4 months of age. The present paper describes weaning practices, factors associated with early supplementation and the effects of supplementation on duration of breast-feeding in a random sample of sixty northern Thai breast-fed infants studied prospectively from birth to 2 years of age. Composition of supplementary foods, energy and protein intake from supplements and changes in the supplementary diet with increasing infant age are also described. Rice-based foods were given from soon after birth; 81% of the sample had received supplements by 6 weeks of age. Early supplementary feeding was significantly associated with rural residence, large household size, maternal employment in agriculture and maternal age. Girls and infants with lower birth weights tended to be supplemented earlier. Despite early feeding of supplements, breast-feeding was prolonged, with median duration of 12 months. Early introduction of supplements and quantity of supplements consumed in the first 3 months were not associated with duration of breast-feeding. However, mothers who gave infant formula as the first supplementary food stopped breast-feeding slightly earlier, as did younger mothers living in households with more children.     

添加辅食对婴幼儿生长发育的影响

目的:了解添加辅食对2岁以下儿童生长发育的影响。方法:以4～6月龄时婴幼儿是否开始添加辅食分组,由专人负责,统一表格、标准和要求,进行统一规定的～6、～9、～12、～18、～24月5个年龄段儿童的体格检查和母亲的1人1表问卷调查。结果:深圳市4月龄儿童添加辅食率为60.2%,6月龄儿童为83.7%。添加辅食组～24月龄儿童的体重明显大于末加辅食组,P<0.01,～18月龄儿童的血红蛋白浓度添加辅食组明显高于末加辅食组,P<0.02,各年龄组儿童的血红细胞数比较,添加辅食组均明显高于末加辅食组,P<0.05或0.01。添加辅食与否对各年龄组儿童身长的影响,对婴儿独走、独坐、叫爸妈发育的影响,以及对婴儿感冒、支气管炎及肺炎、腹泻、佝偻病等发病率的影响,均无显著性差异,P>0.05。结论:及时合理的添加辅食,对儿童的血红细胞数和血红蛋白浓度以及体格生长发育均有较大的益处。应在大力提倡科学母乳喂养的同时,进一步加强儿童辅食添加知识及喂养行为方面的宣传与指导,促进婴幼儿的生长发育。     

Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa

OBJECTIVE: We evaluated feeding practices and growth patterns of infants in the central region of the Limpopo Province over the first 12 mo of life. METHODS: A follow-up study on a cohort of term infants born to 276 mothers recruited during their third trimester of pregnancy was undertaken. The mothers were recruited by the nursing staff at nine randomly selected clinics. From this sample, 219 women gave birth at the local hospital and the infants were followed from birth to 12 mo. Data collected included infant feeding practices and anthropometry at regular intervals (1, 3, 6, 9 and 12 mo). The anthropometric measurements taken were body weight, length, and head circumference. RESULTS: At birth 8.8% of infants had a low birth weight, 9.6% were stunted, 48.9% were underweight, and 7.3% were wasted. Mothers in this study breastfed their infants for long periods with more than 80% still breastfeeding by the ninth month. However, exclusive breastfeeding during the first 3 mo was uncommon as mothers tended to introduce supplementary feeds at an early age, with 56% of the infants receiving some form of supplement by the end of the first month. The most common supplementary foods were maize meal porridge and mabella (sorghum). Stunting became increasingly apparent in the early months with 30% of infants being stunted (<-2 standard deviations [SD] of the National Center for Health Statistics [NCHS] reference curves) by the first month, and this percentage remained high for the 12-mo period, remaining at below - 1 SD NCHS height-for-age standard. Increased weight gain was seen during the first 3 mo and then declined until mean weight-for-age at 12 mo was below 0 SD NCHS. Twelve percent of infants were overweight (>2 SD NCHS) by the 12th month. Postnatally the infants showed a pattern of gradual stunting. Postnatal factors associated with this pattern were related to maternal socioeconomic status, and these included the mother's level of education, employment status, parity, and access to electricity. CONCLUSION: There was a high frequency of underweight infants at birth but stunting was less common. With respect to feeding practices, the mothers tended to introduce supplementary feeds at an early age.     

Growth and feeding practices of 4 and 8 months infants in Southern China

A cross-sectional study was conducted to observe the growth and feeding practices of infants in Southern China. The study comprised 758 infants at 4 (n = 383) and 8 (n = 375) months of age in Guangzhou City, and 398 infants at 4 months of age in the rural areas of Guangdong Province. Anthropometrics and feeding information were obtained. In the city, the mean Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) of the infants were above the National Center for Health Statistics (NCHS) reference median at 4 months. By 8 months, WAZ and WHZ, but not HAZ scores, were below the NCHS reference median (p < 0.05). Rural infants were lighter and shorter than the NCHS reference at 4 months (p < 0.05). Prevalence of breast feeding was 65% at 4 months and 44% at 8 months for urban infants, but 99% of the rural infants were breastfed at 4 months. Rural infants were fed less commercial baby cereals, high-protein foods, and fruits, but more homemade cereals than urban infants. The attained size of the 4 months old urban infants was positively associated with the exposure loads of breast milk, fruits, and vitamin supplements, but negatively associated with formula, rice porridge, and glucose drinks. Body weight of the 4-month rural infants was negatively associated with the exposure loads of formula and glucose drinks. By 8 months, the growth of the urban infants was associated positively with the exposure loads of fruits, high-protein foods, and vitamins supplements, but negatively with home made cereals and Chinese herbs. Improved feeding practices, including the usage of appropriate weaning and complementary foods, are needed for optimal growth of both urban and rural infants.     

The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers’ infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital.     

Infant feeding patterns in the Finnish type I diabetes prediction and prevention nutrition study cohort

OBJECTIVE: To investigate infant feeding patterns during the first 2 y and their relation to sociodemographic factors. DESIGN: A population-based cohort study. SETTING: Oulu and Tampere University Hospital district areas 1996-1999, Finland. SUBJECTS AND METHODS: All newborn infants (n=675) with increased genetic risk for type I diabetes were invited to the study in 1996-1997. Of these, 429 (64%) completed the dietary follow-up form by the time they reached 2 y of age. RESULTS: The median duration of exclusive breastfeeding (BF) was 1.8 months (range 0-6 months) and that of total BF 7.0 months (0.3-25 months). Among the infants 20% were exclusively breastfed at least 4 months (recommendation 4-6 months). Infants were introduced to infant formula at the median age of 1.8 months (range 0-25 months) and other supplementary foods at the median age of 3.5 months (1-6 months). Infant's ponderal index at birth was inversely associated with the duration of total BF. The age of introduction of supplementary foods correlated positively with the duration of total BF. Longer parental education and increased maternal age were associated with a longer duration of BF and older age at introduction of supplementary foods. Infant formula and other supplementary foods were added earlier to the diet of the boys than that of the girls. CONCLUSION: Duration of breastfeeding in Finland is shorter than recommended. Compliance with the current recommendations on the timing of introduction of first supplementary food and dairy products is relatively poor. The diet during infancy seems to be conspicuously influenced by the duration of parental education, maternal age and the sex of the infant.     

Effect of timing of introduction of complementary foods on iron and zinc status of formula fed infants at 12, 24, and 36 months of age

OBJECTIVE: The timing of introduction of complementary food to an infant's diet is variable throughout the world. Our objective was to determine whether early introduction of complementary foods affects iron and zinc status of formulated infants at 12, 24, and 36 months of age. DESIGN: A randomized, prospective trial was conducted. Infants were randomly assigned to receive either a) early introduction (at 3 to 4 months of age) of commercially prepared or parent's choice of complementary foods; or b) late introduction (at 6 months of age) of commercially prepared complementary foods or parent's choice of complementary foods. In addition to complementary foods, infants were fed commercial infant formula as recommended by their pediatrician. Hemoglobin, mean corpuscular volume, and serum ferritin and zinc concentrations were determined at 12, 24, and 36 months of age. Three-day diet diaries were completed at 3, 6, 12, 18, 24, 30, and 36 months of age. SUBJECTS/SETTING: One hundred seventy-five infants younger than 3 months were recruited by mailings to parents in the Cincinnati area. Of these, 172 were enrolled, 90 in the early-introduction group and 82 in the late-introduction group. One hundred thirty-three infants (n = 67 in the early, n = 66 in the late group) completed the study. STATISTICAL ANALYSES PERFORMED: Student t test and regression analyses were used to determine whether there were group differences and whether there was a relationship between serum parameters and dietary intake. RESULTS: Infants fed complementary foods early had significantly greater iron intakes until 6 months of age; however, there were no differences in the iron status parameters (ferritin, hemoglobin, and mean corpuscular volume) at 12, 24, or 36 months of age. The early introduction group consumed slightly less zinc than the late introduction group at 5 months (4.4 vs 4.8 mg/day, P < .01) and 6 months (4.4 vs 4.7 mg/day, P < .01). At all other times there were no differences between the early and late group in zinc intakes. The serum zinc concentration was not associated with dietary zinc. Both groups had normal serum zinc concentrations at 12, 24, and 36 months and there were no differences between groups. APPLICATIONS/CONCLUSIONS: The iron and zinc status of infants in this study was not influenced by the timing or type of complementary foods introduced. However, the infants were formula fed and the mean iron and zinc intakes that were equal or greater than the Recommended Dietary Allowances for the first 6 months of age.     

北京市高碑店地区9月龄婴儿喂养情况分析

目的 了解北京市朝阳区高碑店地区9月龄婴儿喂养现状,分析该地区婴儿喂养中存在的问题。方法 采用横断面调查,使用联合国儿童基金会标准化问卷,对北京市朝阳区高碑店地区529名9月龄婴儿的喂养情况进行调查,分析世界卫生组织(WHO)2008年版《婴幼儿喂养评估指标》中的8个指标。结果 调查地区早开奶率为64.9%,9个月时持续母乳喂养率为92.5%,适龄喂养率(即6个月以下进行纯母乳喂养,6~9月的婴儿在母乳喂养的同时添加辅食)为75.0%,辅食添加种类合格率为64.1%,但9月龄母乳喂养婴儿辅食添加频率合格率仅为17.6%,且辅食合理添加率仅为14.2%。结论 调查地区婴儿中母乳喂养情况较好,但存在适龄喂养率较低及辅食种类和辅食添加频率偏少的问题,应引起重视。     

广州城郊婴儿出生及喂养情况调查

目的:了解目前广州市城、郊区婴儿出生及喂养情况,找出婴儿喂养存在的问题及影响因素。方法:采用整群随机抽样的方法,抽取广州市越秀区和白云区郊区共2 040名42天以上、1岁以内婴儿及其母亲作为调查对象,逐一进行面对面问卷调查。结果:广州市城、郊区低出生体重儿、巨大儿和早产儿发生率分别为3.75%、4.20%和6.13%,城区显著高于郊区(P<0.01)。婴儿4个月内母乳喂养率为41.99%,城、郊区差异有统计学意义(P<0.01);出生后4个月内添加辅食的比例是29.34%,4～6个月为70.28%。Logistic回归分析显示,影响喂养行为的主要因素有乳汁分泌量、分娩方式、母亲年龄、地域、母亲文化程度和家庭年收入等。结论:广州城、郊区婴儿喂养方式仍存在很多不合理现象,应根据人群不同特点有针对性地开展健康教育,普及营养知识和科学育儿观念,提高母乳喂养率,并适时合理地添加辅食,以促进婴儿生长发育。     

广东省4个月婴儿生长状况与喂养模式调查

在广东省的城乡对７７７名４个月的婴儿进行了生长状况与喂养模式的现况调查，与ＷＨＯ推荐的ＮＣＨＳ体格生长标准比较，城市婴儿４个月时其身长与体重的发育良好，而农村婴儿的身长和体重则低于参考标准，也低于同龄的城市婴儿。６４％城市婴儿和９９％的农村婴儿在４个月时仍喂哺母乳，７７％的城市婴儿和５９％的农村婴儿４个月前已经添加了辅助食品，辅助食品的种类有明显的城乡差别，农村辅食质量次于城市。母乳喂养有利于城乡４个月婴儿的体重生长，４个月前添加辅食影响农村婴儿体重生长。应继续在广东城乡提倡母乳喂养，不提倡过早添加辅食，应提高农村婴儿的断奶过渡食品的质量。     

Systematic review concerning the age of introduction of complementary foods to the healthy full-term infant

OBJECTIVES: To evaluate existing data from published studies investigating outcomes (growth, nutritional status and morbidity) in relation to the age of introduction of complementary foods to the healthy full-term infant. To assess the methodological quality of current scientific evidence on which infant feeding recommendations are based. SEARCH STRATEGY: A database was created following a search of electronic databases MEDLINE and BIDS, a handsearch of relevant journals and consultation with international experts in infant feeding practices. The search was conducted during a 6-month period and encompassed the years 1982-1998. INCLUSION CRITERIA: Randomised/non-randomised controlled trials and cohort studies investigating the relationship to the health of full-term infants of the introduction of complementary foods to childhood health. DATA COLLECTION AND ANALYSIS: Assessment of studies for inclusion and their compliance with methodological criteria was undertaken independently by two reviewers and discrepancies were resolved by discussion. RESULTS: From over 400 published papers identified, 33 met specific inclusion criteria. Significant differences in baseline characteristics of subjects in included studies meant that data were not amenable to meta-analysis. The consensus of the authors was that, of the 33 included publications, 13 contained data supporting the current WHO recommendations which attempt to accommodate all infants, including those whose nutritional requirements are not met by exclusive breast-feeding for 6 months. An equal number contained data that would support a recommendation for delaying the introduction of complementary foods until 6 months of age within the study population. The remaining seven were unable to provide evidence to support a change from the current WHO infant feeding recommendations which state that 'infants should be fed exclusively on breast milk from birth to 4-6 months of age'. None of the studies met all the methodological criteria. CONCLUSIONS: This review has shown that there is a lack of clear evidence to either support or refute a change to the current recommendations for the age of introduction of complementary foods to the breast milk or formula fed infant. Whilst exclusive breast feeding for the first 6 months of life can support growth and development in some infants, sub-groups have been identified within certain populations who may require complementary feeding prior to this age.     

Determinants of infant growth in the slums of Dhaka: size and maturity at birth, breastfeeding and morbidity

OBJECTIVE: To investigate the influences of size at birth, breastfeeding and morbidity on growth during infancy in poor areas of urban Bangladesh. DESIGN: This was a prospective observational study of a cohort of newborn infants followed until 12 months of age. SETTING: Slum areas of Dhaka City in Bangladesh. SUBJECTS: A total of 1654 newborn infants were enrolled at birth, and follow-up was completed for 1207 infants. Repeated anthropometric measurements and interviews of caretakers on infant feeding and morbidity were conducted. A mixed effects regression method was used for modeling infant growth. RESULTS: After adjusting for other variables, mean differences in body weight by birth weight and length, small-for-gestational age and prematurity categories remained relatively constant throughout infancy. A positive impact of exclusive breastfeeding in the first 3 5 months on infant growth was detectable at 12 months of age. Although the bigger babies in the sample tended to grow relatively even bigger; exclusive breastfeeding appeared to counteract this pattern. Reported diarrhoea was associated with lower body weights and lengths even after adjusting for feeding patterns. CONCLUSIONS: Size at birth has an important role in determining growth during infancy. Effective strategies for improving birth weight, poorly addressed till now in Bangladesh, are needed. The sustained effect on growth and the even more beneficial effect in lighter infants are compelling reasons for promotion of exclusive breastfeeding in early infancy.     

Session 4: Mineral metabolism and body composition iron status of breast-fed infants

Fe deficiency is a common nutritional disorder during infancy, particularly in low-income countries. The Fe status of a breast-fed infant is strongly influenced by the body Fe content at birth, which is determined by factors that operate before birth (maternal Fe status before and during pregnancy; infant gestational age and birth weight) and at the time of delivery (the timing of umbilical cord clamping). Delaying the clamping of the umbilical cord for 2 min can increase body Fe content by approximately 33% (75 mg), and results in greater Fe stores at 6 months of age. After birth, male gender and a rapid rate of weight gain are associated with lower Fe status. During the first half of infancy dietary Fe requirements depend on Fe stores at birth. For an exclusively-breast-fed full-term normal-birth-weight infant with delayed umbilical cord clamping, whose mother had adequate Fe status during pregnancy, the Fe provided from stores and breast milk is sufficient for >/=6 months, but before this time higher-risk infants may become Fe deficient. Fe supplementation can be beneficial for high-risk infants, but can have adverse effects on growth and morbidity of Fe-replete infants. After 6 months most breast-fed infants will require complementary foods that are rich in Fe.