Early Gut Microbiota Colonisation of Premature Infants Fed with Breastmilk or Formula with or without Probiotics: A Cohort Study

Premature infants have a fragile ecology of the gut microbiota, which is associated with many health problems and may be influenced by formula versus breast feeding. The present study investigated differences in the process of gut microbiota colonisation in preterm infants fed with breastmilk or formula with or without probiotics before 12 weeks. This cohort study recruited 138 premature infants; 31 in the breastmilk (BM) group, 59 in the probiotics formula (PF) group and 48 in the non-probiotics formula (NPF) group, according to the feeding practice they received at birth. Gut bacterial composition was identified with 16S rRNA gene sequencing in faecal samples collected at 1 week, 6 weeks and 12 weeks after birth. The alpha diversity was higher in the PF group compared to the other groups at week 1 and 6 (both p < 0.01) but showed no difference at week 12. The beta diversity of the three groups showed a trend towards similarity at the first two stages (p < 0.001 and p = 0.009, respectively) and finally showed no difference at week 12. Canonical redundancy analysis showed that feeding type could explain the difference in gut microbiota composition at week one and six (both p < 0.01). At genus level, Bifidobacterium was enriched in the PF group, while the Enterococcus and Streptococcus was enriched in the NPF group. In summary, formula with probiotics feeding after birth can affect gut microbiota colonisation and lead to a bacterial community with less potential pathogens.     

Relationship of Diet to Gut Microbiota and Inflammatory Biomarkers in People with HIV

While changes in microbiome composition have been associated with HIV, the effect of diet and its potential impact on inflammation remains unclear. Methods: Twenty-seven people living with HIV (PWH) on antiretroviral therapy (ART) were studied. A comprehensive dietary analysis was performed and two types of dietary patterns were determined. We explored the associations of each dietary pattern with gut microbiota and plasma inflammatory biomarkers. Results: We appreciated two dietary patterns, Mediterranean-like (MEL) and one Western-like (WEL). Compared to participants with the WEL pattern, participants with MEL pattern showed higher abundance of Lachnospira (p-value = 0.02) and lower levels of the inflammatory biomarkers D-dimer (p-value = 0.050) and soluble TNF-alpha receptor 2 (sTNFR2) (p-value = 0.049). Men who have sex with men (MSM) with MEL pattern had lower abundance of Erysipelotrichaceae (p-value < 0.001) and lower levels of D-dimer (p-value = 0.026) than MSM with WEL pattern. Conclusion: MEL pattern favours Lachnospira abundance, and protects against Erysipelotrichaceae abundance and higher levels of the inflammatory biomarkers D-dimer and sTNFR2, precursors of inflammatory processes in HIV-infected patients. Our study contributes to understanding the determinants of a healthier diet and its connections with gut microbiota and inflammation.     

Impact of Maternal Nutritional Supplementation during Pregnancy and Lactation on the Infant Gut or Breastmilk Microbiota: A Systematic Review

Recent evidence indicates that maternal dietary intake, including dietary supplements, during pregnancy and lactation may alter the infant gut or breastmilk microbiota, with implications for health outcomes in both the mother and infant. To review the effects of maternal nutritional supplementation during pregnancy and lactation on the infant gut or breastmilk microbiota a systematic literature search was conducted. A total of 967 studies published until February 2020 were found, 31 were eligible and 29 randomized control trials were included in the qualitative synthesis. There were 23 studies that investigated the effects of probiotic supplementation, with the remaining studies investigating vitamin D, prebiotics or lipid-based nutrient supplements (LNS). The effects of maternal nutritional supplementation on the infant gut microbiota or breastmilk microbiota were examined in 21 and 12 studies, respectively. Maternal probiotic supplementation during pregnancy and lactation generally resulted in the probiotic colonization of the infant gut microbiota, and although most studies also reported alterations in the infant gut bacterial loads, there was limited evidence of effects on bacterial diversity. The data available show that maternal probiotic supplementation during pregnancy or lactation results in probiotic colonization of the breastmilk microbiota. There were no observed effects between probiotic supplementation and breastmilk bacterial counts of healthy women, however, administration of Lactobacillus probiotic to nursing women affected by mastitis was associated with significant reductions in breastmilk Staphylococcal loads. Maternal LNS supplementation during pregnancy and lactation increased bacterial diversity in the infant gut, whilst vitamin D and prebiotic supplementation did not alter either infant gut bacterial diversity or counts. Heterogeneity in study design precludes any firm conclusions on the effects of maternal nutritional supplementation during pregnancy and lactation on the infant gut or breastmilk microbiota, warranting further research.     

Maternal Vitamin D Status Correlates to Leukocyte Antigenic Responses in Breastfeeding Infants

It is unknown if vitamin D (vitD) sufficiency in breastfeeding mothers can lead to physiological outcomes for their children that are discernible from infant vitD sufficiency per se. In a 3-month, randomized vitD supplementation study of mothers and their exclusively breastfeeding infants, the effects of maternal vitD sufficiency were determined on infant plasma concentrations of 25-hydroxyvitamin D (i.e., vitD status) and 11 cytokines. An inverse correlation was seen between maternal vitD status and infant plasma TNF concentration (r = −0.27; p < 0.05). Infant whole blood was also subjected to in vitro antigenic stimulation. TNF, IFNγ, IL-4, IL-13, and TGFβ1 responses by infant leukocytes were significantly higher if mothers were vitD sufficient but were not as closely correlated to infants’ own vitD status. Conversely, IL-10 and IL-12 responses after antigenic challenge were more correlated to infant vitD status. These data are consistent with vitD-mediated changes in breast milk composition providing immunological signaling to breastfeeding infants and indicate differential physiological effects of direct-infant versus maternal vitD supplementation. Thus, consistent with many previous studies that focused on the importance of vitD sufficiency during pregnancy, maintenance of maternal sufficiency likely continues to affect the health of breastfed infants.     

The Influence of Infant Feeding Practices on Infant Mortality in Southern Africa

Objective To examine the adjusted and unadjusted effects of infant feeding practices on infant mortality in Southern Africa. Methods A merged dataset from the most recent Demographic and Health Surveys for Lesotho, Swaziland, Zambia and Zimbabwe was analysed using the Cox Proportional Hazard Model. A total number of 13,218 infants born in 5 years preceding all the surveys with information on infant feeding practices constituted the study population. Infant mortality was the outcome variable and infant feeding practices categorised into; no breastfeeding, partial breastfeeding and exclusive breastfeeding were the main explanatory variables. Maternal demographic and socio-economic characteristics and infants’ bio-demographic characteristics were also studied. Results Although, exclusive breastfeeding was quite low (12 %), exclusively breastfed infants exhibited a 97 % lower risk of dying during infancy compared to infants not breastfed in the region. Variations existed by country in the levels and patterns of both infant mortality and infant feeding practices. Mother’s country, highest level of education and marital status; child’s sex, birth weight and preceding birth interval were the significant predictors of infant mortality in Southern Africa. Conclusions Any form of breastfeeding whether exclusive or partial breastfeeding greatly reduces the risk of infant mortality with the greatest mortality reduction effect observed among exclusively breastfed infants in Southern Africa. To reduce the upsurge of infant mortality, there is the need to step up the effectiveness of child nutrition programmes that promote breastfeeding and put emphasis on exclusive breastfeeding of infants in the region.     

Transient Effect of Infant Formula Supplementation on the Intestinal Microbiota

Breastfeeding is the gold standard for feeding infants because of its long-term benefits to health and development, but most infants in the United States are not exclusively breastfed in the first six months. We enrolled 24 infants who were either exclusively breastfed or supplemented with formula by the age of one month. We collected diet information, stool samples for evaluation of microbiotas by 16S rRNA sequencing, and blood samples for assessment of immune development by flow cytometry from birth to 6 months of age. We further typed the Bifidobacterium strains in stool samples whose 16S rRNA sequencing showed the presence of Bifidobacteriaceae. Supplementation with formula during breastfeeding transiently changed the composition of the gut microbiome, but the impact dissipated by six months of age. For example, Bifidobacterium longum, a bacterial species highly correlated with human milk consumption, was found to be significantly different only at 1 month of age but not at later time points. No immunologic differences were found to be associated with supplementation, including the development of T-cell subsets, B cells, or monocytes. These data suggest that early formula supplementation, given in addition to breast milk, has minimal lasting impact on the gut microbiome or immunity.     

A Positive Impact of an Observational Study on Breastfeeding Rates in Two Neonatal Intensive Care Units

We aimed to investigate whether the participation in an observational study on breastfeeding (Doal) modified breastfeeding outcomes in enrolling neonatal intensive care units (NICUs). This bi-centric before-and-after study included neonates who were admitted during a 4-month period before and a 4-month period after the implementation of Doal. Breastfeeding intention and breastfeeding rates at discharge were compared between the two periods. The association between inclusion in Doal and breastfeeding at discharge was assessed among the infants fulfilling the inclusion criteria of Doal. The present study included 655 neonates. After adjustments, both breastfeeding (aOR 1.21, 95%CI [1.1; 1.4], p = 0.001) and exclusive breastfeeding (aOR 1.8, 95%CI [1.4; 2.3], p < 0.001) at discharge increased in the period after. Breastfeeding intention was higher in one center in the period after (79%) compared to before (59%, p = 0.019). Compared to the period before, neonates who were not included in Doal in the period after had a lower chance to be breastfed at discharge, whereas those included were more frequently exclusively breastfed. The participation in an observational study on breastfeeding was associated with an increase in breastfeeding outcomes in enrolling neonatal intensive care units (NICUs). Patients who are not included deserve attention as they are at risk to be disadvantaged regarding breastfeeding success.     

Microbiota Changes in Fathers Consuming a High Prebiotic Fiber Diet Have Minimal Effects on Male and Female Offspring in Rats

Background: Consuming a diet high in prebiotic fiber has been associated with improved metabolic and gut microbial parameters intergenerationally, although studies have been limited to maternal intake with no studies examining this effect in a paternal model. Method: Male Sprague Dawley rats were allocated to either (1) control or (2) oligofructose-supplemented diet for nine weeks and then mated. Offspring consumed control diet until 16 weeks of age. Bodyweight, body composition, glycemia, hepatic triglycerides, gastrointestinal hormones, and gut microbiota composition were measured in fathers and offspring. Results: Paternal energy intake was reduced, while satiety inducing peptide tyrosine tyrosine (PYY) gut hormone was increased in prebiotic versus control fathers. Increased serum PYY persisted in female prebiotic adult offspring. Hepatic triglycerides were decreased in prebiotic fathers with a similar trend (p = 0.07) seen in female offspring. Gut microbial composition showed significantly reduced alpha diversity in prebiotic fathers at 9 and 12 weeks of age (p < 0.001), as well as concurrent differences in beta diversity (p < 0.001), characterized by differences in Bifidobacteriaceae, Lactobacillaceae and Erysipelotrichaceae, and particularly Bifidobacterium animalis. Female prebiotic offspring had higher alpha diversity at 3 and 9 weeks of age (p < 0.002) and differences in beta diversity at 15 weeks of age (p = 0.04). Increases in Bacteroidetes in female offspring and Christensenellaceae in male offspring were seen at nine weeks of age. Conclusions: Although paternal prebiotic intake before conception improves metabolic and microbiota outcomes in fathers, effects on offspring were limited with increased serum satiety hormone levels and changes to only select gut bacteria.     

Sun Exposure and Vitamin D Supplementation in Relation to Vitamin D Status of Breastfeeding Mothers and Infants in the Global Exploration of Human Milk Study

Although vitamin D (vD) deficiency is common in breastfed infants and their mothers during pregnancy and lactation, a standardized global comparison is lacking. We studied the prevalence and risk factors for vD deficiency using a standardized protocol in a cohort of breastfeeding mother-infant pairs, enrolled in the Global Exploration of Human Milk Study, designed to examine longitudinally the effect of environment, diet and culture. Mothers planned to provide breast milk for at least three months post-partum and were enrolled at four weeks postpartum in Shanghai, China (n = 112), Cincinnati, Ohio (n = 119), and Mexico City, Mexico (n = 113). Maternal serum 25(OH)D was measured by radioimmunoassay (<50 nmol/L was categorized as deficient). Serum 25(OH)D was measured in a subset of infants (35 Shanghai, 47 Cincinnati and 45 Mexico City) seen at 26 weeks of age during fall and winter seasons. Data collected prospectively included vD supplementation, season and sun index (sun exposure × body surface area exposed while outdoors). Differences and factors associated with vD deficiency were evaluated using appropriate statistical analysis. vD deficiency in order of magnitude was identified in 62%, 52% and 17% of Mexican, Shanghai and Cincinnati mothers, respectively (p < 0.001). In regression analysis, vD supplementation (p < 0.01), obesity (p = 0.03), season (p = 0.001) and sites (p < 0.001) predicted maternal vD status. vD deficiency in order of  magnitude was found in 62%, 28%, and 6% of Mexican, Cincinnati and Shanghai infants, respectively (p < 0.001). Season (p = 0.022), adding formula feeding (p < 0.001) and a higher sun index (p = 0.085) predicted higher infant vD status. vD deficiency appears to be a global problem in mothers and infants, though the prevalence in diverse populations may depend upon sun exposure behaviors and vD supplementation. Greater attention to maternal and infant vD status starting during pregnancy is warranted worldwide.     

Long-Term Safety and Efficacy of Prebiotic Enriched Infant Formula—A Randomized Controlled Trial

The present study aims to evaluate the effects of an infant formula supplemented with a mixture of prebiotic short and long chain inulin-type oligosaccharides on health outcomes, safety and tolerance, as well as on fecal microbiota composition during the first year of life. In a prospective, multicenter, randomized, double-blind study, n = 160 healthy term infants under 4 months of age were randomized to receive either an infant formula enriched with 0.8 g/dL of Orafti^®Synergy1 or an unsupplemented control formula until the age of 12 months. Growth, fever (>38 °C) and infections were regularly followed up by a pediatrician. Digestive symptoms, stool consistency as well as crying and sleeping patterns were recorded during one week each study month. Fecal microbiota and immunological biomarkers were determined from a subgroup of infants after 2, 6 and 12 months of life. The intention to treat (ITT) population consisted of n = 149 infants. Both formulae were well tolerated. Mean duration of infections was significantly lower in the prebiotic fed infants (p < 0.05). The prebiotic group showed higher Bifidobacterium counts at month 6 (p = 0.006), and higher proportions of Bifidobacterium in relation to total bacteria at month 2 and 6 (p = 0.042 and p = 0.013, respectively). Stools of infants receiving the prebiotic formula were softer (p < 0.05). Orafti^®Synergy1 tended to beneficially impact total daily amount of crying (p = 0.0594). Supplementation with inulin-type prebiotic oligosaccharides during the first year of life beneficially modulates the infant gut microbiota towards higher Bifidobacterium levels at the first 6 months of life, and is associated with reduced duration of infections.     

北京市0~36月龄婴幼儿肠道菌群特点

目的 了解0~36月龄婴幼儿肠道菌群的变化特点以及0～6月龄是否纯母乳喂养对肠道菌群定植的影响。方法 于2021年1—4月,在北京市海淀区、昌平区及通州区招募0~36月龄健康单胎婴幼儿并收集新鲜粪便,最终纳入291例婴幼儿作为研究对象,并将77例6～36月龄的婴幼儿按照目前是否仍喂养母乳分为持续母乳喂养组和已断奶组,分析0～6月龄是否纯母乳喂养对肠道菌群的影响。利用Illumina Novaseq 6000测序平台对16S rRNA V4区进行测序。结果 1)婴幼儿肠道菌群的多样性和物种组成随年龄变化,Shannon指数随月龄呈现上升趋势。在门水平上,肠道菌群主要由变形菌门(Proteobacteria)、厚壁菌门(Firmicutes)、放线菌门(Actinobacteria)及拟杆菌门(Bacteroidetes)组成,新生儿中变形菌门丰富度最高,但随着月龄增加,厚壁菌逐渐替代变形菌成为主要优势菌。2) 在6～36月龄的婴幼儿中,若6月龄之前的喂养方式均为纯母乳喂养,那么断奶之后Shannon指数和Observed-OTUs指数高于持续母乳喂养的婴幼儿(Z=-2.400, P=0.015);在6～36月龄已断奶的婴幼儿中,6月龄之前纯母乳喂养婴幼儿肠道菌群的Shannon指数高于混合喂养(Z=-2.500, 杜拉拉P=0.011)。结论 婴幼儿肠道菌群多样性及构成随月龄变化明显,并且0～6月龄是否纯母乳喂养影响婴幼儿肠道菌群的多样性。     

Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis

Cow’s milk protein allergy (CMPA) is associated with dysbiosis of the infant gut microbiome, with allergic and immune development implications. Studies show benefits of combining synbiotics with hypoallergenic formulae, although evidence has never been systematically examined. This review identified seven publications of four randomised controlled trials comparing an amino acid formula (AAF) with an AAF containing synbiotics (AAF-Syn) in infants with CMPA (mean age 8.6 months; 68% male, mean intervention 27.3 weeks, n = 410). AAF and AAF-Syn were equally effective in managing allergic symptoms and promoting normal growth. Compared to AAF, significantly fewer infants fed AAF-Syn had infections (OR 0.35 (95% CI 0.19–0.67), p = 0.001). Overall medication use, including antibacterials and antifectives, was lower among infants fed AAF-Syn. Significantly fewer infants had hospital admissions with AAF-Syn compared to AAF (8.8% vs. 20.2%, p = 0.036; 56% reduction), leading to potential cost savings per infant of £164.05–£338.77. AAF-Syn was associated with increased bifidobacteria (difference in means 31.75, 95% CI 26.04–37.45, p < 0.0001); reduced Eubacterium rectale and Clostridium coccoides (difference in means −19.06, 95% CI −23.15 to −14.97, p < 0.0001); and reduced microbial diversity (p < 0.05), similar to that described in healthy breastfed infants, and may be associated with the improved clinical outcomes described. This review provides evidence that suggests combining synbiotics with AAF produces clinical benefits with potential economic implications.     

Protein Intake,Metabolic Status and the Gut Microbiota in Different Ethnicities: Results from Two Independent Cohorts

Background: Protein intake has been associated with the development of pre-diabetes (pre-T2D) and type 2 diabetes (T2D). The gut microbiota has the capacity to produce harmful metabolites derived from dietary protein. Furthermore, both the gut microbiota composition and metabolic status (e.g., insulin resistance) can be modulated by diet and ethnicity. However, to date most studies have predominantly focused on carbohydrate and fiber intake with regards to metabolic status and gut microbiota composition. Objectives: To determine the associations between dietary protein intake, gut microbiota composition, and metabolic status in different ethnicities. Methods: Separate cross-sectional analysis of two European cohorts (MetaCardis, n = 1759; HELIUS, n = 1528) including controls, patients with pre-T2D, and patients with T2D of Caucasian/non-Caucasian origin with nutritional data obtained from Food Frequency Questionnaires and gut microbiota composition. Results: In both cohorts, animal (but not plant) protein intake was associated with pre-T2D status and T2D status after adjustment for confounders. There was no significant association between protein intake (total, animal, or plant) with either gut microbiota alpha diversity or beta diversity, regardless of ethnicity. At the species level, we identified taxonomical signatures associated with animal protein intake that overlapped in both cohorts with different abundances according to metabolic status and ethnicity. Conclusions: Animal protein intake is associated with pre-T2D and T2D status but not with gut microbiota beta or alpha diversity, regardless of ethnicity. Gut microbial taxonomical signatures were identified, which could function as potential modulators in the association between dietary protein intake and metabolic status.     

Association between Vitamin D and Dental Caries in a Sample of Canadian and American Preschool-Aged Children

Background: Inadequate vitamin D levels may increase the risk of caries during childhood. The purpose of this study was to investigate the association between 25-hydroxyvitamin D (25(OH)D) status and severe early childhood caries (S-ECC) in preschool children. Methods: Data were obtained from children <72 months of age in two case–control studies in Winnipeg, Manitoba and Richmond, Virginia. Serum analysis assessed 25(OH)D, calcium and parathyroid concentrations. Data on demographics, dental history and oral hygiene were obtained via questionnaires. Bivariate and multiple logistic regression analyses were performed to assess the relationships between demographic and biological variables and S-ECC. A p-value of ≤0.05 was significant. Results: Data were available for 200 children with S-ECC and 144 caries-free controls. Children with S-ECC had significantly lower 25(OH)D levels than those who were caries-free (p < 0.001), and children with deficient 25(OH)D levels were 10 times more likely to have S-ECC (p < 0.001). Multiple logistic regression revealed that having higher 25(OH)D and calcium concentrations (p = 0.019 and p < 0.0001, respectively), as well as being breastfed in infancy (p < 0.001), were significantly and independently associated with lower odds of S-ECC, while dental insurance (p = 0.006) was associated with higher odds of S-ECC. Conclusions: This study provides additional evidence of an association between nutritional status, specifically vitamin D and calcium levels, and S-ECC.     

The uniqueness of human milk. Psychological differences between breast and bottle feeding

This paper examines the theory that breastfed and bottlefed infants are psychological equivalents. There are 2 patterns of breastfeeding most often encountered, unrestricted and token breastfeedings. There are maternal differences between those who breastfeed and those who do not. The initial experience of breastfeeding is culturally dependent. A mother who practices unretricted breastfeeding is receiving sustained stimulation to her nipples and experiences a generalized body response. Likewise such a breastfeeding mother experiences other long-term psychophysiologic reactions such as lactation amenorrhea and changes in hormonal balance. Breastfeeding women are often interested in a quick return to sexual intercourse and display a more general attitude towards men. A mother's personality and her ability to adjust to life situations often varies with the choice of feeding. 1 study found that mothers who breastfed displayed significantly less neuroticism than those who did not. Breastfeeding behavior appears to be sensitive to even minor variations in the social milieu. The type of breastfeeding practiced is likewise a significant variable for the infant. The initial feeding of an unrestricted breastfed infant is usually smooth unlike the situation for the token breastfed. Both feeding patterns involve assuagement of hunger needs but are dependent on social setting. For the breastfed infant, comfort as well as nourishment are presented with the mother as part of the package. These 2 experiences are often split in bottlefed and token breastfed infants. The 2 sucking patterns resemble each other superficially and the breastfed infant seems to develop more interest in sucking. Different activity levels manifest themselves by the 3rd day postpartum with the breastfed showing a greater propensity toward activity. Intelligence scores are also related to feeding patterns, with those exclusively breastfed for 4-9 months displaying the highest scores in relation to their age.     

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.     

Breastfeeding practices and associated factors among children under 24 months of age in Timor-Leste

OBJECTIVE: To describe breastfeeding practices and to assess the sociodemographic factors associated with selected breastfeeding indicators. DESIGN AND SETTING: The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households from four different geographic areas in Timor-Leste. SUBJECTS: A total of 2162 children aged 0-23 months. RESULTS: A high proportion (97.6%) of infants had been ever breastfed, but only 46.1% had initiated breastfeeding within the first hour of birth. Seventy-eight percent of children <24 months were currently breastfed, 30.7% of infants <6 months were exclusively breastfed and 12.5% of infants <12 months were bottle-fed. A high proportion of infants of 6-9 months (82.0%) were receiving complementary food in addition to breast milk. Multivariate analysis revealed that exclusive breastfeeding was significantly lower in the rural west region (odds ratio (OR)=3.15) compared to the urban region, and among those from richest households (OR=1.90) compared to poorest. Mothers with primary education were significantly more likely to exclusively breastfeed than mothers with no education (OR=0.62). Increasing age of the infant was associated with significantly less current (OR=1.23) and exclusive (OR=1.35) breastfeeding. Continuation of breastfeeding at the end of the first year was significantly lower in non-working mothers (OR=1.58) compared to working mothers, and among infants born in health-care facilities (OR=2.16) than those born at home. CONCLUSIONS: Breastfeeding practices in Timor-Leste were satisfactory, except the exclusive breastfeeding at 6 months. However, more socioeconomically privileged groups demonstrated a poorer breastfeeding performance than disadvantaged groups. Further breastfeeding promotion programmes are needed across all population groups, and should include health-care providers and maternity institutions.     

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.     

Alcohol use alters the colonic mucosa–associated gut microbiota in humans

Alcohol misuse is a risk factor for many adverse health outcomes. Alcohol misuse has been associated with an imbalance of gut microbiota in preclinical models and alcoholic diseases. We hypothesized that daily alcohol use would change the community composition and structure of the human colonic gut microbiota. Thirty-four polyp-free individuals donated 97 snap-frozen colonic biopsies. Microbial DNA was sequenced for the 16S ribosomal RNA gene hypervariable region 4. The SILVA database was used for operational taxonomic unit classification. Alcohol use was assessed using a food frequency questionnaire. We compared the biodiversity and relative abundance of the taxa among never drinkers (ND, n = 9), former drinkers (FD, n = 10), current light drinkers (LD, <2 drinks daily, n = 9), and current heavy drinkers (HD, ≥2 drinks daily, n = 6). False discovery rate–adjusted P values (q values) < .05 indicated statistical significance. HD had the lowest α diversity (Shannon index q value < 0.001), and HD's microbial composition differed the most from the other groups (P value = .002). LD had the highest relative abundance of Akkermansia (q values < 0.001). HD had the lowest relative abundance of Subdoligranulum, Roseburia, and Lachnospiraceaeunc91005 but the highest relative abundance of Lachnospiraceaeunc8895 (all q values < 0.05). The multivariable negative binomial regression model supported these observations. ND and FD had a similar microbial profile. Heavy alcohol use was associated with impaired gut microbiota that may partially mediate its effect on health outcomes.