Spoonfeeding is associated with increased infant weight but only amongst formula‐fed infants

Infant feeding experiences are important for the development of healthy weight gain trajectories. Evidence surrounding milk feeding and timing of introduction to solids is extensive; however, the impact of the method of introducing solids on infant growth has been relatively underexplored. Baby‐led weaning (where infants self‐feed family foods) is proposed to improve appetite regulation, leading to healthier weight gain and a reduced risk of obesity. However, the evidence is mixed and has methodological inconsistencies. Furthermore, despite milk being a large part of the infant diet during the period infants are introduced to solid foods, its influence and interaction with introductory style have not been considered. The aim of this study was to explore growth among infants aged 3–12 months according to both style of introduction to solid foods and milk feeding; 269 infants were weighed and measured, and body mass index (BMI) computed. The results showed that overall, infants who were spoon‐fed (compared with self‐fed) at introduction to complementary feeding (CF) had greater length (but not weight or BMI). However, when milk feeding was accounted for, we found that infants who were both spoon‐fed and fully formula fed had greater weight compared with spoon‐fed, breastfed infants. There was no significant difference in weight among self‐fed infants who were breastfed or formula fed. The results highlight the importance of considering infant feeding as a multicomponent experience in relation to growth, combining both milk feeding and method of CF. This relationship may be explained by differences in maternal feeding style or diet consumed.     

中国九市不同喂养方式婴儿体格生长水平的横断面调查

目的 调查不同喂养方式婴儿体格生长水平的现状和差异。方法 1~<12月龄婴儿的母乳喂养、辅食添加及体格生长数据来自2015年“第五次中国九市7岁以下儿童体格发育调查”。1~<6月龄婴儿的喂养方式分为纯母乳喂养、部分母乳喂养和人工喂养,~<12月龄的喂养方式分为持续母乳喂养和人工喂养。不同喂养方式婴儿体重、身长及头围生长水平比较采用方差分析或t检验。结果 共纳入1~<12月龄婴儿59 170人。1~<6月龄纯母乳喂养率、部分母乳喂养率和人工喂养率分别为48.6%、37.4%和14.0%,~<12月龄持续母乳喂养率和人工喂养率分别为59.9%和40.1%。1~<6月龄纯母乳喂养婴儿平均体重略高于部分母乳喂养婴儿,差值范围为0.06~0.20 kg;也略高于人工喂养婴儿,差值范围为0.09~0.22 kg。6~<12月龄持续母乳喂养婴儿平均身长低于人工喂养婴儿,差值范围为-0.3~-0.1 cm。不同喂养方式在6~<12月龄体重、1~<6月龄身长及1~<12月龄头围上差异均无统计学意义。不同喂养方式婴儿体重、身长及头围生长模式与WHO儿童生长标准相似,但总体上体重和身长平均生长水平略高于WHO儿童生长标准。结论 不同喂养方式生长模式相似,在生后的前半年纯母乳喂养婴儿的生长水平略高于部分母乳喂养和人工喂养婴儿,在后半年持续母乳喂养婴儿的生长水平略低于人工喂养婴儿。     

Breast milk feeding in very low birthweight infants

ABSTRACT. The infant feeding practices of 77 very low birthweight (VLBW) survivors with birthweights under 1500 g were studied. 58 (75%) infants received fresh expressed breast milk (EBM) from their own mothers, of whom 42 were successfully breastfed at a medium postconceptual age of 36 weeks. Overall incidence of breastfeeding in the VLBW population was 44% at 3 months and 23% at 6 months. The postnatal ages at which breastfeeding stopped ranged from 2 months to 28 months (median 4 months). No significant differences in perinatal factors were found between the breast milk and milk formula groups. There were significantly more mothers in the breast milk group who were given advice and encouragement during their pregnancy on breastfeeding and who had planned in the antenatal period to breastfeed their infants. The most common reasons given for deciding against providing breast milk were related to extreme prematurity of the infant. Nursery weight gain of infants fed breast milk and milk formula were similar. Necrotizing enterocolitis occurred significantly less frequently in the breast milk group. The study suggested that the special attention and positve encouragement given to parents of VLBW infants had contributed to the successful establishment and continuation of a feeding regime utilizing fresh breast milk from the infant's own mother, which we believe has immunological, psychological and nutritional benefits in this high-risk infant population.     

Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4-6 months: a longitudinal prospective study based on daily records of feeding

Aim: In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4-6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) "12-month breastfed pooled data set" and the Euro-Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference. Methods: 147 exclusively breastfed infants and 325 non-exclusively breastfed Swedish infants, with a birthweight of 33 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly. Results: Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non-exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12-16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the "WHO pooled breastfed data set" and the Euro-Growth references for exclusively breastfed infants. Conclusion: In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non-exclusively breastfed infants with a high breastfeeding rate.     

不同喂养方式对极低/超低出生体重儿生长发育的影响

目的 探讨极低/超低出生体重（VLBW/ELBW）早产儿纠正年龄6个月内生长发育情况及不同喂养方式对其生长发育的影响。方法 对2016年1月至2017年4月出院并按时完成随访的VLBW/ELBW早产儿109例进行纠正年龄6个月内的生长发育监测。采用Z评分法评价体格指标,并分析不同喂养方式（母乳喂养组：母乳+母乳强化剂;混合喂养组：母乳+早产儿配方奶;人工喂养组：早产儿配方奶）对其生长发育的影响。结果 年龄别体重Z积分、年龄别身长Z积分、身长别体重Z积分、体重指数Z积分的追赶高峰发生于纠正年龄3个月内;年龄别头围Z积分的追赶高峰发生于纠正年龄5个月。VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内。母乳喂养组体重、身长、头围的生长在纠正年龄3个月时均优于混合喂养组和/或人工喂养组（P < 0.05）;母乳喂养组头围、身长的生长在纠正年龄6个月时均优于混合喂养组和/或人工喂养组（P < 0.05）。结论 VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内,提示应加强早期个体化随访及营养指导以减少生长偏离的发生。亲母母乳喂养并添加母乳强化剂是VLBW/ELBW早产儿的最佳喂养方式。     

Decreased thymus size in formula-fed infants compared with breastfed infants

The objective of this research was to investigate if breastfeeding affects the size of the thymus. Ultrasound assessment of the thymic index (a volume estimate) at birth and age 4 months in 47 healthy infants born in the hospital were used. History of feeding mode, body size and illness were registered. At 4 months the geometric mean thymic index (range) was 38.3 (16.2-83.2) in exclusively breastfed infants ( n = 21), 27.3 (15.6-50.0) in partially breastfed infants ( n = 13) and 18.3 (12.2-32.6) in formula fed infants ( n = 13; p = 0.0001, ANOVA). This finding was independent of weight, length, sex and previous or current illness. There was no significant difference in mean thymic index at birth between the three feeding groups and mean thymic index had increased in all three groups from birth to 4 months. For the formula-fed infants it seems that the thymus remains large for a period and then decreases in size after breastfeeding has been terminated. We conclude that the thymus is considerably larger in breastfed than in formula-fed infants at the age of 4 months. The cause of this difference is unknown but human milk contains many immune modulating factors that might cause this effect.     

Breastfeeding modifies the impact of diarrhoeal disease on relative weight: a longitudinal analysis of 2–12 month‐old Filipino infants

Undernutrition and diarrhoeal disease are major causes of infant mortality. We investigated the combined roles of breastfeeding and diarrhoea on infant size in 2940 infants from the Cebu Longitudinal Health and Nutrition Survey. The study aimed to assess whether breastfeeding status modified the deficits associated with diarrhoeal disease. The primary exposures were combinations of current breastfeeding status (yes/no), the presence of diarrhoeal disease in previous week (yes/no) and a categorical survey variable (six surveys taken at bimonthly intervals when infants were 2–12 months of age). Relative weight (weight‐for‐length z‐scores), calculated using the WHO growth standards, was estimated using sex‐stratified, fixed‐effects longitudinal models that also adjusted for energy from complementary foods. Post‐estimation Wald tests were conducted to identify subgroup differences in relative weight. Diarrhoea was associated with reduced relative weight in both breastfed and non‐breastfed infants of 6–12 months. Diarrhoea‐related deficits in relative weight were significantly exacerbated in non‐breastfed girls of 6 and 8 months. Importantly, in infants <6 months, being breastfed and having diarrhoea was still associated with greater relative weight compared with being non‐breastfed and diarrhoea‐free. Breastfeeding emerged as a strong contributor to relative weight in younger infants (<6 months) while diarrhoeal disease strongly contributed to deficits in relative weight in older infants (6–12 months). These findings underscore the importance of breastfeeding for promoting infant nutritional status in infants with or without diarrhoea from birth to 12 months.     

Breastfeeding and catch-up growth in infants born small for gestational age

Postnatal growth was prospectively measured from birth to 1 y in 54 term infants born small for gestational age (SGA), fed either breast milk or a standard term infant formula. Breastfeeding was associated with a 0.36 and 0.64 standard deviation (SD) increase in weight at 2 weeks and 3 months of age. respectively, which persisted beyond the breastfeeding period (0.64 SD at 1 y). Breastfed infants also showed greater catch-up growth in head circumference [SD score (SDS) 0.53 higher at 3 months], and greater body length gain (SDS 0.68 higher at 6 months). This increased growth was independent of potentially confounding obstetric, social and demographic factors. Our findings suggest that breastfeeding may promote faster growth in infants compromised by poor growth in utero. SGA infants may be programmed for a number of adverse outcomes; the possibility that such events are altered by choice of postnatal diet is a key issue for future research.     

Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months.
Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2–6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight ≥2500 g. We compared 475 infants breastfed exclusively for ≥6 months (group A), 870 infants breastfed fully/exclusively ≥4 months, but not exclusively ≥6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C).
Results: In multivariate analysis ≥6 months of exclusive breastfeeding reduced significantly the risk for ≥1 episode of gastrointestinal infection(s) during months 1–9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44–0.82). The application of the World Health Organization (WHO) – child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores.
Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for ≥6 months of exclusive breastfeeding.     

Preventive effect of feeding high-risk infants a casein hydrolysate formula or an ultrafiltrated whey hydrolysate formula. A prospective, randomized, comparative clinical study

In a prospective study of a 1-year birth cohort of 158 high-risk infants the effect of feeding breastmilk, a casein hydrolysate (Nutramigen®) or a new ultrafiltrated whey hydrolysate (Profylac®) on the development of cow milk protein allergy/intolerance (CMPA/CMPI) was assessed and compared. All the infants had biparental or severe single atopic predisposition, the latter combined with cord blood IgE ≥ 0. 5 kU/L. At birth all infants were randomized to Nutramigen or Profylac, which was used when breastfeeding was insufficient or not possible during the first 6 months of life. During the same period this regimen was combined with avoidance of solid foods and cow milk protein. All mothers had unrestricted diets and were encouraged to do breastfeeding only. Moreover, avoidance of daily exposure to tobacco smoking, furred pets and dust-collecting materials in the the bedroom was advised. The infants were followed prospectively from birth to 18 months of age. All possible atopic symptoms were registered and controlled elimination/challenge studies were performed when symptoms suggested CMPA/CMPI. A total of 154 (97%) were followed up and 141 followed the diet strictly. Eighty-eight (62%) of the infants were breastfed for at least 6 months, 20 (14%) were breastfed exclusively, 59 and 62 had varying amounts of Nutramigen or Profylac respectively. CMPA/CMPI was diagnosed in 1/20, 1/59 and 3/62 in the breastfed, the Nutramigen and Profylac groups respectively, but 1 of the latter also had Nutramigen. None of the infants showed reactions against Nutramigen or Profylac. In 4 infants symptoms were provoked by breastmilk when the mother ingested cow milk and in 1 only by cow milk. The incidence of CMPA/CMPI among the infants who followed the dietary prevention programme was 3. 6% (5/141) which was a significant reduction compared to 20% (15/75) in an identically defined high-risk group without dietary preventive measures. None of the infants in the prevention group developed CMPA/CMPI after the age of 6 months. We conclude that feeding breastmilk, an extensively hydrolysed casein formula (Nutramigen) or an ultrafiltrated whey hydrolysate (Profylac) combined with avoidance of solid foods during the first 6 months of life in high-risk infants significantly reduced the cumulative incidence of CMPA/CMPI during the first 18 months of life. No difference was noted whether the infants were fed breastmilk, Nutramigen or Profylac and a diet period of 6 months seems sufficient. Both formulae were well tolerated and accepted by the infants.     

Effect of different types of feeding on fatty acid composition of erythrocyte membrane lipids in full-term infants

Significantly higher levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) in plasma lipids have previously been reported in 2 to 8-wk-old as well as in 6 to 12-mo-old full-term infants fed exclusively human milk than in infants exclusively receiving formula without AA and DHA. However, in real life many infants receive both human milk and breast milk substitute formula. Healthy, full-term infants aged 2 to 12 mo and fed exclusively human milk (n = 29, age: 29.2 [14.6] wk, mean [SD], no human milk substitute formula), exclusively formula without AA and DHA (n = 30, age: 26.6 [15.2] wk, no human milk after the age of 1 mo) or combined diet (n = 38, age: 30.3 [12.8] wk, human milk for > 1 mo and breast milk substitute formula) were investigated in this cross-sectional study. Fatty acid composition of erythrocyte membrane phosphatidylethanolamine (PE), phosphatidylcholine and sphingomyeline lipids was determined by high-resolution capillary gas-liquid chromatography. The most pronounced diet-related differences were seen in PE lipids. Values of PE alpha-linolenic acid (0.07 [0.05] vs 0.26 [0.18] vs 0.19 [0.19], median [range from the 1st to the 3rd quartile], exclusively breastfed vs. exclusively formula fed vs combined diet), eicosapentaenoic acid (0.19 [0.13] vs 0.35 [0.23] vs 0.27 [0.31]) and dihomo-gamma-linolenic acid (1.34 [0.42] vs 1.86 [0.62] vs 1.58 [0.73]) were significantly lower in exclusively breastfed infants than in those fed formula, exclusively or partially. In contrast, PE AA (26.48 [2.50] vs 24.34 [4.74] vs 24.94 [3.64]) and DHA (4.93 [2.91] vs 3.51 [2.14] vs 3.58 [2.27]) values were significantly higher in exclusively breastfed infants than in the other two groups. Conclusion: In full-term infants aged 2 to 12 mo, erythrocyte membrane AA and DHA values are significantly higher with exclusive breastfeeding than with partial breastfeeding or exclusive feeding of formula without AA and DHA.     

How to assess slow growth in the breastfed infant. Birth to 3 months

Pediatricians must monitor early breastfeeding to detect and manage breastfeeding difficulties that lead to slow weight gain and subsequent low milk production. Infant growth during the first 3 months of life provides a clear indication of breastfeeding progress. Healthy, breastfed infants lose less than 10% of birth weight and return to birth weight by age 2 weeks. They then gain weight steadily, at a minimum of 20 g per day, from age 2 weeks to 3 months. Any deviation from this pattern is cause for concern and for a thorough evaluation of the breastfeeding process. Evaluation includes history taking and physical examination for the mother and infant. Observation of a breastfeeding session by a skilled clinician is crucial. A differential diagnosis is generated, followed by a problem-oriented management plan. Special techniques may be used to assist in complicated situations. Ongoing monitoring is required until weight gain has normalized. In most cases, early intervention can restore promptly infant growth and maternal milk supply. Underlying illness of the infant or mother must be considered if weight gain and milk supply do not respond to the earlier-mentioned interventions as expected. Physicians are responsible for knowledge about additional resources and for coordination of breastfeeding care. Pediatricians have a pivotal role in achieving the goals of optimal breastfeeding and appropriate infant growth.     

Association of 6 months of exclusive breastfeeding with higher fat‐free mass in infants in a low‐resource setting with high HIV prevalence in South Africa

Exclusive breastfeeding for 6 months is recommended by the World Health Organisation (WHO) for optimal health and growth of infants, but it is not a common practice in South Africa. A breastfeeding counselling programme was run to inform, encourage and support mothers to exclusively breastfeed their infants for 6 months, and mother–infant pairs were invited to participate in a research project to determine breast milk intake volumes using the dose‐to‐mother deuterium dilution stable isotope technique. This technique yields objective measurements of breast milk intake volumes and also enables determination of exclusivity of breastfeeding, which is most frequently determined by maternal recall and can be subject to bias. Exclusivity of breastfeeding at 6 weeks, 3 months and 6 months following birth of the infants was correlated with infant fat‐free mass at 12 months, which was determined by the dose‐to‐infant deuterium dilution stable isotope technique. Results showed that infants who were exclusively breastfed for 6 months had a higher per cent fat‐free mass at 12 months compared with infants who were not exclusively breastfed for 6 months (P < 0.05). This objective determination of both breastfeeding patterns and infant body composition gives weight to the WHO recommendation of exclusive breastfeeding for 6 months as it demonstrated adequate fat‐free mass in infants at 12 months, even in an area with high HIV prevalence. © 2016 John Wiley & Sons Ltd     

Influence of breastfeeding and complementary food on growth between 5 and 10 months

The aim of this study was to examine the nature of the association between breastfeeding, complementary feeding and growth in a random sample of infants from Denmark, where the prevalence of breastfeeding is high. A semiquantitative food frequency questionnaire and a questionnaire on breastfeeding duration and on weight and length measurements taken at the infant welfare visit at 5 and 10 months were sent to 590 families with 10-month-old infants. A total of 339 infants with complete growth data were included in the analyses. When controlling for mid-parental height and birth weight infants breastfed for ≥ 7 months gained 198 g less in weight ( p < 0:01) and 7 mm less in length ( p < 0:01) during the period from 5 to 10 months than infants breastfed for < 7 months. Controlling for these effects, the 10% of the sample with the highest protein intake (i.e. ≥16 energy percentage) gained 262g more than those with a lower protein intake ( p = 0:03). Infants breastfed for ≥ 7 months received significantly less cow's milk ( p < 0:01), and fewer meat-containing dishes ( p < 0:05) and sweets or cakes ( p < 0:01), which may partly explain the effect of breastfeeding. The long-term consequences of this moderate difference in growth velocity are unknown and the findings should not be used to advocate against breastfeeding during late infancy.     

Timing of solid food introduction and association with later childhood overweight and obesity: The IDEFICS study

This study investigated associations between timing of solid food introduction and childhood obesity and explored maternal characteristics influencing early feeding practices. Cross‐sectional data from children 2–9 years (n = 10,808; 50.5% boys) residing in 8 European countries of the IDEFICS study (2007–2008) were included. Late solid food introduction (≥7 months of age) was associated with an increased prevalence of later childhood overweight/obesity among exclusively breastfed children (OR [odds ratio]: 1.38, 95% CI [confidence interval] [1.01, 1.88]). In contrast, early solid food introduction (<4 months of age) was associated with lower prevalence of overweight/obesity among children that ceased exclusive breastfeeding earlier than 4 months (OR: 0.63, 95% CI [0.47, 0.84]). Children that were introduced to solids right after 6 months exclusive breastfeeding and continued to receive breastmilk (≥12 months) were less likely to become overweight/obese (OR: 0.67, 95% CI [0.51, 0.88]) compared to children that discontinued to receive breastmilk. Analyses were adjusted for age, sex, country, birth weight, parental education level, parental body mass index, tobacco use in pregnancy, gestational weight gain, and gestational diabetes. Underweight mothers, overweight mothers, mothers who reported daily smoking during pregnancy, and low‐educated mothers were less likely to follow recommendations on breastfeeding and timely solids introduction. Future studies should examine whether guidelines for solid food introduction timing have to distinguish between exclusively breastfed, formula fed, and too early exclusive breastfeeding‐ceased infants. There is also need for more prospective studies; recall bias was an important current limitation. In conclusion, health professionals should emphasize benefits of breastfeeding and appropriate solid food introduction, especially to mothers that are less likely to follow recommendations.     

Infant milk feeding practices in the Netherlands and associated factors

AIM: The aim of the study was to describe infant feeding practices and associated factors, and to explore mothers' main reasons for starting and stopping breastfeeding. METHODS: We performed a national inquiry into milk feeding practices among 9133 Dutch infants aged < 7 mo by means of a questionnaire. RESULTS: 78% of mothers initiated breastfeeding. At 1 and 4 mo, respectively, 51 and 25% of infants were fed primarily on human milk; after 6 mo, only 15% of mothers still provided human milk as the only source of milk feeding. During the whole 6-mo period, another 11 to 18% was fed on both breast and formula milk. Women initiating breastfeeding were more likely to be higher educated, have a higher-educated partner, be non-smokers, have a full-time job, and be primiparous. In addition, breastfeeding initiation rate was higher for women born outside the Netherlands. Longer duration of breastfeeding was mostly found amongst higher-educated, non-smoking women. The odds for continuation of breastfeeding after 4 mo increased when mothers' working hours did not exceed 16 h/wk. Infant delivery at home was associated with a higher initiation rate as well as longer duration of breastfeeding compared to hospital delivery. Infants born after 38 wk of gestation, with a birthweight of 3500 g had higher odds to be breastfed for a longer period. CONCLUSION: Only a minority of Dutch infants is breastfed for 6 mo. Maternal and infant characteristics are important predictors of breastfeeding initiation and duration.     

Langfristige Prägung der Gesundheit durch die Säuglingsernährung

The early nutrition from conception to early childhood has imprinting or programming effects on later health and disease risks. Rapid weight gain in fetal life and early childhood increases the risk of later obesity, diabetes and other non-communicable diseases (NCD). In observational cohort studies rapid weight gain from birth to 2 years old was associated with an increased risk of obesity up to adulthood. Breastfeeding is associated with less rapid weight gain in infancy than conventional infant formula nutrition. Several meta-analyses of observational studies found that breastfeeding was associated with an approximately 12–24?% reduction in the risk of obesity in later life. We investigated the early protein hypothesis, which proposes that a high protein intake in infancy leads to increased concentrations of insulinogenic amino acids, the growth factors insulin and insulin-like growth factor-1 (IGF-1) as well as greater weight gain and later obesity. The hypothesis was tested in a double blind randomized clinical trial involving 1678 term infants who received conventional infant and follow-on formulae with higher protein content or with reduced protein content during the first year of life. The reduced protein diet led to significantly reduced body weight, weight-for-length and body mass index (BMI) up to the age of 2 years and to a 2.4–2.9-fold reduction of obesity at 6 years old compared to conventional bottle feeding formulae. We concluded that infant feeding has powerful long-term programming effects, with very large effect sizes on obesity in early school age. Breastfeeding should be actively promoted, protected and supported. Infants not exclusively breastfed should receive infant formulae with reduced protein content. Unmodified cows’ milk contains three times as much protein as human milk and should be avoided as a drink in infancy.     

Prävention der kindlichen Adipositas durch die Säuglingsernährung

The prevalence of overweight and obesity among children and adolescents in Germany has doubled in less than two decades. In addition to familial risk factors and children’s lifestyle, prenatal and postnatal factors modulate the long-term risk of obesity. The imprinting effects of metabolic variables during limited, sensitive time periods of prenatal and postnatal development on long-term health and disease risk is called early metabolic programming of long term health. The role of infant nutrition is supported by a reduced obesity risk in previously breastfed compared to formula fed subjects, documented in numerous studies and three meta-analyses. Breastfeeding might protect against later obesity by inducing lesser weight gain in infancy due to the lower protein content of human milk compared to infant formulas (the early protein hypothesis). We tested this hypothesis in the European Childhood Obesity Study, a double-blind randomized clinical trial enrolling 1,678 infants in 5 countries (Belgium, Germany, Italy, Poland and Spain). Reduced protein intake in infancy normalized growth achieved at 2 years of age relative to breastfed infants and the current WHO growth standard. The difference in weight gain up to 2 years old could reduce the prevalence of obesity in adolescence by some 13%. We conclude that infant feeding practice has a high potential for long-term health effects. The results obtained should stimulate the review of current recommendations and policies for infant formula composition.     

Allergic diseases among very preterm infants according to nutrition after hospital discharge

To cite this article: Zachariassen G, Faerk J, Esberg BH, Fenger‐Gron J, Mortensen S, Christesen HT, Halken S. Allergic diseases among very preterm infants according to nutrition after hospital discharge. Pediatr Allergy Immunol 2011; 22 : 515–520. To determine whether a cow’s milk‐based human milk fortifier (HMF) added to mother’s milk while breastfeeding or a cow’s milk‐based preterm formula compared to exclusively mother’s milk after hospital discharge, increases the incidence of developing allergic diseases among very preterm infants (VPI) during the first year of life. Of a cohort of 324 VPI (gestational age 24–32 wk), the exclusively breastfed VPI were shortly before discharge randomized to breastfeeding without fortification or supplementing with a fortifier. Those not breastfed were fed a preterm formula. The intervention period was from discharge until 4 months corrected age (CA). Follow‐up was performed at 4 and 12 months CA including specific IgE to a panel of allergens at 4 months CA. The incidence during and prevalence at 12 months CA of recurrent wheezing (RW) was 39.2% and 32.7%, while atopic dermatitis (AD) was 18.0% and 12.1%, respectively. Predisposition to allergic disease increased the risk of developing AD (p = 0.04) [OR 2.6 (95% CI 1.0–6.4)] and the risk of developing RW (p = 0.02) [OR 2.7 (95% CI 1.2–6.3)]. Boys had an increased risk of developing RW (p = 0.003) [OR 3.1 (95% CI 1.5–6.5)]. No difference was found between nutrition groups. None developed food allergy. Compared to exclusively breastfed, VPI supplemented with HMF or fed exclusively a preterm formula for 4 months did not have an increased risk of developing allergic diseases during the first year of life.     

Adequacy of expressed breast milk for early gwoth of preterm infants.

Poor weight gain observed in preterm infants who were fed expressed breast milk compared with those fed a cows'' milk formular prompted a detailed study of early postnatal growth in preterm infants fed these two milks. 68 infants were divided into two categories by gestational age at birth (i) 28-32 weeks (n=28), (ii) 33-36 weeks (n=40). They were randomly allocated to a feed of expressed breast milk or a milk formula (Ostermilk 1). Rates of weight gain, linear growth, and head circumference growth were evaluated over two periods: birth-1 month, 1-2 months. The younger group who were fed breast milk showed slower overall growth rates over the first month than those fed formula. In the second month, and for the older infants over both of the 2-monthly periods, growth rates were similar in the two feeding regimens. It is concluded that expressed breast milk is inadequate for the growth of very immature preterm infants during early postnatal life.