The EU Childhood Obesity Project

The European Union Childhood Obesity Project was set up in 2001 to test the hypothesis that the higher risk of obesity seen in formula‐fed infants – as compared with breastfed babies – is a result of the higher protein content in infant formulas than in breastmilk. The infants participating in the study were recruited between 2002 and 2004 and followed up for 2 years. The first results of the study were published earlier this year. After 2 years, the weight‐for‐length and body mass index of the infants fed the lower‐protein formula were significantly lower than those fed the higher‐protein formulas. Extrapolating from previous studies suggests that the children in the higher‐protein group have a 13% increased risk of being obese in adolescence compared with those in the lower‐protein group. An analysis of the timing of weaning has also been published: this showed that formula‐fed infants were given solid foods on average 2 weeks earlier than breastfed infants (19 weeks compared with 21 weeks) and were twice as likely to be introduced to solid foods before the age of 4 months as breastfed infants.     

Low-Protein Infant Formula and Obesity Risk

Infant formulas have been designed to mimic human milk for infants who cannot be breastfed. The overall goal is to establish similar functional outcomes to assure optimal growth, development, maturation of the immune system, and programming of the metabolic system. However, after decades of improving infant formula, growth patterns and body composition development are still different in formula-fed infants compared to breastfed infants, which could contribute to an increased risk of obesity among formula-fed infants. It has been hypothesized that the lower protein concentration of breast milk compared to infant formula influences infants’ growth and body composition. Thus, several trials in formula-fed infants with different protein intake levels have been performed to test this hypothesis. In this review, we discuss the current evidence on low-protein infant formula and obesity risk, including future perspectives and implications.     

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.     

Frühkindliche Ernährung und späteres Adipositasrisiko1

Metabolic factors acting during limited and sensitive time periods of pre- and postnatal development can induce lasting effects on health and disease risk in later life up to old age, including later obesity risk, which is referred to as early metabolic programming of long-term health. Three meta-analyses of observational studies found that obesity risk at school age was reduced with early breastfeeding compared to formula feeding. We assumed that breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy and that one causative factor is the lower protein content of human milk compared to usual infant formulas (the “early protein hypothesis”). We are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial enrolling 1,678 infants in five countries (Belgium, Germany, Italy, Poland, Spain). We have randomized healthy infants born at term to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 years indicates that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the current WHO growth standard, which may furnish a significant long-term protection against later obesity. We conclude that infant feeding practice has a high potential for long-term health effects. The results obtained should stimulate the review of recommendations and policies for infant formula composition.     

Effects of alpha-lactalbumin-enriched formula containing different concentrations of glycomacropeptide on infant nutrition

BACKGROUND: Formula-fed infants have growth and plasma amino acid patterns different from those of breastfed infants. OBJECTIVE: alpha-Lactalbumin is a major protein in human milk, and the addition of bovine alpha-lactalbumin to infant formula has been proposed to modify the plasma amino acid pattern of the recipient infant, possibly allowing a reduction in the protein content of the formula, which may affect growth. DESIGN: We compared breastfed infants and infants fed standard formula or alpha-lactalbumin-enriched formulas (25% of protein) with glycomacropeptide accounting for 15% or 10% of the protein. The protein content of each formula was 13.1 g/L. Ninety-six infants aged 6 +/- 2 wk were recruited. Anthropometric measures were recorded, and interviews were conducted at enrollment and monthly until 6 mo of age. Blood samples were collected at enrollment and at 4 and 6 mo. RESULTS: Formula intake did not differ between groups, and weight gain in the alpha-lactalbumin-enriched formula groups were similar to that of the breastfed infants. The standard formula group gained significantly more weight than did the breastfed infants. All formula-fed infants had significantly higher plasma concentrations of most essential amino acids at 4 and 6 mo than did the breastfed infants, and serum urea nitrogen was also higher in the formula-fed infants. Insulin and leptin concentrations did not differ between groups. CONCLUSIONS: Compared with standard formula-fed infants, infants fed formula with a modified protein composition had growth patterns more similar to those of breastfed infants. All formula-fed groups had plasma amino acid concentrations similar to or higher than those of breastfed infants. This indicates that the protein content of alpha-lactalbumin-enriched formula can be further reduced, which should be evaluated.     

母乳喂养婴儿肥胖的危险因素及预后研究进展

母乳喂养可以为健康婴儿的生长发育提供最佳的营养。近年来的研究显示母乳喂养能预防儿童期肥胖的发生,但某些母乳喂养特别是纯母乳喂养的婴儿为何肥胖,这种现象对远期健康产生怎样的影响等问题逐渐引起学者们的重视。本文对母乳喂养婴儿肥胖的危险因素及预后研究进行总结,母乳中的高蛋白质含量,高水平的胰岛素样生长因子-1(IGF-1)、胃饥饿激素、瘦素以及寡糖多样性可能是导致母乳喂养婴儿生长过快的危险因素;人乳奶瓶喂养、夜间喂养次数多、每次喂养持续时间长、每次喂养间隔时间短等喂养行为问题也是母乳喂养婴儿肥胖的高危因素。不论是对母乳喂养还是配方奶喂养的婴儿,婴儿期超重或肥胖都会增加以后儿童期肥胖的风险。     

The Association of Formula Protein Content and Growth in Early Infancy: A Systematic Review and Meta-Analysis

This systematic review aimed to examine differences in growth outcomes between breastfed infants and infants fed with formula with different protein/energy ratios during the first six months of life. We conducted a systematic review in the PubMed, Web of Science, and Springer databases. Twenty clinical trials qualified for inclusion. We extracted data about the growth outcomes of infants who were exclusive breastfed or exclusively infant formula fed in the first six months and used a meta-analysis to pool the finding data. We categorized study formulas into four groups according to their protein content: <1.8, 1.8–2.0, 2.1–2.2, and >2.2 g/100 kcal. In the first month of life, growth was not different between formula- and breastfed infants. During 2–3 months of life, growth was faster in infants who consumed formulas with protein contents higher than 2.0 g/100 kcal. After 3 months, formula-fed infants grew faster than breastfed infants. Our meta-analysis indicated that the growth outcomes of infants fed with infant formula with a relatively low protein/energy ratios, compared with that a relatively high protein/energy ratio, were close to those of breastfed infants.     

Developing a programme for healthy growth and nutrition during infancy: understanding user perspectives

Background Avoiding excess energy intake and rapid weight gain during infancy may be effective in preventing childhood obesity. We developed a programme for healthy growth and nutrition in formula milk‐fed babies. The aim of this study was to understand users' perspectives about the programme and planned trial. Methods We conducted three focus group discussions (10 mothers) and nine individual interviews (seven health visitors, one midwife and one mother) discussing the programme materials and trial protocol. All sessions were transcribed verbatim and a thematic analysis was performed using the framework approach. Results Mothers reported receiving conflicting messages about infant feeding and were keen for consistent advice. They welcomed the support that the programme would offer to mothers who gave their babies formula milk, but some were sceptical about the feasibility of limiting formula milk quantities. They suggested that recommended quantities should be presented as general guidelines rather than rigid rules. Some mothers said that it was too early to intervene to prevent obesity, that babies could not be overfed and that the risks of formula milk feeding had been exaggerated. Because of the routine advice to feed on demand, babies were fed in response to crying, and crying was equated with ‘hunger’. Some mothers said that growth was genetically determined so they ignored the growth charts. Health visitors used the growth charts to assess adequate weight gain rather than to identify excess weight gain. Health visitors said that mothers would need a lot of education and support to limit formula milk quantities. Conclusions Efforts to prevent childhood obesity by avoiding excess weight gain during infancy have to address mothers' beliefs that babies cannot be overfed, that crying always signals hunger and that growth is determined by genes rather than nutrition. Mothers and healthcare providers have different motivations and understanding these are important in the development of any intervention.     

Human Milk Microbiome and Microbiome-Related Products: Potential Modulators of Infant Growth

Infant growth trajectory may influence later-life obesity. Human milk provides a wide range of nutritional and bioactive components that are vital for infant growth. Compared to formula-fed infants, breastfed infants are less likely to develop later-onset obesity, highlighting the potential role of bioactive components present in human milk. Components of particular interest are the human milk microbiota, human milk oligosaccharides (HMOs), short-chain fatty acids (SCFAs), and antimicrobial proteins, each of which influence the infant gut microbiome, which in turn has been associated with infant body composition. SCFAs and antimicrobial proteins from human milk may also systemically influence infant metabolism. Although inconsistent, multiple studies have reported associations between HMOs and infant growth, while studies on other bioactive components in relation to infant growth are sparse. Moreover, these microbiome-related components may interact with each other within the mammary gland. Here, we review the evidence around the impact of human milk microbes, HMOs, SCFAs, and antimicrobial proteins on infant growth. Breastfeeding is a unique window of opportunity to promote optimal infant growth, with aberrant growth trajectories potentially creating short- and long-term public health burdens. Therefore, it is important to understand how bioactive components of human milk influence infant growth.     

An Infant Formula with Large,Milk Phospholipid-Coated Lipid Droplets Supports Adequate Growth and Is Well-Tolerated in Healthy,Term Asian Infants: A Randomized,Controlled Double-Blind Clinical Trial

Lipids are essential for healthy infant growth and development. The structural complexity of lipids in human milk is not present in infant milk formula (IF). A concept IF was developed mimicking more closely the structure and composition of human milk fat globules. The current study evaluates whether a concept IF with large, milk phospholipid-coated lipid droplets (mode diameter 3 to 5 μm) is equivalent to standard IF with regard to growth adequacy and safety in healthy, term Asian infants. In this randomized, double-blind, controlled trial, infants were randomized after parents decided to introduce formula. Infants received a standard IF with (Control) or without the specific prebiotic mixture scGOS/lcFOS (9:1 ratio; Control w/o prebiotics), or a Concept IF with large, milk phospholipid-coated lipid droplets and the prebiotic mixture. A group of 67 breastfed infants served as a reference. As a priori defined, only those infants who were fully intervention formula-fed ≤28 days of age were included in the equivalence analysis (Control n = 29; Control w/o prebiotics n = 28; Concept n = 35, per-protocol population). Primary outcome was daily weight gain during the first four months of life, with the difference between the Concept and Control as the key comparison of interest. Additionally, adverse events, growth and tolerance parameters were evaluated. Equivalence of daily weight gain was demonstrated between the Concept and Control group after additional correction for ethnicity and birthweight (difference in estimated means of 0.1 g/d, 90%CI [−2.30, 2.47]; equivalence margin +/− 3 g/d). No clinically relevant group differences were observed in secondary growth outcomes, tolerance outcomes or number, severity or relatedness of adverse events. This study corroborates that an infant formula with large, milk phospholipid-coated lipid droplets supports adequate growth and is well tolerated and safe for use in healthy infants.     

The Economic Impact of Lower Protein Infant Formula for the Children of Overweight and Obese Mothers

The global prevalence of obesity is rising rapidly, highlighting the importance of understanding risk factors related to the condition. Childhood obesity, which has itself become increasingly prevalent, is an important predictor of adulthood obesity. Studies suggest that the protein content consumed in infanthood is an important predictor of weight gain in childhood, which may contribute to higher body mass index (BMI). For instance, there is evidence that a lower protein infant formula (lpIF) for infants of overweight or obese mothers can offer advantages over currently-used infant formulas with regard to preventing excessive weight gain. The current study used health economic modelling to predict the long-term clinical and economic outcomes in Mexico associated with lpIF compared to a currently-used formula. A discrete event simulation was constructed to extrapolate the outcomes of trials on the use of formula in infanthood to changes in lifetime BMI, the health outcomes due to the changes in BMI and the healthcare system costs, productivity and quality of life impact associated with these outcomes. The model predicts that individuals who receive lpIF in infancy go on to have lower BMI levels throughout their lives, are less likely to be obese or develop obesity-related disease, live longer, incur fewer health system costs and have improved productivity. Simulation-based economic modelling suggests that the benefits seen in the short term, with the use of lpIF over a currently-used formula, could translate into considerable health and economic benefits in the long term. Modelling over such long timeframes is inevitably subject to uncertainty. Further research should be undertaken to improve the certainty of the model.     

Early weaning is related to weight and rate of weight gain in infancy

Background Evidence relating to the effect of early weaning on infant weight and weight gain is conflicting. The aim of this paper is to compare weight and weight gain in two groups of infants; one group weaned before 4 months (early weaned), the other weaned at 4 months or after. Methods Feeding practices were assessed through semistructured interviews with mothers of 1‐year‐old infants. Weight at birth, 8 weeks and 7 months were taken from an administrative database (Child Health System), and an additional measure of weight was taken at 14 months. Results Infants weaned early were heavier at 7 and 14 months, and gained more weight between 8 weeks and 14 months, even after breastfeeding was controlled for. Conclusion Early weaning is related to rapid weight gain in infancy. This may have implications for childhood obesity.     

The Macronutrient Composition of Infant Formula Produces Differences in Gut Microbiota Maturation That Associate with Weight Gain Velocity and Weight Status

This proof-of-principle study analyzed fecal samples from 30 infants who participated in a randomized controlled trial on the effects of the macronutrient composition of infant formula on growth and energy balance. In that study, infants randomized to be fed cow milk formula (CMF) had faster weight-gain velocity during the first 4 months and higher weight-for-length Z scores up to 11.5 months than those randomized to an isocaloric extensive protein hydrolysate formula (EHF). Here we examined associations among infant formula composition, gut microbial composition and maturation, and children’s weight status. Fecal samples collected before and monthly up to 4.5 months after randomization were analyzed by shotgun metagenomic sequencing and targeted metabolomics. The EHF group had faster maturation of gut microbiota than the CMF group, and increased alpha diversity driven by Clostridia taxa. Abundance of Ruminococcus gnavus distinguished the two groups after exclusive feeding of the assigned formula for 3 months. Abundance of Clostridia at 3–4 months negatively correlated with prior weight-gain velocity and body weight phenotypes when they became toddlers. Macronutrient differences between the formulas likely led to the observed divergence in gut microbiota composition that was associated with differences in transient rapid weight gain, a well-established predictor of childhood obesity and other comorbidities.     

Glycomacropeptide and alpha-lactalbumin supplementation of infant formula affects growth and nutritional status in infant rhesus monkeys

BACKGROUND: Advances in dairy technology make it possible to enrich infant formula with specific bovine milk components that may enhance nutrient status. Glycomacropeptide, a carbohydrate-rich casein peptide, may increase absorption of calcium, iron, or zinc. alpha-Lactalbumin, a major breast-milk protein, may contribute to a balanced amino acid pattern and increase calcium and zinc absorption. OBJECTIVE: We determined the effects of glycomacropeptide- and alpha-lactalbumin-supplemented infant formula on growth; trace mineral status; iron, zinc, and calcium absorption; and plasma amino acid, blood urea nitrogen, and plasma insulin concentrations. DESIGN: Infant rhesus monkeys (n = 5 infants per group) were breastfed or fed control or alpha-lactalbumin- or glycomacropeptide-supplemented formula from birth to 4 mo of age. Hematologic measures and growth were assessed monthly. Mineral absorption was measured with radioisotopes and whole body counting. RESULTS: Infants fed glycomacropeptide had higher food intake than did other formula-fed infants. Infants fed glycomacropeptide or control formula had higher hematocrit values than did infants that were breastfed or fed alpha-lactalbumin. Infants fed glycomacropeptide or control formula had higher plasma zinc and zinc absorption than did breastfed infants. Where differences were observed, breastfed infants and infants fed alpha-lactalbumin had similar plasma essential amino acid and insulin profiles, which were different from those of infants fed glycomacropeptide or control formula. CONCLUSIONS: Glycomacropeptide- or alpha-lactalbumin-supplemented formula has no adverse effects on nutritional status in infant monkeys. Glycomacropeptide supplementation increases zinc absorption, which may permit the reduction of formula zinc concentrations, and alpha-lactalbumin supplementation promotes a plasma amino acid pattern similar to that of breastfed infant monkeys.     

母亲孕期增重及婴儿喂养方式与儿童肥胖的相关性分析

目的分析母亲孕期增重和婴儿的喂养方式与儿童肥胖之间的关系,为制定降低儿童肥胖率的相关措施提供参考。方法选取湖北省江陵县人民医院所在区域内的4家幼儿园中的951名儿童及其家长作为研究对象,采用问卷调查的方式对儿童及母亲的孕期情况进行调查。调查的内容包括:儿童的身高、体重、婴儿喂养方式等。采用单因素分析和多因素Logistic回归分析儿童肥胖与母亲孕期增重和婴儿喂养方式之间的关系。结果发放调查问卷951份,收回有效调查问卷940份,调查问卷的回收率为98.84%。受访儿童中肥胖的发生率为10.00%(94/940)。单因素分析结果表明,母亲孕期体重增加>15 kg的儿童肥胖发生率高于孕期体重增加未超过15 kg的儿童,差异有统计学意义(P<0.05),婴儿6个月内纯母乳喂养的儿童肥胖率低于未进行纯母乳喂养的儿童,差异有统计学意义(P<0.05)。Logistic回归分析显示,母亲孕期体重增加>15 kg是儿童肥胖的危险因素(P<0.05),婴儿6个月内纯母乳喂养是儿童肥胖的保护因素(P<0.05)。结论母亲孕期体重增加>15 kg和婴儿6个月内纯母乳喂养是儿童肥胖的影响因素,应引导孕妇适当控制体重增长,鼓励产妇采用纯母乳喂养婴儿,降低儿童肥胖发生率。     

Early growth and obesity risk – What should health professionals be advising?

Obesity rates in the UK have been continuously increasing among adults and children and have been attributed to nutritional and lifestyle practices that promote a positive shift in energy balance. Over the last few decades, a growing body of evidence suggests that the origins of obesity start at the earliest stages of human development and specifically pre‐conception, in utero and during early infancy. Maternal nutritional status and early life feeding have been identified as ‘critical windows’ for obesity risk. Pre‐conception and pregnancy overweight and obesity, as well as fetal exposure to diabetes and hyperglycaemia, have been associated with high birthweight, which, in turn, has been reported to have a direct link with obesity risk later in life. A number of studies have also demonstrated low birthweight to be associated with increased risk of obesity and suggested that low‐birthweight term infants who demonstrate early ‘catch‐up’ growth have a tendency to become obese adults. Low birthweight has been associated with pre‐conception underweight and inadequate in utero nutrition. Although the links between early growth and later obesity risk implicate maternal pre‐natal nutrition, it has been suggested that nutrition during early infancy also affects later body composition. Breastfeeding has been associated with a reduced prevalence of obesity, although the evidence is still inconsistent and somewhat limited. Recent advances in the ability to manipulate infant formula composition by reducing its protein content and bringing its composition closer to that of breastmilk could potentially help prevent the rapid weight gain observed in formula‐fed infants. Early introduction of complementary foods has also been associated with increased obesity risk later in life. Unfortunately to date, the majority of evidence on the developmental origins of obesity comes from observational studies, making their interpretation difficult and providing an uncertain basis for practice. However, a number of modifiable risk factors in the pre‐natal and early post‐natal periods of human development have been identified, as well as vulnerable subgroups within the population to these risk factors, which may guide health professionals when advising women regarding lifestyle strategies to reduce the risk of obesity for their offspring and for future generations.     

Educational intervention to modify bottle-feeding behaviors among formula-feeding mothers in the WIC program: impact on infant formula intake and weight gain

ObjectiveFormula-fed infants gain weight faster than breastfed infants. This study evaluated whether encouraging formula-feeding caregivers to be sensitive to infant satiety cues would alter feeding practices and reduce infant formula intake and weight gain.DesignDouble-blind, randomized educational intervention, with intake and growth measured before (at 1 to 2 months) and after (4 to 5 months) the intervention.SettingWomen, Infants, and Children (WIC) clinics in Sacramento, California.Participants836 caregivers of young infants were screened; 214 were eligible, and 104 agreed to participate.InterventionIntervention subjects received education promoting awareness of satiety cues and discouraging bottles containing more than 6 ounces before 4 months of age; intervention and control groups received education regarding introduction and feeding of solid food after 4 months of age.Main Outcome MeasuresFormula intake (mL/24 hours) and weight gain (g/week).AnalysisDifferences between groups evaluated using 2-way analysis of covariance (ANCOVA).ResultsSixty-one subjects completed baseline records, 44 attended class, and 38 completed the study. Despite a positive response to the educational intervention, there was no change in bottle-feeding behaviors (formula intake at 4 to 5 months was more than 1100 mL/day in both groups). Infant growth in the intervention group was greater than in the control group (P < .01), contrary to the hypothesis.Conclusions and ImplicationsThe intervention improved knowledge of the key messages, but further research is needed to understand barriers to modifying bottle-feeding behaviors.     

Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes

Background:  Infants born to diabetic women are at higher risk for hypoglycaemia related to hyperinsulinism in response to maternal hyperglycaemia during pregnancy. As such, recommendations to prevent neonatal hypoglycaemia include infant feeding in the early postpartum period. The present study aimed to examine the effect of early breastfeeding and type of nutrition used for the first feed (human milk or formula) on glucose levels in infants born to women with gestational diabetes.
Methods:  The prospective pilot study of 84 infants born to gestational diabetic women examined the glycaemic levels of infants who were breastfed in the delivery room compared to glycaemic levels of those who were not. The study also compared the glycaemic levels of infants who breastfed with those who received formula for their first feed.
Results:  Infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%; Fisher's exact test., P  = 0.05,). Likewise, infants breastfed in the delivery room had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol L⁻¹, P  = 0.03). Additionally, breastfed infants had a significantly higher mean blood glucose level compared to those who were formula fed for their first feed (3.20 versus 2.68 mmol L⁻¹, P  = 0.002).
Conclusions:  Early breastfeeding may facilitate glycaemic stability in infants born to women with gestational diabetes.     

Exploring the Potential of Human Milk and Formula Milk on Infants’ Gut and Health

Early-life gut microbiota plays a role in determining the health and risk of developing diseases in later life. Various perinatal factors have been shown to contribute to the development and establishment of infant gut microbiota. One of the important factors influencing the infant gut microbial colonization and composition is the mode of infant feeding. While infant formula milk has been designed to resemble human milk as much as possible, the gut microbiome of infants who receive formula milk differs from that of infants who are fed human milk. A diverse microbial population in human milk and the microbes seed the infant gut microbiome. Human milk contains nutritional components that promote infant growth and bioactive components, such as human milk oligosaccharides, lactoferrin, and immunoglobulins, which contribute to immunological development. In an attempt to encourage the formation of a healthy gut microbiome comparable to that of a breastfed infant, manufacturers often supplement infant formula with prebiotics or probiotics, which are known to have a bifidogenic effect and can modulate the immune system. This review aims to elucidate the roles of human milk and formula milk on infants’ gut and health.     

Patterns of growth in weight and length among American Samoan infants

Well baby clinic records on 1, 186 infants born in 1975 to 1976 on the island of Tutuila, American Samoa, form the basis for this study of the growth in weight and length from birth to 12 months. Semi‐longitudinal curves of weight and length indicate that these infants have median weights near the NCHS 75th percentile (boys) and 90th percentile (girls) up to 6 months, falling to just below the 75th percentile by 12 months. Median lengths are between the NCHS 50th and 25th percentile. Weight gain from birth to six months was found to be higher than for any other reported population (4.92 kg, sexes combined). The infant feeding pattern was found to exert a significant influence on rate of weight gain for boys between birth and 1–4 months, with the breast‐fed boys gaining more rapidly than artificial‐fed infants.