Infant formula feeding practices associated with rapid weight gain: A systematic review

Excess or rapid weight gain during the first 2 years of life is associated with an increased risk of later childhood and adult overweight and obesity. When compared with breastfed infants, formula fed infants are more likely to experience excess or rapid weight gain, and this increased risk in formula fed infant populations may be due to a number of different mechanisms. These mechanisms include the nutrient composition of the formula and the way formula is prepared and provided to infants. This systematic literature review examines the association between formula feeding practice and excess or rapid weight gain. This review explores these different mechanisms and provides practical recommendations for best practice formula feeding to reduce rapid weight gain. Eighteen studies are included in this review. The findings are complicated by the challenges in study design and accuracy of measurements. Nevertheless, there are some potential recommendations for best practice formula feeding that may reduce excess or rapid weight gain, such as providing formula with lower protein content, not adding cereals into bottles, not putting a baby to bed with a bottle, and not overfeeding formula. Although further well designed studies are required before more firm recommendations can be made.     

Understanding feeding practices of Latinx mothers of infants and toddlers at risk for childhood obesity: A qualitative study

Infancy and toddlerhood are critical stages for the development of habits that can lead to future obesity, and caregivers have an important influence on these habits. We conducted this qualitative semistructured interview study to explore the feeding practices of Latinx mothers of young children who are at risk for childhood obesity in order to identify targets for obesity prevention. We interviewed Latinx mothers (N = 14) of a child ages 6–18 months with a weight‐for‐length ratio > 85th percentile at the time of recruitment. Two researchers independently read through the interviews, identified sections of the interviews pertaining to feeding, and used constant comparative methods to identify the following common themes: mothers overwhelmingly reported permissive feeding styles, driving overfeeding and frequent night‐time feeding. Mothers expressed some difficulty with transitioning to solid foods and reported desiring to feed their child healthy foods by minimizing juice and giving vegetables. Paediatricians and WIC staff were viewed by mothers as trustworthy sources of nutrition information. Most identified a connection between their child's weight and diet, but many lacked the insight or capacity to change their current practices. The mothers in our study provide insight into factors that may predispose young children to obesity and thus potential avenues to support these families. Healthcare providers can better serve them by giving clear, actionable advice on healthy feeding practices for their child, while understanding constraints that may make healthy habits difficult to implement. Paediatricians should be honest about their child's weight status early on to allow time for intervention.     

Toddler obesity prevention: A two‐generation randomized attention‐controlled trial

Rapid weight gain increases risks of obesity and associated co‐morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler–mother physical activity, mealtime interactions and fruit/vegetable intake. The randomized three‐arm, eight‐session, 4‐month trial, conducted 2009–2013, included two intervention arms (responsive parenting and maternal lifestyle) and an attention control (home safety). Baseline and 6‐ and 12‐month follow‐up evaluations included weight and length/height, ankle accelerometry, video‐recorded mealtime interactions (Emotional Availability Scales) and 24‐h diet recalls (Healthy Eating Index‐2015 [HEI‐2015]). Analyses used linear mixed‐effects models with repeated measures comparing intervention versus control changes in BMI z score. We recruited 277 racially mixed (70% African American) toddler–mother dyads (mean ages 20.1 months and 27.3 years) from US WIC and primary care clinics and randomized them into intervention versus control; 31% toddlers and 73% mothers were overweight/obese. At follow‐up, changes in the rate of toddler BMI z score and maternal BMI were non‐significant. Maternal lifestyle group toddlers and mothers spent 24.43 and 11.01 more minutes in physical activity (95% confidence interval [CI]: 2.55, 46.32, and 95% CI: 1.48, 20.54, respectively). Fruit intake increased in both intervention groups. Hostile mealtime interactions increased in the maternal lifestyle group, and in supplementary analyses, mealtime interactions were significantly higher in the responsive parenting group than in the maternal lifestyles group, suggesting that toddler dietary interventions include responsive parenting. Intervention effects were stronger among older versus younger toddlers. Despite no impact on weight gain, additional research should examine integrated two‐generation responsive parenting and maternal lifestyle interventions among toddler–mother dyads.     

Guilt,shame, and postpartum infant feeding outcomes: A systematic review

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: ‘underprepared and ineffectively supported’, ‘morality and perceived judgement’ (breastfeeding), ‘frustration with infant feeding care’ and ‘failures, fears and forbidden practice’ (formula feeding). Both guilt and shame were associated with self‐perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.     

The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer-reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies' biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random-effects models. Eighty studies were included in this review: Fifty-one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi-experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z-scores (HAZ), 23 (29%) measured weight for height z-scores (WHZ), 27 (34%) measured weight for age z-scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention's effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35–2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17–0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004–0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02–0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions.     

Association between timing of introducing solid foods and obesity in infancy and childhood: a systematic review

Determining early-life risk factors for obesity in later life is essential in order to effectively target preventative interventions to reduce obesity. The aim of this systematic review was to investigate current evidence to determine whether the timing of introducing solid foods is associated with obesity in infancy and childhood. Relevant randomized and observational studies from developed countries were identified by searching the following six bio-medical databases (Medline, Embase, British Nursing Index, CINAHL, Maternity and Infant Care, and PsycINFO) and hand-searching reference lists. Studies of pre-term or low birthweight infants were excluded. Twenty-four studies met the inclusion criteria for the systematic review. Data from over 34,000 participants were available for interpretative analysis. No clear association between the age of introduction of solid foods and obesity was found. It is likely that a whole family approach to obesity prevention will be most effective and health professionals should continue to promote healthy infant feeding in line with national recommendations.     

UK health visitors' role in identifying and intervening with infants at risk of developing obesity

Childhood obesity is associated with a number of modifiable risk factors that can be identified during infancy or earlier. In the UK, health visitors advise parents about infant feeding, but little is known about their role in obesity prevention. The aim of this study was to investigate the beliefs and current practices of UK health visitors in relation to recognising and intervening with infants at risk of developing obesity. Thirty members of the health visiting team were interviewed. The interviews were audio‐recorded and transcribed verbatim. Thematic analysis was applied using an interpretative, inductive approach. Health visitors were aware of some of the modifiable risk factors for childhood obesity such as infant feeding practices. They felt they had a role in advising parents about diet but did not formally identify and/or intervene with larger infants. Infant overweight was considered a sensitive issue that was difficult to raise with parents. They believed some parents preferred larger infants and were unaware that their feeding practices might be contributing to obesity risk. A need for training and guidance was identified together with strategies to overcome system barriers. Health visitors do not currently target parents of infants at risk of obesity largely because they do not perceive they have appropriate guidance and skills to enable them to do so. There is an urgent need for tools and training to enable all health care professionals to recognise and manage infants at risk of developing obesity without creating a sense of blame.     

Infant feeding and growth: A study on Turkish infants from birth to 6 months

BACKGROUND: To evaluate the impact of various feeding patterns on the physical growth and mental development of infants, particularly during the first 6 months of life, and to compare growth patterns of Turkish infants with those of infants living in various countries. METHODS: One hundred and seventy-two healthy newborn infants were included in the study and were divided into three feeding groups: (i) 62 infants were exclusively breast-fed (BF); (ii) 58 infants were mixed-fed (MF) with both breast milk and formula; and (iii) 52 infants were formula-fed (FF). Infants were assessed at birth and at 1, 2, 3, 4, 5 and 6 months of age. Anthropometry was repeated on each occasion. The weight and length of the infants was also recorded. Analysis of variance and modified t-test were used for statistical evaluation of the results. RESULTS: Values in the BF group were the closest to the tabular norms for weight. Infants in the FF group tended towards a lower weight during the first 3 months (P < 0.05). During the second 3 months, weight gain observed in the FF group was significantly higher than that of BF infants. In comparison with MF infants, a significant progressive weight gain was detected in BF infants (P < 0.05). The values obtained for length increments were consistent with those for weight (P < 0.05 for BF vs FF). No significant difference was found between the length increments detected for BF and MF infants from birth to 6 months. CONCLUSIONS: These results suggest that exclusive breast-feeding is the most appropriate feeding pattern for newborn infants in Turkey and is sufficient during the first 6 months, the most important fraction of life.     

Impact of adherence to WHO infant feeding recommendations on later risk of obesity and non‐communicable diseases: systematic review

Adherence to WHO infant feeding recommendations has short‐term benefits and may also help in the prevention of non‐communicable diseases (NCDs). This study reviewed the evidence on whether adherence to all elements of the WHO infant feeding recommendations (comparison group those exclusively breastfed to 6 months, introduced to appropriate complementary feeding from 6 months, with continued breastfeeding to at least 24 months; exposure group characterised by non‐adherence to any of the three recommendations) is associated with reduced risk of later obesity or cardiometabolic disease. The population of interest was children not classified as very low weight (weight‐for‐age z‐score >?3.0). MEDLINE, EMBASE, Global Health, CINAHL plus, ProQuest Dissertations and Thesis were systematically searched from 2001 to July 2014, manual reference searching of a birth cohort register ( http://www.birthcohorts.net/ ) as well as papers identified in the search and selected journals was carried out. The database search yielded 9050 records, 275 English‐language full‐text articles were screened, but no studies were eligible, failing to meet the following criteria: comparison (213); exposure (14); population (3); relevant outcome (5); outcome before 24 months (9); insufficient information provided (30); plus one study was qualitative. Eight studies met the inclusion criterion of exclusive breastfeeding to 6 months, but did not meet the other inclusion criteria. The present study has revealed an important gap in the evidence on NCD prevention, and suggestions for addressing this evidence gap are provided.     

Weight gain in the first week of life predicts overweight at 2 years: A prospective cohort study

In formula‐fed infants, rapid weight gain during the first week of life is associated with later obesity. To examine the association between weight gain during the first week and overweight at age 2 among infants with various feeding practices and the relationship between exclusive breastfeeding in early infancy and overweight, we enrolled a prospective cohort of healthy mother–infant dyads and followed them for 2 years. We enrolled 450 mother/infant pairs and obtained information on 306 infants at year 2. Weight change during the first week of life and detailed feeding information were collected during the first month of life. Anthropometric measures were collected at 2 years. Overweight was defined as body mass index (BMI) ≥85th percentile for age. At 2 years, 81% had normal weights and 19% were overweight. Maternal pre‐pregnancy BMI; infant birth weight; maternal education; and Women, Infants, and Children status were associated with the risk of overweight at age 2. Children who gained more than 100 g during the first week were 2.3 times as likely after adjustment (p = .02) to be overweight at age 2 compared to infants who lost weight. There was no association between feeding type and BMI, but feeding type was significantly associated with change in weight at week 1 and anthropometric measurements at age 2. Infant weight gain in the first week of life is related to overweight at age 2, and exclusively breastfed infants are least likely to gain ≥100 g.     

孟鲁司特治疗婴幼儿喘息疗效和安全性系统评价

目的 评价孟鲁司特对<2岁喘息患儿的疗效及安全性。方法 计算机检索EMBASE、PubMed、在研对照试验数据库、Cochrane图书馆、中文科技期刊全文数据库、中国期刊全文数据库和万方数字化期刊群,检索时间均从建库至2010年3月。并手工检索相关会议论文集、药厂资料及所有纳入文献的参考文献,获得孟鲁司特治疗<2岁喘息患儿安慰剂对照的RCT文献。采用Cochrane评价手册5.0.2推荐的方法评估纳入文献的方法学质量。以喘息相关病死率、临床症状评分和β2受体激动剂、糖皮质激素需求量为主要结局指标,以不良反应发生率和生活质量为次要结局指标。对无法进行定量合并的文献进行描述性分析。结果 共检索到相关文献906篇,其中符合纳入标准的6篇RCT文献进入系统评价。5篇文献为在研对照数据库登记的研究。纳入对象为喘息患儿。文献质量评价结果显示：4篇文献详细描述了随机化分组的方法,3篇文献描述了分配隐藏,6篇文献均采用双盲法,5篇文献存在选择性报告研究结果,2篇文献描述了其他偏倚来源。2篇RCT文献的失访率较高（分别为21.7%和32.1%）。因各纳入文献间存在明显的临床异质性,无法进行Meta分析,故而描述性分析。①纳入文献均无喘息相关死亡的报道;②孟鲁司特4 mg·d-1或8 mg·d-1组临床症状评分、使用β2受体激动剂和糖皮质激素等,与安慰剂组差异均无统计学意义（均P>0.05）;③纳入文献均报道了研究过程中药物不良反应的发生率,患儿对孟鲁司特有较好的耐受性。孟鲁司特组和安慰剂组不良反应发生率差异无统计学意义（P>0.05）。6篇文献均没有生活质量的评价指标。结论 现有研究尚不能证实孟鲁司特治疗<2岁婴幼儿喘息有效,治疗20周也未见明显的不良反应。     

Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain

Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2–4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%–5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.     

Dietitians and exercise professionals in a childhood obesity treatment team

There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given.
Conclusion: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.     

The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta‐analysis of observational studies

In the extended UNICEF framework of early childhood nutrition, parents'' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents'' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents'' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran''s Q and quantified with I ². We identified 6 longitudinal and 11 cross‐sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01−0.12]; no substantial heterogeneity (I ² = 0.00%, P _Q < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: −0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low‐to‐moderate quality of literature for the inclusion of parents'' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.     

Inappropriate bottle use: an early risk for overweight? Literature review and pilot data for a bottle‐weaning trial

Identifying early risk factors for childhood obesity is critical, as weight in infancy and early childhood tracks to later periods. Continued bottle use – primarily from excess milk intake – is emerging as a potential risk factor for early childhood overweight. Over three fourths of US infants drink from bottles beyond the recommended weaning age of 12 months, and two thirds of UK infants use a bottle at 18 months. This paper is divided into three parts. Part 1 reviews the literature on beverage intake, weight and bottle use in young children. Part II describes pilot data on milk bottle use and weight in 12–60-month-olds, collected prior to a randomized controlled (RCT) trial of a bottle-weaning intervention. Median daily milk bottle consumption at 12 months was 5.0 (interquartile range = 3–6). Among 12–36-month-olds, current users were significantly more likely to be >95th% weight-for-height (19% vs. 0%, P  < 0.02), and more were >85% weight-for-height (27% vs. 11%, P  < 0.11), vs. non-users. In contrast, current bottle use was not associated with either overweight or obesity in 37–60-month-olds. Part III describes the RCT, begun in fall 2008. It is enrolling 464 parent/12-month-old dyads from a nutrition assistance programme for low-income families. Children's bottle use, anthropometrics, dietary intake and nutrient density (via 24 h recall) are assessed quarterly through 24 months of age. For the intervention, site nutritionists employ a project-developed, visually attractive flip chart. An observational study nested within the RCT will describe dietary changes during this period of feeding transitions.     

Comprehensiveness of infant formula and bottle feeding resources: A review of information from Australian healthcare organisations

The use of infant formula is widespread internationally. In Australia, 55% of infants receive formula before 6 months of age, with higher rates among disadvantaged communities. Infant formula use can contribute to childhood overweight and obesity, through formula composition and feeding behaviours, such as adding cereal to bottles and parental feeding style. While information abounds to promote and support breastfeeding, formula‐feeding parents report a paucity of advice and support; many rely on formula packaging for information. This study systematically searched and reviewed online resources for infant formula and bottle feeding from Australian governments, health services, hospitals, and not‐for‐profit parenting organisations. A comprehensive search strategy located 74 current resources, mostly for parents. Researchers evaluated the resources against best practice criteria derived from Australian government and UNICEF guidelines on six topics. They assessed how comprehensively the resources addressed each topic and whether the resources provided all the information necessary for parents to understand each topic. The mean ‘comprehensiveness’ rating for topics across all resources was 54.36%. However, some topics were addressed more fully than others. Information on ‘discussing infant formula with health workers’ and on ‘preparing infant formula’ was more frequently accurate and comprehensive. However, there was much less comprehensive information on ‘using infant formula’, including amounts of formula to feed, use of bottle teats, appropriate bottle‐feeding practice and responsiveness to infant satiety cues. Over half the resources were written at an acceptable reading level.