Growth trajectories are influenced by breast-feeding and infant health in an afro-colombian community

We conducted a longitudinal study among an Afro-Colombian population to investigate the influence of feeding practices and child morbidity on linear and ponderal growth during infancy. We enrolled 133 children at 5-7 mo and followed them until 18 mo. Repeated anthropometric measures were taken every 2-3 mo, with monthly interviews on feeding practices and daily self-reports on morbid conditions by the mothers of the infants. Mothers' social conditions and infants' fixed variables (gender and gestational age at birth) were measured at baseline. Growth starting points and trajectories were modeled via Hierarchical Linear Models (HLM). Children started with a mean length of 64.8 cm (95% CI: 59.8-69.7) and a mean weight of 7.68 kg (95% CI: 5.37-9.9), and gained length at a rate of 1.13-1.70 cm/mo, and weight at 66.5-319 g/mo. Breast-feeding, defined as receiving breast milk at any time within a 2-3-mo interval, was positively related to length gain (regression coefficient = 0.27 cm/mo; P = 0.04), after adjusting for social conditions and food consumption. Among mothers with low levels of education, breast-feeding had a positive effect on weight gain (regression coefficient = 0.30 kg/mo; P = 0.04); among nonbreast-fed infants, complementary food diversity generated a positive effect on weight (regression coefficient = 0.14 kg/mo; P = 0.03). Mean differences in length were related to the total proportion of healthy time (regression coefficient = 3.1; P = 0.02), whereas weight-gain rates were negatively associated with changes during illness (regression coefficient = -0.70; P = 0.04 for fever). No association was found between diarrhea episodes and infant growth. Our study confirms that breast-feeding after 6 mo of life is important for nutrition and health, likely by mitigating the negative effects of poor social conditions and diarrhea on infant growth.     

Full breast-feeding for at least four months has differential effects on growth before and after six months of age among children in a Mexican community

This study examines the relationship between breast-feeding and growth from 0 to 6 and 6 to 20 mo among 185 children in a Mexican community. Infants from a previous 6-mo longitudinal study were followed up for additional anthropometric measurements at a mean age of 19.9 mo. Size at 6 mo and at follow-up were modeled as outcomes of whether infants were fully breast-fed (exclusively or predominantly breast-fed) for at least 4 mo, controlling for size at birth and 6 mo, respectively, and potential confounders. From birth to 6 mo, fully breast-fed infants had ponderal index increments of 0.07 units larger (P = 0.04) than comparison infants. There were no differences in weight. For length, an interaction between full breast-feeding and socioeconomic status (SES) was found, with fully breast-fed infants of low SES growing more than comparison infants, whereas the opposite was seen at upper SES levels. From 6 to 20 mo, fully breast-fed infants had weight and length increments of 0.53 cm (P < 0.001) and 0.72 kg (P = 0.01) smaller than those of comparison infants. For ponderal index, an interaction between mother's education and breast-feeding revealed an inverted U-shaped response across levels of education. Additionally, logistic regressions of monthly breast-feeding on lagged measurements revealed that relatively heavier infants had higher odds of being fully breast-fed at 2 and 3 mo. Our findings indicate that the benefits of full breast-feeding on growth may be most pronounced early in life. Further research of unmeasured confounders may explain the association of full breast-feeding with slower growth beyond 6 mo.     

Breast-feeding is associated with improved growth in length, but not weight, in rural Senegalese toddlers

BACKGROUND: Prolonged breast-feeding is frequently associated with malnutrition in less-developed countries, even after adjustment for socioeconomic confounders. However, in rural Senegal, breast-feeding is prolonged when the child is stunted. OBJECTIVE: We aimed to test whether the lower height-for-age of children weaned late is explained by their height before weaning or whether prolonged breast-feeding is associated with impaired growth. DESIGN: A cohort of 443 Senegalese children recruited from dispensaries at 2 mo of age were visited in their homes at 6-mo intervals when they were approximately 1.5 to 3 y of age. Weight, length, arm circumference, and triceps skinfold thickness were measured. Six-month increments were analyzed in relation to breast-feeding (breast-fed compared with weaned children or breast-feeding duration), season, and maternal housing with use of multiple linear regression. RESULTS: The mean duration of breast-feeding was 24.1 mo (quartiles 1 and 3: 21.9 and 26.4). Height-for-age at the age of 3 y was negatively associated with age at weaning (P < 0.01), but this association disappeared after adjustment for height-for-age in infancy. Length increments were significantly greater in both the second and third years of life in children breast-fed for longer durations (P < 0.05) and tended to be greater in breast-fed than in weaned children in the second year of life (P = 0.05). In the third year of life, breast-fed children had greater length increments than did weaned children in the subgroup with poor housing (P for interaction < 0.05). Growth in weight did not differ significantly according to breast-feeding. CONCLUSION: Prolonged breast-feeding improved linear growth, and the negative relation between height-for-age and duration of breast-feeding was due to reverse causality.     

Nutritional status and linear growth of Indonesian infants in west java are determined more by prenatal environment than by postnatal factors

One of the health problems in Indonesia is the high prevalence of stunting in infants. Determinants and specifically the relative contribution of prenatal and postnatal factors to growth and nutritional status of Indonesian infants were investigated. Newborn infants, from women recruited at approximately 18 wk of pregnancy from 9 rural villages in West Java, Indonesia, were followed until 12-15 mo of age. Weight, length, morbidity, breast-feeding and food intake were assessed monthly. Determinants of length and weight increase and nutritional status reflected by Z-scores were evaluated using multiple linear regression. Neonatal weight (3.2 +/- 0.5 kg) and length (49.7 +/- 2.2 cm) were reasonable. However, growth started to falter at 6-7 mo of age, resulting in prevalences of 24% stunting and 32% underweight at 12 mo of age. The multiple regression models explained 19-41% of the variation in growth and nutritional status of infants. Neonatal weight (beta = 0.285) and length (beta = 0.492) were the strongest positive predictors of weight-for-age and height-for-age Z-scores, respectively. Fever was negatively associated with weight increase (beta = -0.144) and weight-for-age (beta = -0.142) and weight-for-height Z-scores (beta = -0.255) but not with length increase or height-for-age Z-scores. Intake of complementary foods was positively associated with increases in weight (beta = 0.190) and length (beta = 0.179) and nutritional status of infants (beta = 0.136-0.194). In conclusion, in this rural population in West Java, neonatal weight and especially length, reflecting the prenatal environment, are the most important predictors of infant nutritional status.     

Weight and recumbent length from 1 to 12 mo of age: reference data for 1-mo increments

Serial data from 504 infants were used to develop reference data for 1-mo increments in weight and recumbent length by fitting a family of three-parameter mathematical functions to the serial data for each individual. The percentiles for status and for increments tended to be larger for the boys than for the girls except for the lower percentiles of increments for weight after 9-10 mo and for recumbent length after 8-9 mo. These data can be used to assess growth in white or black infants whether they are breast-fed or formula-fed. These new data will allow earlier evaluation of growth velocity than the reference data for 3- and 6-mo increments that were available previously. This can lead to the earlier initiation of diagnostic procedures and treatment. The present data should be useful also in research studies.     

Nutritional transition during infancy in East Java, Indonesia: 2. A longitudinal study of growth in relation to the intake of breast milk and additional foods

Weight and length of infants, born in two villages in Madura, East Java were measured longitudinally from birth to 12 months (n = 391). In a sub-sample (n = 76) the intake of breast milk and additional foods during 48 h were also measured. The shape of the weight curve of Madurese infants is comparable to that of healthy, exclusively breast-fed infants in the UK and US during the first 6 months of life, in spite of the custom to force-feed from as early as the first week. The use of a more 'appropriate' growth curve of exclusively breast-fed, healthy infants instead of the NCHS reference failed to define more accurately the age at which growth faltering starts. It is recommended to use weight increments as an indicator of the onset of growth faltering. Breast milk intake correlated significantly with attained weight. However, it explains only a small percentage of the variation in weight, viz. 12-24 per cent. There was no correlation between energy or protein intake from breast milk and additional foods and weight gain.     

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

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

An overlap of breastfeeding during late pregnancy is associated with subsequent changes in colostrum composition and morbidity rates among Peruvian infants and their mothers

An overlap of breast-feeding and late pregnancy is associated with decreased intake of human milk and reduced infant growth. We evaluated the association of an overlap with macronutrient and immunological components of milk, infant urinary IgA, and infant and maternal morbidity. On d 2 and 1 mo postpartum, staff measured 24-h intake of breast milk and collected samples from 133 Peruvian women; 68 had breast-fed during the last trimester of pregnancy (BFP) and 65 had not breast-fed during pregnancy (NBFP). Data on maternal and infant anthropometry and health were collected for 1 mo. On d 2, lactose and lysozyme concentrations were higher, total lysozyme intake was higher and concentration and total intake of lactoferrin were lower in the BFP than the NBFP group (P < 0.05). The total 1-mo IgA intake was lower among BFP than NBFP infants (P = 0.01). Urinary IgA concentration was correlated with breast milk IgA concentration (r = 0.29; P = 0.01) but not with breast-feeding during pregnancy. An overlap was not associated with diarrhea but BFP infants were 5 times as likely to have a cough for at least 7 d than NBFP infants (P < 0.05). Reported mastitis was rare and occurred only in the NBFP group (P = 0.05). An overlap of breast-feeding and late pregnancy was associated with changes in milk composition, an increased frequency in symptoms of infant respiratory illness but decreased reported mastitis. Further in-depth studies are warranted to determine the cumulative effects associated with a breast-feeding/pregnancy overlap on infant and maternal outcomes.     

Premature complementary feeding is associated with poorer growth of vietnamese children

The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and weaned infants gained weight more slowly than those exclusively or predominantly breast-fed. From 1 to 3 mo, exclusively breast-fed infants grew more quickly in both weight and length, followed by predominantly breast-fed infants. From 3 to 6 mo, exclusively breast-fed infants gained more weight compared with the other groups, but there was a slight difference (P = 0.047) in length gain only between exclusively and partially breast-fed infants. In the older period (6-12 mo), exclusively and predominantly breast-fed infants grew in length more quickly than partially breast-fed and weaned groups. However, there was no difference in weight gain among groups. Morbidity from diarrhea and acute respiratory infections was significantly lower for the >/=3 mo exclusively breast-fed group (chi(2) and Fisher-Exact Test). Over nearly the whole age range from 1 mo to 4 y, Z-scores for all indices (weight-for-age, height-for-age and weight-for-height) of the children who received complementary food were significantly lower than those of children who were exclusively breast-fed for at least 3 mo (repeated measures ANOVA, adjusted for sex, family size, maternal education and family income). These results show a long-term deterioration of physical growth in infants who received premature complementary feeding and confirm the importance of exclusive breast-feeding for infants for at least 3 mo.     

Zinc during and in convalescence from diarrhea has no demonstrable effect on subsequent morbidity and anthropometric status among infants <6 mo of age

BACKGROUND: Preventing illness and improving growth in the first 6 mo of life is critical to reducing infant mortality. Zinc given for 14 d at the start of diarrhea has been shown to decrease the incidence and prevalence of diarrhea and pneumonia and improve growth in the 2-3 mo after, but no trial has been done in infants <6 mo of age. OBJECTIVE: This study sought to assess the effect of 14 d of zinc supplementation on subsequent morbidity and growth among infants 1-5 mo of age living in Pakistan, India, and Ethiopia. DESIGN: Infants with acute diarrhea were randomly assigned to receive zinc (10 mg/d; n = 538) or placebo (n = 536) for 2 wk. Weekly follow-up visits were conducted for 8 wk after the diarrhea episode. Incidence and prevalence of diarrhea and prevalence of respiratory infections including pneumonia were compared between the groups. Changes in weight, length, and corresponding z scores during the 8 wk of follow-up were also compared. RESULTS: One thousand seventy-four infants were enrolled at the start of follow-up. The groups did not differ significantly in the proportion of infants with at least one episode of diarrhea or respiratory infections. Infants who received zinc had more days of diarrhea (rate ratio = 1.20) than did the infants who received placebo. The groups had similar prevalences of pneumonia and overall respiratory infections. No significant differences in the mean changes in weight-for-age, length-for-age, and weight-for-length z scores were observed between the groups overall or in stratified analyses. CONCLUSION: Young infants do not appear to benefit from 2 wk of zinc, unlike what has been observed among older children.     

Evaluation of test-weighing for the assessment of milk volume intake of formula-fed infants and its application to breast-fed infants

Test-weighing (TW) was evaluated in formula-fed (FF) infants by comparison with direct measurement (DM) of formula intake during a 24 h period at 1, 2, 4 and 6 mo of age. Formula intakes estimated by TW ranged from 87 to 93% of those determined by DM over the 6-mo period. During the study period the number of feedings per day decreased but were not significantly different for FF and BF infants. Volume of intake per feeding by FF infants increased significantly during the 6-mo period whereas milk intakes of BF infants were not different at the four ages studied. These data indicated that when the number of daily feedings decreased with age, FF infants increased their volume of intake per feeding whereas BF infants did not adjust their intakes. Mean volume of milk intake at 4 and 6 mo, estimated by TW, was significantly greater in FF infants compared to breast-fed (BF) infants matched for age and size. Data from this study indicated clearly that when milk intakes of BF infants are compared to those of FF infants, both groups of infants should be test-weighed.     

A summary index of feeding practices is positively associated with height-for-age, but only marginally with linear growth, in rural Senegalese infants and toddlers

Several studies have shown an association between an infant and young child feeding index (ICFI) and height-for-age Z-score (HAZ) in Latin America and Africa. A previous study was unable to reproduce these findings in 500 rural Senegalese 12-42-mo-old children. The relationship of ICFI, dietary diversity index (DDI), food variety index (FVI), meal frequency index (MFI), and breastfeeding (BF) to HAZ and growth in height/length over 6 mo was studied in 1060 6-36-mo-old Senegalese children during 2 visits. List-based food frequencies were recalled for the past 24 h, and height/length and weight measurements were taken. Indicators were transformed into tertiles in age-specific subgroups. DDI, FVI, MFI, and ICFI were poorly concordant across visits at all ages (weighted κ: 0.02-0.25). In cross-sectional analyses that pooled children from the 2 visits, HAZ was positively associated with DDI and FVI at 6-12, 12-18, and 18-24 mo and with ICFI at 6-12 and 18-24 mo (P < 0.001 and P < 0.05, respectively) but was negatively associated with BF at 12-18, 18-24, and 24-30 mo. The length increment between visits was positively associated with MFI and ICFI, measured during the first visit in 18-24-mo-olds (P < 0.001 and P < 0.05, respectively) but not with DDI, FVI, or BF at any age. In conclusion, ICFI, DDI, and FVI were associated with HAZ, particularly during infancy, whereas no indicator was associated with linear growth in this age group. Therefore, the strong association between HAZ and ICFI during infancy may be partly due to maternal adaptation to infant clues, i.e., greater appetite for and interest in non-breast-milk foods among taller infants.     

Iron status at 12 months of age -- effects of body size,growth and diet in a population with high birth weight

OBJECTIVE: To investigate effects of growth and food intake in infancy on iron status at the age of 12 months in a population with high birth weight and high frequency of breast-feeding. DESIGN: In a longitudinal observational study infants' consumption and growth were recorded. Weighed 2 day food records at the ages of 6, 9 and 12 months were used to analyse food and nutrient intake. SETTING: Healthy-born participants were recruited from four maternity wards. Blood samples and growth data were collected from healthcare centres and food consumption data at home. SUBJECTS: Newborn infants (n=180) were selected randomly according to the mother's domicile and 77% (n=138) participated, of them, 83% (n=114), or 63% of original sample, came in for blood sampling. RESULTS: Every fifth child was iron-deficient (serum ferritin <12 microg/l and mean corpuscular volume<74 fl) and 2.7% were also anaemic (Hb<105 g/l). Higher weight gain from 0 to 12 months was seen in infants who were iron-deficient at 12 months (6.7+/-0.9 kg) than in non-iron-deficient infants (6.2+/-0.9 kg) (P=0.050). Serum transferrin receptors at 12 months were positively associated with length gain from 0 to 12 months (adjusted r(2)=0.14; P=0.045) and mean corpuscular volume negatively to ponderal index at birth (adjusted r(2)=0.14; P=0.019) and 12 months (adjusted r(2)=0.17; P=0.006). Iron-deficient infants had shorter breast-feeding duration (5.3+/-2.2 months) than non-iron-deficient (7.9+/-3.2 months; P=0.001). Iron status indices were negatively associated with cow's milk consumption at 9-12 months, significant above 460 g/day, but were positively associated with iron-fortified breakfast cereals, fish and meat consumption. CONCLUSIONS:: In a population of high birth weight, iron deficiency at 12 months is associated with faster growth and shorter breast-feeding duration from 0 to 12 months of age. The results suggest that a diet of 9-12-month-olds should avoid cow's milk above 500 g/day and include fish, meat and iron-fortified breakfast cereals to improve iron status.     

A young child feeding index is not associated with either height-for-age or height velocity in rural Senegalese children

Ruel and Menon recently published a young child feeding index based on characteristics taken from 24-h and 7-d recalls. A strong positive association was found in 7 Latin American Demographic and Health Surveys for 12- to 36-mo-old children (1). The aim of this study was to test for associations of this index with height-for-age and linear growth in African children. Children (n = 500), aged 12-42 mo, living in a rural area of Senegal were visited in their homes in April-May, and 24-h and 7-d food recalls were conducted with their mothers. Height was measured, and measurements taken 7 mo earlier were used to compute linear growth rates. General linear models were used to adjust for potential confounders (child age and sex, maternal height, BMI, and socioeconomic status). The feeding index was not associated with either height-for-age (adjusted means: -1.01, -1.06, and -1.20 Z-scores for the 1st, 2nd, and 3rd tercile, respectively) or with linear growth (6.2, 6.0, and 6.3 cm/7 mo for the 3 terciles, respectively). Continuing breast-feeding was negatively associated with height-for-age (P < 0.05) and positively associated with linear growth (P < 0.01). Frequent consumption of fruit was positively associated with both (P = 0.059 and P = 0.027, respectively, in adjusted models), whereas food consumption from an animal source was not. In conclusion, the composite feeding index was independent of height and linear growth in these rural African children, due in part to reverse causality between breast-feeding duration and stunting.     

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.     

Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women

Maternal weight and body fat changes were studied in 56 women from delivery to 6 mo postpartum. Six-month weight losses (p less than 0.01) in exclusively breast-feeding (BF), exclusively formula-feeding (FF), and combination breast- and formula-feeding mothers (CF) were 8.30 +/- 0.74, 8.19 +/- 0.96, and 7.22 +/- 0.74 kg respectively; however, only BF experienced a significant change between 3 and 6 mo. Suprailiac and subscapular skinfold thickness decreased over 6 mo (p less than 0.01) with the suprailiac region reflecting a significant feeding-method effect. Increases in triceps fatfold measurements at 3 mo suggest that a temporary redistribution of body fat occurs as the energy stores of pregnancy are mobilized. Lactating mothers consumed more (p less than 0.01) kilocalories (BF, 2055 +/- 435; CF, 2005 +/- 515) than did nonlactating mothers (FF, 1453 +/- 503). Age, parity, and prepregnancy weight exerted significant covariable effects. Results suggest that lactation does play a role in postpartum weight and body fat loss but that the current RDA may be too high to permit such losses.     

Morbidity and the growth of stunted and nonstunted children, and the effect of supplementation.

Children aged 9-24 mo were recruited by a survey of poor areas of Kingston, Jamaica. Stunted children were randomly assigned to supplementation or not. Weekly morbidity histories were taken for 2 y. Separate multiple regressions on each symptom for weight or length gain in 2-mo intervals showed significant reductions in weight gain with coughing, apathy, anorexia, diarrhea, and fever, ranging from -2.1 to -16.8 g/d ill. Apathy and diarrhea reduced gains in length (-0.26 and -0.20 mm/d ill). Significant reductions in linear growth with lower respiratory-tract infections (-0.16 mm/d ill) occurred only in nonsupplemented children. Growth over 4-mo intervals was reduced if diarrhea occurred in the first 2 mo of the interval but there were no long-term effects of apathy, fever, or anorexia. Some of the effects of morbidity on growth were therefore transient and morbidity is unlikely to be a major cause of growth retardation in this population.     

Energy intake, not energy output, is a determinant of body size in infants

BACKGROUND: It has been proposed that the primary determinants of body weight at 1 y of age are genetic background, as represented by parental obesity, and low total energy expenditure. OBJECTIVE: The objective was to determine the relative contributions of genetic background and energy intake and expenditure as determinants of body weight at 1 y of age. DESIGN: Forty infants of obese and 38 infants of lean mothers, half boys and half girls, were assessed at 3 mo of age for 10 risk factors for obesity: sex, risk group (obese or nonobese mothers), maternal and paternal body mass index, body weight, feeding mode (breast, bottle, or both), 3-d energy intake, nutritive sucking behavior during a test meal, total energy expenditure, sleeping energy expenditure, and interactions among them. RESULTS: The only difference between risk groups at baseline was that the high-risk group sucked more vigorously during the test meal. Four measures accounted for 62% of the variability in weight at 12 mo: 3-mo weight (41%, P = 0.0001), nutritive sucking behavior (9%, P = 0.0002), 3-d food intake (8%, P = 0.0002), and male sex (3%, P = 0.05). Food intake and sucking behavior at 3 mo accounted for similar amounts of variability in weight-for-length, body fat, fat-free mass, and skinfold thickness at 12 mo. Contrary to expectations, neither total nor sleeping energy expenditure at 3 mo nor maternal obesity contributed to measures of body size at 12 mo. CONCLUSIONS: Energy intake contributes significantly to measures of body weight and composition at 1 y of age; parental obesity and energy expenditure do not.     

Assessment of health and nutritional status of infants in relation to breast feeding practices in Karmouz area, Alexandria

Infants are most precious part of nation's life. Infant health is a reflection of the health of the mother and it gives an indication of the health of the adult population of the future. The present work was designed to study the health and nutritional status of infants in Karmouz area in Alexandria as well as the effect of breast feeding practices on the health status of infants. Accordingly, a house to house survey was conducted through cluster sampling technique. The total sample amounted to 396 mothers and 409 infants. Data were collected about infants health status and their feeding practices. Weight and length were measured for all infants. Stool samples were collected and examined. The results revealed that 55.3% of infants had acute respiratory tract infections (ARI); 16.4% had bronchitis and 4.9% had pneumonia, 44% of the infants suffered from diarrhea, 13.2% were infected with parasites, Gardia lamblia was the most commonly found parasite (9.0%). High proportion of infants was found to be stunted (22.7%), 8.6% were wasted and 7.6% were underweight, 40.3% of mothers were in partial practice level. Infants below six months of age who received solid foods at three months or less had a significantly higher percentage of diarrhea (70.6%) compared to 51.5% among those of late weaning (four months or later). The diarrhea was significantly more common among infants aged 12 - < 18 months with about two times of risk relative to those aged < 6 months. A significantly higher risk of diarrhea was found for infants of bottle--or complementary feeding (OR = 2.05, 2.07 respectively, model X2 = 9.71, P < 0.01), in addition the protective effect of breast feeding persisted after adjustment of confounders by multiple logistic regression. High proportion of mothers (63.8%) continued to breast-feed their babies during diarrheal episodes. On the other hand breast-feeding was not significantly protective against the acute respiratory tract infection. Stunting of the infants increases rapidly with age from 12.6% among infants under six months to 30.4% among those aged from 9 - < 12 months. The percentage of stunted infants varied greatly by education of the mothers, it was doubled from 14.7% among those of mothers of high level of education to 28.9% of non educated mothers with a significant high risk of 2.31 times. The repeated attacks of diarrhea throughout the two years of life was still significantly associated with stunting even after adjustment of confounders by multiple logistic regression;, those with three attacks or more had about three times of risk relative to those without the disease (OR = 2.56, 95% CL = 1.12-5.81, model X2 = 19.03, P < 0.01). Health education program should be emphasized to all mothers to improve their knowledge and practice about breast-feeding and its importance in prevention of diarrhea.     

Breastfeeding attenuates reductions in energy intake induced by a mild immunologic stimulus represented by DPTH immunization: possible roles of interleukin-1beta,tumor necrosis factor-alpha and leptin

An attenuated severity of infections is among the well-documented benefits of breast-feeding. The degree to which this attenuated severity extends to the amelioration of anorexia is understood incompletely, and possible underlying mechanisms have received limited evaluation. This study was designed to test whether breast-feeding attenuates reductions in energy intake associated with a mild immunologic stimulus and to assess poststimulus relationships among putative reductions in energy intake and serum interleukin (IL)-1beta, tumor necrosis factor (TNF)-alpha and leptin concentrations. A quasi-experimental, hospital-based study was conducted in 23 healthy fully breast- (BF) and formula-fed (FF) infants who received the quadruple diphtheria, pertussis, tetanus and hemophilus influenza (DPTH) immunization as an immunologic challenge. Only FF infants had decreased energy intakes (12 +/- 2%, P = 0.001) after immunization. Leptin concentrations increased after immunization only in FF infants (30 +/- 7%, P = 0.03). Correlations between postimmunization increases in IL-beta and reductions in energy intake were of borderline significance (r = -0.56, P = 0.08). These findings support the view that breast-feeding protects against anorectic responses to mild immunologic stimuli. Increases in leptin are associated with reductions in energy consumption in the postimmunization period in FF infants and postimmunization changes in IL-1beta concentrations likely are related to reductions in energy intake in response to immunologic stimuli.