Infant growth patterns in the slums of Dhaka in relation to birth weight, intrauterine growth retardation, and prematurity

BACKGROUND: Relations between size and maturity at birth and infant growth have been studied inadequately in Bangladesh, where the incidence of low birth weight is high and most infants are breast-fed. OBJECTIVE: This study was conducted to describe infant growth patterns and their relations to birth weight, intrauterine growth retardation, and prematurity. DESIGN: A total of 1654 infants born in selected low-socioeconomic areas of Dhaka, Bangladesh, were enrolled at birth. Weight and length were measured at birth and at 1, 3, 6, 9, and 12 mo of age. RESULTS: The infants' mean birth weight was 2516 g, with 46.4% weighing <2500 g; 70% were small for gestational age (SGA) and 17% were premature. Among the SGA infants, 63% had adequate ponderal indexes. The mean weight of the study infants closely tracked the -2 SD curve of the World Health Organization pooled breast-fed sample. Weight differences by birth weight, SGA, or preterm categories were retained throughout infancy. Mean z scores based on the pooled breast-fed sample were -2.38, -1. 72, and -2.34 at birth, 3 mo, and 12 mo. Correlation analysis showed greater plasticity of growth in the first 3 mo of life than later in the first year. CONCLUSIONS: Infant growth rates were similar to those observed among breast-fed infants in developed countries. Most study infants experienced chronic intrauterine undernourishment. Catch-up growth was limited and weight at 12 mo was largely a function of weight at birth. Improvement of birth weight is likely to lead to significant gains in infant nutritional status in this population, although interventions in the first 3 mo are also likely to be beneficial.     

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.     

Ethnicity modifies seasonal variations in birth weight and weight gain of infants

Early growth is considered critical for the development of obesity and adulthood cardiovascular diseases. Because season and environmental temperature at birth have also been associated with obesity, it is important to examine whether birth weight and postnatal weight gain vary by season. Data from the National Collaborative Perinatal Project were used to assess the influence of season on birth weight and weight gain during the first 4 mo of life. The sample included 11,091 whites, 11,477 blacks, 1536 Puerto Ricans and 221 subjects of other ethnic groups born at full-term gestation. Black infants born in the fall had a significantly lower birth weight (3.12 +/- 0.42 kg) than those born in the winter (3.16 +/- 0.43 kg, P = 0.002). This difference was not found in the other ethnic groups. Additionally, weight gain (g/mo) for black and Puerto Rican infants during the first 4 mo of life was significantly lower for those born during the fall (black: 816 +/- 186; Puerto Rican: 820 +/- 181) compared to those born in the spring (black: 844 +/- 194, P < 0.001) and summer (Puerto Rican: 861 +/- 185, P < 0.04). Birth weight and early infancy weight gain varied by season and were modified by ethnicity. The potential importance of seasonal variations in pre- and postnatal growth was evaluated in this study.     

Determinants of infant growth in the slums of Dhaka: size and maturity at birth, breastfeeding and morbidity

OBJECTIVE: To investigate the influences of size at birth, breastfeeding and morbidity on growth during infancy in poor areas of urban Bangladesh. DESIGN: This was a prospective observational study of a cohort of newborn infants followed until 12 months of age. SETTING: Slum areas of Dhaka City in Bangladesh. SUBJECTS: A total of 1654 newborn infants were enrolled at birth, and follow-up was completed for 1207 infants. Repeated anthropometric measurements and interviews of caretakers on infant feeding and morbidity were conducted. A mixed effects regression method was used for modeling infant growth. RESULTS: After adjusting for other variables, mean differences in body weight by birth weight and length, small-for-gestational age and prematurity categories remained relatively constant throughout infancy. A positive impact of exclusive breastfeeding in the first 3 5 months on infant growth was detectable at 12 months of age. Although the bigger babies in the sample tended to grow relatively even bigger; exclusive breastfeeding appeared to counteract this pattern. Reported diarrhoea was associated with lower body weights and lengths even after adjusting for feeding patterns. CONCLUSIONS: Size at birth has an important role in determining growth during infancy. Effective strategies for improving birth weight, poorly addressed till now in Bangladesh, are needed. The sustained effect on growth and the even more beneficial effect in lighter infants are compelling reasons for promotion of exclusive breastfeeding in early infancy.     

Early infant feeding and growth status of US-born infants and children aged 4-71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND: There is controversy over what growth references to use in evaluating breast-fed infants and concern about whether never-breast-fed infants are at risk of overweight in childhood. OBJECTIVE: The objective of this study was to determine whether infants who are exclusively breast-fed for 4 mo differ in average size from infants who are fed in other ways and whether such differences persist through age 5 y. DESIGN: Data from the third National Health and Nutrition Examination Survey (NHANES III) were linked to birth certificates of US-born infants and children. Feeding groups were defined on the basis of feeding patterns over the first 4 mo of life: exclusively breast-fed for 4 mo, partially breast-fed, breast-fed for <4 mo, and never breast-fed. Growth status, indexed as internally derived z scores (SD units) for weight, length (height), weight-for-length (height), midupper arm circumference, and triceps skinfold thickness, was compared among feeding groups. RESULTS: The final sample consisted of 5594 non-Hispanic white, non-Hispanic black, and Mexican American infants and children aged 4-71 mo. Of these, 21% were exclusively breast-fed for 4 mo, 10% were partially breast-fed, 24% were breast-fed for <4 mo, and 45% were never breast-fed. At 8-11 mo, infants who were exclusively breast-fed for4 mo had adjusted mean z scores for weight (-0.21; -0.2 kg), weight-for-length (-0.27), and midupper arm circumference (-0.15) that differed significantly from zero (P < 0. 05). By 12-23 mo, the differences had dissipated; there were no significant differences subsequent to 5 y. Triceps skinfold thickness was not related to early infant feeding. CONCLUSION: Infants who were exclusively breast-fed for 4 mo weighed less at 8-11 mo than did infants who were fed in other ways, but there were few other significant differences in growth status through age 5 y associated with early infant feeding.     

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.     

Effect of sucking characteristics on breast milk creamatocrit

One of the problems in the care of healthy children is that mothers often give infant formulae to their normally growing infants in the first 4 months of life because they believe that they are unable to satisfy them. However, the association of fat content in breast milk with the sucking pattern of the infant is not clearly known. In order to determine whether the fat concentration of human milk was associated with sucking characteristics of the infants, 80 healthy 2-month-old babies and their mothers were included in the study. Milk creamatocrit was assessed at the beginning, at the first, fifth and 10th minutes and at the end of breast feeding. The creamatocrit values increased as the time elapsed from the beginning of breast feeding. There was an inverse relationship between milk volume and creamatocrit at both the beginning and the end of breast feeding (P < 0.05). The mean milk volume was higher and the mean creamatocrit at the end of breast feeding was lower in the infants whose 2-month weight gain was higher than the 75th percentile (75P) compared with those whose 2-month weight gain was lower than the 25th percentile (25P) (for milk volume 105 +/- 36 mL vs. 76 +/- 30 mL, respectively, P < 0.05; and for creamatocrit value 11.4 +/- 4.0 vs. 14.3 +/- 3.8, respectively, P < 0.05). Milk volume is the most important factor affecting weight gain of exclusively breast-fed babies, and fat concentration of human milk is not a primary determining factor in individual differences in weight gain of the infants and appears to be secondary to factors such as number of feeds per day, duration of breast feeding and the volume of milk sucked.     

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.     

Household food security is associated with infant feeding practices in rural Bangladesh

Although household food security (HHFS) has been shown to affect diet, nutrition, and health of adults and also learning in children, no study has examined associations with infant feeding practices (IFP). We studied 1343 infants born between May 2002 and December 2003 in the Maternal and Infant Nutrition Intervention in Matlab study to investigate the effect of HHFS on IFP in rural Bangladesh. We measured HHFS using a previously developed 11-item scale. Cumulative and current infant feeding scales were created from monthly infant feeding data for the age groups of 1-3, 1-6, 1-9, and 1-12 mo based on comparison to infant feeding recommendations. We used lagged, dynamic, and difference longitudinal regression models adjusting for various infant and maternal variables to examine the association between HHFS and changes in IFP, and Cox proportional hazards models to examine the influence of HHFS on the duration of breast-feeding and the time of introduction of complementary foods. Better HHFS status was associated with poor IFP during 3-6 mo but was associated with better IFP during 6-9 and 9-12 mo of age. Although better HHFS was not associated with the time of introduction of complementary foods, it was associated with the type of complementary foods given to the infants. Intervention programs to support proper IFP should target mothers in food-secure households when their babies are 3-6 mo old and also mothers in food-insecure households during the 2nd half of infancy. Our results provide strong evidence that HHFS influences IFP in rural Bangladesh.     

上海市外来人口婴幼儿喂养方法和安全行为教育评价

目的通过健康教育促进上海市徐;12区凌云社区外来人口的婴幼儿喂养水平和幼儿安全意识提高。方法在徐汇区凌云社区的外来人口婴幼儿中随机抽取50名。测量身高和体重并采用自行设计调查表对家长的喂养和安全知识进行基线调查．开展健康教育及行为指导．采用SPSS11．0统计方法对干预前后认知程度处理与分析。结果家长的喂养知识和安全知识水平干预前后有显著差异（X^2=71．37,P〈O．001;X^2=18．26,P〈O．001）,婴幼儿的体重增长差异有显著性（X^2=11．39,P〈O．05）。结论通过儿保门诊的健康教育和系统干预,可以提高外来人口的婴幼儿喂养知识水平和婴幼儿安全知识水平．改善与保证婴幼儿的体格生长及人身安全。     

Breastfeeding, introduction of complementary foods, and adiposity at 5 y of age

BACKGROUND: Although dual-energy X-ray absorptiometry (DXA) is considered the most accurate measure of adiposity in children, it has rarely been used to examine the relation between infant feeding and adiposity during childhood. OBJECTIVE: The objective was to ascertain whether adiposity at age 5 y was related to breastfeeding, to the timing of the introduction of complementary foods during infancy, or to both. DESIGN: Body composition was measured in 313 children at age 5 y by using DXA. Data on breastfeeding, formula feeding, and the timing of the introduction of complementary foods were obtained from the mothers when the children were 3 y old. Regression analysis was used to examine the relation between infant feeding and fat mass after adjustment for lean body mass, sex, birth weight, maternal obesity, race, and other sociodemographic variables. RESULTS: Fifty-three percent of the children were boys, 80% were white, and 20% were black. There was no significant difference in adjusted fat mass between those ever breastfed and those never breastfed (x +/- SE: 4.48 +/- 0.09 and 4.76 +/- 0.17 kg, respectively; P = 0.17). Children who were breastfed for a longer duration and those who were breastfed without concurrent formula feeding did not have significantly lower fat mass than did those children who were never breastfed. Children did not differ significantly in fat mass if they were introduced to complementary foods before or after 4 mo of age (4.49 +/- 0.12 and 4.63 +/- 0.12 kg, respectively; P = 0.42). CONCLUSION: Neither breastfeeding nor the timing of the introduction of complementary foods was associated with adiposity at age 5 y.     

Growth and feeding practices of Vietnamese infants in Australia

OBJECTIVE: To investigate the growth and feeding practices in first-generation Vietnamese infants living in Australia. DESIGN: Cohort study. SETTING: The study was conducted between 1999 and 2002 in Sydney. SUBJECTS: A total of 239 Vietnamese women were recruited randomly from antenatal clinics, and of these 210 were initially seen. During the first year, 20 cases (9.5%) were lost to follow-up. Data were collected at 0.5, 2, 4, 6, 9 and 12 months. RESULTS: Vietnamese infants were significantly longer and heavier than reference data (both P<0.0001). The Vietnamese infants had a significant decline in weight growth with age compared with reference data (P<0.001). The Vietnamese infants had marginally higher s.d. score for ideal weight for length than reference data (P=0.044). There was a significant decline in ideal weight for length with age compared with reference data (P=0.0065). Both parents were significantly shorter (mean s.d. height scores: -1.5+/-0.8 (mother) and -1.8+/-0.8 (father)) than reference data (P<0.001). The incidence of breast feeding was 79%, but half of the breast feeding women had stopped breast feeding by 3 months. A total of 162 (79.8%) infants were given infant formula within the first week, of whom 131 (80.1%) were fed infant formula within the first 24 h after birth. CONCLUSIONS: Vietnamese infants in this study had growth comparable with reference data despite their parents being shorter than reference data. Breast feeding duration was short with infant formula being introduced early.     

早产/低出生体重儿的合理喂养

早产/低出生体重儿是婴幼儿期生长迟缓、发育落后、感染性疾病的高危人群,合理喂养是保证其健康成长的物质基础,关系着近期生长和疾病转归,并利于远期健康。本文将结合早产/低出生体重儿营养管理相关指南,就早产/低出生体重儿的合理喂养问题作适当详述,细化相关喂养建议,促使早产/低出生体重儿获得与同孕周胎儿相似的体质结构,满足生长发育需要,提高生存质量,促进远期健康。     

Birth weight, growth and feeding in infancy: relation to serum lipid concentration in 12-month-old infants

OBJECTIVE: To assess the effects of birth size, growth and feeding in infancy on serum lipids in 12-month-old infants. DESIGN: A longitudinal observation study on infants' consumption and growth. Food and growth records were made every month. At 6, 9 and 12 months, food records were weighed to calculate intake. Serum total cholesterol (TC), high-density lipoprotein-cholesterol (HDL), low-density lipoprotein (LDL) -cholesterol and triglyceride concentrations were analysed at 12 months. SETTINGS: Birth and growth information was gathered from maternity wards and healthcare centres in Iceland and food consumption data at home. SUBJECTS: Randomly selected newborns (n=180) according to the mother's domicile and 77% (n=138) participated, of them 75% (n=103), came in for blood sampling. RESULTS: Among boys, a 1 kg higher birth weight resulted in a 0.79 mmol/l higher TC (P=0.005), but nonsignificant after adjustment for growth. Duration of breastfeeding was related to LDL-cholesterol (B=0.06 +/-0.02, P=0.020, adj. R(2)=0.039), adjusting for gender. Independent of size at birth and breastfeeding, increase in length from 6 to 12 months and in weight from birth to 12 months were negatively related to TC (B=-0.455+/-0.156, P=0.008 and B=-1.086+/-0.474, P=0.032, respecitvely) in boys. PUFA was the strongest nutrient variable predicting TC (B=0.332, adj. R(2)=0.24, P>0.001). Cod liver oil consumption increased both TC and LDL-cholesterol in girls (B=0.141+/-0.051, P=0.008 and B=0.112+/-0.047, P=0.021, respectively). CONCLUSION: Slower growth of high birth weight infants and breastfeeding contributes to higher TC concentration at the age of 12 months. Nutrient intake in infancy also affects lipid profile. The effect of birth weight, growth and nutrient intake in infancy on lipid profile is different for boys and girls.     

Comparison of High and Normal Birth Weight Infants on Eating,Feeding Practices,and Subsequent Weight

Objectives High birth weight (HBW?≥?4000 g) infants are at increased risk for obesity, but research has yet to identify the mechanism for this increased risk and whether certain subsets of HBW infants are at greater risk. Methods This exploratory study examined child eating behaviors and maternal feeding practices and beliefs across 21 HBW and 20 normal birth weight (NBW, 2500–3999 g) infants at 7–8 months of age using maternal-report measures (n?=?41) and a bottle feeding task (n?=?16). Results HBW infants were at increased risk for high weight-for-length at 7–8 months (F (2, 38)?=?6.03, p?=?.02) compared to NBW infants, but no statistically significance differences on weight gained per day since birth, child eating behaviors, or most maternal feeding practices and beliefs were found between HBW and NBW infants. However, HBW infants who maintained a high weight-for-length (≥?85th percentile) at 7–8 months had a higher birth weight, gained more weight per day, and had lower maternal-reported satiety responsiveness and maternal social interactions during feedings than their HBW counterparts who were currently below the 85th percentile. Conclusions for Practice HBW infants did not differ from NBW infants on eating behaviors and feeding practices, but children born at HBW who maintain excess weight during infancy do differ from those infants who fall below the 85th percentile for weight-for-length. Future research should identify risk factors that longitudinally differentiate HBW infants at greatest risk for maintaining excess weight and develop early screening and intervention efforts for this subset of at-risk infants.     

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.     

低出生体重儿婴儿期体格生长指标参考值偏度系数-中位数-变异系数法研究

  目的  了解合肥市主城区低出生体重儿（low birth weight infant,LBWI）0~12月体格生长状况,掌握合肥市早产低出生体重儿和足月小样儿婴儿期生长轨迹。  方法  建立出生队列,228名LBWI进入队列,选取同期同机构接受健康管理的161名正常出生体重儿（normal birth weight infant,NBWI）作为对照组,监测婴儿0~12月龄体格生长指标,以偏度系数-中位数-变异系数（lambda-mu-sigma,LMS）法计算性别年龄别体重、身长各百分位数值,并绘制LMS曲线。  结果  婴儿期LBWI组体重、身长等指标均明显低于NBWI组,差异有统计学意义（均有P < 0.001）;LBWI 3月龄体重达到出生时2.5倍,12月龄体重约为出生时4.3倍,12月龄身长为出生时1.6倍;总体上LBWI组在生后第1年尤其在6月龄前体重、身长呈追赶生长趋势,早产低出生体重儿追赶生长速度快于足月小样儿。  结论  LBWI在婴儿期存在追赶生长,LMS法建立的合肥市早产低出生体重儿与足月小样儿婴儿期生长曲线客观地描述了两者不同的体格生长特点和轨迹。     

Eating behavior disorders in Chilean infants

Eating behavior disorders (EBD) are often observed in children. Most of the related research, however, has been performed in developed countries. In countries like Chile, characterization of food disorders during the first years of life is unknown. OBJECTIVE: The goal of the current study is to characterize the EBD of Chilean children during the first 2 years of life. METHODS: We studied 67 children (mean age = 5.4 months; range = 4-24 months). The study group (SG; according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders) consisted of 34 children with EBD whose mothers spontaneously consulted for difficulties for feeding and the control group (CG) included 33 healthy children. A structured recall was applied to their mothers. RESULTS: EBD onset was observed more frequently during the first semester of life and was associated with new foods. The children in the SG presented with lower birth weight (SG: 3,000 +/- 500 g; CG: 3,400 +/- 500 g; p < .001), weight/length (-0.4 +/- 1.0 vs. 0.8 +/- 1.1; p = .0001), and length/age z scores (-0.7 +/- 1.0 vs. -0.1 +/- 0.8; p = .007) than children in the CG. Early weaning before 4 months of age was more frequently found in the SG (44.1% vs. 12.1%; p = .04). The logistic regression showed as variables those associated with EBD, that is, birth weight and maternal history of EDB during her infancy (chi(2), p = .0003). Mothers of children in the SG felt that their maternal role was more difficult and less satisfactory than mothers of children in the CG (chi(2), p = .03). DISCUSSION: EBDs in Chilean infants are observed during the first months of life and are associated with a lower birth weight, shortened exclusive breast-feeding, maternal history of EBD during their infancy, and lower physical growth. Mothers of children with EBD frequently feel that their maternal role is difficult and unsatisfactory.     

Relations between high ponderal index at birth, feeding practices and body mass index in infancy

OBJECTIVE: We compared feeding practices between infants of high ponderal index (PI) at birth (PI above the 90th percentile) and normal PI at birth (PI between 10th and 90th percentiles), and examined how birth size and infant feeding practices were related to body mass index (BMI) at 12 months. DESIGN: In a cohort of 3000 infants invited to participate in a national Norwegian dietary survey, 1825 participated both at 6 and 12 months of age, and the present study included those born full term and with a PI (weight/length3) at birth > or =10th percentile (n=1441). Data on feeding practices were collected by food-frequency questionnaires, and anthropometrical data were measured by health-care personnel. RESULTS: A lower proportion of infants born with high PI were exclusively breastfed for at least 4 months compared with infants born with normal PI (37 and 47%, respectively; P=0.03). Earlier introduction of solid foods and higher consumption of some foods were also observed among infants of high PI. In a multivariate analysis, adjusted mean BMI (kg/m2) at 12 months was higher for infants of high PI at birth than for infants of normal PI (17.6 and 17.0, respectively; P<0.001) and higher for infants exclusively breastfed <3 months than for infants exclusively breastfed > or =3 months (17.5 and 17.2, respectively; P=0.001). CONCLUSIONS: High PI at birth was associated with a shorter duration of exclusive breastfeeding. Furthermore, high PI at birth and short-term exclusive breastfeeding were both associated with higher BMI at 12 months.     

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife,Osun State,Nigeria

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.