The growth and nutritional status of the breast-fed infant

Gender perceptions predict sex differences in growth patterns of indigenous Guatemalan infants and young children

BACKGROUND

Nearly one-half of Guatemalan children experience growth faltering, more so in indigenous than in nonindigenous children.

OBJECTIVES

On the basis of ethnographic interviews in Totonicapán, Guatemala, which revealed differences in maternal perceptions about food needs in infant girls and boys, we predicted a cumulative sex difference in favor of girls that occurred at ∼6 mo of age and diminished markedly thereafter. We examined whether the predicted differences in age-sex patterns were observed in the village, replicated the examination nationally for indigenous children, and examined whether the pattern in nonindigenous children was different.

DESIGN

Ethnographic interviews (n = 24) in an indigenous village were conducted. Anthropometric measurements of the village children aged 0-35 mo (n = 119) were obtained. National-level growth patterns were analyzed for indigenous (n = 969) and nonindigenous (n = 1374) children aged 0-35 mo with the use of Demographic and Health Survey (DHS) data.

RESULTS

Mothers reported that, compared with female infants, male infants were hungrier, were not as satisfied with breastfeeding alone, and required earlier complementary feeding. An anthropometric analysis confirmed the prediction of healthier growth in indigenous girls than in indigenous boys throughout the first year of life, which resulted in a 2.98-cm height-for-age difference (HAD) between sexes in the village and a 1.61-cm HAD (P < 0.001) in the DHS data between 6 and 17 mo of age in favor of girls. In both data sets, the growth sex differences diminished in the second year of life (P < 0.05). No such pattern was seen in nonindigenous children.

CONCLUSIONS

We propose that the differences in the HAD that first favor girls and then favor boys in the indigenous growth patterns are due to feeding patterns on the basis of gendered cultural perceptions. Circumstances that result in differential sex growth patterns need to be elucidated, in particular the favorable growth in girls in the first year of life.

Tolerance and safety evaluation in a large cohort of healthy infants fed an innovative prebiotic formula: a randomized controlled trial

Background

the addition of oligosaccharides to infant formula has been shown to mimic some of the beneficial effects of human milk. The aim of the study was to assess the tolerance and safety of a formula containing an innovative mixture of oligosaccharides in early infancy.

Methodology/Principal Findings

this study was performed as a multi-center, randomized, double-blind, placebo-controlled trial including healthy term infants. Infants were recruited before the age of 8 weeks, either having started with formula feeding or being fully breast-fed (breastfeeding group). Formula-fed infants were randomized to feeding with a regular formula containing a mixture of neutral oligosaccharides and pectin-derived acidic oligosaccharides (prebiotic formula group) or regular formula without oligosaccharides (control formula group). Growth, tolerance and adverse events were assessed at 8, 16, 24 and 52 weeks of age. The prebiotic and control groups showed similar mean weight, length and head circumference, skin fold thicknesses, arm circumference gains and stool frequency at each study point. As far as the anthropometric parameters are concerned, the prebiotic group and the control group did not attain the values shown by the breastfeeding group at any study point. The skin fold thicknesses assessed in the breastfeeding group at 8 weeks were strikingly larger than those in formula fed infants, whereas at 52 weeks were strikingly smaller. The stool consistency in the prebiotic group was softer than in the control group at 8, 16 and 24 weeks (p<0.001) and closer to that of the breastfeeding group. There was no difference in the incidence of adverse events between the two formula groups.

Conclusions

our findings demonstrate the tolerability and the long term safety of a formula containing an innovative mixture of oligosaccharides in a large cohort of healthy infants.

Trial Registration:

drks-neu.uniklinik-freiburg.de DRKS 00000201

[Nutrient intakes in 2005 by non-breast fed French children of less than 36 months]

BACKGROUND

Knowledge of the nutritional consumption of very young children is of main interest, but little is known about the dietary status of French infants and toddlers.

OBJECTIVE

To assess energy and nutrient intake and the adequacy of diet of French infants and toddlers.

DESIGN AND SETTING

A national cross-sectional survey was conducted in France from January to March 2005, using proportionate quota sampling based on the age of the children, the occupation of the mother, and the family socioeconomic category.

SUBJECTS

Seven-hundred and six children were allocated to 11 age subgroups ranging from one to three months to 31-36 months. Totally or partially breastfed infants were excluded. ANALYSES PERFORMED: Individual consecutive 3-day weight food records were converted into energy intake and intake of 24 nutrients according to food composition databases recently updated for 1260 standard foods and all the formulae and specific baby foods manufactured and marketed in France in 2005.

RESULTS

Mean daily energy intake in 2005 was above the estimated average requirement up to seven months of age, but was lower after one year. Protein, fat, and carbohydrate intakes were adequate, while calcium, magnesium, phosphorus and B group vitamins were above the recommended dietary allowances for all 11 subgroups. However, for toddlers over 12 months of age, some may have had an inadequate intake of alpha-linolenic acid, vitamin E, vitamin C, iron and zinc, whereas mean sodium intake was above the adequate intake for all age subgroups.

CONCLUSIONS

The diet of French infants was adequate for a large proportion of children and satisfied most of their nutritional requirements. However, the intake of iron and alpha-linolenic acid in particular needs to be improved for some French toddlers.

The association between diet and height in the postinfancy period changes with age and socioeconomic status in Filipino youths

Whether the determinants of linear growth can have independent effects beyond the critical infancy period has been questioned. This research uses uniquely suited data from >2000 youths from the Cebu Longitudinal Health and Nutrition Study in the Philippines to examine the association between diet and height in the postinfancy period. Anthropometric, diet, and other data were collected bimonthly from 0 to 2 y, and at the mean ages of 8, 11.5, 15.5, and 18.5 y. Generalized Estimating Equations were used to quantify the mean effects of diet diversity and energy intake on height across increments demarcated by the postinfancy data (2-8.5, 8.5-11.5, 11.5-15.5, and 15.5-18.5 y). We examined whether the effects differed by socioeconomic status (SES) and age. Effects with P < 0.05 were considered significant. Each additional unit of diet variety (range 0-8 U) was associated with a significant 0.33-cm increase in height in boys. Each additional 100 kcal (4186 kJ) was associated with significant increases in height of 0.05 cm in boys, and 0.02 cm in girls. Significant interactions (P < 0.15) with SES showed that each 100 kcal increase in energy intake was associated with a 0.08-cm increase in height at low SES with no difference at high SES. In both boys and girls, the effects of energy intake decreased with age, as shown by a significant age interaction (P < 0.15). The methods used incorporate the longitudinal nature of the data to offer a unique examination of the association between diet and height in the postinfancy period.

Promoting the exclusive feeding of own mother's milk through the use of hindmilk and increased maternal milk volume for hospitalized, low birth weight infants (< 1800 grams) in Nigeria: a feasibility study

A feasibility study was used to determine (1) if hindmilk feedings of own mother's milk, as reported in the United States, could be instituted in a Nigerian neonatal intensive care unit and result in adequate infant weight gain without exogenous additives; and (2) if the use of a hospital-grade electric breast pump to separate foremilk from hindmilk was feasible in this setting. Mean weight gain for 16 preterm infants during the hindmilk intervention (18.8 g/d) exceeded intrauterine standards without the use of exogenous substances. At the time of hospital discharge, mean maternal daily milk volume was 342 mL/kg/d, indicating that the infants, on average, had 90% more milk available to them than they required. Mean infant weight gains were 14.2 and 16.6 g/d from 1 to 7 and 8 to 23 (x = 14.8) days postdischarge, respectively. Therefore, hindmilk feedings are effective and feasible for hospitalized, low birth weight infants in developing countries, and lactation specialists may use our protocol for further research.

Association between breast feeding and growth: the Boyd-Orr cohort study

OBJECTIVE

To investigate the association of breast feeding with height and body mass index in childhood and adulthood.

DESIGN

Historical cohort study, based on long term follow up of the Carnegie (Boyd-Orr) survey of diet and health in pre-war Britain (1937-1939).

SETTING

Sixteen urban and rural districts in Britain.

SUBJECTS

A total of 4999 children from 1352 families were surveyed in 1937-1939. Information on infant feeding and childhood anthropometry was available for 2995 subjects.

MAIN OUTCOME MEASURES

Mean differences in childhood and adult anthropometry between breast and bottle fed subjects.

RESULTS

Breast feeding was associated with the survey district, greater household income, and food expenditure, but not with number of children in the household, birth order, or social class. In childhood, breast fed subjects were significantly taller than bottle fed subjects after controlling for socioeconomic variables. The mean height difference among boys was 0.20 standard deviation (SD) (95% confidence interval (CI) 0.07 to 0.32), and among girls it was 0.14 SD (95% CI 0.02 to 0.27). Leg length, but not trunk length, was the component of height associated with breast feeding. In males, breast feeding was associated with greater adult height (difference: 0.34 SD, 95% CI 0.13 to 0.55); of the two components of height, leg length (0.26 SD, 95% CI 0.02 to 0.50) was more strongly related to breast feeding than trunk length (0.16 SD, 95% CI -0.04 to 0.35). Height and leg length differences were in the same direction but smaller among adult females. There was no association between breast feeding and body mass index in childhood or adulthood.

CONCLUSIONS

Compared with bottle fed infants, infants breast fed in the 1920s and 1930s were taller in childhood and adulthood. As stature is associated with health and life expectancy, the possible long term impact of infant feeding on adult mortality patterns merits further investigation.

Fat content of the diet among preschool children in southwest Britain: II. relationship with growth, blood lipids, and iron status

OBJECTIVE

In most countries, it is recommended that adults restrict fat intake to 30% to 35% of energy to reduce the risk of coronary heart disease and certain cancers. However, the appropriate level of fat in the diet of children is hotly debated. It has been generally accepted that fat intake by children under 2 years of age should not be limited because of fears that nutrient intakes and thus growth and iron status might be compromised. However, there is very little longitudinal information on the relationship between fat intake and growth in representative populations of free-living children under 2 years old. The objective of this study was to investigate the relationship between fat intake as a percentage of energy, and nutrient adequacy, growth, blood lipids, and iron status in 18- and 43-month-old children.

DESIGN

This study forms part of the Avon Longitudinal Study of Parents and Children (ALSPAC)-a geographically-based cohort study in southwest England. A randomly selected subsample of the ALSPAC cohort attended research clinics approximately every 6 months from birth, at which a variety of anthropometric and other measurements were made. Dietary intakes at 18 and 43 months were assessed using a 3-day unweighed food record. A capillary blood sample was taken at 18 months for measurement of hemoglobin and ferritin levels. Nonfasting venous blood samples were taken at 31 and 43 months and analyzed for total and high-density lipoprotein cholesterol. The children were divided into quartiles of fat intake as a percentage of energy (QFI). QFI groups were compared for the number of children reaching recommended nutrient intakes, and for anthropometry, measures of iron status, and blood lipid levels.

PARTICIPANTS

Nine hundred fifty-one children at 18 months and 805 children at 43 months.

RESULTS

The mean (standard deviation) percentages of energy from fat in each quartile at 18 months were 31.2 (2.8), 36.1 (0.9), 39.1 (0.8), and 43.1 (2.2), corresponding to a fat intake in grams of 37.3 (8.1), 44.3 (8.1), 50.4 (10.2), and 55.4 (12.7). The number of children failing to reach recommended intake levels for zinc and vitamin A fell with increasing fat intake, while the number of children consuming less than the recommendations for iron and vitamin C rose at both ages. Despite this, there was no association between fat intake at 18 months and mean height or body mass index (BMI) at either 18 or 31 months. Fat intake at 43 months was also unassociated with concurrent or subsequent height or BMI. There was also no significant increase in the number of children falling below the tenth percentile for height or BMI as QFI fell. Mean ferritin levels at 18 months fell in both sexes as QFI increased. Total cholesterol levels at 31 months were significantly associated with QFI at 18 months, and rose from 3.99 mmol/l in the lowest QFI in boys, to 4.31 mmol/l in the highest QFI. QFI at 43 months was unassociated with cholesterol levels.

CONCLUSIONS

These data do not suggest that fat intakes are an important determinant of growth in these children, even before the age of 2 years, or that children at the bottom of the range of fat intakes are experiencing delayed growth. On the other hand, there is also no evidence in this study that children on higher fat intakes are at a greater risk of becoming obese. In contrast to a number of US studies, we have not found children on lower fat intakes to have lower iron intakes-indeed higher fat intakes were associated with a greater chance of consuming less than the recommended intake of iron and with lower ferritin levels. The association of higher fat intakes with higher total cholesterol levels among boys is of concern, as there is evidence that the process of atherosclerosis begins during the preschool years.

Worldwide timing of growth faltering: implications for nutritional interventions

OBJECTIVE

It is widely assumed that growth faltering starts at around 3 months of age, but there has been no systematic assessment of its timing using representative national datasets from a variety of countries.

METHODOLOGY

The World Health Organization Global Database on Child Growth and Malnutrition includes the results of 39 nationally representative datasets from recent surveys in developing countries. Based on these data, mean z scores of weight for age, length/height for age, and weight for length/height were compared with the National Center for Health Statistics and Cambridge growth references, for children younger than 60 months.

RESULTS

Mean weights start to falter at about 3 months of age and decline rapidly until about 12 months, with a markedly slower decline until about 18 to 19 months and a catch-up pattern after that. Growth faltering in weight for length/height is restricted to the first 15 months of life, followed by rapid improvement. For length/height for age, the global mean is surprisingly close to National Center for Health Statistics and Cambridge references at birth, but faltering starts immediately afterward, lasting well into the third year.

CONCLUSIONS

These findings highlight the need for prenatal and early life interventions to prevent growth failure.

Bone mineral content in girls perinatally infected with HIV

BACKGROUND

Early diagnostic efforts and advances in multidrug therapy have considerably prolonged the survival time of children infected perinatally with HIV. Despite these advances, few studies have addressed calcium status and bone growth in HIV-infected children.

OBJECTIVE

Our objective was to examine the effect of HIV infection on calcium status and bone growth in children.

DESIGN

We measured calcitropic hormones, urinary calcium excretion, bone mineral content, and body composition in 19 young girls aged 9.2 +/- 2.6 y (range: 5.9-15.2 y) who were infected perinatally with HIV.

RESULTS

Serum concentrations of 1,25-dihydroxyvitamin D [1,25(OH)(2)D] and parathyroid hormone concentrations were elevated above normal ranges in 25% and 12% of these girls, respectively. Urinary calcium excretion normalized for creatinine excretion was also elevated (Ca/Cr >0.18) in 17% of these children despite suboptimal calcium intakes (679 +/- 437 mg/d). Total-body bone mineral content, measured with the use of dual-energy X-ray absorptiometry, averaged 845.1 +/- 279.0 g and was on average 2.7 z scores below age- and race-matched values reported in non-HIV-infected healthy girls. Significant positive correlations were found between an indirect marker of bone resorption in urine (N:-telopeptide) and 1,25(OH)2D (P < 0.02, r2 = 0.586, n = 9), and between serum N-telopeptide and total alkaline phosphatase (P < 0.001, r2 = 0.541, n = 17), suggesting that calcium insufficiency may be increasing bone resorption in this group.

CONCLUSIONS

Young girls with HIV infection had low bone mass and evidence of calcium insufficiency. Nutritional counseling of children with HIV infection should emphasize adequate calcium intakes because of the importance of this age period in bone mineral acquisition.

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.

Proliferation and differentiation of stromal-vascular cells in primary culture differ between neonatal pigs consuming maternal or formula milk

Proliferation and differentiation of preadipocytes from 7-d-old pigs consuming maternal or formula milk were examined in primary culture of stromal-vascular (s-v) cells derived from subcutaneous adipose tissue. Unsuckled pigs were bottle-fed isoenergetically with colostrum and then sow's milk (SM) or with formula milk alone (F) from birth to 7 d. Isolated cells were exposed to serum-supplemented medium and serum-free medium to determine proliferation and differentiation, respectively. Proliferation estimated between d 3 and 4 of culture was higher (P<0.05) in cells from F than SM pigs. In addition, the number of s-v cells isolated from 1 g of adipose tissue was higher (P<0.01) in F than SM pigs. Variables assessing differentiation were also affected. The percentage of differentiating cells and lipoprotein lipase (LPL) activity were lower (P<0.05) in F than SM pigs, whereas malic enzyme (ME) activity did not differ significantly between the two groups. In conclusion, formula milk increased the number of s-v cells and their capacity for proliferation, whereas the potential for cell differentiation was lower compared with cells from the maternal milk group. Further studies are required to identify the growth and/or nutritional factors that are implicated in the observed differences and to determine whether subsequent development of adipose tissue is affected.

Cholesterol and triglyceride concentrations, birthweight and central obesity in pre-school children. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

OBJECTIVE

To investigate the relationship between blood cholesterol and triglyceride, birthweight and central obesity in pre-school children, after controlling for height and body mass index.

METHODS

This was a longitudinal population-based study in south-west England. Research clinics were held when the children were 31 and 43 months of age, where anthropometric measurements were made and a non-fasting blood sample was taken and analysed for triglyceride, total cholesterol and high-density lipoprotein (HDL) cholesterol. Low-density lipoprotein (LDL) cholesterol values were calculated using the Friedewald equation. Central obesity was estimated using the ratio of waist circumference:arm circumference (WC:AC).

RESULTS

Complete blood lipid and anthropometric data were available for 385 children at 31 months and 470 children at 43 months. Height was negatively associated with the concentration of triglyceride, and total and LDL cholesterol. There was little evidence for a relationship between body mass index (BMI) and blood lipids at either 31 or 43 months. The only significant relationship between birthweight and blood lipids was a negative association with HDL (and consequently a positive association with the ratio of total:HDL cholesterol) in boys at 43 months. Adjustment for current height and BMI had little effect on the associations between birthweight and blood lipid concentrations. WC:AC was positively associated with triglycerides and negatively associated with HDL values in boys, and had a quadratic relationship with LDL concentrations among girls. These relationships were unchanged or became stronger on adjustment for current height and body mass index.

CONCLUSION

In the pre-school child, central obesity has a relationship with triglyceride and HDL concentrations that is independent of current height and BMI. We have found no evidence that increasing birthweight is associated with a more favourable blood lipid profile at 31 and 43 months.

The effect of breast feeding on lymphocyte subpopulations in healthy term infants at 6 months of age

Breast milk contains many immunologically active components that influence the development of the immune system of the breast-fed infant. The purpose of this study was to investigate the difference in specific lymphocyte subsets between breast-fed and formula-fed 6-mo-old infants. Peripheral blood samples were collected from 79 breast-fed (< 120 mL formula/wk) and 69 formula-fed (breast-fed < 4 wk) infants at 6 mo. All infants had been born at term and had no known illness at the time of blood collection. Packed cells from whole blood were incubated with fluorochrome-labeled monoclonal antibodies, followed by erythrocyte lysis. Washed lymphocytes were analyzed by two-color direct immunofluorescence on a flow cytometer. The percentage of T and B lymphocytes in the peripheral blood of 6-mo-old infants was the same, regardless of feeding regimen. However, the relative frequency of natural killer (NK) cells was greater in breast-fed infants than in formula-fed infants (9.7% vs 7.1%; p < 0.001). The percentage of cells expressing CD4 was lower in breast-fed infants than in formula-fed infants (47.3% vs 50.9%; p < 0.005), and that of cells expressing CD8 was greater (18.0% vs 16.4%; p < 0.05). As a result, the CD4:CD8 ratio in breast-fed infants was lower than that in formula-fed infants (2.8 vs 3.3; p < 0.005). The absolute size of the lymphocyte subpopulations T, B, and CD8+ was the same for each of the two populations of infants. However, breast-fed infants had fewer CD4+ T cells (p < 0.05) and a greater number of NK cells (p < 0.01) than the age-matched formula-fed infants. The immunophenotypic differences between breast-fed and formula-fed infants are consistent with reported age-related changes, suggesting greater maturity in the development of the immune system of breast-fed infants.

Does breast feeding have any impact on non-infectious, non-allergic disorders?

Feeding of breast milk in the first weeks of life appears to have a strong protective effect against necrotising enterocolitis. Nevertheless breast milk also seems to be positively linked to the development of jaundice and to late haemorrhagic disease in infants who have not received vitamin K supplements. There is no consistent evidence that other childhood conditions such as insulin dependent diabetes or cancer are less prevalent among children who have been breast fed. Among adult conditions suggested to be less prevalent in the breast fed, only single reports of significant findings for multiple sclerosis and breast cancer exist and convincing corroboration is not available. There are a number of studies that indicate a relationship between breast feeding and later cholesterol levels--and one that has considered the mortality of ischaemic heart disease among adult males. There is some suggestion that breast feeding (during the first year of life) is the optimal protection against future raised lipid levels and mortality from coronary heart disease, but the evidence is far from conclusive. The major health advantage of breast feeding that has been clearly demonstrated remains in the protection of the infant from certain infections in early life. If there are other long-term health advantages they have yet to be fully elucidated and confirmed.