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Thompson KL, Clarke EC, Wasser H, Schenkelberg MA, Agrawal S, Willis EA. Complementary feeding practices of caregivers of infants with Down syndrome as compared to caregivers of typically developing infants. Appetite 2024; 198:107356. [PMID: 38636668 DOI: 10.1016/j.appet.2024.107356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
Caregiver feeding practices during the complementary feeding period (6 months-2 years) may be particularly important for infants with Down syndrome (DS) as they are at higher risk for later health conditions (e.g., obesity, diabetes) that can be influenced by early feeding practices. However, how well caregivers of infants with DS are meeting infant feeding evidence-based practices is relatively unknown. Caregivers of infants with DS (N = 75) and caregivers of typically developing (TD) infants (N = 66) aged 0-2 years completed an online survey about their infant feeding practices and information sources. Caregiver practices and information sources were statistically compared between groups. Results indicated that there are significant differences in the feeding practices of caregivers of infants with DS when compared to caregivers of TD infants. Caregivers of infants with DS were less likely to meet infant feeding evidence-based practices than caregivers of TD infants. Caregivers of infants with DS were also more concerned about their infant's food intake and later weight status. Some individual feeding practices also significantly differed between groups, with caregivers of infants with DS more likely to meet evidence-based practices of purchasing iron rich foods and avoiding added salt, but less likely to use responsive feeding practices than caregivers of TD infants. Caregivers of infants with DS were also less likely to receive information about how to navigate the complementary feeding period than caregivers of TD infants. Coupled with existing research, the results of the present study suggest that infant feeding evidence-based practices should be reviewed for their appropriateness for this population and additional support for caregivers of infants with DS should be implemented to help them navigate this important period.
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Affiliation(s)
- Kelsey L Thompson
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK Jr Blvd, Chapel Hill, NC, 27514, USA.
| | - Emily C Clarke
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK Jr Blvd, Chapel Hill, NC, 27514, USA
| | - Heather Wasser
- Gillings School of Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27514, USA
| | - Michaela A Schenkelberg
- School of Health and Kinesiology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE, 68182, USA
| | - Seema Agrawal
- Gillings School of Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27514, USA
| | - Erik A Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK Jr Blvd, Chapel Hill, NC, 27514, USA
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Hollinrake G, Komninou S, Brown A. Use of baby food products during the complementary feeding period: What factors drive parents' choice of products? MATERNAL & CHILD NUTRITION 2024:e13689. [PMID: 38898599 DOI: 10.1111/mcn.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
It is recommended that infants are introduced to complementary foods from 6 months old, moving from a solely milk diet to eating a family diet by 12 months old. Although home cooking of family foods is recommended, a rapidly growing market producing baby food products (BFP) such as jars, pouches and snacks has developed. These are often accompanied by marketing claims around nutritional, health and developmental impacts despite research highlighting high sugar content. Although numerous studies have explored drivers of infant formula choice and use, little research has examined the drivers of BFP use. This study used an online survey for United Kingdom parents of infants aged 4-12 months to explore use of BFP alongside perceptions and drivers to purchase products. Overall, 271 parents participated (173 used BFP and 98 did not), with a descriptive analysis of closed items and a thematic analysis for open ended text conducted. The top motivators for using BFP were convenience, time saving, and baby's perceived enjoyment of products. The most purchased puree was fruit based and the most purchased baby snacks were vegetable puffs/sticks, with snack purchases being more common than purees in this sample. Aspects such as perceived healthiness drove choice, with snack foods being seen to enhance self-feeding skills, appetite regulation and motor development. Those who did not use BFP did not trust them and preferred to feed their baby home cooked foods. The findings are important for professionals working with parents, to support them through the transition to solid foods, particularly around raising awareness of marketing techniques and how to check content of foods to make a more informed choice.
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Affiliation(s)
- Grace Hollinrake
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Swansea, UK
- Faculty Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Sophia Komninou
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Swansea, UK
- Faculty Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Swansea, UK
- Faculty Medicine, Health and Life Sciences, Swansea University, Swansea, UK
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3
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Hernández-Barrera L, Trejo-Valdivia B, Téllez-Rojo MM, Baccarelli A, Wright R, Cantoral A, Barquera S. Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity. Arch Med Res 2024; 55:103006. [PMID: 38763021 DOI: 10.1016/j.arcmed.2024.103006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women. METHODS Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects. RESULTS A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO. CONCLUSION Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.
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Affiliation(s)
- Lucía Hernández-Barrera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Belem Trejo-Valdivia
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Martha María Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Andrea Baccarelli
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Wu T, Liao Z, Wang J, Liu M. The Accumulative Effect of Multiple Postnatal Risk Factors with the Risk of Being Overweight/Obese in Late Childhood. Nutrients 2024; 16:1536. [PMID: 38794774 PMCID: PMC11124345 DOI: 10.3390/nu16101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Most past studies focused on the associations of prenatal risk factors with the risks of childhood overweight/obesity. Instead, more postnatal risk factors are modifiable, with less knowledge of their cumulative effects on childhood obesity. We analyzed data of 1869 children in an Australian birth cohort. Key postnatal risk factors included: maternal and paternal overweight/obesity during the child's infancy, tobacco exposure, low family socioeconomic score, breastfeeding duration < 6 months, early introduction of solid foods, and rapid weight gain during infancy. The risk score was the sum of the number of risk factors. The primary outcome is overweight/obesity in late childhood (11-12 years); secondary outcomes are high-fat mass index (FMI), body fat percentage (BF%), and waist-to-height ratio (WHtR). Poisson regression models were used in the analyses. Children with higher risk scores had higher risks of overweight/obesity (p-for-trends < 0.001). After adjusting covariates, compared with those with 0-1 risk factors, children with 4-6 risk factors had 4.30 (95% confidence interval: 2.98, 6.21) times higher risk of being overweight/obesity; the relative risks for high FMI, BF%, and WHtR were 7.31 (3.97, 13.45), 4.41 (3.00, 6.50), and 6.52 (3.33, 12.74), respectively. Our findings highlighted that multiple postnatal risk factors were associated with increased risks of being overweight/obesity in late childhood.
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Affiliation(s)
- Ting Wu
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang 330006, China;
- Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang 330006, China
| | - Zijun Liao
- Capital Institute of Pediatrics, Beijing 100020, China;
| | - Jing Wang
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, VIC 3052, Australia;
- Department of Pediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Mengjiao Liu
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang 330006, China;
- Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang 330006, China
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Radwan H, Naja F, Abbas N, Kharma JA, Obaid RS, Al Ghazal H, Abdelrahim DN, Saqan R, Alameddine M, Al Hilali M, Hasan H, Hashim M. Influence of maternal characteristics and infant feeding patterns on infant growth from birth till 18 months: The MISC study. Pediatr Obes 2024; 19:e13106. [PMID: 38383983 DOI: 10.1111/ijpo.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The growth and development of infants during the first 1000 days of life are crucial for their health. OBJECTIVES This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months. METHODS Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates. RESULTS Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively). CONCLUSION The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth.
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Affiliation(s)
- Hadia Radwan
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Farah Naja
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nada Abbas
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Joelle Abi Kharma
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Reyad Shaker Obaid
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Hessa Al Ghazal
- Sharjah Child-Friendly Office-Sharjah Health Authority, Sharjah, United Arab Emirates
| | - Dana N Abdelrahim
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Roba Saqan
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Marwa Al Hilali
- Clinical Nutrition Department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Hayder Hasan
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mona Hashim
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Camier A, Cissé AH, Heude B, Nicklaus S, Chabanet C, Bernard JY, Lioret S, Charles MA, de Lauzon-Guillain B. Infant feeding practices and body mass index up to 7.5 years in the French nationwide ELFE study. Pediatr Obes 2024:e13121. [PMID: 38622765 DOI: 10.1111/ijpo.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND/OBJECTIVES The infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the associations of infant feeding practices with body mass index (BMI) until 7.5 years. SUBJECTS/METHODS Analyses were based on data from the French nationwide ELFE birth cohort. Data on breastfeeding (BF) and complementary feeding (CF) were collected monthly from 2 to 10 months. Infant feeding practices were characterized using principal component analyses (PCA) and hierarchical ascendant classification. BMI z-score was computed at 1, 2, 3, 5 and 7.5 years, from data collected in the child's health booklet; 7.5-year overweight was defined according to IOTF references. Associations between infant feeding practices and BMI were investigated by linear regression models adjusted for main confounders. RESULTS Ever breastfeeding was not associated with BMI up to 7.5 years. Compared to intermediate breastfeeding duration (1 to <3 months), longer breastfeeding duration (≥6 months) was related to lower 1-year BMI, but not at older ages. Compared to the recommended age at CF introduction (4-6 months), early CF (<4 months) was related to higher BMI up to 5 years with a similar trend at 7.5 years, but not to the risk of overweight. The PCA patterns characterized by early baby cereal introduction and late food pieces introduction or by frequent intake of main food groups were related to a lower BMI up to 7.5 years. CONCLUSION Breastfeeding was related with a lower BMI in infancy but not thereafter, whereas an early CF initiation (<4 months) was associated with a higher BMI in childhood.
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Affiliation(s)
- Aurore Camier
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Aminata Hallimat Cissé
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
| | - Claire Chabanet
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne, Dijon, France
| | - Jonathan Y Bernard
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Marie Aline Charles
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
- Unité mixte Inserm-Ined-EFS ELFE, Ined, Aubervilliers, France
| | - Blandine de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
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7
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Clayton PK, Putnick DL, Trees IR, Ghassabian A, Tyris JN, Lin TC, Yeung EH. Early Infant Feeding Practices and Associations with Growth in Childhood. Nutrients 2024; 16:714. [PMID: 38474842 DOI: 10.3390/nu16050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.
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Affiliation(s)
- Priscilla K Clayton
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
| | - Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
| | - Ian R Trees
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
| | - Akhgar Ghassabian
- Department of Pediatrics and Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Jordan N Tyris
- Division of Hospital Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Tzu-Chun Lin
- Glotech Inc., 1801 Research Blvd Ste 605, Rockville, MD 20850, USA
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
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Aljahdali AA, Cantoral A, Peterson KE, Perng W, Mercado-García A, Téllez-Rojo MM, Ramírez-Silva CI, Jansen EC. Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis. J Pediatr 2024; 265:113768. [PMID: 37802388 DOI: 10.1016/j.jpeds.2023.113768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents. STUDY DESIGN This study included 634 offsprings aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates. RESULTS Median breastfeeding duration was 7 months (minimum = 0, maximum = 36). Boys in the second quartile (median breastfeeding = 5 months) had lower total fat mass % (β (SE) -3.2 (1.5) P = .037), and higher lean mass % (3.1 (1.6) P = .049) and skeletal muscle mass % (1.8 (0.8) P = .031) compared with the reference group (median breastfeeding = 2 months). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) P = .035) was found among girls. No association was found with other cardiometabolic indicators. CONCLUSION Despite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.
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Affiliation(s)
- Abeer A Aljahdali
- Department of Clinical Nutrition, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI
| | | | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI.
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Adriana Mercado-García
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI
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9
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Martins FA, Ramalho AA, de Andrade AM, Opitz SP, Koifman RJ, de Aguiar DM, da Silva IF. Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon. Nutrition 2024; 117:112231. [PMID: 37976617 DOI: 10.1016/j.nut.2023.112231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/17/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator. METHODS This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet. RESULTS The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet. CONCLUSIONS Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.
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Affiliation(s)
| | | | | | - Simone Perufo Opitz
- Graduate Program of Community Health, Federal University of Acre, Rio Branco, Brazil
| | - Rosalina Jorge Koifman
- Department of Epidemiology and Quantitative Methods of Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Debora Melo de Aguiar
- Graduate Program of Community Health, Federal University of Acre, Rio Branco, Brazil
| | - Ilce Ferreira da Silva
- Department of Epidemiology and Quantitative Methods of Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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10
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Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
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Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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Blake MK, Ma R, Cardenas EV, Varanloo P, Agosto Y, Velasquez C, Espina KA, Palenzuela J, Messiah SE, Natale RA. Infant Nutrition and Other Early Life Risk Factors for Childhood Obesity According to Disability Status. Nutrients 2023; 15:4394. [PMID: 37892469 PMCID: PMC10609807 DOI: 10.3390/nu15204394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
One in five preschool-aged children in the United States is obese, and children with disabilities are significantly impacted. This study aimed to determine the association between age at solid food initiation and obesity prevalence in preschool-aged children while considering disability status, ethnicity, gestational age, and birth weight. Analysis was conducted on a sample of 145 children aged 2 to 5 years who were enrolled in ten childcare centers. Parents completed a survey assessing disability status, race and ethnicity, birth weight, gestational age, and age of solid food initiation. Height and weight were collected concurrently. Multivariable logistic regression models generated the odds of developing obesity based on age at solid food initiation, disability status, ethnicity, gestational age, and birth weight. There was no significant difference in the odds of being obese based on age at solid food introduction. Children with disabilities (OR = 0.17, 95% CI 0.04-0.6, p = 0.01) and children born preterm (OR = 0.28, 95% CI 0.08-0.79, p = 0.03) had significantly lower odds of being obese. Hispanic children (OR = 4.93, 95% CI 1.91-15.32, p = 0.002) and children with higher birth weights (OR = 1.47, 95% CI 1.17-1.92, p = 0.002) were more likely to be obese. With pediatric obesity rates continuing to rise, these findings can inform future intervention efforts.
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Affiliation(s)
- Melissa K. Blake
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Science, University of Miami School of Medicine, 1120 N.W. 14th Street, Miami, FL 33136, USA;
| | - Erika Viana Cardenas
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Parisa Varanloo
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Yaray Agosto
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Carolina Velasquez
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Katheryn A. Espina
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Joanne Palenzuela
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
| | - Sarah E. Messiah
- University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX 75207, USA;
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX 75207, USA
| | - Ruby A. Natale
- Department of Pediatrics, University of Miami School of Medicine, Mailman Center for Child Development, 1601 NW 12th Ave, Miami, FL 33136, USA; (E.V.C.); (P.V.); (Y.A.); (C.V.); (K.A.E.); (J.P.); (R.A.N.)
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12
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Gizaw AT, Sopory P, Sudhakar M. Barriers and coping responses towards infant and young child feeding practices in rural Ethiopia: a descriptive qualitative study. BMJ Open 2023; 13:e077008. [PMID: 37821129 PMCID: PMC10582866 DOI: 10.1136/bmjopen-2023-077008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To explore barriers and coping responses toward infant and young child practices (IYCFP) in rural Ethiopia. METHODS A descriptive qualitative study using semi-structured in-depth interviews and focus group discussions was conducted with 98 mothers having infants and young children aged 0-24 months in rural Ethiopia. The mothers were selected purposively by stratifying into four age groups of infants and young children in months: 0-5, 6-8, 9-12 and 13-24. Thematic analysis was performed to elucidate the main ideas regarding the barriers and coping responses to IYCFP across the participant stratum using ATLAS.ti analytical software (V.7.5.18). RESULTS Two main themes emerged from the data. First, there was a discourse on optimal IYCFP that reflects the knowledge and efforts to adhere to recommendations for early breastfeeding initiation, exclusive breast feeding for the first 6 months and introduction of complementary foods at 6 months. Second, in a discourse on struggling with everyday realities, barriers against optimal feeding practices and coping responses were presented. Mothers' responses in the four age strata as barriers to IYCFP were inadequate knowledge towards breast milk, perceived insufficiency of breast milk, beliefs, mothers' excessive workload, limited partner support, food price inflation and shortage, gender roles, dowry demand and cultural understanding of marriage. Relying on cheaper food items and backyard garden was used to cope with the barriers. CONCLUSIONS Barriers towards IYCFP are numerous which extend from intrapersonal to sociocultural factors. Therefore, reducing mothers' work burden to enable appropriate IYCFP by empowering women economically and addressing gender inequalities through collective societal approaches for promoting appropriate feeding is vital in rural communities.
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Affiliation(s)
| | - Pradeep Sopory
- Department of Communication, Wayne State University, Detroit, Michigan, USA
| | - Morankar Sudhakar
- Department of Health, Behavior Society, Jimma University, Jimma, Ethiopia
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13
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Alemu SF, Zerga AA, Yimer RD, Tadesse SE. Time to complementary feeding initiation and its predictors among children aged 9-23 months in Meket District, Northeast Ethiopia: a Cox Weibull regression. J Nutr Sci 2023; 12:e98. [PMID: 37744639 PMCID: PMC10511819 DOI: 10.1017/jns.2023.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/26/2023] Open
Abstract
.Globally and nationally, only 64⋅5 and 49⋅2 % of infants received solid or semi-solid foods, respectively. The available evidence indicates that the time to initiate complementary feeding practices is still poor and varies by region. The aim of the present study was to assess the time to initiation of complementary feeding and its predictors among children aged 9-23 months in Meket District, Amhara Region, Ethiopia. A community-based retrospective cohort study was conducted from June to July 2022 among 459 systematically selected mothers/caregivers with their children from 9 to 23 months of age. The result of descriptive statistics was reported by table, frequency, Kaplan-Meier curve and percent. The proportional hazard model assumption was checked, and a Weibull regression model was used to see the predictors of timely initiation of complementary feeding. An adjusted hazard ratio with a 95 % confidence interval and a P-value of 0⋅05 were used to declare the significant predictors. The median time of complementary feeding initiation was 6 months. Attending primary education (adjusted hazard ration (AHR) 1⋅8; 95 % CI 1⋅16, 2⋅78), occupation of the mother (AHR 1⋅43; 95 % CI 1⋅04, 1⋅95), home delivery (AHR 1⋅61; 95 % CI 1⋅09, 2⋅37) and birth preparedness (AHR 1⋅37; 95 % CI 1⋅03, 1⋅81) were the predictors of time to complementary feeding initiation. The median time to complementary feeding initiation was consistent with the WHO recommendation. Maternal education, maternal employment, place of delivery and birth preparedness were the predictors of time to initiation of complementary feeding. Therefore, working with the education sector, increasing the delivery rate in health facilities, strengthening counselling on birth preparation, increasing maternity leave until 6 months of age and initiating corner feeding should be part of the complementary feeding practices promotion agenda.
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Affiliation(s)
| | - Aregash Abebayehu Zerga
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau Yimer
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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14
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Yamamoto-Hanada K, Kobayashi T, Mikami M, Williams HC, Saito H, Saito-Abe M, Sato M, Irahara M, Miyaji Y, Ishikawa F, Tsuchiya K, Tamagawa-Mineoka R, Takaoka Y, Takemura Y, Sato S, Wakiguchi H, Hoshi M, Natsume O, Yamaide F, Seike M, Ohya Y. Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy. J Allergy Clin Immunol 2023; 152:126-135. [PMID: 36963619 DOI: 10.1016/j.jaci.2023.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Early-onset atopic dermatitis is a strong risk factor for food allergy, suggesting that early effective treatment may prevent transcutaneous sensitization. OBJECTIVES This study tested whether enhanced treatment of atopic dermatitis to clinically affected and unaffected skin is more effective in preventing hen's egg allergy than reactive treatment to clinically affected skin only. METHODS This was a multicenter, parallel-group, open-label, assessor-blind, randomized controlled trial (PACI [Prevention of Allergy via Cutaneous Intervention] study). This study enrolled infants 7-13 weeks old with atopic dermatitis and randomly assigned infants in a 1:1 ratio to enhanced early skin treatment or conventional reactive treatment using topical corticosteroids (TCSs). The primary outcome was the proportion of immediate hen's egg allergy confirmed by oral food challenge at 28 weeks of age. RESULTS This study enrolled 650 infants and analyzed 640 infants (enhanced [n = 318] or conventional [n = 322] treatment). Enhanced treatment significantly reduced hen's egg allergy compared with the conventional treatment (31.4% vs 41.9%, P = .0028; risk difference: -10.5%, upper bound of a 1-sided CI: -3.0%), while it lowered body weight (mean difference: -422 g, 95% CI: -553 to -292 g) and height (mean difference: -0.8 cm, 95% CI: -1.22 to -0.33 cm) at 28 weeks of age. CONCLUSIONS This study highlighted the potential of well-controlled atopic dermatitis management as a component of a hen's egg allergy prevention strategy. The enhanced treatment protocol of this trial should be modified before it can be considered as an approach to prevent hen's egg allergy in daily practice to avoid the adverse effects of TCSs. After remission induction by TCSs, maintenance therapy with lower potency TCSs or other topical therapies might be considered as alternative proactive treatments to overcome the safety concerns of TCSs.
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Affiliation(s)
| | - Tohru Kobayashi
- National Center for Child Health and Development, Tokyo, Japan
| | - Masashi Mikami
- National Center for Child Health and Development, Tokyo, Japan
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Hirohisa Saito
- National Center for Child Health and Development, Tokyo, Japan
| | | | - Miori Sato
- National Center for Child Health and Development, Tokyo, Japan
| | - Makoto Irahara
- National Center for Child Health and Development, Tokyo, Japan
| | - Yumiko Miyaji
- National Center for Child Health and Development, Tokyo, Japan
| | - Fumi Ishikawa
- National Center for Child Health and Development, Tokyo, Japan
| | | | | | | | | | - Sakura Sato
- National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | | | - Miyuki Hoshi
- National Hospital Organization Mie National Hospital, Mie, Japan
| | - Osamu Natsume
- Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Fumiya Yamaide
- Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miwako Seike
- National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- National Center for Child Health and Development, Tokyo, Japan.
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15
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Zhang J, Clayton GL, Hansen SN, Olsen A, Lawlor DA, Dahm CC. Maternal Pre-Pregnancy BMI, Offspring Adiposity in Late Childhood, and Age of Weaning: A Causal Mediation Analysis. Nutrients 2023; 15:2970. [PMID: 37447295 DOI: 10.3390/nu15132970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Infant feeding practices have been hypothesized to influence offspring's body mass index (BMI) later in life, and women with overweight or obesity tend to wean their infants earlier than women with healthy BMI. We, therefore, aimed to investigate how much early age of weaning mediated the maternal-offspring adiposity relationship. The study included 4920 mother-child pairs from the Avon Longitudinal Study of Parents and Children birth cohort. G-computation was applied to estimate the natural direct (NDE) and indirect (NIE) effects, via the age of weaning (<3 months, 3 months, >3 months), of maternal pre-pregnancy overweight or obesity on offspring's BMI and fat mass index. The NDE of maternal overweight or obesity on offspring BMI at 17 years old was 2.63 kg/m2 (95% CI: 2.27 to 2.99). The NIE via the age of weaning was 0.02 kg/m2 (95% CI: 0.00 to 0.04), corresponding to 0.8% of the total effect. Similar results were observed for the offspring's fat mass index. The NDE and NIE were similar to the main analyses when we looked at the relationship stratified by breastfeeding status. Our study found a minimal influence of age of weaning on the pathway between maternal and offspring adiposity, indicating the age of weaning may not be a key mediator.
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Affiliation(s)
- Jie Zhang
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - Gemma L Clayton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol BS8 2BN, UK
| | | | - Anja Olsen
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
| | - Deborah A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol BS8 2BN, UK
| | - Christina C Dahm
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
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16
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Grech AM, Kizirian N, Lal R, Zankl A, Birkner K, Nasir R, Muirhead R, Sau-Harvey R, Haghighi MM, Collins C, Holmes A, Skilton M, Simpson S, Gordon A. Cohort profile: the BABY1000 pilot prospective longitudinal birth cohort study based in Sydney, Australia. BMJ Open 2023; 13:e068275. [PMID: 37290940 PMCID: PMC10255277 DOI: 10.1136/bmjopen-2022-068275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE The health of parents prior to conception, a woman's health during pregnancy and the infant's environment across their first months and years collectively have profound effects on the child's health across the lifespan. Since there are very few cohort studies in early pregnancy, gaps remain in our understanding of the mechanisms underpinning these relationships, and how health may be optimised. 'BABY1000', a pilot prospective longitudinal birth cohort study, aims to (1) identify factors before and during pregnancy and early life that impact longer-term health and (2) assess the feasibility and acceptability of study design to inform future research. PARTICIPANTS Participants were based in Sydney, Australia. Women were recruited at preconception or 12 weeks' gestation, and data were collected from them throughout pregnancy and postpartum, their children until the age of 2 years, and dietary information from a partner (if able) at the last study visit. The pilot aimed to recruit 250 women. However, recruitment ceased earlier than planned secondary to limitations from the COVID-19 pandemic and the final number of subjects was 225. FINDINGS TO DATE Biosamples, clinical measurements and sociodemographic/psychosocial measures were collected using validated tools and questionnaires. Data analysis and 24-month follow-up assessments for children are ongoing. Key early findings presented include participant demographics and dietary adequacy during pregnancy. The COVID-19 pandemic and associated public health and research restrictions affected recruitment of participants, follow-up assessments and data completeness. FUTURE PLANS The BABY1000 study will provide further insight into the developmental origins of health and disease and inform design and implementation of future cohort and intervention studies in the field. Since the BABY1000 pilot was conducted across the COVID-19 pandemic, it also provides unique insight into the early impacts of the pandemic on families, which may have effects on health across the lifespan.
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Affiliation(s)
- Allison Marie Grech
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Nathalie Kizirian
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Ravin Lal
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Angelika Zankl
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Karin Birkner
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Reeja Nasir
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Roslyn Muirhead
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Rachelle Sau-Harvey
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Marjan Mosalman Haghighi
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Clare Collins
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, The University of Newcastle, New Lambton, New South Wales, Australia
| | - Andrew Holmes
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Skilton
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Stephen Simpson
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
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17
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Kim KN, Shin MK. Feeding characteristics in infancy affect fruit and vegetable consumption and dietary variety in early childhood. Nutr Res Pract 2023; 17:307-315. [PMID: 37009139 PMCID: PMC10042718 DOI: 10.4162/nrp.2023.17.2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND/OBJECTIVES Previous studies have shown an association between breastfeeding and higher fruit and vegetable consumption and the level of dietary variety in children. However, few studies have reported this association on the feeding characteristics. Therefore, this study examined the association of the feeding characteristics with the consumption of fruit and vegetable and dietary variety in children. SUBJECTS/METHODS This study recruited 802 participants from their parents with information on their feeding, and 24-h dietary recall. The associations of the feeding characteristics with fruit and vegetable consumption and dietary variety score (DVS) were analyzed using a multiple logistic regression model. RESULTS Compared to the feeding type of exclusive breastfed children, exclusive formula-fed children had a significant association with a lower DVS (odds ratio [OR], 0.42, 95% confidence interval [CI], 0.23-0.77). Fruit and vegetable consumption was classified into 6 groups: non-salted vegetables (NSV), salted vegetables (SV), fruit (F), total vegetables (TV), non-salted vegetables + fruit (NSVF), and total vegetables + fruit (TVF). According to the mean level of fruit and vegetable consumption, compared to the duration of total breastfeeding for 6 month or less, a greater duration of breastfeeding for 12 mon had a significant association with a higher intake of NSVF and TVF (OR, 1.85, 95% CI, 1.20-2.85 and OR, 1.89, 95% CI, 1.22-2.92). On the other hand, the early introduction of formula feeding for 4 mon had a significant association with a lower intake of F and NSVF (OR, 0.59, 95% CI, 0.38-0.91 and OR, 0.63, 95% CI, 0.40-0.99). CONCLUSIONS These results confirm that breastfeeding is associated with higher fruit and vegetable consumption and dietary variety, whereas formula feeding is associated with lower fruit and vegetable consumption and dietary variety. Therefore, the feeding characteristics in infants may affect fruit and vegetable consumption and dietary variety in children.
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Affiliation(s)
- Kyoung-Nam Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Moon-Kyung Shin
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Ajou University College of Medicine, Suwon, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
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18
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Sharaf-Alddin R, Almathkoori R, Kostakis H, Albatineh AN, Al-Taiar A, Akpinar-Elci M. Obesity during Adolescence and Feeding Practices during Infancy: Cross-Sectional Study. EPIDEMIOLOGIA 2023; 4:106-116. [PMID: 36975619 PMCID: PMC10048365 DOI: 10.3390/epidemiologia4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Breastfeeding is proposed to play a role in reducing the risk of obesity throughout life. Kuwait has an extremely high prevalence of childhood obesity (45% of adolescents are overweight/obese) and extremely low breastfeeding indicators, particularly exclusive breastfeeding. In fact, little is known about the association between breastfeeding and obesity from Kuwait and the broader Middle East. AIMS To estimate the prevalence of overweight/obesity in female adolescents in Kuwait and assess its association with breastfeeding during infancy. METHODS This is a cross-sectional study that included 775 girls randomly selected from public and private high schools in Kuwait. The primary exposure was breastfeeding in the first four months of life, and the outcome was overweight/obesity during adolescence. Multivariable logistic regression was used to assess the association between breastfeeding and overweight/obesity while adjusting for potential confounders. RESULTS Approximately 45% of adolescent girls were either overweight/obese. We found no significant association between breastfeeding (exclusive/mixed breastfeeding and formula feeding/no breastfeeding) and overweight/obesity neither in univariable analysis (Crude Prevalence Ratio: 1.14, 95%CI [0.92-1.36] & Crude Prevalence Ratio: 1.29, 95%CI [0.86-1.68]; p = 0.293) for mixed feeding and no breastfeeding respectively, nor in multivariable analysis (Adjusted Prevalence Ratio: 1.14, 95%CI [0.85-1.42] & Adjusted Prevalence Ratio: 1.20, 95%CI [0.68-1.68]; p = 0.589) for mixed feeding and no breastfeeding respectively. CONCLUSION Breastfeeding during infancy was not significantly associated with overweight/obesity during adolescence. However, breastfeeding should be encouraged for its indisputable benefits for infants and their mothers alike. Further prospective studies are needed to assess the association.
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Affiliation(s)
| | - Radhia Almathkoori
- Department of Public Health, Ministry of Health, Kuwait City 13001, Kuwait
| | - Hara Kostakis
- London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HT, UK
| | | | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23508, USA
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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20
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Soriano VX, Ciciulla D, Gell G, Wang Y, Peters RL, McWilliam V, Dharmage SC, Koplin JJ. Complementary and Allergenic Food Introduction in Infants: An Umbrella Review. Pediatrics 2023; 151:190526. [PMID: 36704902 DOI: 10.1542/peds.2022-058380] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multiple systematic reviews examine the introduction of foods in relation to individual health outcomes, but the balance of harms and benefits has not been overviewed systematically. OBJECTIVES We aimed to perform an overview of systematic reviews on age of introduction of complementary and allergenic foods to the infant diet and long and short-term health outcomes. DATA SOURCES We searched Medline, Embase, Cochrane, and PubMed (July 25, 2022). STUDY SELECTION Included systematic reviews examining the introduction of complementary or allergenic foods before age 1. Outcomes included allergic, autoimmune, and inflammatory diseases, neurodevelopment, nutrition, and weight. DATA EXTRACTION Extraction and quality assessment were performed in duplicate (A Measurement Tool to Assess Systematic Reviews) and strength of evidence was assessed. RESULTS We screened 4015 articles and included 32 systematic reviews. There was moderate evidence that peanut and egg should be introduced from 4 to 11 months to prevent food allergy (6 of 10 reviews). Complementary food introduction was not associated with food allergy. Moderate certainty evidence suggested age of complementary food introduction was not associated with eczema. Age at introduction of gluten was not associated with celiac disease (high certainty evidence; 3 of 4 reviews). Low certainty evidence indicated that introducing solids before 4 months may increase the risk of childhood obesity, but not growth. There was insufficient evidence regarding an association between any food introduction and bone health, gastrointestinal diseases, autoimmune disorders, asthma, or allergic rhinitis. LIMITATIONS Gray literature was not included. CONCLUSIONS Current evidence supports introducing complementary foods around 6 months and allergenic foods before 11 months.
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Affiliation(s)
- Victoria X Soriano
- Centre for Food and Allergy Research.,Murdoch Children's Research Institute, Parkville, Australia
| | - Daniela Ciciulla
- Centre for Food and Allergy Research.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics
| | - Grace Gell
- Murdoch Children's Research Institute, Parkville, Australia
| | - Yichao Wang
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics.,School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research.,Murdoch Children's Research Institute, Parkville, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics.,Department of Allergy, Royal Children's Hospital, Parkville, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research.,School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics
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21
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Van Minh H, Khuong DQL, Tran TA, Do HP, Watson F, Lobstein T. Childhood Overweight and Obesity in Vietnam: A Landscape Analysis of the Extent and Risk Factors. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2023. [PMCID: PMC9947684 DOI: 10.1177/00469580231154651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Tackling childhood overweight and obesity is critical not only to improve the health and well-being of children and adolescents, but also for entire populations and future generations. This paper provides the latest evidence on the extent of, and risk factors for, childhood overweight and obesity in Vietnam. The landscape analysis tool developed by the United Nations Children’s Fund (UNICEF) and World Health Organization (WHO) was used. A search for peer-reviewed articles in English on online databases was undertaken. Peer-reviewed Vietnamese articles were also retrieved from a range of sources. The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively. Maternal malnutrition, gestational diabetes during pregnancy, and inadequate infant and young child feeding practices are all risk factors for early childhood overweight. Unhealthy diets, insufficient physical activity, and lack of sleep are among the risk factors for overweight and obesity among school aged children and adolescents. The prevention of overweight and obesity among Vietnamese children requires a whole-of-government, cross-sectoral approach to addresses the obesogenic environment that is negatively influencing the nutrition of children.
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Affiliation(s)
| | | | | | - Hong Phuong Do
- UNICEF, Nutrition Section, Vietnam Country Office, Hanoi, Vietnam
| | - Fiona Watson
- UNICEF, Nutrition Section, East Asia and Pacific Regional Office, Bangkok, Thailand
| | - Tim Lobstein
- World Obesity Federation, London, UK
- University of Sydney, Sydney, NSW, Australia
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22
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Ong YY, Pang WW, Michael N, Aris IM, Sadananthan SA, Tint MT, Liang Choo JT, Ling LH, Karnani N, Velan SS, Fortier MV, Tan KH, Gluckman PD, Yap F, Chong YS, Godfrey KM, Chan SY, Eriksson JG, Chong MFF, Wlodek ME, Lee YS. Timing of introduction of complementary foods, breastfeeding, and child cardiometabolic risk: a prospective multiethnic Asian cohort study. Am J Clin Nutr 2023; 117:83-92. [PMID: 36789947 DOI: 10.1016/j.ajcnut.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The timing of introduction of complementary foods and the duration of breastfeeding (BF) have been independently associated with child overweight and obesity; however, their combined influence on body fat partitioning and cardiometabolic risk is unclear. OBJECTIVE We investigated the associations of the timing of introduction of complementary foods, the duration of BF, and their interaction with child adiposity and cardiometabolic risk markers. METHODS We analyzed data from 839 children in the prospective Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Mothers reported the age at which infants were first fed complementary foods and BF duration, classified as early (≤4 mo) versus typical (>4 mo) complementary feeding (CF) and short (≤4 mo) versus long (>4 mo) duration of any BF, respectively. We measured adiposity and cardiometabolic risk markers at the age of 6 y and examined their associations with infant feeding patterns using multiple regression, adjusting for sociodemographics, parents' body mass index (BMI), maternal factors, birth weight for gestational age, and infant weight gain. RESULTS Of 839 children, 18% experienced early CF, whereas 54% experienced short BF. Short (vs. long) BF and early (vs. typical) CF were independently associated with higher z-scores of BMI [β (95% confidence interval), short BF, 0.18 standard deviation score (SDS) (-0.01, 0.38); early CF, 0.34 SDS (0.11, 0.57)] and sum of skinfolds [short BF, 1.83 mm (0.05, 3.61); early CF, 2.73 mm (0.55, 4.91)]. Children who experienced both early CF and short BF (vs. typical CF-long BF) had synergistically higher diastolic blood pressure [1.41 mmHg (-0.15, 2.97), P-interaction = 0.023] and metabolic syndrome score [0.81 (0.16, 1.47), P-interaction = 0.081]. Early CF-long BF (vs. early CF-short BF) was associated with a lower systolic blood pressure [-3.74 mmHg (-7.01, -0.48)], diastolic blood pressure [-2.29 mmHg (-4.47, -0.11)], and metabolic syndrome score [-0.90 (-1.80, 0.00)]. CONCLUSIONS A combination of early CF and short BF was associated with elevated child adiposity and cardiometabolic markers. Longer BF duration may protect against cardiometabolic risk associated with early CF. This trial was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
- Yi Ying Ong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Navin Michael
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Mya-Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | | | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Republic of Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - S Sendhil Velan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Johan G Eriksson
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Mary F-F Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Mary E Wlodek
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Republic of Singapore.
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23
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Clavenna A, Morabito E, Cartabia M, Campi R, Pandolfini CL, Bonati M. National, longitudinal NASCITA birth cohort study: prevalence of overweight at 12 months of age in children born healthy. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001622. [PMID: 36625429 PMCID: PMC9814999 DOI: 10.1136/bmjpo-2022-001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/11/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of overweight at 12 months in an Italian birth cohort and to identify factors related to an increased likelihood of being overweight. METHODS The Italian NASCITA birth cohort was analysed. Infants were classified as underweight (<5th), normal weight (5-84th) and overweight (≥85th centile) at 12 months of age according to the WHO percentiles of body mass index (BMI) and the prevalence of overweight was estimated. To test the association between the chance of being overweight and parental and newborn characteristics, and infant feeding, healthy newborns (no preterm/low birth weight and with no malformations), with appropriate-for-gestational-age birth weight were selected, and univariate and multivariate analyses were performed. RESULTS The prevalence of overweight was 23.5% (95% CI 22.2% to 24.8%) in all cohort members with 12-month data (N=4270), and 23.1% in the appropriate-for-gestational age subsample (N=2835).A big infant appetite (OR 3.92, 95% CI 2.40 to 6.40) and living in southern Italy (OR 1.58, 95% CI 1.29 to 1.94) were the main variables associated with a greater likelihood of being overweight. Breastfeeding practice did not influence the chance of being overweight, but was associated with an increase (exclusive breast feeding for at least 6 months) or a decrease (breast feeding for at least 12 months) in BMI z score at 12 months. CONCLUSIONS The sociodemographic factors (eg, area of residence, maternal employment status) seem to be the most relevant determinants influencing the chance of being overweight at 12 months. Early interventions, with particular attention to vulnerable families, may be helpful in preventing childhood and adult obesity.
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Affiliation(s)
- Antonio Clavenna
- Laboratory of Pharmacoepidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eleonora Morabito
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Massimo Cartabia
- Laboratory of Pharmacoepidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Rita Campi
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Chiara Liz Pandolfini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Zahra L, Kremer P, Bolton KA. A cross-sectional study of infant feeding practices in Vietnamese-born mothers living in Australia. BMC Pregnancy Childbirth 2022; 22:895. [PMID: 36463117 PMCID: PMC9719657 DOI: 10.1186/s12884-022-05223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Infant feeding practices are a key modifiable risk factor for childhood overweight and obesity; and important for lifelong health and wellbeing. Despite the growing Australian immigrant population, it is unclear how infant feeding practices may differ between ethnicities living in Australia. Few studies have examined the infant feeding practices of Vietnamese mothers who migrate and give birth to infants in Australia - termed Vietnamese-born mothers. The aim of this study was to examine differences in infant feeding practices (breastfeeding, formula feeding and complementary feeding (other fluids and solids)) in Vietnamese-born mothers compared with Australian-born mothers living in Australia. METHOD This study analysed the Australian National Infant Feeding Survey dataset (2010-11), a large national cross-sectional survey measuring feeding practices of infants aged 0-24 months old. Infant feeding practices of Vietnamese-born mothers (n = 261) and a random sub-sample of Australian-born mothers (n = 261) were compared. Associations between ethnicity and infant feeding practices were examined through logistic and linear regression adjusting for maternal age, socioeconomic status, body mass index (BMI) at start of pregnancy, infant age at survey completion and parity. Compliance with the Australian national infant feeding guidelines was also assessed. RESULTS Compliance with infant feeding guidelines was low, with differences in infant feeding practices between groups. At the time of survey completion, when infants were on average 7.2 months old, compared with infants of Australian-born mothers, infants to Vietnamese-born mothers were significantly younger when first exposed to fruit juice (b = -2.41, 95%CI: -4.54- -0.28); less likely to be exposed to solids (AOR: 0.15, 95%CI: 0.05-0.44) and more likely to be exposed to formula milks (AOR: 2.21, 95%CI: 1.10-4.43); toddler milks (AOR: 16.72, 95%CI: 3.11-90.09) and fruit juice (AOR: 2.37, 95%CI: 1.06-5.32) (p < 0.05). CONCLUSION Low adherence with breastfeeding (low breastfeeding and high infant formula use) and other fluids (toddler milks and fruit juice) recommendations outlined by the Australian infant feeding guidelines were observed in this group of Vietnamese-born mothers. To optimise feeding and growth in Vietnamese-Australian children, culturally appropriate infant feeding support targeting breastfeeding durations, reducing reliance on infant formula, and reducing inappropriate introduction to other fluids should be the focus of infant feeding promotion within these mothers.
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Affiliation(s)
- Lauren Zahra
- grid.1021.20000 0001 0526 7079School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC Australia
| | - Peter Kremer
- grid.1021.20000 0001 0526 7079Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Kristy A. Bolton
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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25
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Ua‐areechit T, Suteerojntrakool O, Pongcharoen T, Winichagoon P, Judprasong K, Murphy‐Alford AJ, Lee WTK, Potip B, Sridonpai P, Tongchom W, Chomtho S. Breastfeeding duration is associated with higher adiposity at 6-8 months of age. MATERNAL & CHILD NUTRITION 2022; 19:e13438. [PMID: 36254499 PMCID: PMC9749609 DOI: 10.1111/mcn.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
Breastfeeding (BF) has been identified as a protective factor against childhood obesity. However, evidence of the association between BF duration and adiposity remains inconclusive. Few studies have been conducted among Southeast Asian infants that have measured body composition during infancy using the gold standard stable isotope method. This study aimed to evaluate the association between BF duration and body composition during infancy. Healthy full-term Thai infants aged 6-8 months (n = 60) receiving exclusive or predominant BF for at least 3 months were recruited. Skinfold thickness (SFT) was measured by well-trained investigators. Body composition was assessed by the deuterium dilution technique. Infants with longer BF duration (>6 months; mean 7.5 ± 0.5 months, n = 29) had a higher subscapular SFT z-score than those with shorter BF duration (≤6 months; mean 5.3± 0.9 months, n = 31) by 0.48 (95% confidence interval [CI]: 0.01-0.94). After adjustment for age and sex, BF duration and age at introduction of complementary feeding (CF) were positively associated with fat mass and fat mass index at 6-8 months. One month increase in BF duration and CF age was associated with a 0.37 (95% CI: 0.05, 0.69) kg/m2 and 0.76 (95% CI: 0.18, 1.34) kg/m2 increase in the fat mass index, respectively. After adjusting for infant body mass index (BMI) during the earlier infancy period, the strength of the association was attenuated. This finding may reflect reverse causality where infants with lower BMI received formula or CF earlier. A longitudinal study with follow-up into childhood is warranted to confirm the effects of BF on adiposity in infancy and childhood.
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Affiliation(s)
- Thanida Ua‐areechit
- Division of Nutrition, Department of PediatricsKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Orapa Suteerojntrakool
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand,Ambulatory Division, Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | | | | | - Alexia J. Murphy‐Alford
- Nutrition and Health‐Related Environmental Studies Section, Division of Human HealthInternational Atomic Energy AgencyViennaAustria
| | - Warren T. K. Lee
- Regional Office for Asia and the PacificFood and Agriculture Organization of the United NationsBangkokThailand
| | - Bubphachat Potip
- Institute of NutritionMahidol UniversitySalayaNakhon PathomThailand
| | | | - Wanabhorn Tongchom
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Sirinuch Chomtho
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
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Zheng M, Hesketh KD, Vuillermin P, Dodd J, Wen LM, Baur LA, Taylor R, Byrne R, Mihrshahi S, Sly PD, Tang MLK, Campbell KJ. Determinants of rapid infant weight gain: A pooled analysis of seven cohorts. Pediatr Obes 2022; 17:e12928. [PMID: 35510714 PMCID: PMC9540679 DOI: 10.1111/ijpo.12928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Rapid weight gain (RWG) in infancy is strongly associated with subsequent obesity risk, but little is known about the factors driving RWG. This study explored the child and maternal factors associated with infant RWG. METHODS Data from seven Australian and New Zealand cohorts were used (n = 4542). Infant RWG was defined as a change in weight z-score ≥0.67 from birth to age 1 year. Univariable and multivariable logistic regression assessed the association between child and maternal factors and infant RWG in each cohort. Meta-analysis was conducted to obtain pooled effect sizes. RESULTS Multivariable analyses revealed boys were more likely to experience RWG (OR 1.42 95% CI 1.22, 1.66) than girls. Higher birth weight in kg (OR 0.09, 95% CI 0.04, 0.20) and gestational age in weeks (OR 0.69, 95% CI 0.48, 0.98) were associated with lower RWG risk. Children who were breastfed for ≥6 months showed lower RWG risk (OR 0.45, 95% CI 0.38, 0.53). Children of native-born versus overseas-born women appeared to have higher RWG risk (OR 1.37, 95% CI 0.99, 1.90). Maternal smoking during pregnancy increased RWG risk (OR 1.60, 95% CI 1.28, 2.01), whereas children who started solids ≥6 months (OR 0.77, 95% CI 0.63, 0.93) and children with siblings (OR 0.68, 95% CI 0.57, 0.81) showed lower RWG risk in univariable analysis, but these associations were attenuated in multivariable analysis. No association was found for maternal age, education, marital status and pre-pregnancy BMI. CONCLUSION Maternal country of birth, smoking status, child sex, birth weight, gestational age, infant feeding and parity were potential determinants of infant RWG.
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Affiliation(s)
- Miaobing Zheng
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
| | - Kylie D. Hesketh
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
| | | | - Jodie Dodd
- Discipline of Obstetrics and GynaecologyThe Robinson Research Institute, The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Li Ming Wen
- School of Public Health and Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Louise A. Baur
- School of Public Health and Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Rachael Taylor
- Department of MedicineUniversity of OtagoDunedinNew Zealand
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of MedicineHealth and Human Sciences, Macquarie UniversitySydneyNew South WalesAustralia
| | - Peter D. Sly
- Children's Health and Environment ProgramThe University of QueenslandBrisbaneAustralia
| | | | - Karen J. Campbell
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
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Mothers' feeding practices among infants (4-12 months) and associated factors: a cross-sectional study in Saudi Arabia. J Nutr Sci 2022; 11:e83. [PMID: 36304820 PMCID: PMC9554420 DOI: 10.1017/jns.2022.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022] Open
Abstract
A global target of increasing exclusive breast-feeding (EBF) to at least 50 % by the year 2025 was set by the WHO for infants under 6 months. The lowest prevalence in the world was found in the Eastern Mediterranean region in 2010-18 and little is known about the status of mothers' feeding practices in Saudi Arabia. The present study aimed to assess mothers' actual feeding and weaning practices used with their infants by the mothers' different age groups. The present study was conducted among 247 mothers of infants aged 4-12 months who were attending public well-baby clinics. Quantitative data were obtained by nutritionists using an electronic semi-structured questionnaire about mothers' feeding practices. Only 5·3 % of mothers engaged in EBF, 44·9 % breast-fed their infants after an hour of birth, while 92·7 % of infants had ever been breast-fed. The average intent/plan to continue breast-feeding was 4·9(±3·1) months. Younger mothers introduced weaning food around 4 weeks earlier than older mothers (mean differences were -0·4, 95 % CI -0·71, -0·13; P = 0·031). A total of 64·3 % of infants received complementary feeding before completing 17 weeks. Maternal age group and delivery mode were the only factors associated with the early introduction of complementary feeding. A total of 69·2 % of the mothers believed that 'it is a good time' and 61·1 % felt that 'infants are hungry and need other sources of food'. Online sources and family advice were the top sources of information on mothers' feeding practices. Provision of professional advice about EBF and optimal weaning practices are significant areas for improvement in terms of compliance with recommended infant feeding practices.
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Wu AJ, Aris IM, Hivert MF, Fiechtner L, Davison KK, Redline S, Taveras EM. Associations of Healthy Infant Feeding Practices and Early Childhood Adiposity in the Rise & SHINE Cohort. J Pediatr Gastroenterol Nutr 2022; 75:e15-e19. [PMID: 35641893 PMCID: PMC9329206 DOI: 10.1097/mpg.0000000000003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We studied healthy infant feeding practices among 308 mother-infant pairs, including exclusive breastmilk, satiety cues, complementary food introduction, sugary beverage intake, and bottle use in bed. We examined associations of individual and cumulative infant feeding practices through 12 months of age with body mass index (BMI) z -score at 2 years. Exclusive breastmilk and avoidance of bottle use in bed were associated with lower BMI z -score (β -0.29 units; 95% CI, -0.56, -0.02 units and β -0.32 units; 95% CI, -0.57, -0.07, respectively), when accounting for maternal pre-pregnancy BMI, household income, infant sex, race, and ethnicity. Adherence to 4--5 practices, compared to ≤ 2 practices, was associated with lower BMI z -score (β -0.84 units; 95% CI, -1.35, -0.34 units). Adherence to healthy infant feeding practices may reduce risk of excessive adiposity in early childhood. Targeting multiple infant feeding practices may be a more effective way to prevent childhood adiposity.
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Affiliation(s)
- Allison J Wu
- From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Izzuddin M Aris
- the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- the Diabetes Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Lauren Fiechtner
- the Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
- the Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Kirsten K Davison
- the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- the School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Susan Redline
- the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elsie M Taveras
- the Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
- the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Yang WC, Lauria ME, Fogel A, Ferguson K, Smith ER. Duration of Exclusive Breastfeeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188638. [PMID: 35921669 DOI: 10.1542/peds.2022-057092h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cessation of exclusive breastfeeding (EBF) with early introduction of complementary food provides additional calories for catch-up growth but may also increase the risk of adverse outcomes. The objective of this study was to assess effects of exclusive breastfeeding for less than 6 months compared with 6 months in preterm and low birth weight infants. METHODS Data sources include Medline, Scopus, Web of Science, CINAHL, and Index Medicus through June 30, 2021. Study selection includes randomized trials and observational studies. Primary outcomes were mortality, morbidity, growth, and neurodevelopment. Data were extracted and pooled using random-effects models. The Cochrane Risk of Bias 2 tool was used to assess the risk of bias of included studies. RESULTS A total of 2 studies of 307 preterm or low birth weight infants were included. None of the study results could be pooled. Both studies compared EBF for 4 months to 6 months. Growth was similar between the 4-month and 6-month EBF groups for the following outcomes: weight-for-age z-score at corrected age 12 months (mean [standard deviation], 4-month group: -1.7 [1.1], 6-month group: -1.8 [1.2], 1 study, 188 participants, low certainty evidence), absolute weight gain (gram) from 16 to 26 weeks of age (4-month group: 1004 [366], 6-month group: 1017 [350], 1 study, 119 participants, very low certainty evidence), and linear growth gain (cm) from 16 to 26 weeks of age (4-month group: 4.3 [0.9], 6-month group: 4.5 [1.2], 1 study, 119 participants, very low certainty evidence). There were no apparent differences in reported morbidity symptoms. No difference in the timing to achieve motor development milestones between the 2 groups was found (1 study; 119 participants, very low certainty evidence). A limited number of studies prevented data pooling. CONCLUSIONS The evidence is very uncertain about the effect of exclusive breastfeeding for less than 6 months for preterm and low birth weight infants. Further studies are warranted to better answer this question.
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Affiliation(s)
- Wen-Chien Yang
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia.,ICF, Rockville, Maryland
| | | | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
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Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana. J Nutr Sci 2022; 11:e43. [PMID: 35754984 PMCID: PMC9201873 DOI: 10.1017/jns.2022.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.
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Dang J, Chen T, Ma N, Liu Y, Zhong P, Shi D, Dong Y, Zou Z, Ma Y, Song Y, Ma J. Associations between Breastfeeding Duration and Obesity Phenotypes and the Offsetting Effect of a Healthy Lifestyle. Nutrients 2022; 14:nu14101999. [PMID: 35631148 PMCID: PMC9143350 DOI: 10.3390/nu14101999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Additional metabolic indicators ought to be combined as outcome variables when exploring the impact of breastfeeding on obesity risk. Given the role of a healthy lifestyle in reducing obesity, we aimed to assess the effect of breastfeeding duration on different obesity phenotypes according to metabolic status in children and adolescents, and to explore the offsetting effect of healthy lifestyle factors on the associations between breastfeeding duration and obesity phenotypes. Methods: A total of 8208 eligible children and adolescents aged 7–18 years were recruited from a Chinese national cross-sectional study conducted in 2013. Anthropometric indicators were measured in the survey sites, metabolic indicators were tested from fasting blood samples, and breastfeeding duration and sociodemographic factors were collected by questionnaires. According to anthropometric and metabolic indicators, obesity phenotypes were divided into metabolic healthy normal weight (MHNW), metabolic unhealthy normal weight (MUNW), metabolic healthy obesity (MHO), and metabolic unhealthy obesity (MUO). Four common obesity risk factors (dietary consumption, physical activity, screen time, and sleep duration) were used to construct a healthy lifestyle score. Scores on the lifestyle index ranged from 0 to 4 and were further divided into unfavorable lifestyles (zero or one healthy lifestyle factor), intermediate lifestyles (two healthy lifestyle factors), and favorable lifestyle (three or four healthy lifestyle factors). Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the associations between breastfeeding duration and obesity phenotypes. Furthermore, the interaction terms of breastfeeding duration and each healthy lifestyle category were tested to explore the offsetting effect of lifestyle factors. Results: The prevalence of obesity among Chinese children and adolescents aged 7–18 years was 11.0%. Among the children and adolescents with obesity, the prevalence of MHO and MUO was 41.0% and 59.0%, respectively. Compared to the children and adolescents who were breastfed for 6–11 months, prolonged breastfeeding (≥12 months) increased the risks of MUNW (OR = 1.35, 95% CI: 1.19–1.52), MHO (OR = 1.61, 95% CI: 1.27–2.05), and MUO (OR = 1.46, 95% CI: 1.20–1.76). When stratified by healthy lifestyle category, there was a typical dose–response relationship between duration of breastfeeding over 12 months and MUNW, MHO, and MUO, with an increased risk of a favorable lifestyle moved to an unfavorable lifestyle. Conclusions: Prolonged breastfeeding (≥12 months) may be associated with increased risks of MUNW, MHO, and MUO, and the benefits of breastfeeding among children and adolescents may begin to wane around the age of 12 months. The increased risks may be largely offset by a favorable lifestyle.
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Affiliation(s)
- Jiajia Dang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Ting Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Ning Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yunfei Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Panliang Zhong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Di Shi
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
- Correspondence: (Y.S.); (J.M.); Tel.: +86-10-82801624 (Y.S.); Fax: +86-10-82801178 (Y.S.)
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
- Correspondence: (Y.S.); (J.M.); Tel.: +86-10-82801624 (Y.S.); Fax: +86-10-82801178 (Y.S.)
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Langley-Evans SC. Early life programming of health and disease: the long-term consequences of obesity in pregnancy: a narrative review. J Hum Nutr Diet 2022; 35:816-832. [PMID: 35475555 PMCID: PMC9540012 DOI: 10.1111/jhn.13023] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
The prevalence of overweight and obesity is rising in all parts of the world and among young women it presents a very clear danger during pregnancy. Women who are overweight or who gain excessive weight during pregnancy are at greater risk of complications in pregnancy and labour, and are more likely to lose their child to stillbirth, or themselves die during pregnancy. This narrative review considers the evidence that in addition to increasing risk of poor pregnancy outcomes, obesity has the capacity to programme fetuses to be at greater risk of cardiometabolic disorders later in life. An extensive body of evidence from prospective and retrospective cohorts, and record linkage studies demonstrates associations of maternal obesity and/or gestational diabetes with cardiovascular disease, type-1 and type-2 diabetes. Studies in animals suggest that these associations are underpinned by adaptations that occur in fetal life, which remodel the structures of major organs including the brain, kidney and pancreas. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Simon C Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD
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Barbosa C, Costa A, Hetherington MM, Oliveira A. Association of early feeding practices with dietary patterns of 7-year-olds from the birth cohort Generation XXI. Appetite 2022; 171:105909. [DOI: 10.1016/j.appet.2021.105909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/17/2021] [Accepted: 12/30/2021] [Indexed: 11/02/2022]
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Tsenoli M, Khan MAB, Östlundh L, Arora T, Omar O. Complementary feeding practices and the associated risk of childhood obesity among ethnic minority groups living in high-income countries: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e053821. [PMID: 35273047 PMCID: PMC8915298 DOI: 10.1136/bmjopen-2021-053821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Complementary feeding (CF) is defined as the period from when exclusive breast milk and formula are no longer sufficient for meeting the infant's nutritional needs. The CF period occurs from birth to 23 months of age. Though the recommended guidelines for introducing CF is from around 6 months of age, data indicates that some infants are introduced to food earlier than 6 months which can predispose children to obesity and overweight. Obesity in ethnic minority groups (EMG) is higher than their native counterparts and often tracks into adulthood. Hence, our aim was to conduct a systematic review and meta-analysis on the available literature to identify the risk of childhood overweight/obesity associated with CF practices concerning their timing, as well as the frequency and type of CF food introduced. We focused specifically on EMG children living in high-income countries. METHODS AND ANALYSIS A methodological literature search surrounding childhood obesity and overweight (COO) risk associated with CF practices will be conducted in May 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The following academic databases will be methodologically searched: PubMed, EMBASE, PsycINFO, CINAHL, SCOPUS, Cochrane Library and the WHO Global Index Medicus. Three independent researchers will be involved in independent screening and review the included articles based on the predefined inclusion and exclusion criteria. Where conflicts arise during the screening process, it will be resolved through discourse until a consensus is reached. Information on CF practices and anthropometric measurements will be extracted to ascertain the risk of COO. For this study, WHO body mass index for age and sex percentiles, Centers for Disease Control and Prevention classification and other recognised country-specific classifications will be utilised for the outcome. ETHICS AND DISSEMINATION Formal ethical approval is not needed as the results will be drawn from currently available published literature. Outcomes of the review will be shared through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021246029.
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Affiliation(s)
- Maido Tsenoli
- University of South Wales, Pontypridd, UK
- Birmingham Community Healthcare NHS Foundation Trust, Aston, UK
| | - Moien A B Khan
- Nutrition Studies Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- Primary Care, NHS North West London Local Area Team, London, UK
| | - Linda Östlundh
- National Medical Library, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Teresa Arora
- College of Natural & Health Sciences, Zayed University, Dubai, UAE
| | - Omar Omar
- College of Health Sciences, Qatar University, Doha, Ad Dawhah, Qatar
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Samuel A, Osendarp SJM, Feskens EJM, Lelisa A, Adish A, Kebede A, Brouwer ID. Gender differences in nutritional status and determinants among infants (6–11 m): a cross-sectional study in two regions in Ethiopia. BMC Public Health 2022; 22:401. [PMID: 35219315 PMCID: PMC8881837 DOI: 10.1186/s12889-022-12772-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A limited number of studies suggest that boys may have a higher risk of stunting than girls in low-income countries. Little is known about the causes of these gender differences. The objective of the study was to assess gender differences in nutritional status and its determinants among infants in Ethiopia.
Methods
We analyzed data for 2036 children (6–11 months old) collected as the baseline for a multiple micronutrient powders effectiveness study in two regions of Ethiopia in March–April 2015. Child, mother, and household characteristics were investigated as determinants of stunting and wasting. Multiple logistic regression models were used separately for boys and girls to check for gender differences while adjusting for confounders. The study is registered at http://www.clinicaltrials.gov/ with the clinical trials identifier of NCT02479815.
Results
Stunting and wasting prevalence is significantly higher among boys compared to girls, 18.7 vs 10.7% and 7.9 vs 5.4%, respectively. Untimely initiation of breastfeeding, not-exclusive breastfeeding at the age of 6 months, region of residence, and low maternal education are significant predictors of stunting in boys. Untimely introduction to complementary food and low consumption of legumes/nuts are significant predictors of stunting in both boys and girls, and low egg consumption only in girls. Region of residence and age of the mother are significant determinants of wasting in both sexes. Analysis of interaction terms for stunting, however, shows no differences in predictors between boys and girls; only for untimely initiation of breastfeeding do the results for boys (OR 1.46; 95%CI 1.02,2.08) and girls (OR 0.88; 95%CI 0.55,1.41) tend to be different (p = 0.12).
Conclusion
In Ethiopia, boys are more malnourished than girls. Exclusive breastfeeding and adequate dietary diversity of complementary feeding are important determinants of stunting in boys and girls. There are no clear gender interactions for the main determinants of stunting and wasting. These findings suggest that appropriate gender-sensitive guidance on optimum infant and young child feeding practices is needed.
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von Ash T, Alikhani A, Lebron C, Risica PM. Racial/ethnic differences in maternal feeding practices and beliefs at 6 months postpartum. Public Health Nutr 2022; 25:1-10. [PMID: 35029142 PMCID: PMC9991812 DOI: 10.1017/s1368980021005073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/04/2021] [Accepted: 12/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine racial/ethnic differences in maternal feeding practices and beliefs in a sample of low-income smoke-exposed women. DESIGN Cross-sectional analysis using data collected during a randomised control trial. Maternal feeding practices and beliefs were assessed using the Infant Feeding Questionnaire (IFQ), which was administered at 6 months postpartum. ANOVA was used to examine differences in IFQ items by race/ethnicity, while multivariable linear regression models were used to examine differences in IFQ factor scores by race/ethnicity adjusting for potential confounders. SETTING Participants were recruited from prenatal clinics. PARTICIPANTS 343 women (39 % non-Hispanic White, 28 % Hispanic/Latina, 13 % Black, and 20 % other). RESULTS Racial/ethnic minority mothers were more likely than non-Hispanic White mothers to put cereal in their infant's bottle so that the infant would stay full longer (P = 0·032), state their infant wanted more than just formula or breast milk prior to 4 months (P = 0·019), allow their infant to eat whenever he/she wanted (P = 0·023) and only allow their infant to eat at set times (P < 0·001). Adjusting for potential confounders, racial/ethnic minority mothers had higher scores for factors 1 (concern about infant undereating or becoming underweight), 2 (concern about infant's hunger), 4 (concern about infant overeating or becoming overweight) and 5 (feeding infant on a schedule), and lower scores for factor 7 (social interaction with the infant during feeding) than White mothers. Racial/ethnic differences were not found for the other two factors. CONCLUSIONS Differences in maternal feeding practices and beliefs across race/ethnicity are present at 6 months postpartum.
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
- Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Anna Alikhani
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
| | - Cynthia Lebron
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-S121-8, Providence, RI02912, USA
- Center for Health Promotion & Health Equity, Brown School of Public Health, Providence, RI, USA
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Infant feeding practices associated with adiposity peak and rebound in the EDEN mother-child cohort. Int J Obes (Lond) 2022; 46:809-816. [PMID: 34980907 DOI: 10.1038/s41366-021-01059-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE High magnitude of adiposity peak and early adiposity rebound are early risk markers of later obesity. Infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the association between infant feeding practices and age and magnitude of adiposity peak and rebound. SUBJECTS/METHODS Analyses were based on data from the French EDEN mother-child cohort. Data on breastfeeding and complementary feeding were collected at birth and 4, 8, and 12 months. From clinical examinations and measurements collected in the child's health booklet up to 12 years, individual growth curves were modeled, and ages and magnitudes of adiposity peak and rebound were estimated. Associations between infant feeding practices and growth were investigated by multivariable linear regression in children after testing a child-sex interaction. RESULTS In the studied population (n = 1225), adiposity peak occurred at a mean of 9.9 ± 2 months and adiposity rebound at 5.5 ± 1.4 years. Associations between infant feeding practices and adiposity peak or rebound were moderated by child sex. For girls, each additional month of breastfeeding was related to a 2-day increase in the age at adiposity peak (p < 0.001), and an 18-day increase in the age at adiposity peak (p = 0.004). Whereas for boys, each additional month for the age at complementary food introduction was associated with a 29-day increase in the age at adiposity rebound (p = 0.02). For boys, long breastfeeding duration was only related to reduced body mass index at adiposity peak. CONCLUSIONS Child sex has a moderating effect on the association between infant feeding practices and adiposity peak or rebound. The well-known association between breastfeeding duration and early growth seems stronger in girls than boys. The association found for complementary feeding in boys may give new insights into preventing obesity.
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Timing of Introduction to Solid Food, Growth, and Nutrition Risk in Later Childhood. J Pediatr 2022; 240:102-109.e3. [PMID: 34481809 DOI: 10.1016/j.jpeds.2021.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/22/2021] [Accepted: 08/26/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the relationship between the timing of infant cereal introduction between 4 and 6 months of age and growth and dietary intake in later childhood. STUDY DESIGN A longitudinal cohort study was conducted among healthy children 0-10 years of age participating in The Applied Research Group for Kids cohort study between June 2008 and August 2019 in Toronto, Canada. RESULTS Of 8943 children included, the mean (SD) age of infant cereal introduction was 5.7 (2.1) months. In the primary analysis, children who were introduced to infant cereal at 4 vs 6 months had 0.17 greater body mass index z score (95% CI 0.06-0.28; P = .002) and greater odds of obesity (OR 1.82; 95% CI 1.18-2.80; P = .006) at 10 years of age. In the secondary analysis, children who were introduced to infant cereal at 4 vs 6 months had 0.09 greater height-for-age z score (95% CI 0.04-0.15; P = .002) at 1 year of age, an association that was not observed at 5 or 10 years of age. Children who were introduced to infant cereal at 4 vs 6 months had greater nutrition risk which was primarily determined by a less-favorable eating behavior score at 18 months to 5 years of age (0.18 units higher; 95% CI 0.07-0.29; P = .001). CONCLUSIONS Introduction of infant cereal at 4 vs 6 months was associated with greater body mass index z score, greater odds of obesity, similar height-for-age z score, and less favorable eating behavior. These findings support recommendations for introducing solid food around 6 months of age.
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Arredondo A, Lugo OBR, Orozco E, Rosa CPTDL. Breastfeeding and feeding practices in the first year of life and its association with overweight and obesity of children in Mexico. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate feeding practices in the first year of life and their association with the development of overweight and obesity in children in Mexico. Methods: the association between overweight and obesity with different feeding practices were evaluated. The data was processed using the statistical package Stata version 14 using logistic regression models. Results: 396 children were evaluated; the prevalence of overweight and obesity was 6% and 7.7% presented a possible risk of overweight. 6.9% had exclusive breastfeeding in the first 6 months of life and 71.7% were fed infant formula. The variables significantly associated with the development of overweight and obesity in the first year of life were the age of the child (p =0.043, RR=0.57), the introduction of fluids in the first three days of life (p=0.02, RR=2.90), consumption of foods with a high sugar content (p =0.01, RR=0.25), consumption of milk other than breast (p =0.02, RR3.25) and egg consumption (p =0.05; RR=0.28). Conclusions: our results show that it is essential to attend complementary feeding practices and reinforce exclusive breastfeeding in the first year of life, as measures to prevent overweight and obesity to improve health in childhood.
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Gudeta AN, Andrén Aronsson C, Balcha TT, Agardh D. Complementary Feeding Habits in Children Under the Age of 2 Years Living in the City of Adama in the Oromia Region in Central Ethiopia: Traditional Ethiopian Food Study. Front Nutr 2021; 8:672462. [PMID: 34778331 PMCID: PMC8581346 DOI: 10.3389/fnut.2021.672462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022] Open
Abstract
Updated information on child feeding practices, nutritional status, and trends related to parental sociodemographic variables is required in developing countries. The objective of this study was to describe infant feeding practices and associated sociodemographic factors among Ethiopian children with an emphasis on complementary feeding (CF). Information on infant feeding and anthropometric measures was obtained from 1,054 mother-child pairs participating in a birth cohort study of children born between 2017 and 2020 prospectively followed in the city of Adama located in the Oromia region of central Ethiopia. Logistic regression models were used to identify sociodemographic and food groups associated with the initiation of CF. The introduction of complementary foods at 6 months of age was 84.7% (95% CI, 82.5, 86.8). Vegetables, cereals (teff, wheat, barley), and fruits were most often the earliest types of foods introduced. Wasting, stunting, underweight, and low body mass index (BMI) by age were found in 6.0, 16.9, 2.5, and 6.3%, respectively. Maternal age and occupation were the factors associated with timely initiation of CF [OR = 2.25, (95% CI, 1.14, 4.41)] and [OR = 0.68, (95% CI, 0.48, 0.97)], respectively. This study demonstrates that the majority of Ethiopian children in the Oromia region follow the recommendations of WHO on CF.
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Affiliation(s)
- Adugna Negussie Gudeta
- Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Carin Andrén Aronsson
- Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Taye Tolera Balcha
- Division of Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Daniel Agardh
- Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
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Rybak TM, Goetz AR, Stark LJ. Examining patterns of postnatal feeding in relation to infant's weight during the first year. Appetite 2021; 166:105473. [PMID: 34153422 PMCID: PMC9280867 DOI: 10.1016/j.appet.2021.105473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is mixed evidence regarding specific infant feeding behaviors and later risk for overweight and obesity. We sought to detect underlying patterns in duration of breastfeeding, introduction of solid foods and sweetened beverages, in order to understand the relation to later weight. METHODS Patterns of postnatal feeding were examined among infants enrolled in the Infant Feeding Practices Study II (N = 3033). At monthly intervals, mothers reported on the duration of any and exclusive breastfeeding, age of solid food and sweetened beverage introduction, and reported infant weight at ages 9- and 12-months. Latent profile analysis was used to empirically derive patterns of postnatal feeding and examine associations with weight z-scores at 9 and 12 months. RESULTS Two profiles emerged: (1) Short breastfeeding duration and early introduction to solid foods and sweetened beverages (Short BF/Early Introduction; 53%) and (2) longer breastfeeding duration and later introduction to solid foods and sweetened beverages (Longer BF/Later Introduction; 43%). Infants in the Shorter BF/Early Introduction profile had significantly greater weight z-scores at 9 (M = 0.18) and 12 months (M = 0.26), compared to those in the Longer BF/Later Introduction profile (M = -0.21; M = -0.17, respectively). CONCLUSIONS Overall, shorter BF duration and earlier food and sweetened beverage introduction is associated with higher weight z-scores at 9 and 12 months. Early intervention should aim to promote breastfeeding and later introduction of solids and discourage consumption of sweetened beverages. These postnatal patterns of feeding behaviors provides important context to inform targeted interventions aimed at reducing risk for later obesity.
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Affiliation(s)
- Tiffany M Rybak
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Amy R Goetz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Lori J Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Characteristics associated with feeding organic foods during complementary feeding: the nationwide Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort. Br J Nutr 2021; 126:1215-1224. [PMID: 33331257 DOI: 10.1017/s0007114520005097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Organic food consumption and its effects on health remain understudied in adults and in children. The aim of this study was to describe family characteristics associated with feeding infants organic foods during the complementary feeding period. The analysis included 9764 children from the French Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort. In addition to telephone interviews conducted at 2, 12 and 24 months, a monthly questionnaire about milk feeding and complementary foods (including organic foods) was completed by parents between 3 and 10 months. Associations between family characteristics and feeding with organic foods during complementary feeding were analysed by multivariable multinomial logistic regression. Overall, 51 % of infants never consumed organic food during the complementary feeding period (up to 10 months), 24 % sometimes, 15 % often and 9 % always or almost always. As compared with infants never fed organic foods, those 'often' or 'always' fed organic foods were born to older mothers, with higher education level or family income, and lower pre-pregnancy BMI. As compared with never-smoking women, women who had stopped smoking before pregnancy were more likely to feed their infant organic foods. Feeding with organic foods was also related to long breast-feeding duration and later introduction to complementary foods. To conclude, associations between feeding with organic foods and family socio-economic position as well as infant feeding practices need to be considered when studying the impact of organic foods on children's health and development.
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Infant Feeding and Ethnic Differences in Body Mass Index during Childhood: A Prospective Study. Nutrients 2021; 13:nu13072291. [PMID: 34371801 PMCID: PMC8308235 DOI: 10.3390/nu13072291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/16/2022] Open
Abstract
This study investigated ethnic differences in childhood body mass index (BMI) in children from Dutch and Turkish descent and the role of infant feeding factors (breastfeeding duration, milk feeding frequency, as well as the timing, frequency and variety of complementary feeding (CF)). We used data from 244 children (116 Dutch and 128 Turkish) participating in a prospective study in the Netherlands. BMI was measured at 2, 3 and 5 years and standard deviation scores (sds) were derived using WHO references. Using linear mixed regression analyses, we examined ethnic differences in BMI-sds between 2 and 5 years, and the role of infant feeding in separate models including milk or CF factors, or both (full model). Relative to Dutch children, Turkish children had higher BMI-sds at age 3 (mean difference: 0.26; 95%CI: 0.04, 0.48) and 5 (0.63; 0.39, 0.88), but not at 2 years (0.08; -0.16, 0.31). Ethnic differences in BMI-sds were somewhat attenuated by CF factors at age 3 (0.16; -0.07, 0.40) and 5 years (0.50; 0.24, 0.77), whereas milk feeding had a minor impact. Of all factors, only CF variety was associated with BMI-sds in the full model. CF factors, particularly CF variety, explain a small fraction of the BMI-sds differences between Dutch and Turkish children. The role of CF variety on childhood BMI requires further investigation.
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Chaparro MP, Anderson CE. Differences in Early Childhood Dietary Behaviors by Infant Feeding Type and Sex. J Nutr 2021; 151:2001-2009. [PMID: 33847341 DOI: 10.1093/jn/nxab076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type of infant feeding has been linked to later nutritional outcomes, including dietary diversity and obesity in childhood. Little is known about how introduction to complementary feeding and diet quality in early childhood vary by infant feeding type and sex. OBJECTIVE Our objective was to investigate whether early childhood dietary patterns vary by infant feeding type and sex. METHODS Data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infants and Toddler Feeding Practices Study 2 (ITFPS-2) was used, including children with complete information on the WIC infant food package received at ages 1, 7, and 11 mo (N = 2839). Based on this information, children were grouped as fully breastfed, mostly breastfed, mostly formula fed, and fully formula fed. Outcomes include introduction of complementary foods; caloric intake aged between 1 and 36 mo; and Healthy Eating Index (HEI)-2015 between 13 and 36 mo. Mixed models were used adjusting for child's, mother's, and family's sociodemographic characteristics. RESULTS Across all infant feeding groups, the mean age of introduction to any solids was before the age of 6 mo; fully breastfed children were introduced to complementary foods closer to the recommended age (mean 5.1-5.2 mo) compared with other feeding groups (mean 4.6-4.8 mo). Fully formula fed infants consumed significantly more energy than fully breastfed infants at ages 1 mo (boys = 55 kcal/d, girls = 47 kcal/d), 12 mo (boys = 68 kcal/d, girls = 59 kcal/d), 24 mo (boys = 81 kcal/d, girls = 71 kcal/d), and 36 mo (boys = 95 kcal/d, girls = 83 kcal/d). No meaningful differences were observed for HEI-2015 between infant feeding groups or child sex, with average scores of HEI-2015 for all children being 61-63 out of 100. CONCLUSION Early childhood dietary patterns were slightly better among children who were fully breastfed as infants, compared with children in other infant feeding groups. The diets of all WIC-participating children could be improved.
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Affiliation(s)
- M Pia Chaparro
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Christopher E Anderson
- Division of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, Irwindale, CA, USA
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Jian C, Carpén N, Helve O, de Vos WM, Korpela K, Salonen A. Early-life gut microbiota and its connection to metabolic health in children: Perspective on ecological drivers and need for quantitative approach. EBioMedicine 2021; 69:103475. [PMID: 34256346 PMCID: PMC8324810 DOI: 10.1016/j.ebiom.2021.103475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022] Open
Abstract
The colonisation and development of the gut microbiota has been implicated in paediatric metabolic disorders via its powerful effect on host metabolic and immune homeostasis. Here we summarise the evidence from human studies on the early gut microbiota and paediatric overweight and obesity. Manipulation of the early gut microbiota may represent a promising target for countering the burgeoning metabolic disorders in the paediatric population, provided the assembly patterns of microbiota and their health consequences can be decoded. Therefore, in this review, we pay particular attention to the important ecological drivers affecting the community dynamics of the early gut microbiota. We then discuss the knowledge gaps in commonly studied exposures linking the gut microbiota to metabolic disorders, especially regarding maternal factors and antibiotic use. This review also attempts to give directions for future studies aiming to identify predictive and corrective measures for paediatric metabolic disorders based on the gut microbiota. Gut microbiota; Metabolism; Paediatric overweight and obesity; Ecological driver; Dynamics; Infants.
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Affiliation(s)
- Ching Jian
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Noora Carpén
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Otto Helve
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Department of Health Security, Helsinki, Finland
| | - Willem M de Vos
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Laboratory of Microbiology, Wageningen University & Research, Wageningen, Netherlands
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Brunet G, Vidal L, Bove I, Girona A, Iragola V, Ceriani F, Rodríguez R, Martínez A, Fuletti D, Ares G. The social representations of complementary feeding. Appetite 2021; 165:105324. [PMID: 34029670 DOI: 10.1016/j.appet.2021.105324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
The social representations of complementary feeding are expected to shape parents' decisions and to provide justification or legitimization for their practices. The aims of the present work were: i) to explore the social representations of complementary feeding in parents and health professionals, ii) to evaluate if the onset of complementary feeding modify social representations in parents, and iii) to compare the representations of parents and pediatricians. Three groups of participants were considered: 170 parents of children who had not started complementary feeding (1-4 months old), 170 parents of children who had started complementary feeding (7-10 months old) and 212 pediatricians. Parents were recruited in health facilities in Montevideo (Uruguay), whereas pediatricians were recruited at the National Pediatrics Conference. Participants were asked to complete a word association task with "the first meals of a baby". All the responses provided by participants were grouped into categories using content analysis. The structure of the social representations was assessed considering the frequency of mention and the average rank of appearance of the categories. Results showed that the social representations of complementary feeding for both parents and pediatricians were extremely narrow and mainly focused on specific foods: puree and a small set of vegetables and fruits. None of the categories showed high frequency of mention and low rank of appearance, indicating that the structure of the social representations did not include any element in the first periphery. According to the theory of social representations, results from the present work suggest that the social representations of complementary feeding for Uruguayan parents and pediatricians are deeply rooted and resistant to change.
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Affiliation(s)
- Gerónimo Brunet
- Espacio Interdisciplinario, Universidad de la República, José Enrique Rodó 1843, CP 11200, Montevideo, Uruguay.
| | - Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 S/n, CP 91000, Pando, Canelones, Uruguay
| | - Isabel Bove
- UNICEF Uruguay, Bulevar General Artigas 1659, CP 11600, Montevideo, Uruguay
| | - Alejandra Girona
- Departamento de Nutrición Básica, Escuela de Nutrición, Universidad de la República, Av. Américo Ricaldoni S/n, CP 11600, Montevideo, Uruguay; Red Uruguaya de Apoyo a la Nutrición y Desarrollo Infantil, Pedro Vidal 2145, CP 11600, Montevideo, Uruguay
| | - Valentina Iragola
- Espacio Interdisciplinario, Universidad de la República, José Enrique Rodó 1843, CP 11200, Montevideo, Uruguay
| | - Florencia Ceriani
- Red Uruguaya de Apoyo a la Nutrición y Desarrollo Infantil, Pedro Vidal 2145, CP 11600, Montevideo, Uruguay
| | - Raquel Rodríguez
- Departamento de Nutrición Básica, Escuela de Nutrición, Universidad de la República, Av. Américo Ricaldoni S/n, CP 11600, Montevideo, Uruguay; Red Uruguaya de Apoyo a la Nutrición y Desarrollo Infantil, Pedro Vidal 2145, CP 11600, Montevideo, Uruguay
| | - Andrea Martínez
- Red Uruguaya de Apoyo a la Nutrición y Desarrollo Infantil, Pedro Vidal 2145, CP 11600, Montevideo, Uruguay
| | - Darío Fuletti
- UNICEF Uruguay, Bulevar General Artigas 1659, CP 11600, Montevideo, Uruguay
| | - Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 S/n, CP 91000, Pando, Canelones, Uruguay
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Analysis of the labelling of a sample of commercial foods for infants and young children in 13 countries. J Public Health Policy 2021; 42:390-401. [PMID: 34012013 DOI: 10.1057/s41271-021-00290-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Abstract
The World Health Organisation (WHO), European Commission (EC) and Public Health England (PHE) published evidence of inappropriate content, marketing and labelling of commercial foods for infants and young children. Despite this, EC regulations are not yet established. To reduce rates of noncommunicable diseases (NCDs) a better understanding of the food environment is needed. This study aimed to assess the labelling and listed macronutrient and sodium content of commercially available pureed foods marketed for infants and young children under 3 years of age (0-36 months) in 13 countries. A standardized protocol was developed to guide photograph collection and a sample of 155 products were obtained. All products were within current WHO and EC guidelines. However, 103 (67.7%) products were marketed for infants between 4 and 6 months, and many and contained added sugars. Action is needed to improve the nutrient composition, marketing and labelling of these products to reduce NCDs.
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Complementary Feeding and Overweight in European Preschoolers: The ToyBox-Study. Nutrients 2021; 13:nu13041199. [PMID: 33916419 PMCID: PMC8066073 DOI: 10.3390/nu13041199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Complementary feeding (CF) should start between 4–6 months of age to ensure infants’ growth but is also linked to childhood obesity. This study aimed to investigate the association of the timing of CF, breastfeeding and overweight in preschool children. Infant-feeding practices were self-reported in 2012 via a validated questionnaire by >7500 parents from six European countries participating in the ToyBox-study. The proportion of children who received breast milk and CF at 4–6 months was 51.2%. There was a positive association between timing of solid food (SF) introduction and duration of breastfeeding, as well as socioeconomic status and a negative association with smoking throughout pregnancy (p < 0.005). No significant risk to become overweight was observed among preschoolers who were introduced to SF at 1–3 months of age compared to those introduced at 4–6 months regardless of the type of milk feeding. Similarly, no significant association was observed between the early introduction of SF and risk for overweight in preschoolers who were breastfed for ≥4 months or were formula-fed. The study did not identify any significant association between the timing of introducing SF and obesity in childhood. It is likely that other factors than timing of SF introduction may have impact on childhood obesity.
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Rossiter C, Cheng H, Appleton J, Campbell KJ, Denney-Wilson E. Addressing obesity in the first 1000 days in high risk infants: Systematic review. MATERNAL AND CHILD NUTRITION 2021; 17:e13178. [PMID: 33780128 PMCID: PMC8189222 DOI: 10.1111/mcn.13178] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
Early intervention is critical for addressing the challenge of childhood obesity. Yet many preventive interventions do not target infants most at risk of future overweight or obesity. This systematic review examines interventions delivered before 2 years that aim to ameliorate excess weight gain among infants at high risk of overweight or obesity, due to sociodemographic characteristics, parental weight or health status, infant feeding or health behaviours. We searched six databases for interventions: (a) delivered before age two, (b) specifically aimed at infants at high risk of childhood obesity and (c) that reported outcomes by weight status beyond 28 days. The search identified over 27,000 titles, and 49 papers from 38 studies met inclusion criteria: 10 antenatal interventions, 16 postnatal and 12 conducted both before and after birth. Nearly all targeted infant and/or maternal nutrition. Studies varied widely in design, obesity risk factors, outcomes and quality. Overall, nine interventions of varying quality reported some evidence of significantly improved child weight trajectory, although effects tended to diminish over time. Interventions that improved weight outcomes tended to engage parents for a longer period, and most offered health professional input and support. Two studies of limited quality reported significantly worse weight outcomes in the intervention group.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Appleton
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia.,Tresillian Family Care Centres, Belmore, New South Wales, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia
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50
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Wood CT, Witt WP, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater AM, Flower KB, Kay MC, Perrin EM. Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life. Acad Pediatr 2021; 21:288-296. [PMID: 32961335 PMCID: PMC10910619 DOI: 10.1016/j.acap.2020.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether proportion of breast versus formula feeding and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants. METHODS Using data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2- to 6-month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models. RESULTS Of the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (adjusted odds ratio [aOR] 0.34; 95% confidence interval [CI]: 0.17, 0.69) when compared to infants who were formula-fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96). CONCLUSIONS Feeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.
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Affiliation(s)
- Charles T Wood
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine (CT Wood and EM Perrin), Durham, NC.
| | - Whitney P Witt
- College of Health, Lehigh University, (WP Witt), Bethlehem, PA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Duke Clinical Research Institute (AC Skinner), Durham, NC
| | - Hsiang S Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine/Bellevue Hospital Center (HS Yin), New York, NY
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center (RL Rothman), Nashville, Tenn
| | - Lee M Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University (LM Sanders), Stanford, Calif
| | - Alan M Delamater
- Department of Pediatrics, University of Miami School of Medicine (AM Delamater), Miami, Fla
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine (KB Flower), Chapel Hill, NC
| | - Melissa C Kay
- Duke Center for Childhood Obesity Research and Duke Global Digital Health Science Center, Duke University School of Medicine and Duke Global Health Institute (MC Kay), Durham, NC
| | - Eliana M Perrin
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine (CT Wood and EM Perrin), Durham, NC
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