Full Breastfeeding and Obesity in Children: A Prospective Study from Birth to 6 Years

An optimized culturomics strategy for isolation of human milk microbiota

Viable microorganisms and a diverse microbial ecosystem found in human milk play a crucial role in promoting healthy immune system and shaping the microbial community in the infant's gut. Culturomics is a method to obtain a comprehensive repertoire of human milk microbiota. However, culturomics is an onerous procedure, and needs expertise, making it difficult to be widely implemented. Currently, there is no efficient and feasible culturomics method specifically designed for human milk microbiota yet. Therefore, the aim of this study was to develop a more efficient and feasible culturomics method specifically designed for human milk microbiota. We obtained fresh samples of human milk from healthy Chinese mothers and conducted a 27-day enrichment process using blood culture bottles. Bacterial isolates were harvested at different time intervals and cultured on four different types of media. Using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis, we identified a total of 6601 colonies and successfully obtained 865 strains, representing 4 phyla, 21 genera, and 54 species. By combining CBA and MRS media, we were able to cultivate over 94.4% of bacterial species with high diversity, including species-specific microorganisms. Prolonged pre-incubation in blood culture bottles significantly increased the number of bacterial species by about 33% and improved the isolation efficiency of beneficial bacteria with low abundance in human milk. After optimization, we reduced the pre-incubation time in blood culture bottles and selected optimal picking time-points (0, 3, and 6 days) at 37°C. By testing 6601 colonies using MALDI-TOF MS, we estimated that this new protocol could obtain more than 90% of bacterial species, reducing the workload by 57.0%. In conclusion, our new culturomics strategy, which involves the combination of CBA and MRS media, extended pre-incubation enrichment, and optimized picking time-points, is a feasible method for studying the human milk microbiota. This protocol significantly improves the efficiency of culturomics and allows for the establishment of a comprehensive repertoire of bacterial species and strains in human milk.

FTO and MC4R polymorphisms, and selected pre-, peri- and postnatal factors as determinants of body mass index and fatness in children: a thorough analysis of the associations

BACKGROUND

Overweight and obesity among children have become significant global health concerns. Previous studies have highlighted the potential role of genetic factors, particularly polymorphisms in the FTO and MC4R genes, as well as environmental factors in the development of childhood obesity. This study aimed to investigate the relationships between genetic, socioeconomic and perinatal factors, adverse childhood events (ACEs), and lifestyle, and their impact on overweight, obesity and body composition parameters in children. Additionally, we explored potential interactions between genetic factors and ACEs.

METHODS

Four hundred fifty-six children aged 6-12 years participated in our study. Information on the socioeconomic status, perinatal factors, ACEs and lifestyle of the children was collected with a questionnaire completed by their parents/guardians. We examined the children's body weight and conducted an electrical bioimpedance analysis. Overweight and obesity were diagnosed based on the International Obesity Task Force and McCarthy criteria. We genotyped two selected polymorphisms in the FTO and MC4R genes using the TaqMan SNP allelic discrimination method.

RESULTS

Higher BMI (Body Mass Index) z scores were related to higher paternal BMI and lower maternal age at the child's birth. Higher FMI (Fat Mass Index) z scores were associated with higher paternal BMI, increased gestational weight, lower maternal education and the presence of the FTO risk allele. Higher FatM (fat mass in kg) z scores were linked to lower maternal education, lower maternal age at the child's birth, higher maternal body weight gain, paternal BMI and the presence of the FTO risk allele. Moreover, interaction effects were observed on BMI z scores between ACE and FTO AA, and on FMI z scores and FatM z scored between ACE and MC4R CC.

CONCLUSIONS

The contribution of environmental factors is more strongly related to changes in body composition than genetic ones. Additionally, the presence of the risk allele combined with unfavourable environmental factors like ACEs leads to visible interaction effects, resulting in increased BMI z scores and FMI z scores in children.

Prevalence and determinants of overweight and obesity among preschool-aged children from migrant and socioeconomically disadvantaged contexts in Montreal, Canada

Among migrant and socioeconomically disadvantaged preschool-aged children followed in social perinatal primary care services in Montreal, Canada, we estimated the prevalence of overweight/obesity and identified determinants of body mass index z-score (zBMI) at 4-5 years old. We conducted a retrospective cohort study using electronic medical records of 275 child-mother dyads followed from birth to 4-5 years. Anthropometric measures and established maternal, perinatal and child risk factors for childhood obesity were examined. Age- and sex-specific zBMI at 4-5-years were computed and categorized according to WHO standards. Linear regression with model averaging was used to identify early life factors associated with zBMI. At 4-5 years, children's weight status was classified as underweight (1.5%), normal weight (69.7%), at-risk-of-overweight (19.2%), overweight (6.9%), and obesity (2.7%). Primiparity (0.51, 95% CI 0.24; 0.78), higher birthweight (1.04, 95% CI 0.70; 1.37), accelerated weight gain in the first year of life (0.21, 95% CI 0.13; 0.31), and introduction to solid foods before 6 months (0.89, 95% CI 0.42; 1.36) were associated with a higher zBMI, while less than high school education (-0.50, 95% CI -0.95; -0.05) and higher gestational age (-0.14, 95% CI -0.21; -0.05) were associated with lower zBMI at 4-5 years. Overweight/obesity is prevalent among preschool-aged children from migrant and socioeconomically disadvantaged contexts and is associated with known risk factors. Future research is needed to better understand the role of social perinatal primary care services in promoting optimal weight gain among children living in contexts of vulnerability.

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

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

Global Impact of Obesity

The prevalence of preobesity and obesity is rising globally, multiple epidemiologic studies have identified preobesity and obesity as predisposing factors to a number of noncommunicable diseases including type 2 diabetes (T2DM), cardiovascular disease (CVD), and cancer. In this review, we discuss the epidemiology of obesity in both children and adults in different regions of the world. We also explore the impact of obesity as a disease not only on physical and mental health but also its economic impact.

Best Practices for the Care of Breastfeeding Patients Requiring Local or General Anesthesia

The care of breastfeeding patients who require anesthesia presents unique challenges; therefore, caregivers must be knowledgeable regarding drugs' pharmacodynamic and pharmacokinetic profiles to ensure the safety of the breastfed infant. Although most anesthetic drugs are compatible with breastfeeding, health care providers continue to advise patients to "pump and dump." This advice can lead to undesirable outcomes, including interruption or cessation of breastfeeding, creating possible physical and psychological challenges for parents and their neonates. This article outlines best practices for the care of breastfeeding patients receiving anesthesia.

Adiposity and feeding practices in the first two years of life among toddlers in Guadalajara, Mexico

BACKGROUND

Feeding practices in the first two years of life have a direct impact on nutritional status and adiposity. The purpose of this study was to identify the differences in feeding practices during the first two years of life by sex and type of feeding in the first semester of postnatal life and their relationships with adiposity in toddlers.

METHODS

An analytical cross-sectional study that included 150 toddlers aged 12 to 24 months who were healthy, full-term, and had adequate weight for their gestational ages, was conducted at the New Civil Hospital and at a private practice in Guadalajara. Body compositions were obtained by bioelectrical impedance (BIA) measurements, and a modified questionnaire was used. Then, the parents completed two 24-h dietary recalls. In addition to the descriptive statistics, ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used in the contrast analysis of the quantitative variables. To analyze the qualitative variables, we used X² tests. Afterward, linear regression tests were conducted to identify the relationships between adiposity and feeding practices during the first two years.

RESULTS

There were direct relationships between adiposity and duration of full breastfeeding (r = 0.610, p = 0.021), age of introduction of ultra-processed products (r = 0.311, p = 0.011), sugar (r = 0.186; p = 0.024) and age at which eggs were introduced (r = -0.202; p = 0.016).

CONCLUSIONS

Adiposity was related to feeding practices in the first two years of life in toddlers.

Association of maternal body composition and diet on breast milk hormones and neonatal growth during the first month of lactation

INTRODUCTION

Preterm birth is associated with altered growth patterns and an increased risk of cardiometabolic diseases, with breast milk (BM) being a counteracting factor. Preterm infants also show alterations in adipokines and gut hormones influencing appetite and metabolism. Since these hormones are present in BM, it is possible that their levels may equilibrate deficiencies improving infant growth. We aimed to assess 1) the BM levels of ghrelin, resistin, leptin, insulin, peptide YY, and the gastrointestinal peptide in women with preterm and term labor; 2) the relationship between BM hormones and neonatal growth; and 3) the influence of maternal body composition and diet on these BM hormones.

METHODS

BM from 48 women (30 term and 18 preterm labor) was collected at days 7, 14, and 28 of lactation. Maternal body composition was evaluated by bioimpedance, and neonate anthropometric parameters were collected from medical records. The maternal dietary pattern was assessed by a 72-h dietary recall at days 7 and 28 of lactation. BM hormones were analyzed by the U-Plex Ultra-sensitive method. Data were analyzed using linear regression models. BM from women with preterm labor had lower ghrelin levels, with the other hormones being significantly higher compared to women with term delivery.

RESULTS

In premature infants, growth was positively associated with BM ghrelin, while, in term infants, it was positively associated with insulin and negatively with peptide YY. In the first week of lactation, women with preterm labor had higher body fat compared to women with term labor. In this group, ghrelin levels were positively associated with maternal body fat and with fiber and protein intake. In women with term labor, no associations between anthropometric parameters and BM hormones were found, and fiber intake was negatively associated with peptide YY.

DISCUSSION

Preterm labor is a factor influencing the levels of BM adipokines and gut hormones, with BM ghrelin being a relevant hormone for premature infant growth. Since ghrelin is lower in BM from women with preterm labor and the levels are associated with maternal fat storage and some dietary components, our data support the importance to monitor diet and body composition in women who gave birth prematurely to improve the BM hormonal status.

Proinflammatory maternal diet and early weaning are associated with the inflammatory diet index of Brazilian children (6-12 mo): A pathway analysis

OBJECTIVE

The aim of this study was to assess the dietary inflammatory index (DII) and its association with maternal factors and excess body weight in Brazilian children aged <2 y during complementary feeding.

METHODS

This was a cross-sectional study (2016-2019), conducted with 231 mothers and children ages 6 to 24 mo. The food consumption of the mother-child dyad was obtained through the mean of three 24-h recalls, as well as information on the consumption of breast milk. The DII was used to verify the quality of the diet. Children's weight and length were measured, and the weight/height index was calculated. Path analysis was used to assess the interrelationships between variables. Multiple linear regression was conducted to identify the components of the child's DII (C-DII) that contributed the most to explaining its variation.

RESULTS

The children had an anti-inflammatory diet (C-DII -0.37 ± 0.91) whereas the mothers had a proinflammatory diet (M-DII +0.24 ± 0.86). Fiber was the nutrient that contributed most to the variations in the C-DII. Approximately 28% of children were overweight. In the pathway analysis, we verified a direct negative effect of education on excess body weight (standardized coefficients [SC], -0.180; P = 0.034) and C-DII (SC, -0.167; P = 0.002); negative direct effect of breastfeeding on the C-DII (SC, -0.294; P < 0.001); and positive direct effect of M-DII on C-DII (SC, 0.119; P = 0.021).

CONCLUSION

Children's proinflammatory diet during the period of complementary feeding was associated with maternal proinflammatory diets, lower education, and absence of breastfeeding practice.

The role of the gut microbiome in the intergenerational transmission of the obesity phenotype: A narrative review

Obesity is considered an epidemic by the World Health Organization. In particular, maternal obesity can affect the development of obesity and other related metabolic disorders in infants. Recently, both animal and human studies have pointed to the importance of the gut microbiome in facilitating the transmission of the obesity phenotype from mother to offspring. The gut microbiome changes significantly during the progression of pregnancy, and the microbiota of the amniotic fluid and placenta have recently been shown to colonize the infant gut in utero. Microbial composition, diversity, and richness are significantly altered by maternal obesity, which in turn affects the infant's acquisition of the gut microbiome and their risk to develop metabolic disorders. C-section has also been shown to affect the colonization of the infant gut and offspring metabolic and immune health. This narrative review seeks to discuss the role of the gut microbiome in the transmission of the obesity phenotype from mother to child, as well as how birth delivery, breastfeeding, and probiotic interventions may modulate this relationship.

Association between breastfeeding, parents' body mass index and birth weight with obesity indicators in children

Background

Childhood obesity is potentially affected by breastfeeding, parents’ body mass index and birth weight. Thus, this study aimed to verify the association between breastfeeding, parents’ body mass index and birth weight with obesity indicators in children.

Methods

This is a cross-sectional study, including data from 402 schoolchildren between 9 and 11 of age in the city of São Caetano do Sul, Brazil. Parents or guardians answered a questionnaire about breastfeeding (month), birth weight (kg), and parental body weight and height (parents’ body mass index [kg/m²] was calculated). Body mass index (kg/m²), waist circumference (cm) and body fat (%), determined via bio-impedance, were measured and used as obesity indicators. Multi-level linear regression models were used to assess the respective associations adjusted for the potential confounders.

Results

Considering body mass index of children, the overall prevalence of eutrophic, overweight and obese were 58.2%, 20.9% and 17.2%, respectively. Significant and positive correlations were observed between breastfeeding, maternal as well as paternal body mass index and the children’s body mass index, body fat and waist circumference. Birth weight was weakly and positively associated with body mass index and body fat but was not associated with waist circumference. After adjusting for school, sex, age, race/ethnicity, annual household income, sedentary time and moderate-to-vigorous physical activity, maternal body mass index and birth weight were positively associated with children’s body mass index (β: 0.228; 95%CI: 0.142; 0.314 and β: 0.001; 95%CI: 0.001; 0.002), body fat (β: 0.484; 95%CI: 0.297; 0.671 and β: 0.002; 95%CI: 0.001; 0.003) and waist circumference (β: 0.509; 95%CI: 0.304; 0.715 and β: 0.003; 95%CI: 0.001; 0.005). Breastfeeding was not associated with any obesity indicators.

Conclusion

Maternal body mass index and birth weight were associated with children’s obesity indicators. The perinatal environment, therefore, appears to be a critical contributor to childhood obesity and public policies need to address parental obesity in order to tackle childhood obesity.

Trial registration:

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500).

The Impact of Gestational Diabetes Mellitus on Human Milk Metabolic Hormones: A Systematic Review

Gestational diabetes mellitus (GDM) is a common pregnancy complication with short- and long-term health consequences for the infant and mother. Breastfeeding is the recommended mode of feeding as it offers an opportunity to reduce the risk of GDM consequences, likely partially mediated through changes in human milk (HM) composition. This review systematically reviewed 12 identified studies that investigated the impact of GDM on concentrations of HM metabolic hormones. Meta-analysis was not possible due to significant heterogeneity in study designs and hormone measurement techniques. The risk of bias was assessed using the National Institute for Clinical Excellence (NICE) tool. The methodological qualities were medium in half of the studies, while 25% (3/12) of studies carried a high risk of bias. Significant relationships were reported between GDM and concentrations of HM ghrelin (3/3 studies), insulin (2/4), and adiponectin (2/6), which may play an integral role in infant growth and development. In conclusion, preliminary evidence suggests that GDM may alter HM metabolic hormone concentrations; however, these relationships may be limited to the early lactation stage.

Breastfeeding and overweight/obesity among children and adolescents: a cross-sectional study

Background

Overweight and obesity are major public health crises among children and adolescents and contribute to a significant economic burden. We aimed to investigate the relationship between breastfeeding duration and overweight and obesity in children and adolescents in Qingdao, China in 2017.

Methods

This study conducted a survey with 10,753 students (5370 boys and 5383 girls) aged 6 to 16 years from the Shibei District of Qingdao, China in 2017. Anthropometric measurements were taken by well-trained personnel and self-completed questionnaires were used to collect data from students. A variety of statistical methods were used in this study, including univariate and multivariate analyses, as well as linear and nonlinear regression models.

Results

The prevalence of overweight and obesity was 15.45% and 19.76%, respectively. There was a significant negative correlation between breastfeeding duration and BMI in children and adolescents (β = -0.025, 95% CI: -0.033, -0.005, P < 0.01). Among boys, the BMI in children and adolescences of those who have been breastfed for more than 12 months was significantly lower than that of others whose breastfeeding duration was less than 12 months (β = -0.440, 95%CI -0.655, -0.224, P < 0.01). Breastfeeding has a particularly positive effect on the prevalence of obesity in boys aged 9 to 11 years (OR = 0.978, 95% CI: 0.958,0.999, P < 0.05).

Conclusion

Breastfeeding can significantly reduce the prevalence of overweight and obesity among children and adolescents aged 6 to 16 years. Those who were breastfed for more than 12 months had a lower risk of developing overweight and obesity, especially boys between the ages of 9 and 11.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03394-z.

Human milk microbiota: what did we learn in the last 20 years?

Human milk (HM) is the gold standard for infant nutrition during the first months of life. Beyond its nutritional components, its complex bioactive composition includes microorganisms, their metabolites, and oligosaccharides, which also contribute to gut colonization and immune system maturation. There is growing evidence of the beneficial effects of bacteria present in HM. However, current research presents limited data on the presence and functions of other organisms. The potential biological impacts on maternal and infant health outcomes, the factors contributing to milk microbes' variations, and the potential functions in the infant's gut remain unclear. This review provides a global overview of milk microbiota, what the actual knowledge is, and what the gaps and challenges are for the next years.

Breastfeeding Associations with Childhood Obesity and Body Composition: Findings from a Racially Diverse Maternal-Child Cohort

Background: Studies suggest breastfeeding lowers obesity risk in childhood, but generalizability of existing evidence is limited. We examined associations of breastfeeding with childhood overweight, obesity, and percentage body fat, in a racially diverse maternal-child cohort. Methods: This cross-sectional study included 823 children, ages 4-8 years, enrolled in the Environmental Exposures and Child Health Outcomes (ECHO) cohort, a subset of the National Institute of Child Health and Human Development Fetal Growth Studies cohort. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for overweight [BMI (kg/m²) 85th to <95th percentile] and obesity (BMI ≥95th percentile) in relation to breastfeeding including duration of exclusive and total breastfeeding. Linear regression was used to evaluate association between breastfeeding and percentage body fat measured by bioelectrical impedance analysis. Results: Fifty-two percent of children were male, 32% non-Hispanic Black, 29% Hispanic, 27% non-Hispanic White, and 13% Asian; 16% were overweight and 13% obese. Six months of exclusive breastfeeding, compared with no breastfeeding, was associated with 60% lower odds of obesity (95% CI 0.18-0.91) adjusting for age, gender, race, socioeconomic status, maternal BMI, and child's activity. Percentage body fat was inversely associated with breastfeeding duration. For none, <6, and ≥6 months of exclusive breastfeeding, adjusted mean percentage body fat was 16.8, 14.5, and 13.4, respectively. Results did not differ by gender, race/ethnicity, or maternal BMI status. Conclusions: Exclusive breastfeeding for the first 6 months of life is inversely and significantly associated with obesity and percentage body fat at ages 4-8 years. These findings support current breastfeeding guidelines.

Understanding income-related differences in distribution of child growth, behaviour and development using a cross-sectional sample of a clinical cohort study

OBJECTIVES

Children from low-income households are at an increased risk of social, behavioural and physical health problems. Prior studies have generally relied on dichotomous outcome measures. However, inequities may exist along the range of outcome distribution. Our objective was to examine differences in distribution of three child health outcomes by income categories (high vs low): body mass index (BMI), behaviour difficulties and development.

DESIGN AND SETTING

This was a cross-sectional study using data from a primary care-based research network with sites in three Canadian cities, and 15 practices enrolling participants.

PARTICIPANTS, INDEPENDENT VARIABLE AND OUTCOMES

The independent variable was annual household income, dichotomised at the median income for Toronto (<$C80 000 or ≥$C80 000). Outcomes were: (1) growth (BMI z-score (zBMI) at 5 years, 1628 participants); (2) behaviour (Strengths and Difficulties Questionnaire (SDQ) at 3-5 years, 649 participants); (3) development (Infant Toddler Checklist (ITC) at 18 months, 1405 participants). We used distributional decomposition to compare distributions of these outcomes for each income group, and then to construct a counterfactual distribution that describes the hypothetical distribution of the low-income group with the predictor profile of the higher-income group.

RESULTS

We included data from 1628 (zBMI), 649 (SDQ) and 1405 (ITC) children. Children with lower family income had a higher risk distribution for all outcomes. For all outcomes, thecounterfactual distribution, which represented the distribution of children with lower-income who were assigned the predictor profile of the higher-income group, was more favourable than their observed distributions.

CONCLUSION

Comparing the distributions of child health outcomes and understanding different risk profiles for children from higher-income and lower-income groups can offer a deeper understanding of inequities in child health outcomes. These methods may offer an approach that can be implemented in larger datasets to inform future interventions.

Maternal BMI, breastfeeding and perinatal factors that influence early childhood growth trajectories: a scoping review

Obesity rates among children are rapidly rising internationally and have been linked to noncommunicable diseases in adulthood. Individual preventive strategies have not effectively reduced global obesity rates, leading to a gap in clinical services regarding the development of early perinatal interventions. The objective of this scoping review is to explore the relationship between maternal BMI and breastfeeding behaviors on child growth trajectories to determine their relevance in developing interventions aimed at preventing childhood obesity.The scoping review was guided and informed by the Arksey and O'Malley (2005) framework. A systematic search was performed in four databases. Studies included in the final review were collated and sorted into relevant themes. A systematic search yielded a total of 5831 records (MEDLINE: 1242, EMBASE: 2629, CINAHL: 820, PubMed: 1140). Results without duplicates (n = 4190) were screened based on relevancy of which 197 relevant-full-text articles were retrieved and assessed for eligibility resulting in 14 studies meeting the inclusion criteria. Data were extracted and charted for the studies and six themes were identified: (1) healthy behaviors, lifestyle, and social economic status; (2) parental anthropometrics and perinatal weight status; (3) genetics, epigenetics, and fetal programming; (4) early infant feeding; (5) infant growth trajectories; and (6) targeted prevention and interventions. Early life risk factors for child obesity are multifactorial and potentially modifiable. Several at-risk groups were identified who would benefit from early preventative interventions targeting the importance of healthy weight gain, exclusive breastfeeding to 6 months, and healthy lifestyle behaviors.

Human Milk Metabolic Hormones: Analytical Methods and Current Understanding

Human milk (HM) contains a wide array of peptide hormones including leptin and adiponectin, which are involved in the regulation of infant growth and development. These essential hormones might play an important role in the regulation of metabolic reprogramming of the new-born infant. However, HM hormone studies are sparse and heterogeneous in regard to the study design, sample collection, preparation and analysis methods. This review discussed the limitations of HM hormone analysis highlighting the gaps in pre-analytical and analytical stages. The methods used to quantify HM metabolic hormones (leptin, adiponectin, ghrelin, insulin, obestatin, resistin and apelin) can be classified as immunoassay, immunosensor and chromatography. Immunoassay methods (ELISA and RIA) have been predominantly used in the measurement of these HM hormones. The relative validity parameters of HM hormones analysis are often overlooked in publications, despite the complexity and differences of HM matrix when compared to that of plasma and urine. Therefore, appropriate reports of validation parameters of methodology and instrumentation are crucial for accurate measurements and therefore better understanding of the HM metabolic hormones and their influences on infant outcomes.

Human Milk Microbiota and Oligosaccharides: A Glimpse into Benefits, Diversity, and Correlations

Human milk represents a cornerstone for growth and development of infants, with extensive array of benefits. In addition to exceptionally nutritive and bioactive components, human milk encompasses a complex community of signature bacteria that helps establish infant gut microbiota, contributes to maturation of infant immune system, and competitively interferes with pathogens. Among bioactive constituents of milk, human milk oligosaccharides (HMOs) are particularly significant. These are non-digestible carbohydrates forming the third largest solid component in human milk. Valuable effects of HMOs include shaping intestinal microbiota, imparting antimicrobial effects, developing intestinal barrier, and modulating immune response. Moreover, recent investigations suggest correlations between HMOs and milk microbiota, with complex links possibly existing with environmental factors, genetics, geographical location, and other factors. In this review, and from a physiological and health implications perspective, milk benefits for newborns and mothers are highlighted. From a microbiological perspective, a focused insight into milk microbiota, including origins, diversity, benefits, and effect of maternal diet is presented. From a metabolic perspective, biochemical, physiological, and genetic significance of HMOs, and their probable relations to milk microbiota, are addressed. Ongoing research into mechanistic processes through which the rich biological assets of milk promote development, shaping of microbiota, and immunity is tackled.

Weight Status and Visceral Adiposity Mediate the Relation between Exclusive Breastfeeding Duration and Skin Carotenoids in Later Childhood

BACKGROUND

Breastfeeding is associated with healthier weight and nutrient status in early life. However, the impact of breastfeeding on carotenoid status beyond infancy, and the influence of adiposity, are unknown.

OBJECTIVES

The aim of the study was to retrospectively investigate the relation between breastfeeding and carotenoid status, and the mediating effect of weight status and adiposity on this relation, among school-age children.

METHODS

This was a secondary analysis of baseline data collected from a randomized-controlled clinical trial. Children 7-12 y old (n = 81) were recruited from East-Central Illinois. DXA was used to assess visceral adipose tissue (VAT) and whole-body total fat percentage (%Fat; i.e., whole-body adiposity). Weight was obtained to calculate children's BMI percentiles. Skin carotenoids were assessed via reflection spectroscopy. Macular carotenoids were assessed as macular pigment optical density (MPOD). Dietary, birth, and breastfeeding information was self-reported by parents.

RESULTS

Skin carotenoids were inversely related to %Fat (P < 0.01), VAT (P < 0.01), and BMI percentile (P < 0.01). VAT and BMI percentile significantly mediated this relation between exclusive breastfeeding duration and skin carotenoids, after adjustment for dietary carotenoids, energy intake, and mother education.

CONCLUSIONS

Weight status and adipose tissue distribution mediate the positive correlation between exclusive breastfeeding duration and skin carotenoids among children aged 7-12 y. The results indicate the need to support breastfeeding and healthy physical growth in childhood for optimal carotenoid status.This trial was registered at clinicaltrials.gov as NCT03521349.

Are Mothers Certain About Their Perceptions of Recalled Infant Feeding History?

INTRODUCTION

Maternal recall of infant feeding, a potential measurement bias, is used to identify the relationship between mothers' own milk (MOM) feeding and subsequent health outcomes. This study describes maternal recall certainty of MOM feedings at four time periods.

METHOD

In this secondary analysis, mothers of children ages 4-36 months describe infants' MOM feeding and rate certainty of their recall.

RESULTS

MOM was the first feeding for 78.5% of infants and received by 83% the first week, 85% the first month, and 62% the fourth month. Ratings of recall certainty were > 95% for each time period. Recall certainty was significantly different for four time periods (χ² = 9.67, p = 0.02), with no two periods significantly different in post hoc analyses.

DISCUSSION

Maternal recall certainty of infant feeding was high regardless of elapsed time. Measuring maternal recall certainty may be useful in clinical practice and studies linking MOM exposure to subsequent health outcomes.

Reliability and Validity Study of the Children's Eating Behavior Questionnaire in Chinese School-Age Children

Children's Eating Behavior Questionnaire (CEBQ) was widely used in western countries to measure children's eating behavior and played an important role in the research on the risk of childhood obesity, but it is rarely used in China yet. This study aimed to examine the Chinese version of CEBQ's reliability and validity in a pilot study, then applied it to bigger population. Data was collected with CEBQ in two districts of Shanghai, respectively. Using stratified cluster sampling method, a total of 2,520 children were included in the study. The questionnaires were filled out by children's parents. It was proved that the Cronbach's coefficient α of the questionnaire was greater than 0.7, indicating that the questionnaire had good internal consistency. Aside from the subscales 'Emotional undereating' and 'Food fussiness', the Pearson's correlation coefficients of the other subscales were all greater than 0.5. It showed that test-retest reliability of CEBQ was acceptable. We found that boys and girls had different eating behavior characteristics. And there was a graded association between eating behavior and nutritional status of school-age children. It suggested that appetitive traits of school-age children could be used as indicators of susceptibility to weight gain. In conclusion, the Chinese version of CEBQ was of good reliability and validity, so it is considered as a reliable tool that can be applied to Chinese school-age children's eating behavior and related studies.

Impact of the factors shaping gut microbiota on obesity

Obesity is considered as a risk factor for chronic health diseases such as heart diseases, cancer and diabetes 2. Reduced physical activities, lifestyle, poor nutritional diet and genetics are among the risk factors associated with the development of obesity. In recent years, several studies have explored the link between the gut microbiome and the progression of diseases including obesity, with the shift in microbiome abundance and composition being the main focus. The alteration of gut microbiome composition affects both nutrients metabolism and specific gene expressions, thereby disturbing body physiology. Specifically, the abundance of fibre-metabolizing microbes is associated with weight loss and that of protein and fat-metabolizing bacteria with weight gain. Various internal and external factors such as genetics, maternal obesity, mode of delivery, breastfeeding, nutrition, antibiotic use and the chemical compounds present in the environment are known to interfere with the richness of the gut microbiota (GM), thus influencing weight gain/loss and ultimately the development of obesity. However, the effectiveness of each factor in potentiating the shift in microbes' abundance to result in significant changes that can lead to obesity is not yet clear. In this review, we will highlight the factors involved in shaping GM, their influence on obesity and possible interventions. Understanding the influence of these factors on the diversity of the GM and how to improve their effectiveness on disease conditions could be keys in the treatment of metabolic diseases.

BMI Trajectories During the First 2 Years, and Their Associations With Infant Overweight/Obesity: A Registered Based Cohort Study in Taizhou, China

Objective: The purpose of this study was to identify trajectories of body mass index (BMI) in toddlers from birth to 2 years old and examine their association with infantile overweight/obesity. Methods: Data were collected from 19,054 children born in any hospital or community healthcare center in Taizhou, China from 2018 to 2019 with at least three BMI measurements after birth. The Latent Class Growth Mixture Model was used to identify distinct BMI trajectories during the first 2 years of infants. Multiple logistic regression models were conducted to explore the associated factors of different BMI trajectories, and log-binomial regression was performed to assess the association between the trajectories and overweight/obesity. Results: Three heterogeneous BMI trajectories were identified and labeled as "lower" (36.21%, n = 6,899), "middle" (53.15%, n = 10,128) and "upper" (10.64%, n = 2,027), respectively. Several characteristics of infants and their corresponding mothers were found to be correlated with infant BMI trajectories, including infant sex, mode of delivery and weight at birth, as well as maternal parity, early pregnancy BMI and status of gestational diabetes mellitus. Furthermore, compared with those in the lower trajectory, infants in the middle [prevalence ratio (PR) = 2.63, 95% confidence interval (95%CI) = 2.17-2.63] or upper (PR = 2.98, 95%CI = 1.51-2.98) trajectory groups were prone to be overweight/obesity at their final observation. Conclusion: Heterogeneous BMI trajectories were observed in our study. Characteristics of both infants and their corresponding mothers could be potential determinants of infant growth. Moreover, infants in the middle and upper trajectory groups were more likely to suffer overweight/obesity.

NURR1 Alterations in Perinatal Stress: A First Step towards Late-Onset Diseases? A Narrative Review

Perinatal life represents a delicate phase of development where stimuli of all sorts, coming to or from the mother, can influence the programming of the future baby's health. These stimuli may have consequences that persist throughout adulthood. Nuclear receptor related 1 protein (NURR1), a transcription factor with a critical role in the development of the dopaminergic neurons in the midbrain, mediates the response to stressful environmental stimuli in the perinatal period. During pregnancy, low-grade inflammation triggered by maternal obesity, hyperinsulinemia or vaginal infections alters NURR1 expression in human gestational tissues. A similar scenario is triggered by exposure to neurotoxic compounds, which are associated with NURR1 epigenetic deregulation in the offspring, with potential intergenerational effects. Since these alterations have been associated with an increased risk of developing late-onset diseases in children, NURR1, alone, or in combination with other molecular markers, has been proposed as a new prognostic tool and a potential therapeutic target for several pathological conditions. This narrative review describes perinatal stress associated with NURR1 gene deregulation, which is proposed here as a mediator of late-onset consequences of early life events.

Rapid Weight Gain, Infant Feeding Practices, and Subsequent Body Mass Index Trajectories: The CALINA Study

We aimed to study growth patterns according to rapid weight gain (RWG) and infant feeding practices during the first 120 days and whether infant feeding practices mediated the association between RWG in the first semester of life and subsequent body mass index (BMI) z-score in children from age 1 to 6. (1) Methods: 862 children from the Growth and Feeding during Lactation and Early Childhood in Children of Aragon study (CALINA in Spanish) were examined. Repeated-measures ANOVA analyses were conducted to assess growth trajectories according to RWG and type of feeding practice. The product of coefficients mediation method was used to assess the potential contribution of infant feeding practices to the association between RWG and BMI z-score. Mediation models were conducted using IBM SPSS-PROCESS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. (2) Results: BMI and weight z-score trajectories were significantly higher in the RWG group and the formula-fed group. No significant differences were found regarding height. Infant feeding practices did not mediate the association between RWG and BMI z-score but were associated with BMI at 6 years. (3) Conclusions: Infant feeding practices and RWG determine different growth trajectories of BMI and weight during childhood. Although infant feeding practices did not mediate the association between early RWG and BMI later in life, formula feeding is independently related to higher BMI growth patterns later in childhood.

Hormone levels in preterm and donor human milk before and after Holder pasteurization

BACKGROUND

After birth, breastfeeding is the exclusive source of hormonal signaling between mother and infant. Hospitalized infants often receive donor milk when their own mother's milk is unavailable.

METHODS

The presence of insulin, leptin, cortisol, progesterone, and testosterone was examined in samples from milk bank donors and mothers of preterm infants. We further investigated the effect of Holder pasteurization (HoP) on hormone levels.

RESULTS

Comparing nonpasteurized samples, leptin levels were nearly threefold higher in milk from mothers of preterm infants versus donated milk, and regardless of milk source, leptin levels were significantly decreased by HoP. Insulin concentrations were also decreased by HoP, and among mothers of preterm infants, obesity was associated with significantly higher content of leptin and insulin. While combined use of donor milk and HoP was associated with cortisol levels nearly threefold higher than those in nonpasteurized own mother's milk, progesterone and testosterone content did not differ by source or pasteurization.

CONCLUSIONS

The hormonal composition of breast milk is impacted by HoP and maternal obesity. Compared to nonpasteurized maternal milk, use of pasteurized donor milk dramatically decreases the intake of leptin while increasing the intake of cortisol. Further research is necessary to define optimal breast milk processing practices.

Breastfeeding History, Preschool Children's Sleep, and Obesity

Breastfeeding and sleep are both considered medically and physiologically protective factors for child health. Most existing research studied their impact on child health outcomes, respectively. Few studies examined the two factors collectively to explore any potential associations among a history of breastfeeding and quantity of sleep in children and child health. This study sought to uncover the association among breastfeeding history, the amount of sleep, and obesity in preschool-aged children to provide additional insights into their protective physical and psychological effects on health outcomes. As part of a larger study examining obesity in preschool children, the current investigation explored the association among obesity, a history of breastfeeding, and the total number of hours of preschool children's sleep, as reported by parents. Actual heights and weights were collected on a total of 1,693 children 3-5 years of age enrolled in licensed child care facilities in Mississippi. Descriptive analyses of the demographic and parent survey variables were conducted to explore the status related to breastfeeding in Mississippi. To understand the relationships between breastfeeding and covariates, bivariate analyses such as chi-square independent tests, Cochran-Mantel-Haenszel chi-square tests, and Fisher's exact tests were performed. Obesity was negatively correlated to breastfeeding, and Caucasian mothers were significantly more likely to breastfeed than African American mothers. Obesity was also negatively correlated to the amount of sleep, and African American children reportedly slept significantly less than Caucasian children. The average amount of time of sleep reported for children with a history of being breastfed was significantly higher than for those who were not breastfed, suggesting that breastfeeding could have a significant positive association with preschool children's sleep, serving as an additional protective factor obesity. The interaction between breastfeeding and subsequent sleep as children mature is an important area for future research to fully explore their foundational impact in family health practices that combat obesity in children and promote other subsequent health outcomes.

Succession of Bifidobacterium longum Strains in Response to a Changing Early Life Nutritional Environment Reveals Dietary Substrate Adaptations

Diet-microbe interactions play a crucial role in modulation of the early life microbiota and infant health. Bifidobacterium dominates the breast-fed infant gut and may persist in individuals during transition from a milk-based to a more diversified diet. Here, we investigated adaptation of Bifidobacterium longum to the changing nutritional environment. Genomic characterization of 75 strains isolated from nine either exclusively breast- or formula-fed (pre-weaning) infants in their first 18 months revealed subspecies- and strain-specific intra-individual genomic diversity with respect to carbohydrate metabolism, which corresponded to different dietary stages. Complementary phenotypic studies indicated strain-specific differences in utilization of human milk oligosaccharides and plant carbohydrates, whereas proteomic profiling identified gene clusters involved in metabolism of selected carbohydrates. Our results indicate a strong link between infant diet and B. longum diversity and provide additional insights into possible competitive advantage mechanisms of this Bifidobacterium species and its persistence in a single host.

A cross-sectional study using the Childhood Measurement Programme for Wales to examine population-level risk factors associated with childhood obesity

OBJECTIVE

The aim of this cross-sectional study was to examine the association between childhood obesity and modifiable population-level risk factors, after accounting for deprivation.

DESIGN

A review of the literature identified population-level risk factors including a healthy childcare setting, the local food environment, accessible open space, community safety and crime. Data for these risk factors were then identified and matched by each of the twenty-two local government areas in Wales to each child that had data on height and weight in the Wales Childhood Measurement Programme (CMP) (2012-2017). Multivariable logistic regression was used to identify associations with childhood obesity.

SETTING

The current study was undertaken in Wales, UK, where approximately one in eight 4-5-year-olds are classified as obese.

PARTICIPANTS

All participants were children aged 4 or 5 years who attend school, measured as part of the CMP, between 2012 and 2017 (n 129 893, mean age 5·0 (sd 0·4) years).

RESULTS

After adjusting for deprivation, small but statistically significant associations were found between childhood obesity and percentage of land available as accessible open space OR 0·981 (95 % CI: 0·973, 0·989) P < 0·001) and density of fast food outlets OR 1·002 (95 % CI 1·001, 1·004, P = 0·001). No other population-level risk factors were associated with childhood obesity.

CONCLUSIONS

The current study indicates that, even after accounting for deprivation, risk factors such as the density of fast food outlets and access to green space should be considered when tackling childhood obesity as a public health issue.

The role of gut micorbiome in obesity and diabetes

BACKGROUND

Obesity and diabetes became a grooving problem in both adults and children. Many hypotheses concerned agents involved in the excessive weight gain process and it's consequences. Not only genetic or environmental factors, but also intestinal microbiome seems to play a role in the pathophysiology of this phenomenon.

DATA SOURCES

A systematic review was conducted using Pubmed as the medical database source. Studies concerning connection between microbiome and metabolic disorders such as obesity and diabetes from last 10 years were analyzed.

RESULTS

Intestinal bacteria may be involved both in the development of obesity, and its further complications. The pro-inflammatory and immunomodulating effect of dysbiosis are possible triggers of insulin resistance and diabetes. Early interventions aimed at the microbiome, as well as attempts to modify the microbiome at later stages may become new opportunities in the prevention and treatment of obesity and carbohydrate metabolism disorders.

CONCLUSIONS

The gut microbiome has been shown to be an important part of the metabolic processes. The use of probiotic, prebiotics and symbiotics is promising, but requires further investigations to determine the specific metabolic effects of each bacteria strain and substance.

Risk Factors for Unhealthy Weight Gain and Obesity among Children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by social and communication deficits and repetitive behaviors. Children with ASD are also at a higher risk for developing overweight or obesity than children with typical development (TD). Childhood obesity has been associated with adverse health outcomes, including insulin resistance, diabetes, heart disease, and certain cancers. Importantly some key factors that play a mediating role in these higher rates of obesity include lifestyle factors and biological influences, as well as secondary comorbidities and medications. This review summarizes current knowledge about behavioral and lifestyle factors that could contribute to unhealthy weight gain in children with ASD, as well as the current state of knowledge of emerging risk factors such as the possible influence of sleep problems, the gut microbiome, endocrine influences and maternal metabolic disorders. We also discuss some of the clinical implications of these risk factors and areas for future research.

Natural Selection, The Microbiome, and Public Health

The microbiome is composed of hundreds of interacting species that have co-evolved with the host and alterations in microbiome composition have been associated with health and disease. Insights from evolutionary ecology may aid efforts to ameliorate microbiome-associated diseases. One step toward this goal involves recognition that the idea of commensalism has been applied too broadly to human/microbe symbioses. Commensalism is most accurately viewed on a symbiosis continuum as a dividing line that separates a spectrum of mutualisms of decreasing positive interdependence from parasitisms of increasing severity. Insights into the evolution of the gut microbial symbiosis continuum will help distinguish between human actions that will advance or hinder health. Theory and research indicate that a major benefit of mutualistic microbes will be protection against pathogens. Mismatches between current and ancestral diets may disfavor mutualists, resulting in microbiome effects on health problems, including obesity, diabetes, autism, and childhood allergy. Evolutionary theory indicates that mutualisms will be favored when symbionts depend on resources that are not used by the host. These resources, which are referred to as human-inaccessible microbiota-accessible carbohydrates (HIMACs), can be supplied naturally through diet. Public health interventions need to consider the position of gut microbes on the mutualist-parasite continuum and the specific associations between prebiotics, such as HIMACs, and the mutualists they support. Otherwise interventions may fail to restore the match between human adaptations, diet, and microbiome function and may thereby fail to improve health and even inadvertently promote illness.