The relationship between breastfeeding and weight status in a national sample of Australian children and adolescents

Innovative continuum of care to promote exclusive breast feeding in Pakistan: protocol of a pilot randomised controlled trial

BACKGROUND

Breastmilk being the ideal nutrition from birth to 2 years and beyond has many health benefits for both newborn and mothers. This study will assess the feasibility and acceptability of a continuum of care programme, which is a health facility and community based till 6 months post partum to encourage ideal breastfeeding practices.

METHODS AND ANALYSIS

A pilot randomised control trial having two-parallel arms of intervention and control groups was conducted in gynaecology and obstetrics department of Aziz Bhatti Shaheed Teaching Hospital with a community outreach component of 6 months. 50 women between 28 and 32 weeks of gestation fulfilling inclusion criteria will be allocated in 1:1 randomly into intervention and control groups through computer-generated random number generator software. 25 participants in intervention group will receive counselling and training on breast feeding during antenatal visits along with a family member of support by a trained female doctor within the hospital, at birth by a trained nurse and at home for 6 months by a trained lady health worker. It will be supported by reading materials and videos through a mobile phone WhatsApp application. The 25 participants in control group will receive the support already provided within the hospital and at home. The primary outcomes feasibility and acceptability will be determined at 6 months post partum from participants and providers by a semistructured questionnaire. The secondary outcomes are rates of infant early initiation and exclusive breast feeding at 2 weeks, 1, 3 and 6 months, Infant Feeding Attitude at 1 month and Breastfeeding Self-Efficacy at 3 months. Quantitative and qualitative data will be analysed via SPSS software V.20 and thematic analysis, respectively.

CONCLUSION

This pilot randomised controlled trial (RCT) will guide the interventions for the definite RCT.

ETHICS AND DISSEMINATION

Approved by institutional ethical committee, informed consent from all participants and results will be disseminated in peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05951868.

An exploration into the influence of birthweight and breastfeeding status on the weight status of 3-year-olds in an Irish cohort

BACKGROUND

Childhood obesity is a growing concern in Ireland. Childhood obesity can increase the risk of developing many non-communicable diseases and have lasting psychological and social consequences.

AIM

The aim of this study is to explore if weight at birth and breastfeeding status influence the weight status of 3-year-olds in an Irish cohort.

METHOD

This retrospective cohort study utilised data (National Child Health Screening Programme) on 3-year-olds born between 1 January 2011 and 3 March 2014 in the North West of Ireland.

RESULTS

Overall, 4144 children were included in the study. The main findings of this study were that 5.4% (n = 222) and 7.1% (n = 296) of the cohort were overweight or obese respectively with a higher percent of males than females in each category. Just under 55% (n = 2266) of the cohort were never breastfed, with only 7.4% breastfed for greater than 6 months. Those born with a high birthweight were more likely to be overweight or obese at 3 years (p ≤ 0.001).

CONCLUSION

These findings provide regionally specific data and highlight the need for focussed public health efforts to reduce the prevalence of overweight and obesity in children aged 3 years in this area. Interventions from pregnancy through childhood are warranted, with an initial emphasis on breast feeding initiation and maintenance.

Breastfeeding at 6 months of age had a positive impact on overweight and obesity in Japanese adolescents at 15 years of age

AIM

A number of studies have indicated the potential benefits that breastfeeding has on reducing childhood obesity, but few studies have evaluated the effect on adolescent obesity. We examined the association between breastfeeding and overweight or obesity at 15 years of age using data from a large nationwide longitudinal study launched by the Japanese Government in 2001.

METHODS

We analysed data for 26 164 participants with known infant feeding practices at 6 months of age, namely the duration of breastfeeding or formula feeding. Overweight or obesity at 15 years of age were calculated based on the subject's self-reported height and weight. Multinomial logistic regression analysis adjusted the data for child factors, namely sex, siblings, birth weight and physical activity clubs and the maternal factors of age, educational attainment and smoking status.

RESULTS

Formula feeding was associated with an increased risk of overweight or obesity at 15 years of age. The adjusted odds ratios (95% confidence intervals) were 0.99 (0.89-1.09) for partial breastfeeding and 1.23 (1.02-1.48) for formula feeding, when exclusive breastfeeding was the reference category.

CONCLUSION

Breastfeeding during infancy had potential benefits for overweight or obesity among 15-year-old adolescents. Our results provide further evidence of the importance of breastfeeding.

Effect of migrant parents' bodyweight perception on children's body bodyweight: A longitudinal analysis of population cohort study

Children of migrants in Australia are disproportionally affected by overweight/obesity. Their parents, however, are likely to put little effort into lifestyle changes if unable to recognise their children's suboptimal bodyweight. We examined the potential impact of migrant parents' bodyweight perception on their children's bodyweight over time and whether the region-of-birth of parents and acculturation to the host nation's way of life moderated the relationship, as very little is known about these in the Australian context. We analysed a sample of 2046 children of migrant parents drawn from 8 waves of population-based cohort data, the Longitudinal Study of Australian Children, capturing their lived experience from ages 2 to 17. After controlling for child, parent, family, and neighbourhood factors influencing children's bodyweight, multilevel models showed higher children's bodyweight in subsequent waves if their parents perceived children's bodyweight as lower than their actual bodyweight (i.e., underestimation). However, the rate of increase in children's bodyweight attenuated over time. The effect of migrant parents' underestimation on children's subsequent bodyweight differed by region-of-birth, with higher children's bodyweight in successive waves if their parents were from the Americas, compared to migrant parents from North/West Europe. Parents' acculturation, however, did not have a discernible effect. Although migrant parents' bodyweight perception of their children's bodyweight status influenced children's bodyweight in subsequent waves, this factor was not enough to explain the extent of disparities in children's bodyweight observed in the Australian migrant population. Further research is needed to assess the effects of other types of perception (such as perceptions of healthy weight and physical exercise) on bodyweight disparities in children of migrants.

Analysis of the Influence of Pre-Pregnancy BMI and Weight Gain during Pregnancy on the Weight of Healthy Children during the First 2 Years of Life: A Prospective Study

Background: Increased pre-pregnancy maternal BMI (pBMI) and gestational weight gain (GWG) have been found to increase infants’ birthweight and result in the programming of child weight and impact its later weight gain. Aim: To assess the impact of pBMI and GWG on the weight of children from birth to 2 years of age and over the duration of breastfeeding. Methods: Single Centre observational prospective longitudinal cohort study. Data were collected from medical records, and medical history. The analysis of multiple linear and mixed models was involved. Findings: 20% of females were overweight, while 13% were obese before the pregnancy. An overall model, including gender and smoking, indicated a significant impact of pBMI category on a child’s birth mass (p = 0.01). The GWG category affected a child’s birth weight (p = 0.018, Effect size 0.41). pBMI did not affect the breastfeeding duration. Conclusion: pBMI and GWG correlate with birth weight and weight in neonatal period, however they become insignificant in later childhood. Weight assessment methods among children aged up to two years of age require standardization. Maternal weight before the pregnancy nor the weight gain during the pregnancy do not influence the length of breastfeeding. The biggest limitation was the small sample size and the failure to account for weight gain per trimester of pregnancy. Further research on a larger population should be continued.

Exploring the Potential of Human Milk and Formula Milk on Infants’ Gut and Health

Early-life gut microbiota plays a role in determining the health and risk of developing diseases in later life. Various perinatal factors have been shown to contribute to the development and establishment of infant gut microbiota. One of the important factors influencing the infant gut microbial colonization and composition is the mode of infant feeding. While infant formula milk has been designed to resemble human milk as much as possible, the gut microbiome of infants who receive formula milk differs from that of infants who are fed human milk. A diverse microbial population in human milk and the microbes seed the infant gut microbiome. Human milk contains nutritional components that promote infant growth and bioactive components, such as human milk oligosaccharides, lactoferrin, and immunoglobulins, which contribute to immunological development. In an attempt to encourage the formation of a healthy gut microbiome comparable to that of a breastfed infant, manufacturers often supplement infant formula with prebiotics or probiotics, which are known to have a bifidogenic effect and can modulate the immune system. This review aims to elucidate the roles of human milk and formula milk on infants’ gut and health.

Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App

Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.

Relationship between breastfeeding and obesity in high school girls

Objectives Some factors in infancy can play a role in the development of adolescent obesity. Understanding these factors can help prevent early complications in adolescents associated with obesity in adulthood. The aim of this study was to determine the prevalence of overweight and obesity among high school girls in Khorramabad and its relationship with breastfeeding history. Methods This was a cross-sectional study. This study was conducted in 832 high school girls during the academic year 2016-2017. Samples were selected by multi-stage random sampling. General questionnaires, physical activity, and 24-h food questions were completed through interviews with students. Data regarding breastfeeding was obtained by mothers. Results The prevalence of overweight and obesity in the study population was 16.3 and 5.8%, respectively. Overweight and obesity had a significant association with breastfeeding history (p = 0.001), while there was no significant relationship between overweight and obesity with school type, student's age, parental occupation, education Parents, household size, birth rate, physical activity, and energy intake. Conclusions The results of this study showed that breast feeding has a protective effect on overweight and obesity during adolescence. To reduce the incidence of overweight and obesity, necessary education regarding breastfeeding should be provided.

Clinical relevance and validity of tools to predict infant, childhood and adulthood obesity: a systematic review

OBJECTIVE

To determine the global availability of a multicomponent tool predicting overweight/obesity in infancy, childhood, adolescence or adulthood; and to compare their predictive validity and clinical relevance.Design/SettingThe PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The databases PubMed, EMBASE, CINAHL, Web of Science and PsycINFO were searched. Additional articles were identified via reference lists of included articles. Risk of bias was assessed using the Academy of Nutrition and Dietetics' Quality Criteria Checklist. The National Health and Medical Research Council's Levels of Evidence hierarchy was used to assess quality of evidence. Predictive performance was evaluated using the ABCD framework.

SUBJECTS

Eligible studies: tool could be administered at any life stage; quantified the risk of overweight/obesity onset; used more than one predictor variable; and reported appropriate prediction statistical outcomes.

RESULTS

Of the initial 4490 articles identified, twelve articles (describing twelve tools) were included. Most tools aimed to predict overweight and/or obesity within childhood (age 2-12 years). Predictive accuracy of tools was consistently adequate; however, the predictive validity of most tools was questioned secondary to poor methodology and statistical reporting. Globally, five tools were developed for dissemination into clinical practice, but no tools were tested within a clinical setting.

CONCLUSIONS

To our knowledge, a clinically relevant and highly predictive overweight/obesity prediction tool is yet to be developed. Clinicians can, however, act now to identify the strongest predictors of future overweight/obesity. Further research is necessary to optimise the predictive strength and clinical applicability of such a tool.

Duration of Breastfeeding, but Not Timing of Solid Food, Reduces the Risk of Overweight and Obesity in Children Aged 24 to 36 Months: Findings from an Australian Cohort Study

This study aimed to determine whether breastfeeding duration and the timing of solid food were independently associated with being overweight or obese in early childhood. Subjects were 953 children participating in the Study of Mothers and Infants Life Events Affecting Oral Health (SMILE) birth cohort study, based in Adelaide, Australia. Socio-demographic information and data on breastfeeding duration and age of introduction of solid food were collected at birth, 3, 4, 6, 12, and 24 months via mailed or online questionnaires completed by mothers. The weight and height of children were measured at a dental examination when children were aged between 24 and 36 months. Body mass index was calculated, and children were categorised into weight groups according to the World Health Organization growth standards. Multivariable logistic regression analysis was conducted, adjusting for maternal age at birth, education, socio-economic status, pre-pregnancy weight, smoking in pregnancy, method of delivery, and child’s birthweight. Risk of overweight/obesity was independently associated with maternal pre-pregnancy BMI, smoking in pregnancy, and birthweight. Children that were breastfed for 12 months or more had a significantly lower risk of being overweight/obese than those breastfed for less than 17 weeks (AOR 0.49; 95%CI 0.27, 0.90; p for trend =0.009). Age of introduction of solid food, however, was not associated with the risk of being overweight/obese at 24 to 36 months. This study provides further evidence of an inverse relationship between breastfeeding and risk of overweight/obesity, however, no association with the timing of solid food was detected.

Infant nutrition and maternal obesity influence the risk of non-alcoholic fatty liver disease in adolescents

BACKGROUND & AIMS

The pathway to non-alcoholic fatty liver disease (NAFLD) in adolescents may have its origins in adiposity gains, nutrition and sedentary lifestyle established during childhood. There is inadequate knowledge regarding the associations between infant nutrition and subsequent NAFLD. We examined the association of maternal factors and infant nutrition, with the subsequent diagnosis of NAFLD in adolescents.

METHODS

Adolescents aged 17years in the Western Australian Pregnancy (Raine) Cohort study had fatty liver assessment using liver ultrasound. Prospectively recorded data on maternal pregnancy and infant feeding were examined against a NAFLD outcome during late adolescence.

RESULTS

NAFLD was diagnosed in 15.2% of the 1,170 adolescents examined. Ninety-four percent had been breastfed as infants. The duration of breastfeeding before starting supplementary milk was ⩾4months in 54.4% and ⩾6months in 40.6%. Breastfeeding without supplementary milk ⩾6months (adjusted odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.43-0.94, p=0.02), maternal pre-pregnancy obesity (adjusted OR: 2.29; 95% CI: 1.21-4.32, p=0.01) and adolescent obesity (adjusted OR: 9.08; 95% CI: 6.26-13.17, p<0.001) were associated with NAFLD independent of a Western dietary pattern at 17years of age. Adolescents with NAFLD who had been breastfed for ⩾6months had a less adverse metabolic profile compared with adolescents breastfed for <6months. Supplementary milk intake starting before 6months was associated with a higher prevalence and ultrasound severity of NAFLD compared with intake starting after 6months (17.7% vs. 11.2%, p=0.003 and 7.8% vs. 3.4%, p=0.005 respectively).

CONCLUSION

Though NAFLD is generally mediated through adiposity gains, breastfeeding for at least 6months, avoidance of early supplementary formula milk feeding, and normal maternal pre-pregnancy BMI may reduce the odds of a NAFLD diagnosis during adolescence.

LAY SUMMARY

Non-alcoholic fatty liver disease (NAFLD) is a common liver disorder in which there is too much fat in the liver of people who do not consume excessive amounts of alcohol. In this large study, we found that infants who consumed breast milk for less than 6months before starting infant formula milk, infants who were obese as teenagers or had mothers who were obese at the start of pregnancy, were much more likely to have NAFLD at 17years of age. Based on our findings we consider that reducing the risk of NAFLD in teenagers needs to start before birth, by encouraging normal body mass index before pregnancy, as well as breastfeeding without infant formula milk consumption for the first 6months of life.

Family members' infant feeding preferences, maternal breastfeeding exposures and exclusive breastfeeding intentions

BACKGROUND

Maternal breastfeeding intentions are strongly associated with breastfeeding exclusivity and duration. Factors that affect new mothers' exclusive breastfeeding intentions have not been adequately examined.

OBJECTIVE

The purpose of this study was to examine the association between family member's infant feeding preferences, breastfeeding exposures, and womens' exclusive breastfeeding intentions.

METHODS

1277 breastfeeding mother-infant pairs were recruited from four public hospitals in Hong Kong. We used multiple logistic and linear regression models to explore the impact of the family members' infant feeding preferences and breastfeeding exposures on exclusive breastfeeding intentions.

RESULTS

78.1% mothers reported an intention to exclusively breastfeed, and the median intended duration of exclusive breastfeeding was 26 weeks. The husband's preference for breastfeeding (aOR = 1.67; 95% CI 1.20-2.31), previous breastfeeding experience (aOR = 1.56; 95% CI 1.10-2.23) and attendance at an antenatal breastfeeding class (aOR = 2.09; 95% CI 1.45-3.02) were all strongly associated with higher maternal intention to exclusively breastfeed. For every additional family member who preferred breastfeeding, the odds of intending to exclusively breastfeed increased by 32% (aOR1.32; 95% CI, 1.13-1.55). Similarly, the proportion of participants intending to exclusively breastfeed increased progressively with more breastfeeding exposures.

CONCLUSIONS

Including fathers and other significant family members in antenatal breastfeeding education can help to maximize breastfeeding support for the new mother and encourage new mothers to exclusively breastfeed.

Relationship Between Exclusive Breastfeeding and Lower Risk of Childhood Obesity: A Narrative Review of Published Evidence

BACKGROUND

The pattern of infant feeding during the first 1000-day period-from conception to the second birthday-has a significant influence on the child's growth trajectory. The relationship between exclusive breastfeeding and lower risk of childhood obesity has elicited much scientific interest, given the fact that this form of malnutrition is becoming a global epidemic.

AIM

This narrative review aims to examine the evidence in the literature linking exclusive breastfeeding with reduction in obesity in children.

LITERATURE SEARCH

Using appropriate search terms, PubMed database was searched for relevant articles that met the review objective.

RESULTS

Evidence for the protective effect of exclusive breastfeeding against childhood obesity have been provided by studies which explored 5 physiologic mechanisms and those that established the causality between breastfeeding and lower risk of obesity. The few studies that disputed this relationship highlighted the influence of confounding factors. A new insight on molecular mechanisms, however, points to a direct and indirect effect of human milk oligosaccharides on the prevention of overweight and obesity.

CONCLUSIONS

The preponderance of current evidence strongly suggests that exclusivity in breastfeeding can prevent the development of obesity in children.

Same-sex twins are taller and heavier than opposite-sex twins (but only if breastfed): Possible evidence for sex bias in human breast milk

Recent studies show that human and other mammalian breast milk may be tailored for the sex of the offspring. Such sex bias suggests that opposite-sex twins, who receive breast milk that cannot simultaneously be tailored for both sexes, may be at a disadvantage for growth compared with same-sex twins. An analysis of data from the National Longitudinal Study of Adolescent Health (Add Health) shows that, controlling for sex, age, birth weight, and zygosity, breastfed same-sex twins are, on average, about 1 inch taller and 12 pounds heavier than their opposite-sex counterparts through adolescence and early adulthood. In contrast, never-breastfed same-sex twins tend to be shorter and lighter than their opposite-sex counterparts. These results may be potential evidence for sex bias in human breast milk and its long-term effects.

Independent effect of type of breastfeeding on overweight and obesity in children aged 12-24 months

This study aimed to analyze the effect of type of breastfeeding on the nutritional status of children between 12-24 months of age. This cohort study included 435 children born in 2012 in a public hospital in Joinville, Santa Catarina State, Brazil. Two years after delivery the mothers and their children were contacted in their homes for a new investigation of demographic, economic, nutritional, and anthropometric data. In the unadjusted analysis, children who were not exclusively breastfed were more likely to be overweight (including obesity) at 2 years of age (OR = 1.6; p = 0.049) than exclusively breastfed children. After adjusting for several covariates, children who were not exclusively breastfed had a 12% higher risk of overweight including obesity compared to unadjusted analysis (OR = 2.6 vs. OR = 1.8; p = 0.043). In addition, birthweight was also an independent determinant of overweight including obesity (OR = 2.5; p = 0.002). The practice of exclusive breastfeeding can reduce the risk of overweight in children from developing countries such as Brazil.

Effectiveness of a theory-based breastfeeding promotion intervention on exclusive breastfeeding in China: A randomised controlled trial

OBJECTIVE

To investigate the effectiveness of a designed intervention programme on the promotion of exclusive breast feeding during 6 months post partum among Chinese primiparous women, based on the theory of planned behaviour.

DESIGN

Randomised controlled trial.

SETTING

A tertiary hospital in Shanghai, China.

PARTICIPANTS

Chinese primiparous women who were able to breastfed their babies and companied by either husband or mothers.

INTERVENTION

Participants were randomly divided into the intervention and control group. On the basis of the theory of planned behaviour, mothers in the intervention group received the TPB-based intervention programme, including individual instruction, group education and telephone counselling, whereas both the intervention and control group continued to receive routine nursing care.

MEASUREMENTS AND FINDINGS

Data were collected between October 2013 and June 2014. Initially, 352 participants were included. However, 67 of them dropped out or were lost to follow-up. Finally, 285 participants were included into the analysis, including 157 participants in the intervention group and 128 participants in the control group. Though some bias might exist, rates of exclusive breast feeding were consistently and significantly higher in the intervention group than the control group at 3 days (40.1% versus 10.9%, P<0.001), 6 weeks (57.3% versus 29.7%, P<0.001), 4 months (56.7% versus 15.6%, P<0.001) and 6 months post partum (42.0% versus 10.2%, P<0.001).

CONCLUSION AND IMPLICATIONS

The TPB-based breast-feeding promotion intervention is effective in improving exclusive breast-feeding rates in primiparous women. Although the current intervention that provides continued support during the hospitalisation and follow-up at home, problems remains in the workplaces.

Prevalência de sobrepeso e obesidade entre crianças de 7 a 10 anos atendidas em uma unidade de Estratégia Saúde da Família - ESF

Objetivos: Estabelecer a prevalência de sobrepeso e obesidade entre crianças cadastradas em unidade de Estratégia Saúde da Família. Métodos: Estudo descritivo, quantitativo, de corte transversal, com população alvo de 134 crianças de 7 a 10 anos de idade. Foi calculado o índice de massa corporal das crianças e aplicado questionário sobre práticas alimentares e atividade física. No tratamento estatístico dos dados foi usado o SPSS versão 19, utilizando-se os procedimentos: média, desvio padrão, frequência, teste t  e Qui Quadrado. Usou-se Odds ratio de prevalência  com intervalo de confiança de 95%. A importância relativa dos fatores estudados no risco da criança apresentar sobrepeso ou obesidade foi observada pelo ajuste do modelo regressão logística. Resultados: Foram avaliadas 86 crianças de ambos os sexos. A taxa de sobrepeso foi de 17,5% e de obesidade de 25% entre meninas e 4,3% de sobrepeso e 13% de obesidade entre meninos (p=0,061). Crianças matriculadas na rede particular tiveram 18,8% de sobrepeso e 37,5% de obesidade enquanto nas da rede pública as taxas foram de 8,6% e 14,3%, para sobrepeso e obesidade, respectivamente (p=0,058). As demais variáveis não foram estatisticamente significativas após a aplicação do modelo de regressão logística. Conclusão: Houve alta prevalência de sobrepeso e obesidade na população estudada, principalmente entre crianças matriculadas na rede particular e do sexo feminino.

ADHD symptoms, breast-feeding and obesity in children and adolescents

BACKGROUND

Attention-deficit-hyperactivity disorder (ADHD) has been found to be related to overweight/obesity in children and adolescents, but it is a heterogeneous disorder, and the relationships between the dimensions of ADHD and overweight/obesity are not clear. The aim of this study was to explore which dimensions of the disorder are specifically associated with overweight/obesity.

METHODS

The study sample consisted of 300 treatment-naive children with ADHD and 75 healthy controls aged 7-17 years. The ADHD module of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version was used to diagnose ADHD. The severity of ADHD symptoms was assessed via Conners' Parent Rating Scale (CPRS). The weight, height, and breast-feeding duration of the study samples and controls were recorded. Body mass index (BMI) was categorized according to the national age/sex-specific reference values.

RESULTS

The rate of overweight/obese children was higher in the ADHD group. The association between ADHD symptoms and BMI percentile scores was evaluated using structural equation modeling. In that model, it was observed that the Cognitive Problems/Inattentive and Oppositional subscores of the CPRS had a positive predictive effect on the BMI percentile scores, but breast-feeding duration had a negative predictive effect on the BMI percentile scores.

CONCLUSION

Inattention, oppositionality and breast-feeding duration were associated with overweight/obesity in children and adolescents with ADHD. Longitudinal studies are needed to more fully understand this relationship and the mechanisms underlying the association between ADHD and overweight/obesity.

Childhood obesity: Current and novel approaches

The prevalence of childhood obesity has increased over the last fifty years by approximately 5% per decade, and approximately a quarter of all children are now either overweight or obese. These children have a significantly increased risk of many future health problems including adult obesity, type 2 diabetes and heart disease. Despite this relentless increase, common-sense approaches aimed at prevention and treatment have failed to solve the problem. Current approaches at prevention have faced major challenges with some progress in implementing smaller scale programs and social marketing, but little action on broad public policy approaches which often appears unpalatable to society or individual governments. Meanwhile, treatment approaches have mainly focused on lifestyle change, and novel approaches are urgently needed. Prevention needs to shift to improving maternal health prior to conception, with more research focussed on the impact of early years in programming offspring to future overweight/obesity. Likewise, treatment paradigms need to move from simply thinking that obesity can be solved by readdressing diet and activity levels. Novel approaches are needed which take into consideration the complex physiology which regulates early childhood growth and the development of obesity in susceptible individuals.

Predictors of slow colonic transit in children

PURPOSE

Slow transit constipation (STC) and functional fecal retention (FFR) are two forms of severe intractable constipation in childhood diagnosed by nuclear transit studies (NTS). This retrospective study aims to identify the predicting factors for STC and FFR by looking at the association with neuropsychiatric disorders (NPD), obesity, family history of constipation and atopic disease.

PATIENTS AND METHODS

A retrospective chart review was conducted on children with intractable constipation referred for NTS between 1st April 2003 and 1st April 2014. Comparisons were made between STC, FFR and normal transit patients with regards to NPD, obesity (BMI z score >95th percentile), family history of constipation in first and second-degree relatives and atopic disease which included food allergy, asthma and eczema.

RESULTS

Between 2003 and 2014, 97 patients were referred for a NTS. Out of 36 patients with NPD, 21 (58.3 %) had STC and 13 (36.1 %) had FFR (p < 0.05). 15.8 % of patients with constipation were obese, compared to 6.4 % in the general Australian paediatric population (p < 0.05). There was no significant association between constipation and atopic disease or family history.

CONCLUSION

Neuropsychiatric disorders, in particular autism, are useful predictors of STC and FFR in children. Obesity may be associated with a higher risk of developing chronic constipation.

The association between breastfeeding and childhood obesity: a meta-analysis

Background

The increase in childhood obesity is a serious public health concern. Several studies have indicated that breastfed children have a lower risk of childhood obesity than those who were not breastfed, while other studies have provided conflicting evidence. The objective of this meta-analysis was to investigate the association between breastfeeding and the risk of childhood obesity.

Methods

The PubMed, EMBASE and CINAHL Plus with Full Text databases were systematically searched from start date to 1^st August 2014. Based on the meta-analysis, pooled adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. I² statistic was used to evaluate the between-study heterogeneity. Funnel plots and Fail-safe N were used to assess publication bias and reliability of results, and results from both Egger test and Begg test were reported.

Results

Twenty-five studies with a total of 226,508 participants were included in this meta-analysis. The studies’ publication dates ranged from 1997 to 2014, and they examined the population of 12 countries. Results showed that breastfeeding was associated with a significantly reduced risk of obesity in children (AOR = 0.78; 95% CI: 0.74, 0.81). Categorical analysis of 17 studies revealed a dose-response effect between breastfeeding duration and reduced risk of childhood obesity.

Conclusion

Results of our meta-analysis suggest that breastfeeding is a significant protective factor against obesity in children.

Nutrition for healthy term infants, six to 24 months: An overview

Nutrition for Healthy Term Infants is a joint statement by Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada. It was republished in September 2012, with recommendations on infant feeding from birth to six months of age. The statement was most recently updated in April 2014, with recommendations for feeding older infants and young children from six to 24 months of age. The present practice point outlines the statement development process and principles of feeding, with specific recommendations for clinicians. Health professionals who counsel families on nutrition in infants and young children are advised to read the statement in its entirety because discussion in the longer document expands on and clarifies advice summarized in the principles and recommendations given here. The complete statement is available on Health Canada's website: www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php.

Factors associated with obesity and overweight in school-aged children

To assess the factors associated with excess weight (overweight/obese) in school children enrolled in the public education network in Divinópolis, Minas Gerais, Brazil. Cross-sectional study with 1187 children between 6 and 14 years of age from municipal schools in Divinópolis, Minas Gerais. The prevalence of obesity and overweight was calculated based on the parameters of the World Health Organization, using the WHO Anthro-Plus Program. Logistic regression was used to identify the variables associated with excess weight, at a significance level of 5%. A prevalence of 24.4% of excess weight was identified. Family income and maternal education were determinants of overweight in the study population (p<0.05). Excess weight was configured as an important health problem among the students. The public power needs to implement intersectoral measures with a view to the prevention and reduction of the prevalence of overweight and obesity among school-aged children.

Learning to eat vegetables in early life: the role of timing, age and individual eating traits

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4–38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were “learners” (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled “plate-clearers”. 16% were considered “non-eaters” eating less than 10 g by the 5^th exposure and the remainder were classified as “others” (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children.

Body composition changes in the first 6 months of life according to method of feeding

BACKGROUND

Early feeding choices may affect long-term health outcomes. Therefore, understanding body composition changes in healthy breastfed infants has become an important research focus.

OBJECTIVES

The aims of this review were to investigate the body composition changes that occur during weight loss in breastfed term newborns and to examine body composition differences between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 6 months of life.

METHODS

We performed a review of the existing literature using PubMed. We searched for studies published in English since January 1, 2000, that involved human infants ranging in age from birth to 6 months. We used the following MEDLINE Medical Subject Headings: ((breastfeeding) OR (infant formula)) AND ((body composition) OR (bioelectrical impedance) OR (absorptiometry, photon) OR (total body potassium) OR (isotope dilution) OR (air-displacement plethysmography)). Our search yielded 6 studies.

RESULTS

Two studies reported that newborn weight loss was due to a reduction in the quantity of both fat mass and fat-free mass. Three out of 4 articles that evaluated body composition changes according to method of feeding reported no differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 4.5 months of life. One study reported that exclusively breastfed infants at 3 months of age and exclusively breastfed boys at 6 months of age had higher fat mass contents compared to exclusively formula-fed infants.

CONCLUSION

Because of the limited number of studies available, larger studies are needed to clarify the differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants.

Racial and ethnic differences associated with feeding- and activity-related behaviors in infants

OBJECTIVE

To examine parental reports of feeding and activity behaviors in a cohort of parents of 2-month-olds and how they differ by race/ethnicity.

METHODS

Parents participating in Greenlight, a cluster, randomized trial of obesity prevention at 4 health centers, were queried at enrollment about feeding and activity behaviors thought to increase obesity risk. Unadjusted associations between race/ethnicity and the outcomes of interest were performed by using Pearson χ(2) and Kruskal-Wallis tests. Adjusted analyses were performed by using proportional odds logistic regressions.

RESULTS

Eight hundred sixty-three parents (50% Hispanic, 27% black, 18% white; 86% Medicaid) were enrolled. Exclusive formula feeding was more than twice as common (45%) as exclusive breastfeeding (19%); 12% had already introduced solid food; 43% put infants to bed with bottles; 23% propped bottles; 20% always fed when the infant cried; 38% always tried to get children to finish milk; 90% were exposed to television (mean, 346 minutes/day); 50% reported active television watching (mean, 25 minutes/day); and 66% did not meet "tummy time" recommendations. Compared with white parents, black parents were more likely to put children to bed with a bottle (adjusted odds ratio [aOR] = 1.97, P < .004; bottle propping, aOR = 3.1, P < .001), and report more television watching (aOR = 1.6, P = .034). Hispanic parents were more likely than white parents to encourage children to finish feeding (aOR = 1.9, P = .007), bottle propping (aOR = 2.5, P = .009), and report less tummy time (aOR = 0.6, P = .037).

CONCLUSIONS

Behaviors thought to relate to later obesity were highly prevalent in this large, diverse sample and varied by race/ethnicity, suggesting the importance of early and culturally-adapted interventions.

Relationship between Breast Feeding and Obesity in Children with Low Birth Weight

Background

Breast feeding appears to play a role in determining obesity and abdominal obesity during childhood, specifically in children with a history of low birth weight.

Objective

The purpose of this study is to investigate the relation of breast-feeding with either of abdominal obesity and obesity among Iranian school children.

Materials and Methods

A total of 1184 students (625 girls and 559 boys), aged 10 to 13 years old, were selected from 112 governmental elementary schools in Iran. Height, weight, waist circumference and blood pressure were measured using standard instruments and a pretested standardized questionnaire was performed for compiling information about family economics and educational level, first–degree family history of obesity, history of breast feeding, food pattern and birth weight, as well.

Results

13.68% (n = 160) of students had a history of low birth weight, and 26.41% of them had abdominal obesity. Of all participants, 22.04% were overweight and 5.32% were obese which was more prevalent in girls than in boys (P = 0.03). First-degree family history of obesity (P = 0.001), excessive gestational weight gain (P = 0.001) and birth weight (P = 0.01) were significantly correlated with the prevalence of obesity and abdominal obesity during childhood. Moreover the prevalence of abdominal obesity in children with low birth weight was significantly correlated with breast feeding (P = 0.04); But this relation was not significantly about obesity in our participants (P = 0.9). Furthermore duration of breast feeding was significantly and inversely correlated with obesity and abdominal obesity in schoolchildren with low birth weight (P = 0.01).

Conclusions

The results suggest that Breast feeding and its long-term consequences were important factors for preventing metabolic syndrome criteria in childhood and later years of life span. With regard to the increasing prevalence of obesity in children, more research is urgently needed to clarify whether breast feeding have negative consequences for the risk of chronic disease in children, especially in children with low birth weight.