Infant feeding in Sweden: socio-demographic determinants and associations with adiposity in childhood and adolescence

Socio-demographic determinants of body mass index among school children in Ebonyi State, Nigeria

BACKGROUND

African specific studies on the factors associated with the growth pattern of children are needed to guide evidence and develop effective population-based interventions that can be tailored to the unique African context.

PURPOSE

The purpose of this study was to determine the socio-economic correlates of body mass index (BMI) of primary and secondary school children in Ebonyi State, which is situated in south-eastern Nigeria.

METHODOLOGY

This was a quantitative, cross-sectional study that utilised clustering and stratified sampling techniques to select 1000 learners from primary and secondary schools located in Abakaliki local government area. Apart from a questionnaire, a Mettler weighing scale was also used for data collection. A generalised linear model was used to test the association between the participants' socio-demographic characteristics and their BMI.

RESULT

BMI was positively related to female gender but negatively related to age and level of education. The mode of cooking, who the participants live with and how they get to school also predicted changes in BMI. Other variables like mother's occupation and family's mode of transport were also associated with BMI changes while father's level of education, mother's level of education, father's occupation and the type of residence did not have any statistical relationship with BMI.

CONCLUSION

The present study shows that the BMI of school children is influenced by the socio-demographic characteristics surrounding them. Therefore, efforts should be made to improve the socio-economic standing of families in this community.

Reported habitual intake of breakfast and selected foods in relation to overweight status among seven- to nine-year-old Swedish children

Aim: The aim of this study was to examine the reported frequency of breakfast intake and selected food and beverages in the investigated group of Swedish children in comparison with recommended intakes. Furthermore, the study analyses these food habits and some demographic and lifestyle factors in relation to overweight and obesity. Methods: This cross-sectional study builds on data collected in 2008 and 2010. Measured anthropometric data and parent questionnaire data were collected. A total of 2620 Swedish children (52.1% boys) aged seven to nine years were included. Results: The majority of parents reported that their children (95.4%) had breakfast every day. The majority of children had fresh fruit (84.7%) and vegetables (83.9%) most days a week. Only 1.6% of the children were reported to have fast food and 6.0% to have sugar containing soft drinks, four days a week or more. The prevalence of overweight including obesity (OW/OB) was 17.8% for boys, 18.6% for girls. The odds of being OW/OB was higher among those not having breakfast every day (odds ratio (OR) 1.9, 95% confidence interval (CI) 1.20–2.96), drinking diet soft drink (OR 2.6, 95% CI 1.52–4.42) and skimmed/semi-skimmed milk (OR 1.8, 95% CI 1.37–2.36) four days a week or more. Parents being overweight and having low education levels were also related to a higher risk of their children being overweight. Conclusions: The parental reports of children’s food habits pointed at favourable eating patterns for most investigated children. Breakfast skipping, diet soft drinks and low-fat milk consumption were more frequent among OW/OB children. Longitudinal studies are needed to determine the causal relationships.

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review

CONTEXT

Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.

EVIDENCE ACQUISITION

PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.

EVIDENCE SYNTHESIS

Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.

CONCLUSIONS

Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

Toward Early Identification of Sensory Over-Responsivity (SOR): A Construct for Predicting Difficulties With Sleep and Feeding in Infants

Sensory over-responsivity (SOR) is a type of sensory modulation disorder in which heightened sensitivity to non-noxious sensations interrupts daily life. In this preliminary study within a larger investigation, we used infants with sleep/feeding difficulties as a proxy for later development of SOR. We tested evidence for construct validity and internal reliability of preand perinatal factors that, together, could predict infant sleep/feeding difficulties. We obtained retrospective data on 360 mother-infant dyads on 38 pre- and perinatal variables and linked the data with infant referral for sleep/feeding difficulties. We analyzed the data with Rasch analysis to examine evidence for a unidimensional construct. Our results show good evidence for a construct comprising 18 of the 38 pre- and perinatal variables examined. This construct may represent a step toward early identification of SOR and provide therapists with evidence to support the use of pre- and perinatal information as predictors of infant sleep/feeding difficulties.

Can we identify women who initiate and then prematurely cease breastfeeding? An Australian multicentre cohort study

BACKGROUND

Health authorities recommend 6 months of fully breastfeeding and continuation of breastfeeding for at least a year. Many women initiate breastfeeding in hospital but discontinue before the six-month period, and therefore do not optimise the public health benefits. The aim of this study was to determine whether these women could be identified at hospital discharge, to enable targeted interventions.

METHODS

A secondary analysis of women who intended to breastfeed and were enrolled in a large randomised trial was undertaken. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analyses were undertaken to determine the variables associated with early cessation of breastfeeding within six months, compared to women who continued to breastfeed.

RESULTS

Of 2148 women who initiated breastfeeding in hospital, 877 continued to breastfed either partially (N = 262) or fully (N = 615) until six months postpartum and 1271 ceased breastfeeding early. Median breastfeeding duration in women who ceased early was 3(+6) weeks (IQR 1(+1) to 11(+2) weeks). In multivariate analysis, factors that were significantly associated with early cessation of breastfeeding were maternal factors of lower education (less than 12 years of schooling, no completion of further education), smoking (pre-pregnancy or during pregnancy), and newborn factors of preterm birth and low birthweight (all p < 0.01). These variables correctly identify 83% of women.

CONCLUSION

We can identify women who initiate and then prematurely discontinue breastfeeding prior to hospital discharge. Evaluation of additional interventions to support longer duration of breastfeeding in women at risk of ceasing prematurely is needed.

A two-decade perspective on mothers' experiences and feelings related to breastfeeding initiation in Sweden

OBJECTIVE

The purpose was to examine mothers' experiences and feelings related to breastfeeding initiation from a two-decade perspective.

METHODS

A repeated cross-sectional survey was conducted at a maternity ward before and after introduction of Baby Friendly Hospital Initiative (BFHI) and in a follow-up survey. Women participated in 1992 (n = 83), 1993 (n = 74) and 2011 (n = 94).

RESULTS

The duration of time at the first suckling differed; in 2011, the baby sucked 24.4 minutes compared to 12.7 minutes in 1992 (p < .001) and 13.6 minutes in 1993 (p < .001). In 1992, 34.6% of the women reported using supplementary formula compared with 5.9% in 1993 and 9.3% in 2011 (p < .001). The mothers' contacts with the child or the father as well as their moods did not vary during the years. Mothers rated their feelings towards breastfeeding as being lower in 2011 than in 1992 and 1993 (p = .008). In 2011, mothers experienced breastfeeding as being more difficult and reported a higher degree of tension, insecurity and anxiety.

CONCLUSIONS

Supplementation was given to healthy newborn infants, which does not conform to BFHIs intentions. Routines and support in relation to breastfeeding initiation need to be continuously evaluated in order to strengthen and sustain the BFHI.

Breastfeeding shows a protective trend toward adolescents with higher abdominal adiposity

OBJECTIVE

The question of whether breastfeeding has a protective effect against the development of overweight or obesity later in life remains controversial, especially during adolescence. The objective was to assess the relationship between breastfeeding and adolescents' body composition.

METHODS

The HELENA study is a cross-sectional study involving 3,528 adolescents from 10 European cities. The outcome measures were body weight and height, subscapular skinfolds as well as waist circumferences. Breastfeeding, smoking status, and parental socioeconomic status were assessed by self-administered questionnaires. Dietary intake was recorded using two 24-hour recall surveys. Two adjustment approaches were used: i) covariance analysis adjusted for confounding factors (propensity score adjustment) and ii) multivariate quantile regression.

RESULTS

After adjustment, no significant associations were observed between breastfeeding and body composition parameters (BMI Z-score; sum of skinfolds; waist-to-height ratio). An adjusted quantile regression analysis showed a non-significant trend for a protective effect of breastfeeding toward the highest percentiles of adiposity in boys but not in girls. This is of particular interest with respect to the superiority of the waist-to-height ratio over waist circumference and BMI for detecting cardiometabolic risk factors.

CONCLUSION

This first European study, including a large set of factors influencing adolescents' body composition, showed a non-significant trend toward a protective effect of breastfeeding on highest percentiles of adolescent's abdominal adiposity.

Breast-fed infants and their later cardiovascular health: a prospective study from birth to age 32 years

The aim of the present study was to evaluate the impact of infant breast-feeding on cardiovascular risk in young adults. This unique study group involved 158 subjects (eighty-two females) originally collected prospectively at birth in 1975 and followed up to the age of 32 years. Frequent visits during the first year guaranteed the knowledge of the precise duration of breast-feeding. All infants received at least some breast milk. Participants were assessed for both individual cardiovascular risk factors (blood pressure, plasma lipids, homeostatic model assessment of insulin resistance and waist circumference) and the general clinical risk of cardiovascular events by calculating the Framingham risk score (FRS) and the metabolic syndrome criteria score (NCEP-ATPIII; National Cholesterol Education Program's Adult Treatment Panel III). Data on lifestyle factors were carefully collected. Linear regression analyses revealed that the effect of the duration of breast-feeding was not relevant (0·02 decrease in the FRS per one additional breast-feeding month; 95 % CI - 0·19, 0·09). Similarly, the effect of breast-feeding was minor on all of the individual cardiovascular risk factors. We used sex, physical activity, dietary fat and vitamin C, smoking and alcohol consumption as covariates. Again, logistic regression analyses detected no significant impact of the duration of breast-feeding on the risk of the metabolic syndrome according to the NCEP-ATPIII (OR 0·95, 95 % CI 0·8, 1·1). The strongest independent predictor for later CVD risk was male sex. In conclusion, in this prospectively followed cohort of young adults born at term and at weight appropriate for gestational age, the duration of breast-feeding did not have an impact on the accumulation of cardiovascular risk factors.

Determinants of infant formula use and relation with growth in the first 4 months

The wide variety of infant formula available on the market can be confusing for parents and physicians. We aimed to determine associations between predominant type of formula used from birth to 4 months and parental and child characteristics and type of physician consulted, and then to describe relations between type of formula used and growth. Our analyses included 1349 infants from the EDEN mother-child cohort. Infant's feeding mode and type of formula used were assessed at 4 months by maternal self-report. Infant's weight and height from birth to 4 months, measured in routine follow-up, were documented by health professionals in the infant's personal health record. Anthropometric z-scores were calculated by using World Health Organization growth standards. Multinomial logistic regression was used to identify factors associated with the type of formula predominantly used; relations with growth were analysed by linear regressions. Partially hydrolysed formulas were more likely to be used by primiparous women (P < 0.001), those breastfeeding longer (P < 0.001) and for infants with family history of allergies (P = 0.002). Thickened formulas were more often used by mothers returning to employment in the first 4 months (P = 0.05) and breastfeeding shortly (P < 0.001). No significant relation was found between infant's growth and type of formula (P > 0.20). Infants breastfed shorter showed higher weight-for-age (P < 0.001) and length-for-age (P = 0.001) z-score changes between birth and 4 months. The use of a specific type of infant formula seems to be mainly related to parental characteristics. Infant's growth in the first 4 months is related to other factors than to the type of formula used.

Nutrition and Iron Status of 1-Year Olds following a Revision in Infant Dietary Recommendations

A previous study showed low iron status in 12-month-old Icelandic infants associated most strongly with cow's milk intake and growth. Infant dietary recommendations were revised in 2003. This study investigated nutrition and iron status in a new infant cohort. Subjects/Methods. Randomly selected infants were prospectively investigated for diet, anthropometry, and iron status (n = 110–141). Results. Breastfeeding initiation rate was 98%; 38% of 5-month olds were exclusively and 20% of 12-month olds partially breastfed. Formula was given to 21% of 6-month olds and 64% of 12-month olds, but cow's milk to 2.5% and 54.4% of 6- and 12-month olds, respectively. Iron depletion (serum ferritin < 12 μg/L) affected 5.8%, 1.4% were also iron deficient (MCV < 74 fl), and none were anemic (Hb < 105 g/l). Iron status associated negatively with growth and breastfeeding duration and positively with meat and formula intake at 9–12 months, but not with cow's milk. Conclusion. Improved iron status might be explained by a shift from cow's milk to formula in the diet of Icelandic 6–12-month olds. Dietary changes altered associations between foods and iron status.

Intestinal microbiota of 6-week-old infants across Europe: geographic influence beyond delivery mode, breast-feeding, and antibiotics

OBJECTIVES

: There are many differences in diet and lifestyle across Europe that may influence the development of the infant gut microbiota. This work aimed to assess the impact of geographic area, mode of delivery, feeding method, and antibiotic treatment on the fecal microbiota of infants from 5 European countries with different lifestyle characteristics: Sweden, Scotland, Germany, Italy, and Spain.

PATIENTS AND METHODS

: Fecal samples from 606 infants (age 6 weeks) recruited within the European project INFABIO were analyzed by fluorescent in situ hybridization combined with flow cytometry using a panel of 10 rRNA targeted group- and species-specific oligonucleotide probes. Information on factors potentially affecting gut microbiota composition was collected with questionnaires and associations were evaluated with multivariate analyses.

RESULTS

: The Bifidobacterium genus was predominant (40% average proportion of total detectable bacteria), followed by Bacteroides (11.4%) and enterobacteria (7.5%). Northern European countries were associated with higher proportions of bifidobacteria in infant feces, whereas a more diverse microbiota with more bacteroides characterized southern countries. Bifidobacteria dominated the microbiota of breast-fed infants, whereas formula-fed babies had significantly higher proportions of Bacteroides and members of the Clostridium coccoides and Lactobacillus groups. Newborns delivered by cesarean section or from mothers treated with antibiotics perinatally had lower proportions of Bacteroides and members of the Atopobium cluster.

CONCLUSIONS

: Delivery mode and feeding method influenced the fecal microbiota of European infants at 6 weeks, as expected, but the effect of country of birth was more pronounced, with dominant bifidobacteria in northern countries and greater early diversification in southern European countries.

Determinants of breast-feeding in a Finnish birth cohort

OBJECTIVE

To assess milk feeding on the maternity ward and during infancy, and their relationship to sociodemographic determinants. The validity of our 3-month questionnaire in measuring hospital feeding was assessed.

DESIGN

A prospective Finnish birth cohort with increased risk to type 1 diabetes recruited between 1996 and 2004. The families completed a follow-up form on the age at introduction of new foods and age-specific dietary questionnaires.

SETTING

Type 1 Diabetes Prediction and Prevention (DIPP) project, Finland.

SUBJECTS

A cohort of 5993 children (77 % of those invited) participated in the main study, and 117 randomly selected infants in the validation study.

RESULTS

Breast milk was the predominant milk on the maternity ward given to 99 % of the infants. Altogether, 80 % of the women recalled their child being fed supplementary milk (donated breast milk or infant formula) on the maternity ward. The median duration of exclusive breast-feeding was 1.4 months (range 0-8) and that of total breast-feeding 7.0 months (0-25). Additional milk feeding on the maternity ward, short parental education, maternal smoking during pregnancy, small gestational age and having no siblings were associated with a risk of short duration of both exclusive and total breast-feeding. In the validation study, 78 % of the milk types given on the maternity ward fell into the same category, according to the questionnaire and hospital records.

CONCLUSIONS

The recommendations for infant feeding were not achieved. Infant feeding is strongly influenced by sociodemographic determinants and feeding practices on the maternity wards. Long-term breast-feeding may be supported by active promotion on the maternity ward.