Do Breast Fed Babies Exclusively Bottle Fed Have Increased Need for More Volume
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Early on feeding of larger volumes of formula milk is associated with greater trunk weight or overweight in later infancy
Nutrition Journal volume 17, Article number:12 (2018) Cite this article
Abstract
Groundwork
The relation betwixt infant feeding and growth has been extensively evaluated, but studies examining the book of formula milk consumption on infant growth are limited. This study aimed to examine the effects of early feeding of larger volumes of formula on growth and risk of overweight in later infancy.
Methods
In total, 1093 infants were studied prospectively. Milk records nerveless at 3 mo of age were used to define the following three feeding groups: breast milk feeding (BM, no formula), lower-book formula milk feeding (LFM, <840 ml formula/d), and higher-book formula milk feeding (HFM, ≥840 ml formula/d). Body weight and length were measured at 3 time points of 3, 6 and 12 mo of historic period.
Results
The results showed that the difference in weight and length betwixt the HFM and BM infants was significant at three mo of historic period (P < 0.05) and continued until 12 mo of age (P < 0.001). The adjusted mean changes in weight-for-length z-scores (WLZ) and BMI-for-historic period z-scores (BAZ) from iii to 6 mo of age were significantly higher in HFM and LFM group than in BM group. Two-style interactions between feeding practice and historic period intervals were significant for WLZ changes (P = 0.002) and BAZ changes (P = 0.017). Compared with BM-fed infants, infants fed with HFM had 1.60-fold (95% CI ane.05–2.44) higher odds of greater torso weight (1SD < WLZ ≤ii SD) at the historic period of 6 mo and one.55-fold (95% CI 1.01–2.37) higher odds of greater torso weight and 2.13-fold (95% CI one.03–four.38) higher odds of overweight (WLZ > two SD) at the age of 12 mo.
Conclusion
Feeding higher volumes of formula in early infancy is associated with greater body weight and overweight in later infancy.
Peer Review reports
Groundwork
The prevalence of overweight and obesity in children is a major wellness problem worldwide. Early infancy is a period of fast growth and weight gain, and infants who gain more than weight during infancy become susceptible to obesity in childhood or later life [1,2,3,4,5]. Feeding patterns such equally breastfeeding or formulas-feeding are the main factors that impact the growth and development in infancy [six, vii]. Some studies have primarily focused on the clan between diverse feeding patterns in infancy and the risk of overweight and obesity in childhood and adulthood. Information technology is more often than not acknowledged that formula-fed infants proceeds more than weight than breastfed infants and breastfeeding is an important protector against overweight and obesity [8,9,x,eleven,12]. Notwithstanding, few studies have focused on differences in the growth and risk of overweight in infants fed with different type and book of milk in early infancy.
The departure in weight proceeds between formula-fed and breast-fed infants is likely to exist related to differences in both the composition and book of intake between formula and breast milk. A systematic review concluded that formula-fed infants have a 1.2-to nine.v-fold higher energy intake and a 1.2-to 4.8-fold higher protein intake than those who are breastfed in the offset week of life [13]. This divergence is attributed to the higher free energy and protein content of formula and a college volume of consumption, which may lead to greater weight gain in formula-fed infants compared to breastfed infants during early infancy [13]. This review suggested that higher amounts of formula consumption may expose formula-fed infants to energy-dense milk, leading to a greater adventure of overweight. Hopkin'southward study examined the effect of the type and book of milk fed during infancy on childhood growth, and the results showed that feeding infants high volumes of formula (≥600 ml/d) was associated with increased torso weight and height through 3 y of age and suggested that milk intake should be measured in detail in hereafter research [14]. Another study observed the relationship between bottle size and weight gain in formula-fed infants and found that using a large bottle in early infancy independently contributed to greater weight proceeds and modify in weight-for-length z-scores (WLZ) at the age of six mo [xv]. Therefore, feeding larger volumes of formula may be associated with greater body weight and length gains.
The baby formula has been widely used in Communist china over the last decade and most 65.3% infants aged within six mo has consumed infant formula [sixteen]. However,whether the big corporeality of formula intake in early infancy may contribute to the increased prevalence of overweight and obesity in later life has non been extensively studied. Thus, the present written report aimed to investigate the association between the book of formula milk consumption at three mo of age and changes in torso weight and length at 3 time points during the kickoff year, and to examine the effects of unlike volumes of formula milk during early on infancy on growth and risk of overweight in afterward infancy.
Methods
Written report design
The data were collected from a subgroup of the Tongji Maternal and Kid Wellness Cohort (TMCHC) study, which was described previously [17]. Using a population-based, prospective, observational study blueprint, TMCHC collected detailed information on pregnant women and their infants and to investigate the influence of dietary factors on maternal and child health during pregnancy and infancy. This study was canonical by the Institutional Review Board of the Tongji Medical College of Huazhong University of Scientific discipline and Technology and therefore was performed in accordance with the ethical standards outlined in the Announcement of Helsinki. The written informed consent was obtained from participants' families before participants were included in the report.
Healthy neonates (n = 1229) who were born between March 2014 and June 2015 from TMCHC and who were followed up with until 1 year of historic period were screened for enrollment in the present study. Neonates with nascency defects or congenital long-term diseases were excluded.. The sample size of 1093 was estimated using the unproblematic random sampling method (\( n={\left({Z}_{\alpha /2}\right)}^2\times \frac{i}{\varepsilon^2}\times \frac{one-p}{p}\alpha =0.05,\upvarepsilon =0.22 \)), and nosotros used half-dozen.7% as the estimated rate of overweight and obesity at 1 year of age (P = 6.vii%) [xviii]. We used 11% as the estimated rate of lost-to-follow upwardly, the sample size at recruitment was 1093/(i–0.11) = 1229.
Data about maternal characteristics such as age, education, pre-pregnancy height and weight, occupation, gravidity, parity, wellness condition and delivery, and baby characteristics including sex activity, gestational historic period, fashion of delivery and nascence weight and length were obtained by the Maternal and Children Healthcare Information Tracking System of Wuhan. After enrollment, the participants were interviewed past a customs dr. 3 times: at 3 months, 6 months and 12 months postpartum. At each of these interviews, data on baby feeding exercise, sleep duration, illness, dietary supplement intake, introduction of solid foods were obtained. Trunk weight and length was measured by the trained community doctor. Body weight was measured to the nearest 100 chiliad using a pedobarometer, with infants wearing calorie-free indoor vesture. Recumbent length was measured to the nearest 0.1 cm using an infantometer. Both weight and length were taken in indistinguishable and means of the replicates were recorded. Detailed records of formula consumption were collected at the age of three mo.
In total, 1146 infants completed examinations at all growth points. Later on excluding twins (due north = 16) and premature infants (northward = 37),1093 good for you singleton total-term infants were ultimately selected for analysis, including 587 boys and 512 girls (Fig. 1 and Tabular array one).
Enrollment, eligibility and study sample. Feeding patterns at the age of three mo: BM, no formula milk; LFM, <840 ml formula milk/d; HFM, ≥840 ml formula milk/d
Infant feeding assessments
Baby feeding patterns were categorized according to the total volume of formula milk consumed at the age of 3 mo, which was calculated by caregivers' answers to 2 questions: "How many times was your child fed infant formula?" and "How much formula milk does your kid usually intake at each feeding?" The caregivers was also inquired most how to prepare the formula solution for infants. Generally, the caregivers prepared the formula milk co-ordinate to the instruction of manufacturers by using measurements provided past manufacturers. To verify the volume of formula consumption provided by the caregivers, we compared the book of formula consumption recorded by community doctor at their home visit with the intake reported by the caregivers in randomly selected 100 formula-fed infants at the age of 3 mo in the present study. The quantities are comparable in two independent reports recorded by customs dr. and the caregivers for 100 infants. Based on Chinese baby feeding recommendations and references to the dietary intake of Chinese residents [19, 20], we divided the book of formula into college (840 ml or more than) and lower (less than 840 ml) consumption every bit the iii-month-sometime infants consumed an average of 140 ml of formula half-dozen times/d for a total of 840 ml/d, which was P75 of formula intake in formula-fed infants in the present study. The three feeding groups were identified equally follows: breast milk feeding (BM, no formula milk); lower-volume formula milk feeding (LFM, <840 ml formula milk/d); and higher-volume formula milk feeding (HFM, ≥840 ml formula milk/d). Breast milk feeding was divers as infants who exclusively consumed breast milk without other liquids or solids with the exception of vitamin and mineral supplements or medicines. Formula feeding included any formula feeding with or without some breast milk and was subdivided into LFM and HFM according to the volume of formula milk intake per twenty-four hour period.
Anthropometric indexes
For our analysis, we calculated age-and sexual activity-specific z scores for the following 2 anthropometric indexes: weight-for-length z score (WLZ) and BMI-for-age z score (BAZ) using WHO Anthro software (version 3.2.2) based on the 2006 WHO growth standards [21]. To assess longitudinal growth, interval growth changes between iii feeding groups were determined by obtaining the differences in WLZ and BAZ from nascence to 3 mo, three to half dozen mo, and 6 to 12 mo of historic period. The infants' weight condition was measured by WLZ and was classified as greater body weight (1SD < WLZ ≤ 2SD), which represented at-risk for overweight, and overweight (WLZ > 2SD).
Statistical analyses
Epidata3.ane database software was used for double entry and validation. Chi-square tests for categorical variables and ANOVA for continuous variables were performed to explore differences in maternal and infant characteristics between feeding groups. All data including weight, length, WLZ and BAZ were expressed as the mean ± standard divergence (ten ± s) and analyzed using a one-mode ANOVA to compare differences between feeding groups (LFM and HFM versus BM to understand the impact of formula milk exposure).
To exam the issue of formula consumption on changes in WLZ and BAZ, linear mixed-effect modeling was used to analyze repeated measurements. Adjusted confounders including babe sex activity, infant birth weight, cesarean delivery, pre-pregnancy BMI and weight gain during pregnancy, and WLZ or BAZ at birth, which accept previously been shown to influence infant growth, were centered at their mean values in the multivariate model. The basic model included feeding groups (BM, LFM or HFM) and age intervals (0, 3, 6 and 12 mo of age) and interactions between feeding exercise and age intervals. In addition to these fixed effects, a random outcome that represented the betwixt-babe variability was included in the model.
Associations between formula consumption at 3 mo of age and infants' weight condition were also investigated using logistic regression analyses afterwards adjusting for babe sexual activity, infant birth WLZ, babe birth weight, introduction of solid foods, cesarean delivery, pre-pregnancy maternal trunk mass alphabetize and weight gain during pregnancy. All P values were ii-tailed, with P < 0.05 considered to be statistically significant. All analyses were performed using SPSS software (IBM SPSS Statistics V21.0.).
Results
Descriptive
For this study,1093 healthy full-term infants were included in the final analysis. Based on their feeding practice at iii months of age (Table 1), they were classified into the BM feeding group (610, 55.5%), LFM feeding group (363, 33.ii%) and HFM feeding group (120, 13.2%). The results also showed that mothers who fed breast milk to their infants had a normal BMI before pregnancy (68.2% vs 65.6% vs 56.seven%, p < 0.05) and no cesarean deliveries (42.3% vs 36.iv% vs 19.ii%, p < 0.001) compared to both LFM and HFM mothers. Overall, solid foods were introduced to 63.seven% of infants before the age of 6 mo. With respect to the sex of the infants, 50.5% of the breastfed infants were female, more than that of LFM infants (42.4%) or HFM infants (38.3%) (p < 0.01) .
As shown in Tabular array 2, in that location were no significant differences in birth weight and length betwixt any of the feeding groups (p > 0.05). The boilerplate values of body weight and length at three time points were greater in infants in the HFM group than those in the BM groups(p < 0.05 or p < 0.01), but there was no meaning deviation between infants in the LFM and BM group except those at 12 mo (p < 0.001). The differences in WLZ betwixt the HFM and BM infants were only meaning at 12 mo of age (P < 0.001), the same equally the differences betwixt the LFM and BM infants (p < 0.01). The differences in BAZ were significant at both half dozen (p < 0.05) and 12 mo (p < 0.01) of age between the HFM and BM infants, but only significant at 12 mo of age (p < 0.05) between the LFM and BM infants.
Linear mixed-effect modeling results
The adjusted mean changes in WLZ and BAZ of infants are shown in Table 3. Overall, 2-manner interactions between feeding practice and age intervals were significant for WLZ changes (P = 0.002) and BAZ changes (P = 0.017) after adjusting for potential confounders.
In the showtime iii mo of life, infants in both the LFM and HFM groups showed like changes in WLZ and BAZ compared to their BM counterparts (P > 0.0.five). From 3 to 6 mo of historic period, LFM infants showed higher WLZ proceeds (+0.26 vs +0.12, P = 0.016) and BAZ gain (+0.12 vs −0.01, P = 0.013) than BM infants. Furthermore, HFM infants showed higher WLZ gain (+0.xxx vs +0.12,P = 0.023) and BAZ proceeds (+0.15 vs −0.01, P = 0.033) than BM infants. From 6 to 12 mo of age, WLZ and BAZ changes were stable in the LFM and HFM groups, whereas the BM group had less WLZ and BAZ gains than both formula groups; however, the divergence was simply statistically significant in WLZ modify (Fig. two and Table iii).
Feeding practice and infant growth. Adjusted mean WLZ and BAZ of infants from birth to 12 mo of historic period for BM, LFM, and HFM groups. Analyses were performed with the use of linear mixed-effect modeling and adjusted for infant sex, infant birth weight, cesarean, pre-pregnancy BMI, weight gain during pregnancy and WLZ or BAZ at birth. BM: breast milk; LFM: <840 ml formula milk/d; HFM:≧840 ml formula milk/d; WLZ, weight-for-length z score. BAZ, BMI-for-age z scores
Logistic regression model results
Tabular array four presents the crude and adjusted models for the association betwixt book of formula milk consumption and the OR of infant greater body weight and overweight at 6 and 12 months. In both rough and adjusted models, lower-volume formula milk feeding (LFM) was not associated with greater trunk weight and overweight. Higher-volume formula milk feeding (HFM), by contrast, was related to greater trunk weight and overweight at the ages of 6 and 12 mo. Infants who were HFM fed had 1.threescore-fold (95% CI one.05–2.44, P = 0.021) higher odds of greater torso weight than those who were BM fed at the age of 6 mo, and they had 1.55-fold (95% CI one.01–2.37, P = 0.046) higher odds of greater body weight and 2.13-fold (95% CI ane.03–iv.38, P = 0.045) higher odds of overweight than BM fed infants at the age of 12 mo.
Word
This study examined the effects of the type and volume of milk fed in early on infancy on growth and risk of overweight in subsequently infancy. The results showed that feeding of higher-volumes of formula milk (≥840 ml/d) at iii month of historic period was associated with greater body weight and higher take chances of overweight at 6 and 12 months of age than was breast milk feeding. The feeding of lower-volume formula milk (<840 ml/d) contributed to higher body weight, body length, and more than change in WLZ and BAZ from 3 to half dozen month, only had no effect on the gamble of overweight in later infancy. These findings were consequent with previous studies that demonstrated that growth in infancy may exist afflicted by both the type and volume of milk fed [10, xiv, xv, 22].
Rapid growth in early on infancy had been shown to increase the gamble of overweight or obesity during afterward life [2], which conformed to our findings that higher-book formula feeding contributed to greater trunk weight and body length, and more change in WLZ and BAZ from 3 to 6 months of age, thus increased risk of overweight in later infancy. A possible explanation for this relationship is that formula-fed infants are ever overfed. Firstly, formula-fed infants are fed with bottles [23,24,25], while chest-fed infants at the iii mo of age are usually fed direct from the chest considering the Chinese mothers has not returned to work according to the China'south labor law. These bottle-fed infants lose their ability to self-regulate intake and delay the satiety response compared with the breast-fed infants [26,27,28]. More often than not, the boilerplate volume of baby formula consumed is essentially higher than the volume of breast milk on all days analyzed (virtually 840 ml/d recommended by the manufacturer for the fully formula-fed infants at iii mo of age vs 750 ml/d for exclusively breast-fed infants) [29]. The energy content was not adamant in the present study, but previous studies reported that the energy content of conventional formula milk (67 kcal/100 ml) was college than breast milk (65 kcal/100 ml) [xiii]. Thus, the formula-fed infants consume a higher volume and more than energy dense milk and consequently gain more weight.
Another possible explanation is related to "the early poly peptide hypothesis", which postulate that differences in protein supply between man milk and infant formula play an important function in early programming. This hypothesis assume that more protein intake is causative for a more than rapid weight gain in the first two y of life and higher risk of obesity observed in formula-fed than in breastfed children [30, 31]. The more than rapid weight gain in formula-fed infants might exist mediated through an amino acids-induced secretion of insulin and insulin-like growth gene I (IGF-I) [32, 33]. Although the protein intake was not determined in the present study due to lack of information on the volume of chest milk, infants fed with college volumes formula milk were speculated to consume more protein than breast-fed infants considering the protein content was higher in formula milk (1.3~1.7 k/100 ml) than in breast milk (i.0 g~one.3 g/100 ml) [13, 34]. Several other biological mechanisms have been proposed to explain the association between formula feeding and chance of obesity. These include the early differences in the evolution of gut microbiota and leptin which is found in breast milk but not in formula milk [35,36,37,38], or other feeding behaviors [39].
To the all-time of our knowledge, this is the commencement study to examine baby growth in lower-and higher-volume formula-fed infants compared to chest-fed infants in Chinese population. The most important strength of this study was that a prospective population-based pattern were applied to assess growth trajectories and weight condition, which helped reduce the gamble of recall bias to a minimum. Boosted force of our assay was its strong design to consider possible balance confounding factors including gestational weight gain, pre-pregnancy BMI, mode of delivery and other feeding or health characteristics of infants, such as records of milk intake, frequency slumber duration, disease status and vitamin D intake. This allowed us to diminish potential confounders as possible as we can.
Despite the stiff blueprint, some infants were unable to be included in the electric current study because of incomplete data, which may enhance the option bias. Some other limitation of this report was that follow-up time of the report population was short and the observed associations may change with increasing follow-upwards time. Long-term follow-upwardly should exist included in the further study to determine whether higher-volume formula intake influence the grow and development and risk of obesity in babyhood. In improver, some important factors, such as volume of breastmilk consumption, energy intake, protein intake or detailed records of complementary foods, were not available and analysed in the present written report. Finally, WLZ and BAZ were evaluated based on the 2006 WHO growth standards which might be invalid or even misleading for determining the infants' weight status because the population sample was exclusively breastfed infants from countries other than People's republic of china.
Conclusions
In this current study, we institute that infants who consumed higher-volumes of formula milk at the historic period of 3 mo gained more body weight and length in subsequently infancy than breastfed infants. Infants fed with higher-volumes of formula milk seemed to have an increased risk of greater body weight and overweight. Thus, the higher-volume formula feeding should be avoided in the early infancy to forbid overweight or obesity in later on infancy. Further studies with more than details on milk intake, the energy intake and nutrients intake, are needed to explore the mechanisms backside the clan between the college-volumes of formula consumption and the greater run a risk of overweight.
Abbreviations
- BAZ:
-
BMI-for-age Z score
- BM:
-
No formula milk
- BMI:
-
Trunk Mass Index
- HFM:
-
≥ 840 ml formula milk/d
- IGF-I:
-
Insulin-similar growth factors-i
- LAZ:
-
Length-for-historic period Z score
- LFM:
-
< 840 ml formula milk/d
- TMCHC:
-
Tongji Maternal and Child Health Cohort
- WAZ:
-
Weight-for-age Z score
- WHO:
-
Globe Health Organization
- WLZ:
-
Weight-for-Length Z score
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Acknowledgments
The authors are grateful to the maternity clinics of Hubei Maternal and Child Wellness Hospital and Jiangan Maternal and Child Health Infirmary for their cooperation, the staff and students who considerable assistance with many aspects of this report assisted. We gratefully acknowledge the participating pregnant women and infants. Nosotros are grateful to everyone in Tongji Maternal and Child Health Cohort Written report Group.
Funding
This work was supported by the National Plan on Bones Research Project of China (NO.2013FY114200) awarded to Nianhong Yang.
Availability of data and materials
The datasets used and/or analysed during the current study bachelor from the corresponding author on reasonable request.
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Contributions
XY, LH and NY designed the study; JH,ZZ, YW, YW, JW, LZ and ZN acquired the data; JH, ZZ and XY analyzed and interpreted the information, drafted and revised the manuscript. All authors approved the final version of the manuscript.
Corresponding authors
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Ideals approval and consent to participate
The Tongji Medical Higher,Huazhong Academy of Science and Engineering science approved the study design (Protocol No 02; 2013). The trail was registered at Clinical Trials (NCT:03099837). All subjects accept signed a consent course to participate of the study.
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"Not applicable".
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Huang, J., Zhang, Z., Wu, Y. et al. Early feeding of larger volumes of formula milk is associated with greater body weight or overweight in later infancy. Nutr J 17, 12 (2018). https://doi.org/10.1186/s12937-018-0322-5
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DOI : https://doi.org/10.1186/s12937-018-0322-5
Keywords
- Feeding practise
- Formula milk
- Growth
- Overweight
- Greater trunk weight
Source: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-018-0322-5
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