Association of Breastfeeding Intensity and Bottle-Emptying Behaviors at Early Infancy With Infants' Risk for Excess Weight at Late Infancy

Abstract

OBJECTIVE. Our goal was to test the hypothesis that infants who were breastfed more intensively during early infancy (Յ6 months) will be less likely to have excess weight during late infancy (Ͼ6 months) and to examine the independent impact of infantinitiated bottle emptying and mothers' encouragement of bottle emptying on infants' risk for excess weight.METHOD. The sample consisted of 1896 mothers who participated in postpartum surveys of the Infant Feeding Practice Study II and who provided at least 1 weight measurement of their infants during the second half of infancy. We used multiple logistic regression models to assess the association between infants' risks for excess weight during the second half of infancy and 3 self-reported feeding practices during the first half of infancy after adjusting for a series of sociodemographic characteristics. The early feeding practices examined included the percentage of all milk feedings in which infants consumed breast milk (breastfeeding intensity), the frequency of bottle feedings in which infants initiated bottle emptying, and the frequency of bottle feedings in which mothers encouraged bottle emptying.RESULTS. Infants fed with low (Ͻ20% of milk feeds being breast milk) and medium (20%-80%) breastfeeding intensity in the first half of infancy were at least 2 times more likely to have excess weight during the second half of infancy than those breastfed at high intensity (Ͼ80%). Infants who often emptied bottles in early infancy were 69% more likely than those who rarely emptied bottles to have excess weight during late infancy. However, mothers' encouragement of bottle emptying was negatively associated with their infants' risk for excess weight during the second half of infancy.CONCLUSIONS. Infants' risk for excess weight during late infancy was negatively associated with breastfeeding intensity but positively associated with infant-initiated bottle emptying during early infancy. These findings not only provide evidence for the potential risk of not breastfeeding or breastfeeding at a low intensity in development of childhood obesity, but they also suggest that infant-initiated bottle emptying may be an independent risk factor as well. Pediatrics 2008;122:S77-S84 T HE ESTIMATED PERCENTAGE of 6-to 11-year-old US children considered to be obese more than quadrupled since the 1960s to ϳ19% during 1999 -2004. 1 The increase in childhood obesity was also observed among preschoolers and infants, with ϳ4-and 5-percentage-point increases among 6-to 23-month-olds and 2-to 5-year-olds, respectively, from the late 1970s to 2000. 2 Along with the rise in pediatric obesity, there has been an increase in the prevalence of obesity-related health conditions in youth, such as elevated serum lipid and insulin concentrations, asthma, type 2 diabetes, and hypertension, that once were considered to be adult problems. [3][4][5][6] In addition, children who are obese have been shown to be more likely to develop psychosocial problems. 7 Given the numerous health risks associated wi...

Mode of Delivery and Breastfeeding Practices

“…The construction of breastfeeding intensity was based on previous research that used the same IFPS II data to assess breastfeeding practices. 14,15 Family member and clinician opinions pertaining to infant feeding were assessed during the prenatal period by inquiring about the mother's, her partner's, and her clinician's beliefs regarding the best method to feed the baby. Family and clinician opinion included three categories according to the preferred infant feeding method: breastfeed only, formula only or both formula and breastfeed, and no opinion.…”

Breastfeeding and the Use of Human Milk

“…39 This concept is further supported by the observations that infants who are fed by bottle, formula, or expressed breast milk will have increased bottle emptying, poorer selfregulation, and excessive weight gain in late infancy (older than 6 months) compared with infants who only nurse from the breast. 40,41 Diabetes Up to a 30% reduction in the incidence of type 1 diabetes mellitus is reported for infants who exclusively breastfed for at least 3 months, thus avoiding exposure to cow milk protein. 13,42 It has been postulated that the putative mechanism in the development of type 1 diabetes mellitus is the infant' s exposure to cow milk β-lactoglobulin, which stimulates an immune-mediated process crossreacting with pancreatic β cells.…”

Obesity Prevention in Children from Birth to Age 5

“…65 The mother is learning to distinguish hunger cues from other cues, and if she misreads these cues, she could be potentially overfeeding her infant. Infant feeding methods such as breast vs. bottle feeding, 66,67 breastfeeding duration, [68][69][70] liquid diet weaning age, 71,72 and introduction of solid foods 11,73 affect obesity risk. Two different meta-analyses found breastfeeding offers a protective effect to reduce the infants' later life obesity risk (by as much as 15%), but the causality is still not understood.…”