Excessive Weight Gain Followed by Catch-Down in Exclusively Breastfed Infants: An Exploratory Study

Abstract

Some infants experience excessive weight gain (EWG) during exclusive breastfeeding, but causes and consequences are unknown. The objective was to identify factors associated with early EWG. Infants with EWG (HW-group) were examined at 5, 9 and 18 mo and compared to a breastfed group with normal weight gain (NW-group). Anthropometry, body composition, milk and blood samples, and milk intake were measured. Mean body-mass-index-for-age z-scores (BAZ) increased 1.93 from birth to 5 mo in the HW-group (n = 13) while the NW-group (n = 17) was unchanged (−0.01). The HW-group had 70% more fat mass at 5 mo, and then showed marked catch-down in BAZ from 5 to 18 mo (−0.84). Milk intake at 5–6 mo did not differ between the groups. In the HW-group milk-leptin was lower at 5 mo and serum-leptin was considerably higher at 5 and 9 mo compared to the NW-group. Serum-leptin at 5 mo was positively associated with weight-for-age z-score (WAZ) and fat mass and negatively with WAZ change from 5 to 9 mo. In conclusion, breastfed infants with EWG had catch-down growth when other foods were introduced. Low milk-leptin in the HW-group may have stimulated appetite and milk intake when weight gain was high. High serum-leptin in the HW-group suggests early leptin resistance, which could impact cerebral regulation of energy intake. Larger studies are needed to confirm these results.

Breastmilk Lipids and Oligosaccharides Influence Branched Short‐Chain Fatty Acid Concentrations in Infants with Excessive Weight Gain

“…The dynamic composition of breastmilk changes during emptying of a breast (from foremilk to hindmilk), diurnally between feedings, during the course of lactation, and between mothers . Previously, similar daily energy and macro nutrient intake from breastmilk have been reported for the two groups in the present cohort and only breastmilk leptin concentration was lower in the HW‐group at 5 months of age . Here, we demonstrate that α‐linolenic acid, oleic acid, and 3‐oxohexadecanoic acid were lower in the HW‐group breastmilk at 5 months, potentially contributing to the rapid weight gain in early life.…”

“…Recently, breastmilk microbiota richness was found to be negatively correlated with omega‐3 PUFAs, indicating that the breastmilk microbiota may be another source of variation for the breastmilk fatty acid profile . We speculate that the lower α‐linolenic acid observed in the breastmilk from the mothers in the HW‐group may be sourced from the differences in the maternal diet or the breastmilk microbiota diversity, since we did not observe a significant difference in maternal pre‐pregnancy BMI in the present cohort …”

“…Breastfeeding frequency, 24‐h breastmilk intake (g kg −1 day −1 ), the proportion of exclusively breastfed infants as well as daily energy intake from breastfeeding and complementary feeding were not different between HW‐ and NW‐groups at 5 months of age (Table S8, Supporting Information). The untargeted breastmilk profiling resulted in 1026 features in positive mode and 601 features in negative mode after the data cleaning procedure.…”

“…SKOT III is a prospective observational cohort study consisting of infants exclusively breastfed ≥4 months with high weight gain (HW‐group) and normal weight gain (NW‐group) aiming to identify the predictors and consequences of EWG in the early life for exclusively breastfed infants. It has been described in detail elsewhere . Briefly, 15 infants aged 4–6 months having a weight‐for‐age z ‐score (WAZ) >2.0 and with at least +1 SD increment in WAZ within the first 5 months postpartum considered as having EWG and were enrolled to the HW‐group.…”

“…Further, we hypothesize that differences in breastmilk composition between mothers of infants with excessive and normal weight gain can contribute to the variation in fecal SCFA concentration at 5 and 9 months. In the present study we address this hypothesis based on sample profiling analyses and HMO concentrations from previously published studies . We aim to identify the breastmilk metabolites and HMOs that are potentially associated with fecal SCFA concentrations and that differ between infants with excessive and normal growth.…”