Abstract
Objective:Infant growth trajectories, in terms of size, tempo and velocity, may programme lifelong obesity risk. Timing of breastfeeding cessation and weaning are both implicated in rapid infant growth; we examined the association of both simultaneously with a range of growth parameters.Design:Longitudinal population-based twin birth cohort.Subjects:The Gemini cohort provided data on 4680 UK infants with a median of 10 (interquartile range=8–15) weight measurements between birth and a median of 6.5 months. Age at breastfeeding cessation and weaning were reported by parents at mean age 8.2 months (s.d.=2.2, range=4–20). Growth trajectories were modelled using SuperImposition by Translation And Rotation (SITAR) to generate three descriptors of individual growth relative to the average trajectory: size (grams), tempo (weeks, indicating the timing of the peak growth rate) and velocity (% difference from average, reflecting mean growth rate). Complex-samples general linear models adjusting for family clustering and confounders examined associations between infant feeding and SITAR parameters.Results:Longer breastfeeding (>4 months vs never) was independently associated with lower growth velocity by 6.8% (s.e.=1.3%) and delayed growth tempo by 1.0 (s.e.=0.2 weeks), but not with smaller size. Later weaning (⩾6 months vs <4 months) was independently associated with lower growth velocity by 4.9% (s.e.=1.1%) and smaller size by 102 g (s.e.=25 g).Conclusions:Infants breastfed for longer grew slower for longer after birth (later peak growth rate) but were no different in size, while infants weaned later grew slower overall and were smaller but the timing of peak growth did not differ. Slower trajectories with a delayed peak in growth may have beneficial implications for programming later obesity risk. Replication in cohorts with longer follow-up, alternative confounding structures or randomised controlled trials are required to confirm the long-term effects and directionality, and to rule out residual confounding.
Highlights
Faster infant growth is an established risk factor for later obesity.[1]Twin analyses indicate less genetic influence on infancy weight gain than later in childhood, which points towards a critical period when growth is more modified by environmental factors.[2,3]Infant feeding practices are often targeted as modifiable environmental factors for obesity prevention.[4,5,6] systematic reviews of prospective cohorts support a small protective effect of breastfeeding on later obesity,[7,8] most studies of the age at weaning and subsequent obesity have reported no evidence of association.[9]
In adjusted models with the SuperImposition by Translation And Rotation (SITAR) parameter velocity as the outcome, both later weaning and longer breastfeeding were independently associated with lower growth velocity; infants weaned at or after 6 months grew 4.9% (s.e. = 1.1%) slower than infants weaned by 4 months, and infants breastfed for more than months grew 6.8% (s.e. = 1.3%) slower than those never breastfed (Supplementary Table 1, model 3)
In this study of infant feeding and growth trajectories, longer breastfeeding and later weaning were both associated with lower growth velocity, and with delayed tempo and smaller size, respectively
Summary
Faster infant growth is an established risk factor for later obesity.[1]Twin analyses indicate less genetic influence on infancy weight gain than later in childhood, which points towards a critical period when growth is more modified by environmental factors.[2,3]Infant feeding practices are often targeted as modifiable environmental factors for obesity prevention.[4,5,6] systematic reviews of prospective cohorts support a small protective effect of breastfeeding on later obesity,[7,8] most studies of the age at weaning and subsequent obesity have reported no evidence of association.[9]. Faster infant growth is an established risk factor for later obesity.[1]. Twin analyses indicate less genetic influence on infancy weight gain than later in childhood, which points towards a critical period when growth is more modified by environmental factors.[2,3]. Infant feeding practices are often targeted as modifiable environmental factors for obesity prevention.[4,5,6] systematic reviews of prospective cohorts support a small protective effect of breastfeeding on later obesity,[7,8] most studies of the age at weaning and subsequent obesity have reported no evidence of association.[9] Mixed findings from cohort studies are supported by results from randomised controlled trials (RCTs) like PROBIT, a large long-term RCT of breastfeeding exclusivity and duration, which found no differences in obesity prevalence at age 6.5 or. 11.5 years.[10,11] Three shorter-term RCTs of weaning at 6 vs months found no differences in anthropometric outcomes between 6 and 12 months.[12,13,14] There is a suggestion from two US and Danish Cohorts that early weaning (before 4 months) is only associated with later weight gain if breastfeeding ceased by 4 months,[15,16] indicating that it may be important to account for both feeding practices concurrently
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