Abstract

While it is known that breastfeeding promotes healthy brain development in children, the potential effects of formulas substantially differing in composition (ie, milk-based versus soy-based) during infancy on brain development are unclear. Seventy-one 8-year-old children who were predominantly breastfed, milk formula fed, or soy formula fed during infancy were recruited for an MR imaging examination of the brain and a Behavior Rating Inventory of Executive Function assessment (completed via a questionnaire to the parents). Brain cortical features measured from MR imaging such as cortical thickness and surface area were extracted and compared among groups and correlated with Behavior Rating Inventory of Executive Function test scores. Clusters in the frontal and occipital lobes showed significant differences (cluster-wise P ≤ .05, corrected for multiple comparisons) in cortical thickness or surface area among the 3 diet groups. The effects were more prominent for boys, particularly for comparison of the milk formula fed versus soy formula fed boys. Assessments of executive function and behavior showed significantly lower Behavior Rating Inventory of Executive Function test scores in soy formula fed versus milk formula fed groups, which were mostly attributed to differences in boys. There were no differences between milk formula fed and breastfed groups for either sex. Mean cortical thickness for several of the clusters in the brain showing infant diet-associated effects significantly correlated with Behavior Rating Inventory of Executive Function scores. Choices of infant diets (ie, breastfed, milk formula fed, soy formula fed) may have long-term and sex-specific effects on the cortical development and executive function and behavior of children's brains.

Highlights

  • BACKGROUND AND PURPOSEWhile it is known that breastfeeding promotes healthy brain development in children, the potential effects of formulas substantially differing in composition during infancy on brain development are unclear

  • The American Association of Pediatrics reaffirmed its breastfeeding guidelines, which are essentially consistent with the World Health Organization recommendations.[1]

  • The most recent Centers for Disease Control and Prevention Breastfeeding Report Card shows that currently, 83.2% of children born in United States started out breastfeeding, 46.9% of all infants were exclusively breastfed at 3 months, and 57.6% of all infants were at least partially breastfed at 6 months.[2]

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Summary

Methods

Seventy-one 8-year-old children who were predominantly breastfed, milk formula fed, or soy formula fed during infancy were recruited for an MR imaging examination of the brain and a Behavior Rating Inventory of Executive Function assessment (completed via a questionnaire to the parents). Inclusion criteria for the participants included the following: 90–101 months of age; parental report of full-term gestation at birth (38–42 weeks); parental report of birth weight between the 5th and 95th percentile for age (2.5–4.2 kg); and parental report of predominant use of breast milk, milk-based formula, or soy-based formula during infancy. BF infants were exclusively or partially breastfed for at least 8 months (rounded to the closest number) before completely transitioning to formula or other diets; MF and SF infants were fed for same type of formula (cow’s milk–based or soy-based) since the first weeks of life throughout the first year of life.

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