Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial

Julie A Mennella,Alissa D Smethers,Michelle T Delahanty,Virginia A Stallings,Jessica E Decker,Jillian C Trabulsi

doi:10.3390/nu13113946

Julie A Mennella, Alissa D Smethers + Show 4 more

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https://doi.org/10.3390/nu13113946

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Abstract

This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers’ weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of “What We Eat in America” food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.

Highlights

Introduction published maps and institutional affilThe evidence that infants’ early nutritional environment plays a crucial role in optimizing growth [1], developing a palate for a healthful diet [2], and reducing disease risks [3,4]provides additional importance for recent dietary guidance for children 2 years of age and younger [5,6,7,8]
While within the range of typically growing healthy infants, the formula-induced differences in weight-for-length Z (WLZ) scores remained significantly different between the groups up to 11.5 months [13]—a time when children begin the transition to a more complex diet. The children in this trial, the majority of whom were Black Americans, were phenotyped from 2 weeks to 1.5 years [13], from the time the randomized formula was the sole source of their nutrition to when formula was no longer a part of their diet. We focused on these children when they were young toddlers, aged 1 year and 1.5 years, and report on the food and nutrient contents of their diets and their mothers’ feeding practices related to the provision of snack foods [20], an important context that can have either positive or negative consequences on their nutritional intake and weight status [21,22]
We first established that of the 83 infants who remained in the trial at 1 year, there were no significant differences between the groups at enrollment

Summary

Introduction

Introduction published maps and institutional affilThe evidence that infants’ early nutritional environment plays a crucial role in optimizing growth [1], developing a palate for a healthful diet [2], and reducing disease risks [3,4]provides additional importance for recent dietary guidance for children 2 years of age and younger [5,6,7,8]. The infant’s diet is unique, typically consisting of a sole source of liquid nutrition—human milk, human milk substitutes (infant formula), or both. Infants fed formula gain weight faster during the first year [9] and are at greater risk for later obesity than breastfed infants [10,11,12], formula-fed infants are not a homogeneous group. Randomized controlled trials (RCTs) revealed that isocaloric formulas of different macronutrient composition had different effects on early rapid weight gain [13,14,15], a consistent and established risk factor for later obesity and other comorbidities [16,17,18].

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