Abstract
BackgroundThe prevalence of obesity among infants less than 2 years of age has increased by more than 60% over the last three decades. Obese infants and toddlers are at an increased risk for staying overweight into adolescence and adulthood. Metabolic programming has been demonstrated in animal models whereby early life feeding habits result in life-long changes in hormone balance and metabolism. Our study explores if newborn over-nutrition on the first day of life (DOL1) is associated with risk for future overweight and obesity in childhood.MethodsRetrospective chart data was collected for full term formula-fed infants born between January 2008 and December 2012 who continued care at the same institution. Data included the volume of formula (ml) consumed on DOL1 as well, as subsequent yearly BMI measures from well child checkups (WCC). Overfeeding was categorized as any feed greater than or equal to 30 ml on any of the first seven feeds while controlling for birth weight.ResultsThe final data set included 1106 infants (547 male; 559 female). 1023 of the 1106 newborns (93%) were overfed at least once during DOL1, while 789 of 1106 (71%) were overfed 3 or more times during their first 7 feeds. After adjusting for birth weight, infants who were overfed 5 of the first 7 feeds were 5 times as likely to be overweight or obese at their 4th year well child check-up (p < 0.05) compared to children not overfed. Infants who were overfed on all 7 of their first 7 feeds were 7 times more likely to be overweight or obese at their 4th year WCC (p = 0.017).ConclusionsInfants overfed on DOL1 were significantly more likely to be overweight or obese at their 4th year WCC, compared to infants not overfed on their first day of life. Newborn families may benefit from counseling regarding age-appropriate volumes of formula during this critical time period. Future studies will aim to look at effect of implementation of smaller feeding bottle size on reducing overfeeding practices and future risk of overweight and obesity.
Highlights
Participant characteristics (Table 1) The final sample included 1106 formula fed infants, of which 547 were male and 559 were female (Table 1). 77% of the population had a length of stay (LOS) of one or 2 days, while all had LOS 5 days or less. 36% of the population was delivered by cesarean-section while 64% were non-cesarean section birth
Overfeeding practices Using the overfeeding definition of any feed greater than or equal to 30 mL, we found that 99 of the 1106 (9%) newborns in our cohort were overfed once in their Day Of Life 1 (DOL1), 135 were overfed twice (12%), 180 were overfed 3 times (16%), 169 were overfed 4 times (15%), 166 were overfed 5 times (15%), 156 were overfed 6 times (14%), and 118 were overfed all 7 times of their first 7 feeds (11%) (Table 1)
Risk for overweight and obesity from overfeeding After adjusting for birth weight, infants who were overfed 5 of the first 7 feeds were 5.19 times as likely to present as overweight or obese at their 4th year well child checkups (WCC) (p = 0.050), while infants who were overfed all 7 of the first 7 feeds of life were 7.22 times as likely to be overweight or obese at their 4th year WCC compared to children not overfed on their first day of life (p = .017) (Table 3)
Summary
The prevalence of obesity among infants less than 2 years of age has increased by more than 60% over the last three decades. The prevalence of obesity among infants less than two years of age has increased by more than 60% over the last three decades, and obese infants and toddlers are at an increased risk for staying overweight into adolescence and adulthood [1]. In rodent studies, overfeeding as early as the second day of life has been shown to lead to brown adipose tissue hypo-activity This supports the early programming hypothesis for obesity risk, as brown adipose tissue is protective against obesity through energy expenditure needed for thermogenesis [8]. Early overfeeding in female rats has been shown to have long-term dysregulatory effects in the ghrelin signaling pathway [9] Other factors such as protein content of formula have been shown to affect future body weight composition well into childhood [10]
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