Early Feeding Practices Research Articles

Early Feeding Practices and Celiac Disease Prevention: Protocol for an Updated and Revised Systematic Review and Meta-Analysis.

Uncertainty remains in regard to when, how, and in what form gluten should be introduced into the diet, particularly of infants genetically predisposed to developing celiac disease (CD). MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials databases will be searched from inception. Randomized controlled trials (RCTs) and observational studies (cohort, case-control, or cross-sectional studies) investigating the association between early feeding practices and the risk of CD and/or CD autoimmunity will be included. In prospective studies, participants will be infants regardless of the risk of developing CD. For retrospective studies, participants will be children or adults with CD or presenting with positive serology indicative of CD. Interventions will be gluten-containing products of any type. Exposures will be breastfeeding and/or the introduction of gluten-containing products of any type. In control groups, there will be no exposure, different degrees of exposure (partial vs. exclusive breastfeeding, different amounts of gluten, etc.), or a placebo. The primary outcome measure will be CD or CD autoimmunity (i.e., anti-transglutaminase or anti-endomysial antibodies). At least two reviewers will independently assess the risk of bias using a validated risk assessment tool depending on study design. Disagreements will be resolved by discussion to achieve a consensus with the involvement of one or more additional reviewers if required. If appropriate, data will be pooled. If not, a narrative synthesis will be performed. The findings will be submitted to a peer-reviewed journal.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years.

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices.

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers’ infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital.

Association of early feeding practices with dietary patterns of 7-year-olds from the birth cohort Generation XXI

Early feeding practices have been related to child's body mass index (BMI), however, their role in establishing dietary patterns is less well understood. The aim of this study was to examine the association of parent-reported early feeding practices (breastfeeding duration, type of foods and timing of complementary feeding) and dietary patterns identified at age 7 to explain BMI z-scores at 10 years of age. Participants were children from the Generation XXI cohort, evaluated at 4, 7 and 10 years of age (n = 3673). At 7 years-old, dietary intake was assessed with a validated food-frequency questionnaire. Two dietary patterns were previously derived: “Energy-dense foods” (higher in energy-dense foods, and lower in vegetable soup, significantly associated with BMI z-score at 10 years-old, and the “Fish-based” dietary pattern (higher in fish consumption and low in energy-dense foods). Adjusted sex-stratified associations were estimated by generalized linear models. Boys and girls who were never breastfed or were breastfed for a very short duration had lower scores in the “Fish-based” dietary pattern, compared to those with longer breastfeeding durations (Boys: β = −0.219; 95%CI: 0.361; −0.077; Girls: β = −0.223; 95%CI: 0.358; −0.088). No significant associations between breastfeeding and the “Energy-dense foods” dietary pattern were found. Boys and girls who were offered cereals as a first food during complementary feeding, in comparison with soup, presented lower scores in the “Energy-dense foods” dietary pattern (Boys: β = −0.183; 95%CI: 0.292; −0.074; Girls: β = −0.155; 95%CI: 0.259; −0.050), but only girls presented higher scores in the ‘Fish-based’ dietary pattern (β = 0.137; 95%CI: 0.006; 0.267). The age of introduction of complementary feeding was not significantly associated with the dietary patterns. Parents should be supported in their infant feeding decisions, given the potential effects of breastfeeding duration and first foods at complementary feeding on shaping longer term dietary patterns of young children.

Associations between Cultural Identity, Household Membership and Diet Quality among Native Hawaiian, Pacific Islander, and Filipino Infants in Hawai'i.

Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawaiʻi, ages 3–12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants’ diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization’s minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3–12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6–12 months. Approximately 10% of infants, ages 6–12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawaiʻi.

Neonatal Birthweight, Infant Feeding, and Childhood Metabolic Markers.

Antenatal and early neonatal nutritional environment may influence later metabolic health. Infants of mothers with gestational diabetes mellitus (GDM) have higher risk for childhood obesity and metabolic syndrome (MetS). Leptin and adiponectin are known biomarkers for MetS and may guide interventions to reduce later obesity. We sought to examine the relationship between birthweight, early infancy feeding practices, and biomarkers for MetS in offspring of women with mild GDM. Secondary analysis of a prospective observational follow-up study on the offspring of women who participated in a multicenter randomized treatment trial on mild GDM. Children were evaluated by research coordinators and biospecimens collected at the age of 5 to 10. Plasma concentrations of leptin and adiponectin were compared between large for gestational age (LGA) and average birthweight (AGA) infants, and according to whether solid foods were introduced early (<6 months of age) or at the recommended age (≥6 months of age). Multivariable analysis adjusted for fetal sex, race/ethnicity, and maternal body mass index. Leptin and adiponectin were measured in 336 plasma samples. In bivariate analysis, compared with AGA children, LGA children had lower leptin (5.0 ng/mL [3.6-6.0] vs. 5.8 ng/mL [4.5 = 6.6], p = 0.01) and similar adiponectin (6.3 µg/mL [5.1-7.9] vs. 6.4 µg/mL [5.3-8.6], p = 0.49) concentrations. Maternal/child characteristics were similar between the early/delayed solid feeding groups. Leptin and adiponectin concentrations were similar in the early fed and delayed feeding groups (5.8 ng/mL [4.6-6.7] vs. 5.6 ng/mL [4.2-6.6], p = 0.50 and 6.4 µg/mL [5.4-8.1] vs. 6.4 µg/mL [5.1-8.8], p = 0.85, respectively). After controlling for covariates, children who were LGA and AGA at birth had similar leptin concentrations. Birthweight and early infancy feeding practice are not associated with alterations in leptin and adiponectin in children of women with mild GDM. · Adipocytokines are markers of metabolic status.. · Children of women with mild GDM may be at risk for MetS.. · Biomarkers similar in LGA and AGA groups.. · Biomarkers similar in early and delayed solid-fed groups.. · Nonhuman milk does not modify effect of feeding practice..

Infant Feeding Clusters Are Associated With Respiratory Health and Allergy at School Age in the PARIS Birth Cohort

To identify first year of life feeding cohorts and examine associations between respiratory health and allergy at 8 years of age and infant feeding practices.A total of 3446 infants born in Paris, France, were managed from birth to 8 years of age.Questionnaires were collected at 1,3,6,9, and 12 months of life, focusing on breastfeeding, consumption of infant formula (regular, partially hydrolyzed, extensively hydrolyzed, prebiotics and probiotics, and soy), and solid food introduction. Multidimensional longitudinal cluster analysis was used to place children with similar early feeding practices into 5 cohorts. Standardized questionnaires, physician documentation, lung function, fractional exhaled nitric oxide, and specific immunoglobulin E were collected at 8 years of life. These data were used to identify atopic morbidity correlations between feeding cohorts. Multivariable logistic and linear regression models adjusted for early respiratory and allergic outcomes and parental history of allergy.Participants were grouped into 5 feeding clusters on the basis of early feeding patterns: cluster 1 (45%): mostly regular formula; cluster 2 (27%): exclusively breastfed during the first 3 months; cluster 3: (17%) prebiotic or probiotic formula; cluster 4: (7%) partially hydrolyzed formula, and cluster 5: (4%) extensively hydrolyzed or soy formula. Compared with infants in cluster 1, children fed extensively hydrolyzed or soy formula were more likely to have diagnosis of food allergy (cluster 5). Infants fed partially hydrolyzed formula (cluster 4) had a significant lower lung function (forced expiratory volume in 1 second; forced vital capacity), higher fractional exhaled nitric oxide, and higher risk of allergic sensitization at 8 years of life, compared with that of cluster 1. Compared with infants fed mostly regular formula (cluster 1), infants exclusively breastfed during the first 3 months (cluster 2) had a lower rate of asthma diagnosis.Children breastfeeding at least 3 months in this study had protection against developing asthma and food allergy later in life, compared with other feeding groups. Infants with early partially hydrolyzed formula had higher rates of asthma and atopy at 8 years of age, even while controlling for early respiratory or allergic disease and family history of atopy.This supports previous recommendations regarding breastfeeding and the prevention of atopic conditions. The authors caution pediatricians against recommending hydrolyzed or hypoallergenic formulas universally or on the basis of family history alone and highlight potential future morbidity. This study revealed no benefits in preventing atopic disease with prebiotic or probiotic formulas, although the grouping of multiple different types of these formulas in 1 heterogenous group is a significant study limitation. The mechanisms underlying these results deserve further study.

Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants.

Early enteral feeding practices are potentially modifiable risk factors for necrotising enterocolitis (NEC) in very preterm or very low birth weight (VLBW) infants. Observational studies suggest that conservative feeding regimens, including slowly advancing enteral feed volumes, reduce the risk of NEC. However, it is unclear whetherslow feed advancement may delay establishment of full enteral feeding, andif itcould be associated with infectious morbidities secondary to prolonged exposure to parenteral nutrition. To determine the effects of slow rates of enteral feed advancement on the risk of NEC, mortality, and other morbidities in very preterm or VLBW infants. We searched CENTRAL (2020, Issue 10), Ovid MEDLINE (1946 to October 2020), Embase via Ovid (1974 to October 2020), Maternity and Infant Care database (MIDIRS) (1971 to October 2020), CINAHL (1982 to October 2020), and clinical trials databases and reference lists of retrieved articles for eligible trials. We included randomised or quasi-randomised controlled trials that assessed effects of slow (up to 24 mL/kg/d) versus faster rates of advancement of enteral feed volumes on the risk of NEC in very preterm or VLBW infants. Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence. Outcomes of interest were NEC, all-cause mortality, feed intolerance, and invasive infection. We included 14 trials involving a total of 4033 infants (2804 infants participated in one large trial). None of the trials masked parents, caregivers, or investigators. Risk of bias was otherwise low. Most infants were stable very preterm or VLBW infants of birth weight appropriate for gestation. About one-third of all infants were extremely preterm or extremely low birth weight (ELBW), and about one-fifth were small for gestational age, growth-restricted, or compromised as indicated by absent or reversed end-diastolic flow velocity in the foetal umbilical artery. Trials typically defined slow advancement as daily increments of 15 to 24 mL/kg, and faster advancement as daily increments of 30 to 40 mL/kg. Meta-analyses showed that slow advancement of enteral feed volumes probably has little or no effect on the risk of NEC (RR 1.06, 95% confidence interval (CI) 0.83 to 1.37; RD 0.00, 95% CI -0.01 to 0.02; 14 trials, 4026 infants; moderate-certainty evidence) or all-cause mortality prior to hospital discharge (RR 1.13, 95% CI 0.91 to 1.39; RD 0.01, 95% CI -0.01 to 0.02; 13 trials, 3860 infants; moderate-certainty evidence). Meta-analyses suggested that slow advancement may slightly increase feed intolerance (RR 1.18, 95% CI 0.95 to 1.46; RD 0.05, 95% CI -0.02 to 0.12; 9 trials, 719 infants; low-certainty evidence) and may slightly increase the risk of invasive infection (RR 1.14, 95% CI 0.99 to 1.31; RD 0.02, 95% CI -0.00 to 0.05; 11 trials, 3583 infants; low-certainty evidence). The available trial data indicate that advancing enteral feed volumes slowly (daily increments up to 24 mL/kg) compared with faster rates probably does not reduce the risk of NEC, death, or feed intolerance in very preterm or VLBW infants. Advancing the volume of enteral feeds at a slow rate may slightly increase the risk of invasive infection.

Children are victims of industrialization and commercialization of early feeding practices: A review of obesity in preschool children in Egypt

Introduction: Obesity Is Global Problem Which Begins From Early Childhood. Early Exclusive Breastfeeding (EBF) without foods or Milk Formula (MF) before 6 months, with continued breastfeeding for two years are optimal feeding practices. Aim: To review studies conducted to assess the nutritional status of preschool children with a focus on obesity and stunting and their association with EBF vs MF feeding. Methods: We used online search engines of the Egyptian university libraries consortium (www.eulc.edu) to search for studies on overweight, obesity stunting and wasting in preschool children. We identified 919 theses that were filtered to 32 studies then to 18 theses fitting the criteria of the study. Analysis of the pooled data was done for the studies with children who were EBF (2 studies) vs children who were exposed to MF (16 studies) by age and sex. Findings: Pooled analysis for children aged 6-59 months among MF vs. EBF studies as follows: overweight 5.4% vs. 3.45%, obesity 13.8% vs. 5.65%, stunting 21.6% vs. 1.15% and wasting 9.7% vs. 0.85% respectively. Obesity and overweight were higher in males in both studies, whereas stunting and wasting were higher in females in both studies (ages 0-72 months). Early and extended MF feeding, foods before 6 months of life, chips and canned drinks were prominent risk factors for obesity. Large family size was associated with obesity and short birth interval with stunting. Colostrum feeding, longer duration of breastfeeding, fruits and vegetables were protective. Obese children showed clinical signs of anemia, vitamin A and D deficiency, severe asthma and developmental delay. Conclusions: Obesity and MF feeding beyond 6 months and well into 5 years of age threaten child health. Policies and legislations are needed to control, counter and monitor marketing tactics supported by guiding messages. Keywords: Obesity; overweight; stunting; wasting; fast foods; breastfeeding; birth spacing; child development; infancy; preschool children; anthropometry; growth.

A qualitative study of providers\u2019 perceptions of parental feeding practices of infants and toddlers to prevent childhood obesity

BackgroundWith a recent focus on establishing US Dietary Guidance for children ages 0 to 2 years old, the objective of this qualitative study was to determine misconceptions and barriers that prevent parents from implementing early childhood feeding and obesity prevention practices as reported by healthcare, community-based, and education providers.MethodsTrained researchers conducted one-on-one qualitative phone interviews, using a semi-structured script, with early childhood health and education providers working with families of young children. Interviews were audiotaped, transcribed verbatim, and analyzed using the classic analysis approach. Transcripts were coded by researchers and analyzed for themes.ResultsProviders (n = 21) reported commonly observed obesogenic practices including overfeeding tendencies, early initiation of solids or less optimal feeding practices, lack of autonomy and self-regulation by child, and suboptimal dietary patterns. Sources of parental misconceptions about feeding were often related to cultural, familial, and media influences, or lack of knowledge about optimal feeding practices for infants or toddlers.ConclusionsProviders indicated a need for engaging and consistent child feeding and obesity prevention education materials appropriate for diverse cultural and literacy levels of parents, with detailed information on transitioning to solid foods. Early education and community-based providers reported limited access to evidence-based educational materials more so than healthcare providers. It is an opportune time to develop reputable and evidence-based child feeding guidance that is readily available and accessible for parents of infants and toddlers to prevent early childhood obesity.

Associations of Feeding Practices in Early Life and Dietary Intake at School Age with Obesity in 10- to 12-Year-Old Arab Children.

Understanding the role in pediatric obesity of early life feeding practices and dietary intake at school age is essential for early prevention. The study aimed to examine associations of early life feeding practices, environmental and health-related exposures, and dietary intake at school age as determinants of obesity in children aged 10–12 years. In an earlier study of 233 healthy infants in two Arab towns in northern Israel, neonatal history, feeding practices, and health information were obtained up to age 18 months. This follow-up study assessed dietary intake and anthropometric measurements at age 10–12 years using the 24 h recall method. Overall, 174 children participated in this study. Almost all (98%) the children were breastfed. The prevalence of obesity at school age was 42%. A multivariable model adjusted for energy intake and socioeconomic status showed positive associations of total fat intake and of weight-for-height z score, but not feeding practices in infancy, with obesity. Higher gestational age at birth was associated with lower odds of obesity at age 10–12 years. In conclusion, in a population with near universal breastfeeding, gestational age at birth, weight indicators but not feeding practices in infancy, and total fat intake at school age were associated with increased likelihood of obesity.

Do Early Infant Feeding Practices and Modifiable Household Behaviors Contribute to Age-Specific Interindividual Variations in Infant Linear Growth? Evidence from a Birth Cohort in Dhaka, Bangladesh

ABSTRACTBackgroundCauses of infant linear growth faltering in low-income settings remain poorly understood. Identifying age-specific risk factors in observational studies might be influenced by statistical model selection.ObjectivesTo estimate associations of selected household factors and infant feeding behaviors within discrete age intervals with interval-specific changes in length-for-age z-scores (LAZs) or attained LAZ, using 5 statistical approaches.MethodsData from a birth cohort in Dhaka, Bangladesh (n = 1157) were analyzed. Multivariable-adjusted associations of infant feeding patterns or household factors with conditional LAZ (cLAZ) were estimated for 5 intervals in infancy. Two alternative approaches were used to estimate differences in interval changes in LAZ, and differences in end-interval attained LAZ and RRs of stunting (LAZ < −2) were estimated.ResultsLAZ was symmetrically distributed with mean ± SD = −0.95 ± 1.02 at birth and −1.00 ± 1.04 at 12 mo. Compared with exclusively breastfed infants, partial breastfeeding (difference in cLAZ: −0.11; 95% CI: −0.20, −0.02) or no breastfeeding (−0.30; 95% CI: −0.54, −0.07) were associated with slower growth from 0 to 3 mo. However, associations were not sustained beyond 6 mo. Modifiable household factors (smoking, water treatment, soap at handwashing station) were not associated with infant growth, attained size, or stunting. Alternative statistical approaches yielded mostly similar results as conditional growth models.ConclusionsThe entire infant LAZ distribution was shifted down, indicating that length deficits were mostly caused by ubiquitous or community-level factors. Early-infant feeding practices explained minimal variation in early growth, and associations were not sustained to 12 mo of age. Statistical model choice did not substantially alter the conclusions. Modifications of household hygiene, smoking, or early infant feeding practices would be unlikely to improve infant linear growth in Bangladesh or other settings where growth faltering is widespread.

A qualitative study of cognitive, behavioral, and environmental influences on Hispanic mothers’ early childhood feeding practices

Young children's lifestyle behaviors are largely shaped by their parents. There are socioeconomic risk factors particular to Hispanic populations that influence the way parents feed their children. As obesity continues to be a public health issue with substantial inequities across race and ethnicity, it is critical to understand Hispanic parents' food choices and feeding practices. The objective of this qualitative study is to identify the behavioral, environmental, and cognitive factors that influence the parental food choices and feeding behaviors of Hispanic mothers of children ages 0–5 years. Snowball sampling was used to recruit participants from the community (n = 30) who were 1) female; 2) Hispanic; 3) over the age of 18; and 4) a mother to child(ren) between the ages zero and five. Each interview consisted of a brief demographic survey and a set of open-ended questions based on Social Cognitive Theory constructs. A thematic analysis using a combined deductive and inductive approach was used to analyze transcriptions. Results indicated that mothers' attitudes around breastfeeding were connected with their challenges, while their attitudes around solid foods were expressed in their feeding strategies. Mothers used strategies of modeling, repeated exposure, and practices of “sneaking” in healthy foods and bribing to promote healthy eating. Mothers were most likely to seek out information from (1) pediatricians, (2) female family members, and (3) the internet. Hispanic mothers actively seek out information from many different sources that impact how they feed their young children. Understanding their trusted sources and how it influences the SCT constructs is an important step in preventing early childhood obesity.

Early breastfeeding and complementary feeding in Ethiopia: cross-sectional data from implementation of nutrition programming on regional inequalities

Improving nutrition for young children remains an urgent priority globally. Ethiopia has made great strides over the last two decades in improving health and nutrition for children. The task of scaling improved nutrition services now turns to addressing progress on the regional level. This research sought to highlight regional disparities identified in scaling nutrition services for child nutrition in Ethiopia, by identifying variations in early breastfeeding and child feeding practices and associated socio-demographic characteristics by geographic area in four regions of the country. The cross-sectional study data derived from an evaluation of nutrition services and programming and included 1299 participants, of whom 50% reported practicing recommended early breastfeeding practices. This varied from less than 8% in one zone of Afar region to 84% in a zone of Tigray, with differences also noted by socio-demographic characteristics. Among the total sample, 70% of respondents met the recommendation for minimum number of feedings per day, and 16% met the recommendation for dietary diversity. Less than 8% of families in the service population in Northwestern Tigray zone met the dietary diversity recommendation compared to 36% in South Wollo, Amhara region. Utilizing regional and zonal data will allow for government and other agencies involved in improving nutrition and health outcomes to appropriately provide services and programs for families and children over the life course.

Early childhood factors associated with obesity at age 8 in Vietnamese children: The Young Lives Cohort Study

BackgroundOver recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8.MethodsThis study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organization’s thresholds for body-mass-index (BMI) for age Z-scores. Associations between early and concurrent socio-behavioral factors, childhood nutrition and physical activity variables were analyzed using STATA 15. Bivariate and multivariable analyses were completed utilizing logistic regression models.ResultsThe prevalence of ow/ob increased from 1.1% in both sexes at age 1 to 7% in females and 13% in males at age 8. Bivariate analyses show greater likelihood of ow/ob at age 8 was significantly associated with early life sociodemographic factors (at age 1), male sex (OR = 2.2, 1.6–3.1), higher wealth (OR = 1.1–1.4), and urban residence (OR = 4.3, 3–6). In adjusted analyses, ow/ob at age 8 was associated with early nutrition practices at age 5, including frequent consumption of powdered milk (OR = 2.8, 1.6–4.6), honey/sugar (OR = 2.7, 1.8–4.1), prepared restaurant/fast foods (OR = 4.6, 2.6–8.2), and packaged sweets (OR = 3.4, 2.3–4.9). In addition, breastfeeding for 6 months or longer was protective against obesity at age 8 (OR = 0.3, 0.1–0.9).ConclusionsWe found that increased consumption of powdered milk, honey/sugar, packaged sweets, and prepared restaurants/fast foods are associated with childhood ow/ob. In contrast, breastfeeding for 6 months or longer was protective against childhood ow/ob. These findings suggest that public health programs and campaigns aimed to prevent childhood ow/ob in Vietnam should target early feeding practices.

Enacting the Code by effective national laws influence trends in exclusive breastfeeding: An analytical study from the Eastern Mediterranean Region

Introduction: The marketing of breast milk substitutes (MBMSs) is presumed to be associated with declines in breastfeeding practices. National laws to control the MBMS are expected to improve exclusive breastfeeding (EBF) and continued breastfeeding (CBF) rates. Aim: This study aims to study the effect of national laws that control MBMS on EBF and CBF trends in the Eastern Mediterranean Region (EMR) countries. Methods: EMR infant feeding data for EBF and CBF were derived from the Global Database of the United Nations International Children’s Emergency Fund/World Health Organization (WHO). Data for the code of MBMS came from the WHO report in 2020. Percent change in EBF and CBF over the past 3 decades was correlated with scores given to the national laws according to their coverage of the provisions under the code. Results: Percent change in EBF correlated significantly with the total score given to national laws (r0.8; p&lt;0.001) and with provisions for monitoring and enforcement, promotion to the general public, and engagement with health workers and health systems (p&lt;0.05). CBF rates did not correlate with any of the scores for the national laws. Duration of the national law correlated with monitoring and enforcement (p&lt;0.05). Conclusion: MBMS is the main drive for low EBF rates. National laws can directly influence early feeding practices only when all the provisions under the code are covered. National laws need to cover the code in its entirety.

Infant feeding practices and later parent-reported feeding difficulties: a systematic review.

Early feeding practices may influence the acceptance of new foods and contribute to the development of feeding difficulties later in childhood. The aim of this systematic review was to evaluate the association of breastfeeding duration, timing of complementary feeding introduction, and feeding techniques with feeding difficulties or their subtypes, namely picky or fussy eating, food refusal, and food neophobia, in children older than 1 year of age. Guidance from the Cochrane Collaboration and the Centre for Reviews and Dissemination was followed. MEDLINE, Embase, and PsycINFO databases were searched up to December 2019. Additionally, references from included articles were screened. Interventional and observational studies were eligible. Of the 3653 records obtained after the search strategy was applied, 21 observational studies (cohort, case-control, cross-sectional), many with important methodological limitations, and 1 randomized controlled trial were included. Three authors extracted data independently. Results were synthesized narratively. Twelve observational studies assessed the association of breastfeeding duration with parent-reported feeding difficulties. Longer duration of breastfeeding tended to be associated with fewer childhood feeding problems in the majority of studies, but the differences were often small and not significant. Eight observational studies that examined the timing of complementary feeding introduction in relation to parent-reported feeding difficulties showed inconsistent results. Baby-led weaning, as compared with spoon-feeding, was significantly associated with less fussiness at age 12 to 36 months in 1 of 5 studies. This review showed no strong evidence to support the hypothesis that early feeding practices contribute significantly to specific parent-reported feeding difficulties in children older than 1 year of age. Additional methodologically rigorous studies are needed to confirm these findings. PROSPERO registration number CRD42018115792.

Effects of Long-Term Malnutrition on Education Outcomes in Ghana: Evidence from a Panel Study

Aside the direct effect on GDP at the macro level, the microeconomic impacts of undernutrition are also manifested in lower educational outcomes, reduced productivity and reduced lifetime earnings. This study sought to examine the effect of child malnutrition on learning outcomes by exploiting a nationally representative panel data which allow us to control for child-level unobserved heterogeneity in Ghana. Using a random-effects and Poisson estimations, this study shows that while current malnutrition affects children’s learning outcomes negatively, its effect may disappear in the future, especially with the implementation of appropriate interventions. The study concludes that while nutrition matters for learning outcomes, so do other educational inputs. Results are, however, differentiated by individual and household characteristics, including gender and locality. The evidence from this study serves as a useful tool for improving policies and programmes that focus on early feeding practices among pre-schoolers and improved nutrition of children of school-going age.

Early Infant Feeding Practices Among Mothers of Southeast Nigeria

Background: The promotion of optimal infant feeding practices is the most cost-effective of all interventions to reduce infant mortality. In spite of the recommendation of the WHO for optimal breastfeeding practices, several studies in Nigeria on early infant feeding practices have indicated a need for continuous auditing of feeding practices among mothers to make improvements. Objective: This study evaluated the early infant feeding practices of mothers and associated factors. Methods: A cross-sectional, descriptive, multi-centre, questionnaire-based survey was conducted among 2,287 mother-infant pairs in 13 Baby Friendly Hospitals in Southeast Nigeria. Results: The rate of early initiation of breastfeeding [EIBF] within the first one hour of birth was 22.9%, while the exclusive breastfeeding [EBF] rate was 39.3%. The main deterrent to EBF was early introduction of water [94.0%], formula [40.9%] and complementary feeds [85.7%]. There was a statistically significant difference [p<0.001] between the nutritional status of the exclusively breastfed infants and those non-exclusively breastfed, with moderate underweight, and severe underweight malnutrition in the non-exclusively breastfed group. Sociodemographic factors associated with EBF were infant’s birth order [p<0.001], maternal age [p=0.010], mother’s and spouse’s education [p<0.001 and p<0.001], mother’s and spouse’s occupation [p<0.001 and p<0.001]. Conclusion: Policies and measures to promote hospital deliveries targeting all mothers, with special focus on the poor, rural, working, and primiparous mothers, should become a top priority to improve the rate of EIBF. Promotion of EBF with emphasis on the dangers of early introduction of water, formula and complementary feeding should be intensified.

Echocardiography of the right ventricle in infancy: Do early feeding practices make a difference?

Background: It is important to understand the role of various feeding practices during infancy on the development of the cardiac structures, to intervene early with the prevention of cardiovascular disease. Aim: The aim of the study was to compare the structures and functions of the right side of the heart in exclusively breastfed (EBF) and formula-fed (FF) babies in the 1st year of life. Methods: A cross-sectional study was conducted for 76 healthy infants aged 3–24 months of life of whom 38 were EBF and 38 were FF in the first 6 months of life. The right ventricular functions and dimensions of the chamber were assessed by echocardiography. The measurements included percent fractional shortening (%FS), right ventricular velocity time integral (RV-VTI), cardiac output, and tricuspid annular plane systolic excursion (TAPSE), e prime, and s prime. Results: Mean values of %FS for the right side were significantly higher in EBF infants in 51.33±5.20 than in FF infants (49.22±3.75) at p&lt;0.05. There was a significant increase in mean RV VTI values in EBF infants (17.2±2.73) than FF infants (15.9±1.94) p&lt;0.01. We noticed a significant increase (Cardiac Output) in EBF infants (5.81±1.01) than FF infants (5.26±1.18). TAPSE was significantly higher in EBF infants (1.56±0.18) than FF infants (1.46 ±0.20) at p&lt;0.05. Conclusion: EBF in infancy supports the higher performance of the right side of the heart in infancy.