Formula Feeding Research Articles

Gut Microbiota-Derived 5-Hydroxyindoleacetic Acid Alleviates Diarrhea in Piglets via the Aryl Hydrocarbon Receptor Pathway.

With the improvement in sow prolificacy, formula feeding has been increasingly used in the pig industry. Diarrhea remains a serious health concern in formula-fed (FF) piglets. Fecal microbiota transplantation (FMT) is an efficacious strategy to reshape gut microbiota and the metabolic profile for treating diarrhea. This study aims to investigate whether FMT from breast-fed piglets could alleviate diarrhea in FF piglets. The piglets were randomly assigned to the control (CON) group, FF group, and FMT group. Our results showed that FF piglets exhibited a higher diarrhea incidence, damaged colonic morphology, and disrupted barrier function. In contrast, FMT treatment normalized the morphology and barrier function. FMT suppressed the JNK/MAPK pathway and production of proinflammatory cytokines. Additionally, FF piglets had a lower abundance of the beneficial bacterial genus Bifidobacterium compared to CON piglets. Following FMT administration, Bifidobacterium was restored. Meanwhile, 5-HIAA, a metabolite of tryptophan, and AHR-responsive CYP1A1 and CYP1B1 were upregulated. Importantly, integrated multiomics analysis revealed a strong positive correlation between Bifidobacterium and 5-HIAA. In vitro, 5-HIAA supplementation reversed the LPS-induced disruption of tight junctions and production of proinflammatory cytokines in IPEC-J2 cells. In conclusion, FMT reduced diarrhea incidence and improved growth performance. The alleviative effect of FMT on diarrhea was associated with Bifidobacterium and 5-HIAA.

THU313 Lactation As A Possible Protective Factor For Postpartum Diabetes In Women With Gestational Diabetes Mellitus: A Retrospective Analysis

Abstract Disclosure: V.R. Dávila-Parrilla: None. C. Stanton: None. C. Hackerson: None. H. Song: None. J.R. Hens: None. J.J. Wysolmerski: None. A. Merriam: None. R. Belfort De Aguiar: Research Investigator; Self; Fractyl Laboratories. Gestational diabetes mellitus (GDM) is associated with a variety of health issues for the developing babies, and it has long-term implications to the mother’s health such as increased risk of Type 2 Diabetes Mellitus (T2DM). Prior studies have shown that lactation appears to protect women with GDM against development of T2DM. A retrospective analysis was performed to better characterize the population of women with GDM seen at the Yale New Haven Hospital (YNHH) and evaluate the potential effects of lactation on postpartum diabetic/pre-diabetic status. We hypothesized that mothers who chose exclusive lactation would have an improvement in postpartum oral glucose tolerance test (OGTT) results when compared to those who chose exclusive formula feeding or a combination of both. Medical records of 71 women with GDM followed at the Maternal-Fetal Clinic (MFM) with singleton and who delivered at YNHH were identified and data were collected from chart review. All women were scheduled for a ∼6-8 weeks postpartum visit. Of these, 55 (77%) attended their visit and completed an OGTT. Their average age was 33±5 y.o, pre-pregnancy BMI was 33.8±7.1 and post-partum BMI was 31.1±10.7 kg/m². Racial distribution was: 62% Caucasian, 18% African American, 13% Asian women and a 7% chose “not listed” category. During pregnancy, patients’ GDM was treated with dietary modifications only (45.5%), insulin (45.5%) or metformin (9.1%). When looking at preferred infant feeding practices, 44% of mothers chose exclusive lactation, 27% formula fed exclusively, and 29% preferred using mixed feeding (both formula and lactation). A significant difference was found when comparing infant feeding practice by race with 50% Caucasian choosing exclusive lactation in contrast to 15% of African American (P=0.056). There were no significant differences in BMI pre-pregnancy and postpartum between groups when sorting by infant feeding practices. However, BMI at the time of post-partum OGTT was higher in women that did not lactate in comparison to the women that exclusively formula fed (28.9±13, 36.1±6.7, P=0.05). Based on post-partum OGTT, 71% normalized to healthy status while 22% were diagnosed with pre-DM and 7% T2DM. No significant differences in fasting and 2-hour glucose levels were observed when comparing infant feeding practices. DM status was not affected by race or BMI. We observed that almost one third of the women with GDM that came to the 6–8-week postpartum OGTT remained pre-diabetic/diabetic and no beneficial effect of lactation in glucose metabolism was noted. We speculate that longer duration of lactation is needed for the protective effects of lactation in preventing dysglycemia to be noted. Presentation: Thursday, June 15, 2023

SAT261 Hypervitaminosis A With Hypercalcemia Without Overtly Excessive Vitamin A Intake

Abstract Disclosure: C. Chiou: None. B. Greck: None. Background: Hypervitaminosis A (hypervitA) is an uncommon cause of hypercalcemia and is due to excessive intake of preformed vitamin A (vitA), i.e., retinoids, especially in emulsified form, a common preparation in supplement. In contrast, provitamin (carotenoids) does not cause hypervitA due to limit in absorption and conversion to vitA. The tolerable upper intake level (UL) and recommended dietary allowance (RDA) of vitA for adult are 3000 and 700 (female) - 900 (male) mcg retinoid activity equivalent (RAE) respectively. While daily intake of vitA > UL carries risk of chronic toxicity, there are reports of hypervitA with chronic intake of vitA below UL. VitA is mainly stored in hepatic stellate cells (HSC). Liver injury can induce HSC to transform, releasing vitA, and losing capacity of vitA storage. Renal insufficiency is known with higher vitA levels in blood. Potentially, the threshold of vitA toxicity from supplement is much less in conditions with hepatic and/or renal disease. Here we report a case without history of excessive vitA intake developed hypervitA in relatively short period of time after hospitalization while in the acute and long-term care unit. Clinical Case: A 57-year male was hospitalized for alcohol related pancreatitis. It was complicated by sepsis, multi-organ failure requiring respirator, parenteral nutrition and/or tube feeding. Mild hypercalcemia was noted 4 weeks after admission, initially intermittently, then persistently and progressively higher, peak of 12.6 mg/dL at 4 months after admission. Prior calcium levels were low or normal up to 6 years before admission. Evaluation of hypercalcemia found low i-PTH, low 1,25-D, hypercalciuria, negative serum protein electrophoresis, and normal PTH-related protein. VitA was surprisingly elevated at 137 [38-98] mcg/dL. Nutritional intake was reviewed. No history of excessive vitA intake. Patient was on total parenteral nutrition (TPN) and/or tube feeding most of time, the range and average of daily preformed vitA supplement from admission to onset of hypercalcemia were 0-1309 and 1006 mcg RAE respectively; while from onset to peak of hypercalcemia, 0-3327 and 1891 mcg RAE respectively. The maximal daily preformed vitA via TPN is 1000 mcg RAE. All preformed vitA in tube feeding is from original formula without extra addition. After discovery of hypervitA, feeding formula was changed to one containing much less preformed vitA, and hypercalcemia slowly improved. Conclusion: HypervitA can develop relatively easily with tube feeding and/or parenteral nutrition with average daily preformed vitA above RDA but way below UL in a susceptible patient. In patients with liver disease and/or renal insufficiency, careful selection of feeding formula and/or nutritional supplement regarding content of preformed vitA, and alert to potential development of hypervitA are advisable. Presentation: Saturday, June 17, 2023

Breast feeding in infants diagnosed with phenylketonuria (PKU): a scoping review

BackgroundPhenylketonuria (PKU) is the most common inherited disease of amino acid metabolism, characterised by elevated levels of phenylalanine (Phe). There is a lack of infant feeding guidance for those with...

‘At the breast is best?’ A corpus-informed feminist critical discourse analysis of the marginalisation of expressing human milk in online infant feeding promotional discourse

Existing feminist analyses of infant feeding practices have examined the promotion of long-term exclusive direct breastfeeding (DBF) as symbolic of “total motherhood” (Wolf 2011), where formula feeding is framed in contrast as “risky” (Murphy 1999, 2000; Brookes et al 2016; Woollard 2018). Discourses of expressing human milk (EHM), and their discriminatory potential, are currently under-researched. However, researchers note that rhetorical strategies that exclude EHM as a form of breastfeeding can reinforce the perceived normalcy of feeding at the breast and relegate breastmilk expression and formula feeding as “deviant” practices (Murphy 1999; Hunt and Thomson 2017; Rasmussen et al., 2017; Coffey-Glover, 2020; Anders et al 2022).To that end, this study integrates Feminist Critical Discourse Analysis (Lazar 2005, 2007, 2014) and corpus linguistics (e.g. Baker 2014) to examine discourses of breastmilk expression (EHM) in a corpus of online infant feeding promotional literature taken from seven organisations, with a particular focus on the largest two organisations in the corpus: La Leche League Great Britain (LLLGB) and the UK National Health Service (NHS). The analysis reveals language choices that marginalise EHM in servitude of “breast is best” (Murphy 1999), and specifically reinforce the message that ‘at the breast is best’. We show how EHM is marginalised in the texts via representations of exclusive DBF as the ‘gold standard’ of infant feeding, recirculating discourses of “total motherhood” (Wolf 2011), “natural mothering” (Bobel 2003) and “intensive motherhood” (Hays 1996).

Comparison between Breast Feeding and Formula Feeding in Neonates with Idiopathic Hyperbilirubinemia

Comparison between Breast Feeding and Formula Feeding in Neonates with Idiopathic Hyperbilirubinemia

Cornering the Market on Maternal Affect: A Discourse Analysis of a Social Media Marketing Campaign for Infant Formula

Breastfeeding advocates and global health agencies have been sounding alarms about the dangers of digital marketing practices of the formula-feeding industry. This study comprised a feminist discourse analysis of materials produced (blog, social media posts, comments) in a paid partnership between baby formula brand Enfamil and an influencer, Marilou Bourdon from Trois fois par jour. Our analysis reveals a sophisticated marketing campaign that co-opts feminist critiques of breastfeeding promotion discourse while carefully avoiding explicitly violating the International Code of Marketing of Breast-milk Substitutes. Underlying this campaign is a rhetoric reliant on pathos to assuage maternal guilt and shame for feeding formula.

Prebiotics in New-Born and Children's Health.

At present, prebiotics, like probiotics, are receiving more attention as a promising tool for health maintenance. Many studies have recognized the role of prebiotics in preventing and treating various illnesses including metabolic disorders, gastrointestinal disorders, and allergies. Naturally, prebiotics are introduced to the human body in the first few hours of life as the mother breastfeeds the newborn. Prebiotic human milk oligosaccharides (HMOs) are the third largest constituent of human breastmilk. Studies have proven that HMOs modulate an infant's microbial composition and assist in the development of the immune system. Due to some health conditions of the mother or beyond the recommended age for breastfeeding, infants are fed with formula. Few types of prebiotics have been incorporated into formula to yield similar beneficial impacts similar to breastfeeding. Synthetic HMOs have successfully mimicked the bifidogenic effects of breastmilk. However, studies on the effectiveness and safety of consumption of these synthetic HMOs are highly needed before massive commercial production. With the introduction of solid foods after breastfeeding or formula feeding, children are exposed to a range of prebiotics that contribute to further shaping and maturing their gut microbiomes and gastrointestinal function. Therefore, this review evaluates the functional role of prebiotic interventions in improving microbial compositions, allergies, and functional gastrointestinal disorders in children.

Infants exposed in utero to Hurricane Maria have gut microbiomes with reduced diversity and altered metabolic capacity.

The gut microbiome is a potentially important mechanism that links prenatal disaster exposures with increased disease risks. However, whether prenatal disaster exposures are associated with alterations in the infant's gut microbiome remains unknown. We established a birth cohort study named Hurricane as the Origin of Later Alterations in Microbiome (HOLA) after Hurricane Maria struck Puerto Rico in 2017. We enrolled vaginally born Latino term infants aged 2 to 6 months, including n = 29 infants who were exposed in utero to Hurricane Maria in Puerto Rico and n = 34 infants who were conceived at least 5 months after the hurricane as controls. Shotgun metagenomic sequencing was performed on infant stool swabs. Infants exposed in utero to Hurricane Maria had a reduced diversity in their gut microbiome compared to the control infants, which was mainly seen in the exclusively formula-fed group (P = 0.02). Four bacterial species, including Bacteroides vulgatus, Clostridium innocuum, Bifidobacterium pseudocatenulatum, and Clostridium neonatale, were depleted in the exposure group compared to the control group. Compositional differences in the microbial community and metabolic genes between the exposure and control groups were significant, which were driven by the formula feeding group (P = 0.02 for the microbial community and P = 0.008 for the metabolic genes). Metabolic modules involved in carbohydrate metabolism were reduced in the exposure group. Prenatal maternal exposure to Hurricane Maria was associated with a reduced gut commensal and an altered microbial composition and metabolic potential in the offspring's gut. Breastfeeding can adjust the composition of the gut microbiomes of exposed infants. IMPORTANCE Climate change is a serious issue that is affecting human health. With more frequent and intense weather disasters due to climate change, there is an urgent need to evaluate and understand the impacts of prenatal disaster exposures on the offspring. The prenatal stage is a particularly vulnerable stage for disease origination. However, the impact of prenatal weather disaster exposures on the offspring's gut microbiome has not been evaluated. Our HOLA study starts to fill this knowledge gap and provides novel insights into the microbiome as a mechanism that links prenatal disaster exposures with elevated disease risks. Our major finding that reduced microbial diversity and altered metabolic capacity are associated with prenatal hurricane exposures warrants further studies to evaluate the impact of weather disasters on the unborn.

Measures for the Prevention of Mother-to-Child Human T-Cell Leukemia Virus Type 1 Transmission in Japan: The Burdens of HTLV-1-Infected Mothers.

The main mode of mother-to-child transmission of the human T-cell leukemia virus (HTLV)-1 is through breastfeeding. Although the most reliable nutritional regimen to prevent HTLV-1 transmission is exclusive formula feeding, a recent meta-analysis revealed that short-term breastfeeding within 90 days does not increase the risk of infection. The protocol of the Japanese Health, Labor, and Welfare Science Research Group primarily recommended exclusive formula feeding for mothers who are positive for HTLV-1. However, there has been no quantitative research on the difficulties experienced by HTLV-1-positive mothers in carrying out these nutritional regimens, including the psychological burden. Therefore, this review was performed to clarify the burdens and difficulties encountered by mothers who are positive for HTLV-1; to this end, we analyzed the data registrants on the HTLV-1 career registration website "Carri-net" website. The data strongly suggest that it is not sufficient to simply recommend exclusive formula feeding or short-term breastfeeding as a means of preventing mother-to-child transmission; it is important for health care providers to understand that these nutritional regimens represent a major burden for pregnant women who are positive for HTLV-1 and to provide close support to ensure these women's health.

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context.

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.

Breastfeeding and Environmental Consciousness: A Narrative Review of Environmental Implications and Potential Contributions to Reduce Waste and Energy Consumption.

Breastfeeding is a natural and essential process that not only confers numerous health benefits to infants and mothers but also plays an important role in environmental sustainability. This narrative review explores the environmental implications of breastfeeding in comparison to formula feeding and examines the potential contributions of breastfeeding to reduce waste, energy consumption, and carbon footprint. By exploring the existing literature and research findings, this review sheds light on how breastfeeding aligns with environmental conservation efforts and reinforces the importance of promoting breastfeeding practices for a more sustainable and environment-friendly future.

31 Iron Deficiency in Formula-fed Very Preterm Infants: Do We Need to Revise Recommendations for Iron Supplementation?

Abstract Background Preterm infants are at risk for iron deficiency (ID). The Canadian Paediatric Society (CPS) recommends iron supplementation of 2 to 3mg/kg/day for breastfed (BF) preterm infants born <2 kg. Additional iron supplementation is not recommended if these infants are primarily formula-fed (FF) with iron-rich formula, since formula is thought to provide enough iron. However, these recommendations are not universally accepted. Objectives To investigate how feeding type influences the iron status of very preterm infants (VPI) at 4 to 6 months corrected age. Design/Methods A retrospective population-based cohort study was conducted using a provincial database of all VPI (<31 weeks gestational age) born in Nova Scotia from 2005-2018. Information about feeding type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. Two groups were compared using chi-square and unpaired t-tests. Results 392 infants were studied (gestational age: 23-30 weeks). Of these, 285 were exclusively FF with iron-rich formula, and 107 were exclusively or partially BF. Neonatal variables were comparable between the two groups. An elemental iron intake of >2 mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were less likely to receive additional iron supplements. However, total iron intake (from formula and supplements) was higher in FF infants. Despite this, 36.8% of infants in FF group developed ID, versus 20.6% in the BF group (Table 1). Conclusion Most VPI fail to receive elemental iron of >2 mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than in BF infants, despite higher iron intake. Our findings do not support the current CPS guidelines.

32 Risk Factors for Iron Deficiency in Formula-fed very Preterm Infants: A Population-based Study from Nova Scotia

Abstract Background Iron prophylaxis is routinely recommended for preterm infants, as they are vulnerable to develop iron deficiency (ID). Recent work from our group has demonstrated that despite early iron prophylaxis, ID is common in very preterm infants (VPI), with an incidence of 32% at 4 to 6 months corrected age (CA). Additionally, ID is more prevalent in exclusively formula-fed (FF) VPI compared to infants who are exclusively or partially breast-fed. Objectives To explore the risk factors associated with ID in the FF infants. Design/Methods A retrospective population-based cohort study was conducted using a provincial database. All VPI born in Nova Scotia from 2005 to 2018 who were exclusively fed with iron-rich formula (>10 mg/L) at 4 to 6 months CA were included. Information about formula type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin <20 and <12 mcg/L at 4- and 6-months CA, respectively. Results ID was present in 36.8% (105) of 285 FF infants. Table 1 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were lower in the ID group. More babies in the ID group received blood transfusion (Odds:1.1-3.0). Other maternal and neonatal variables were comparable between the groups. ID children did not have a lower iron intake than non-ID children. Conclusion Lower gestational age, lower birth weight, and need for blood transfusions increased the risk of ID in FF infants. Optimal iron supplementation in this population should be guided by a risk-adapted strategy.

Infant feeding as a transgressive practice in the context of HIV in the UK: A qualitative interview study

HIV transmission risk via breastfeeding is greatly reduced by antiretroviral therapy but is not zero. Current UK guidelines recommend exclusive formula feeding; however, women can breastfeed if they meet certain criteria. We examine the narrative accounts of mothers with HIV (pregnant or recently given birth) who navigated divergent cultural and national policy norms regarding infant feeding.Mothers with HIV, the majority of whom in the UK are of Black African ethnicity, face a complex decision regarding infant feeding, which has implications for their sense of identity, belonging and citizenship. While the UK has one of the lowest breastfeeding rates globally, breastfeeding is normalised across African and Asian cultures. However, HIV remains stigmatised and formula feeding could signal one's HIV-positive status. Our participants made difficult trade-offs to mitigate the variety of threats they faced, and both feeding options (breast or formula) felt transgressive, with immense hazards involved for these intersectionally-disadvantaged women.

Breastfeeding and impact on childhood hospital admissions: a nationwide birth cohort in South Korea

Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.

Infant body composition: A comprehensive overview of assessment techniques, nutrition factors, and health outcomes.

Body composition assessment is a valuable tool for clinical assessment and research that has implications for long-term health. Unlike traditional measurements such as anthropometrics or body mass index, body composition assessments provide more accurate measures of body fatness and lean mass. Moreover, depending on the technique, they can offer insight into regional body composition, bone mineral density, and brown adipose tissue. Various methods of body composition assessment exist, including air displacement plethysmography, dual-energy x-ray absorptiometry, bioelectrical impedance, magnetic resonance imaging, D3 creatine, ultrasound, and skinfold thickness, each with its own strengths and limitations. In infants, several feeding practices and nutrition factors are associated with body composition outcomes, such as breast milk vs formula feeding, protein intake, breast milk composition, and postdischarge formulas for preterm infants. Longitudinal studies suggest that body composition in infancy predicts later body composition, obesity, and other cardiometabolic outcomes in childhood, making it a useful early marker of cardiometabolic health in both term and preterm infants. Emerging evidence also suggests that body composition during infancy predicts neurodevelopmental outcomes, particularly in preterm infants at high risk of neurodevelopmental impairment. The purpose of this narrative review is to provide clinicians and researchers with a comprehensive overview of body composition assessment techniques, summarize the links between specific nutrition practices and body composition in infancy, and describe the neurodevelopmental and cardiometabolic outcomes associated with body composition patterns in term and preterm infants.

Pengembangan Pakan Ikan Berprotein Tinggi Dari Keong Mas (Pomacea Canaliculata) Terhadap Ikan Nila (Oreochromis Niloticus) Dan Penerapannya Dalam Program Kerja Kuliah Kerja Nyata Di Masyarakat Desa Sungai Petai

This research focuses on developing high protein fish feed derived from golden snails with the addition of a mixture of fish pellets. The aim of this research is to produce high quality fish feed from available local resources and apply it in the Community Service Program (KKN) in village communities. Experimental methods were used to develop a feed formula with the right ratio of golden snails and fish pellets. The feed developed has a high protein content and a balanced nutritional composition. Furthermore, the KKN program was implemented in the village by involving students as facilitators in the socialization and application of high protein fish food to the community. The results show positive adoption of the feed by village communities and increased productivity of fish farming. This program provides dual benefits, namely increasing village community income through more efficient fish farming and supporting sustainable use of local resources.

Formula Feeding Is Associated with Rapid Weight Gain between 6 and 12 Months of Age: Highlighting the Importance of Developing Specific Recommendations to Prevent Overfeeding.

We examined differences in mean daily calorie intake and rapid weight gain risk among 6- to 12-month-old infants by milk feeding status: breastmilk only, breastmilk and formula (combined), or formula only. Another objective was to determine what frequency and amount of formula fed were associated with overfeeding among infants. Mother-infant dyads (n = 240) were recruited from a pediatric clinic mainly serving Medicaid recipients. At 6, 9, and 12 months of infants' age, 24 h feeding recalls were conducted using the multiple-pass method. Infant weight measurements were accessed from clinic records to estimate rapid weight gain between 6 and 12 months. Among the participants, 82% received WIC. More than half of the participants were either African American or Latino by race/ethnicity. Calorie intake among formula-only fed infants was higher than in the other two milk feeding groups. One-fourth of the infants were experiencing rapid weight gain, and the risk was 3-fold higher among formula-only fed infants. Exceeding daily calorie requirements or overfeeding was associated with both formula amount and the frequency of feeding (p < 0.01). Specific guidelines and education on formula feeding practices are critical to prevent accelerated growth among infants. Gaining further understanding on parenting style and formula feeding practices is also warranted.

Infant feeding method and special educational need in 191,745 Scottish schoolchildren: A national, population cohort study

BackgroundInfant breastfeeding has been associated with reduced incidence of childhood physical and mental health problems. This study investigated relationships between infant feeding methods and the risk of Special Educational Need (SEN).&#x0D; MethodsA retrospective population cohort of schoolchildren in Scotland was constructed by linking together health (maternity, birth, and health visitor records) and education (annual school pupil census) databases. Inclusion was restricted to singleton children, born in Scotland from 2004 onwards with available breastfeeding data and who attended local authority mainstream or special schools between 2009 and 2013. Generalised estimating equation models with a binomial distribution and logit link function investigated associations between infant feeding method at 6–8 weeks and any-cause and cause-specific SEN, adjusting for sociodemographic and maternity factors.&#x0D; FindingsOf 191 745 children meeting inclusion criteria, 126 907 (66·2%) were formula-fed, 48 473 (25·3%) exclusively breastfed, and 16 365 (8·5%) mixed fed. Overall, 23 141 (12·1%) children required SEN. Compared with formula feeding, mixed feeding and exclusive breastfeeding were associated with decreased any-cause SEN (OR 0·90, 95% CI 0·84–0·95; and 0·78, 0·75–0·82), and SEN attributed to learning disabilities (0·75, 0·65–0·87; and 0·66, 0·59–0·74), and learning difficulties (0·85, 0·77–0·94; and 0·75, 0·70–0·81). Compared with formula feeding, exclusively breastfed children had less communication problems (0·81, 0·74–0·88), social-emotional-behavioural difficulties (0·77, 0·70–0·84), sensory impairments (0·79, 0·65–0·95), physical motor disabilities (0·78, 0·66–0·91), and physical health conditions (0·74, 0·63–0·87). Feeding method was not significantly associated with mental health conditions or autism.&#x0D; InterpretationMany women struggle to exclusively breastfeed for the full 6 months recommended by WHO; however, this study provides evidence that a shorter duration of nonexclusive breastfeeding could nonetheless be beneficial with regard to the development of SEN.