Infant Feeding Patterns Research Articles

Influência regional no consumo precoce de alimentos diferentes do leite materno em menores de seis meses residentes nas capitais brasileiras e Distrito Federal

The aim was to assess regional influences on food consumption in infants less than six months of age. A cross-sectional study was conducted in a sample of 18,929 infants participating in the Second Survey on Breastfeeding Prevalence in Brazilian State Capitals and the Federal District in 2008. Consumption rates for tea, fruit juices, formula milk, and porridge were calculated for the State capitals from the five geographic regions of the country. Food consumption was estimated by logit analyses and Poisson models. Differences in food consumption profile were observed between the different regions: tea was more common in State capitals in the South (RP = 2.37), while non-maternal milk (RP = 1.50 and 1.47) and juices (RP = 1.57 and 1.55) were more frequent in the Northeast and Southeast, respectively. Porridge was more common in the Northeast (RP = 3.0). Brazil's geographic regions thus display different infant feeding patterns. Public policy should take cultural diversity into account when planning strategies to improve infant nutrition and health.

Breastfeeding and Otitis Media: A Review of Recent Evidence

Human milk provides infants with antimicrobial, anti-inflammatory, and immunomodulatory agents that contribute to optimal immune system function. The act of breastfeeding allows important bacterial and hormonal interactions between the mother and baby and impacts the mouth, tongue, swallow, and eustachian tubes. Previous meta-analyses have shown that lack of breastfeeding and less intensive patterns of breastfeeding are associated with increased risk of acute otitis media, one of the most common infections of childhood. A review of epidemiologic studies indicates that the introduction of infant formula in the first 6months of life is associated with increased incidence of acute otitis media in early-childhood. More recent research raises the issues of how long this increased risk persists, and whether lack of breastfeeding is associated with diagnosis of otitis media with effusion. However, many studies suffer from lack of study of younger populations and imprecise definitions of infant feeding patterns. These findings suggest that measures of the association between breastfeeding history and otitis media risk are sensitive to the definition of breastfeeding used; future research is needed with more precise and consistent definitions of feeding, with attention to distinctions between direct breastfeeding and human milk feeding by bottle.

P2-432 Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi, Kenya

IntroductionLittle evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference...

Glucose tolerance and insulin resistance in Indian children: relationship to infant feeding pattern

Our objective was to examine whether longer duration of breast-feeding and later introduction of complementary foods are associated with lower glucose concentrations and insulin resistance (IR-HOMA) in Indian children. Breast-feeding duration (six categories from <3 to ≥18 months) and age at introduction of complementary foods (four categories from <4 to ≥6 months) were recorded at 1, 2 and 3 year follow-up of 568 children from a birth cohort in Mysore, India. At 5 and 9.5 years of age, 518 children were assessed for glucose tolerance and IR-HOMA. All the children were initially breast-fed; 90% were breast-fed for ≥6 months and 56.7% started complementary foods at or before the age of 4 months. Each category increase in breast-feeding duration was associated with lower fasting insulin concentration (β = -0.05 pmol/l [95% CI -0.10, -0.004]; p = 0.03) and IR-HOMA (β = -0.05 [95% CI -0.10, -0.001]; p = 0.046) at 5 years, adjusted for the child's sex, age, current BMI, socioeconomic status, parent's education, rural/urban residence, birthweight and maternal gestational diabetes status. Longer duration of breastfeeding was associated with higher 120-min glucose concentration at 5 years (β = 0.08 mmol/l [95% CI 0.001, 0.15; p = 0.03]) but lower 120-min glucose concentration at 9.5 years (β = -0.09 [95% CI -0.16, -0.03]; p = 0.006). Age at starting complementary foods was unrelated to the children's glucose tolerance and IR-HOMA. Within this cohort, in which prolonged breast-feeding was the norm, there was evidence of a protective effect of longer duration of breast-feeding against glucose intolerance at 9.5 years. At 5 years longer duration of breast-feeding was associated with lower IR-HOMA.

The role of infant feeding practices in the explanation for ethnic differences in infant growth: the Amsterdam Born Children and their Development study

Rapid early growth in infants may influence overweight and CVD in later life. Both rapid growth and these disease outcomes disproportionately affect some ethnic minorities. We determined ethnic differences in growth rate (Δ standard deviation scores, ΔSDS) during the first 6 months of life and assessed the explanatory role of infant feeding. Data were derived from a multiethnic cohort for the Amsterdam Born Children and their Development study (The Netherlands). Growth data (weight and length) of 2998 term-born singleton infants with no fetal growth restriction were available for five ethnic populations: Dutch (n 1619), African descent (n 174), Turkish (n 167), Moroccan (n 232) and other non-Dutch (n 806). ΔSDS for weight, length and weight-for-length between 4 weeks and 6 months were defined using internal references. Infant feeding pattern (breast-feeding duration, introduction of formula feeding and complementary feeding) in relation to ethnic differences in growth rate was examined by multivariate linear regression. Results showed that the growth rate was higher in almost all ethnic minorities, with β between 0·07 and 0·41 for ΔSDS weight and between 0·12 and 0·42 for ΔSDS length, compared with ethnic Dutch infants. ΔSDS weight-for-length was similar across groups, except for Moroccan infants (β 0·25, P<0·05) after correction for confounders. In general, exclusive breast-feeding for 4 months was associated with slower growth for all three growth measures. Feeding factors explained, to a small degree, the higher weight and length gain in African descent infants, but not the higher ΔSDS weight-for-length in the Moroccan population. More research is needed to elucidate the underlying mechanisms of the high infant growth rate in Turkish and Moroccan infants.

Overweight, Obesity, and Metabolic Syndrome in Adults and Children in South Korea: A Review of the Literature

Overweight, obesity, and metabolic syndrome are increasing in South Korea dramatically. This review of the literature summarizes published studies on the prevalence of overweight, obesity, and metabolic syndrome in South Korean adults and children; summarizes studies related to obesity management and prevention in South Korean adults and children; and identifies gaps in the literature for further research. A PubMed, CINAHL, and Google Scholar search identified articles published between January 1, 2000, and June 30, 2010, using the following key search terms: overweight, obesity, adult, children, adolescent, metabolic syndrome, prevention, and South Korea. Inclusion criteria included articles published in English or Korean, and primary or secondary research that measured the prevalence and characteristics of overweight and obesity or described a management or prevention program. Twelve articles met the inclusion criteria and were categorized into either adult or child studies. In adults, the prevalence of overweight and obesity has increased as South Korea has moved from an agricultural to a modern society. In children, there were associations between infant feeding patterns, familial relationships, and dietary and physical activity patterns. There were few programs to manage or prevent overweight. Further research is needed to develop effective strategies to prevent and manage overweight and obesity in adults and children, using family-based interventions that include multigenerational family members.

The effect of milk formula advertisement on breast feeding and other infant feeding practice in Lagos, Nigeria

This study investigated the level of impact milk formula advertisements had on mothers’ choice of infant feeding in Lagos State, Nigeria. A total of 225 mothers with children 0-2years were randomly selected from five hospitals in Lagos Island local government area of Lagos State. Validatedquestionnaires were used to obtain information from the mothers on their age, occupation, infant feeding pattern and type of infant formula advertisement seen. Data collected were analyzed using frequency distribution, percentages and analysis of variance (ANOVA). The result of the study showed that 92% of the mothers were within the reproductive years (20-40years). Fifteen percent of the mothers were housewives and 84.9% had some form of occupation. The result also revealed that70% of the mothers breast fed only, 1.8% formula fed their babies and 27% practiced mixed feeding. The percentage of the mothers who saw or heard advertisement often from television, magazines,posters, radio and bill board were 31.6%, 24.9%, 18.2%, 3.6% and 3.1%, respectively, 82.7% of the mothers had seen or heard of some form of infant formula advertisement. The most commonly advertised infant formula was NAN (51.1%). The most common type of advertisement seen was television advert (31%); 18.7% of the mothers were influenced by infant formula advert while 64% were not. The result showed that there was a significant effect on the infant feeding practices before and after infant formula advertisement was seen at (f=3.387; 0.003) and (f=4.025; 0.001), respectively. The study concluded that there was a high percentage of mothers who breast fed their infants however analyses of the data before and after advert between the groups and within the groups of women showed that infant formula advertisement had a significant effect on mothers’ choice of infant feeding.

Infants Perceived as “Fussy” Are More Likely to Receive Complementary Foods Before 4 Months

Our purpose was to assess early infant-feeding patterns in a cohort of low-income black mothers and to examine associations between maternal perception of infant temperament and complementary feeding (CF) before 4 months. We used cross-sectional data from the 3-month visit (n = 217) of the Infant Care, Feeding and Risk of Obesity Study to assess relationships between early feeding of solids or juice and 6 dimensions of perceived infant temperament. Descriptive statistics were used to assess infant-feeding patterns, and logistic regression models were fit for each diet-temperament relationship found significant in the bivariate analyses. Seventy-seven percent of the infants were fed solid foods at 3 months, 25% were fed juice, and 6% were exclusively breastfed. In multivariable analyses, 2 dimensions of perceived infant temperament were associated with early feeding of solid foods (distress-to-limitations odds ratio [OR]: 1.97 [95% confidence interval (CI): 1.12-3.44]; activity-level OR: 1.75 [95% CI: 1.07-2.85]), whereas 1 dimension, low-intensity pleasure, was associated with early feeding of juice (OR: 0.51 [95% CI: 0.34-0.78]). Maternal characteristics significantly associated with early CF included breastfeeding, obesity, and depressive symptoms. Low-income black mothers may represent a priority population for interventions aimed at improving adherence to optimal infant feeding recommendations. That maternal perceptions of several domains of perceived infant temperament are related to early CF suggests that this is an important factor to include in future observational research and in the design of interventions.

Infant-feeding patterns and cardiovascular risk factors in young adulthood: data from five cohorts in low- and middle-income countries.

Background Infant-feeding patterns may influence lifelong health. This study tested the hypothesis that longer duration of breastfeeding and later introduction of complementary foods in infancy are associated with reduced adult cardiovascular risk.Methods Data were pooled from 10 912 subjects in the age range of 15–41 years from five prospective birth-cohort studies in low-/middle-income countries (Brazil, Guatemala, India, Philippines and South Africa). Associations were examined between infant feeding (duration of breastfeeding and age at introduction of complementary foods) and adult blood pressure (BP), plasma glucose concentration and adiposity (skinfolds, waist circumference, percentage body fat and overweight/obesity). Analyses were adjusted for maternal socio-economic status, education, age, smoking, race and urban/rural residence and infant birth weight.Results There were no differences in outcomes between adults who were ever breastfed compared with those who were never breastfed. Duration of breastfeeding was not associated with adult diabetes prevalence or adiposity. There were U-shaped associations between duration of breastfeeding and systolic BP and hypertension; however, these were weak and inconsistent among the cohorts. Later introduction of complementary foods was associated with lower adult adiposity. Body mass index changed by −0.19 kg/m2 [95% confidence interval (CI) −0.37 to −0.01] and waist circumference by −0.45 cm (95% CI −0.88 to −0.02) per 3-month increase in age at introduction of complementary foods.Conclusions There was no evidence that longer duration of breastfeeding is protective against adult hypertension, diabetes or overweight/adiposity in these low-/middle-income populations. Further research is required to determine whether ‘exclusive’ breastfeeding may be protective. Delaying complementary foods until 6 months, as recommended by the World Health Organization, may reduce the risk of adult overweight/adiposity, but the effect is likely to be small.

Food for thought: Breastfeeding and early childhood education services

In developing Ministry of Health guidelines for early childhood education (ECE) services to support breastfeeding, the authors of this article consulted widely with the health and ECE sectors early in 2009. The article discusses the main themes and issues raised by the parents, educators, advocates and health representatives who participated. Although ECE centres have a mandate to be responsive and reciprocal with children and their families and whanau, the stories shared demonstrate that current infant feeding patterns and practices in ECE settings provide food for thought.

Effect of Breastfeeding Duration on Infant Growth Until 18 Months of Age: A National Birth Cohort Study

Background Optimal nutrition during the 1st year of life is critical to infants' healthy growth and development, and breastfeeding is a key component. However, little is known about the effect of breastfeeding duration on infant growth in Taiwan. Purpose The aim of this study was to examine the effect of breastfeeding duration on infant growth. Methods This study was based on questionnaire interviews as part of the Taiwan Birth Cohort Study, which collected information on breastfeeding duration and infant growth among infants aged from 0 to 18 months. Participants were selected from Taiwan birth registry data for 2005, using multistage stratified random sampling. The sample population was 15,868 infants ranging in gestational age between 37 and 41 weeks, excluding those with birth defects or who were hospitalized after birth. The χ2 test, analysis of variance and generalized estimating equations were used to analyze the effects of infant feeding patterns and other factors on infant growth. Results Breastfeeding duration had no significant effect on infant weight within the first 6 months, but after the 7th month, infants who had been breastfed for ≥6 months were lighter than infants who were not breastfed. Before 18 months of age, infants who had been breastfed for ≥6 months were slightly shorter than infants who had been breastfed for Conclusion These results show that different infant feeding practices correspond to differences in infant growth from 0 to 18 months, and are consistent with the World Health Organization's new growth standards.

Cohort profile: the Cebu longitudinal health and nutrition survey.

The Cebu Longitudinal Health and Nutrition Survey (CLHNS) was originally conceptualized as an interdisciplinary study of infant-feeding patterns, particularly the overall sequencing of feeding events (milks and complementary foods), the factors affecting feeding decisions and how feeding patterns affect the infant, mother and household. The idea was to study these topics within as natural a setting as possible and to analyse how infant-feeding decisions interacted with social, economic and environmental factors to affect health, nutritional, demographic and economic outcomes. The study was subsequently expanded to cover a wide range of maternal and child health and demographic issues that could be well studied using a prospective, community-based sample. The study was initially the product of collaboration among researchers at the Carolina Population Center at the University of North Carolina at Chapel Hill (led by B.M.P. with J.S.A. and D.K.G.), The Office of Population Studies Foundation at the University of San Carlos in Cebu, Philippines (led by the late Director Wilhelm Fleiger) and the Nutrition Center of the Philippines (led by Florentino Solon). L.S.A. took the lead for follow-up surveys beginning in 1990. Later, the study team was expanded to include researchers presently at the Northwestern University (C.W.K. and T.M.D.) and Johns Hopkins University (M.J.H.). The study was initiated with cooperation and approval from the Cebu Department of Health. The CLHNS website includes a full list of investigators and their affiliations. The CLHNS was one of the first large-scale, population-based surveys designed with a conceptual framework in mind. The guiding framework was adapted from Mosley and Chen’s health determinants model, which posits that underlying community-, householdand individual-level variables affect a set of proximate health behaviours which, in turn, influence health outcomes such as growth and infectious disease morbidity and mortality. The study was designed by a highly interdisciplinary group of economists, sociologists, nutritionists, demographers and physicians. The CLHNS has been funded by a large number of government and non-government organizations (listed in the Funding section).

Is Infant Feeding Pattern Associated With Father’s Quality of Life?

The aim of this study was to compare the health-related quality of life of fathers under different infant feeding type scenarios. The Medical Outcomes Study 36-item Short-Form was used to measure the health-related quality of life of 1,699 fathers, and the scores were used to look for associations with different infant feeding methods. Multivariable linear regression analysis was used to explore the contribution of the other potential related factors on fathers' quality of life. After controlling for confounding factors, fathers whose infants were ever being breast-fed reported lower scores than fathers whose infants were bottle-fed. Except for the infant feeding pattern, having a job, higher family income, and being the major caregiver were positively related to the father's quality of life. Fathers may not benefit during breast-feeding process. Because fathers' involvement plays an important role in the success of breast-feeding, the development of interventions that enable fathers to support their breast-feeding partner is very important.

Infant-feeding pattern of HIV-positive women in a prevention of mother-to-child transmission (PMTCT) programme

Objectives. To evaluate the infant-feeding choices, practices and possible determinants among HIV-positive women enrolled in a prevention of mother-to-child transmission programme in Ibadan, Nigeria. Methods. A cross-sectional survey involving HIV-positive women who had received infant-feeding counselling prior to delivery. A structured questionnaire was administered at ≤ 72 hrs and not ≥ 6 weeks of delivery and was complemented with an in-depth interview. Results. A total of 241 women were studied. The choice of infant feeding was formula for 223 (93.5%) and in actual practice, 9 (3.7%) mothers admitted mixed feeding. There was no statistical significant difference between the feeding pattern and the socio-demographic characteristics. The major factor influencing the choice of infant feeding was “The desire to reduce the risk of transmission” which was recorded among 204 (84.6%) of the women. Greatest support in maintaining infant-feeding option was the spouse (36.1%). From the in-depth interview of 23 non-breastfeeding (infant formula) mothers, the major challenge faced was stigmatisation. Conclusion. Despite the premium placed on breastfeeding in this locality, with infant-feeding counselling, most HIV-positive women chose and practiced formula feeding. It is necessary to address how best HIV-positive mothers could handle or overcome criticisms and stigmatisation by others.

Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper

The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies.

Infant feeding among women attending an immunisation clinic at a tertiary health institution in Ibadan, Nigeria

Maternal characteristics can affect a mother’s decision to breastfeed. This study used a cross‐sectional design to assess maternal variables and infant feeding patterns among nursing mothers attending an immunisation clinic in Ibadan, Nigeria. A total of 264 mothers who consecutively attended the immunisation clinic and met certain inclusion criteria were interviewed. A majority of mothers (204, 77.2%) were in the middle of the reproductive age span (24–35 years); 180 (68.2%) had attended tertiary educational institutions. Almost all the mothers (257, 97.3%) had good knowledge about exclusive breast‐feeding. Exclusive breast‐feeding decreased with the age of the infant; by six months of age, only 40% of infants were exclusively breastfed. Of the mothers who practiced exclusive breast‐feeding, 30 (18.5%) initiated breast‐feeding within 30 minutes after birth. There may be a need to increase the emphasis placed on the time that complementary feeding should be introduced.

Counseling and choosing between infant-feeding options: Overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon)

As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices.

Hospital influences on early infant feeding practices.

Newborn nursery nursing staff members were surveyed to determine their attitudes and teaching practices regarding breast- and bottle-feeding. Concurrently, mothers using this nursery responded to a structured interview concerning their infant-feeding practices at 14 to 21 days postpartum and possible hospital influences on these practices. The nursing staff strongly advocated breast-feeding and did not favor specific bottle-feeding practices or products. Nursing staff counseling was generally interpreted by mothers as supporting breast-feeding, but this did not deter a large proportion of mothers who stated an initial preference for breast-feeding from introducing formula as a supplementary or exclusive form of infant feeding during the short study period. Almost all mothers doing any amount of bottle-feeding at the time of their interview were using the same formula brand and a ready-to-feed preparation used during their hospital stay. Other influences on mother's infant-feeding patterns are discussed. It is concluded that the hospital staff and routines exerted a stronger influence on mothers' infant-feeding practices by nonverbal teaching (the hospital "modeling" of infant formula products) than by verbal teaching (counseling supporting breast-feeding). Future studies might explore new ways of supporting mothers who desire to breast-feed by designing innovative hospital routines to model breast-feeding rather than feeding by infant formula.

Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?

A woman's decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4-hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding-related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69). Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.

Effects of different feeding patterns on body weight of perinatal women in rural area

To study the relations between different feeding patterns and the body weight retention of the perinatal women living in rural areas of China. A cluster sampling method was used to investigate 409 women, who are currently living in rural areas of Tianjin, at pregnant and perinatal status. While, their body weights and heights before pregnancy, antepartum and postpartum were measured, respectively. Body weight retention was the difference of the measured data after postpartum minus pre-pregnant weight. Variance analysis was used for statistic comparison. The rate of exclusive breastfeeding was 70.9% (290/409) within four months. The net body weight retention of women (5.8 kg) using the exclusive breastfeeding was lower than that of the women (7.0 kg) using artificial feeding within 4 - 6 months, but there was no significantly statistic difference (F = 1.45, P = 0.236). However, there was the opposite result within 7 - 9 months, the data showed that the body weight retention in the women using the exclusive breastfeeding was 4.9 kg, which was significantly higher than that the women (2.9 kg) with artificial feeding (F = 3.17, P = 0.043). The food consumption of the women (901 g) using exclusive breastfeeding was the highest, followed by those (877 g) using mixed feeding and the women (750 g) using artificial feeding. The body weight retention after postpartum should be related to infant feeding patterns. After postpartum, the weight loss of women using the exclusive breastfeeding is relatively low. While, for the women using the exclusive breastfeeding, the net weight retention during pregnancy and after postpartum were lower than those with artificial feeding. Therefore, it is necessary to enhance health education and guidance on promoting exclusive breast-feeding as well as increasing awareness on pre-pregnant health.