Infant Feeding Study Research Articles

8548 Breast Development in Infant Girls: Does Endogenous Estrogen Production During Minipuberty Play a Role?

Abstract Disclosure: M. Goldberg: None. S. Zhao: None. A. Kelly: None. V.A. Stallings: None. D.M. Umbach: None. W.J. Rogan: None. N. Shaw: None. D.P. Sandler: None. Background: Breast tissue, present at birth in most term infants, regresses during infancy but persists longer in girls than boys. In girls, this persistence is thought to be due in part to stimulation by estradiol (E2) produced during minipuberty, the postnatal activation of the hypothalamic-pituitary-gonadal axis. Empirical data are sparse, however. Because E2 concentrations in infant girls fluctuate, repeated E2 measures may be necessary to adequately characterize production across minipuberty and to detect effects on estrogen-sensitive breast tissue. Hypothesis: Higher average exposure to E2 during minipuberty is associated with larger breast bud diameter in late infancy in term females. Methods: We leveraged data from 136 girls from the Infant Feeding and Early Development (IFED) Study, a prospective cohort of reproductive development in term infants enrolled during 2010-2013 from the Philadelphia area. We measured E2 in serum samples collected at study visits every 2-4 weeks from age 2-32 weeks. We assessed breast bud diameter via ultrasound at the 32-week visit. For data analysis, we log2-transformed both E2 and breast bud diameter. For E2 concentrations below the limit of detection (2.99 pg/mL, 35% of samples), we applied multiple imputation. We first calculated the intraclass correlation coefficient (ICC) of repeated E2 to understand the relative magnitude of total variation from within subjects. We then calculated subject-specific mean of E2 across time and estimated associations with breast bud diameter at the 32-week visit using both age- and multivariable-adjusted linear regression models. We present results as percent change in breast bud diameter per doubling in average E2 concentration ([2β-1] x 100%). Results: Most infants were Black (71%) and formula-fed (76%). The median number of E2 measures per girl was 9 (range: 5-10). Most of the variation in E2 concentrations was due to within-individual variation (ICC=0.27). The geometric mean E2 concentration from 2-32 weeks of age was 5.1 pg/mL (95% confidence interval [CI]: 4.7-5.4). The median breast bud diameter at the 32-week visit was 13.7mm (range: 4.4-30.5). A doubling in average E2 concentration across minipuberty was associated with a 26% larger breast bud diameter (95% CI 10-43%). This association was similar after adjustment for feeding method, race, gestational age, neonatal weight, and breast bud diameter at the neonatal visit (percent change: 28%, 95% CI: 12-46%). Conclusions: Our results suggest that endogenous estrogen production in females during minipuberty stimulates the infant breast bud. More research is needed to investigate the potential biologic relevance of this hormonal stimulation of infant breast tissue to later breast development and risk of malignant and benign breast disorders. Presentation: 6/1/2024

A comparison of ultrasound-based testis volume with Prader orchidometry and stability of testis size relative to peers from birth to 28weeks.

Testis volume, an indicator of the reproductive development during minipuberty, is commonly measured by Prader orchidometer, despite ultrasound being the gold standard. Data are lacking on the longitudinal relationship between these two measures and on the stability of boys' relative testis size across infancy. To examine the relationship between ultrasound-based and orchidometer-based testis volume measurements and to assess the stability of relative testis size among individual boys in the study. The Infant Feeding and Early Development study is a longitudinal cohort of healthy infants recruited from hospitals in the Philadelphia area during 2010-2013. We measured testis size from birth to 28weeks in 147 infants using Prader orchidometry (nine study visits) and ultrasound (five study visits). We modeled testis growth, extracted predicted volumes for each boy on each day of the study, and ranked these volumes from smallest to largest. The average testis volume trajectory exhibited linear growth over the first 16weeks followed by slower growth and then a plateau. Prader orchidometry overestimated testis size by almost 3-fold, compared to ultrasound. A range of ultrasound volumes corresponded to each bead size (e.g., bead size of 1 cm3 corresponded to an ultrasound-based volume between 0.11 and 0.87 cm3). Infants changed rankings of median of 22 positions (of 147) across the entire 6-month follow-up. Infants' ranks near birth were highly correlated with their ranks at the end of the study. Consistent with other studies, we found wide variability in testis size during infancy and that Prader orchidometry overestimates testis size. When compared to ultrasound, orchidometry only crudely estimates testis size in this age group. Ultrasound-based volumes generally showed stability in relative testis size across infancy. Accurate measurement of testis size is difficult using orchidometry in infants. This highlights the need for ultrasound for accurate measurement, with a one-time measurement likely sufficient to determine relative testis size across the first 6 months of infancy.

Environmental Phenols and Growth in Infancy: The Infant Feeding and Early Development Study.

Higher mean and rapid increases in body mass index (BMI) during infancy are associated with subsequent obesity and may be influenced by exposure to endocrine-disrupting chemicals such as phenols. In a prospective US-based cohort conducted 2010-2014, we investigated associations between environmental phenol exposures and BMI in 199 infants. We measured seven urinary phenols at ages 6-8 and 12 weeks and assessed BMI z-score at up to 12 study visits between birth and 36 weeks. We examined individual and joint associations of averaged early infancy phenols with level of BMI z-score using mean differences (β [95% confidence intervals (CI)]) and with BMI z-score trajectories using relative risk ratios (RR [95% CI]). Benzophenone-3, methyl and propyl paraben, and all phenols jointly were positively associated with higher mean BMI z-score (0.07 [-0.05, 0.18], 0.10 [-0.08, 0.27], 0.08 [-0.09, 0.25], 0.17 [-0.08, 0.43], respectively). Relative to a Stable trajectory, benzophenone-3, 2,4-dichlorophenol, 2,5-dichlorophenol, and all phenols jointly were positively associated with risk of a Rapid Increase trajectory (1.46 [0.89, 2.39], 1.33 [0.88, 2.01], 1.66 [1.03, 2.68], 1.41 [0.71, 2.84], respectively). Early phenol exposure was associated with a higher mean and rapid increase in BMI z-score across infancy, signaling potential long-term cardiometabolic consequences of exposure.

Environmental phenol exposures in 6- to 12-week-old infants: The Infant Feeding and Early Development (IFED) study

BackgroundExposure to phenols, endocrine-disrupting chemicals used in personal care and consumer products, is widespread. Data on infant exposures are limited despite heightened sensitivity to endocrine disruption during this developmental period. We aimed to describe distributions and predictors of urinary phenol concentrations among U.S. infants ages 6–12 weeks. MethodsThe Infant Feeding and Early Development (IFED) study is a prospective cohort study of healthy term infants enrolled during 2010–2013 in the Philadelphia region. We measured concentrations of seven phenols in 352 urine samples collected during the 6- or 8- and/or 12-week study visits from 199 infants. We used linear mixed models to estimate associations of maternal, sociodemographic, infant, and sample characteristics with natural-log transformed, creatinine-standardized phenol concentrations and present results as mean percent change from the reference level. ResultsMedian concentrations (μg/L) were 311 for methylparaben, 10.3 for propylparaben, 3.6 for benzophenone-3, 2.1 for triclosan, 1.0 for 2,5-dichlorophenol, 0.7 for BPA, and 0.3 for 2,4-dichlorophenol. Geometric mean methylparaben concentrations were approximately 10 times higher than published estimates for U.S. children ages 3–5 and 6–11 years, while propylparaben concentrations were 3–4 times higher. Infants of Black mothers had higher concentrations of BPA (83%), methylparaben (121%), propylparaben (218%), and 2,5-dichorophenol (287%) and lower concentrations of benzophenone-3 (−77%) and triclosan (−53%) than infants of White mothers. Triclosan concentrations were higher in breastfed infants (176%) and lower in infants whose mothers had a high school education or less (−62%). Phenol concentrations were generally higher in summer samples. ConclusionsWidespread exposure to select environmental phenols among this cohort of healthy U.S. infants, including much higher paraben concentrations compared to those reported for U.S. children, supports the importance of expanding population-based biomonitoring programs to infants and toddlers. Future investigation of exposure sources is warranted to identify opportunities to minimize exposures during these sensitive periods of development.

Safety and Suitability of Infant Formula Manufactured from Extensively Hydrolyzed Whey Protein Compared to Intact Protein: A Combined Analysis of Two Randomized Controlled Studies.

Our aim was to assess the nutritional safety and suitability of an infant formula manufactured from extensively hydrolyzed protein in comparison to infant formula manufactured from intact protein (both with low and standard protein content). We performed a combined analysis of raw data from two randomized infant feeding studies. An analysis of covariance (ANCOVA) model was used to determine the non-inferiority of daily weight gain (primary outcome; margin -3 g/day), with the intervention group as a fixed factor and geographic region, sex, and baseline weight as covariates (main model). The data of 346 infants exposed to the formula were included in the analysis. The sample size of the per-protocol analysis with 184 infants was too small to achieve sufficient statistical power. The lower limit of the 97.5% confidence interval (-0.807) of the mean group difference in daily weight gain (i.e., 2.22 g/day) was above the -3 g/day margin (full analysis set). Further anthropometric parameters did not differ between the infant formula groups throughout the study. Growth was comparable to breastfed infants. We conclude that the infant formula manufactured from extensively hydrolyzed protein meets infant requirements for adequate growth and does not raise any safety concerns.

Evaluation of the Healthy Start voucher scheme on maternal vitamin use and child breastfeeding: a natural experiment using data linkage.

Having a good start in life during pregnancy and infancy has been shown to be important for living both a healthy life and a longer life. Despite the introduction of many policies for the early-years age group, including voucher schemes, with the aim of improving nutrition, there is limited evidence of their impact on health. To assess the effectiveness of the Healthy Start voucher scheme on infant, child and maternal outcomes, and to capture the lived experiences of the Healthy Start voucher scheme for low-income women. This was a natural experiment study using existing data sets, linked to routinely collected health data sets, with a nested qualitative study of low-income women and an assessment of the health economics. Representative sample of Scottish children and UK children. Growing Up in Scotland cohort 2 (n = 2240), respondents to the 2015 Infant Feeding Study (n = 8067) and a sample of 40 participants in the qualitative study. The Health Start voucher, a means-tested scheme that provides vouchers worth £3.10 per week to spend on liquid milk, formula milk, fruit and vegetables. Infant and child outcomes - breastfeeding initiation and duration; maternal outcomes - vitamin use pre and during pregnancy. The exposed group were women receiving the Healthy Start voucher (R), with two control groups: eligible and not claiming the Healthy Start voucher (E) and nearly eligible. There was no difference in vitamin use during pregnancy for either comparison (receiving the Healthy Start voucher, 82%; eligible and not claiming the Healthy Start voucher, 86%; p = 0.10 vs. receiving the Healthy Start voucher, 87%; nearly eligible, 88%; p = 0.43) in the Growing Up in Scotland cohort. Proportions were similar for the Infant Feeding Study cohort (receiving the Healthy Start voucher, 89%; eligible and not claiming the Healthy Start voucher, 86%; p = 0.01 vs. receiving the Healthy Start voucher, 89%; nearly eligible, 87%; p = 0.01); although results were statistically significantly different, these were small effect sizes. There was no difference for either comparison in breastfeeding initiation or breastfeeding duration in months in Growing Up in Scotland, but there was a negative effect of the Healthy Start voucher in the Infant Feeding Survey. This contrast between data sets indicates that results are inconclusive for breastfeeding. The qualitative study found that despite the low monetary value the women valued the Healthy Start voucher scheme. However, the broader lives of low-income women are crucial to understand the constraints to offer a healthy diet. Owing to the policy being in place, it was difficult to identify appropriate control groups using existing data sources, especially in the Infant Feeding Study. As the Healthy Start voucher scheme attempts to influence health behaviour, this evaluation can inform other policies aiming to change behaviour and use voucher incentives. The null effect of Healthy Start vouchers on the primary outcomes may be due to the value of the vouchers being insufficient to change the broader lives of low-income women to offer a healthy diet. The methods developed to undertake an economic evaluation alongside a natural experiment using existing data can be used to explore the cost-effectiveness of the Healthy Start voucher scheme. This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 11. See the NIHR Journals Library website for further project information.

Postpartum defects in inflammatory response after gestational diabetes precede progression to type 2 diabetes: a nested case-control study within the SWIFT study

BackgroundGestational diabetes (GDM) is a distinctive form of diabetes that first presents in pregnancy. While most women return to normoglycemia after delivery, they are nearly ten times more likely to develop type 2 diabetes than women with uncomplicated pregnancies. Current prevention strategies remain limited due to our incomplete understanding of the early underpinnings of progression. AimTo comprehensively characterize the postpartum profiles of women shortly after a GDM pregnancy and identify key mechanisms responsible for the progression to overt type 2 diabetes using multi-dimensional approaches. MethodsWe conducted a nested case-control study of 200 women from the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT) to examine biochemical, proteomic, metabolomic, and lipidomic profiles at 6–9 weeks postpartum (baseline) after a GDM pregnancy. At baseline and annually up to two years, SWIFT administered research 2-hour 75-gram oral glucose tolerance tests. Women who developed incident type 2 diabetes within four years of delivery (incident case group, n = 100) were pair-matched by age, race, and pre-pregnancy body mass index to those who remained free of diabetes for at least 8 years (control group, n = 100). Correlation analyses were used to assess and integrate relationships across profiling platforms. ResultsAt baseline, all 200 women were free of diabetes. The case group was more likely to present with dysglycemia (e.g., impaired fasting glucose levels, glucose tolerance, or both). We also detected differences between groups across all omic platforms. Notably, protein profiles revealed an underlying inflammatory response with perturbations in protease inhibitors, coagulation components, extracellular matrix components, and lipoproteins, whereas metabolite and lipid profiles implicated disturbances in amino acids and triglycerides at individual and class levels with future progression. We identified significant correlations between profile features and fasting plasma insulin levels, but not with fasting glucose levels. Additionally, specific cross-omic relationships, particularly among proteins and lipids, were accentuated or activated in the case group but not the control group. ConclusionsOverall, we applied orthogonal, complementary profiling techniques to uncover an inflammatory response linked to elevated triglyceride levels shortly after a GDM pregnancy, which is more pronounced in women who progress to overt diabetes.

Early Life Anti-Müllerian Hormone Trajectories in Infant Girls.

Minipuberty is a period of increased reproductive axis activity in infancy, but the importance of this period is not well understood, especially in girls. Previous studies reported a peak in hormone concentrations at 3 to 4 months old. Our objective is to describe anti-Müllerian hormone (AMH) trajectories in the context of other minipuberty factors among healthy infant girls using longitudinal measures of AMH. The Infant Feeding and Early Development study is a longitudinal cohort study of healthy infants, recruited from hospitals in the Philadelphia area during 2010 to 2013. We measured AMH in 153 girls who contributed 1366 serum samples across 11 study visits over 36 weeks. We also measured follicle stimulating hormone (FSH), estradiol, and ovarian characteristics. We used latent class mixed effects models to cluster trajectories of AMH concentration with age. Using linear mixed models, we estimated FSH and ovarian characteristic trajectories separately by AMH cluster. We classified infants into four clusters that represent patterns of AMH that were high and decreasing (decreasing), had a peak around 12 weeks or 20 weeks (early peak and middle peak), or were consistently low (low). Infants in these clusters differed in their FSH trajectories, timing of estradiol production, and ovarian characteristics. The AMH clusters identified suggest variation in the timing and the magnitude of the minipuberty response in infant girls. The decreasing and low clusters have not been described previously and should be further evaluated to determine whether they represent an opportunity for the early identification of later reproductive conditions.

Infant Age Moderates Associations between Infant Temperament and Maternal Technology Use during Infant Feeding and Care.

Previous research illustrated that infants’ temperamental traits shape parents’ behaviors, but parents’ behaviors can also elicit or intensify infants’ behaviors in ways that shape temperament. One understudied aspect of parenting that may exhibit bidirectional influences with temperament is parent technology use (e.g., use of mobile devices) within family contexts. To date, few studies have examined whether maternal technology use is associated with infant temperament and whether age-related differences in these associations exist. The present study was a secondary analysis of pooled data from three infant feeding studies. Mothers (n = 374) of young infants (age 16.2 ± 6.2 weeks) completed measures of maternal technology use during infant feeding and care interactions, infant temperament, and family demographics. Maternal technology use was positively associated with negative affectivity and negatively associated with orienting/regulatory capacity but was not associated with positive affectivity/surgency. The association between maternal technology use and negative affectivity was stronger for younger infants than older infants, while the association between maternal technology use and orienting/regulatory capacity was not significant for younger infants but was for older infants. Findings suggest maternal technology use is associated with infant negative affectivity and orienting/regulatory capacity, but the strength of these associations may change with infant age. Further longitudinal research is needed to verify this interpretation and understand mechanisms underlying these associations.

Type of Milk Feeding and Introduction to Complementary Foods in Relation to Infant Sleep: A Systematic Review.

Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. This study aimed to systematically review the existing literature on infant sleep and its relation to the timing of introduction to complementary foods and type of milk feeding to better understand their role(s) in infant sleep. Cohort, longitudinal, cross-sectional studies, and controlled trials were identified using online searches of five databases up to April 2020. Twenty-one articles with a total of 6225 infants under 12 months-of-age were eligible. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies (67%) reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies (>65%) reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (<12 months-of-age). Future studies using standardized methodologies and definitions, transdisciplinary expertise, and longitudinal design are required to better understand the complex role of feeding on sleep.

Epigenome-Wide Association Study of Infant Feeding and DNA Methylation in Infancy and Childhood in a Population at Increased Risk for Type 1 Diabetes.

We assessed associations between infant diet (e.g., breastfeeding and introduction to solid foods) and DNA methylation in infancy and childhood. We measured DNA methylation in peripheral blood collected in infancy (9–15 months of age) in 243 children; and in a subset of 50 children, we also measured methylation in childhood (6–9 years of age) to examine persistence, and at birth (in cord blood) to examine temporality. We performed multivariable linear regression of infant diet on the outcome of methylation using epigenome-wide and candidate site approaches. We identified six novel CpG sites associated with breastfeeding duration using an EWAS approach. One differentially methylated site presented directionally consistent associations with breastfeeding (cg00574958, CPT1A) in infancy and childhood but not at birth. Two differentially methylated sites in infancy (cg19693031, TXNIP; cg23307264, KHSRP) were associated with breastfeeding and were not present at birth; however, these associations did not persist into childhood. Associations between infant diet and methylation in infancy at three sites (cg22369607, AP001525.1; cg2409200, TBCD; cg27173510, PGBD5) were also present at birth, suggesting the influence of exposures other than infant diet. Infant diet exposures are associated with persistent methylation differences in CPT1A, which may be one mechanism behind infant diet’s long-term health effects.

Reproductive Hormone Concentrations and Associated Anatomical Responses: Does Soy Formula Affect Minipuberty in Boys?

Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow milk formula, or breast milk feeding during study follow-up. In the 147 infant boy participants, serum testosterone, luteinizing hormone, stretched penile length, anogenital distance, and testis volume were longitudinally assessed from birth to 28 weeks. We examined feeding-group differences in age trajectories for these outcomes using mixed-effects regression splines. Median serum testosterone was at pubertal levels at 2 weeks (176 ng/dL [quartiles: 124, 232]) and remained in this range until 12 weeks in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n = 55) and boys fed cow milk formula (n = 54). Compared with breastfed boys (n = 38), soy formula-fed boys had a more rapid increase in penile length (P = .004) and slower initial lengthening of anogenital distance (P = .03), but no differences in hormone trajectories. Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.

Association of infant diet with subsequent obesity at 2-5years among children exposed to gestational diabetes: the SWIFT study.

This longitudinal analysis evaluated the independent and joint associations of any breastfeeding (BF) or exclusive BF (EBF) and intake of sugar-sweetened beverages (SSBs) and 100% fruit juice from birth to 1year with subsequent overweight and obesity among young children exposed to gestational diabetes (GDM). The analysis utilised prospectively collected data from participants enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes after GDM (SWIFT); 1035 pregnant women (20-45years) diagnosed with GDM, of whom 75% were of Black, Hispanic or Asian race and ethnicity. Mother-infant dyad characteristics and infant dietary intake were assessed via research protocols at in-person examinations, telephone interviews and monthly mailed surveys from birth to 1year. Child weight, length and height were obtained from electronic health records at birth (2008-2011) and ages 2-5years (2010-2016) to classify BMI percentile groups (n = 835). Adequate BF (≥6months), adequate EBF duration (≥6months), and SSB and 100% fruit juice intake in the first year were independently associated with child obesity at ages 2-5years (all p < 0.05). Compared with children with adequate EBF and no intake of SSB or 100% fruit juice, those with adequate EBF and intake of 100% fruit juice and/or SSBs had a four- to fivefold higher odds of obesity (aOR 4.2, 95% CI:1.6, 11.2 for 100% fruit juice; aOR 4.5, 95% CI:1.4, 8.5 for fruit juice or SSBs; and aOR 4.7, 95% CI:1.4, 15 for SSBs; all p < 0.01), while those with inadequate EBF (<6months) and intake of 100% fruit juice and/or SSBs had a six- to 12-fold higher odds of obesity (aOR 6.4, 95% CI:2.4, 17.2 for fruit juice; aOR 6.6, 95% CI:2.7, 14.8 for fruit juice or SSBs; and aOR 12.2, 95% CI:4.3, 25 for SSBs; all p < 0.001). Compared with children with adequate BF and no intake of SSB or 100% fruit juice, those with adequate BF and intake of 100% fruit juice and/or SSBs had a threefold higher odds of obesity (aOR 3.1, 95% CI:1.1, 7.3 for fruit juice; aOR 3.3, 95% CI:1.3, 8.3 for fruit juice or SSBs; and aOR 3.4, 95% CI:1.3, 8.5 for SSBs; all p < 0.05), while those with inadequate BF (<6months) and intake of 100% fruit juice and/or SSB were associated with five- to tenfold higher odds of obesity (aOR 4.8, 95% CI:2.3, 12.2 for fruit juice; aOR 6.0, 95% CI:2.5, 12.8 for fruit juice or SSBs; aOR 9.5, 95% CI:3.7, 15.1 for SSBs; all p < 0.05). This is the first study to prospectively evaluate the relation of BF or EBF duration and intake of SSB and 100% fruit juice during the first year of life with subsequent obesity in children exposed to GDM. Adequate BF or EBF combined with avoidance of SSB and 100% fruit juice during early infancy may ameliorate future child obesity in this high-risk population.

Association between Breastfeeding and DNA Methylation over the Life Course: Findings from the Avon Longitudinal Study of Parents and Children (ALSPAC).

Background: Breastfeeding is associated with short and long-term health benefits. Long-term effects might be mediated by epigenetic mechanisms, yet the literature on this topic is scarce. We performed the first epigenome-wide association study of infant feeding, comparing breastfed vs non-breastfed children. We measured DNA methylation in children from peripheral blood collected in childhood (age 7 years, N = 640) and adolescence (age 15–17 years, N = 709) within the Accessible Resource for Integrated Epigenomic Studies (ARIES) project, part of the larger Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Cord blood methylation (N = 702) was used as a negative control for potential pre-natal residual confounding. Results: Two differentially-methylated sites presented directionally-consistent associations with breastfeeding at ages 7 and 15–17 years, but not at birth. Twelve differentially-methylated regions in relation to breastfeeding were identified, and for three of them there was evidence of directional concordance between ages 7 and 15–17 years, but not between birth and age 7 years. Conclusions: Our findings indicate that DNA methylation in childhood and adolescence may be predicted by breastfeeding, but further studies with sufficiently large samples for replication are required to identify robust associations.

Psychosocial Experiences of HIV-Positive Women of African Descent in the Cultural Context of Infant Feeding: A Three-Country Comparative Analyses.

Infant feeding among mothers of African descent living with Human Immunodeficiency Virus (HIV) is a critical practice that is influenced by policies, cultural expectations, and the resultant psychosocial state of the mother. Hence, this paper draws insights from a broader infant feeding study. It provides insights into how guidelines on infant feeding practices, cultural expectations, migration, or geographic status intersect to influence the psychosocial experiences of mothers living with HIV. We compared psychosocial experiences of Black mothers of African descent living with HIV in Nigeria versus those in high-income countries (Canada and USA), in the context of contrasting national infant feeding guidelines, cultural beliefs about breastfeeding, and geographic locations. Survey was conducted in venue-based convenience samples in two comparative groups: (Ottawa, Canada and Miami-FL, USA combined [n = 290]), and (Port Harcourt, Nigeria [n = 400]). Using independent samples t-statistics, we compared the means and distributions of six psychosocial attributes between Black mothers in two distinct: Infant feeding groups (IFGs), cultural, and geographical contexts at p < 0.05. Psychosocial attributes, such as discrimination and stigma, were greater in women who exclusively formula feed (EFF) than in women who exclusively breastfeed (EBF) at p < 0.01. Heightened vigilance, discrimination, and stigma scores were greater in women whose infant feeding practices were informed by cultural beliefs (CBs) compared to those not informed by CBs at p < 0.001. Discrimination and stigma scores were greater among mothers in Canada and the USA than in Nigeria at p < 0.001. Heightened vigilance and perceived stress scores were less among women in Canada and the USA than in Nigeria at p < 0.001. The guidelines on infant feeding practices for mothers with HIV should consider cultural expectations and migration/locational status of mothers.

Characterization of ovarian development in girls from birth to 9months.

The minipuberty of infancy is a period of increased reproductive axis activity. Changes in reproductive hormone concentrations and organ size occur during this period, but longitudinal changes have not been well described. The objective of this study was to characterize ovarian growth trajectories and ovarian follicle development during the first 9months of life in a large longitudinal cohort of healthy girls. Data from the Infant Feeding and Early Development Study, a longitudinal cohort study of oestrogen-responsive outcomes in healthy infants, were used to estimate ovarian growth trajectories and describe the presence of ovarian antral follicles in girls 0-9months old. Ovarian ultrasound evaluations were performed on the infants within 72hours of birth (newborn visit) and at 4, 8, 16, 24, and 32weeks of age. Mixed-effects regression splines were used to characterize changes in ovarian volume during infancy and assess the association between the presence of ovarian follicles at the newborn visit and ovarian growth. This analysis included 163 girls with two or more ovarian ultrasounds in the study. Results from the estimated overall ovarian growth trajectory show that ovarian volume increases more than sixfold during the first 16weeks after birth and then remains relatively stable in the later weeks of infancy. Among girls with observable ovaries at the newborn visit (n=133), girls with at least one visible ovarian follicle showed more rapid initial ovarian growth compared with girls without visible follicles. Infant ovarian volume increased to a peak at 16weeks, which was influenced by the number and size of developing follicles. This research contributes to future development of reference ranges for postnatal ovarian growth in healthy, term infants.

Moments of Pleasure: A Preliminary Classification of Gustatory mmms and the Enactment of Enjoyment During Infant Mealtimes.

The enjoyment of food and the sharing of mealtimes is a normative cultural and social practice. Empirical research on eating enjoyment has, however, been a rather neglected area across the social sciences, often marginalized in favor of health or focusing on individual preferences rather than shared enjoyment. Even with regards to children, their enjoyment of food is typically rated retrospectively via parental reports of mealtime behavior. What is missing is an understanding of how enjoyment becomes a normative, cultural practice during mealtimes. This paper examines this issue in the context of parents feeding their 5–8-month-old infants in the family home, since it is within this context that we can see the early emergence of such practices in often highly routinized situations. The enactment of eating as enjoyable, and of the food as appreciated or “liked” in some way, is a culturally normative practice that becomes recognizable through particular non-lexical (“mmm,” “ooh”) or lexical (“this is nice, isn't it?”) utterances. The data comprise 66 infant mealtimes video-recorded over almost 19 h, from five families living in Scotland. The analysis uses discursive psychology and focuses on the sequential position of different types of parental gustatory mmms as produced during the infant meals. A classification of four types of mmm were identified in the corpus—announcement, receipting, modeling, and encouragement mmms—each associated with features of sequential and multimodal organization within the mealtime. In the majority of instances, mmms were uttered alone with no other assessment terms, and parents typically produced these as an orientation to the enjoyment of their infants', rather than their own, eating practices. The receipting mmms, for instance, occurred at the precise moment when the infant's mouth closed around the food. It is argued that eating enjoyment can be considered as much an interactional practice as an individual sensation, and that non-lexical vocalizations around food are an essential part of sensory practices. The paper thus aims to bridge the gap between cultural and psychological studies of eating enjoyment and contribute to developmental studies of infant feeding in everyday interaction.

The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China.

The objective of this study was to document the types of foods introduced to infants before six months of age and identify factors associated with their early introduction. A prospective cohort study of infant feeding for the first six months after birth was undertaken in the city of Chengdu, PR China. The participants were 845 mothers who delivered their infants in hospitals in Chengdu. Mothers were interviewed within 15 days of giving birth and were followed up with for six months. The outcome measures were the introduction of complementary foods to infants within four and six months postpartum. Complementary foods are defined as any food, whether manufactured or locally prepared, used as a complement to breast milk or infant formula. In this study the emphasis was on solids and not liquid foods. More than 94% of the infants were given complementary foods (semi-solid or solid foods) before the age of six months and 10% by four months. The most commonly introduced food was infant cereal, which was given to three quarters of the infants by six months. Multivariate analysis showed that maternal education level was a significant factor affecting the introduction of complementary foods before four months, adjusted odds ratio 2.983 (1.232–7.219), with the more educated mothers introducing complementary foods earlier. More antenatal and postnatal health promotion efforts are required to highlight the benefits of introducing solid foods later than is the current practice in Chengdu, at or close to six months of age. Further education is also required for training health professionals including pediatricians, midwives, and community health staff.

Developing a core outcome set for childhood obesity prevention: A systematic review.

Synthesis of effects of infant feeding interventions to prevent childhood obesity is limited by outcome measurement and reporting heterogeneity. Core outcome sets (COSs) represent standardised approaches to outcome selection and reporting. The aim of this review is to identify feeding outcomes used in infant feeding studies to inform an infant feeding COS for obesity prevention interventions. The databases EMBASE, Medline, CINAHL, CENTRAL, and PsycINFO searched from inception to February 2017. Studies eligible for inclusion must examine any infant feeding outcome in children ≤1year. Feeding outcomes include those measured using self-report and/or observational methods and include dietary intake, parent-child interaction, and parental beliefs, among others. Data were extracted using a standardised data extraction form. Outcomes were assigned to outcome domains using an inductive, iterative process with a multidisciplinary team. We identified 82 unique outcomes, representing nine outcome domains. Outcome domains were "breast and formula feeding," "introduction of solids," "parent feeding practices and styles," "parent knowledge and beliefs," "practical feeding," "food environment," "dietary intake," "perceptions of infant behaviour and preferences," and "child weight outcomes." Heterogeneity in definition and frequency of outcomes was noted in reviewed studies. "Introduction of solids" (59.5%) and "breastfeeding duration" (55.5%) were the most frequently reported outcomes. Infant feeding studies focus predominantly on consumption of milks and solids and infant weight. Less focus is given to modifiable parental and environmental factors. An infant feeding COS can minimise heterogeneity in selection and reporting of infant feeding outcomes for childhood obesity prevention interventions.

Qualitative Studies of Infant and Young Child Feeding in Lower-Income Countries: A Systematic Review and Synthesis of Dietary Patterns.

Continued high rates of both under- and over-nutrition in low- and low-middle-income countries highlight the importance of understanding dietary practices such as early and exclusive breastfeeding, and dietary patterns such as timely, appropriate complementary feeding—these behaviors are rooted in complex cultural ecologies. A systematic review and synthesis of available qualitative research related to infant and young child dietary patterns and practices from the perspective of parents and families in low income settings is presented, with a focus on barriers and facilitators to achieving international recommendations. Data from both published and grey literature from 2006 to 2016 was included in the review. Quality assessment consisted of two phases (Critical Appraisal Skills Program (CASP) guidelines and assessment using GRADE-CERQual), followed by synthesis of the studies identified, and subsequent thematic analysis and interpretation. The findings indicated several categories of both barriers and facilitators, spanning individual and system level factors. The review informs efforts aimed at improving child health and nutrition, and represents the first such comprehensive review of the qualitative literature, uniquely suited to understanding complex behaviors leading to infant and young child dietary patterns.