Effects Of Early Infant Feeding Patterns On Growth Of Infants Under 12 Month Of Age

Objective: To investigate the effect of different feeding patterns on infant growth and examine the effects of early feeding of larger volumes of formula on growth and risk of overweight in later infancy,and to provide evidence-based guidelines of rational feeding pattern for prevention overweight or obesity during early life.Methods: One thousand and ninety nine newborns born from the Tongji Maternal and Child Health Cohort(TMCHC)study between February 2014 to June 2016 in a district of Wuhan City were recruited in this study.The Body weight and length were measured in newborn,and 3-month,6-month and 12-month age of infants.A questionnaire was used to obtain the information on feeding pattern of the infants,and infants were divided into exclusively breast-fed group,fix-fed group and formula-fed group according the feeding pattern.WHO Child Growth Standards were used to calculate the length-for-age z score(LAZ),weight-for-age z-score(WAZ),weight-for-length z-score(WLZ)and BMI-for-age z score(BAZ),and to evaluate the effects of different feeding pattern on growth and development of infants under12-month of age.Milk records collected at 3 month of age were used to define the following 3 feeding patterns: breast milk feeding(BM,no formula),lower-volume formula milk feeding(LFM,<840 ml formula/d),and higher-volume formula milk feeding(HFM,?840 ml formula/d),and the association between the higher-volume formula feeding and risk of greater body weight or overweight was observed.Variance analysis,chi square test,Logistic regression and mixed effects model were used for statistical analysis.Results:1.Effects of different feeding pattern on growth The exclusive breastfeeding rate in newborn was 30.6%,and this number was 55.5%in 3-month-old infants.The rate of sustaining exclusive breastfeeding during first 3 months was 25.5% and as for 6-month-old infants,the exclusive breastfeeding rate was 16.8%.62.4% infants were introduced complementary foods under 6 month of age.Body weight and length were higher than WHO reference values after 3 months of age.WAZ,LAZ,WLZ,BAZ,greater body weight and overweight increased with age.The greater body weight rates of 3 months,6 months and 12 months were 27.3%,30.2% and 28.8% respectively.The overweight rates were 6.9%,10.6% and 6.7%respectively.As for growth and development of 6 and 12 months of age,the weight and length of the infants who had been formula-fed and mix-fed in their neonatal and3-month-old age were significant greater than those with exclusive breastfeeding(P<0.05).Non-exclusive breastfeeding(including formula feeding and mixed feeding)at 3 month of age was positively associated with the greater body weight at the age of6 and 12 months(P<0.05).Non-exclusive breastfeeding from 0 to 3 months was positively associated with the greater body weight at the age of 6(P<0.05).The index of physical development is higher than the WHO new standard reference value after 3month of age.2.Effects of different volumes of formula milk during early infancy on growth The difference in weight and length between the HFM and BM infants was significant at 3 month of age(P<0.05)and continued until 12 mo of age(P<0.001).From 3 to 6mo of age,LFM infants showed higher WLZ gain(+0.26 vs +0.12,P = 0.016)and BAZ gain(+0.12 vs-0.01,P = 0.013)than BM infants.Furthermore,HFM infants showed higher WLZ gain(+0.30 vs +0.12,P = 0.023)and BAZ gain(+0.15 vs-0.01,P = 0.033)than BM infants.Compared with BM-fed infants,infants fed with HFM had 1.60-fold(95% CI 1.05-2.44)higher odds of greater body weight(1SD<weight-for-length z-scores(WLZ)?2 SD)at the age of 6 month and 1.55-fold(95% CI 1.01-2.37)higher odds of greater body weight and 2.13-fold(95% CI1.03-4.38)higher odds of overweight(WLZ>2 SD)at the age of 12 month.Conclusions: Breastfeeding during early infancy helps to prevent overweight or obesity later in infancy.Feeding higher volumes of formula in early infancy is associated with greater body weight and overweight in later infancy.Exclusive breastfeeding should be strengthened in the feeding practice in infants until 6 month of age.