To examine the association between timing of introduction of solid foods during infancy and obesity at 3 years of age.
We studied 847 children in Project Viva, a prospective pre-birth cohort study. The primary outcome was obesity at 3 years of age (BMI for age and gender ≥95th percentile). The primary exposure was the timing of introduction of solid foods, categorized as <4, 4 to 5, and ≥6 months. We ran separate logistic regression models for infants who were breastfed for at least 4 months (“breastfed”) and infants who were never breastfed or stopped breastfeeding before the age of four months (“formula-fed”), adjusting for child and maternal characteristics, which included change in weight-for-age z score from 0 to 4 months–a marker of early infant growth.
In the first 4 months of life, 568 infants (67%) were breastfed and 279 (32%) were formula-fed. At age 3 years, 75 children (9%) were obese. Among breastfed infants, the timing of solid food introduction was not associated with odds of obesity (odds ratio: 1.1 [95% confidence interval: 0.3–4.4]). Among formula-fed infants, introduction of solid foods before 4 months was associated with a sixfold increase in odds of obesity at age 3 years; the association was not explained by rapid early growth (odds ratio after adjustment: 6.3 [95% confidence interval: 2.3–6.9]).
Among formula-fed infants or infants weaned before the age of 4 months, introduction of solid foods before the age of 4 months was associated with increased odds of obesity at age 3 years.
Comments
Childhood Obesity
Childhood obesity is an overwhelming concern in society today. In a recent study done on the timing of the introduction of solid foods, infants were monitored over a three year period. The children who were formula fed had a tendency to be more obese than the children that were breastfed, while those who did not breastfeed for four months before being introduced to solid foods increased the chances of obesity at three years by six times, and children that breastfed for at least four months did not report and association with obesity (Huh, Rifas-Shiman, Taveras, Oken, & Gillman, 2011).
The European Union Childhood Obesity Project examined the importance of protein count in formulas with the hypothesis that lower protein count would lead to slower growth rates of the children. The results supported the hypothesis which suggested the higher the protein count in formula, the more at risk for obesity the child is because of faster growth rates (Hunty, 2009).
The two articles reflect the importance of the timing of introduction of solid foods and adhering to the nutritional guidelines for the child to help reduce the risk of childhood obesity. This knowledge can educate physicians and mothers to help children remain as healthy as possible while they are still preschool aged. The physicians rely on valid studies to help them make decisions that are in the best interest of the patient’s wellbeing. Evidence based practice will help pediatricians to monitor breastfeeding and formula feeding and make sure that the parents are aware of the consequences of introducing solid foods too early.
As a future Occupational Therapist and hopefully mother, these studies are of extreme interest to me because I would never want to harm my child in any way. I believe that, thanks to the publication of these articles, and because of public knowledge, health care practitioners will carefully monitor the feeding habits of children as they develop and intensely advocate to the parents the importance of adhering to the nutritional guidelines for their child.
Conflict of Interest:
None declared
Early solid food introduction related to early risk of stunting in breastfed children Lao PDR
Early solid food introduction related to early risk of stunting in breastfed children Lao PDR
Susanna Y. Huh, and colleagues raise an important concern regarding the association of early introduction of solid foods and obesity among formula-fed infants or infants weaned before the age of 4 months.(1)
Interestingly, this association was not observed in breastfed infants which would constitute another important argument to promote breastfeeding in western countries.
As a paediatrician, long working in developing countries (more than 20 years), we share a similar concern with a different issue. The protection of this unique and vital life saving intervention is crucial for us.(2) We, (foreign and Lao pediatricians), have continously to struggle hard against any deceptive attempts to decrease breastfeeding rate in traditional high breastfeeding countries such as Laos.(3;4)
In Laos, 95% of mothers breastfeed their new-borns but the rate of exclusive breastfeeding is only 26.4%.(5) The advertising of breast milk substitute is subtle, attractive and highly convincing, though thoroughly misleading.(3) A new challenge is the increased marketing of formula milk company and the limited budget to develop breastfeeding campaign with similar budget in similar country as Laos.
An UNICEF official recently stated that “The advertising of formula is having a huge impact in South-east Asia, because it is a growing market for the companies.(6)”
In Lao PDR early solid food introduction is common.(7) Glutinous rice is a frequent first food supplement and is given pre-chewed by mothers to 20–48% of infants in the first week of life. (7)
In 2005 we enrolled 300 pairs of infants (under 6 months of age) and their mothers during a cross-sectional survey conducted in 41 randomly selected villages on the outskirts of Vientiane capital city, Lao PDR.(5) Children were follow-up until the age of 4 years.
All mothers breastfed their infants. Before being breastfed, 81 (27%) children received either water or formula milk. Colostrum was given by 276 (92.5%) mothers but mean time to first breastfeeding was given at 14.6 (11.2–18.0) h. A total of 161 (53.7%) infants received an early food supplement in the form of chewed glutinous rice (77,25.6%), formula milk (66, 22%) or rice soup with carrots (16, 5.3%). Chewed glutinous rice was given to infants as an early (mean 34.6, 95% CI:29.3–39.8 days) complementary food by 53.7% of mothers.(5) Thirty infants (10%) had severe stunting and 9 (3%) had acute malnutrition at six months.
Stunting at six months was associated with early rice supplementation (OR¼1.35, 95% CI: 1.04–1.75). No obesity was observed so far at the age of 4 years in this breastfed cohort of children.
Improving exclusive breastfeeding remains an important challenge for children in developing countries.
Reference
1 Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children 1. Pediatrics 2011.
2 UNICEF. Exclusive breastfeeding. http://www unicef org/progressforchildren/2006n4/index_breastfeeding html [ 2010 [cited 2010 Oct. 10];
3 Barennes H, Andriatahina T, Latthaphasavang V, Anderson M, Srour L. Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos. BMJ 2008;(337):a1379.
4 Slesak G, Douangdala P, Inthalad S, Onekeo B, Somsavad S, Sisouphanh B et al. Misuse of coffee creamer as a breast milk substitute: a lethal case revealing high use in an ethnic minority village in Northern Laos. http://www bmj com/cgi/eletters/337/sep09_2/a1379#207174 [ 2009
5 Barennes H, Simmala C, Odermatt P, Thaybouavone T, Vallee J, Martinez-Ussel B et al. Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR. Eur J Clin Nutr 2007; 63(3):323-331.
6 Marwaan Macan-Marker. Children Under Five Straggling. Global Geopolitics Globalnewsblog.com; Inter Press Service. http://globalnewsblog com/wp/2008/09/13/asia-pacific-mdgs-children-under- five-straggling/ [ 2008 Available from: URL:Global Geopolitics Globalnewsblog.com
7 Kaufmann S, Marchesich R, Dop MC. Fao Nutrition Country Laos . Fao nutrition country profiles, editor. 1-38. 2003. Rome Italy.
Conflict of Interest:
None declared