Feeding patterns and growth trajectories in breast-fed and formula-fed infants during the introduction of complementary food.

INTRODUCTION: Introduction: several investigations have identified breastfeeding as a protective factor for rapid infant weight gain and childhood obesity while other studies have found that this protective effect could be the result of confounding factors. Objectives: to assess the associations between lactation practices (breast-fed vs formula-fed infants) during the introduction of complementary food period, as well as the following: a) patterns of food intake; and b) trajectories of growth at six, nine and 12 months (z-score of weight, height and body mass index [BMI] and changes in these z-scores from six to 12 months). Methods: two hundred and three infants randomly selected from Spanish Primary Health Centres were measured. Parents recorded all infant's food consumption for three days (g/day). Linear regression models were applied. Results: breast-fed infants had a lower intake of cereals, fruit baby food, vegetables with meat/fish and a total intake of food compared to formula-fed infants at nine months of age. After adjusting for sex, parental education and total food intake, breastfed children continued to have lower intake of cereals (-5.82, 95% CI: -9.22, -2.43), and lower total food intake (-301.23, 95% CI: -348.50, -253.96). Breast-fed infants had a lower change in z-score of weight, height and BMI from six to 12 months of age and these differences remained when adjusting for all confounders. Conclusions: formula-fed infants during the complementary feeding period have a higher food intake and show higher rates of rapid infant weight gain compared to breast-fed infants. These differences in growth trajectories depending on breastfeeding maintenance and food intake during early life must be considered in adiposity risk evaluation.

INTRODUCCIÓN: Introducción: varios estudios han identificado la lactancia materna como un factor protector frente a la ganancia rápida de peso y la obesidad infantil, mientras que otros estudios han encontrado que este efecto protector podría ser el resultado de la interferencia de factores de confusión. Objetivos: evaluar las asociaciones entre el tipo de lactancia (leche materna versus lactantes alimentados con fórmula) durante la introducción de la alimentación complementaria, así como: a) los patrones de ingesta de alimentos; y b) las trayectorias de crecimiento a los seis, nueve y 12 meses (z-score de peso, estatura e índice de masa corporal (IMC) y variaciones en estos z-score entre los seis y los 12 meses. Métodos: se midieron 203 neonatos seleccionados en centros de salud primaria españoles. Los padres registraron el consumo de alimentos de todos los bebés durante tres días (g/día). Se aplicaron modelos de regresión lineal. Resultados: los bebés alimentados con leche materna tuvieron una menor ingesta de cereales, alimentos para bebés a base de frutas, verduras con carne/pescado, así como una menor ingesta total de alimentos en comparación con los bebés alimentados con fórmula a los nueve meses de edad. Después de realizar el ajuste por sexo, educación de los padres y consumo total de alimentos, los niños alimentados con leche materna continuaron teniendo una menor ingesta de cereales (-5,82, IC 95%: -9,22, -2,43) y una ingesta total de alimentos más baja (-301,23, IC 95%: -348,50, -253,96). Los bebés alimentados al pecho tuvieron un menor incremento en la puntuación z-score de peso, talla e IMC entre los seis y los 12 meses de edad y estas diferencias se mantuvieron cuando se ajustaron para todos los factores de confusión. Conclusiones: los lactantes alimentados con fórmula durante el periodo de alimentación complementaria tienen una mayor ingesta de alimentos y muestran tasas más altas de ganancia de peso en comparación con los lactantes alimentados con leche materna. Estas diferencias en las trayectorias de crecimiento en función del mantenimiento de la lactancia materna y la ingesta de alimentos durante los primeros años de vida deben considerarse en la evaluación del riesgo de adiposidad.

Early life risk factors and their cumulative effects as predictors of overweight in Spanish children.

OBJECTIVES: To explore early life risk factors of overweight/obesity at age 6 years and their cumulative effects on overweight/obesity at ages 2, 4 and 6 years. METHODS: Altogether 1031 Spanish children were evaluated at birth and during a 6-year follow-up. Early life risk factors included: parental overweight/obesity, parental origin/ethnicity, maternal smoking during pregnancy, gestational weight gain, gestational age, birth weight, caesarean section, breastfeeding practices and rapid infant weight gain collected via hospital records. Cumulative effects were assessed by adding up those early risk factors that significantly increased the risk of overweight/obesity. We conducted binary logistic regression models. RESULTS: Rapid infant weight gain (OR 2.29, 99% CI 1.54-3.42), maternal overweight/obesity (OR 1.93, 99% CI 1.27-2.92), paternal overweight/obesity (OR 2.17, 99% CI 1.44-3.28), Latin American/Roma origin (OR 3.20, 99% CI 1.60-6.39) and smoking during pregnancy (OR 1.61, 99% CI 1.01-2.59) remained significant after adjusting for confounders. A higher number of early life risk factors accumulated was associated with overweight/obesity at age 6 years but not at age 2 and 4 years. CONCLUSIONS: Rapid infant weight gain, parental overweight/obesity, maternal smoking and origin/ethnicity predict childhood overweight/obesity and present cumulative effects. Monitoring children with rapid weight gain and supporting a healthy parental weight are important for childhood obesity prevention.

Social vulnerabilities as determinants of overweight in 2-, 4- and 6-year-old Spanish children.

Background: Differences in obesity prevalence among vulnerable groups exist in childhood but it remains unclear whether these differences may be partly determined by socioeconomic status (SES), parental body mass index (BMI) and early life risk factors. We aimed to explore (i) longitudinal associations between belonging to a minority group and being overweight/obese at age 2, 4 and 6 and (ii) associations between accumulation of social vulnerabilities and being overweight/obese at age 6. Methods: In total, 1031 children (53.8% boys) were evaluated at birth and re-examined during a 6-year follow-up in a representative cohort of Aragon (Spain). Children from minority (vulnerable) groups included Spanish Roma/gypsies, Eastern Europeans, Latin Americans and Africans. Two more vulnerable groups were defined at baseline as children whose parents reported low occupation and education. Ethnicity, SES and parental BMI were collected via interviews. We used logistic mixed-effects models and adjusted for parental BMI, SES, mother's tobacco use, maternal weight gain, birth weight, infant weight gain and breastfeeding practices. Results: Regardless of confounders, Roma/gypsy children (OR = 4.63;[1.69-12.70]95%CI) and with Latin American background (OR = 3.04;[1.59-5.82]95%CI) were more likely to be overweight/obese at age 6 compared with non-gypsy Spanish group. Children with three vulnerabilities (OR = 2.18;[1.31-3.64]95%CI) were more likely to be overweight/obese at age 6 compared with children with no vulnerabilities. No associations were found between belonging to a minority group and overweight/obesity in children under 6. Conclusion: Interventions should target Roma/gypsy children, Latin American children and those who accumulate more vulnerabilities as they are at higher risk of being overweight/obese at age 6.

Infant growth and early adiposity depending on immigrant background and anthropometric standards; the CALINA Study.

OBJECTIVE: To compare infant growth and adiposity pattern up to 2 years of age in Spanish infants, depending on maternal origin and anthropometric standards. METHODS: Longitudinal study of a representative cohort of infants born at term in Aragon (Spain) (n = 1.430). Mean z-scores of weight, length, body mass index, triceps and subscapular skinfolds were calculated until 24 months of age using World Health Organization (WHO), Euro-Growth and Spanish growth standards and categorized by maternal origin (Spanish vs. immigrant). RESULTS: Infants of immigrant mothers had higher weight, length, body mass index, triceps and subscapular skinfolds than Spanish maternal origin infants during the first months of life. Mean z-scores significantly varied depending on growth standards used. At 18 months of age, all anthropometric differences between both groups disappeared, but only when using WHO growth standards. Mean triceps and subscapular skinfold z-scores substantially and progressively increased from 3 months to 24 months of age in both groups compared to WHO standards. At 24 months, the prevalence of infants at risk of overweight and overweight were similar in both groups (Spanish: 15.1% and 3.8%; immigrant: 14.7% and 4.9%, respectively). CONCLUSIONS: Infant growth, adiposity patterns and prevalence of overweight depend on maternal origin, showing initial differences which progressively disappeared at 24 months of life when WHO growth standards were used. Differences in infant mean anthropometric measurements depend on anthropometric standard used.

Infant growth and early adiposity depending on immigrant background and anthropometric standards; the CALINA Study / Crecimiento y adiposidad durante la primera infancia dependiendo del origen de la familia y de los estándares antropométricos; estudio CALINA

Objective: To compare infant growth and adiposity pattern up to 2 years of age in Spanish infants, depending on maternal origin and anthropometric standards. Methods: Longitudinal study of a representative cohort of infants born at term in Aragon (Spain) (n = 1.430). Mean z-scores of weight, length, body mass index, triceps and subscapular skinfolds were calculated until 24 months of age using World Health Organization (WHO), Euro-Growth and Spanish growth standards and categorized by maternal origin (Spanish vs. immigrant). Results: Infants of immigrant mothers had higher weight, length, body mass index, triceps and subscapular skinfolds than Spanish maternal origin infants during the first months of life. Mean z-scores significantly varied depending on growth standards used. At 18 months of age, all anthropometric differences between both groups disappeared, but only when using WHO growth standards. Mean triceps and subscapular skinfold z-scores substantially and progressively increased from 3 months to 24 months of age in both groups compared to WHO standards. At 24 months, the prevalence of infants at risk of overweight and overweight were similar in both groups (Spanish: 15.1% and 3.8%; immigrant: 14.7% and 4.9%, respectively). Conclusions: Infant growth, adiposity patterns and prevalence of overweight depend on maternal origin, showing initial differences which progressively disappeared at 24 months of life when WHO growth standards were used. Differences in infant mean anthropometric measurements depend on anthropometric standard used (AU)

Objetivo: comparar el patrón de crecimiento infantil y adiposidad temprana hasta los 2 años en los niños españoles, según el origen materno y los estándares antropométricos. Métodos: estudio longitudinal en una cohorte representativa de niños nacidos a término en Aragón (España) (n = 1.430). Se calcularon z-scores de peso, longitud, índice de masa corporal, pliegue tricipital y subescapular hasta los 2 años usando estándares de crecimiento de la Organización Mundial de la Salud (OMS), Euro-Growth y nacionales, y se categorizaron según el origen materno (español vs. inmigrante). Resultados: los niños de madre de origen inmigrante presentaron mayor peso, longitud, índice de masa corporal y pliegues tricipital y subescapular que los de origen español durante los primeros meses de vida. Los valores medios de z-score variaron significativamente según el estándar de crecimiento utilizado. A los 18 meses, las diferencias entre ambos grupos desaparecieron solo al emplear los estándares de la OMS. Los valores de z-score de pliegues tricipital y subescapular se incrementaron de manera sustancial y progresiva desde los 3 a los 24 meses comparándolos con los estándares de la OMS. A los 24 meses, la prevalencia de niños con riesgo de sobrepeso y sobrepeso fue similar en ambos grupos (español: 15,1% y 3,8%; inmigrante: 14,7% y 4,9%, respectivamente). Conclusiones: el patrón de crecimiento y la adiposidad durante la primera infancia, así como la prevalencia de sobrepeso mostraron diferencias según el origen de la madre que desaparecieron progresivamente a los 24 meses de vida al emplear los estándares de la OMS. Se objetivaron diferencias en los valores antropométricos según el estándar de crecimiento utilizado (AU)

Subcutaneous fat distribution in small for gestational age newborns.

We assessed the anthropometric characteristics of symmetric (SGA-S) and asymmetric (SGA-A) term newborns and describe their subcutaneous fat differences. We assessed perinatal data, maternal characteristics and anthropometric variables (including skinfold thicknesses) in 139 small for gestational age (SGA) term infants, classified as symmetric and asymmetric according to their ponderal index (using the 10(th) percentile as the cut-off criterion). Despite an overall small body size and lower amounts of subcutaneous fat than the reference population, SGA-S term newborns showed a proportionate body fat distribution and SGA-A were thinner and had a lower percentage of central subcutaneous fat than SGA-S. These findings, resulting from intrauterine growth restriction, could be associated with different early and later postnatal outcomes among SGA groups.