An examination of children's eating behaviours as mediators of the relationship between parents' feeding practices and early childhood body mass index z-scores.

OBJECTIVE: Parent's use of restrictive feeding practices is associated with child weight. Similarly, the literature shows that children's eating behaviours are also associated with child weight. Given this interrelationship between children's eating behaviours, restrictive feeding practices and child weight, examination of possible mediator relationships is warranted. This study aimed to examine the relationships between overt restriction and covert restriction with child body mass index z-scores (BMIz) and determine if children's eating behaviours (satiety responsiveness and food responsiveness) act as mediators. METHOD: Parents of Australian children (n = 977) 2.0-5.0 years of age (49.4% male) provided data in an online survey on child eating behaviours, parent's restrictive feeding practices and child anthropometrics (modified z-scores were created to screen for biologically implausible values). Correlation analysis was used to determine variables to include in mediation models. Hayes' PROCESS macros in spss was used to examine mediation, controlling for covariates of child BMIz. RESULTS: Overt restriction was the only parent feeding practice related to child BMIz (B = 0.132, P = 0.04). Mediation analysis showed that the indirect effect of overt restriction on child BMIz (controlling for child age, gender, parent BMI and income) became non-significant when controlling for food responsiveness, thus suggesting full mediation, explaining 5.75% of the relation. CONCLUSION: Overt restriction and covert restriction have distinctly different relationships with children's eating behaviours. Food responsiveness appears an important intermediary in the relationship between overt restriction and child BMIz.

Breastfeeding: a key modulator of gut microbiota characteristics in late infancy.

The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants' gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more 'mature' microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children's feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.

Balancing training and outcomes in total knee replacement: A ten-year review.

INTRODUCTION: 10-year study examining differences in total knee arthroplasty (TKA) functional outcomes and survivorship in patients operated on by consultant and trainee orthopaedic surgeons. METHOD: Data was prospectively collected from all elective TKAs performed at our three linked institutions. Patient demographics, surgeon grade, and length of hospital stay were recorded. Outcomes pre-operatively and at 1, 3, 5, 7 and 10 years included mortality, need for revision surgery and function as documented by the patients' Knee Society Score. RESULTS: 686 patients were included in the study. 450 (65.5%) patients were operated by consultant surgeons and 236 (34.4%) by trainees. On multivariate analysis no significant differences were observed between groups in length of hospital stay (p = 0.695), implant survival (p = 0.422), and function (p = 0.507) at 10 years. On Cox regression analysis no significant difference was observed in mortality (p = 0.209) at 10 years. 4 patients over this time period were lost to formal follow up. CONCLUSION: No significant difference was observed in the TKA outcomes between consultants and trainees 10 years post-operatively.

The Iodine Status of Queensland Preschool Children After the Introduction of Mandatory Iodine Fortification in Bread: An Exploratory Study Using a Convenience Sample.

Introduction Appropriate dietary iodine is essential for thyroid hormone synthesis, especially in young children. Following an iodine fortification in bread initiative, approximately 6 % of Australian preschool children were expected to have an excessive iodine status. The aim of this study was to document the current iodine status of preschool children using urinary iodine concentration (UIC) as a biomarker of iodine intake. Methods A convenience sample of fifty-one preschool children, aged 2-3 years, were recruited from south east Queensland. UIC was ascertained from spot morning and afternoon urine samples collected on two consecutive days and food frequency questionnaires were completed for each participant. Dietary iodine intake was extrapolated from UIC assuming 90 % of dietary iodine is excreted in urine and a urine volume of 0.5 L/day. Results A median UIC of 223.3 µg/L was found. The calculated median dietary iodine intake was 124.8 µg/day (SD 47.0) with 9.8 % of samples above the upper level of 200 µg for dietary iodine for children within this age group. No foods were associated with UIC. Discussion Limited by sample size and recruitment strategies, no association was found between usual food intake and UIC. Extrapolated dietary iodine intake indicated that children within this cohort consumed adequate amounts of dietary iodine, although the number of children consuming above the upper limit of 300 µg/day was almost double of expected. The development of a UIC criteria to assess appropriate parameters for varying degrees of iodine status is required for the monitoring of iodine nutrition in this vulnerable age group.

Dairy and plant based food intakes are associated with altered faecal microbiota in 2 to 3 year old Australian children.

The first 1000 days (conception to 24 months) is when gut microbiota composition and eating patterns are established, and a critical period influencing lifelong health. The aim of this study is to examine the associations between food intakes and microbiota composition at the end of this period. Diet was quantified for 37 well-nourished Australian children aged between 2 to 3 years by using a food frequency questionnaire and 24 hr recalls. Both dairy and plant-based (fruit, vegetables, soy, pulses and nuts) food intakes were associated with distinct microbiota profiles. Dairy intake was positively associated with the Firmicutes:Bacteroidetes ratio, and in particular Erysipelatoclostridium spp., but negatively associated with species richness and diversity. Vegetable intake was positively associated with the relative abundance of the Lachnospira genus, while soy, pulse and nut intake was positively associated with the relative abundance of bacteria related to Bacteroides xylanisolvens. Fruit intake, especially apples and pears, were negatively associated with the relative abundance of bacteria related to Ruminococcus gnavus. In this cohort of young children dairy and plant based food intakes were found to be associated with altered microbiota composition. Further exploration is needed to elucidate the effect of these dietary and microbial differences on host phenotype.

Why do women stop breast-feeding? Results from a contemporary prospective study in a cohort of Australian women.

BACKGROUND/OBJECTIVES: Australian guidelines recommend infants be breast-fed for at least their first year of life; however, for a variety of reasons many mothers cease breast-feeding before this age. The objective of this study was to determine the reasons why women stop breast-feeding their infant completely, in relation to the age of the infant. SUBJECTS/METHODS: Primiparous Australian women aged between 18 and 40 years underwent a self-administered questionnaire-based birth cohort study on infant-feeding attitudes, behaviours and feeding patterns. Data were extracted from the demographic questionnaire and from questionnaires administered at 2, 4, 6 and 12 months of infant age between October 2010 and September 2011. RESULTS: Breast-feeding initiation in this cohort was 97%; however, by 52 weeks of infant age 46% of mothers had completely ceased breast-feeding. In those mothers who had ceased breast-feeding before 26 weeks the most common reason was 'I did not have enough milk'. In those mothers who had completely stopped breast-feeding between 26 and 52 weeks the most common reason reported as being very important in the decision to cease breast-feeding was 'My baby lost interest'. CONCLUSIONS: Maternal concerns regarding breast trauma, milk supply and infant satiety were central mediators of breast-feeding duration among these Queensland women. Further research into the antecedents of sucking pathologies and reasons for nipple trauma is indicated. Health professionals can assist women to recognise cues of hunger and satiety in their infants and understand the dynamics and natural history of breast-feeding to prolong breast-feeding relationships.

Antenatal breastfeeding intention, confidence and comfort in obese and non-obese primiparous Australian women: associations with breastfeeding duration.

BACKGROUND/OBJECTIVES: Maternal adiposity is known to affect breastfeeding initiation and duration via both antenatal and postnatal factors. This study investigates associations between maternal pregravid body mass index (BMI), breastfeeding duration and antenatal breastfeeding confidence, intention and social comfort among primiparous Australian women. SUBJECTS/METHODS: Women in their first pregnancy (n=462) were recruited by convenience sampling in Queensland, Australia. Participants responded to an antenatal and six postnatal questionnaires during their infants' first year between June 2010 and March 2012. Maternal pregravid BMI was examined against breastfeeding duration, participants' antenatal infant feeding intentions and measures of breastfeeding confidence and social comfort. RESULTS: Breastfeeding initiation in this cohort was 97%, but 46% of mothers had ceased breastfeeding at 52 weeks postpartum. Breastfeeding duration differed significantly (χ(2) (2)=7.21, P=0.007) between normal, overweight and obese women. No differences were found in antenatal intention for feeding type nor intended breastfeeding duration by one-way ANOVA (F(2,178)=1.77, P=0.17). More than half of the pregnant respondents anticipated social discomfort breastfeeding in public, with obese women significantly more likely to anticipate discomfort breastfeeding in the presence of close female friends, (χ(2) (1)=5.53, P=0.019). CONCLUSIONS: This study confirmed the risk of premature cessation of breastfeeding for obese mothers. Interventions during pregnancy that address body image issues in relation to breastfeeding may facilitate breastfeeding success for obese mothers and their infants and accrue short- and long-term health benefits for both.

Early life nutrition and the opportunity to influence long-term health: an Australasian perspective.

There are now significant data to support the hypothesis that early life nutrition in the fetus, infant and young child can have profound effects on long-term health. This review considers some of this evidence with specific reference to the current burden of disease in Australia and New Zealand. As the findings of further research become available, recommendations on optimizing early life nutrition should be formulated and made widely available as part of the preventative health policy agenda in both Australia and New Zealand.

Advantages of collecting multiple urinary iodine concentrations when assessing iodine status of a population.

AIM: To evaluate the effect of collecting multiple (four) urine samples on the extensive variance often observed within a cohort when determining iodine status via urinary iodine concentration (UIC). METHODS: Fifty-one children aged two to three years and thirty children aged 8-10 years participated in the study in South East Queensland, Australia. Each child's four urine samples were analysed using ammonium persulphate digestion before a Sandell-Kolthoff reaction method. Analysis of variance techniques were used to assess the effect of using multiple urine samples. RESULTS: The median UICs were 223.3 and 141 µg/L for two- to three-year-olds and eight- to 10-year-olds, respectively. The coefficient of variance (CV) of UIC for children aged two to three years was reduced by 35.6%, 36.5% and 39.7% when two, three and four samples were included in the adjustment, respectively. Similarly, the CV of UIC for children aged 8-10 years was reduced by 24.7%, 30.7% and 34.7%, respectively. CONCLUSION: Although the practicality and cost of collecting multiple UICs need to be considered, collecting multiple UIC samples from each participant provides a more accurate reflection of a cohort iodine status.

Short term variability in urinary bisphenol A in Australian children.

Used frequently in food contact materials, bisphenol A (BPA) has been studied extensively in recent years, and ubiquitous exposure in the general population has been demonstrated worldwide. Characterizing within- and between-individual variability of BPA concentrations is important for characterizing exposure in biomonitoring studies, and this has been investigated previously in adults, but not in children. The aim of this study was to characterize the short-term variability of BPA in spot urine samples in young children. Children aged ≥2-<4 years (n=25) were recruited from an existing cohort in Queensland, Australia, and donated four spot urine samples each over a two day period. Samples were analysed for total BPA using isotope dilution online solid phase extraction-liquid chromatography-tandem mass spectrometry, and concentrations ranged from 0.53 to 74.5 ng/ml, with geometric mean and standard deviation of 2.70 ng/ml and 2.94 ng/ml, respectively. Sex and time of sample collection were not significant predictors of BPA concentration. The between-individual variability was approximately equal to the within-individual variability (ICC=0.51), and this ICC is somewhat higher than previously reported literature values. This may be the result of physiological or behavioural differences between children and adults or of the relatively short exposure window assessed. Using a bootstrapping methodology, a single sample resulted in correct tertile classification approximately 70% of the time. This study suggests that single spot samples obtained from young children provide a reliable characterization of absolute and relative exposure over the short time window studied, but this may not hold true over longer timeframes.

Omega-3 fatty acids: a review of the effects on adiponectin and leptin and potential implications for obesity management.

An increase in adiposity is associated with altered levels of biologically active proteins. These include the hormones adiponectin and leptin. The marked change in circulating concentrations of these hormones in obesity has been associated with the development of insulin resistance and metabolic syndrome. Variations in dietary lipid consumption have also been shown to impact obesity. Specifically, omega-3 fatty acids have been correlated with the prevention of obesity and subsequent development of chronic disease sequalae. This review explores animal and human data relating to the effects of omega-3 fatty acids (marine lipids) on adiponectin and leptin, considering plausible mechanisms and potential implications for obesity management. Current evidence suggests a positive, dose-dependent relationship between omega-3 fatty acid intake and circulating levels of adiponectin. In obese subjects, this may translate into a reduced risk of developing cardiovascular disease, metabolic syndrome and diabetes. In non-obese subjects, omega-3 is observed to decrease circulating levels of leptin; however, omega-3-associated increases in leptin levels have been observed in obese subjects. This may pose benefits in the prevention of weight regain in these subjects following calorie restriction.

Can a Web-based food record accurately assess energy intake in overweight and obese women? A pilot study.

BACKGROUND: Innovative dietary intake measurement tools, such as web-based food records, are becoming increasingly available for self-monitoring. However, the accuracy of this method has not been well studied. This pilot study aimed to evaluate the accuracy of energy intake (EI) estimated by a web-based food record, by comparison with total energy expenditure (TEE) measured by doubly-labelled water (DLW) in overweight and obese women. METHODS: Total energy expenditure (TEE) was assessed in weight stable (±1 kg) women (n = 9), with a mean (SD) age of 34.5 (11.3) years and body mass index of 29.2 (1.4) kg m(-2) over 10 days using the DLW technique. All food and beverages were self-reported for 9-days using a web-based food record and mean daily EI calculated. Food record accuracy was assessed by calculating the absolute (EI - TEE) and percentage (EI/TEE × 100) differences between EI and TEE. Women were identified as under-reporters of EI based on the 95% confidence limits of the expected EI : TEE of 1. RESULTS: The mean (SD) self-reported EI was 8351 (1225) kJ day(-1) [1996 (293) kcal day(-1) ] and TEE was 10 648 (1774) kJ day(-1) [2545 (424) kcal day(-1) ]. The mean (SD) absolute difference in self-reported EI and TEE was -2301 (1535) kJ day(-1) [-550 (367) kcal day(-1) ], representing a mean reporting accuracy of 79.6% (14.1%), with four participants under-reporting EI. CONCLUSIONS: This pilot study highlights the opportunity for the use of the Internet as a novel medium for recording and assessing dietary intake. Although further research is needed in more diverse population groups, the accuracy of web-based food records for assessing EI appears to be consistent with other published dietary intake methods.

A comparison and validation of child versus parent reporting of children's energy intake using food frequency questionnaires versus food records: who's an accurate reporter?

BACKGROUND & AIMS: The aim of this study was to (i) to compare the accuracy of reporting for child's total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW. METHODS: Healthy weight children (mean ± SD age 9.8 ± 1.3 years, n = 6 girls/3 boys) and their parents independently completed an FFQ about children's intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW. RESULTS: The mean difference (limits of agreement LOA, ± 2SD) when compared to DLW was; child 130 (-1518, 1258) kcal or (113 ± 35% of TEE); father 398 (0,796) kcal or (121 ± 13%); mother 807 (-213, 1824) kcal or (144 ± 26%) and for the WFR -153 (1089, -1395) kcal or 95 ± 32%. CONCLUSIONS: Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years.

Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation.

BACKGROUND/OBJECTIVES: There is a growing body of evidence that nutritional status influences the morbidity and mortality of children undergoing treatment for cancer. The aim of this paper is to determine if nutritional status is associated with survival post-pediatric bone marrow transplant. SUBJECTS/METHODS: This was a single-center retrospective audit of patients who underwent an autologous or allogeneic hematopoietic stem cell transplant. Patients were divided into three weight categories of underweight, ideal weight and overweight defined by percent ideal body weight. The outcome of interest, overall post transplant survival, was compared between weight categories. RESULTS: Of 113 patients, 15 (13%) were underweight and 41 (36%) were classified as overweight. After adjustment for age, sex, donor source, conditioning therapy and year of transplant, overweight patients were significantly less likely to survive than ideal-weight patients (hazard ratio (HR) 1.91; 95% confidence interval, 1.10-3.31). There was no significant increase in mortality when underweight patients were compared with ideal-weight patients (HR 1.47; 95% confidence interval, 0.57-3.79). CONCLUSIONS: Children who are overweight before hematopoietic stem cell transplantation have decreased survival compared with ideal-weight children.

A comparison of two screening methods to determine the validity of 24-h food and drink records in children and adolescents.

BACKGROUND/OBJECTIVES: Dietary assessment in humans is hampered by the phenomena of under and overreporting of energy intake, when food records are used to evaluate habitual dietary intake. Different methods to evaluate mis-reporting have been proposed using cut-offs derived from estimates of reported energy intake and basal metabolic rate, or, from predictions of total energy expenditure. This study compares the effect of using two different cut-off approaches to screen food records for validity, completed by a large cohort of Australian children (n=2460), from Grades 1, 5 and 10 (aged 5-17 years). SUBJECTS/METHODS: Energy intake was calculated from 24-h food and drink records for each child. These data were screened using the Goldberg and McCrory cut-offs. The effect of using these two cut-offs on the collected dataset was explored by considering the mean and standard deviation of energy intake in each year level before and after the cut-offs were applied. RESULTS: The use of the Goldberg cut-off resulted in 9% of the total cohort being classified as underreporters, with 60% of these subjects being in Grade 10. The McCrory cut-offs revealed that overall, 22% of the total cohort underreported EI. 33.3% of Grade 1 children were classified as overreporters with this value falling to about 20% of Grade 10 children, while 10-15% of Grade 1 children underreported, with this figure rising to about 30% in Grade 10. CONCLUSIONS: Both the Goldberg and McCrory approaches have their advantages and disadvantages, and we suggest that consideration should be given to the reason for screening data before a particular approach is used, with recognition that these methods do differ in their aims and outcomes. The McCrory method consistently classified a greater number of children as underreporters.

Defining anthropometric cut-off levels related to metabolic risk in a group of Sri Lankan children.

BACKGROUND: Body mass index (BMI) is widely used as a measure of adiposity. However, currently used cut-off values are not sensitive in diagnosing obesity in South Asian populations. AIM: To define BMI and waist circumference (WC), cut-off values representing percentage fat mass (%FM) associated with adverse health outcomes. SUBJECTS AND METHODS: A cross-sectional descriptive study of 285 5-14 year old Sri Lankan children (56% boys) was carried out. Fat mass (FM) was assessed using the isotope (D(2)O) dilution technique based on 2C body composition model. BMI and WC cut-off values were defined based on %FM associated with adverse health outcomes. RESULTS: Sri Lankan children had a low fat free mass index (FFMI) and a high fat mass index (FMI). Individuals with the same BMI had %FM distributed over a wide range. Lean body tissue grew very little with advancing age and weight gain was mainly due to increases in body fat. BMI corresponding to 25% in males and 35% in females at 18 years was 19.2 kg/m(2) and 19.7 kg/m(2), respectively. WC cut-off values for males and females were 68.4 cm and 70.4 cm, respectively. CONCLUSION: This chart analysis clearly confirms that Sri Lankan children have a high %FM from a young age. With age, more changes occur in FM than in fat free mass (FFM). Although the newly defined BMI and WC cut-off values appear to be quite low, they are comparable to some recent data obtained in similar populations.

Validity of currently used cutoff values of body mass index as a measure of obesity in Sri Lankan children.

OBJECTIVE: The aim of the study was to determine the reliability of body mass index based (BMI) cutoff values in diagnosing obesity among Sri Lankan children. METHODS: Height, weight, waist circumference (WC) and hip circumference (HC) in 282 children were measured. Total body water was determined by deuterium dilution and fat mass (FM) derived using age and gender specific constants. A percentage FM of 30% for girls and 25% for boys were considered as cutoff levels for obesity. RESULTS: Two hundred and eighty two children (M/F: 158/124) were studied and 99 (80%) girls and 72 (45.5%) boys were obese based on % body fat. Eight (6.4%) girls and nine (5.7%) boys were obese based on International Obesity Task Force (IOTF) cutoff values. Percentage FM and WC centile charts were able to diagnose a significant proportion of children as true obese children. The FM and BMI were closely associated in both girls (r = 0.82, p < 0.001) and boys (r = 0.87, p < 0.001). Percentage FM and BMI had a very low but significant association; girls (r = 0.32, p < 0.001) and boys (r = 0.68, p < 0.001). FM had a significant association with WC and HC. BMI based cutoff values had a specificity of 100% but a very low sensitivity, varying between 8% and 23.6%. CONCLUSIONS: BMI is a poor indicator of the percentage fat and the commonly used cutoff values were not sensitive to detect cases of childhood obesity in Sri Lankan children.

Benefit of early commencement of growth hormone therapy in children with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a chromosomal disorder and growth failure is a common presentation. Growth hormone (GH) treatment is beneficial in PWS although the optimal age for starting GH is unknown. We investigated whether GH response in PWS was associated with the age of GH commencement by comparing 16 children who commenced GH before 3 years of age (early group) with 40 children who commenced GH after 3 years of age (late group) from the Ozgrow database. Height SDS, body mass index (BMI) SDS, bone age (BA)-chronological age (CA) ratio, change in height (delta Ht) SDS and change in BMI during 4 years of GH treatment were compared between the groups. The early group had better height SDS and delta Ht SDS. BA delay was more pronounced in the early group but BA did not mature beyond CA with GH therapy in either group. Although the initial GH dose for the early group was lower than that of the late group, the former had better height outcome. The starting GH dose seen in the database is lower than the dose used by international centres.

Assessment of body composition in Sri Lankan children: validation of a skin fold thickness equation.

BACKGROUND: Morbidity associated with obesity is related to the fat mass (FM) of the body. The direct estimation of FM is difficult. Skin fold thickness (SFT) is a simple and cheap alternative for accurate assessment of FM, and population specific equations are necessary for accurate assessment of FM using SFT. OBJECTIVE: To develop a SFT prediction equation to estimate FM of Sri Lankan children. DESIGN, SETTING AND METHOD: Across-sectional descriptive study was done at the University Paediatric Unit of Lady Ridgeway Hospital, Colombo. Data were collected from 5 to 15 year old healthy children. Triceps, biceps, supra-iliac and subscapular SFT were measured using Harpendens skin fold caliper. Total body water was assessed using an isotope dilution method (D2O), and fat free mass calculated. FM was assessed based on 2 compartment body composition model. Multiple regression analysis was used to develop prediction equation and validated using PRESS (prediction of sum of squares) statistical technique. Independent variables were age, triceps SFT, subscapular SFT and sex. RESULTS: Prediction equation for FM [(0.68 x age) + (0.246 x triceps SFT) + (0.383 x subscapular SFT) - (1.61 x sex code) -3.45] was able to predict 76.4% of variance with a root mean squared error (RMSE) of 3.4 kg. PRESS statistics was 3.4 kg with press residuals of 1.56 kg. Bland-Altman technique showed that the majority of the residuals were within mean bias +/-1.96 SD. CONCLUSION: Results of this study provide an SFT equation for the prediction of FM in Sri Lankan children.

Attainment of early feeding milestones in preterm neonates.

OBJECTIVE: This study aimed to document the ages at which preterm neonates commence suckle-feeds and attain exclusive suckle-feeding, as well as the time taken to transition from commencement of suckle-feeds to exclusive suckle-feeding. It was hypothesized that gestational age (GA) at birth and degree of neonatal morbidity would influence the timing of these early feeding milestones. STUDY DESIGN: A chart review was conducted for all neonates born <37;0 weeks GA admitted to a tertiary level perinatal facility over a 12-month period (n=735). Complete data relating to attainment of feeding milestones were available on 472 neonates. RESULTS: Correlation analysis indicated that both a low GA at birth and a high neonatal morbidity rating were statistically significantly correlated with an increased transition time from commencement of suckle-feeds to exclusive suckle-feeding. Cox regression indicated that both of these variables were statistically significant risk factors for a delayed GA at attainment of exclusive suckle-feeding. CONCLUSION: Preterm neonates who were less mature at birth and/or who displayed a greater degree of neonatal morbidity took longer to transition from starting suckle-feeds to achieving independent suckle-feeding, and were more mature at attainment of independent suckle-feeding.