Weight Status in the First 6 Months of Life and Obesity at 3 Years of Age Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation. Is Slower Early Growth Beneficial for Long-Term Cardiovascular Health? Formula Tolerance in Postbreastfed and Exclusively Formula-fed Infants Energy utilization and growth in breast-fed and formula-fed infants measured prospectively during the first year of life. Chicken extract affects colostrum protein compositions in lactating women. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Neonatal weight loss in breast and formula fed infants Rapid Maturation of Gastric Relaxation in Newborn Infants High energy feeding in small for gestation infants. Low nutrient intake and early growth for later insulin resistance in adolescents born preterm Infant weight gain and childhood overweight status in a multicenter, cohort study. Effect of birth weight and postnatal weight gain on body composition in early infancy: The Generation R Study.
OBJECTIVE . The goal was to examine the associations of weight-for-length at birth and at 6 months with obesity at 3 years of age . METHODS . We studied 559 children in Project Viva , an ongoing , prospect i ve , cohort study of pregnant women and their children . We measured length and weight at birth , 6 months , and 3 years . Our main exposures were weight-for-length z score at birth adjusted for gestational age and weight-for-length z score at 6 months adjusted for weight-for-length z score at birth . We used multivariate regression analyses to predict the independent effects of birth weight-for-length z score and , separately , 6-month weight-for-length z score on BMI z score  , the sum of subscapular and triceps skinfold thicknesses  , and obesity ( BMI for age and gender of ≥95th percentile ) at age 3 . RESULTS . Mean weights at birth , 6 months , and 3 years were 3.55 , 8.15 , and 15.67 kg , respectively . Corresponding lengths were 49.9 , 66.9 , and 97.4 cm . At 3 years , 48 children ( 9 % ) were obese . After adjustment for confounding variables and birth weight-for-length z score , each increment in 6-month weight-for-length z score was associated with higher BMI z scores , higher sums of subscapular and triceps skinfold thicknesses , and increased odds of obesity at age 3 . The predicted obesity prevalence among children in the highest quartiles of both birth and 6-month weight-for-length z scores was 40 % , compared with 1 % for children in the lowest quartiles of both . Whereas birth weight-for-length z scores were associated with higher BMI z scores , the magnitude of effect was smaller than that of weight-for-length z scores at 6 months . CONCLUSIONS . More-rapid increases in weight for length in the first 6 months of life were associated with sharply increased risk of obesity at 3 years of age . Changes in weight status in infancy may influence risk of later obesity more than weight status at birth BACKGROUND No evidence -based recommendations exist concerning what dietary macronutrient composition optimizes weight loss during lactation while maintaining milk production . OBJECTIVES The study was design ed to test the following hypotheses : compared with a reduced-calorie , high-carbohydrate ( H-CHO ) diet , an isonitrogenous , isocaloric high-fat ( H-F ) diet will decrease milk production and carbohydrate oxidation , increase gluconeogenesis and hexoneogenesis , and not affect energy balance . DESIGN Seven healthy lactating mothers and their infants were studied on 2 occasions in r and om order for 8 d separated by 1 - 2 wk . On one occasion , the subjects received the H-F ( 30 % of energy as carbohydrate and 55 % as fat ) diet and on the other occasion received the H-CHO ( 60 % of energy as carbohydrate and 25 % as fat ) diet .  Milk production , infant intakes , and substrate and hormone concentrations were measured . Glucose rates of appearance , production , gluconeogenesis , glycogenolysis , and hexoneogenesis were measured by using stable-isotope gas chromatography-mass spectrometric techniques , and energy expenditure and substrate oxidation were measured by using indirect calorimetry . RESULTS Milk volume , lactose , and protein concentrations were unaffected . Milk fat , energy , and infant intakes were higher ( P < 0.05 ) during the H-F diet . Neither gluconeogenesis nor hexoneogenesis was different . During the H-F diet , energy expenditure and fat and protein oxidation rates were higher ( P < 0.05 ) , and the daily energy balance deficit was greater ( P < 0.01 ) . CONCLUSIONS Milk fat , energy output , and energy expenditure were higher during the H-F diet , which result ed in a greater negative energy balance . The lactating mothers adapted to a low carbohydrate intake by decreasing carbohydrate oxidation . Additional studies are warranted to determine whether a hypocaloric H-F diet might promote weight loss to a greater extent than the H-CHO diet while maintaining milk production Background —Accelerated neonatal growth increases the later propensity to cardiovascular disease ( CVD ) in animals , whereas slower growth is thought to have a beneficial effect . To test this hypothesis in humans , we measured flow-mediated endothelium-dependent dilation ( FMD ) in a population subject to slower early growth and in healthy controls . Methods and Results —High-resolution vascular ultrasound was used to measure the change in brachial artery diameter in response to reactive hyperemia in adolescents age 13 to 16 years who were either part of a cohort born preterm and followed up prospect ively ( n=216 ) or controls born at term ( n=61 ) . Greater weight gain or linear growth in the first 2 weeks postnatally was associated with lower FMD at adolescence ( regression coefficient , −0.026-mm change in mean arterial diameter per 100-g increase in weight ; 95 % CI , −0.040 to −0.012 mm ; P = 0.0003 ) independent of birthweight and potential confounding factors . Mean FMD in the half of the preterm population with the lowest rates of early growth was higher than in both the half with the greatest growth ( P = 0.001 ) and subjects born at term ( P = 0.03 ) . Conclusions —FMD was 4 % lower in adolescents with the highest compared with the lowest rate of weight gain in the first 2 weeks after birth , a substantial negative effect similar to that for insulin-dependent diabetes mellitus or smoking in adults . Our findings are consistent with the adverse effects of accelerated neonatal growth on long-term cardiovascular health and suggest that postnatal growth patterns could explain the previously reported association between birthweight and later CVD Objective . Perceived intolerance to infant formula is a frequently reported reason for formula switching . Formula intolerance may be related to perceived symptoms of constipation , fussiness , abdominal cramps , and excessive spit-up or vomit . Commercially available formulas differ from each other in processing and in sources and levels of protein , lipids , and micronutrients . These differences may affect tolerance . The objective of this article was to compare the tolerance of two commercially available powder infant formulas that differ in composition . Measures of tolerance in exclusively breastfed infants weaned to an infant formula and exclusively formula-fed infants were evaluated . Methods . Two clinical studies were conducted . In study 1 , 82 healthy , full-term infants who were exclusively breastfed at the time of enrollment were  r and omized at weaning to formula A ( commercially available Similac With Iron Powder ) or formula B ( previously available Enfamil With Iron Powder ) . Parents completed daily records of tolerance during exclusive breast milk feeding , during the weaning period , and for a 2-week exclusive formula-feeding period . In study 2 , 87 healthy , full-term infants who were exclusively formula-fed at the time of study enrollment ( by 2 weeks of age ) were fed a st and ard cow milk-based formula ( previously commercially available Similac With Iron Powder ) and then r and omized to receive formula A or B for a 2-week period . Parents completed daily records of tolerance throughout the study . Formula A was a cow milk-based formula with a whey : casein ratio of 48:52 and a fat blend of 42 % high-oleic safflower , 30 % coconut , and 28 % soy oils . Formula B was a cow milk-based formula with a whey : casein ratio of 60:40 and a fat blend of 45 % palm olein , 20 % soy , 20 % coconut , and 15 % high-oleic sunflower oils . Both formulas had lactose as the source of carbohydrate and contained 12 mg of iron per liter . Only formula A contained nucleotides at the time of the study . Measures of tolerance included volume of each formula feeding , occurrences of spit-up and /or vomit , and the color ( yellow , green , brown , or black ) and consistency ( water , loose/mushy , soft , formed , or hard ) of each stool . Results . In both studies , volume of formula intake , weight gain , and incidence of spit-up or vomit did not differ between feeding groups . In study 1 , stool frequency decreased significantly from the exclusive breast milk period to weaning . Stools also became firmer as infants moved from breast milk to weaning and to exclusive formula feeding . When formula was introduced into the diet , stools became less yellow and more green . Infants weaned to formula B had less frequent stools , fewer brown stools , and more yellow stools than did infants fed formula A. In both studies , infants fed formula B experienced significantly firmer stools than did those fed formula A. Conclusions . The present clinical studies indicate that the composition and /or processing of milk-based powder iron-fortified infant formulas affect stool characteristics experienced by infants . The inclusion of palm olein oil in formula B may be the reason for the observed differences in stool characteristics . Palm olein is used in infant formulas to provide palmitic acid at a level similar to that found in breast milk . However , palmitic acid from palm olein is arranged differently from that in breast milk triglyceride and is poorly absorbed . Unabsorbed palmitic acid tends to react with calcium to form insoluble soaps , and the level of these soaps is correlated with stool hardness . The pattern of softer stools and greater frequency of stooling associated with formula A is similar to the stool pattern in the exclusively breastfed infant . Thus , the use of formula A may ease the transition from breast milk to formula feeding and ameliorate parents ' perception that constipation is associated with iron-fortified formula This study is the first to report approximations of energy requirements for male and female breast-fed and formula-fed infants based on individual estimates of total daily energy expenditure ( TDEE ) and energy deposition derived from total body fat ( TBF ) and fat-free mass ( FFM ) gain as determined by total-body electrical conductivity . In 46 healthy , full-term infants the effect of > or = 4 mo of exclusive breast-feeding compared with formula feeding on macronutrient and energy intake , TDEE , energy deposition , and growth were investigated prospect ively . Metabolizable energy intake ( MEI ) was assessed from macronutrient intake by test weighing ( MEI-TW ) and from the sum of TDEE and energy deposition  ( MEI-Pred ) . At 1 - 2 , 2 - 4 , 4 - 8 , and 8 - 12 mo of age MEI-Pred averaged 431 + /- 38 , 393 + /- 33 , 372 + /- 33 , and 355 + /- 21 kJ x kg(-1 ) x d(-1 ) for boys , and 401 + /- 59 , 376 + /- 25 , 334 + /- 33 , and 326 + /- 17 kJ x kg(-1 ) x d(-1 ) for girls . No significant difference between breast-fed and formula-fed infants was found with respect to weight , length , head circumference , TBF , FFM , and TDEE at all ages , or for gain in length , weight , TBF , and FFM . MEI-TW was significantly different between feeding groups at 1 - 4 mo of age ( formula-fed being greater than breast-fed , P < 0.005 ) . This feeding effect , however , was not significant for MEI-Pred ( MJ/d ) . MEI-TW differed from MEI-Pred only in breast-fed infants at 1 - 4 mo ( P < 0.05 at 2 - 4 mo ) . The data from this study indicate that energy requirements in infants are lower than the recommendations in guidelines currently in use This study investigated the effect of supplementation with chicken extract on plasma and colostrum protein compositions in lactating women . Thirty healthy pregnant women were evenly divided into the control ( n = 15 ) or chicken extract ( CE ) group ( n = 15 ) . The CE group was given one bottle ( 70 mL/bottle ) of chicken extract three times a day to provide 18 g protein from the 37th week pregnancy to 3 days postpartum . All women in the CE group consumed chicken extract at least for 2 weeks ( 18 + /- 5 days ) . High protein supplement was restricted in the control group . Blood sample s were collected during the 37th week pregnancy and 3-day postpartum , and milk was collected during 3-day postpartum . The results showed that plasma total protein was significantly lower by 14 % in the CE group compared with that in the control group during 3-day postpartum . Plasma epidermal growth factor ( EGF ) significantly elevated by 236 % during 3-day postpartum compared with those during the 37th week pregnancy in the CE group . The levels of lactoferrin , EGF , and transforming growth factor-beta2 ( TGF-beta2 ) in colostrum significantly increased by 34 % , 62 % , and 196 % , respectively , in the CE group compared with those in the control group . However , the levels of total protein , casein , lactalbumin , and secretory immunoglobulin A in colostrum did not significantly differ between two groups . Therefore , supplementation with chicken extract increased colostrum levels of lactoferrin , EGF , and TGF-beta2 , which are important for the growth and immune functions of the infants , in lactating women BACKGROUND Protein intake during infancy was associated with rapid early weight gain and later obesity  in observational studies . OBJECTIVE The objective was to test the hypothesis that higher protein intake in infancy leads to more rapid length and weight gain in the first 2 y of life . DESIGN In a multicenter European study , 1138 healthy , formula-fed infants were r and omly assigned to receive cow milk-based infant and follow-on formula with lower ( 1.77 and 2.2 g protein/100 kcal , respectively ) or higher ( 2.9 and 4.4 g protein/100 kcal , respectively ) protein contents for the first year . For comparison , 619 exclusively breastfed children were also followed . Weight , length , weight-for-length , and BMI were determined at inclusion and at 3 , 6 , 12 , and 24 mo of age . The primary endpoints were length and weight at 24 mo of age , expressed as length and weight-for-length z scores based on the 2006 World Health Organization growth st and ards . RESULTS Six hundred thirty-six children in the lower ( n = 313 ) and higher ( n = 323 ) protein formula groups and 298 children in the breastfed group were followed until 24 mo . Length was not different between r and omized groups at any time . At 24 mo , the weight-for-length z score of infants in the lower protein formula group was 0.20 ( 0.06 , 0.34 ) lower than that of the higher protein group and did not differ from that of the breastfed reference group . CONCLUSIONS A higher protein content of infant formula is associated with higher weight in the first 2 y of life but has no effect on length . Lower protein intake in infancy might diminish the later risk of overweight and obesity . This trial was registered at clinical trials.gov as NCT00338689 Objective : To define the range of neonatal weight loss in a population relative to feeding method . Design : Prospect i ve observational cohort study . Setting : Maternity service providing geographically defined , community based newborn follow up . Participants : 971 consecutive term newborns of birth weight ⩾ 2500 g during the first 2–3 weeks of life ; 34 excluded ( inadequate data ) . 937 included : 45 % breast fed , 42 % formula fed , 13 % breast and formula fed . Outcome measures : Maximum weight loss and timing , age on regaining birth weight . Results : Median weight loss  : formula fed 3.5 % , breast fed 6.6 % . Upper centiles for maximum weight loss differ considerably ( 95th centiles : breast fed = 11.8 % , formula fed = 8.4 % ; 97.5th centiles : breast fed = 12.8 % , formula fed = 9.5 % ) . Median time of maximum weight loss : 2.7 days for breast fed and formula fed . Recovery of birth weight  : breast fed median 8.3 days , 95th centile 18.7 days , 97.5th centile 21.0 days ; formula fed median 6.5 days , 95th centile 14.5 days , 97.5th centile 16.7 days . The time taken to regain birth weight correlates with both the degree and timing of initial weight loss for all groups . Conclusions : Early neonatal weight loss is defined allowing identification of infants who merit closer assessment and support We studied gastric volume , wall compliance , sensory perception , and receptive relaxation during the first postnatal 80 h in 17 healthy term infants , using a computer-driven air pump and simultaneously measuring pressure and volume within a latex balloon placed through the oropharynx into the stomach . To evaluate gastric compliance , we measured pressures while we infused air into the intragastric balloon at different rates ( 10 , 20 , and 60 mL/min ) in r and om sequence . In all infants , there was a linear relationship between intragastric pressure and volume to the maximum pressure tested , 30 mm Hg . Gastric compliance ranged from 0.2 mL/mm Hg to 3.8 mL/mm Hg . Different infusion rates had no effect on compliance . We calculated gastric receptive relaxation by measuring the volume needed to maintain a constant pressure of 10 mm Hg within the balloon for 5 min . Gastric receptive relaxation ranged from 0.5 mL/min to 54 mL/min . Gastric compliance and receptive relaxation increased with postnatal age ( r = 0.70 , p < 0.005;r = 0.79 , p < 0.001 , respectively ) and with number of feedings ( r = 0.80 , r = 0.88 , respectively , both p < 0.001 ) . There was no correlation between weight or type of feeding ( breast versus formula ) and either gastric compliance or relaxation . In conclusion , these results may explain the small feedings that neonates ingest in the first days of life . During the first 3 postnatal d , the newborn stomach becomes more compliant and develops more receptive relaxation , associated with a larger volume capacity Seventeen low weight infants with symmetrical growth retardation ( no wasting ) were entered in a r and omised , double-blind comparison of high energy , 3.6 MJ/L ( 87 kcal/100 ml ) v st and ard energy 2.7 MJ/L ( 65 kcal/100 ml ) feeds given ad libitum during their first three months . Intakes were measured throughout , and energy absorption was determined at home from balance studies at 6 weeks and 3 months of age . Infants on high energy feeds absorbed the same proportion of energy intake but consumed less feed throughout the study . Regulation of feed intake was such that by 2 months of age energy intakes were similar in both groups , though before this time infants on high energy feeds had a higher net energy intake and grew slightly faster . Appetite regulation seems to be present at birth or soon after but is not fully developed for several weeks , and until this time increased energy intake can be imposed by adjusting the energy density of the feed BACKGROUND In animals , acceleration of neonatal growth is thought to increase the later propensity to insulin resistance and non-insulin-dependent diabetes , whereas slow growth as a consequence of undernutrition is thought to have a beneficial effect . To test this hypothesis in people , we measured fasting concentrations of 32 - 33 split proinsulin , a marker of insulin resistance , in adolescents born preterm who had participated in r and omised intervention trials of neonatal nutrition , and in adolescents born at term . METHODS We determined fasting 32 - 33 split proinsulin concentration in participants aged 13 - 16 years born preterm and r and omised to receive a nutrient-enriched or lower-nutrient diet ( n=216 ) or in a reference group born at term ( n=61 ) . FINDINGS Fasting 32 - 33 split proinsulin concentration was greater in children given a nutrient-enriched diet ( geometric mean 7.2 pmol/L , 95 % CI 6.4 - 8.1 ) than in those given the lower-nutrient diet ( 5.9 pmol/L [ 5.2 - 6.4 ] ; mean difference 20.6 % [ 5.0 - 36.3 ] ; p=0.01 ) . Healthy babies born at term had similar fasting 32 - 33 split proinsulin concentrations ( 6.9 pmol/L ; 6.0 - 8.2 ) to the nutrient-enriched group . In non-r and omised analyses , fasting 32 - 33 split proinsulin concentration was associated with greater weight gain the first 2 weeks of life ( 13.2 % [ 5.4 - 20.9 ] change per 100 g weight increase ; p=0.001 ) independent of birthweight , gestation , neonatal morbidity , and demographic , anthropometric , and socioeconomic factors . INTERPRETATION Our results suggest that relative undernutrition early in life in children born preterm may have beneficial effects on insulin resistance OBJECTIVE To determine whether a rapid rate of weight gain in early infancy is associated with overweight status in childhood . DESIGN Prospect i ve , cohort study from birth to age 7 years . SETTING Twelve sites across the United States . PARTICIPANTS Twenty-seven thous and , eight hundred ninety-nine ( 27 899 ) eligible participants born at full term between 1959 and 1965 . MAIN OUTCOME MEASURE Overweight status at age 7 years , defined by a body mass index above the 95th percentile of the Centers for Disease Control and Prevention reference data . RESULTS In the 19 397 participants with complete data ( 69.6 % ) , the prevalence of  overweight status at age 7 years was 5.4 % . The rate of weight gain during the first 4 months of life ( as 100 g/month ) was associated with being overweight at age 7 years , after adjustment for several confounding factors : odds ratio : 1.38 ; 95 % confidence interval : 1.32 - 1.44 . This association was present in each birth weight quintile , and remained significant after adjustment for the weight attained at age 1 year ( odds ratio : 1.17 ; 95 % confidence interval : 1.11 - 1.24 ) . CONCLUSIONS A pattern of rapid weight gain during the first 4 months of life was associated with an increased risk of overweight status at age 7 years , independent of birth weight and weight attained at age 1 year . These findings may lead to new hypotheses regarding the cause of childhood obesity , which may contribute to our underst and ing of this increasing public health problem in the United States BACKGROUND Rapid postnatal weight gain is associated with obesity and type 2 diabetes in later life . The influence of rapid weight gain on body composition in early infancy is still unknown and the critical periods of weight gain for later disease are debated . AIMS To investigate the effect of birth weight and rapid weight gain on body composition in the first 6 months of life . STUDY DESIGN The Generation R Study , a population -based prospect i ve cohort study from fetal life onwards . SUBJECTS AND OUTCOME MEASURES We measured  body fat and fat distribution by skinfold thickness  at the age of 6 weeks and 6 months in 909 Dutch term infants . Analyses were adjusted for current body mass index , sex and maternal socioeconomic status , pre-pregnancy body mass index , height and duration of breastfeeding . RESULTS Upward postnatal weight percentile change was associated with increased skinfold thickness , percentage body fat at 6 weeks and 6 months and a larger truncal/peripheral fat ratio at 6 months ( p<0.01 for all ) . Birth weight was inversely associated with truncal/peripheral fat ratio ( p<0.01 ) but not with relative body fat at 6 months . CONCLUSION During early postnatal rapid weight gain infants do not grow in all body tissues in equal measure . Instead , they acquire relatively large amounts of fat , which is preferentially distributed to the truncal region . Long term observational studies have to assess if such changes in body composition persist into adulthood
Faster weight gain early in infancy may contribute to a greater risk of later obesity in formula-fed compared to breast-fed infants .
One potential explanation for the difference in weight gain is higher macronutrient intake in formula-fed infants during the first weeks of life .