Intro of solid foods in bottle feeding may lead to obesity

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Starting formula-fed babies on solid food too early may increase their risk

of becoming obese by the time they reach age 3, according to a prospective

study.

The study, which followed more than 840 young children, found that

formula-fed infants introduced to solid food before four months of age had a

6.3-fold increased odds of obesity at age 3 (95% confidence interval 2.3 to

6.9), na Y. Huh, MD, MPH, of Children's Hospital Boston, and colleagues

reported online in *Pediatrics*.

However, the same didn't hold for breastfed infants -- who showed no impact

of timing of solid food introduction on obesity at age 3 (odds ratio 1.1,

95% CI 0.3 to 4.4), Huh and co-authors wrote.

The findings from the longitudinal study support guidelines recommending

holding off on solids until at least 4 months of age and preferably to six

months of age, the researchers noted.

" Additionally, it further confirms the tremendous long-term nutritional

value of breast feeding during the first six months of life, " commented

Cliff Nerwen, MD, of Cohen Children's Medical Center of New York City, in a

statement sent to reporters.

Increasing adherence to the guidelines might be one preventive strategy to

reduce the rising incidence of childhood obesity, seen even among infants

and pre-school age children, Huh's group suggested.

" One possible reason why we saw an association among formula-fed but not

breastfed infants is that formula-fed infants may increase their energy

intake when solids are introduced, " they wrote in the paper.

" Breastfeeding may promote self-regulation of an infant's energy intake, and

the mother may learn to recognize her infant's hunger and satiety cues, "

they explained.

The researchers followed 847 children in Project Viva, a prospective,

longitudinal prebirth cohort study of mother-offspring pairs. The mothers

were recruited between 1999 and 2002 at the obstetrical offices of a

multispecialty group practice in eastern Massachusetts.

Six months after delivery, the mothers filled out a questionnaire detailing

what type of food their baby ate and when solid foods -- including infant

cereal, teething biscuits, and fruit -- were first introduced.

At age 4 months, 67% of the children were breastfed and 33% were

formula-fed.

Breast feeding was linked a more normal pattern of growth (weight-for-length

z score 0.35 versus 0.54 U, *P*=0.01) and to a slower introduction of solid

foods (8% versus 33% before 4 months, 17% versus 9% after 6 months, *P*

<0.0001).

For the primary outcome of obesity at 3 years of age, breastfed children

were less likely to have a body mass index at or above the 95th percentile

for age and gender at that point compared with those who had been fed

formula (7% versus 13%) and had lower BMI z scores (0.36 versus 0.63 U).

Although early introduction of solid food didn't appear to impact obesity

risk in breastfed children, bottle-fed infants who tried solid food before 4

months were more likely to be obese at 3 years (25% versus 5% introduced at

4 to 5 months, *P*<0.0001).

In formula-fed infants, even after adjustment for factors including early

infant growth, early introduction to solids predicted a 0.36-unit higher BMI

z score at age 3 (95% CI 0.10 to 0.61).

The researchers illustrated the effect by noting that adding 0.4 units to

the BMI z score would take a 3-year-old from the 50th percentile to the 66th

percentile, the equivalent of adding 1.1 pounds of weight.

The finding that this effect of early solid foods was independent of early

growth was important, according to Huh's group, since " rapid weight gain

during the first few months of life has been associated with an increased

risk of obesity, and maternal perceptions of infant hunger or large infant

size seem to influence the decision to introduce solid foods early. "

Late introduction to solid food, after 6 months of age, had no effect on

breastfed babies, but showed a trend for increased obesity risk at 3 years

(OR 3.6, *P*=0.06), which the researchers said they couldn't rule out given

the low statistical power due to few children in this group.

They noted that they couldn't exclude the possibility of residual

confounding either and noted that maternal education and income levels were

relatively high in their study cohort -- which may limit generalizability to

more disadvantaged populations.

LINK<http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/24723?utm_content=\

GroupCL & utm_medium=email & impressionId=1297061716488 & utm_campaign=DailyHeadlines & \

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*Primary source: **Pediatrics*

Source reference:

Huh SY, et al " Timing of Solid Food Introduction and Risk of Obesity in

Preschool-Aged Children " *Pediatrics*

2011;127:e544–e551.<http://www.pediatrics.org/cgi/doi/10.1542/peds.2010-0740>

--

Ortiz, MS, RD

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