Acta Pædiatrica ISSN 0803-5253
REGULAR ARTICLE
Parental feeding control in relation to feeding mode and growth pattern during early infancy Niklas Timby ([email protected])1, Olle Hernell1, Bo L€onnerdal2, Magnus Domell€of1 1.Department of Clinical Sciences, Pediatrics, Ume a University, Ume a, Sweden 2.Department of Nutrition, University of California, Davis, CA, USA
Keywords Breastfeeding, Energy regulation, Formula feeding, Parental control Correspondence Niklas Timby, MD, Department of Clinical Sciences, Pediatrics, Ume a University, S-90185 Ume a, Sweden. Tel: +46907852103 | Email: [email protected] Received 28 April 2014; accepted 16 June 2014. DOI:10.1111/apa.12721 Clinical Trial Registration: The study was registered with number NCT00624689 at clinicaltrials.gov.
ABSTRACT Aim: A high level of parental control of feeding and disturbed energy self-regulation has previously been suggested as a mechanism for the accelerated growth observed in formula-fed compared with breast-fed infants. This study explored factors associated with parental control of feeding in a population of formula-fed infants with high levels of self-regulation. Methods: We included 141 formula-fed and 72 breast-fed infants from a randomised controlled trial, who were prospectively followed from under 2 months of age to 12 months of age. Anthropometry was recorded at baseline, 4, 6 and 12 months of age. Parental feeding control was assessed using a Child Feeding Questionnaire at 4 and 12 months. Results: The formula-fed groups fully compensated for different energy and protein densities by regulating their volume intakes. Parents of formula-fed infants had a lower pressure to eat score at 12 months than parents of breast-fed infants. A high parental restrictive score at 12 months was associated with weight at 12 months and high parental pressure to eat score at 12 months with body mass index at 12 months. Neither were associated with feeding mode. Conclusion: Formula-fed infants had a high level of energy self-regulation and were subjected to low parental control. Parental control of feeding was mainly influenced by infant growth.
INTRODUCTION Breastfeeding has been associated with a lower risk of becoming overweight in the future than formula feeding (1,2), and several biological mechanisms have been suggested to explain this difference. These include programming effects due to faster growth of formula-fed infants during infancy (3,4), differences in the development of gut microbiota (5,6) and the level of parental control of feeding and its influence on the development of the infant0 s selfregulation of intake. Formula feeding has been associated with a high level of parental control (7) and disturbed development of self-regulation (8). Thus, formula-fed infants showed less variability in volume between feeds, earlier daytime concentration of feedings and larger total daily intake volume compared with breast-fed infants (9). The level of parental control has been suggested to influence infant and childhood growth. A high level of maternal control at 6 months of age has been identified as a risk factor for both underweight and overweight problems
Abbreviations BMI, Body mass index; CFQ, Child Feeding Questionnaire.
1072
between 6 and 12 months of age (10). In another study, maternal control in infancy explained 13% of the negative dose–response relationship between breastfeeding and body mass index (BMI) at 3 years of age (11). This study is based on a randomised controlled trial exploring the health effects of feeding infants an experimental formula compared with a standard formula (SF). The experimental formula had a reduced energy (60 kcal/ 100 mL vs 66 kcal/100 mL) and protein (1.20 g/100 mL vs 1.27 g/100 mL) content and was supplemented with a
Key notes
High parental control of feeding has previously been suggested as a mechanism for the accelerated growth observed in formula-fed infants. This study explored factors associated with parental control of feeding in 141 formula-fed infants and compared them to 72 breast-fed infants. Formula-fed infants had a high level of self-regulation of intake and were subjected to low parental control and parental control of feeding was mainly influenced by infant growth.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 1072–1077
Timby et al.
bovine milk fat globule membrane fraction. Primary outcomes in the main trial were weight at 6 months of age and cognitive function at 12 months of age. Surprisingly, we found that the formula-fed groups regulated their ingested volumes during the intervention to a degree that resulted in identical total energy and protein intakes until 6 months and growth until 12 months of age (12). The aim of this study was to measure parental control of feeding in parents of formula-fed and breast-fed infants in the same study population. Our hypothesis was that the higher level of self-regulation we observed in formula-fed infants in our study population, compared with previous studies, could be due to differences in parental control between different populations. We further hypothesised that the parents of formula-fed infants in our cohort would display less controlling behaviour compared with previous studies and at a level more close to a breast-fed reference group.
METHODS Study population As described previously (12), 160 formula-fed infants were originally recruited from March 2008 to February 2012 and randomised to receive experimental formula or SF from inclusion until 6 months of age. A breast-fed reference group with 80 infants was recruited during the same period. In this study, all infants that remained at follow-up at 12 months of age – 141 (88%) of the formula-fed and 72 (90%) of the breast-fed infants – were included (Fig. 1). The randomised groups (experimental and SF) were pooled to one formula-fed group. Inclusion criteria in the original randomised controlled trial were
REGULAR ARTICLE
Parental feeding control in relation to feeding mode and growth pattern during early infancy Niklas Timby ([email protected])1, Olle Hernell1, Bo L€onnerdal2, Magnus Domell€of1 1.Department of Clinical Sciences, Pediatrics, Ume a University, Ume a, Sweden 2.Department of Nutrition, University of California, Davis, CA, USA
Keywords Breastfeeding, Energy regulation, Formula feeding, Parental control Correspondence Niklas Timby, MD, Department of Clinical Sciences, Pediatrics, Ume a University, S-90185 Ume a, Sweden. Tel: +46907852103 | Email: [email protected] Received 28 April 2014; accepted 16 June 2014. DOI:10.1111/apa.12721 Clinical Trial Registration: The study was registered with number NCT00624689 at clinicaltrials.gov.
ABSTRACT Aim: A high level of parental control of feeding and disturbed energy self-regulation has previously been suggested as a mechanism for the accelerated growth observed in formula-fed compared with breast-fed infants. This study explored factors associated with parental control of feeding in a population of formula-fed infants with high levels of self-regulation. Methods: We included 141 formula-fed and 72 breast-fed infants from a randomised controlled trial, who were prospectively followed from under 2 months of age to 12 months of age. Anthropometry was recorded at baseline, 4, 6 and 12 months of age. Parental feeding control was assessed using a Child Feeding Questionnaire at 4 and 12 months. Results: The formula-fed groups fully compensated for different energy and protein densities by regulating their volume intakes. Parents of formula-fed infants had a lower pressure to eat score at 12 months than parents of breast-fed infants. A high parental restrictive score at 12 months was associated with weight at 12 months and high parental pressure to eat score at 12 months with body mass index at 12 months. Neither were associated with feeding mode. Conclusion: Formula-fed infants had a high level of energy self-regulation and were subjected to low parental control. Parental control of feeding was mainly influenced by infant growth.
INTRODUCTION Breastfeeding has been associated with a lower risk of becoming overweight in the future than formula feeding (1,2), and several biological mechanisms have been suggested to explain this difference. These include programming effects due to faster growth of formula-fed infants during infancy (3,4), differences in the development of gut microbiota (5,6) and the level of parental control of feeding and its influence on the development of the infant0 s selfregulation of intake. Formula feeding has been associated with a high level of parental control (7) and disturbed development of self-regulation (8). Thus, formula-fed infants showed less variability in volume between feeds, earlier daytime concentration of feedings and larger total daily intake volume compared with breast-fed infants (9). The level of parental control has been suggested to influence infant and childhood growth. A high level of maternal control at 6 months of age has been identified as a risk factor for both underweight and overweight problems
Abbreviations BMI, Body mass index; CFQ, Child Feeding Questionnaire.
1072
between 6 and 12 months of age (10). In another study, maternal control in infancy explained 13% of the negative dose–response relationship between breastfeeding and body mass index (BMI) at 3 years of age (11). This study is based on a randomised controlled trial exploring the health effects of feeding infants an experimental formula compared with a standard formula (SF). The experimental formula had a reduced energy (60 kcal/ 100 mL vs 66 kcal/100 mL) and protein (1.20 g/100 mL vs 1.27 g/100 mL) content and was supplemented with a
Key notes
High parental control of feeding has previously been suggested as a mechanism for the accelerated growth observed in formula-fed infants. This study explored factors associated with parental control of feeding in 141 formula-fed infants and compared them to 72 breast-fed infants. Formula-fed infants had a high level of self-regulation of intake and were subjected to low parental control and parental control of feeding was mainly influenced by infant growth.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 1072–1077
Timby et al.
bovine milk fat globule membrane fraction. Primary outcomes in the main trial were weight at 6 months of age and cognitive function at 12 months of age. Surprisingly, we found that the formula-fed groups regulated their ingested volumes during the intervention to a degree that resulted in identical total energy and protein intakes until 6 months and growth until 12 months of age (12). The aim of this study was to measure parental control of feeding in parents of formula-fed and breast-fed infants in the same study population. Our hypothesis was that the higher level of self-regulation we observed in formula-fed infants in our study population, compared with previous studies, could be due to differences in parental control between different populations. We further hypothesised that the parents of formula-fed infants in our cohort would display less controlling behaviour compared with previous studies and at a level more close to a breast-fed reference group.
METHODS Study population As described previously (12), 160 formula-fed infants were originally recruited from March 2008 to February 2012 and randomised to receive experimental formula or SF from inclusion until 6 months of age. A breast-fed reference group with 80 infants was recruited during the same period. In this study, all infants that remained at follow-up at 12 months of age – 141 (88%) of the formula-fed and 72 (90%) of the breast-fed infants – were included (Fig. 1). The randomised groups (experimental and SF) were pooled to one formula-fed group. Inclusion criteria in the original randomised controlled trial were
