Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
School of Public Health and Sydney Medical School, The University of Sydney, Sydney, Australia.
Int J Obes (Lond). 2021 Oct;45(10):2230-2237. doi: 10.1038/s41366-021-00892-5. Epub 2021 Jul 6.
BACKGROUND/OBJECTIVES: The role of infant feeding practices in longitudinal growth trajectories in children remains equivocal. This study utilised two longitudinal approaches to examine the associations of infant feeding mode (breastfeeding, mixed feeding, formula feeding), breastfeeding duration, and the timing of solid foods introduction with body mass index (BMI) z-score in early childhood.
SUBJECTS/METHODS: Secondary analyses of data from the Healthy Beginnings Trial were conducted. Infant feeding practices were reported by mothers at 6, 12, and 24 months of child age. Child weight and length were measured at birth, 12, 24, 42, and 60 months. Two longitudinal approaches: linear spline multilevel model (LSMM) and group-based trajectory modelling (GBTM) were used to describe BMI z-score trajectories and assess its associations with infant feeding practices.
The LSMM approach demonstrated that the breastfeeding group showed lower BMI z-scores from ages 12 to 60 months than the mixed feeding and formula feeding groups. Children who were breastfed for ≥ 6 versus < 6 months exhibited a lower BMI z-score trajectory from ages 12 to 60 months. Results from the GBTM approach revealed that the mixed feeding (OR: 1.83, 95%CI 1.04, 3.21) and the formula feeding group (OR: 2.00, 95%CI 0.67, 5.92) showed a tendency for higher odds of following the "High BMIz" trajectory than the breastfeeding group. Breastfeeding duration ≥6 versus < 6 months was linked with lower odds of following the "High BMIz" trajectory (OR 0.65, 95%CI 0.43, 0.98). Both approaches revealed no evidence of an association between the timing of solid foods introduction and BMI z-score trajectory.
The two longitudinal approaches revealed similar findings that infant feeding mode and breastfeeding duration, but not the timing of solid foods introduction, were associated with BMI z-score trajectory in early childhood. The findings provide robust longitudinal evidence to encourage and support extended breastfeeding for childhood obesity prevention.
背景/目的：婴儿喂养方式对儿童纵向生长轨迹的作用仍存在争议。本研究采用两种纵向方法，探讨婴儿喂养方式（母乳喂养、混合喂养、配方奶喂养）、母乳喂养持续时间以及固体食物引入时间与儿童早期体重指数（BMI）z 分数的关系。
受试者/方法：对健康开端试验（Healthy Beginnings Trial）的数据进行二次分析。母亲在儿童 6、12 和 24 个月时报告婴儿喂养方式。在出生、12、24、42 和 60 个月时测量儿童的体重和身高。采用线性样条多层模型（LSMM）和基于群组的轨迹建模（GBTM）两种纵向方法来描述 BMI z 分数轨迹，并评估其与婴儿喂养方式的关系。
LSMM 方法表明，从 12 个月到 60 个月，母乳喂养组的 BMI z 分数低于混合喂养组和配方奶喂养组。与母乳喂养时间＜6 个月相比，母乳喂养时间≥6 个月的儿童从 12 个月到 60 个月的 BMI z 分数轨迹较低。GBTM 方法的结果显示，混合喂养组（OR：1.83，95%CI 1.04，3.21）和配方奶喂养组（OR：2.00，95%CI 0.67，5.92）比母乳喂养组更有可能遵循“高 BMIz”轨迹。母乳喂养时间≥6 个月比＜6 个月与遵循“高 BMIz”轨迹的几率较低（OR 0.65，95%CI 0.43，0.98）有关。两种方法都没有发现固体食物引入时间与 BMI z 分数轨迹之间存在关联的证据。
两种纵向方法得出的相似结果表明，婴儿喂养方式和母乳喂养持续时间，而不是固体食物引入时间，与儿童早期 BMI z 分数轨迹有关。这些发现为鼓励和支持延长母乳喂养以预防儿童肥胖提供了强有力的纵向证据。
