Background Presumed benefits of human milk (HM) in avoiding rapid infancy weight gain and later obesity could relate to its nutrient composition. However, data on breast milk composition and its relation with growth are sparse. Objective We investigated whether short-chain fatty acids (SCFAs), known to be present in HM and linked to energy metabolism, are associated with infancy anthropometrics. Methods In a prospective birth cohort, HM hindmilk samples were collected from 619 lactating mothers at 4–8 wk postnatally [median (IQR) age: 33.9 (31.3–36.5) y, body mass index (BMI) (kg/m2): 22.8 (20.9–25.2)]. Their offspring, born at 40.1 (39.1–41.0) wk gestation with weight 3.56 (3.22–3.87) kg and 51% male, were assessed with measurement of weight, length, and skinfold thickness at ages 3, 12, and 24 mo, and transformed to age- and sex-adjusted z scores. HM SCFAs were measured by 1H-nuclear magnetic resonance spectroscopy (NMR) and GC-MS. Multivariable linear regression models were conducted to analyze the relations between NMR HM SCFAs and infancy growth parameters with adjustment for potential confounders. Results NMR peaks for HM butyrate, acetate, and formic acid, but not propionate, were detected. Butyrate peaks were 17.8% higher in HM from exclusively breastfeeding mothers than mixed-feeding mothers (P = 0.003). HM butyrate peak values were negatively associated with changes in infant weight (standardized B  = −0.10, P = 0.019) and BMI (B = −0.10, P = 0.018) between 3 and 12 mo, and negatively associated with BMI (B = −0.10, P = 0.018) and mean skinfold thickness (B = −0.10, P = 0.049) at age 12 mo. HM formic acid peak values showed a consistent negative association with infant BMI at all time points (B < = −0.10, P < = 0.014), whereas HM acetate was negatively associated with skinfold thickness at 3 mo (B = −0.10, P = 0.028) and 24 mo (B = −0.10, P = 0.036). Conclusions These results suggest that HM SCFAs play a beneficial role in weight gain and adiposity during infancy. Further knowledge of HM SCFA function may inform future strategies to support healthy growth.

Growth patterns of breastfed infants, while widely considered to be optimal, show substantial inter-individual differences, partly influenced by breast milk (BM) nutritional composition. However, BM nutritional composition does not accurately indicate BM nutrient intakes. This study aimed to examine the associations between both BM intake volumes and macronutrient intakes with infant growth and adiposity. Mother-infant dyads (N=94) were recruited into the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) from a single maternity hospital at birth; all infants were vaginally delivered and received exclusive breastfeeding (EBF) for at least 6 weeks. Infant weight, length, and skinfolds thicknesses (reflecting adiposity) were repeatedly measured from birth to 12 months. Post-feed BM samples were collected at 6 weeks to measure triglycerides (fat), lactose (carbohydrate) (both by 1H-NMR) and protein concentrations (DUMAS method). BM intake volume was estimated from 70 infants between 4-6 weeks using dose-to-the-mother deuterium-oxide (2H2O) turnover. In the full cohort and among 60 infants who received EBF for 3+ months, higher BM intake at 6 weeks was associated with initial faster growth between 0-6 weeks (B±SE 3.58±0.47 for weight and 4.53±0.6 for adiposity gains, both p<0.0001) but subsequent slower growth between 3-12 months (B±SE -2.27±0.7 for weight and -2.65±0.69 for adiposity gains, both p<0.005). BM carbohydrate and protein intakes at 4-6 weeks were positively associated with early (0-6 weeks) but tended to be negatively related with later (3-12 months) adiposity gains, while BM fat intake showed no association, suggesting that carbohydrate and protein intakes may have more functional relevance to later infant growth and adiposity.

Aims/hypothesisThis study aimed to explore the infancy growth trajectories of ‘recent’ and ‘earlier’ offspring of mothers with gestational diabetes mellitus (OGDM), each compared with the same control infants, and investigate whether ‘recent’ OGDM still exhibit a classical phenotype, with macrosomia and increased adiposity.MethodsWithin a prospective observational birth cohort, 98 ‘earlier’ OGDM born between 2001 and 2009 were identified using 75 g oral glucose tolerance testing at 28 weeks gestation, 122 recent OGDM born between 2011 and 2013 were recruited postnatally through antenatal diabetes clinics, and 876 normal birthweight infants of mothers with no history of diabetes were recruited across the full study period as the control group. All infants followed the same study protocol (measurements at birth, 3, 12 and 24 months, including weight, length and skinfold thickness indicating adiposity, and detailed demographic data). In all cases, GDM was defined using the International Association of Diabetes and Pregnancy Study Group criteria.ResultsEarlier OGDM had higher birthweight SD scores (SDS) than control infants. Conversely, recent OGDM had similar birthweight- and length SDS to control infants (mean ± SD, 0.1 ± 1.0 and− 0.1 ± 0.9, respectively), but lower mean skinfold thickness SDS (−0.4 ± 0.6 vs 0.0 ± 0.9; p < 0.001). After birth, earlier OGDM showed reduced gains in weight and length between 3 and 12 months. In contrast, recent OGDM had increased weight and skinfold thickness gains until 3 months, followed by reduced gains in those variables from 3 to 12 months, compared with control infants. At 24 months, recent OGDM had lower adiposity than control infants (mean skinfold thickness SDS −0.3 ± 0.7 vs 0.0 ± 0.8; p < 0.001). At all time points recent OGDM had lower growth measurements than earlier OGDM.Conclusions/interpretationRecent OGDM showed different growth trajectories to the earlier group, namely normalisation of birthweight and reduced adiposity at birth, followed by initial rapid weight gain but subsequent reduced adiposity postnatally. While avoidance of macrosomia at birth may be advantageous, the longer-term health implications of these changing growth trajectories are uncertain.Electronic supplementary materialThe online version of this article (10.1007/s00125-019-4970-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Background: Highly consistent positive associations are reported between infancy growth and later obesity risk. However, it is unclear whether infancy growth parameters beyond body weight add to the prediction of later obesity risk. Aim: To assess whether infancy length and skinfold thicknesses add to infancy weight in the prediction of childhood adiposity. Subjects and methods: This analysis included 254 children with available data on infant growth from birth to 24 months and childhood adiposity at age 6-11 years measured by DXA. Multilevel linear regression was used to examine the predictors of childhood percent body fat (%BF), with adjustment for sex and age at follow-up visit. Results: Birth weight and weight gain (modelled as changes in z-score) between 0-3 months and 3-24 months showed independent positive relationships with childhood %BF. The addition of gains in infant length and skinfolds between 0-3 months, but not 3-24 months, improved overall model prediction, from 18.7% to 20.7% of the variance in childhood %BF (likelihood ratio test, p < 0.0001), although their independent effect estimates were small (infant length gain: negative trend, partial R-square 0.6%, p ¼ 0.2; skinfolds: positive trend, 1.3%, p ¼ 0.09). Conclusion: Infancy length and skinfolds contribute significantly, but only modestly, to the prediction of childhood adiposity.

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