Effects of early feeding on growth velocity and overweight/obesity in a cohort of HIV unexposed South African infants and children

Abstract

BackgroundSouth Africa has the highest prevalence of overweight/obesity in Sub-Saharan Africa. Assessing the effect of modifiable factors such as early infant feeding on growth velocity and overweight/obesity is therefore important. This paper aimed to assess the effect of infant feeding in the transitional period (12 weeks) on 12–24 week growth velocity amongst HIV unexposed children using WHO growth velocity standards and on the age and sex adjusted body mass index (BMI) Z-score distribution at 2 years.MethodsData were from 3 sites in South Africa participating in the PROMISE-EBF trial. We calculated growth velocity Z-scores using the WHO growth standards and assessed feeding practices using 24-hour and 7-day recall data. We used quantile regression to study the associations between 12 week infant feeding and 12–24 week weight velocity (WVZ) with BMI-for-age Z-score at 2 years. We included the internal sample quantiles (70th and 90th centiles) that approximated the reference cut-offs of +2 (corresponding to overweight) and +3 (corresponding to obesity) of the 2 year BMI-for-age Z-scores.ResultsAt the 2-year visit, 641 children were analysed (median age 22 months, IQR: 17–26 months). Thirty percent were overweight while 8.7% were obese. Children not breastfed at 12 weeks had higher 12–24 week mean WVZ and were more overweight and obese at 2 years. In the quantile regression, children not breastfed at 12 weeks had a 0.37 (95% CI 0.07, 0.66) increment in BMI-for-age Z-score at the 50th sample quantile compared to breast-fed children. This difference in BMI-for-age Z-score increased to 0.46 (95% CI 0.18, 0.74) at the 70th quantile and 0.68 (95% CI 0.41, 0.94) at the 90th quantile . The 12–24 week WVZ had a uniform independent effect across the same quantiles.ConclusionsThis study demonstrates that the first 6 months of life is a critical period in the development of childhood overweight and obesity. Interventions targeted at modifiable factors such as early infant feeding practices may reduce the risks of rapid weight gain and subsequent childhood overweight/obesity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13006-015-0041-x) contains supplementary material, which is available to authorized users.

A review of complementary feeding practices in South Africa

“…This is evidenced by the high number of HIV/ PMTCT infant and young child feeding studies included in this review (n = 14 articles). 11,20,22,23,25,[27][28][29][30][31][32][33][34][35] However, the results on breastfeeding practices found by this review need to be interpreted against the existing policy background and the changes made in HIV and infant feeding guidelines in South Africa. The practice of giving free formula might have influenced more mothers to choose to formula feed and might have made formula feeding more acceptable in communities.…”

“…Cereal based foods were the most popular type of complementary food (13 studies)-specifically maize meal porridge (sometimes described as soft and thin), and commercial infant cereal 10,[12][13][14][15]17,19,20,21,36,37,39,41 (6) Use of water and other non-milk liquids Water was commonly given to infants before 6 months (10 studies) 1,11,12,15,19,20,30,32,36,39 Black tea, rooibos tea, sugar water, traditional herb mixtures, gripe water, antacid preparations and ijuba (a sorghum beer) were also given to children from birth 11,12,14,19,20,36 (7) Foods of concern Processed meats, soft drinks, sweets and salty crisps were some of the foods being given to older infants and young children that are cause for concern 13,14,17 (8) Meal frequency Only four studies reported on the total number of feeds per day:…”

Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now?

“…If implemented globally at near universal levels (> 90%), optimal breastfeeding practices could reduce global child deaths by more than 800,000 [ 3 ], which makes breastfeeding the most effective preventive intervention to improve infant mortality [ 4 ]. The numerous benefits of breastfeeding continue to accrue throughout childhood and into adulthood, including reduced morbidity from diarrhoeal and respiratory illness [ 5 ], and reduced risk of overweight and obesity in children, another of the six UN targets [ 1 , 6 ]. Although long term follow-up studies on infant feeding practices have implicit methodological challenges [ 7 ], the favourable effect of breastfeeding on cognitive performance indicators has recently been presented [ 8 , 9 ].…”

Predicting Undernutrition at Age 2 Years with Early Attained Weight and Length Compared with Weight and Length Velocity

“…The World Health Organization (WHO) published growth velocity standards in 2009, 15 offering the opportunity to score weight and length gain according to age and sex. Two studies have used the WHO growth velocity standards to assess the relationship with future nutritional status, but one focused on the association with obesity and did not compare the predictive ability of weight velocity with other growth measures, 16 and the other studied children with cystic fibrosis in the US. 17 Studying growth velocities could help to identify critical time windows for prevention or early interventions of undernutrition.…”