Factors Associated with Anthropometry Z-Scores in Exclusively Breastfed Infants Aged 0-6 Months in 10 Cities of China

Objectives: The present study evaluated anthropometry Z-scores of exclusively breastfed infants aged 0~6 months and examined their associations with various parent-infant factors. Methods: This cross-sectional study included 383 mother-infant dyads from 10 Chinese cities in the final analyses, under strict inclusion and exclusion criteria. Data were collected by trained investigators using questionnaires covering demographic characteristics, perinatal health, maternal and infant factors during lactation. Nutrient intake was assessed and calculated by 24 h recall. Anthropometric measurements of parents and infants were taken using calibrated instruments, with infant growth assessed via Chinese growth standards. Statistical analyses included correlation and linear mixed-effect models accounting for regional clustering, with variable selection guided by backward elimination step regression. Nonlinear relationships were explored using spline and piecewise regression methods. Results: Over 60% of the mothers had inadequate energy and protein intake. Approximately two-thirds of the participants had fat intakes exceeding the upper limit. Inadequate or excessive gestational weight gain, poor maternal sleep quality, lactational mastitis, higher maternal fat intake and infant gastrointestinal symptoms were associated with lower infant anthropometry Z-scores. A threshold effect was detected between maternal fat intake and infant WAZ, BMI Z, and WLZ. Conclusions: This study found that anthropometry Z-scores of exclusively breastfed infants aged 0-6 months were significantly associated with certain maternal-infant factors and maternal fat intake, emphasizing the need for early intervention on adverse factors and balanced maternal diet nutrition during lactation.