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Breast-feeding and growth in Brazilian infants
C G Victora1, S S Morris, F C Barros
1Departamento de Medicina Social, Universidade Federal de Pelotas, Brazil. cvictora@nutecnet.com.br
Insights
Infant feeding patterns, including exclusive and predominant breastfeeding, show minimal differences in growth during the first six months. These findings support pooling these groups for developing new infant growth references.
Area of Science:
- Pediatrics
- Human Nutrition
- Growth Monitoring
Background:
- International growth references are being developed based on World Health Organization feeding recommendations.
- Exclusive breastfeeding is recommended for 4-6 months, but exclusively breastfed infants are few, potentially causing selection bias in growth references.
- Variability in infant growth based on feeding patterns requires examination, particularly comparing exclusively and predominantly breastfed infants.
Purpose of the Study:
- To examine linear and soft tissue growth variations in infants based on feeding patterns.
- To compare growth differences between exclusively breastfed and predominantly breastfed infants.
- To inform the construction of new international infant growth references.
Main Methods:
- Longitudinal study of approximately 1450 infants in urban Brazil at 1, 3, 6, and 12 months.
- Infants were weighed and measured; 24-hour dietary recalls were collected from caretakers.
- Growth analyses addressed potential biases including reverse causality, regression to the mean, and confounding.
Main Results:
- Little association between feeding pattern and growth in the first month.
- From 3-6 months, fully weaned infants showed fastest growth, while exclusively breastfed infants grew slowest.
- Virtually no growth differences were observed between exclusively and predominantly breastfed infants within the first six months.
Conclusions:
- Exclusively and predominantly breastfed infants exhibit similar growth patterns in the first six months of life.
- The findings suggest that these two feeding groups can be combined when constructing new infant growth references.
- This supports a broader approach to infant growth assessment, accommodating variations in early feeding practices.
Abstract:
A new international growth reference is being prepared based on children who are fed according to World Health Organization recommendations, which entail exclusive breast-feeding for the first 4-6 mo of life. However, the number of exclusively breast-fed infants in most societies is small, so that selection biases may result from using such a population. We examined the variability in linear and soft tissue growth of infants according to their feeding patterns, emphasizing differences between exclusively and predominantly (breast milk plus fluids) breast-fed infants. About 650 infants from a relatively developed urban area in southern Brazil were examined at the ages of 1, 3, 6, and 12 mo, and an additional 800 infants at 6 and 12 mo. At each visit, infants were weighed and measured and a 24-h dietary recall was completed with the infants' caretakers. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean, and confounding. There was little association between feeding pattern and growth in the first month. From 1 to 3 mo, partially breast-fed infants tended to gain more weight, followed by those who were completely weaned. From 3 to 6 mo, fully weaned infants grew fastest in weight and length and exclusively breast-fed infants grew slowest. After 6 mo of age, the growth in length of partially breast-fed and fully weaned infants was similar, but the latter gained more weight. There were virtually no differences between exclusively and predominantly breast-fed infants in the first 6 mo of life. There results suggest that both of these groups may be pooled for the purpose of constructing growth references.