Article Commentary: The Influence of Early Infant-Feeding Practices on the Intestinal Microbiome and Body Composition in Infants

Despite many years of widespread international recommendations to support exclusive breastfeeding for the first six months of life, common hospital feeding and birthing practices do not coincide with the necessary steps to support exclusive breastfeeding. These common hospital practices can lead to the infant receiving formula in the first weeks of life despite mothers’ dedication to exclusively breastfeed. Consequently, these practices play a role in the alarmingly high rate of formula-feeding worldwide. Formula-feeding has been shown to alter the infant gut microbiome in favor of proinflammatory taxa and increase gut permeability and bacterial load. Furthermore, several studies have found that formula-feeding increases the risk of obesity in later childhood. While research has demonstrated differences in the intestinal microbiome and body growth between exclusively breast versus formula-fed infants, very little is known about the effects of introducing formula to breastfed infants either briefly or long term on these outcomes. Understanding the relationships between mixed-feeding practices and infant health outcomes is complicated by the lack of clarity in the definition of mixed-feeding as well as the terminology used to describe this type of feeding in the literature. In this commentary, we highlight the need for hospitals to embrace the 10 steps of the Baby Friendly Hospital Initiative developed by UNICEF and the WHO for successful breastfeeding. We present a paucity of studies that have focused on the effects of introducing formula to breastfed infants on the gut microbiome, gut health, growth, and body composition. We make the case for the need to conduct well-designed studies on mixed-feeding before we can truly answer the question: how does brief or long-term use of formula influence the health benefits of exclusive breastfeeding?

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Exclusive breastfeeding rate and factors associated with infant feeding practices in Indonesia

Paediatrica Indonesiana ◽

10.14238/pi56.1.2016.24-31 ◽

2016 ◽

Vol 56 (1) ◽

pp. 24 ◽

Cited By ~ 2

Author(s):

Yovita Ananta ◽

Ellen Gandaputra ◽

Elina Waiman ◽

I Gusti Ayu Nyoman Partiwi ◽

Nanis Sacharina Marzuki ◽

...

Keyword(s):

Infant Feeding ◽

Exclusive Breastfeeding ◽

Head Circumference ◽

Feeding Practices ◽

Infant Feeding Practices ◽

Developmental Status ◽

Factors Associated ◽

Breastfed Infants ◽

Breastfeeding Rate ◽

Duration Of Breastfeeding

Background Breast milk is the ideal food for infants. According to the 2007 Indonesian National Household Health Survey, only 23% of mothers exclusively breastfeed for six months.Objectives To determine the rate of exclusive breastfeeding in Indonesia, to evaluate factors associated with infant feeding practices, and to compare the nutritional and developmental status between exclusively-breastfed and formula-fed infants.Methods A survey was conducted in hospitals located in 17 provinces in Indonesia. The rate of exclusive breastfeeding was calculated. Many variables were investigated as potential predictors for exclusive breastfeeding using a multivariable logistic regression analysis. Further analysis was performed to compare the nutritional and developmental status between exclusively breastfed and formula-fed infants at the time of survey.Results From 1,804 infant subjects, the overall rate of exclusive breastfeeding was 46.3%, ranging from 10.5% in East Java to 66.9% in Jambi. Predominant breastfeeding, complementary feeding, and formula feeding rates were 14.3%, 8.6%, and 30.7%, respectively. Maternal unemployment was associated with a longer duration of breastfeeding (P=0.000). There were significantly more formula-fed infants who were undernourished compared to exclusively-breastfed infants (14% vs. 8%, P=0.001). There were also significantly more infants in the formula-fed group who had abnormal head circumference compared to those in the exclusively-breastfed group (9% vs. 6%, P=0.031). Child development, as assessed by the Pre-screening Developmental Questionnaire, was similar between the two groups (P=0.996).Conclusion The overall rate of exclusive breastfeeding in Indonesia is 46.3%. Maternal unemployment is associated with longer duration of breastfeeding. Exclusive breastfed infants have significant better growth and head circumference compared to formula fed infants, while the development is similar between the two groups.

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Breastfeeding Practices Among Hispanic and Non-Hispanic Women at the Postpartum Visit

Journal of Human Lactation ◽

10.1177/0890334418774765 ◽

2018 ◽

Vol 34 (3) ◽

pp. 485-493 ◽

Cited By ~ 1

Author(s):

Cameryn C. Garrett ◽

Michelle Azimov ◽

Khozema Campwala ◽

Maria Sarmiento ◽

Kristen Faye Linton

Keyword(s):

Infant Feeding ◽

Exclusive Breastfeeding ◽

Formula Feeding ◽

Feeding Practice ◽

Obese Women ◽

Mixed Feeding ◽

Postpartum Visit ◽

Feeding Patterns ◽

Hispanic Mothers ◽

Hispanic White

Background: Breastfeeding is an active area in public health advocacy. Despite documented benefits for infants and mothers, exclusive breastfeeding is not universal. Ethnicity, among other variables, has been shown to influence breastfeeding practice. Research aim: Our study aimed to determine which variables are associated with infant feeding patterns at the postpartum visit; compare the sociodemographic variables associated with infant feeding patterns between Hispanic and non-Hispanic mothers; and determine the odds of exclusive breastfeeding, mixed feeding, and exclusive formula feeding associated with sociodemographic characteristics. Methods: A retrospective, cross-sectional two-group comparison design was used. Hispanic and non-Hispanic women’s ( N = 666) infant feeding patterns at 6-week postpartum were analyzed. Group comparisons were made of the demographic characteristics and infant feeding practice. Results: Thirty-four percent of Hispanic participants reported exclusive breastfeeding compared with 59% of non-Hispanic White participants. Language and body mass index were significantly associated with infant feeding patterns among Hispanic participants. Compared with non-Hispanic White participants, Hispanic participants had increased odds of reporting mixed feeding and exclusive formula feeding. Conclusion: Breastfeeding initiatives should target English-speaking Hispanic mothers and obese Hispanic mothers to align breastfeeding rates with medical recommendations. Healthcare providers may benefit from additional training to address barriers to breastfeeding among obese women and to provide culturally sensitive support that encourages continued breastfeeding in this population.

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Differences in the Fecal Metabolome and Microbiome Between Exclusive and Partial Breastfed Infants are More Pronounced at 2 Months Compared to 5 Months

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_169 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1097-1097 ◽

Cited By ~ 1

Author(s):

Aidong Wang ◽

Aly Diana ◽

Sofa Rahmannia ◽

Rosalind Gibson ◽

Lisa Houghton ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Feeding Practices ◽

Illumina Miseq ◽

Short Chain Fatty Acids ◽

P Value ◽

Fecal Samples ◽

Breastfed Infants ◽

Funding Sources ◽

Gates Foundation ◽

The Impact

Abstract Objectives This study aimed to characterize the impact of feeding practices on the infant fecal metabolome and microbiome at 2 months and 5 months of age in exclusive breastfeeding (EBF) and partial breastfeeding (PBF) infants. Methods Fecal samples were collected from infants at 2 months and 5 months of age from Bandung, Indonesia. Exclusive breastfeeding was determined using the stable isotope deuterium dose-to-mother (DTM) technique. Fecal metabolites were extracted using Dulbecco's phosphate-buffered saline, and analyzed using NMR spectroscopy. Fecal microbial DNA was extracted at the same time using the MoBio PowerLyzer PowerSoil DNA isolation kit (MoBio, Carlsbad, CA). The V4 region of 16SrRNA was targeted. The DNA library sample was analyzed via 300-bp paired-end sequencing on the Illumina MiSeq platform. Results Fecal samples from EBF infants at 2 months of age revealed significantly higher human milk oligosaccharides (HMOs), short-chain fatty acids and related metabolites compared to PBF infants. However, fecal samples from infants at 5 months of age revealed no differences in metabolome between EBF and PBF after p-value adjustment for multiple comparisons. Gut microbes, especially Bifidobacterium were higher in EBF infants at age 2 months even though not statistically significant. However, this difference was eliminated at age 5 months. Conclusions In the present study, infant feeding practices had a stronger influence on the infant fecal metabolome and microbiome at the age of 2 months as compared to 5 months. Funding Sources 2014 Bill & Melinda Gates Foundation. CS would also like to acknowledge funding from the Kinsella endowed chair in Food, Nutrition, and health as well as USDA-NIFA Hatch project 1,021,411.

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Persistence of Supplemented Bifidobacterium longum subsp. infantis EVC001 in Breastfed Infants

mSphere ◽

10.1128/msphere.00501-17 ◽

2017 ◽

Vol 2 (6) ◽

Cited By ~ 49

Author(s):

Steven A. Frese ◽

Andra A. Hutton ◽

Lindsey N. Contreras ◽

Claire A. Shaw ◽

Michelle C. Palumbo ◽

...

Keyword(s):

Human Milk ◽

Gut Microbiome ◽

Bifidobacterium Longum ◽

Specific Substrate ◽

Fecal Microbiome ◽

Microbiome Composition ◽

Breastfed Infants ◽

Gut Function ◽

First Time

ABSTRACT The gut microbiome in early life plays an important role for long-term health and is shaped in large part by diet. Probiotics may contribute to improvements in health, but they have not been shown to alter the community composition of the gut microbiome. Here, we found that breastfed infants could be stably colonized at high levels by provision of B. infantis EVC001, with significant changes to the overall microbiome composition persisting more than a month later, whether the infants were born vaginally or by caesarean section. This observation is consistent with previous studies demonstrating the capacity of this subspecies to utilize human milk glycans as a nutrient and underscores the importance of pairing a probiotic organism with a specific substrate. Colonization by B. infantis EVC001 resulted in significant changes to fecal microbiome composition and was associated with improvements in fecal biochemistry. The combination of human milk and an infant-associated Bifidobacterium sp. shows, for the first time, that durable changes to the human gut microbiome are possible and are associated with improved gut function. Attempts to alter intestinal dysbiosis via administration of probiotics have consistently shown that colonization with the administered microbes is transient. This study sought to determine whether provision of an initial course of Bifidobacterium longum subsp. infantis (B. infantis) would lead to persistent colonization of the probiotic organism in breastfed infants. Mothers intending to breastfeed were recruited and provided with lactation support. One group of mothers fed B. infantis EVC001 to their infants from day 7 to day 28 of life (n = 34), and the second group did not administer any probiotic (n = 32). Fecal samples were collected during the first 60 postnatal days in both groups. Fecal samples were assessed by 16S rRNA gene sequencing, quantitative PCR, mass spectrometry, and endotoxin measurement. B. infantis-fed infants had significantly higher populations of fecal Bifidobacteriaceae, in particular B. infantis, while EVC001 was fed, and this difference persisted more than 30 days after EVC001 supplementation ceased. Fecal milk oligosaccharides were significantly lower in B. infantis EVC001-fed infants, demonstrating higher consumption of human milk oligosaccharides by B. infantis EVC001. Concentrations of acetate and lactate were significantly higher and fecal pH was significantly lower in infants fed EVC001, demonstrating alterations in intestinal fermentation. Infants colonized by Bifidobacteriaceae at high levels had 4-fold-lower fecal endotoxin levels, consistent with observed lower levels of Gram-negative Proteobacteria and Bacteroidetes. IMPORTANCE The gut microbiome in early life plays an important role for long-term health and is shaped in large part by diet. Probiotics may contribute to improvements in health, but they have not been shown to alter the community composition of the gut microbiome. Here, we found that breastfed infants could be stably colonized at high levels by provision of B. infantis EVC001, with significant changes to the overall microbiome composition persisting more than a month later, whether the infants were born vaginally or by caesarean section. This observation is consistent with previous studies demonstrating the capacity of this subspecies to utilize human milk glycans as a nutrient and underscores the importance of pairing a probiotic organism with a specific substrate. Colonization by B. infantis EVC001 resulted in significant changes to fecal microbiome composition and was associated with improvements in fecal biochemistry. The combination of human milk and an infant-associated Bifidobacterium sp. shows, for the first time, that durable changes to the human gut microbiome are possible and are associated with improved gut function.

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Energy contribution from non-breastmilk items in low-income Guatemalan infantsin their sixth month of life

Salud Pública de México ◽

10.21149/spm.v57i2.7407 ◽

2015 ◽

Vol 57 (2) ◽

pp. 117 ◽

Cited By ~ 1

Author(s):

Marieke Vossenaar ◽

Jeniece Alvey ◽

Ilse Van Beusekom ◽

Colleen M Doak ◽

Noel W Solomons

Keyword(s):

Infant Feeding ◽

Low Income ◽

Exclusive Breastfeeding ◽

Complementary Feeding ◽

Health Clinic ◽

Mixed Feeding ◽

Delivery Method ◽

Energy Contribution ◽

Breastfed Infants ◽

Early Infant

Objective. To examine the nature and energy contribution of complementary feeding in breastfed infants in their sixth month of life, and the prevalence of the use of bottles as a delivery method. Materials and methods. We recruited 156 breastfeeding infants at a health clinic in metropolitan Quetzaltenango, Guatemala. A previous-day recall was performed. Results. Sixty nine mothers (44%) reported offering items other than breastmilk. The median contribution ofenergy from complementary foods among infants with mixed feeding (n=66) was 197 kcal/day (interquartile range [IQR] 49-353). The median energy contribution of formula or cow’s milk among consumers (n=39) was 212 kcal/day (IQR 84-394).Bottles were used on the previous day by 55 (80%) of the 69 mothers not offering exclusive breastfeeding. Conclusions. Premature introduction of non-breastmilk items is commonly practiced in feeding Guatemalan infants. Adherence to the internationally recognized guidelines for early infant feeding should be an intervention priority for this population.

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Feeding Practices among Human Immunodeficiency Virus-Exposed Infants in Ethiopia: Systematic Review and Meta-Analysis

Advances in Public Health ◽

10.1155/2021/9068074 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Habtamu Temesgen ◽

Ayenew Negesse ◽

Temesgen Getaneh ◽

Yibelu Bazezew ◽

Dessalegn Haile ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Exclusive Breastfeeding ◽

Meta Analysis ◽

Feeding Practices ◽

Mixed Feeding ◽

Replacement Feeding ◽

Hiv Exposed Infants ◽

Pooled Prevalence ◽

Immunodeficiency Virus ◽

Hiv Exposed

Background. Infant and young child feeding in the context of human immunodeficiency virus- (HIV-) infected mothers has significant challenges due to the risk of transmission of the virus via breastfeeding. In Ethiopia, a number of independent studies have been conducted to assess the feeding practice of HIV-exposed infants. But, there is no concrete evidence to show the national figure in Ethiopia. Hence, this review and meta-analysis aims to estimate the pooled prevalence of feeding practices among HIV exposed infants in Ethiopia. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Articles were searched through search engines in PubMed, Cochrane Library, Google Scholar, and direct Google search. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment. The random effects model was used to estimate the pooled prevalence of infant feeding practices. Heterogeneity and publication bias were assessed. Trim and fill analysis was performed. Additionally, meta-regression was also performed. Results. In this review, a total of 26, 22, and 22 studies and 7413, 6224, and 6222 study participants for exclusive breastfeeding, replacement feeding, and mixed feelings were included, respectively. The overall pooled prevalence of exclusive breastfeeding, replacement feeding, and mixed feeding of HIV exposed infant was 63.99 % (95% Confidence Interval (CI): 52.32, 75.66), 16.13% (95% CI: 11.92, 20.32), and 20.95% (95% CI: 11.35, 30.58)) in Ethiopia, respectively. Conclusion and Recommendations. In Ethiopia, almost three in five HIV-exposed infants were exclusively breastfed. But still, mixed feeding during the period of first 6 months was practiced in almost one-fifth of the exposed infants in Ethiopia. Additionally, replacement feeding was also practiced even though not recommended for developing countries. Therefore, the government of Ethiopia should strengthen the health institutions to implement the existing infant feeding strategies and guidelines to increase exclusive breastfeeding for the first 6 months and to avoid mixed feeding during the periods of six months.

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C-section Delivery Is a Barrier to and Demographic-maternal-child Factors Have Mixed Effects on the Length of Exclusive Breastfeeding Under Nutrition Transition in Lebanon (P11-058-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-058-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 3

Author(s):

Rana Chehab ◽

Lara Nasreddine ◽

Racha Zgheib ◽

Michele Forman

Keyword(s):

Exclusive Breastfeeding ◽

Statistical Significance ◽

Nutrition Transition ◽

Feeding Practices ◽

Bottle Feeding ◽

National Council ◽

Mixed Feeding ◽

Cross Sectional ◽

Child Characteristics ◽

Lower Odds

Abstract Objectives The study aims to: estimate the prevalence of exclusive breastfeeding in Lebanon; and examine socio-demographic, maternal, and child-related determinants associated with exclusive breastfeeding for 40 days and 6 months. Methods In a cross-sectional study of a nationally representative sample of 1005 Lebanese mother-child dyads, mothers of children < 5 years completed face-to-face interviews about child feeding practices, socio-demographic, maternal, and child characteristics. Exclusive breastfeeding versus mixed feeding or exclusive bottle feeding at 40 days or versus mixed feeding or bottle and solid feeding at 6 months served as the dependent variables. Multivariable logistic regression models were fitted and adjusted for significant covariates with P < 0.10 in the unadjusted analysis. For all other analyses, P < 0.05 indicated statistical significance. Results 41% and 12% of the children were exclusively breastfed for 40 days and 6 months, respectively. Compared to the mixed fed or exclusively bottle fed at 40 days, the older the child at the interview the higher the odds by 1.4% per month of exclusive breastfeeding, whereas children delivered via C-section had a 26% or 53% lower odds of exclusively breastfeeding respectively. Also, compared to the exclusively bottle fed at 40 days, children in families with 3 + siblings had a 73% higher odds of exclusively breastfeeding, while children in families owning 2 + cars had a 58% lower odds of exclusively breastfeeding. Compared to the mixed fed at 6 months, children of overweight or obese mothers at the interview had 45% or 53% lower odds of exclusively breastfeeding respectively, whereas heavier children at the interview had a 10% per kg higher odds of exclusively breastfeeding. Compared to the bottle and solid fed at 6 months, children delivered via C-section and those in families owning 2 + cars had a lower odds of exclusively breastfeeding by 62% and 58% respectively. Conclusions Socio-demographic, maternal and child characteristics influenced infant feeding practices over time in Lebanon. C-section delivery was consistently associated with a lower odds of exclusive breastfeeding for 40 days and 6 months. Reducing elective C-section delivery would enhance exclusive breastfeeding in a population undergoing social and nutrition transition. Funding Sources Lebanese National Council for Scientific Research through its support to the Associated Research Unit (ARU) for “Nutrition and Non-communicable Diseases in Lebanon”.

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Effects of Exclusive Breast Feeding for First Six Months of life on Children Weight, Height and Head Circumference in Sulaimani City, Kurdistan-Iraq and Compare with Other Types of Feeding

Iraqi Journal of Pharmaceutical Sciences ( P-ISSN 1683 - 3597 E-ISSN 2521 - 3512) ◽

10.31351/vol30iss1pp76-80 ◽

2021 ◽

Vol 30 (1) ◽

pp. 76-80

Author(s):

Sardar M. Weli

Keyword(s):

Breast Milk ◽

Breast Feeding ◽

Exclusive Breastfeeding ◽

Head Circumference ◽

Growth And Development ◽

Formula Feeding ◽

Mixed Feeding ◽

Kurdistan Region ◽

Essential Nutrients ◽

Breast Fed

Breastfeeding (BF) serves as a complete nutritional source for the first six months of infant’s life. Breast milk contains all essential nutrients that necessary for the physiological growth and development of infants. The aim of this study was to compare the physiological growth of infants including weight, height and head circumference who were exclusively breastfed for 6 months and those who were given bottle-fed or mixed fed and to find a percentage of exclusive breastfeeding among mothers who contributed in this study in Sulaimani city. This study was carried out in Sulaimani city/ Kurdistan region of Iraq and the cases were enrolled between the first of October 2018 and first of October 2019. The infants’ weight, height and head circumstances were measured at different age levels (At age two, six, nine and fifteen months). The results of this study found that Among 198 mothers who were contributed in this study; 92 (46.5%) of mothers had EBF while 90 (45.5%) had mixed feeding and only 16 (8%) had exclusive formula feeding (EFF) in the first six months of baby’s life. Infant’s weight at age 2 months were no differences between types of feeding. However, at ages 6 and 9 were significantly high in infants who breastfed compared to formula fed but no differences were found between EBF and mixed feeding. At age 15 months weights of infants were again no differences were found between all types of feeding. For height parameter, infants who exclusively breastfed for six months were significantly higher than those of formula fed at age 2, 6, 9 and 15 months. Regarding head circumferences no significant differences between types of feeding at age 2 months were showed. Nevertheless, at age 6 and 15 months were significantly high in infants who breastfed than formula fed. The present study conclude that infants who breast fed for first six months of life have a higher weight, height and head circumferences than infants who exclusively formula fed. The percentage of EBF among Kurdish mothers were similar with other countries of Iraq but was low compared to the recommended rate of WHO.

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Infant Feeding Practices of HIV Positive Mothers and Its Association with Counseling and HIV Disclosure Status in Ethiopia: A Systematic Review and Meta-Analysis

AIDS Research and Treatment ◽

10.1155/2019/3862098 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 1

Author(s):

Getaneh Mulualem Belay ◽

Chalachew Adugna Wubneh

Keyword(s):

Systematic Review ◽

Exclusive Breastfeeding ◽

Odds Ratio ◽

Meta Analysis ◽

Feeding Practices ◽

Hiv Disclosure ◽

Hiv Positive ◽

Mixed Feeding ◽

Hiv Positive Mothers ◽

Disclosure Status

Introduction. Breastfeeding is the ideal food source for all newborns globally. However, in the era of Human Immune Deficiency Virus (HIV) infection, feeding practice is a challenge due to mother-to-child HIV transmission. Therefore, this systematic review and meta-analysis aimed to estimate the national prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers and its association with counseling and HIV disclosure status to the spouse in Ethiopia. Methods. We searched all available articles from the electronic databases including PubMed, EMBASE, Google Scholar, and the Web of Science. Moreover, reference lists of the included studies and the Ethiopian institutional research repositories were used. Searching of articles was limited to the studies conducted in Ethiopia and published in English language. We have included observational studies including cohort, cross-sectional, and case-control studies. The weighted inverse variance random effects model was used. The overall variations between studies were checked through heterogeneity test (I2). Subgroup analysis by region was conducted. To assess the quality of the study, the Joanna Briggs Institute (JBI) quality appraisal criteria were employed. Publication bias was checked with the funnel plot and Egger’s regression test. Result. A total of 18 studies with 4,844 participants were included in this study. The national pooled prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers were 63.43% (95% CI: 48.19, 78.68) and 23.11% (95% CI: 10.10, 36.13), respectively. In the subgroup analysis, the highest prevalence of exclusive breastfeeding practice was observed in Tigray (90.12%) and the lowest in Addis Ababa (41.92%). Counseling on feeding option with an odds ratio of 4.32 (95% CI: 2.75, 6.77) and HIV disclosure status to the spouse with an odds ratio of 6.05 (95% CI: 3.03, 12.06) were significantly associated with exclusive breast feedings practices. Conclusion. Most mothers report exclusive breastfeeding, but there are still almost a quarter of mothers who mix feed. Counseling on feeding options and HIV disclosure status to the spouse should be improved.

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