Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study.
Andrea C Wilson, J Stewart Forsyth, Stephen A Greene, Linda Irvine, Catherine Hau, Peter W Howie
Objective: To investigate the relation of infant feeding practice to childhood respiratory illness, growth, body composition, and blood pressure. Design: Follow up study of a cohort of children (mean age 7.3 years) who had detailed infant feeding and demographic data collected prospectively during the first two years of life. Setting: Dundee. Subjects: 674 infants, of whom 545 (81%) were available for study. Data on respiratory illness were available for 545 children (mean age 7.3 (range 6.1ˇ 9.9) years); height for 410 children; weight and body mass index for 412 children; body composition for 405 children; blood pressure for 301 children (mean age 7.2 (range 6.9ˇ10.0) years). Main outcome measures: Respiratory illness, weight, height, body mass index, percentage body fat, and blood pressure in relation to duration of breast feeding and timing of introduction of solids. Results: After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower (17.0% (95% confidence interval 15.9% to 18.1%) for exclusive breast feeding, 31.0% (26.8% to 35.2%) for partial breast feeding, and 32.2% (30.7% to 33.7%) for bottle feeding. Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood (21.0% (19.9% to 22.1%) v 9.7% (8.6% to 10.8%)). It was also associated with increased percentage body fat and weight in childhood (mean body fat 18.5% (18.2% to 18.8%) v 16.5% (16.0% to 17.0%); weight standard deviation score 0.02 ( - 0.02 to 0.06) v - 0.09 ( - 0.16 to 0.02). Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk (mean 94.2 (93.5 to 94.9) mm Hg v 90.7 (89.9 to 91.7) mm Hg). Conclusions: The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.
The extent to which adult health is determined by nutritional factors in early life has been the subject of much debate since Barker observed that low birth weight and weight at 1 year are associated with adult disease.1 One of the explanations for these findings is that nutritional deficiencies at critical periods of fetal and infant growth may induce permanent changes in physiological function.2 Whether infant feeding practice influences childhood or adult health remains uncertain. Breast feeding is associated with health gain during infancy, with reduction in gastroenteritis and respiratory disease,3 but whether these benefits extend into childhood has not been established. Infant feeding practice varies widely throughout the United Kingdom. Exclusive breast feeding is recommended for at least four months, with solid foods being introduced thereafter,4 5 but currently in the United Kingdom 64% of infants are breast fed initially, with only 19% still being breast fed at 4 months of age. Additionally, 90% of infants start eating solid foods before the age of 4 months.6 With this variance between recommendation and practice, robust evidence is needed to support the national policy. We determined the relation between infant feeding practice and childhood health. Outcome measures were episodes of respiratory illness and measurements of growth, body composition, and blood pressure. Infant feeding data from the first two years of life were collected prospectively as part of the Dundee infant feeding study.
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