Problematic feeding recommendations? Misinformed parents may be at risk of overfeeding or underfeeding infants

29 Jul 2019 --- Common dietary recommendations from hospitals and infant formula manufacturers for introducing solid foods to infants could raise the risk of overfeeding or underfeeding. This is according to a computer modeling study funded by the US National Institutes of Health (NIH). The researchers warn against these inconsistent and potentially problematic feeding recommendations, which can cause complications in the second half of the first year of life when infants are also consuming breastmilk or formula.

“There are several sources available to parents that provide guidance on the quantity of complementary foods [foods other than breastmilk or formula] during infancy, but the information varies by source and it is often difficult for parents to know how to adjust complementary feedings based on their primary feeding method [breastmilk or formula],” Layla Esposito, Ph.D., the Program Officer responsible for the administration of the NIH grant, tells NutritionInsight.

The researchers assert that medical and professional organizations, government agencies and industry must consider developing consistent guidelines on how best to introduce infants to solid food, including appropriate portion sizes and food types based on whether the primary feeding type is breastmilk or formula.

“The main long-term risk of overfeeding an infant is childhood overweight and obesity, which comes with numerous health consequences,” explains Dr. Esposito. “Some of the long-term risks of chronic underfeeding of an infant/toddler include malnutrition, stunting, increased risk for disease, and impacts on cognitive development, just to name a few.”

The American Academy of Pediatrics has some general information on serving sizes for toddlers, and a sample menu for 8-12-month olds, notes Dr. Esposito. This study examines recommendations from four other sources: Children’s Hospital of Philadelphia (CHOP), Johns Hopkins Medicine, Enfamil and Similac [formula brands]. The authors note that the amount of food recommended for this age group varies greatly among these sources.

Parents often seek guidance from medical professionals on how and when to first give solid foods to their infant. Recommendations, however, vary significantly for infants between six months and one year of age. Many organizations recommend waiting until an infant is six months old before introducing solid foods, note the researchers. Last April, the European Food Safety Authority (EFSA) suggested that the complementary feeding of infants should begin between three and six months.

The researchers assert that medical and professional organizations, government agencies and industry must consider developing consistent guidelines on how best to introduce infants to solid food, including appropriate portion sizes and food types based on whether the primary feeding type is breastmilk or formula.

Computer simulated feeding regimens
In the NIH-funded study, researchers developed a computer model that captured feeding behaviors, physical activity levels, estimated metabolism and body size of infants from six months to one year in response to guidance from Children’s Hospital of Philadelphia, Johns Hopkins Medicine in Baltimore, and baby formula manufacturers Enfamil and Similac. All of the simulated tests resulted in either overweight or underweight simulated infants by nine months.

When virtual caregivers fed infants according to the four different guides, none of the simulated situations resulted in normal weight at 12 months, when infants were also being breastfed along average observed patterns. Reducing breast milk portions in half while caregivers fed infants according to complementary feeding guidelines resulted in overweight body mass indexes (BMI) between 9-11 months for Children’s Hospital of Philadelphia, Johns Hopkins Medicine, and Enfamil guidelines. Cutting breast milk portions in half also led to infants reaching unhealthy underweight BMI percentiles between 7-11 months for female and male infants when caregivers followed Children’s Hospital of Philadelphia, Johns Hopkins Medicine and Similac guidelines.

“Because it would be difficult or impossible to conduct this study with humans, modeling offers a unique opportunity to examine different feeding scenarios in silico,” highlights Dr. Esposito. “The article points out several limitations of computation modeling include that models cannot account for all factors that influence infant feeding. In addition, these models are based on different assumptions, and the accuracy of those assumptions can influence the outcome of the simulations.

Findings of the research were published in the American Journal of Preventative Medicine.

In the infant nutrition space, sugar is another major concern. Recently, the European division of The World Health Organization (WHO) slammed the baby food market, noting that a large proportion of products are high in sugar and incorrectly promoted as suitable for infants under six months.

By Benjamin Ferrer