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- Title
Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices With Gut Microbiota and Risk of Overweight in the First Year of Life.
- Authors
Forbes, Jessica D.; Azad, Meghan B.; Vehling, Lorena; Tun, Hein M.; Konya, Theodore B.; Guttman, David S.; Field, Catherine J.; Lefebvre, Diana; Sears, Malcolm R.; Becker, Allan B.; Mandhane, Piushkumar J.; Turvey, Stuart E.; Moraes, Theo J.; Subbarao, Padmaja; Scott, James A.; Kozyrskyj, Anita L.
- Abstract
Importance: The effect of neonatal and infant feeding practices on childhood obesity is unclear. The gut microbiome is strongly influenced by feeding practices and has been linked to obesity. Objective: To characterize the association between breastfeeding, microbiota, and risk of overweight during infancy, accounting for the type and timing of supplementary feeding. Design, Setting, and Participants: In this study of a subset of 1087 infants from the prospective CHILD pregnancy cohort, mothers were recruited between January 1, 2009, and December 31, 2012. Statistical analysis was performed from February 1 to December 20, 2017. Main Outcomes and Measures: Feeding was reported by mothers and documented from hospital records. Fecal microbiota at 3 to 4 months (from 996 infants) and/or 12 months (from 821 infants) were characterized by 16S ribosomal RNA sequencing. Infants with a weight for length exceeding the 85th percentile were considered to be at risk for overweight. Results: There were 1087 infants in the study (507 girls and 580 boys); at 3 months, 579 of 1077 (53.8%) were exclusively breastfed according to maternal report. Infants who were exclusively formula fed at 3 months had an increased risk of overweight in covariate-adjusted models (53 of 159 [33.3%] vs 74 of 386 [19.2%]; adjusted odds ratio, 2.04; 95% CI, 1.25-3.32). This association was attenuated (adjusted odds ratio, 1.33; 95% CI, 0.79-2.24) after further adjustment for microbiota features characteristic of formula feeding at 3 to 4 months, including higher overall richness and enrichment of <italic>Lachnospiraceae.</italic> A total of 179 of 579 infants who were exclusively breastfed (30.9%) received formula as neonates; this brief supplementation was associated with lower relative abundance of <italic>Bifidobacteriaceae</italic> and higher relative abundance of <italic>Enterobacteriaceae</italic> at 3 to 4 months but did not influence the risk of overweight. At 12 months, microbiota profiles differed significantly according to feeding practices at 6 months; among partially breastfed infants, formula supplementation was associated with a profile similar to that of nonbreastfed infants (higher diversity and enrichment of <italic>Bacteroidaceae</italic>), whereas the introduction of complementary foods without formula was associated with a profile more similar to that of exclusively breastfed infants (lower diversity and enrichment of <italic>Bifidobacteriaceae</italic> and <italic>Veillonellaceae</italic>). Microbiota profiles at 3 months were more strongly associated with risk of overweight than were microbiota profiles at 12 months. Conclusions and Relevance: Breastfeeding may be protective against overweight, and gut microbiota may contribute to this effect. Formula feeding appears to stimulate changes in microbiota that are associated with overweight, whereas other complementary foods do not. Subtle microbiota differences emerge after brief exposure to formula in the hospital. These results identify important areas for future research and distinguish early infancy as a critical period when transient gut dysbiosis may lead to increased risk of overweight.This cohort study characterizes the association between breastfeeding, microbiota, and risk of overweight during infancy, accounting for the type and timing of supplementary feeding.Key Points: Question: How do infant feeding practices influence gut microbiota and risk of overweight? Findings: Among 1087 infants from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, earlier cessation of breastfeeding and supplementation with formula (more so than complementary foods) were associated with a dose-dependent increase in risk of overweight by age 12 months; this association was partially explained by specific gut microbiota features at 3 to 4 months. Subtle but significant microbiota differences were observed after brief exposure to formula limited to the birth hospital stay, but these differences were not associated with overweight. Meaning: Breastfeeding may contribute to protection against overweight by modifying the gut microbiota, particularly during early infancy.
- Subjects
OBESITY risk factors; BIRTH weight; CONFIDENCE intervals; ENTEROBACTERIACEAE; INFANTS; INFANT nutrition; LONGITUDINAL method; MEDICAL prescriptions; NUTRITIONAL requirements; RNA; GUT microbiome; CAUSAL models; ATTITUDES of mothers; ODDS ratio
- Publication
JAMA Pediatrics, 2018, Vol 172, Issue 7, pe181161
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2018.1161