Ong, Yi Ying, Pang, Wei Wei, Michael, Navin, Aris, Izzuddin M., Sadananthan, Suresh Anand, Tint, Mya Thway, Choo, Jonathan Tze Liang, Ling, Lieng Hsi, Karmani, Neerja, Velan, Sendhil, Fortier, Marielle V., Tan, Kok Hian, Gluckman, Peter D., Yap, Fabian, Chong, Yap-Seng, Godfrey, Keith, Chan, Shiao-Yng, Eriksson, Johan G., Chong, Mary F.F., Wlodek, Mary E. and Lee, Yung Seng (2022) Timing of introduction of complementary foods, breastfeeding, and child cardiometabolic risk: a prospective multi-ethnic Asian study. American Journal of Clinical Nutrition. (doi:10.1016/j.ajcnut.2022.10.021). (In Press)
Abstract
Background: timing of introduction of complementary foods and duration of breastfeeding have been independently associated with child overweight and obesity but their combined influence on body fat partitioning and cardiometabolic risk is unclear.
Objective: we investigated associations of timing of introduction of complementary foods, duration of breastfeeding, and their interaction with child adiposity and cardiometabolic risk markers.
Methods: we analyzed data from 839 children in the prospective Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Mothers reported the age at which infants were first fed complementary foods and breastfeeding duration, classified as early (≤4months) vs. typical (>4months) complementary feeding (CF) and short (≤4months) vs. long (>4months) duration of any breastfeeding (BF), respectively. We measured adiposity and cardiometabolic risk markers at age 6 years and examined their associations with infant feeding patterns using multiple regression, adjusting for socio-demographics, parents’ body mass index (BMI), maternal factors, birthweight-for-gestational-age, and infant weight gain.
Results: of 839 children, 18% experienced early CF while 54% experienced short BF. Short (vs. long) BF and early (vs. typical) CF were independently associated with higher z-BMI [β (95% CI), short BF: 0.18 SDS (-0.01,0.38); early CF: 0.34 SDS (0.11,0.57)] and sum of skinfolds [short BF: 1.83 mm (0.05,3.61); early CF: 2.73 mm (0.55,4.91)]. Children who experienced both early CF and short BF (vs. typical CF-long BF) had synergistically higher diastolic blood pressure [1.41 mmHg (-0.15,2.97), p-interaction=0.023] and metabolic syndrome score [0.81 (0.16,1.47), p-interaction=0.081]. Early CF-long BF (vs. early CF-short BF) was associated with lower systolic blood pressure [-3.74 mmHg (-7.01,-0.48)], diastolic blood pressure [-2.29 mmHg (-4.47,-0.11)], and metabolic syndrome score [-0.90 (-1.80,0.00)].
Conclusions: a combination of early CF and short BF was associated with elevated child adiposity and cardiometabolic markers. Longer breastfeeding duration may protect against cardiometabolic risk associated with early complementary feeding.
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