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The effect of breast or formula feeding on infant body composition: A systematic review and meta-analysis

Presented at the Neonatal Society 2012 Summer Meeting (programme).

Gale C, Logan KM, Santhakumaran S, Parkinson JRC, Hyde MJ, Modi N

Department of Academic Neonatal Medicine, Imperial College, London, UK

Background: Early life nutrition: breast or formula feeding, may programme later life body composition, and several potential biological pathways have been described. The effect of early nutrition on body composition in infancy has yet to be determined. The objective of this paper was to systematically review longitudinal and cross-sectional studies which have examined in-vivo body composition in healthy, term, appropriate weight for gestational age babies, during infancy, in relation to feeding method (breast feeding or formula feeding). Research Ethics Approval was not required.

Methods: PubMed was searched for human studies, in any language, reporting percentage fat mass in breast fed and commercial, cow’s milk based formula fed infants at the same time points using one of the following techniques: total body electrical conductivity, air displacement plethysmography, dual energy absorptiometry , total body potassium, magnetic resonance imaging, computed tomography, isotope dilution. Quality of studies was assessed. Differences in fat mass (kg), fat free mass (kg) and percentage fat mass between feeding groups were extracted and eligible studies were compared at pre-specified postnatal ages.

Results: We identified 15 studies for inclusion in the systematic review and 11 studies for inclusion in the metaanalysis. In formula compared to breast-fed infants, fat-free mass was higher at 3-4 months (mean difference [95%CI]) (0.13kg [0.03,0.23]), 8-9 months (0.29kg [0.09, 0.49]) and 12 months (0.30kg [0.13,0.48]); fat-mass was lower at 3-4 months (-0.09kg [-0.18, -0.01]) and 6 months (-0.18 [-0.34, -0.01]). Conversely at 12 months there was an increase in fat-mass in formula-fed infants (0.29kg [-0.03, 0.61]), figure 1.

Figure 1: Difference in fat-mass (mean and 95% confidence intervals) – formula fed vs breast fed infants.

Conclusion: Formula feeding, when compared to breast feeding, is associated with altered body composition in infancy. The possibility that the increase in fat-free mass, accompanied by a trend to greater adiposity in formula-fed infants by one year of age is indicative of nutritional programming should be considered.

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