Jansen E 1 , Daniels L 1 *, Byrne R 1 , Mihrshahi S 1 , Magarey A 1,2 , Nicholson J 3,4

1. The Association Between Maternal Infant Feeding Practices and Child Weight at 11-17 Months in First-time Australian Mothers Jansen E1, Daniels L1*, Byrne R1, Mihrshahi S1, Magarey A1,2, Nicholson J 3,4 1 Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, Australia 2Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, Australia 3 Queensland University of Technology, Brisbane, Australia 4 Murdoch Children’s Research Institute, Melbourne, Australia * t:61 (0) 7 3138 6139 | e: l2.daniels@qut.edu.au Background By 2-3 years of age approximately 15% of Australian children are overweight and a further 4% are obese [1]. Obesity prevention strategies need to start as early as possible and one potential strategy is promoting positive feeding practices. Early feeding practices can influence child food intake, eating behaviours and weight status [2]. Nonresponsive feeding has been implicated in the development of childhood obesity [3]. Practices such as only allowing an infant to feed at set times, have the potential to override a child’s internal cues of hunger and satiety. This may impair self-regulation of energy intake, leading to overeating and excess energy intake [4]. To date there are very few studies examining feeding practices in children under two years of age and how they relate to child weight status. Results continued Table 2: Characteristics of study sample (N=293) Aim Examine the cross-sectional associations between maternal infant feeding practices/beliefs and child weight in Australian children aged 11-17 months, taking into account maternal and child-related characteristics • Methods • Participants • The sample for this study included 293 mother-child dyads from the control group enrolled in the NOURISH RCT (in 2008) [5] • Inclusion criteria • Mothers: • First-time mothers; facility with English • > 18 years • No self report of eating disorder or mental health problems • Children: • Healthy term (gestational age >35 weeks, birth weight >2500g) • 11-17 months old • Outcome Measures • Anthropometric data were measured by trained staff at 2-7 months and • 11-17months of age • The following variables were self-reported using a written questionnaire: • Feeding practices and beliefs • Based on Infant Feeding Questionnaire (IFQ) [6] • Factor structure reanalysed for NOURISH sample due to: • Concurrent rather than retrospective use of IFQ • High prevalence of breastfeeding  3 items related to bottle feeding excluded • Infant sample (Baughcum sample mean age 16.2±3.5 months) • Australian sample • New, validated 4-factor-solution used here • Data Analyses • Multiple regression analysis • Two models: one foreach ‘weight’ outcome as the dependent variable • 1. weight-for-age z-scores at 14 months • 2. change in weight-for-age z-scores from 4 to 14 months • Z-scores were calculated from WHO Child Growth Standards (2006 • reference scores) • Both models were adjusted for covariates (see Table 2) a Difference between weight-for-age z-score at 4 months and weight-for-age z-score at 14 months of age b N=271 due to missing data on this variable c Mother’s concern about her own weight; Weight Concern Scale by Killen et al. (1994) [7]; range 0-5, higher scores indicate more concern; N=287 due to missing data on this variable d N=270 due to missing data on this variable Associations between child weight and feeding practices/beliefs, controlled for all child-related and maternal covariates from Table 2 are presented in the table below. While weight at 14 months was related to 3 out of the 4 feeding practices/beliefs (i.e. concern for under- and overweight, and responsive infant-feeding); change in weight from 4 to 14 months was significantly inversely related to responsive infant-feeding. Additionally, 5 covariates in total were independently related to weight and change in weight – birth weight, child’s age, mother’s perception of child’s weight status, and mother’s concern about her own weight. Table 1: New factor structure of IFQ [6] – 15 items*, 4 factors • Table 3: Adjusted regression models associating child weight with • maternal feeding practices/beliefs (N=262) Note: Cases with missing data on any independent variable or covariate were excluded; adjusted R2 and Standardized β’s for models including all covariates are reported DV= dependent variables, IV= independent variables • Conclusions • In the adjusted models, maternal feeding practices/beliefs explained more variance of child weight at 14 months than weight gain until that age. • Responsive infant-feeding was inversely related to both weight indicators, providing evidence for the existence of an association at an early age. • This is in line with speculative, mostly cross-sectional findings that responsive feeding plays a role in accelerated growth and overweight; assumingly because inappropriate responses to child’s hunger and satiety cues impede the development of the child’s self-regulation of energy intake, leading to overeating and overweight eventually [4]. • Encouraging responsive feeding (e.g. baby feeds whenever she wants, feeding to stop baby being unsettled) may be an important strategy to promote healthy child weight during the first 1.5 years of a child’s life. • Longitudinal studies are needed to determine direction of relationships. Note: Words in italic represent minor word changes * Two items were excluded because they loaded weakly onto a separate factor R indicates item is reverse coded for scoring. Higher scores on each factor indicate more concern about underweight, more awareness of cues, more concern about overweight, more responsive to feeding on cues • Strengths and Limitations • + Concurrent use of revalidated Infant Feeding Questionnaire [6] • + Adjustment for a range of maternal & child-related characteristics • Maternal feeding practices and beliefs were self-reported • Cross-sectional data analysis  no information about direction of effects • ± Applied less frequently used measurement tool of child feeding as other commonly used instruments to assess feeding practices have not been validated in very young children Results Characteristics of first-time mothers and their children are presented in Table 2. References [1] Department of Health and Ageing. Canberra, 2008; [2] Ventura & Birch. Int J BehavNutr Phys Act 2008;5:15; [3] Hurley et al. J Nutr 2011, 141(3):495-501;[4] DiSantiset al. Int J Obes 2011, 35:480-492; [5] Daniels et al. Bmc Public Health 2009;9:387; [6] Baughcumet al. J Dev BehavPediatr 2001;22(6):391-408; [7] Killenet al. Int J Eat Disorder 1994;16(3):227-38 Acknowledgements NOURISH is funded by NHMRC ID 426704. S Mihrshahi’s post doctoral fellowship is funded by HJ Heinz Co.