Background and Aims

Macronutrient distribution changes during complementary feeding (CF) and is indicated to impact growth and health outcomes. This study investigates macronutrient distribution between breastfed and formula fed very low birth weight (VLBW) infants during the period of weaning.

Methods

This study is a subgroup analysis of a randomized intervention trial in VLBW infants. In addition to formula or breastfeeding infants were fed a standardized CF concept. Depending on the type of feeding infants were assigned to either a breastmilk or formula group. Nutritional intake was assessed using self-reported monthly 3-day dietary records from 3-12 months (M3-M12) of corrected age. Group differences were calculated using a linear-mixed effects model accounting for possible correlations between siblings of multiple births.

Results

Among all infants who underwent randomization (177), dietary record analysis was done in 120 infants. In M3 16% of infants were breastfed decreasing to only 3% in M12. Although, there was no significant difference in energy intake (kcal) between the groups, macronutrient distribution (% of energy) significantly differed until M5. Proportional intakes of protein and carbohydrates were significantly higher in formula fed infants whereas proportional fat intake was significantly higher in breastfed infants. (Figure 1) Formula fed infants did not meet fat intake recommendations (0-3 months: 45-50%, 4-12 months: 35-45%) from 7 to 12 months of corrected age.

Conclusions

These results indicate that there is a gap in macronutrient intake between breastfed and formula fed VLBW infants during the period of CF, hence, possibly playing a critical role in growth regulation in VLBW infants.

Background and Aims

We characterized infants’ gut microbiome maturation as a trajectory in the Microbiota and Health Study (MH), Bangladesh (NCT02361164). For bacteria in trajectory, we examined their associations with diet, metabolites, and health.

Methods

Reference set was MH infants with vaginal delivery, absence of diarrhea episodes until 24 months, weight-for-length Z-scores > -2 at all visits (n=37/222). Using metagenomics data from fecal samples (birth, 2, 6, 10, 15, 18 and 24 months), modeling of microbiome-age was performed to capture age-appropriate maturation. Fecal metabolites were measured using a mass spectrometry platform. Consumption of 13 food items was recorded every month qualitatively. A market basket algorithm was applied at different age-groups to identify feeding-patterns associated with microbiome maturation.

Results

In gut microbiome maturation reference trajectory, bacteria known to produce Short-Chain Fatty-Acids (SCFAs) were Bifidobacterium longum (acetate), Blautia obeum and Veillonella parvula (propionate), Eubacterium rectale, Faecalibacterium prausnitzii and Anaerostipes hadrus (butyrate). Fecal propionate significantly increased with age (p-value = 2.4x10-41). Suji intake was associated with higher butyrate, and milk consumption with lower butyrate (both p-values < 0.05) at multiple timepoints. Blautia obeum abundance was significantly higher in 0 vs. 3+ diarrhea episodes (cumulative incidence from 10 to 24 months) by a longitudinal, permutation-based test (p-value < 0.05). Blautia obeum was positively associated with egg consumption at 15 months (p-value = 0.04).

Conclusions

SCFAs-producing bacteria, amongst others, constituted the reference microbiome trajectory characterizing the infants’ age-appropriate gut microbiome maturation and its link to diet and health.

Background and Aims

Fish is a good source of protein. It can be utilised by low income families with limited access to other animal source proteins to improve the nutrition status of children below the age of five. The main objective of the study was to assess the effect of fish given during the complementary feeding on improved head circumference (HC) and Mid-upper circumference (MUAC) among infants aged 6 -7 months.

Methods

A randomised controlled trial was conducted from April 2019 to January 2020 in Samfya district, Luapula Province Zambia. Infants (238) were randomised to either the fish group (intervention) or the sorghum group (control). The infants were given fish powder and sorghum powder respectively for a period of 6 months and they were followed weekly for product distribution (Fish and sorghum powder) and to monitor compliance. Head circumference measurements were conducted at baseline and once each follow-up month for a period of six months while MUAC measurements were conducted twice (at baseline and endline).

Results

A Linear mixed effects model using STATA (version 16), showed that fish improved head circumference for age z score (HCZ) by 0.53 (95% CI: 0.23-0.82), p-value <0.001 and MUAC by 0.36 (95% CI: 0.13-0.59) p-value <0.002. Fish had an effect on HC and MUAC.

Conclusions

Therefore, fish can be used as a main protein for infants and young child feeding in low-income countries and regions with limited access to meat.

Background and Aims

Methods

Results

Conclusions

Background and Aims

Current crises like the COVID-19 pandemic and conflict exacerbate the double burden of childhood undernutrition and overweight/obesity linked to later-life NCDs that many countries face. However, the timing and nature of this link is not well understood. We take a lifecourse perspective to investigate whether later-life NCD-effects of the Chinese famine of 1959-1961 depend on: the life stage when people were exposed; severity of famine exposure; and gender differences.

Methods

We used data from China Health and Retirement Longitudinal Study (2011-2018, n=11,094). We measured famine exposure using self-reported experiences, we measured life stages using age at famine exposure, and we measured NCDs using multimorbidity. We performed Poisson growth curve models.

Results

First, compared with people unexposed to famine, people exposed before age 18 had higher risk of later-life multimorbidity, particularly if exposed in-utero (IRR = 1.90, 95% CI [1.70, 2.12], p < .001) and in the 1^st 1,000 days of life (IRR = 1.86, 95% CI [1.73, 2.00], p < .001; 0-6 months group: IRR = 1.95, 95% CI [1.67, 2.29], p < .001). Second, the famine effects did not differ between people moderately and severely exposed. Third, the famine effects did not differ between women and men.

Conclusions

In an individual`s life course, in-utero and the 1^st 1,000 days is a critical time window of development and growth with marked long-term NCD implications if famine/malnutrition are experienced at this time. However, this window remains open till young adulthood. This highlights the need to invest more in nutrition to tackle the challenges of later-life NCDs.

Background and Aims

Human milk oligosaccharides (HMOs) are known to drive gut microbiome development during early life. We assessed microbiome related secondary-endpoints in a randomized controlled trial of infants fed formulas containing a blend of five HMOs.

Methods

Formula-fed infants (7-21d at enrollment) were randomized to control (CG, n=154), standard cow’s milk-based infant formula [IF] until age 6 months (m), follow-up formula [FUF] until 12m, growing-up milk [GUM] until 15m or the same formula regimen supplemented with either lower (TG1, 1.5g/L, n=155) or higher (TG2, 2.5g/L, n=153) HMO concentration in IF, followed by identical FUF (0.5g/L) and GUM (0.4g/L) for both TG1 and TG2. Fecal samples (baseline, 3, 6, 12, 15m) were used for microbiome profiling. Microbiome-age predictor training using Genus, Species, or CAZyme composition was conducted with reference data from non-randomized vaginally delivered breastfed infants that were enrolled in parallel (HMG-VD, n=31). Models were applied to CG, TG1, and TG2 to predict microbiome-age and identify outliers (microbiome-for-age z-score: |MAZ|>3). Microbiome-age trajectories were compared for each group against the HMG-VD reference trajectory.

Results

Using Genus-based model (10 features, R²=0.862), TG trajectories converged on reference trajectory earlier than CG, i.e., significantly distinct until ~11.4 months (CG), ~9.4 months (TG1), ~9.6 months (TG2). Following intervention, outliers were significantly reduced in TGs compared to CG (overall trend test p=0.0002) and at visits (3-6m p=0.0002; 12-15m: p=0.0377). Trends on other data models were similar.

Conclusions

IF, FUF, and GUM supplemented with specific blend of five HMOs modifies the infant gut microbiome maturation trajectory towards that of breastfed, vaginally-delivered reference infants.

Background and Aims

The development of the infant’s microbiome during the first 1000 days of life is dependent on a range of factors. In this study, we planned to evaluate the presence of previously identified risk factors for dysbiosis in children with cow's milk allergy (CMA) and to compare with healthy children.

Methods

This study used a cross-sectional electronic survey with a national convenience sample of 270 children with CMA according to their caregivers and 2154 healthy controls in Turkey.

Results

Maternal body weight at conception (p<0.01) and at delivery (p<0.001), weight gain during pregnancy (p<0.01) were significantly higher in children with CMA. Antibiotic use at birth or during the first week of life were also higher in children with CMA (41.9% vs. 27.4%; p<0.01). There was no difference in maternal age, infants gender, delivery mode, breastfeeding during the first 24 hours of life, presence of pets at home. When we combined three risk factors (C-section delivery and antibiotic use during or first 7 days of life and no breastfeeding in first hour life), the presence of these risk factors are common in CMA group (74/270; 27.4%) comparing the healthy controls (412/2154; 19.1%) (p<0.001).

Conclusions

Maternal overweight and antibiotic use during early life, and combination of three risk factors (C-section delivery and antibiotic use during or first 7 days of life and no breastfeeding in first hour life) are associated with an increased risk of CMA, and are also known to be associated with gastro-intestinal microbiota composition.

Background and Aims

In early life, the gut microbiome and nutrition of an infant are highly dynamic and essential for (metabolic) health and the development/maturation of the immune system. We explored the relationship of infant diet to the composition and development of the gut microbiome from birth to 1 year of age in the Dutch birth cohort, Lifelines-NEXT.

Methods

We collected 2,962 stool samples and dietary information from 714 infants at 7 time points during the first year of life, and used multivariable generalized additive models, adjusted for technical covariates and energy intake.

Results

We found that formula feeding (FF) was positively associated with commensals of the oral cavity (e.g. Streptococcus parasanguinis) in the infant gut microbiome from 0.5-3 months of age (FDR<0.05; Figure 1), while breastfeeding (BF) was positively associated with both skin (e.g., Cutibacterium avidum; Figure 2) and oral bacteria (e.g. Haemophilus parainfluenzae; Figure 3).

Following the introduction of complementary/solid food, Streptococcus thermophilus, (commonly used in fermented dairy products), was positively associated with infant yoghurt/quark intake at 9 and 12 months of age (Figure 4).

Lastly, the consumption of at least 3 portions of fruit a week was positively associated with Veillonella dispar (Figure 5) at 6 months of age. This Veillonella species was found to be positively associated with higher insulin sensitivity and lower inflammation levels in adult gut microbiome dietary studies.

Conclusions

In conclusion, in a large longitudinal metagenomic study, we identified associations of feeding mode, yoghurt and fruit intake with the infant gut microbiome composition.

Background and Aims

Human milk oligosaccharides (HMOs) are important for healthy infant development. We assessed growth, safety, and gastrointestinal (GI) tolerance in infants fed formulas containing a blend of five HMOs (2’-fucosyllactose, 2',3-di-fucosyllactose, lacto-N-tetraose, 3’-sialyllactose, and 6’-sialyllactose).

Methods

In a multicenter study in Europe, formula-fed infants (FFI; 7-21d at enrollment) were randomized to control (CG, n=233, standard cow’s milk-based infant formula [IF] until age 6mo, follow-up formula [FUF] until 12mo, growing-up milk [GUM] until 15mo) or the same formula regimen supplemented with either lower (TG1, 1.5g/L, n=230) or higher (TG2, 2.5g/L, n=230) HMOs in IF, followed by identical FUF (0.5g/L) and GUM (0.4g/L) for both TG1 and TG2. Non-randomized breastfed infants (BF, n=96) were included as a reference group. Anthropometry, stooling pattern, GI tolerance, and adverse events (AEs) were assessed through 15mo.

Results

Mean anthropometric z-scores were similar among FFI and tracked closely with WHO standards through 15mo (largely within ±1.0 SD). Soft stooling pattern was observed in FFI with no differences in stool consistency between FFI and BF after 4mo. Parent-reported GI symptoms (spit-up/gassiness) and associated behaviors (crying/fussiness/sleep) were generally comparable between FFI and BF. A validated GI symptom index was <19 in FFI through 15mo and largely comparable with BF, indicating sustained good GI tolerance. Parent-reported and physician-confirmed AEs were similar among FFI.

Conclusions

IF, FUF and GUM with a specific blend of five HMOs support adequate growth and are safe and well-tolerated through age 15mo.

Background and Aims

Methods

Results

Conclusions