Responsive feeding may help prevent excess weight gain in infants: JAMA

The cohort study of 175 mother-infant dyads and 4630 feedings interrogated eating behaviour by feeding every hour on one day and ad-lib on another day for 6 hours. The researchers found an average statistically significant increase in infant intake (5.21 kcal/kg over 6 hours) when feeding was offered more frequently.

Previous studies have shown that the capacity for regulation of energy intake (REI) to match energy needs may contribute to differences in weight gain, and prevention of infant weight gain is a priority. Lyndsey A. F. Reynolds, University of Michigan, Ann Arbor, Michigan and colleagues, therefore, aimed to determine capacity for REI across infancy. They addressed the question of whether healthy full-term infants accurately downregulate intake per feeding when offered feedings more frequently.

For this purpose, the researchers recruited a convenience sample of mother-infant dyads from the Michigan community between 2015 and 2019. Healthy infants, full-term, with weight suitable for gestational age; biological mothers aged 18 years or above, English speaking; and a custodial and legal guardian and infant having had consumed 2 oz or more per feeding from an artificial nipple at least once per week were eligible for inclusion. Infants were followed in the home setting with staff support for up to 12 months.

The study included 175 infant-mother dyads with infants ages 1, 2.5, 5, 7, 10, and 12 months. In the intervention condition (494 pairs), mothers were fed every hour for six hours. Mothers fed infants as they typically would for 6 hours in the control condition (494 pairs). Kilocalories were calculated, and intake was recorded.

The difference in caloric intake per Kg of body weight between intervention and control conditions was taken as the capacity for regulation of REI, where 0 indicates a perfect REI.

The mean breastfeeding duration for those who reported stopping by 12 months was 17.83 weeks. As designed, the intervention condition included more feedings at shorter intervals than the control.

The study revealed the following findings:

• After collapsing the data across age points in a mixed model accounting for repeated measures within participants, the REI estimate at one month differed from 0.
• On average, infants ate 5.21 kcal/kg more in the frequent feeding intervention condition than in the ad-lib feeding control condition. This difference did not significantly change over 12 months of infancy (REI slope = −0.01 kcal/kg per month).

"The study's result suggests that increased feeding frequency may lead to excess energy intake, thereby offering evidence in favour of the hypothesis that infants have reduced regulation of energy intake," the researchers conclude.

Reference:

Reynolds LAF, McCaffery H, Appugliese D, et al. Capacity for Regulation of Energy Intake in Infancy. JAMA Pediatr. Published online April 17, 2023. doi:10.1001/jamapediatrics.2023.0688