Increased frequency of feeding offerings in infants associated with increased energy intake

by Neerav Mullur, Alex Gipsman, MD

Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a prospective cohort study of 175 infants between 1 and 12 months of age, more frequent food offerings within a 6-hour period was associated with an increase in frequency and a reduction in duration of feedings.

2. Data collapsed across age points showed a significant difference in energy intake per kilogram of body weight between intervention and control conditions, but the difference was not significant when tested for each separate age point.

Evidence Rating Level: 2 (Good)

Study Rundown:

The capacity of infants to regulate their energy intake is not fully understood but is known to be important in minimizing excess weight gain in infants. This prospective cohort study sought to examine the impact of more frequent, shorter feedings on energy intake in infants. 175 infant-mother dyads were included in the study. Infants ranged from 1, 2.5, 5, 7, 10, or 12 months of age. Mothers were instructed to feed their infants normally within a 6-hour window, and then on a separate day within the same week, to offer their infants a feed every hour within a 6-hour window. Increased feed offerings was associated with an increased frequency of actual feeding and shortened duration of feeds. The capacity for regulation of energy intake (REI) was calculated as the difference in caloric intake per kilogram of body weight between intervention and control conditions, where 0 represents a perfect REI. The estimated REI after collapsing data across age points was 5.21 kcal/kg, indicating an imperfect estimated REI. REI did not differ significantly between conditions when test results were computed for each age point separately. The results of the study indicate that increased frequency of feeding offering in infants may contribute to excess energy intake, thereby offering evidence in favor of the hypothesis that infants have reduced regulation of energy intake. One limitation of this study is that in asking mothers to change their normal feeding times as part of the intervention condition, behaviors may have been altered despite mothers being blinded to the study hypothesis. Further studies exploring the effects of increased caloric intake in infants would help assess whether the observed increases in energy intake are associated with clinically significant weight gain in infants.

In-Depth [prospective cohort]:

175 mother-infant dyads were included in the study, with 4630 feedings taking place in 494 pairs of intervention and control conditions. The study aimed to examine the relative ability of infants of age 1, 2.5, 5, 7, 10, and 12 months to regulate energy intake. This was assessed through comparing energy intake within a 6-hour window in a control condition consistent with normal feeding, and an intervention condition where feeding was offered more frequently than normal, every hour within the 6-hour window. The difference between energy intake per kilogram of body weight in intervention and control conditions was used as a measure of REI. The difference in caloric intake (kcal/kg) between the intervention and control condition including breast milk, formula, and solid foods, was calculated as 7.38 (95% CI -0.05-14.81) in 1-month infants, 3.77 (95% CI -0.32-7.86) in 2.5-month infants, 3.11 (95% CI -0.98-7.20) in 5-month infants, 3.27 (95% CI -0.91-7.45) in 7-month infants, 5.18 (95% CI -1.03-11.39) in 10-month infants, and 1.97 (95% CI -6.75-10.69) in 12-month infants. Upon collapsing data across age points, a significant difference in caloric intake between intervention and control conditions was 5.21 kcal/kg (95% CI 2.89-7.54).

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