Wednesday, July 20, 2011

Excessive bottle feeding can lead to childhood obesity

Children who still drink from bottles at age two are at risk of becoming obese by age five, a new study shows. The American Academy of Pediatric Dentistry recommends weaning children from bottles at 12 to 14 months. Prolonged bottle use, particularly at bed time, can cause tooth decay and bacterial infections like caries. However, 22 percent of 6,750 children involved in a large national US study were still drinking primarily from a bottle or were put to bed with a bottle at 24 months of age. Almost 23 percent of these children were obese (in the 95th percentile for body mass index [BMI]) by age 5.5 years, compared with 16 percent of children who had been weaned from bottles earlier. [J Pediatr. 2011 Apr 27. Epub ahead of print] “Drinking from a bottle beyond infancy is a behavior that could contribute to obesity by encouraging the child to consume excess calories,” commented the study authors, led by Rachel Gooze, a doctoral candidate in public health at Temple University’s Center for Obesity Research and Education in Philadelphia, US. For example, they noted that an average weight (about 12 kg) 2-year-old girl put to bed with an 8-ounce bottle of whole milk gets 12 percent of her daily caloric needs from the bottle. Weight gain would depend on how much excess these calories represent. In general, children should begin eating a variety of solid foods at about 6 months in addition to about 16 ounces of milk and no more than about 4 ounces of juice, plus more water. Prolonged bottle use is often a comfort issue for children and parents. Smaller, cross-sectional studies have suggested an association between prolonged bottle use, particularly at bed time, and weight gain but this is the first prospective study of size to do so. This latest study was limited by confounders such as physical activity and diet, where over-fed children may have had a higher caloric intake of nutrition-poor foods like sugary drinks as well as being less likely to have breastfed. The researchers did control for confounders including socioeconomic status, maternal obesity, breast feeding, age at introduction of solid foods and weight at birth and at 9 months. Under-reporting by parents of prolonged bottle use among heavier children may also have falsely decreased the association with obesity. It is unclear whether the association holds beyond 5.5 years. “A multilevel obesity prevention strategy is considered optimal because it alters children’s social and physical environments in multiple settings, such as the home, child care, school, and neighborhood,” the researchers said, and noted that discontinuing bottle use after one year will not be harmful and may help prevent obesity.

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