BODY SIZE AS A DETERMINANT OF INFANT ADIPOSITY: RESULTS part 2

15 Dec
2009

To capture actual maternal practice, the MIFPQ was administered, and the corresponding percent­ages of women answering each question are listed in Table 4. The purpose of this questionnaire was to capture actual practices to support findings in the interview schedule and the MIFAQ. Therefore, there were no right or wrong answers.


Table 5. Nonmilk Food Introduction Based on Body Size Perception at Birth

Maternal VerbalPerception of Infant Size at BirthNonmilk Foods Introduced Before Two MonthsNonmilk Foods Introduced After Two MonthsTotal Number/ Percent

Small baby

8/57

6/43

14/100%

Average baby

16/50

16/50

32/100%

Large baby

4/50

4/50

8/100%

The questions in the MIFPQ focused on three major areas of infant feeding practices that have been identified as having an impact on infant adiposity: Food control behaviors, infant behavior management, and peer pressure. With regard to food control behaviors, there was high consistency between women’s response in all areas that measured food control. Approximately three-quarters of the respondents reported that they fed their babies whenever they perceived the infant to be hungry and, therefore, did not rely on fixed feeding sched ules. Analysis of responses to the semistructured interview schedule which was used to supplement the questionnaires revealed that some of the cues that women used to determine infant hunger, infant satiety and feeding times were: 1) infant crying, 2) infant awakeness or length of sleep, 3) sucking on fingers or lips, and 4) fussiness. The most important cue reported was the infant’s ability to sleep for long periods of time, which mothers stated was a reflection of satiety. This cue correlated highly with the reported practice of not waking the infant for feeding as assessed in question 2. In both questions 1 and 2, over 76% of the participants reported that they utilized infant cues and did not wake up their infants for feeding. Consequently, the percentage of women who reported a low reliance on the aforementioned cues to determine when to feed their infants corresponded almost exactly with the percentage of women who indicated that they did not wake their infants to feed them. Question 3 evaluated the potential for force-feeding, and based on the responses, it seems that 49% of the women exhibited a potential to force-feed their babies by insisting through their actions that their babies finish their bottles.  canadian pharmacy viagra

Table 6. Infant Weight for Height (Quetelet) Indices Using NCHS Standards

NCHS Standards

Percentages

Weight for height greater than 95th percentile

31.5

Weight for height greater than 85th percentile

9.3

Weight for height less than 85th percentile

59.2

Weight for height less than or equal to 50th percentile

42.6

Weight for height less than fifth percentile

3.0

Regarding the influence of peers and relatives on infant feeding decisions as measured by question 6, 72.5% of the women responded that they would not change their feeding practices based on comments from others. However, when this question was probed further in the semistructured interview session, the majority of mothers said that if a comment was made about their child’s growth, they would consult the child’s physician for advice since “my friends and relatives do not know that much about babies anyway.” Surprisingly, with the exception of the nurse practitioner, none of the subjects indicated that she would consult the nurse or the WIC dietitian on site for advice on the growth of the infant, even though the majority of contact was with these professionals.
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The Food Frequency Questionnaire, which was administered at well-baby visits as well as through monthly telephone checks, revealed that cereal was the most frequent solid food introduced into the infant’s diet. The reason given for this was that mothers believed that cereal promoted satiety and increased infant sleep time. This observation supports the earlier finding that over 76% of the women thought letting their baby sleep was more important than waking them to feed them. Another reason for the early introduction of cereal was that many mothers lamented that often they were not the first to give their infants cereal. Even when they desired to follow the recommendations of their healthcare providers, they felt thwarted because whenever they left their babies in the care of grandmothers and other older relatives, they returned to find that the children had been given cereal in the bottle to prevent them from crying and make them sleep.

Table 7. Correlation of Infant Quetelet Indices and Time of Nonmilk Food Introduction

Variable

Correlation Coefficient

P Value

BMI and noncereal solids-0.590.001
BMI and nonmilk liquids-0.590.02
BMI and cereal-0.170.20
BMI and all foods before four months-0.340.02

Overall, 75.9% of the infants received nonmilk foods before four months of age and Table 5 shows the percentage of infants who received it before two months of age. This table was generated using maternal perception of their infants’ size at birth as the analysis groups because we wanted to answer the question of whether maternal perception of size at birth had any influence on when infants were fed nonmilk foods. It was observed that women who perceived their infants as small introduced nonmilk foods earlier than women who perceived their infants as average. One-way ANOVA analysis revealed that the mean time of the introduction of nonmilk foods was significantly different between mothers who perceived their infants as small and those who perceived their infants as average, p=0.03. The Body Parts Ranking Scale (BPRS), defined earlier, was used to assess maternal perception of infant fatness. Its purpose was to assess which parts of the body mothers rated as most important in determining if an infant was fat. It included six cards which mothers ranked in importance from most important to least important, from first place (#1) to last place (#6). Aggregates of the rankings showed that the body part perceived to be most important in determining fatness was the face, and the least important was the buttocks. Probing on the importance of the face in assessing fatness, it was determined that some mothers perceived that fatness in the face was indicative of overall infant health. Some of their comments to that regard were “the baby’s healthiness is all in the face”; “if the face ain’t healthy, the body ain’t going to be healthy.”

Infant length and weight measurements were converted to BMI or Quetelet indices and presented in Table 6. The most striking finding was that over 31% of the infants had BMI measures greater than the 95th percentile of the NCHS growth standards and were, therefore, overweight in this sample. In total, over 40% of the infants were over the 85th percentile.

To assess whether there was any relationship between early introduction of foods and infant adiposity outcomes, BMI was correlated with other variables, and the results are shown in Table 7. Negative correlations were observed for all pairs except BMI and cereal. In comparing the correlation statistic for each of the pairs, the data suggested that the earlier the introduction of nonmilk liquids and solids, the larger the infant’s BMI by the age of six- to seven months. suhagra 100

Maternal weight and height data, which were collected at the last visit to allow for postpregnancy weight stabilization, were used in calculating maternal BMI. It was observed that 64% of the women had a BMI over 25, and 33% had a BMI over 30 by the time their infants were six months old. As previously reported in Table 6, 17 of the 54 infants were above the 95th percentile, according to the NCHS standards. Of the 17 infants, nine had mothers who were overweight or obese, and eight had mothers of normal BMI. Cross-tabulating maternal BMI, infant BMI, and maternal perception of infant current body size showed that 66.6% of the overweight women whose infants were above the 95th percentile selected the slim images on the AAIBH scale to represent the current body size of their babies. This was compared to 37.5% of normal BMI women who also were parents of obese infants and selected the slim images on the AAIBH scale to represent the current body size of their baby. Noting that some studies have found a relationship between parental obesity and preference for larger children, we assessed the relationship between maternal final BMI and maternal perception of current infant body size at six months of infant age. Spearman correlation was conducted. The Spearman correlation statistic was 0.36 with a p value of 0.008. This means that there was a significant positive but mild correlation between maternal final BMI and the mother’s perceived current infant body size.

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