BODY SIZE AS A DETERMINANT OF INFANT ADIPOSITY: RESULTS

14 Dec
2009

RESULTS

In spite of the effort exerted to minimize loss to follow-up, complete data were available for 54 mother-infant dyads at the end of the study. Of all those lost to follow-up, over 90% had their phones cut off, had moved from their original place of residence, or had changed their clinic membership. For the remaining 10%, some stated that they were not coming back to the clinic for personal reasons but would supply no other definitive reason for their refusal to come to the clinic. For this study, the greatest attrition occurred between the fourth- and sixth-month well-child visits. It is generally noted by researchers working in inner cities that certain characteristics inherent to inner city populations make attrition an ongoing challenge of research in this area. Thus, the high attrition observed in this study was determined to not be unusual.


Table 1. Means of Maternal Perception of Infant Body Size by Category

Perception Categories

Mean ± SD

Preferred body size2.9±0.83
Healthy body size2.9±0.78
Typical body size3.2±1.18
Current body size3.2±0.97

The mean age of the mothers at the end of the study was 25.3±0.6 years. The mean weight was 73.7±2.6 kg and the mean BMI was 28.Ш.0 kg/m2. The majority of the participants were single (81%), and 94.7% were WIC participants. The mean number of children was 2.5±0.2; 38% of the women were first time mothers, and almost all the women (96%) had sought prenatal care during pregnancy. Thirty-three percent of the mothers had BMI >30, and 31.1% had a BMI between 25-30. Over 50% of the mothers in this sample were overweight using the IOM weight standards of 1990 which were in operation during the conduct of this study. These values were used and are still being used in this report, because they have been validated for use in pregnancy. When the data is subjected to recent BMI standards where overweight is defined as BMI >25.0, then over 66% of the women in the study are overweight.

Table 2. Indices of Healthiness, Satisfaction, and Adequacy

Current SizeCurrent SizeCurrent Size

Total in

Larger Than (a,b,c)Same as (a,b,c)Smaller (a,b,c)

Percents

Healthiness

35.2°

40.1°

24.7°

100.0

Satisfaction

20.4b

48. lb

31.5b

100.0

Adequacy

43.0C

7.0C

50.0C

100.0
a = healthy size; b = preferred size; с = typical size

At the first meeting each mother was asked to verbally rate her infant according to whether she perceived him/her to be small, average, or large at birth. Twenty-one percent of the mothers rated their infants as small at birth, 56.2% as average and 22.9% as large. The numbers of males and females in each of the three rated groups were not significantly different. To assess the relationship between actual birthweight and maternal verbal rating of size at birth, spearman correlation was performed and resulted in a correlation coefficient of 0.58 and a p value of 0.0001. This means that overall mothers’ verbal size ratings of their infants’ correlated positively with the infants’ actual birth size category, and this observation was not due to chance. eriacta tablets

Table 3. Maternal Infant Feeding Attitude Questionnaire

Early Infant Feeding                                                    Percent With Knowledge Deficit

Babies should be breastfed from the first day of birth.                              35.3 Babies need formula because breast milk does not

have all the ingredients they need for growth.                                       19.7 The first milk from the breast (colostrum) is good for the baby.                   26.5 It is important to start the baby on the bottle early

or else the baby might refuse it later.                                                  48.0

Infant Satiety

If a baby starts to cry after he has been fed, it ALWAYS
means the baby is not full.

8.9

If a baby cries after feeding, it does not mean the baby is hungry.

14.5

Infant Health and Fatness

Fatness is always the best way to tell how healthy a baby is.

20.6

Usually, thin babies are unhealthy babies.

14.8

Fat babies are always healthier than thin babies.

9.8

Infants who are given foods other than milk before
they are two months old are always healthier than
infants who receive other foods later.

17.6

Scheduling & Supplemental Feeding

Babies need to be introduced to other foods before four
months of age so that they can learn to accept new foods.

31.3

Foods, like mashed vegetables, cereal, and ground meats, should
not be given to an infant before four months of age because it
may make the baby sick.

20.6

Eggs and ground meats should be given to
infants as soon as possible; that is, before they are
four months old because it makes them healthy.

7.8

Foods that are good to give a baby before four months are
mashed potatoes, mashed vegetables, and applesauce.

38.3

Among the four body size perceptions assessed with the AAIBH Scale, the largest means observed was for Current and typical body sizes which were both 3.2. The smallest means were for preferred and healthy body sizes which were both 2.9 (Table 1). Significant mean group difference was found comparing typical body size and preferred body size, p=0.03, and marginal significance was found between typical and healthy body sizes, p=0.06. Overall, there were no significant gender differences in mean body sizes selected. buy antibiotics canada

Table 4. Maternal Infant Feeding Practices

Food Control BehaviorThere ore two moin woys people think infonts should be fed. Some people feed their infants only when they look hungry, and others feed their infants ony time they think the boby needs it. Which of these do you do?
Feed my baby when she/he is hungry using certain signs(please give cues used to determine hunger)                                               77.5
Feed my baby whenever 1 think the baby needs il^-that is, based on a schedule                                                                    21.5
Do something in between                                                                          1.0
Some women think thot a baby’s usual feeding time should not be delayed and will wake up their baby to feed it if it is past its feeding time. Which of these do you usually do?
Allow the baby sleep and not pay attention to the time                                   76.5
Wake the baby up to feed him/her                                                             22.5
Do something in between                                                                          1.0
Many times bottle-fed babies do not finish their bottles. If your baby does not finish the bottle do you usually…?
Allow the baby to refuse the bottle                                                            46.1
Encourage the baby to finish the bottle later                                                 49.0
Do something in between                                                                          4.9
Behavior ManagementWhen your baby cries, if you check and it is not wet or hurting, do you usually…?
Feed my baby to comfort it                                                                    31.3
Comfort my baby some other way                                                             66.7
Do something in between                                                                          2.0
Suppose half an hour after feeding your baby, you notice it is fussy and unhappy. Would you usually…?
Try to feed my baby to comfort him/her                                                       22.5
Avoid feeding my baby so as not to mess up the baby’s schedule                       13.7
Do something in between                                                                        63.8
Peer and Relatives’ PressureMany times, friends or relatives who mean well may tell a mother that her baby is not gaining enough weight. If you were told this by a friend of family member, what do you think you would do?
Encourage my baby to eat more                                                               15.7
Continue with my usual feeding routine                                                        72.5
Do something in between (be specific)                                                        11.8

After examining the means of the different body sizes the question was asked, “Does the current body size value reflect what mothers selected as their preferred body size or does it conform to the typical Infant body size selected by mothers”? Secondly, were any of the means significantly different from each other? It was found that the mean Current body size was not significantly different from the mean typical infant body size, suggesting that mothers’ selections of their infants’ current body Size did not differ from that of the perceived typical size. However, there was a significant difference between preferred body size and typical body size, p=0.03.
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To further explore the difference in means noted for each body size, indices were developed to assess maternal satisfaction with infant body size, maternal-perceived infant healthiness, and infant adequacy in reaching the body size norm of the community. The Satisfaction Index measured how satisfied mothers were with their infants’ actual size by six months of age, and this was objectively measured by subtracting the numeric value of current body size from that of preferred body size. The Adequacy Index measured how adequately the mother’s perceived infant current body size reflected her perceived size for a typical infant aged six months and was calculated by subtracting typical body size from current body size. The Healthiness Index was calculated by subtracting the value of current body Size from healthy body size and it measured the difference between the infant’s current body size and the mother’s perceived healthy size for that infant. The results of the calculations of these indices and their outcomes are presented in Table 2.

The most important finding in this table is that over 50% of the infants did not attain the preferred size that their mothers had selected. This means they were perceived to be either larger than or smaller than what their mothers preferred. Specifically, one-fifth of the infants were perceived to be larger than their maternal preferred size. Similarly, over 35% of the infants were perceived by their mothers to be larger than their perceived healthy size for infants of their ages. Noteworthy is that according to maternal selection, 43% of the children exceeded the perceived typical size of infants in the neighborhood, which means that these children seemed to their mothers to be larger than the typical infant in the neighborhood. kamagra oral jelly 100mg

Maternal infant feeding beliefs and how they compared to the current feeding recommendations were assessed with the MIFPQ and MIFAQ questionnaires mentioned earlier. Listed in Tables 3 and 4 are the questions and the responses collected from the mothers. In the MIFPQ, the results reflect the percentage of women who selected the wrong answer for the questions asked in the four categories. This is denoted as “knowledge deficit” in the second column.

A striking finding in this sample of women was that over one-third believed that babies should not be breast fed from the first day of birth and just over a quarter thought colostrum was not beneficial to babies. Additionally, almost a third of the women believed babies needed to be introduced to other foods before four months of age so that they could learn to accept new foods. Most significant was the finding that 48% of mothers believed that it was important to start their babies on the bottle early or else the baby might refuse it later. Summarizing the findings of the questionnaire, it was concluded that knowledge deficits regarding appropriate infant feeding range from 7.8% to a high of 48.0% in this study and was an area requiring intervention.

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