Excerpt from Breastfeeding Answers Made Simple - A Guide for Helping Mothers

Excerpt from Breastfeeding Answers Made Simple – A Guide for Helping Mothers

 

By Nancy Mohrbacher, IBCLC, FILCA

 

Formula-fed babies gain significantly more weight than breastfed babies between 3 and 12 months of age and have more negative health outcomes.  The greater milk intake in formula-fed babies and the higher protein levels in formula (Koletzko et al., 2009) are two factors that contribute to formula-fed babies’ greater weight gain. But there are many others (Dewey, 2003):

Formula-fed babies may also be more likely to be fed by the clock rather than on cue, with less regard for their hunger and satiety. 

 

Milk intake. One reason babies fed non-human milks gain more weight between 3 and 12 months than breastfed babies is that they consume much more milk. On average, babies fed formula consume 15% more milk at 3 months, 23% more at 6 months, 20% more at 9 months, and 18% more at 12 months (Heinig, Nommsen, Peerson, Lonnerdal, & Dewey, 1993). But because breastfed babies leave milk in the breast after feedings, researchers concluded that limited milk availability is not the reason they take less milk (Dewey, Heinig, Nommsen, & Lonnerdal, 1991b). Researchers noted that breastfed babies continued to gain less weight even after solid foods were started, and if availability of food was the reason, they could have consumed more solids to make up for the difference, but they didn’t (Dewey, Heinig, Nommsen, & Lonnerdal, 1991a). 

 

Eating habits. Differences in milk flow between breast and bottle may be another reason bottle-fed babies consume more milk and gain more weight. Due to an inborn reflex, during the first 3 to 4 months of life, swallowing milk automatically triggers suckling (Wolf & Glass, 1992). When babies outgrow this reflex, feeding becomes a fully voluntary activity. Because milk flows more consistently from the bottle than the breast (which has a natural ebb and flow of milk due to milk ejections), babies tend to consume more milk from the bottle at a feeding. Before reflexive suckling is outgrown, babies fed by bottle are at greater risk of overfeeding, which can cause unhealthy feeding patterns that last a lifetime. One large, prospective randomized, controlled trial (16,755 babies in Belarus) compared volume of milk per feeding in formula-fed and breastfed babies (Kramer et al., 2004). At each feeding the formula-fed babies took 49% more milk at 1 month, 57% more at 3 months, and 71% more at 5 months. Mothers’ behaviors also influenced milk intake. Babies whose mothers encouraged them to finish the bottle were heavier than other babies. Babies also took more formula at feedings when their mothers offered bottles containing more than 6 ounces (177 mL).

 

Family behaviors and attitudes. Families who value health and fitness are more likely to breastfeed, but there is more to it. As described above, breastfeeding encourages healthy eating habits by giving the baby more control over how much milk he consumes. But the baby is not the only one who learns from this experience. As the breastfed baby grows and thrives, his mother learns to trust her baby to take the milk he needs, and this trust extends to solid foods at family meals. Whatever foods the baby eats, an important aspect of healthy parenting (and a lesson taught by breastfeeding) is responsive feeding, which means learning and respecting baby’s hunger and satiety cues (Pelto, Levitt, & Thairu, 2003). One U.K. study found that between 6 and 12 months of age breastfeeding mothers put less pressure on their babies to eat solid foods and were more sensitive to their baby’s cues, which were associated with less mealtime negativity at 1 year (Farrow & Blissett, 2006). U.S. research found that longer breastfeeding duration was associated with less restrictive child-feeding behaviors by parents at 1 year (Taveras et al., 2004).

 

Nutrient use and metabolic programming. Another reason for differences in milk intake may be the differences in how mother’s milk and formula are metabolized by the baby. Formula-fed babies appear to use the nutrients in formula less efficiently, so they may require more milk to meet their nutritional needs. For example, one U.S. study concluded that “formula-fed infants are almost twofold less efficient than breastfed infants in their utilization of dietary nitrogen…” (Motil, Sheng, Montandon, & Wong, 1997, p. 15). 

 

Formula has a different effect on a baby’s metabolism than mother’s milk. U.K. research has found that at 6 days of age formula-fed newborns had a more prolonged insulin response than breastfed babies, which U.S. research has found is associated with more fatty tissue, greater weight gain, and obesity (Lucas, Boyes, Bloom, & Aynsley-Green, 1981; Odeleye, de Courten, Pettitt, & Ravussin, 1997). Another preliminary U.S. study on babies 5 months old also found that those fed formula had elevated insulin levels (Dewey, Nommsen-Rivers, & Lonnerdal, 2004). This mechanism may also explain in part the association between formula-feeding and increased risk of Type 2 diabetes later in life (Young et al., 2002). Formula is also missing hormones, such as leptin and adiponectin, which help babies regulate appetite and energy metabolism (Li, Fein, & Grummer-Strawn, 2008). Higher leptin levels in mother’s milk have been associated with lower body mass index (BMI) in their babies at 3 to 4 weeks of age (Doneray, Orbak, & Yildiz, 2009).

 

Due in part to differences in calories consumed while asleep (sleeping metabolism), formula-fed babies need more calories from food than breastfed babies to function and grow: 7% more at 3 months and 9% more at 6 months (Butte et al., 2000). 

 

Another aspect of metabolic programming that may affect later weight gain was suggested by the U.S. researchers who monitored the weight gain and health outcomes of 653 people formula-fed during infancy for 2 to 3 decades (Stettler et al., 2005). These researchers found that greater weight gain during the first 8 days of life was associated with increased incidence of overweight 20 to 30 years later. They concluded that the first 8 days may be a “critical period” during which human physiology is programmed. This means that during this critical period breastfed babies’ greater weight loss after birth and slower return to birth weight may help activate a healthier metabolic program, which reduces the risk of overweight and obesity during childhood and beyond.

References

 

Butte, N. F., Wong, W. W., Hopkinson, J. M., Heinz, C. J., Mehta, N. R., & Smith, E. O. (2000). Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. American Journal of Clinical Nutrition, 72(6), 1558-1569.

Dewey, K. G. (2003). Is breastfeeding protective against child obesity? Journal of Human Lactation, 19(1), 9-18.

Dewey, K. G., Heinig, M. J., Nommsen, L. A., & Lonnerdal, B. (1991a). Adequacy of energy intake among breast-fed infants in the DARLING study: relationships to growth velocity, morbidity, and activity levels. Davis Area Research on Lactation, Infant Nutrition and Growth. Journal of Pediatrics, 119(4), 538-547.

Dewey, K. G., Heinig, M. J., Nommsen, L. A., & Lonnerdal, B. (1991b). Maternal versus infant factors related to breast milk intake and residual milk volume: the DARLING study. Pediatrics, 87(6), 829-837.

Dewey, K. G., Nommsen-Rivers, L. A., & Lonnerdal, B. (2004). Plasma insulin and insulin-releasing amino acid (IRAA) concentrations are higher in formula-fed than in breastfed infants at 5 mo. of age. [abstract]. Experimental Biology 2004.

Doneray, H., Orbak, Z., & Yildiz, L. (2009). The relationship between breast milk leptin and neonatal weight gain. Acta Paediatrica, 98(4), 643-647.

Farrow, C., & Blissett, J. (2006). Breast-feeding, maternal feeding practices and mealtime negativity at one year. Appetite, 46(1), 49-56.

Heinig, M. J., Nommsen, L. A., Peerson, J. M., Lonnerdal, B., & Dewey, K. G. (1993). Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING Study. American Journal of Clinical Nutrition, 58(2), 152-161.

Koletzko, B., von Kries, R., Closa, R., Escribano, J., Scaglioni, S., Giovannini, M., et al. (2009). Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. American Journal of Clinical Nutrition, 89(6), 1836-1845.

Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. (2004). Feeding effects on growth during infancy. Journal of Pediatrics, 145(5), 600-605.

Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2008). Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants' risk for excess weight at late infancy. Pediatrics, 122 Suppl 2, S77-84.

Lucas, A., Boyes, S., Bloom, S. R., & Aynsley-Green, A. (1981). Metabolic and endocrine responses to a milk feed in six-day-old term infants: differences between breast and cow's milk formula feeding. Acta Paediatrica Scandinavica, 70(2), 195-200.

Motil, K. J., Sheng, H. P., Montandon, C. M., & Wong, W. W. (1997). Human milk protein does not limit growth of breast-fed infants. Journal of Pediatric Gastroenterology and Nutrition, 24(1), 10-17.

Odeleye, O. E., de Courten, M., Pettitt, D. J., & Ravussin, E. (1997). Fasting hyperinsulinemia is a predictor of increased body weight gain and obesity in Pima Indian children. Diabetes, 46(8), 1341-1345.

Pelto, G. H., Levitt, E., & Thairu, L. (2003). Improving feeding practices: current patterns, common constraints, and the design of interventions. Food and Nutrition Bulletin, 24(1), 45-82.

Stettler, N., Stallings, V. A., Troxel, A. B., Zhao, J., Schinnar, R., Nelson, S. E., et al. (2005). Weight gain in the first week of life and overweight in adulthood: a cohort study of European American subjects fed infant formula. Circulation, 111(15), 1897-1903.

Taveras, E. M., Scanlon, K. S., Birch, L., Rifas-Shiman, S. L., Rich-Edwards, J. W., & Gillman, M. W. (2004). Association of Breastfeeding With Maternal Control of Infant Feeding at Age 1 Year. Pediatrics, 114(5), e577-583.

Wolf, L. S., & Glass, R. P. (1992). Feeding and Swallowing Disorders in Infancy. Tucson, AZ: Therapy Skill Builders.

Young, T. K., Martens, P. J., Taback, S. P., Sellers, E. A., Dean, H. J., Cheang, M., et al. (2002). Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among native canadians. Archives of Pediatrics and Adolescent Medicine, 156(7), 651-655.

 

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Nancy Mohrbacher, IBCLC, FILCA, is best known as the coauthor of The Breastfeeding Answer Book, a research-based counseling guide that has sold more than 130,000 copies worldwide. She is also coauthor of the best-selling guide for parents, Breastfeeding Made Simple.