Cross-sectional study of nutritive profile and association with feeding practices in infants at 6 to 7 months of age

INTRODUCTION

Optimal nutrition in the first few months of life is critical for long-term growth and development. Health organisations throughout the globe, such as the World Health Organization (WHO), American Academy of Pediatrics (AAP), Indian Academy of Pediatrics (IAP), Infant and Young Child Feeding (IYCF), all recommend EBF for the first 6 months of life, followed by the introduction of complementary feeding while continuing breastfeeding till 2 years of age.^[1] Despite these recommendations for 6 months of EBF, global trends show an increase in formula feeding and early initiation of complementary foods.

Infant feeding practices vary across the globe and have been rapidly changing owing to various social, economic and cultural changes. Some factors influencing infant feeding trends include maternal education, employment status and maternity leave duration for working mothers, conveniency for mother, familial supportive environment and access to health care. Sometimes, poor comprehension of EBF guidelines or conflicts with traditional beliefs and cultural practices lead to early interruption of EBF.^[2] At times, inadequate communication and understanding about the adequacy and sufficiency of EBF may be the impediments.^[3] Many baby formula feeds are being commercially marketed as ‘enriched and fortified’ with nutritional supplements. While fortification of pre-term formula feeds has been shown to be beneficial, there are limited studies in this regard for term infants. Despite the strong endorsement for breastfeeding, there has been an increased tendency to formula feed babies even in low and middle-income countries, where it adds to the financial burden of the household. Studies in many Western countries reveal that breastfeeding is no longer the major mode of feeding and most infants are started on some formula feeding before 2 months of age.^[2] The Problem: In India, while EBF rates rose to 43% by 2019 National Family Health Survey-5 (NFHS-5), over 50% of the infant population still does not receive EBF for the full 6 months.^[4,5] Although there has been a rise in the percentage of EBF babies, >50% of Indian infant population is still not exclusively breastfed. In a large survey carried out in the United States, while breastfeeding initiation rates were as high as 80%, the percentage of mothers who were receiving some breastfeeding at 6 and 12 months was only 27.0% and 12.3%, respectively, while EBF was only 7.9% at 6 months.^[2] In another follow-up study in the U.S. in 2017, during the 1^st month of life, while 53% mothers attempted to breastfeed, the largest category by the end of 1^st month is of formula-fed babies (32.9%), followed bydirect breast feeding (DBF) (23.8%), followed by mixed feeding. Mothers who used formula feed were found to be less educated and were employed fulltime.^[6,7]

Exclusive breastfed children have a lower incidence of otitis media, Upper Respiratory Tract Infections (URTI), Lower Respiratory Tract Infections (LRTI), asthma, Respiratory Syncitial Virus (RSV) bronchiolitis, Necrotizing EnteroColitis (NEC), atopic dermatitis, inflammatory bowel disease, obesity, celiac disease , Sudden Infant Death Syndrome (SIDS) and malignancies like leukaemia and better neurodevelopmental outcome compared to commercial formula-fed children. Better neurodevelopmental outcome was also found in infants, including pre-terms who were exclusively breastfed.^[8,9] The window of vulnerability: The 6–7-month period is a vital transition from milk to solids, yet there is a lack of data on how varied feeding practices during this time correlate specifically with physical growth parameters and micronutrient deficiencies in healthy term infants.

MATERIAL AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Among healthy term infants aged 6–7 months, different feeding practices resulted in comparable physical growth and biochemical calcium/iron status.

The findings support the existing WHO recommendations by demonstrating that infants can maintain a normal nutritional profile at the start of the complementary feeding window, though further long-term follow-up is necessary to track health trajectories into childhood.