Infant feeding practice influences childhood growth and blood pressure

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Nutritional Health Inequalities in children Do
they matter?
Professor Stewart Forsyth
Ninewells Hospital and Medical SchoolDundee,
Scotland
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Health Inequalities

• Birth, Poverty and Wealth. Titmus R 1943
• National newspapers
• Poor folks babies stand less chance
• Babies beware of poor parents

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Cardiovascular Health and Social Class -Trends
from Childhood to Adulthood
EE/Kg
Social Class
(Poulton, 2002)
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Cardiovascular Health and Social Class - Trends
from Childhood to Adulthood
EE/Kg
Social Class
(Poulton, 2002)
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Association between childrens experience of
socio-economic disadvantage and adult health

• Children who grow up in socially deprived
  families have poorer cardiovascular health in
  adulthood
• Upward mobility does not mitigate or reverse the
  adverse effects of childhood socio-economic
  deprivation on adult health
• Poulton (2002)

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Possible mechanisms

• Is it a consequence of social class related
  differences in parenting practices
• Infant Feeding Practice

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Breastfeeding at 6-8 weeks by Council Area - 2006
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DUNDEE INFANT FEEDING STUDY
A prospective observational study1984 - present
BMJ 1990 1993 1998
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Duration of Breast Feeding by Social Class
Weeks
Social Class of Father
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Gastrointestinal Illness (GI) in First Year of
Life by Social Class
No of GI Illnesses per Infant
Social Class of Father
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Gastrointestinal Illness by Type of Milk Feed
No of GI Illnesses per infant
Type of Milk Feed
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Research Questions

• To what extent does infant feeding practice
  directly influence childhood health indicators
  across the social spectrum?
• Is breast feeding associated with a reduction in
  health inequalities during childhood?

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Characteristics of Social Class Groups
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Childhood Health Indicators

• Birth 12 Months
• Gastrointestinal illness
• Ear infections
• Respiratory illness
• Age 7 Years
• Blood pressure
• Body composition

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Effect of Breast Feeding on GI Illness by Social
Class
GI Illnesses per Infant
Type of Milk Feed
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Ear Infections in First Year of Life by Social
Class
No of Ear Infections per Infant
Social Class of Father
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Effect of Breast Feeding on Ear Infections by
Social Class
Ear infections per Infant
Type of Milk Feed
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Respiratory Illnesses (RI) in First Year of Life
by Social Class
No of RI Illnesses per Infant
Social Class of Father
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Effect of Breast Feeding on Respiratory
Infections by Social Class
Respiratory infections per Infant
Type of Milk Feed
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Birth 12 months

• Across each of the social class categories,
  breast feeding significantly reduces
  gastrointestinal, ear and respiratory illness
• Breast fed children from lower socioeconomic
  groups had better outcomes than formula fed
  children from more affluent families

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Effect of Breast Feeding on Blood Pressure at
age 7 yrs by Social Class
Type of Milk Feed
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Effect of Breast Feeding on Blood Pressure at
age 7 yrs by Social Class
Diastolic BP
Type of Milk Feed
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Percentage body fat - Skinfolds
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Introduction of Solid Feeding by Social Class
Weeks
Social Class of Father
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Relation of Solid Feeding to Body Fat at 7 Years
and Social Class
Body Fat
Timing of Introduction of Solid Foods
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Patterns of body fat during childhood
Modified from Rolland-Cachera et al, 1984
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At Age 7 Years

• Breast feeding is associated with lower blood
  pressure across the social categories
• Delayed solid feeding is associated with lower
  body fat across the social categories.

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Daily intake of long chain n-3 fatty acids and
LBW, prematurity and IUGR
Quantile LBW Preterm IUGR
0 7.1 7.1 8.2 1 3.1 4.1 8.8 2 3.2 3.8 7.2 3 1.
8 2.4 5.1 4 2.5 3.5 6.4 5 2.1 2.9 5.3 p lt0.001
0.01 0.001
Olsen and Secher, 2002 Indices
Percentages
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n - 3 fatty acid content and relative DHA
concentration of common marine foods
n-3 content DHA concentration (g/kg wet
weight) ( fatty acid) Mackerel 40
11 Herring 20 4.3 Sardines 20
10 Salmon 12 11 Cod liver 100
9.5
(Olsen et al 1995 Kinsella et al 1990)
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Maternal DHA, Oily Fish Intake and Social Class
(12-14 weeks gestation)
DHA
Social Class
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Postpartum Depression - Seafood Consumption
Predicts Lower Prevalence Rates
South Africa (24.5)
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Brazil (24.1)
r - 0.81 p lt0.0005
22.5
Germany (20.0)
U. Arab Emirates (18.0)
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Australia (18.6)
New Zealand (17.4)
17.5
Italy (15.0)
15
Netherlands (14.0)
UK (14.4)
Postpartum depression (EPSD) point prevalence ()
Spain (13.6)
Canada (12.7)
Israel (12.4)
12.5
Ireland (11.0)
France (11.0)
USA (11.5)
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Switzerland (10.2)
Sweden (9.0)
7.5
Hong Kong (5.5)
Chile (5.5)
5
Malaysia (3.0)
2.5
Japan (2.0)
Singapore (0.5)
0
0
20
40
60
80
100
120
140
160
Apparent Seafood Consumption( lbs/person/year)
Hibbeln JR, unpublished, 4/2000
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Prevalence of Children with Low Verbal IQ at age
8 years and Mothers Omega-3 Fatty Acid from
Seafood
Hibbeln et al, Lancet 2007
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Blood pressure (SD) of 6 year old children
randomised to a formula in infancy with or
without LCPUFA supplement n Systolic Diastoli
c LCPUFA 65 92.4 57.3 (8.0)
(8.3) No LCPUFA 70 94.8 61.0
(9.7) (9.0) Indices mmHg
plt0.01
Forsyth et al, BMJ 2003
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Blood pressure (SD) of 6 year old children who
were breast fed in infancy or randomised to
formula with or without LCPUFA supplement n S
ystolic Diastolic Breast 79 92.5
57.9 (9.8) (8.1) LCPUFA 65 92.4
57.3 (8.0) (8.3) No LCPUFA 70
94.8 62.0 (9.7) (9.0) Indices
mmHg
Forsyth et al, BMJ 2003
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Nutrition-Related Health InequalitiesWindows of
Opportunity
0 -9 MONTHS
PRENATAL
0 9 MONTHS
POSTNATAL
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Inequalities in Health

• We have concluded that early childhood is the
  period of life at which intervention could most
  hopefully weaken the continuing association
  between health and class.
• The Black Report 1980