Abstract
Background
Studies show that by 3 months, over half of US infants receive formula, and guidelines play a key role in formula feeding. The question then is, what might happen if caregivers follow guidelines and, more specifically, are there situations where following guidelines can result in infants who are overweight/have obesity?
Methods
We used our “Virtual Infant” agent-based model representing infant–caregiver pairs that allowed caregivers to feed infants each day according to guidelines put forth by Johns Hopkins Medicine (JHM), Children’s Hospital of Philadelphia (CHOP), Children’s Hospital of the King’s Daughters (CHKD), and Women, Infants, and Children (WIC). The model simulated the resulting development of the infants from birth to 6 months. The two sets of guidelines vary in their recommendations, and do not provide studies that support amounts at given ages.
Results
Simulations identified several scenarios where caregivers followed JHM/CHOP/CHKD and WIC guidelines, but infants still became overweight/with obesity by 6 months. For JHM/CHOP/CHKD guidelines, this occurred even when caregivers adjusted feeding based on infant’s weight. For WIC guidelines, when caregivers adjusted formula amounts, infants maintained healthy weight.
Conclusions
WIC guidelines may be a good starting point for caregivers who adjust as their infant grows, but the minimum amounts for JHM/CHKD/CHOP recommendations may be too high.
IMPACT
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Our virtual infant simulation study answers the question: can caregivers follow current formula-feeding guidelines and still end up with an infant who is overweight or has obesity?
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Our study identified several situations in which unhealthy weight gain and/or weight loss could result from following established formula-feeding recommendations.
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Our study also suggests that the minimum recommended amount of daily formula feeding should be lower for JHM/CHOP/CHKD guidelines to give caregivers more flexibility in adjusting daily feeding levels in response to infant weight.
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WIC guidelines may be a good starting point for caregivers who adjust as their infant grows.
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In order to understand how to adjust guidelines, we can use computational simulation models, which serve as “virtual laboratories” to help overcome the logistical and ethical issues of clinical trials.
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Acknowledgements
Research reported in this publication was supported by the Global Obesity Prevention Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725. It was also supported by NICHD via Grants U01HD086861 and 5R01HD086013, and the Agency for Healthcare Research and Quality (AHRQ) via Grant R01HS023317. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or AHRQ.
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Conceived and designed the experiments: M.C.F., K.J.O., B.Y.L., R.M.S., S.N., and A.A. Parameterized the experiments: M.C.F., K.J.O., R.M.S., and S.N. Programed the model and experiments: D.L.H., M.S.G., and M.D. Performed the experiments: R.M.S., D.H.L., K.J.O., S.N., and A.A. Analyzed the data: K.J.O., M.C.F., L.D.H., R.M.S., S.N., S.S., S.R., P.W., A.A., and B.Y.L. Wrote the paper: M.C.F., K.J.O., B.Y.L., L.D.H., R.M.S., S.N., S.S., S.R., P.W., and A.A. Helped guide input data collection: B.Y.L., M.C.F., S.S., and A.A. Helped guide technical methodology: B.Y.L., M.C.F., D.L.H., and A.A.
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Ferguson, M.C., O’Shea, K.J., Hammer, L.D. et al. Can following formula-feeding recommendations still result in infants who are overweight or have obesity?. Pediatr Res 88, 661–667 (2020). https://doi.org/10.1038/s41390-020-0844-3
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DOI: https://doi.org/10.1038/s41390-020-0844-3
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