2.8 Procedimiento y Procesamiento de la Investigación
4.2.1 Macro ambiente
The aim of this dissertation was to assess whether and how infant-caregiver feeding interactions—as measured by the eating behaviors that are exhibited by infants and interpreted by caregivers—influenced infant feeding, growth, and metabolic development. Although BEBQ and CEBQ measures may be significantly associated with observational measures (Rogers et al. 2018), including dietary measures of complementary feeding and observational measures such as the Responsiveness to Child Feeding Cues Scale (Hodges et al. 2013) will be important for improving our understanding of the early infant feeding environment and how it may influence later health.
Understanding how early dietary environments shape metabolic development,
specifically as it relates to later health, was another important aim of this study. Although leptin is a relatively easy biomarker to assess, it would be beneficial to assess additional biomarkers to understand the various physiological pathways leptin may influence. For example, there is some evidence that leptin sensitivity may be influenced by the gut microbiome (Schéle et al. 2013). Leptin itself may downregulate synthesis of endocannabinoids (appetite-promoting peptides),
thereby reducing levels in the hypothalamus (Di Marzo 2008). Of note, both gut microbiota and endocannabinoid levels have been shown to be altered among leptin-resistant mice (Geurts et al. 2011). Analysis of the gut microbiome and circulating endocannabinoid levels—in addition to leptin—among human subjects may be important for elucidating how early life alterations along these pathways may influence long-term metabolic programming.
8.4 Conclusion
This dissertation set out to understand how both household contexts and individual infants’ eating behaviors influence infants’ dietary environments, such as infant-caregiver interactions and infant feeding, and how those dietary environments influence growth and metabolic development. This research employed the framework of the developmental niche to understand how various agents and interactions may influence infant feeding and growth outcomes. The developmental niche facilitated an interrogation of mothers’ ethnotheories and experiences of infant feeding and what led them to pursue the strategies they ultimately
employed, specifically in terms of giving their infants breastmilk and/or formula as well as the method of delivery. The findings illustrated that mothers often internalized messages from healthcare providers and public health messages and that those internalizations sometimes led to conflict within themselves or with others, conflicts that needed to be negotiated within the context of their own relationships with their infants. These results highlight the need to
incorporate more nuance into conversations about breastfeeding and formula feeding, and they underscore the importance of nonjudgmental support from partners, family and friends, and healthcare providers.
This study also used the developmental origins of health and disease framework to understand how infants’ dietary environments influence biology. Specifically, infant eating behaviors were important predictors of growth and body composition, and the role of infant
feeding and leptin may be important through other, unobserved pathways. These findings are particularly interesting given the high rates of breastfeeding in this cohort, and they highlight the importance of elucidating potential behavioral and physiological pathways through which infant feeding and metabolic hormones such as leptin may influence growth during periods of high plasticity, and how those growth and metabolic hormone patterns influence long-term health outcomes.
APPENDIX A. HOUSEHOLD INTERVIEW GUIDE Section A: Identification
1 Household ID 2 Child Case ID 3 Interview date
Section B: Family Characteristics (Initial visit)
1. What is your age?
2. What is your ethnicity? Race?
3. How many years of school do you have? 4. What is your occupation?
5. Are you married?
a. Does your husband or partner live in this household? b. What is the occupation of your husband or partner? 6. Do you have children currently living in your home? How many? 7. How many people live in this household (including the baby and you)?
8. How long have you lived in North Carolina?
9. Where are you from originally (if not North Carolina)? Section C: Child characteristics(Initial visit)
1. What is the name of your baby? 2. What is his/her gender?
3. What is his/her date of birth? 4. What was his/her birth weight? 5. What was his/her birth length?
6. Compared with other newborn babies, how big do you think your baby was when s/he was born: very small, small, medium or big?
7. Did you have any complications while you were pregnant (before birth)?
a. If yes, what were they? (anemia, infection, pre-eclampsia/hypertension, diabetes) 8. Did you go to the doctor for a checkup while you were pregnant?
a. If yes, how many times?
9. Did you give birth early, before your due date? How many weeks pregnant were you? 10.Sometimes during delivery, a woman may have problems or complications that endanger
the mother, the baby or both. Did you have any problems or complications during your delivery?
a. If yes, what were they?
11.Did you have a vaginal or cesarean birth?
a. If cesarean: why did you have a cesarean?
b. If normal: Was it your choice to have a natural birth?
Section D: Infant Feeding(All visits; administer to participating family members) 1. (Initial visit only) Did you breastfeed your baby at birth?
2. (Initial visit) Why did you breastfeed your baby?
4. Are you still breastfeeding your baby?
a. If no: When did you stop breastfeeding? b. Why did you stop breastfeeding
5. Do you think moms should breastfeed their babies? Why or why not?
6. Has s/he received formula?
a. If so, when did s/he start drinking the formula?
b. Did or does your baby breastfeed and drink formula at the same time? c. When does your baby breastfeed, and when does she/he take formula?
7. Do you think moms should give their babies formula? Why or why not? 8. Does anyone give you information about how to feed your baby?
9. Is your baby eating solid foods other than milk or formula? If yes:
a. When did s/he begin eating solid foods or cereal, other than milk or formula? b. What was the first food you offered your baby?
c. How did you prepare it?
d. Why did you decide to give food to your baby? If no:
e. When do you plan to give your baby solid foods?
f. What kinds of foods do you think you will give your baby first? 10.Does your baby drink liquids other than breastmilk or formula? If so, why? 11.What are the best foods for your baby right now?
12.How do you know which foods are good for your baby? 13.Who helps you feed the baby?
a. If anyone: do these people live in the house with you? 14.Do you have any worries about your baby’s eating?
15.Do you have any worries about your baby’s growth?
16.Do you think your baby is growing faster, slower, or the same as other babies? 17.Do you think your baby is the same size as, smaller, or larger than other babies?
Section E: Child Symptom History(All visits)
1. In the past one week, has the child experienced any of the following symptoms?: a. Nasal congestion, cold
b. Itchy skin or rash
1. If so, what part of the body?
c. Fever (how high?)___________
d. Infected wound (location) ___________ e. Cough or sneezing
f. Diarrhea g. Flu h. Vomiting i. Teething
j. Loss of appetite (what signs does your baby give)__________
2. If the answer to any of the previous questions is yes: how long did they last, one day, one week or more than one week?
Section F: Household Eating (Initial visit)
1. Where do you shop for food for your family?
2. How far is that/are those places from where you live? 3. How often do you cook for your family?
4. How do you decide what to cook? 5. Do other people cook for your family?
6. How often does your family eat out at a restaurant?
a. How often does your family eat at a fast food restaurant (such as McDonalds or Burger King)?
b. How often does your family eat at other restaurants? c. What kinds of restaurants are these places?
7. In the past year, have you ever worried about having enough food to feed everyone in your household?
Section G: Infant Diet History
See IFPS-II form
Section H: Infant Appetite (All visits; administer to participating family members) See separate form for infant appetite: BEBQ-R.
APPENDIX B. QUALITATIVE CODEBOOK Codebook 1 Codebook 2 Breastfeeding Benefits Cessation Challenges Identity Production Shame/Guilt
Should (Others Do This) Support
Why (Initiate/Continue)
Formula Benefits
Drawbacks
Why (Initiate/Continue)
(Making) Decisions Feeding Advice
Start Solids
What’s Good (for Baby) What’s Right (for Mom/Family) Infant Feedback
Worry Infant Eating
WORKS CITED
Adair LS. 2008. Child and adolescent obesity: Epidemiology and developmental perspectives. Physiology & Behavior 94(1):8.
Adair LS. 2012. How could complementary feeding patterns affect the susceptibility to NCD later in life? Nutrition, Metabolism and Cardiovascular Diseases 22(10):765-769. Adair LS, and Prentice AM. 2004. A Critical Evaluation of the Fetal Origins Hypothesis and Its
Implications for Developing Countries. The Journal of Nutrition 134(1):191-193.
Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Michaelsen KF, Moreno L, Puntis J, Rigo J et al. . 2008. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. Journal of pediatric gastroenterology and nutrition 46(1):99- 110.
Agras WS, Kraemer HC, Berkowitz RI, and Hammer LD. 1990. Influence of early feeding style on adiposity at 6 years of age. The Journal of Pediatrics 116(5):805-809.
Alexe D-M, Syridou G, and Petridou ET. 2006. Determinants of Early Life Leptin Levels and Later Life Degenerative Outcomes. Clinical Medicine & Research 4(4):326-335.
American Academy of Pediatrics. Section on Breastfeeding. 2012. Breastfeeding and the Use of Human Milk. Pediatrics 129(3).
Arenz S, Rückerl R, Koletzko B, and Kries Rv. 2004. Breast-feeding and childhood obesity--a systematic review. International Journal of Obesity and Related Disorders 28(10):1247- 1256.
Arsenault JE, Havel PJ, de Romaña DL, Penny ME, Van Loan MD, and Brown KH. 2007. Longitudinal measures of circulating leptin and ghrelin concentrations are associated with the growth of young Peruvian children but are not affected by zinc supplementation. Am J Clin Nutr 86(4):1111-1119.
Ashcroft J, Semmler C, Carnell S, Van Jaarsveld CH, and Wardle J. 2008. Continuity and stability of eating behaviour traits in children. European Journal of Clinical Nutrition 62(8):985-990.
Asiodu IV, Waters CM, Dailey DE, Lee KA, and Lyndon A. 2015. Breastfeeding and use of social media among first-time African American mothers. J Obstet Gynecol Neonatal Nurs 44(2):268-278.
BabyCenter L.L.C. 2018. BabyCenter: Expert Advice. BabyCenter, L.L.C.
Baile CA, Della-Fera MA, and Martin RJ. 2000. Regulation of metabolism and body fat mass by leptin. Annual Review of Nutrition 20:105-127.
Baird J, Poole J, Robinson S, Marriott L, Godfrey K, Cooper C, Inskip H, Law C, and Group TSWsSS. 2008. Milk feeding and dietary patterns predict weight and fat gains in infancy. Paediatric and Perinatal Epidemiology 22(6):575-586.
Baker P, Smith J, Salmon L, Friel S, Kent G, Iellamo A, Dadhich JP, and Renfrew MJ. 2016. Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway? Public Health Nutrition
19(14):2540-2550.
Barker DJ. 1990. The fetal and infant origins of adult disease. BMJ : British Medical Journal 301(6761):1111-1111.
Barker DJ, Osmond C, Forsén TJ, Kajantie E, and Eriksson JG. 2005. Trajectories of Growth among Children Who Have Coronary Events as Adults. The New England Journal of Medicine 353(17):1802-1809.
Barker DJ, Osmond C, and Law CM. 1989. The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis. J Epidemiol Community Health 43(3):237- 240.
Barston S. 2014. Supporting Formula-Feeding Moms During World Breastfeeding Week. Huffington Post.
Belkin L. 2009. In Support of Bottle Feeding. Motherlode: Adventures in Parenting: The New York Times.
Bentley ME, Dee DL, and Jensen JL. 2003. Breastfeeding among Low Income, African- American Women: Power, Beliefs and Decision Making. The Journal of Nutrition 133(1):305S-309S.
Bernard HR. 2011. Research methods in anthropology: Qualitative and quantitative approaches: Rowman Altamira.
Blair NJ, Thompson JMD, Black PN, Becroft DMO, Clark PM, Han DY, Robinson E, Waldie KE, Wild CJ, and Mitchell EA. 2007. Risk factors for obesity in 7‐year‐old European children: the Auckland Birthweight Collaborative Study. Archives of Disease in Childhood 92(10):866-871.
Bluher S, and Mantzoros CS. 2004. The Role of Leptin in Regulating Neuroendocrine Function in Humans. Journal of Nutrition 134(Supplement):2469S.
Blum LM. 2000. At the breast: Ideologies of breastfeeding and motherhood in the contemporary United States: Beacon Press.
Boney CM, Verma A, Tucker R, and Vohr BR. 2005. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3):e290-e296.
Bouret SG. 2010. Leptin, nutrition, and the programming of hypothalamic feeding circuits. Nestle Nutrition Workshop Series: Pediatric Program 65:25-39.
Bouret SG, Draper SJ, and Simerly RB. 2004. Trophic Action of Leptin on Hypothalamic Neurons That Regulate Feeding. Science 304(5667):108-110.
Breij LM, Mulder MT, van Vark-van der Zee LC, and Hokken-Koelega ACS. 2017. Appetite- regulating hormones in early life and relationships with type of feeding and body composition in healthy term infants. Eur J Nutr 56(4):1725-1732.
Bridges N. 2016. The faces of breastfeeding support: Experiences of mothers seeking breastfeeding support online. Breastfeed Rev 24(1):11-20.
Brisbois TD, Farmer AP, and McCargar LJ. 2012. Early markers of adult obesity: a review. Obesity Reviews 13(4):347-367.
Brockway M, Benzies K, and Hayden KA. 2017. Interventions to Improve Breastfeeding Self- Efficacy and Resultant Breastfeeding Rates: A Systematic Review and Meta-Analysis. Journal of Human Lactation 33(3):486-499.
Brown A, and Lee MD. 2015. Early influences on child satiety-responsiveness: the role of weaning style. Pediatric Obesity 10(1):57-66.
Brown A, and Rowan H. 2016. Maternal and infant factors associated with reasons for introducing solid foods. Maternal & Child Nutrition 12(3):500-515.
Bunik M, Clark L, Marquez Zimmer L, Jimenez LM, O'Connor ME, Crane LA, and Kempe A. 2006. Early infant feeding decisions in low-income Latinas. Breastfeeding Medicine 1(4):225-235.
Bureau USC. 2018. American Community Survey 1-year Estimates.
Carnell S, Benson L, Pryor K, and Driggin E. 2013. Appetitive traits from infancy to
adolescence: using behavioral and neural measures to investigate obesity risk. Physiology & Behavior 121:79-88.
Carnell S, and Wardle J. 2007. Measuring behavioural susceptibility to obesity: Validation of the child eating behaviour questionnaire. Appetite 48(1):104-113.
Carnell S, and Wardle J. 2008. Appetite and adiposity in children: evidence for a behavioral susceptibility theory of obesity. The American Journal of Clinical Nutrition 88(1):22-29. Cattaneo A, Williams C, Pallás‐Alonso CR, Hernández‐Aguilar MT, Lasarte‐Velillas JJ, Landa‐
Rivera L, Rouw E, Pina M, Volta A, and Oudesluys‐Murphy AM. 2011. ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence? Maternal & child nutrition 7(4):335-343.
Centers for Disease Control and Prevention. 2010. Breastfeeding Report Card - United States, 2010. Atlanta, GA.
Centers for Disease Control and Prevention. 2016. Breastfeeding Report Card: Progressing Toward National Breastfeeding Goals, United States 2016.
Centers for Disease Control and Prevention. 2018a. Breastfeeding Among U.S. Children Born 2009–2015, CDC National Immunization Survey. Atlanta, GA: Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention. 2018b. Breastfeeding Report Card United States, 2018. Atlanta, GA.
Centers for Disease Control and Prevention. 2018c. CDC's Work to Support & Promote Breastfeeding in Hospitals, Worksites, & Communities. In: Prevention CfDCa, editor. Centers for Disease Control and Prevention. 2019. Nutrition, Physical Activity and Obesity:
Data, Trends and Maps. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, and Martines J.
2015. Breastfeeding and maternal health outcomes: a systematic review and meta- analysis. Acta Paediatrica 104:96-113.
Cisco J. 2017. Who Supports Breastfeeding Mothers? Human Nature 28(2):231-253.
Collinson A, Moore S, O'Connell M, Charalambos C, and Prentice A. 2005. Developmental changes in leptin as a measure of energy status in human infants in a natural ecologic setting. Am J Clin Nutr 81(2):488-494.
Cross-Barnet C, Augustyn M, Gross S, Resnik A, and Paige D. 2012. Long-Term Breastfeeding Support: Failing Mothers in Need. Matern Child Health J 16(9):1926-1932.
Crujeiras AB, Carreira MC, Cabia B, Andrade S, Amil M, and Casanueva FF. 2015. Leptin resistance in obesity: An epigenetic landscape. Life Sci 140:57-63.
Daniels L, Mallan KM, Fildes A, and Wilson J. 2015. The timing of solid introduction in an ‘obesogenic’ environment: a narrative review of the evidence and methodological issues. Aust N Z J Public Health 39(4):366-373.
Dearden L, and Ozanne SE. 2015. Early life origins of metabolic disease: Developmental programming of hypothalamic pathways controlling energy homeostasis. Front Neuroendocrinol 39:3-16.
Demerath EW, Reed D, Choh AC, Soloway L, Lee M, Czerwinski SA, Chumlea WC, Siervogel RM, and Towne B. 2009. Rapid Postnatal Weight Gain and Visceral Adiposity in Adulthood: The Fels Longitudinal Study. Obesity 17(11):2060-2066.
Dennis C-L, and McQueen K. 2009. The Relationship Between Infant-Feeding Outcomes and Postpartum Depression: A Qualitative Systematic Review. Pediatrics 123(4):e736-e751. DeVellis RF. 1991. Scale development: Theory and applications.
Dewey KG, Yang ZY, and Boy E. 2009. Systematic review and meta-analysis of home fortification of complementary foods. Maternal and Child Nutrition 5(4):283-321. Di Marzo V. 2008. The endocannabinoid system in obesity and type 2 diabetes. Diabetologia
51(8):1356.
DiGirolamo AM, Grummer-Strawn LM, and Fein SB. 2008. Effect of Maternity-Care Practices on Breastfeeding. Pediatrics 122(Supplement 2):S43-S49.
DiPatrizio NV. 2016. Endocannabinoids in the Gut. Cannabis and Cannabinoid Research 1(1):67-77.
Dovey TM, Staples PA, Gibson EL, and Halford JCG. 2008. Food neophobia and ‘picky/fussy’ eating in children: A review. Appetite 50(2):181-193.
Dubois L, Farmer A, Girard M, Peterson K, and Tatone-Tokuda F. 2007. Problem eating
behaviors related to social factors and body weight in preschool children: A longitudinal study. International Journal of Behavioral Nutrition and Physical Activity 4(1):9.
Engeli S. 2008. Dysregulation of the Endocannabinoid System in Obesity. J Neuroendocrinol 20:110-115.
Eriksson JG, Forsén TJ, Osmond C, and Barker D. 2003a. Obesity from cradle to grave. International Journal of Obesity and Related Disorders 27(6):722-727.
Eriksson JG, Forsen TJ, Osmond C, and Barker DJP. 2003b. Pathways of infant and childhood growth that lead to type 2 diabetes. Diabetes Care 26(11):3006-3010.
Eriksson JG, Gluckman PD, and Hanson MA. 2006. Patterns of growth: relevance to developmental origins of health and disease. Developmental origins of health and disease:223-232.
Evenhouse E, and Reilly S. 2005. Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias. Health Serv Res 40(6 Pt 1):1781-1802. Fein SB, Labiner-Wolfe J, Scanlon KS, and Grummer-Strawn LM. 2008a. Selected
Complementary Feeding Practices and Their Association With Maternal Education. Pediatrics 122(Supplement 2):S91-S97.
Fein SB, Labiner-Wolfe J, Shealy KR, Li R, Chen J, and Grummer-Strawn LM. 2008b. Infant Feeding Practices Study II: Study Methods. Pediatrics 122(Supplement 2):S28-S35.
Fields DA, and Demerath EW. 2012. Relationship of insulin, glucose, leptin, IL-6 and TNF-α in human breast milk with infant growth and body composition. Pediatric Obesity 7(4):304- 312.
Fields DA, George B, Williams M, Whitaker K, Allison DB, Teague A, and Demerath EW. 2017. Associations between human breast milk hormones and adipocytokines and infant growth and body composition in the first 6 months of life. Pediatric Obesity 12 Suppl 1:78-85.
Fisher JO, Birch LL, Smiciklas-Wright H, and Picciano MF. 2000. Breast-Feeding Through the