VOLUME 64 #{149}OCTOBER 1979 #{149}NUMBER 4
Pedtrs
The
Effect
of Feeding
on Fat Deposition
in
Early
Infancy
Ann G. Ferris,
PhD,
Virginia
A. Beal,
MPH,
Mary
Jane
Laus,
MS
and
David
W. Hosmer,
PhD
From the Department of Food Science and Nutrition and Division of Public Health, University of Massachusetts, Amherst, and the Department of Nutritional Sciences, University of Connecticut, Storrs
ABSTRACT. Trained nutritionists surveyed 92 female
infants and their mothers in Western Massachusetts at
monthly intervals from birth to age 6 months. A diet history, a three-day record of food intake and 11
anthro-pometnc measurements were obtained at each home visit.
Skinfold measurements showed an earlier plateau than
in other published studies. There were no significant
differences in fat thicknesses when infants were classified by method of feeding until age 2 months, but formula-fed
infants with solids started before age 2 months had the
largest mean skinfolds which peaked at age 3 months and
then decreased and became similar to those of the other
groups by age 5 months. Pediatrics 64:397-401, 1979;
skinfolds, infant diet, growth and development, over-weight.
Longitudinal skinfold data on infants appear to
be limited to that from Europe.’ In the course of
a study of the effects of infant feeding on fat
depo-sition, monthly measuremenLs of skinfold thickness
were obtained on 92 female infants in
Massachu-setts and were compared with the data of Karlberg
et a1.
The value ofskinfolds as a measure offat depends
on how well the measurements correlate with body
Received for publication Aug 28, 1978; accepted Feb 12, 1979.
Scientific Contribution No. 731, Storrs Agricultural Experiment
Station, University of Connecticut, Storrs, CT 06268.
Reprint requests to (A.G.F.) Department of Nutritional
Sd-ences, U-17, University of Connecticut, Storrs, CT 06268. PEDIATRICS (ISSN 0031 4005). Copyright © 1979 by the American Academy of Pediatrics.
ns7 However, in infants and children, the
relationship between these measures changes with
age and development.8 In children, a change in
distribution of fat from the subcutaneous layer to
the body cavities and from the limbs to the trunk
has been reported.#{176} In infants, changes. in total
body fat occur even more rapidly. Skinfold
thick-ness increases for about six months in boys and
girls. Then in most babies, fat widths begin to
decrease in relative amts” although the peak
for fat deposition is known to vary widely’ and the
actual percentage of change in total body fat from
birth to age 6 months is unknown.’2 Therefore,
caution must be exercised in the interpretation of
infant skinfold data, especially when adult
equa-tions are used to estimate total body fat from the skinfold measures. In this light, the following report will examine the fat deposition patterns and
differ-ences in that pattern noted in relation to the
method of feeding chosen for the infant in the first
months of life.
PROCEDURES
Pregnant women were recruited primarily through obstetricians in private practice. “High-risk” pregnancies, including mothers under 18 years
of age were excluded from the study. Since sex
differences appear in fat deposition even at birth,’3
female infants only were chosen for intensive study.
The 125 male infants became part of the larger
differ-Age (mo) N Mean SD Percentiles
10th 25th 50th 75th 90th
Supraiiac
1 90 5.5 2.6 0.0 4.0 6.0 7.0 8.7
2 88 7.8 2.9 4.0 6.2 8.0 10.0 11.1
3 85 8.8 3.2 5.0 7.0 8.5 10.9 12.2
4 82 8.8 3.2 5.0 6.4 8.5 10.5 12.9
5 79 8.9 3.2 5.0 7.0 8.5 10.2 13.0
6 80 8.7 3.1 5.0 6.0 8.5 10.5 12.0
Chest
1 90 3.0 1.9 0.0 2.0 3.0 4.0 5.0
2 88 4.5 1.6 3.0 3.5 4.5 5.1 6.6
3 85 4.8 1.9 3.0 4.0 4.5 5.2 6.2
4 82 4.6 1.6 3.0 3.5 4.2 5.0 6.5
5 79 4.5 1.6 3.0 3.5 4.0 5.0 6.0
6 80 4.4 1.5 3.0 3.2 4.2 5.0 6.0
TABLE 2. Triceps and Subscapular Skinfold Thickness (mm) of Female Infants in the Infant Growth Study
Age (mo) N Mean SD Percentiles
10th 25th 50th 75th 90th
Triceps
1 90 5.9 2.2 4.0 5.0 6.0 7.0 8.0
2 88 7.4 2.3 5.0 6.0 7.0 8.5 11.0
3 85 8.1 2.5 5.0 6.0 8.0 10.0 11.0
4 82 8.2 2.6 5.2 6.2 8.0 10.0 11.3
5 79 8.3 2.8 5.0 6.0 8.0 10.0 12.0
6 80 8.5 2.6 5.5 6.2 8.2 10.0 11.5
Subscapular
1 90 5.8 2.4 0.1 5.0 6.1 7.3 8.0
2 88 7.3 1.8 5.0 6.2 7.5 8.0 9.5
3 85 7.9 1.9 6.0 6.0 7.5 9.0 10.5
4 82 7.6 1.7 6.0 6.2 7.0 8.7 10.5
5 79 7.3 1.8 5.5 6.0 7.0 8.0 10.0
6 80 7.2 1.8 5.2 6.0 7.0 8.0 10.0
ent time schedule. This phase of the study involved
six home visits for 92 female infants by two
nutri-tionists. Each monthly visit was within four days of
the monthly birth date. Eleven anthropometric
variables were taken. Skinfold measures included
triceps, subscapular, chest, and suprailiac. All
skin-fold measurements (mm) were made on the right
side of the body, with the Lange skinfold caliper
(Cambridge Instruments, Cambridge, MD).
Varia-tions between calipers were checked with a block
measured by micrometer as described by Tanner
and Whitehouse.’ Records were adjusted to account
for variation. Inter-investigator variations were
checked three times during the study. Maximum
difference found was 0.4 mm. The techniques used
were those described by Weiner and Lourie’4 except
that a reading was taken as soon as the needle
became steady.
TABLE 1. Supraiiac and Chest Skinfold
Infant Growth Study
Dietary information was obtained monthly by use of a detailed nutrition history’#{176} and a three-day food intake record. The nutrients were calculated from the United States Department of Agriculture
Handbook No. 816 and information was obtained
from baby food manufacturers.
Relationships of feeding patterns to skinfold mea-surements were analyzed as a two-factor
expen-ment with repeated measures on one factor.’7 18The
Friedman rank sums test was used to assess the
consistency in the observed trends of wt’9
RESULTS
The unsmoothed centile ranks for triceps,
subsca-pular, supraiiac, and chest skinfolds and body
weight are presented in Tables 1 to 3.
The best available comparison data for infant
skinfolds are those of the three-year longitudinal
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TABLE 3. Percentiles for Weight (kg) for Female Infants, Aged 0 to 6 Months in the
Infant Growth Study
Age (mo) N Weight (kg)
Percentiles
5th 10th 25th 50th 75th 90th 95th
Birth 92 2.69 2.78 3.15 3.38 3.64 3.92 4.15
1 91 3.27 3.46 3.81 4.15 4.42 4.80 5.15
2 89 3.88 4.10 4.57 4.92 5.32 5.73 5.92
3 86 4.37 4.79 5.17 5.52 6.06 6.47 6.57
4 83 4.92 5.31 5.77 6.13 6.61 7.00 7.27
5 82 5.50 5.75 6.17 6.68 7.17 7.57 7.95
6 82 5.94 6.06 6.59 7.01 7.59 8.04 8.58
study in Sweden by Karlberg et al.5 Infant Growth
Study data are compared to the 10th, 50th, and
90th percentiles of the Swedish data in Figure 1. All
three percentile levels reported by Karlberg et a!
showed a deceleration in triceps skinfo!d
measure-ments after 3 months of age but continued to
in-crease to age 6 months. In contrast, the female
infants in the present study had a plateau in triceps
skinfold measurements evident in the 10th, 25th,
and 90th percentiles after age 2. months and in the
50th and 75th percentiles after age 3 months.
Sim-ilar patterns were observed in skinfold thicknesses
at the other three sites. This implies a shorter
period of rapid deposition of fat in the present
study.
Comparison of the data for weight with the
Na-tional Center for Health Statistics (NCHS) for the
United Staths#{176} found that significant differences
existed at birth
(x2
40.21, df= 6, P < .001) and at1 month of age
(x2
= 13.09, df, = 6, P < .05).However, by age 3 months, no significant
differ-ences were noted. At birth the greatest differences
in cell frequencies were noted in the extremes of the
population. Only one of the 92 infants had a weight
below the tenth percentile of the NCHS standards
at birth and at 1 month of age. This was not
unexpected since infants with low birth weights
were excluded from the present study but not from
the NCHS standards. Conversely, 16 of the subjects
were above the 95th percentile of the NCHS
stand-ards at birth.
Chi-square analysis was also used to compare the
data for length with the NCHS standards. No
sig-nificant differences were found at 1, 3, or 6 months
of age. Birth lengths were not used because of the
unreliability of the hospital measure of birth length.
Feeding Pattern Differences
In experimental studies in which diet is
con-trolled, clear-cut differences in feeding may be set into the protocol of the study. However, with a free-living population in which pediatric
recommenda-1 2 3 4 5 8
Agi In Months
Fig I . Triceps skinfold thicknesses: comparison of infant
growth study (IGS) and Karlberg et al.5
tions and maternal practices in infant feeding are
not controlled, such clear-cut differentiation is
dif-ficult. This is especially true during the first six months of life, when the type of milk fed is subject
to change and solid foods may be introduced at any
age.
To simplify correlations with diet, infants were classified by the type of feeding at 1, 2, and 3
months of age. Relatively distinct feeding groups could be identified at age 2 months. Most infants at
this age had been on the same milk since birth, and
the majority of changes occurred after age 2
months. Therefore, for the primary analysis of this report the groupings at 2 months of age proved to be the most satisfactory.
At age 2 months, the four feeding groups were: 1. Infants fed breast milk alone (N = 40). 2. Infants fed breast milk with food supplements,
either formula or milk solids, in excess of5O kcal/
day (N = 12).
9-
8-Trlc.ps
SkiMold ThlckIMss#{149}s
mm
7-
6-Brsast
- - - Brssst and Food
ippl.msnt a
OOFormul a
0 - #{128}3Formulaand SolIds
I I
-
I I I II 2 3 4 5 6
Aga In Months
Fig 2. Adjusted mean monthly triceps skinfold mea-surements of the four feeding groups classified at age 2 months.
TABLE 4. Adjusted Mean Monthly Triceps Skinfold Measurements of the Four
Feeding Groups Classified At Age 2 Months
Age (mo) Groups
Breast (N = 37) Breast
and Food
Sup-plements (N = 10) Formula (N
= 10) Formula and Solids
(N = 18)
Mean SD Mean SD Mean SD Mean SD
1 5.8 2.1 6.1 1.8 6.0 1.4 5.6 3.3
2 7.3 2.0 8.2 3.2 7.7 2.6 7.5 2.3
3 7.8 2.6 8.1 2.9 7.8 1.7 9.3 2.7
4 7.8 2.4 8.1 3.2 7.6 2.2 9.1 2.9
5 8.1 2.4 8.3 2.9 8.6 3.8 8.8 3.0
6 8.7 2.7 8.5 2.6 8.4 3.3 8.2 1.9
4. Infants fed formula and solid food in excess of 50
kcal/day (N = 20).
The analysis of variance model chosen to analyze the data was a two-factor experiment with repeated
measures on one factor.’7 The model was used to analyze the individual skinfold measurements, an average ofali skinfolds, or an average of triceps plus subscapular skinfolds at each month for each of the subjects. Additional analyses were also performed
by usingbirth weight as a co-variant. All
calcula-tions were performed by using BMDP2V.’8 In none
was a significant difference among diet groups
noted. Analysis ofvariance results are not presented
here, but are available elsewhere.2’ While the
anal-ysis of variance did not support a hypothesis of differences between groups, a Friedman rank sums
test was used to examine the consistency of the
trends. In Figure 2 and for the other variables
analyzed, there was a tendency for the formula with
solids group to be “larger” than ‘the other groups.
In all skirifold measurements, a peak at age 3 months was noted in the group means adjusted for birth weight for infants fed formula and solids (Fig
2). The values, however, sharply decrease and are
similar to those of the other groups by age 5 months.
The mean values for triceps skinfold dependent on type of feeding at age 2 months are presented in Table 4.
DISCUSSION
The plateau for triceps skinfold thickness in in-fants at approximately 6 months of age in the
Swedish data5 is similar to that reported in other
studies.2’22 Recent work from Germany reported a leveling closer in age to that seen in the present
study. The workers in Berlin attributed their
re-sults to the success of the clinic’s massive
commu-mty nutrition education program. Since the present
investigation did not include dietary advice, we
must look for other reasons for the earlier plateau
in skinfold measurements.
First, in both the Swedish5 and German studies,
the smoothed percentiles were based on limited
data and then smoothed. In the German study, only
one measurement was taken before 6 months of
age. Although more frequent measurements (total
of eight) were taken in the Swedish study, 48% of the data for the smoothed centile ranks were inter-polated. No interpolated data were used in the calculation of the centile ranks for skinfold
mea-surements in the present study.
Second, in the present investigation, the exam-iners found a problem in getting an accurate pinch on breast-fed infants. The hardness of the fat made
it difficult to feel the interface of the muscle and
fat. There was no problem, however, in pinching the fat away from the muscle of the formula-fed infants. Since a larger percentage of the infants in
Swed-ish5 study, this could be an important difference. In
any event, obtaining reliable skinfold
measure-ments from active infants is a very difficult
proce-dure.
SUMMARY AND CONCLUSION
Analysis of longitudinal skinfold measurements
of 92 female infants from birth to 6 months of age
showed an earlier plateau of skinfold measurements
than would be expected from previously reported
data.5 Skinfold measurements reached a plateau
after 2 to 3 months of age. When fat deposition
patterns were analyzed according to the method of
feeding, no significant differences among groups were noted. However, formula-fed infants with
solids started before 2 months ofage had the highest
mean skinfolds which peaked and then decreased
and became similar to those of the other groups by
5
months of age.ACKNOWLEDGMENT
This work was supported in part by Experiment Sta-tion Project No. 347, Nutritional Improvement in the
Northeast, University of Massachusetts, Agricultural Ex-periment Station, Paper No. 2239.
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