Infant feeding and health-related quality of life in healthy Chinese infants: results from a prospective, observational cohort study

Nicholas P Hays, Meng Mao, Lan Zhang, John Ge, Robert Northington, Manjiang Yao, Sheri Volger, Nicholas P Hays, Meng Mao, Lan Zhang, John Ge, Robert Northington, Manjiang Yao, Sheri Volger

Abstract

Background: Infant feeding regimens, including breastfeeding, formula-feeding, or a combination of the two, may influence infant health-related quality of life (HRQOL). However, few studies have examined this association.

Methods: This prospective cohort study assessed HRQOL in relation to three parent-selected feeding regimens: exclusively breastfed (n = 136), exclusively study formula-fed (n = 140), and mixed-fed with study formula and breast milk (n = 151). Healthy Chinese infants were enrolled at their first normally scheduled well infant clinic visit at age 42 days (study day 1). Parents independently chose their infants' feeding regimens prior to recruitment into the study, with infants in the formula and mixed-fed groups already consuming an infant formula enriched with α-lactalbumin and increased sn-2 palmitate and oligofructose. The Infant and Toddler Quality of Life Questionnaire, which includes six infant-focused and three parent-focused concepts, was used to assess HRQOL at day 1 and at a follow-up visit 48 days later. Scores for each concept ranged from 0 to 100. Parent quality of life (assessed using the Mental Component Summary score of the SF-12v2 Health Survey) was included in the ANCOVA model to adjust for its potential effect on parent's perception of infant HRQOL.

Results: HRQOL concept scores were high in all three study groups at both visits (mean scores 71-95). Day 1 HRQOL scores were not significantly different between groups. At day 48, 5 of 9 HRQOL scores were not significantly different between groups. However, scores for Temperament and Moods, General Health Perceptions and Parent Impact-Time were slightly but statistically significantly lower in the formula-fed group (mean scores 75-86; all p ≤ 0.01) compared to the breastfed (78-90) and mixed-fed (77-91) groups. Day 48 Parent Impact-Emotional scores were also significantly lower by a small margin (4 points; p = 0.003) in the formula-fed group compared with the breastfed group.

Conclusions: HRQOL was high in this population of healthy infants, with only a few small differences in HRQOL concept scores observed between breastfed, formula-fed and mixed-fed infants. These results indicate favorable physical, mental, and social well-being in these infants and parents. Assessment of infant HRQOL is therefore feasible and provides valuable insight into parental perceptions of their child's health and well-being.

Trial registration: ClinicalTrials.gov, NCT01370967 .

Keywords: Breastfeeding; Infant and Toddler Quality of Life Questionnaire (ITQOL); Infant formula; Patient outcome assessment; Short Form 12 Health Survey, version 2 (SF-12v2).

Figures

Fig. 1
Fig. 1
Enrollment and discontinuation of study participants (Breastfed, group of infants who were exclusively fed breast milk; Formula-fed, group of infants who were exclusively fed with formula containing high sn-2 palmitate and oligofructose; Mixed-fed, group of infants who were breastfed and fed with formula containing high sn-2 palmitate and oligofructose)

References

    1. Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–490. doi: 10.1016/S0140-6736(15)01024-7.
    1. Briefing Materials for the Food Advisory Committee Meeting on Infant Formula. Accessed 29 Jun 2016.
    1. Spieth LE, Harris CV. Assessment of health-related quality of life in children and adolescents: an integrative review. J Pediatr Psychol. 1996;21(2):175–193. doi: 10.1093/jpepsy/21.2.175.
    1. Iacono G, Merolla R, D’Amico D, Bonci E, Cavataio F, Di Prima L, Scalici C, Indinnimeo L, Averna MR, Carroccio A, et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis. 2005;37(6):432–438. doi: 10.1016/j.dld.2005.01.009.
    1. Quinlan PT, Lockton S, Irwin J, Lucas AL. The relationship between stool hardness and stool composition in breast and formula-fed infants. J Pediatr Gastroenterol Nutr. 1995;20(1):81–90. doi: 10.1097/00005176-199501000-00014.
    1. Bowatte G, Tham R, Allen KJ, Tan DJ, Lau M, Dai X, Lodge CJ. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):85–95. doi: 10.1111/apa.13151.
    1. Harmsen HJ, Wildeboer-Veloo AC, Raangs GC, Wagendorp AA, Klijn N, Bindels JG, Welling GW. Analysis of intestinal flora development in breast-fed and formula-fed infants by using molecular identification and detection methods. J Pediatr Gastroenterol Nutr. 2000;30:61–67. doi: 10.1097/00005176-200001000-00019.
    1. Nauta AJ, Ben Amor K, Knol J, Garssen J, van der Beek EM. Relevance of pre- and postnatal nutrition to development and interplay between the microbiota and metabolic and immune systems. Am J Clin Nutr. 2013;98(2):586S–593S. doi: 10.3945/ajcn.112.039644.
    1. Manificat S, Dazord A, Langue J, Danjou G, Bauche P, Bovet F, Cubells J, Tockert E, Conway K. Evaluation of the quality of life of the infant and very young child: validation of a questionnaire. Arch Pediatr. 2000;7:605–614. doi: 10.1016/S0929-693X(00)80127-X.
    1. Yao M, Lien EL, Capeding MR, Fitzgerald M, Ramanujam K, Yuhas R, Northington R, Lebumfacil J, Wang L, DeRusso PA. Effects of term infant formulas containing high sn-2 palmitate with and without oligofructose on stool composition, stool characteristics, and bifidogenicity: a randomized, double-blind, controlled trial. J Pediatr Gastroenterol Nutr. 2014;59(4):440–448. doi: 10.1097/MPG.0000000000000443.
    1. Nowacki J, Lee HC, Lien R, Cheng SW, Li ST, Yao M, Northington R, Jan I, Mutungi G. Stool fatty acid soaps, stool consistency and gastrointestinal tolerance in term infants fed infant formulas containing high sn-2 palmitate with or without oligofructose: a double-blind, randomized clinical trial. Nutr J. 2014;13(1):105. doi: 10.1186/1475-2891-13-105.
    1. Kolida S, Tuohy K, Gibson GR. Prebiotic effects of inulin and oligofructose. Br J Nutr. 2002;87(Suppl 2):S193–S197. doi: 10.1079/BJN/2002537.
    1. Closa-Monasterolo R, Gispert-Llaurado M, Luque V, Ferre N, Rubio-Torrents C, Zaragoza-Jordana M, Escribano J. Safety and efficacy of inulin and oligofructose supplementation in infant formula: results from a randomized clinical trial. Clin Nutr. 2013;32(6):918–927. doi: 10.1016/j.clnu.2013.02.009.
    1. Grange A, Bekker H, Noyes J, Langley P. Adequacy of health-related quality of life measures in children under 5 years old: a systematic review. J Adv Nurs. 2007;59(3):197–220. doi: 10.1111/j.1365-2648.2007.04333.x.
    1. Stein REK, Jessop DJ. Functional Status II (R) - a measure of child health status. Med Care. 1990;28(11):1041–1055. doi: 10.1097/00005650-199011000-00006.
    1. Varni JW, Limbers CA, Neighbors K, Schulz K, Lieu JE, Heffer RW, Tuzinkiewicz K, Mangione-Smith R, Zimmerman JJ, Alonso EM. The PedsQL Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants. Qual Life Res. 2011;20(1):45–55. doi: 10.1007/s11136-010-9730-5.
    1. Raat H, Landgraf JM, Oostenbrink R, Moll HA, Essink-Bot ML. Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample. Qual Life Res. 2007;16:445–460. doi: 10.1007/s11136-006-9134-8.
    1. World Health Organization . WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization; 2006.
    1. Yerger K, Mao M, Ge J, Northington R, Yao M, Nowacki J, Hays N. Stool characteristics and gastrointestinal tolerance of Chinese infants fed term formula containing increased sn-2 palmitate and oligofructose: an observational study. Arch Dis Child. 2014;99(Suppl 2):A209. doi: 10.1136/archdischild-2014-307384.568.
    1. Volger S, Hays NP, Northington R, Mao M, Ge J, Landgraf JM. Feasibility and application of the Infant Toddler Quality of Life (ITQOL) in a community-based sample of healthy infants in China. Qual Life Res. 2014;23(1 Suppl):53.
    1. HealthActCHQ Inc . Confidential scoring rules, Infant and Toddler Quality of Life Questionnaire - 97. Cambridge: HealthActCHQ Inc; 2008.
    1. Ware J, Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233. doi: 10.1097/00005650-199603000-00003.
    1. Lam ET, Lam CL, Fong DY, Huang WW. Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese? J Eval Clin Pract. 2013;19(1):200–208. doi: 10.1111/j.1365-2753.2011.01800.x.
    1. Saris-Baglama RN, Dewey CJ, Chisholm GB, Plumb E, King J, Rasicot P, Kosinski M, Bjorner JB, Ware JE., Jr . QualityMetric Health Outcomes™ scoring software 4.0 User’s guide. Lincoln: QualityMetric Inc.; 2010.
    1. Nakonezny PA, Shull RD. JMASM 26: Hettmansperger and McKean linear model aligned rank test for the single covariate and one-way ANCOVA case (SAS) J Modern Applied Stat Methods. 2007;6(1):336–340.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–592.
    1. Mohangoo AD, de Koning HJ, De Jongste JC, Landgraf JM, van der Wouden JC, Jaddoe VWV, Hofman A, Moll HA, Mackenbach JP, Raat H. Asthma-like symptoms in the first year of life and health-related quality of life at age 12 months: the Generation R study. Qual Life Res. 2012;21(3):545–554. doi: 10.1007/s11136-011-9957-9.
    1. Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14:539–547. doi: 10.1007/s11136-004-0704-3.
    1. Chen YC, Chie WC, Kuo SC, Lin YH, Lin SJ, Chen PC. The association between infant feeding pattern and mother’s quality of life in Taiwan. Qual Life Res. 2007;16(8):1281–1288. doi: 10.1007/s11136-007-9233-1.
    1. Chen YC, Chie WC, Chang PJ, Chuang CH, Lin YH, Lin SJ, Chen PC. Is infant feeding pattern associated with father’s quality of life? Am J Mens Health. 2010;4(4):315–322. doi: 10.1177/1557988309350491.
    1. Zubaran C, Foresti K. The correlation between breastfeeding and maternal quality of life in southern Brazil. Breastfeed Med. 2011;6(1):25–30. doi: 10.1089/bfm.2010.0017.
    1. Manificat S, Dazord A. [Impact of the mode of breastfeeding on the infant and the quality of life of the mother and the quality of life of the child: results of a pilot study] Impact du mode d'allaitement du nourrisson sur la qualité de vie de la mère et la qualité de vie de l'enfant: Résultats d'une étude pilote. Le Pédiatre. 2000;36(1):17–23.
    1. American Academy of Family Physicians. Family Physicians Supporting Breastfeeding (Position Paper). Accessed 29 Jun 2016.

Source: PubMed

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