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FORMULA INTAKE in EARLY INFANCY By FORMULA INTAKE IN EARLY INFANCY by Susana Finkbeiner A thesis submitted to the Faculty of the University of Delaware in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition Spring 2016 © 2016 Susana Finkbeiner All Rights Reserved FORMULA INTAKE IN EARLY INFANCY by Susana Finkbeiner Approved: __________________________________________________________ Jillian C. Trabulsi, Ph.D., R.D. Professor in charge of the Advisory Committee Approved: __________________________________________________________ P. Michael Peterson, Ed.D. Chair of the Department of Behavioral Health and Nutrition Approved: __________________________________________________________ Kathleen S. Matt, Ph.D. Dean of the College of Health Sciences Approved: __________________________________________________________ Ann L. Ardis, Ph.D. Senior Vice Provost for Graduate and Professional Education ACKNOWLEDGMENTS I would like to acknowledge my advisors, Dr. Jillian Trabulsi and Dr. Julie Mennella, for their continuous support, encouragement, and guidance. Their incredible mentorship and expertise were invaluable to my graduate school experience. I would also like to acknowledge the third committee member, Dr. Mia Papas, for dedicating her time and expertise. iii TABLE OF CONTENTS LIST OF TABLES ....................................................................................................... vii LIST OF FIGURES ........................................................................................................ x ABSTRACT .................................................................................................................. xi Chapter 1 INTRODUCTION .............................................................................................. 1 2 LITERATURE REVIEW ................................................................................... 7 2.1 History of Energy Requirements and Energy Intake in Early Infancy...... 7 2.2 Current Energy Requirements and Energy Intake in Early Infancy ........ 11 2.3 History of Protein Requirements and Protein Intake in Early Infancy.... 13 2.4 Current Protein Requirements and Protein Intake in Early Infancy ........ 15 2.5 Weight Gain in Infancy and Later Life Weight Status ............................ 17 2.6 Association Between Diet Composition and Weight Gain in Infancy .... 21 2.7 Infant Formula Composition and its Effect on Feeding Behaviors and Growth ..................................................................................................... 23 2.8 Summary.................................................................................................. 27 3 STATEMENT OF THE PROBLEM................................................................ 29 4 AIMS ................................................................................................................ 30 4.1 Specific Aims .......................................................................................... 30 5 METHODS ....................................................................................................... 32 5.1 Subjects.................................................................................................... 32 5.2 Research Design ...................................................................................... 33 5.3 Study Formulas........................................................................................ 35 5.4 Testing Procedures Overview.................................................................. 35 5.4.1 Anthropometry ............................................................................ 36 5.4.2 Demographics and health history assessments ............................ 36 5.4.3 Energy intake measurement ........................................................ 37 5.4.4 Validation of energy intake measurement ................................... 39 iv 5.5 Statistical Analysis .................................................................................. 41 5.5.1 Preliminary analyses.................................................................... 41 5.5.2 Primary Analyses......................................................................... 41 6 RESULTS ......................................................................................................... 43 6.1 Subject Characteristics ............................................................................ 43 6.1.1 Characteristics of subjects who completed a 1-day diet record at 0.4 months of age..................................................................... 44 6.1.2 Characteristics of subjects who completed the 3-day TWbottle method at 0.6 months of age........................................................ 44 6.1.3 Characteristics of mother-infant dyads by formula group........... 46 6.2 Dietary Intake at 0.4 Months (all Infants Feeding CMF), Assessed via a 1-Day Diet Record ................................................................................ 46 6.2.1 Energy intake of CMF fed infants at 0.4 months of age compared to historical data on energy intake .............................. 47 6.2.2 Protein intake of CMF fed infants at 0.4 months of age compared to historical data on protein intake.............................. 48 6.2.3 Energy and protein intake of CMF fed infants at 0.4 months of age compared to the 2005 DRIs .................................................. 48 6.3 Dietary Intake at 0.6 Months (Infants Feeding Either CMF or EHF), Assessed via the 3-Day TWbottle Method ................................................. 49 6.3.1 Energy intake of CMF and EHF fed infants at 0.6 months of age compared to historical data on energy intake ....................... 49 6.3.2 Protein intake of CMF and EHF fed infants at 0.6 months of age compared to historical data on protein intake ....................... 49 6.3.3 Dietary intake of CMF and EHF fed infants at 0.6 months of age compared to 2005 DRIs ........................................................ 50 6.3.4 Comparison of dietary intake by formula type (CMF vs. EHF fed infants) at 0.6 months of age ................................................. 50 7 DISCUSSION................................................................................................... 52 7.1 Reported Energy and Protein Intake at 0.4 Months of Age in CMF Fed Infants Compared to Historical Data ....................................................... 52 7.2 Reported Energy and Protein Intake at 0.4 Months of Age in CMF Fed Infants Compared to the Energy EER and Protein AI (2005 DRIs)........ 53 v 7.3 Measured Energy and Protein Intake at 0.6 Months of Age in CMF Fed Infants Versus Historical Data.......................................................... 53 7.4 Measured Energy and Protein Intake at 0.6 Months of Age in EHF Fed Infants Versus Historical Data.......................................................... 54 7.5 Measured Energy and Protein Intake at 0.6 Months of Age in CMF Fed Infants Compared to the Energy EER and Protein AI (2005 DRIs). 54 7.6 Measured Energy and Protein Intake of EHF Fed Infants at 6 Months of Age Compared to the Energy EER and Protein AI (2005 DRIs)........ 55 7.7 Comparison of Dietary Intake Variables at 0.6 Months of Age by Formula Type (CMF vs. EHF) ................................................................ 56 8 CONCLUSIONS .............................................................................................. 58 TABLES ....................................................................................................................... 60 FIGURES ..................................................................................................................... 88 REFERENCES ............................................................................................................. 92 Appendix A IRB HUMAN SUBJECTS APPROVAL ....................................................... 102 B INFORMED CONSENT ................................................................................ 105 C PARTICIPANT HANDOUTS ....................................................................... 113 D DATA COLLECTION FORM....................................................................... 120 vi LIST OF TABLES Table 1: Summary of scientific literature on energy intake (kcal/kg/d) determined by the test weighing method in young infants.................61 Table 2: Summary of scientific literature on protein intake (g protein/kg/d) determined by the test weighing method in young infants ................63 Table 3: Macronutrient composition of study formulas compared to breast milk.....................................................................................................65 Table 4: Demographic characteristics of mother-infant dyads at study entry (Visit 1)…………………………………………….…………….….66 Table 5: Subject count for 1-day diet record when infants were 0.4 months of age (Visit 1)…………………………..……………….......….......67 Table 6: Characteristics of infants who returned a 1-day diet record (DR) versus those who did not returned a 1-day diet record (No DR)…....68 Table 7: Comparison of infant characteristics for infants randomized to a study formula versus those who withdrew from study after Visit 2. …......69 Table 8: Subject count for 3-day TWbottle method, when infants were 0.6 months of age (Visit 2)………………………………………..…….70 Table 9A: Demographic characteristics according to formula group in subjects who completed Visit 2….…………………………...........................71 Table 9B: Characteristics
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