Tommerup, Kristiane; (2024) Parent-Child Reciprocity in Infant Feeding and Infant Weight Development: Bio-Psycho-Social Interactions. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Rapid weight gain in infancy (RWG) is a risk factor for overweight in childhood and adulthood. Formula feeding (FF) is a hypothesised cause, although mechanisms are unclear (e.g. due to feeding from a bottle or the nutritional content of formula milk). Emerging evidence indicates biopsychosocial interactions between parental feeding and child weight, but few studies have examined infant feeding modality (IFM) and weight in the critical first year of life. Part one of this thesis (Studies 1-3) triangulates epidemiology and the twin design to examine biopsychosocial interactions in a population-based cohort of n=2404 British twins born in 2007 (Gemini). In Study 1, infants fed with combinations of breastfeeding and FF, compared to being exclusively breastfed (EBF), had steeper weight gain trajectories across the first year of life. Both FF infants and those breastfed from a bottle showed steeper weight gain than those EBF from the breast, implicating bottle-feeding as a potential mechanism in RWG. The weight gain of twins discordant for IFMs did not differ and pointed towards potential reciprocity in infant feeding decisions: twins fed with more bottle or formula were smaller than their co-twin in early infancy. Study 2 explored reciprocity using bi-directional epidemiological analyses and twins discordant for IFMs. Slower early weight gain, and maternal concern for slow weight gain, predicted the introduction of formula milk. Study 3 explored whether FF is responsive to children’s genetic liability towards slow early weight gain (i.e. gene-environment correlation), and whether breastfeeding buffers the expression of genetic influence on RWG (i.e. gene-environment interaction). No evidence of gene-environment interplay was found. The second part of this thesis (Study 4) describes the development of BRIGHT (Baby Responsive Intervention for Growth & Health Tracking), a digital intervention aiming to reduce RWG among FF infants by supporting responsive bottle-feeding, integrating insights from Studies 1-3.

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