Date of Award
Fall 2025
Document Type
Open Access Dissertation
Department
Epidemiology and Biostatistics
First Advisor
Jihong Liu
Abstract
This dissertation focused on the association of early life factors with complementary feeding and infant growth. Three studies were included: 1) to explore if there is an association between maternal postpartum depressive symptoms and complementary feeding practices among infants aged six to twelve months, 2) to measure the association between complementary feeding practices and infant growth during the first year of life, and 3) to assess the association between maternal gestational weight gain (GWG) and offspring's obesity during the infant’s first year of life and the mediating roles of birth weight and breastfeeding in the association among women with overweight or obesity.
To achieve the first and second aims, we utilized the data from the Infant Feeding Practices Study II, a longitudinal study in the United States (U.S.) that followed mother-infant dyads from late pregnancy to twelve months postpartum. The first study found that women with likely postpartum depression were more likely to introduce complementary foods earlier, compared to those without likely postpartum depression. However, the association was weakened over time. Additionally, maternal postpartum depressive symptoms were positively associated with meeting the World Health Organization (WHO) recommended minimum meal frequency from six to twelve months of age. No associations were found between maternal postpartum depressive symptoms and dietary diversity. Interventions targeting the alleviation of postpartum depressive symptoms should be developed and implemented early in the postpartum period to prevent the premature introduction of complementary foods.
The findings of the second study showed that the later timing of introducing complementary foods was associated with lower z-scores for infant growth from six to twelve months of age, such as the weight-for-age z-scores (WAZ), length-for-age z-scores (LAZ), weight-for-length z-scores (WLZ), and body mass index z-scores (BMIZ). Additionally, introducing complementary foods before six months of age was associated with higher WAZ from six to twelve months of age, and this association was strengthened as infants got older. Dietary diversity scores were negatively associated with WAZ from six to twelve months of age, while meal frequency was not associated with any indices of infant growth. Our findings suggest that introducing complementary foods at six months of age and feeding infants diverse foods may help prevent rapid weight and reduce the risk of infant overweight or obesity. The implementation of overweight and obesity prevention via complementary feeding practices may be initiated as early as infancy.
The last study, which used the data from a randomized clinical trial with mothers with overweight or obesity, found that there was a high prevalence of gaining excessive GWG among women with overweight or obesity. It was found that maternal GWG was not associated with infant obesity at six and twelve months of age, and breastfeeding and infant birth weight did not mediate the association. More studies are needed to explore the risk factors of overweight or obesity in infants whose mothers were overweight or obese. Future studies conducted in larger sample sizes and effective interventions to prevent women with overweight or obesity from gaining excessive GWG are warranted.
In conclusion, early life factors, such as postpartum depression, were associated with infant complementary feeding. Furthermore, practicing recommended complementary feeding (e.g., introducing complementary foods at six months of age and feeding infants diverse foods) may help reduce the risk of infant overweight or obesity. Developing interventions to prevent or treat postpartum depression and promote appropriate complementary feeding practices will likely facilitate healthy growth and lower the future risk of obesity among infants.
Rights
© 2025, Xuanxuan Zhu
Recommended Citation
Zhu, X.(2025). Early Life Factors for Complementary Feeding and Growth. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/8120