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IntroductionThe aims of the PROBIT trial (clinicaltrials.gov: NCT03131284) were to prevent overweight or obesity occurring at two years of life, and improve feeding patterns during infancy.MethodsThe trial compared 252 northern Italian newborns whose paediatricians offered their parents an educational programme from the child’s birth to the age of two years (intervention arm) with 216 newborns whose parents did not undergo the programme (control arm). This sample size was 80% powerful to detect, with a 0.05 α error, a 40% lower prevalence of overweight/obesity and a 57% lower prevalence of obesity in the intervention arm. At each well visit, the parents of the children in the intervention arm were given oral and written information about protective behaviours, with particular emphasis on responsive feeding. Overweight and obesity at two years of age were, respectively, defined as a body mass index of more than the 85th and the 95th percentile in accordance with the WHO growth charts. The sample size had 80% power to detect a 40% lower prevalence of overweight/obesity and a 57% lower prevalence of obesity in the intervention arm.ResultsAt the age of two years, the prevalence of obesity in the intervention arm was 35% lower than among the controls, but the difference was not statistically significant (8.7% vs. 13.4%; p = 0.10) There was no difference in the prevalence of overweight/obesity between the groups (26.8% vs. 28.3%; p = 0.49). At the age of three months, a higher proportion of the infants in the intervention group were fed on demand (93% vs. 80%, p < 0.001).ConclusionsThe PROBIT trial failed to detect a significantly lower prevalence of obesity in the intervention arm, but did improve early feeding patterns. More powerful trials and meta-analyses are required to establish whether educating newborns’ parents can decrease the prevalence of early obesity.

Introducing commercial milk formula (CMF) as prelacteal feeds can disturb exclusive breastfeeding and shorten breastfeeding duration. However, the prelacteal feeding of CMF has been growing alongside its increasing sales in Indonesia. This study examined predictors of the CMF feeding in the Malang and Sidoarjo districts of Indonesia. This analysis used post‐delivery data collected from 676 mothers in a cohort evaluation of a cluster randomised controlled trial (Baduta study). Multivariate random effects logistic models were employed to assess factors associated with the CMF feeding. A total of 467 (69.1%) respondents reported giving CMF to their infants during the first 3 days after delivery. Mothers with low breastfeeding self‐efficacy (BFSE) were at a higher risk of providing CMF within 3 days of birth compared to those with medium or high BFSE (adjusted odds ratio (aOR) 8.12; 95% confidence interval (CI) (4.26–15.48). Receiving explanations to solve breastfeeding problems from health professionals (aOR: 1.87; 97% CI: 1.12–3.11) and primipara parity (aOR: 1.71; 95% CI: 1.12–3.04) were positively associated with the CMF feeding. Early initiation of breastfeeding (EIBF) was protective against CMF feeding (aOR: 0.40; 95% CI: 0.22–0.58). There was an interaction between EIBF and BFSE. EIBF was protective among mothers with high or medium BFSE, but had no effect among those with low BFSE. CMF feeding was prevalent in Indonesia. Future strategies should focus on improving health‐staff capacity to strengthen BFSE during pregnancy and provide adequate counselling for mothers with breastfeeding problems. Prelacteal feeding of commercial milk formula was prevalent in Indonesia. Future strategies should focus on improving health‐staff capacity to strengthen breastfeeding self‐efficacy during pregnancy and provide adequate counselling for mothers with breastfeeding problems as both factors are the important determinants of this harmful practice. Summary Nearly 7 in 10 newborns received commercial milk formula during the first 3 days of their life. Parity, breastfeeding self‐efficacy, early initiation of breastfeeding and receiving explanations to solve breastfeeding problems were the predictors of this practice. Mothers with medium and high breastfeeding self‐efficacy who performed early initiation of breastfeeding were less likely to introduce early commercial milk formula. However, this practice was not influenced by early initiation of breastfeeding among those with low breastfeeding self‐efficacy. Support from healthcare providers regarding breastfeeding difficulties was positively associated with the outcome indicating the need to improve the quality of the service.

ObjectivesA high dairy protein intake in infancy, maternal pre-pregnancy BMI, and delivery mode are documented early programming factors that modulate the later risk of obesity and other health outcomes, but the mechanisms of action are not understood.MethodsThe Childhood Obesity Project is a European multicenter, double-blind, randomized clinical trial that enrolled healthy infants. Participating infants were either breastfed (BF) or randomized to receive higher (HP) or lower protein (LP) content formula in the first year of life. At the ages 5.5 years (n = 276) and 8 years (n = 232), we determined plasma metabolites by liquid chromatography tandem-mass-spectrometry of which 226 and 185 passed quality control at 5.5 years and 8 years, respectively. We assessed the effects of infant feeding, maternal pre-pregnancy BMI, smoking in pregnancy, delivery mode, parity, birth weight and length, and weight gain (0–24 months) on the metabolome at 5.5 and 8 years.ResultsAt 5.5 years, plasma alpha-ketoglutarate and the acylcarnitine/BCAA ratios tended to be higher in the HP than in the LP group, but no metabolite reached statistical significance (Pbonferroni>0.09). There were no group differences at 8 years. Quantification of the impact of early programming factors revealed that the intervention group explained 0.6% of metabolome variance at both time points. Except for country of residence that explained 16% and 12% at 5.5 years and 8 years, respectively, none of the other factors explained considerably more variance than expected by chance.ConclusionsPlasma metabolome was largely unaffected by feeding choice and other early programming factors and we could not prove the existence of a long term programming effect of the plasma metabolome.

Exclusive breastfeeding in the first six months of life and continuation of breastfeeding until the second year are recommended for the healthy growth and development of infants and young children. However, the use of commercial milk formula has increased in recent decades in low and middle-income countries, including Nepal. Understanding the trends and determinants is crucial for designing evidence-based and context-specific infant and young child feeding support programs. There is limited evidence on the use of commercial milk formula in Nepal. Therefore, this study aimed to explore the trends and prevalence of commercial milk formula feeding practices and their associated factors among mothers of children aged 0-23 months in Nepal. We used data from four consecutive nationally representative surveys (2006, 2011, 2016, and 2022). A total weighted sample of 7,705 (0-5 months: 1,978; 6-23 months: 5,727) children aged 0-23 months was included in the analysis. The trends were presented as frequency distributions. Multivariable logistic regression was performed to assess the association between individual and underlying factors with commercial milk formula feeding in the first two years of life. For enhanced analytical clarity and programmatic relevance, we stratified our analysis into two distinct age groups: 0-5 months and 6-23 months. Over the study period (2006-2022), the prevalence of commercial milk formula feeding among infants aged 0-5 months increased steadily from 1.95% (95% confidence interval (CI): 0.83-4.55) to 11.09% (95% CI: 8.01-15.16). A similar but less upward trend was observed among children aged 6-23 months, with prevalence rising from 2.03% (95% CI: 1.26, 3.27) to 6.68% (95% CI: 5.26, 8.45). Among 0-5 months, infants born to mothers with secondary and higher education (adjusted odds ratio (aOR): 12.48; 95% CI: 2.63, 59.14), mothers aged 25-34 years (aOR: 2.29; 95% CI: 1.14, 4.60), and born by caesarean section (aOR: 2.16; 95% CI: 1.01, 4.59) were more likely to receive formula feeding compared to their counterparts. Similarly, among 6-23 months, children who were male (aOR: 1.67; 95% CI: 1.15, 2.42), perceived as small at birth (aOR: 2.76; 95% CI: 1.48, 5.15), first born (aOR: 2.59; 95% CI: 1.02, 6.56), born in health facilities (aOR: 3.18; 95% CI: 1.16, 8.73), and whose fathers had secondary or higher education (aOR: 3.14; 95% CI: 1.22, 8.10) were more likely to receive commercial milk formula. The prevalence of commercial milk formula feeding practices has increased during 2006-2022. Evidence-informed, context-specific interventions are essential to halt and reverse commercial milk formula feeding practices and protect, promote, and support breastfeeding and recommended infant feeding practices. A program designed to address this issue should target vulnerable groups and leverage the specific factors identified in this study.

ObjectivesTo quantify infant mortality rates (IMR) using expanded racial categories, and to examine associations between infant formula exposure, housing instability and postneonatal mortality among Minnesota WIC Participants.MethodsBirths in Minnesota from 2014 through 2019 (n = 404,102) and associated infant death records (n = 2034) were used to calculate neonatal and postneonatal rates using expanded racial categories. Those births that participated in the WIC program (n = 170,011) and their linked death records (n = 853) were analyzed using logistic regression to examine associations between formula exposure, housing instability, and postneonatal death.ResultsPostneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28 days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2–4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364 days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4).Conclusions for PracticeDisaggregating Black mortality rates revealed inequities in infant mortality among Black families of varied backgrounds. Formula exposure and housing instability are modifiable risk factors associated with postneonatal mortality. Appropriate interventions to reduce barriers to breastfeeding and provide housing stability for vulnerable families could reduce disparities in postneonatal mortality.SignificanceWhat is Already Known on This Subject?Large disparities in infant mortality rates by race and ethnicity persist in the U.S. population. Other factors are known to increase the risk of infant mortality, including prematurity, smoking, mother’s nativity (country of mother’s birth) and education level, and breastfeeding exclusivity. Less is known about the factors impacting postneonatal mortality.What This Study Adds?Disaggregation of standard race and ethnicity categories reveals hidden disparities in postneonatal infant mortality. Two less studied factors, housing instability and exposure to infant formula by 28 days of days, are associated with postneonatal mortality.

ObjectivesBeginning in February 2022, the United States faced an infant formula shortage that severely impacted access and affordability. Little is known about how this shortage impacted infant feeding intentions among expectant mothers. Our study sought to determine the impact of the formula shortage on prenatal feeding intentions and to understand expectant mothers’ feelings and perceived stress related to the shortage.MethodsThis cross-sectional, exploratory, observational study of pregnant women (n = 57) residing in New York City utilized a self-administered online survey in May–July 2022.ResultsThe results indicate that ten (17.5%) respondents changed their feeding intentions during the infant formula shortage for months 0–3 or 3–6 of infancy to include more breastfeeding than originally intended. These mothers also reported significantly higher stress levels related to the shortage than their non-changing peers.Conclusions for practiceOur results suggest that the formula shortage influenced feeding intentions among a subset of surveyed expectant mothers. The stress associated with the shortage influenced prenatal feeding intentions to include more breastfeeding than intended prior to the shortage. Prenatal healthcare providers should consider the availability of infant formula as one of myriad factors that influence infant feeding intentions, and that the stress associated with whether infant formula is readily available may influence these intentions as well.SignificanceNumerous factors, including social, cultural, and economic influences, can shape prenatal infant feeding intentions. Our results suggest that availability of infant formula may be an additional element in this decision-making process. Our study found that the 2022 infant formula shortage influenced expectant mothers to include more breastfeeding in their feeding plans than they had originally intended as a result of the shortage. To our knowledge, there has been no research published that examines the effect of an infant formula shortage on the feeding intentions of expectant mothers.

Formula feeding is providing infants with prepared formula as an alternative to or alongside breastfeeding. While breast milk is widely regarded as the optimal source of nutrition for infants, formula feeding is a common practice. The recommended approach is exclusive breastfeeding for the first six months, followed by the introduction of complementary foods after that period, which is crucial for child growth and development. Formal feeding has a negative impact on an infant's health, causing malnutrition and other illnesses. Therefore, this study was investigated to assess formula feeding and determinant factors among mothers with infants in six sub-Saharan African countries. A total weighted sample of 26,119 mothers with infants and young children less than two years was included in this study. The data were taken from a recent demographic and health survey in six sub-Sahara African countries. A multilevel, multivariable logistic regression model was used to identify the determinant factors associated with formula feeding. In the multivariable analysis, the adjusted odds ratio with a 95% CI was used to declare a statistically significant association with formula feeding among mothers with infants. In this study, the proportion of mothers with infants who use formula feeding was 17.1%. In multilevel logistic analysis (model III), the significant factors associated with formula feeding were the age of the mothers; 25-34 years (AOR = 1.3; 95% CI (1.2-1.41)), 35-49 years (AOR = 1.4; 95% CI (1.22-1.54)), multiple children (AOR = 1.4; 95% CI (1.23-1.77)), maternal educational status; secondary and higher (AOR = 2.4; 95% CI (2.11-2.66)), mother's employment status; (AOR = 1.24; 95% CI (1.14-1.5));, richer households (AOR = 1.2; 95% CI (1.10-1.36)), place of delivery (AOR = 2.1; 95% CI (1.83-2.44)), household media exposure (AOR = 1.5; 95% CI (1.3-1.68))place of residence (AOR = 1.97; 95% CI (1.79-2.17)), community illiteracy level (AOR = 1.17; 95% CI (1.02-1.34)), and community media exposure (AOR = 1.2; 95% CI (1.03-1.38)). Formula feeding among mothers with infants in Sub-Saharan Africa has emerged as a public health concern. The recommended approach is to promote exclusive breastfeeding for the first six months, followed by the introduction of complementary feeding after that period. Factors associated with formula feeding include older maternal age, secondary and higher education, delivery in health institutions, employment status, higher household income, twin births, urban residence, low community illiteracy rates, and increased community media exposure. Stakeholders and health policymakers should be focused on strategies to improve breast feeding and discourage infant formula feeding.

International provisions are in place to restrict marketing practices that idealise the use of commercial milk formula (CMF) and discourage breastfeeding. In high‐income countries, women of lower socioeconomic position (SEP) are less likely to breastfeed. This study aimed to characterise the nature of exposure to CMF marketing in the UK, the extent to which women hold positive beliefs about CMF and examine the relationship between exposure to CMF marketing, holding positive beliefs about CMF and SEP. Data on these topics were collected for 1052 pregnant women and mothers of children under 18 months of age between February 2020 and February 2021. Participants were assigned a ‘CMF marketing score’ according to the number of locations where they recalled seeing advertisements, engaging with companies or receiving promotional activity. The extent to which women held positive beliefs about CMF (‘CMF positivity score’) was determined by level of agreement with 17 statements. Principal component analysis, analyses of covariance and regression analyses were applied. Every woman reported exposure to CMF marketing from multiple channels. CMF marketing score did not vary across SEP groups (p = 0.342). Women of lower and middle SEP held stronger CMF positive beliefs than women of higher SEP, including ‘Breastfeeding and formula feeding provide a baby with the same health benefits’ (p < 0.005). CMF marketing score was not associated with CMF positivity score. Marketing suggesting CMF provides benefits similar to, or greater than, breastfeeding should be restricted to help mitigate current inequalities in infant feeding practices. All women in this UK study reported exposure to formula milk marketing. Women of lower and middle socioeconomic position (SEP) were more likely than those of higher SEP to believe formula provides equal or greater benefits than breastfeeding. Tighter legislation is needed to restrict marketing suggesting formula is breastmilk equivalent/superior. Summary Every woman in this UK sample reported exposure to commercial milk formula (CMF) marketing, including frequently seeing advertisements on TV and receiving pop‐up advertisements on social media. Women of lower and middle socioeconomic position held stronger beliefs that CMF provides the same or greater benefits than breastfeeding than women of higher SEP. No association was found between the number of forms of CMF marketing women were exposed to and holding more positive beliefs about CMF. To support a reduction in infant feeding inequalities, detailed legislation is needed to restrict marketing that suggests CMF provides equal or superior benefits to breastfeeding.

Background: Human milk (HM) offers critical short- and long-term benefits for preterm and very low birth weight (VLBW) infants. In 2021, a human milk bank (HMB) was established at the IRCCS Giannina Gaslini Institute, aiming to improve HM feeding rates in this vulnerable population. Methods: We retrospectively analyzed feeding data from 442 VLBW infants (BW < 1500 g) admitted between 2018 and 2024. Data were drawn from the Vermont Oxford Network and Italian Neonatal Network registries. Feeding modalities—exclusive HM, infant formula milk (IM), and mixed feeding (MF)—were recorded and analyzed before and after HMB introduction. Results: Before 2021, MF was predominant, with exclusive HM rates below 10%. Following HMB implementation, exclusive HM feeding increased significantly, reaching 47.2% in 2024 (p < 0.0001). Regression analysis showed a positive trend for HM (+4.84%/year, p = 0.05), and a declining trend for IM (−1.96%/year) and MF (−2.88%/year). Projections suggest HM rates may exceed 58% by 2030. Conclusions: The introduction of the HMB was associated with a significant shift in feeding practices, increasing HM use and reducing IM exposure among VLBW infants. These findings underscore the importance of institutional strategies such as donor milk availability, lactation support, and maternal education in optimizing neonatal nutrition. Ongoing efforts are essential to sustain and extend these improvements beyond NICU discharge, ensuring the long-term benefits of human milk for preterm infants.

Introduction Breastfeeding (BF) is the healthiest form of nutrition for babies and is recommended exclusively (EBF) for at least the first six months of life. The carbon footprint of formula feeding (FF) has been studied, but that of BF is unknown. Aim To identify the environmental impact of three types of infant feeding taking into account the accessories needed and the diet of postpartum women in the baby’s first month of life. Methods This is a multicentre, cross-sectional study conducted in the Barcelona North Metropolitan Area (Catalonia, Spain). The participating sites are primary care settings that will recruit 408 postpartum women (4–6 weeks) as per inclusion/exclusion criteria. The data will be collected through a GREEN MOTHER Survey that includes 4 dimensions: 1) socio-demographic and clinical data; 2) data on the newborn and accessories used in infant feeding; 3) general data on the mother's diet (food consumption habits), and 4) recording of 24 h of the mother’s diet. The data analysis will be performed to check the prevalence of infant feeding types at birth and month 1, as well as a comparative analysis of three types of infant feeding on environmental impact (climate change; water consumption, and scarcity). Ethics. This project was approved by the Research Ethics Committee of the Jordi Gol i Gurina University Institute Foundation for Primary Health Care Research (IDIAP) under code 22/101-P dated 22/02/2023. Discussion A second phase of the GREEN MOTHER study is planned, which will consist of an educational intervention to promote breastfeeding, nutrition and sustainability. This intervention will be based on the results obtained in Phase I. We expect that the project results – through the publication and dissemination of scientific papers and reports among relevant stakeholders (association of community midwives, healthcare and primary care attention professionals and the public) – will increase public awareness of breastfeeding and its impact on sustainability. Trial registration Both phases of the GREEN MOTHER study protocol were registered in ClinicalTrials.gov, NCT05729581.