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Review
. 2010 Jan;6(1):38-52.
doi: 10.1111/j.1740-8709.2009.00186.x.

Inappropriate bottle use: an early risk for overweight? Literature review and pilot data for a bottle-weaning trial

Karen A Bonuck  1 , Vincent Huang, Jason Fletcher
Affiliations
Review

Inappropriate bottle use: an early risk for overweight? Literature review and pilot data for a bottle-weaning trial

Karen A Bonuck et al. Matern Child Nutr. 2010 Jan.

Abstract

Identifying early risk factors for childhood obesity is critical, as weight in infancy and early childhood tracks to later periods. Continued bottle use - primarily from excess milk intake - is emerging as a potential risk factor for early childhood overweight. Over three fourths of US infants drink from bottles beyond the recommended weaning age of 12 months, and two thirds of UK infants use a bottle at 18 months. This paper is divided into three parts. Part 1 reviews the literature on beverage intake, weight and bottle use in young children. Part II describes pilot data on milk bottle use and weight in 12-60-month-olds, collected prior to a randomized controlled (RCT) trial of a bottle-weaning intervention. Median daily milk bottle consumption at 12 months was 5.0 (interquartile range = 3-6). Among 12-36-month-olds, current users were significantly more likely to be >95th% weight-for-height (19% vs. 0%, P < 0.02), and more were >85% weight-for-height (27% vs. 11%, P < 0.11), vs. non-users. In contrast, current bottle use was not associated with either overweight or obesity in 37-60-month-olds. Part III describes the RCT, begun in fall 2008. It is enrolling 464 parent/12-month-old dyads from a nutrition assistance programme for low-income families. Children's bottle use, anthropometrics, dietary intake and nutrient density (via 24 h recall) are assessed quarterly through 24 months of age. For the intervention, site nutritionists employ a project-developed, visually attractive flip chart. An observational study nested within the RCT will describe dietary changes during this period of feeding transitions.

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Conflict of interest statement

Key messages

  1. •

    Prolonged and excessive bottle use is a potential, but little researched risk factor for overweight in infancy and early childhood.

  2. •

    Our pilot data from 150 low‐income multi‐ethnic toddlers support prior work finding that bottles are associated with excess milk intake and a higher risk of obesity in younger children.

  3. •

    A randomized controlled trial of a bottle‐weaning intervention and observational study of how continued bottle use into the second year of life affects children's dietary patterns, feeding behaviours and weight, nested within this trial, are described.

Figures

Figure 1
Figure 1
Number of milk bottle users by age, entire sample (n = 150).
Figure 2
Figure 2
Amount of current daily milk bottles* by age, all observations (n = 150). *Box plots present interquartile ranges; medians contained within the interquartile range.
Figure 3
Figure 3
Amount of current daily milk bottles* by age: current users only (n = 90). *Box plots present interquartile ranges; medians contained within the interquartile range.
See this image and copyright information in PMC

References

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    1. Alexy U., Sichert‐Hellert W., Kersting M., Manz F. & Schöch G. (1999) Fruit juice consumption and the prevalence of obesity and short stature in German preschool children. Journal of Pediatric Gastroenterology and Nutrition 29, 343–349. - PubMed
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    1. American Academy of Pediatric Dentistry (2003) Policy on Early Childhood Caries (ECC): classifications, consequences, and preventive strategies. (Revised 2003) Reference Manual 2005–2006. Available at: http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf (accessed 17 March 2009).
    1. American Heart Association (2007) Dietary Recommendations for Children. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3033999 (accessed 18 June 2008).

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