Karen Harris

Karen Harris is a professional writer and editor with more than two decades of experience in research-driven nonfiction writing. With a background in journalism and a Master's degree in English, she brings a meticulous approach to fact-finding, source evaluation, and clear communication of complex topics. Her work spans health, lifestyle, and consumer education, always with a focus on accuracy and readability.

Context

Rapid or excess weight gain (RWG) during the first two years of life is associated with an increased risk of later childhood and adult overweight and obesity. Formula-fed infants are more likely than breastfed infants to experience rapid weight gain.


Potential mechanisms include:

  • Formula nutrient composition (e.g., protein content)

  • Mode of feeding (e.g., bottle characteristics)

  • Parental feeding practices (e.g., overfeeding, adding cereals)

This systematic review examined associations between formula feeding practices and rapid weight gain in infancy.

Study Overview

Design: Systematic review (PRISMA-guided)


Population: Infants fed formula during the first year of life


Included Studies: 18 studies


Exposure Pathways Examined:

  • Nutrient composition (e.g., protein content, hydrolyzed formula)

  • Mode of feeding (e.g., bottle size, bottle feeding frequency)

  • Parental feeding practices (e.g., adding cereals to bottles, putting infant to bed with bottle, feeding on schedule vs demand, overfeeding)

Outcome: Rapid or excess weight gain in the first two years of life (definitions varied across studies)


Quality Assessment: Mixed Methods Appraisal Tool (MMAT)

Key Findings

Protein Content

Lower-protein formula may reduce the likelihood of rapid weight gain compared with higher-protein formula.
Evidence was based on a limited number of randomized controlled trials.


Hydrolyzed Formula

Some evidence suggested hydrolyzed formula may reduce rapid weight gain, possibly through enhanced satiety mechanisms.
Findings were limited and not definitive.


Adding Cereals to Bottles

Some studies found a positive association between adding cereal to bottles and rapid weight gain, though findings were not consistent across all studies.


Bottle Size

Use of larger bottles may be associated with increased weight gain in some studies. Smaller bottles (<177 ml) were suggested as a potential intervention in one study.


Overfeeding

Higher formula intake and encouraging bottle emptying were associated with rapid weight gain in some studies, though measures relied heavily on parent-reported data.


Putting Infant to Bed With Bottle

One study found an association between bottle-to-bed practices and rapid weight gain, while others did not.


Scheduled vs Demand Feeding

Evidence was inconsistent regarding whether feeding on demand or on a schedule was associated with rapid weight gain.


Limitations

  • Substantial variation in definitions and measurement of rapid weight gain.

  • Many studies relied on parent-reported feeding practices and infant weight measures.

  • Limited number of randomized controlled trials.

  • Heterogeneity in exposure measurement and study design.

  • Incomplete control for confounding factors such as timing of solid food introduction.

  • Focus restricted to rapid weight gain within the first two years.

Neutral Interpretation

There is limited and heterogeneous evidence suggesting that certain formula feeding practices and higher protein content may contribute to rapid weight gain in infancy. However, the current evidence base is insufficient to support firm clinical recommendations.

Full Citation

Appleton J, Russell CG, Laws R, Fowler C, Campbell K, Denney-Wilson E.
Infant formula feeding practices associated with rapid weight gain: A systematic review.
Maternal & Child Nutrition. 2018.
PMID: 29655200.
Available via PubMed: https://pubmed.ncbi.nlm.nih.gov/29655200/

Disclosure

This summary is based on the published systematic review.
It is provided for informational purposes only and does not constitute medical advice.