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Title: Developmental assessments during the first 5 years of life in infants fed breast milk, cow's milk formula or soy formula

Author
item BELLANDO, JAYNE - Arkansas Children'S Nutrition Research Center (ACNC)
item MCCORKLE, GINGER - Arkansas Children'S Nutrition Research Center (ACNC)
item SPRAY, BEVERLY - Arkansas Children'S Nutrition Research Center (ACNC)
item SIMS, CLARK - Arkansas Children'S Nutrition Research Center (ACNC)
item Badger, Thomas
item CASEY, PATRICK - Arkansas Children'S Nutrition Research Center (ACNC)
item SCOTT, HOLLY - Chenal Family Therapy
item BEALL, SARAH - Chenal Family Therapy
item SORENSEN, SETH - Arkansas Children'S Nutrition Research Center (ACNC)
item ANDRES, ALINE - Arkansas Children'S Nutrition Research Center (ACNC)

Submitted to: Food Science and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/17/2020
Publication Date: 5/13/2020
Citation: Bellando, J., Mccorkle, G., Spray, B., Sims, C.R., Badger, T.M., Casey, P.H., Scott, H., Beall, S.R., Sorensen, S.T., Andres, A. 2020. Developmental assessments during the first 5 years of life in infants fed breast milk, cow's milk formula or soy formula. Food Science and Nutrition. https://doi.org/10.1002/fsn3.1630.
DOI: https://doi.org/10.1002/fsn3.1630

Interpretive Summary: Breastfeeding is considered the ideal source of infant nutrition and is exclusively recommended until age 6 months. However, the differential effects of breastfeeding and formula-feeding on language and cognitive development remain understudied. In this study, we analyzed 504 mother and infant pairs. Parents, following the advice of their pediatricians, made decisions about which diet to feed their infant before enrolling in the study. Study visits included in this report were performed at 3, 12, 24, 36, 48 and 60 months. Family demographics were obtained upon enrollment. Mothers participated in a brief assessment of intelligence as well as a general assessment of psychiatric wellbeing and family environment at the 3-month visit. The mental and motor development of the children were measured at the 3, 12 and 24-month visits. Language assessments of the children were completed at each study visit, and their general intellectual functioning was evaluated at ages 48 and 60 months. Our results demonstrate that all feeding groups scored within normal limits for all assessments, indicating that formula feeding does not result in clinically detrimental outcomes with respect to cognitive function and language development. While results suggested a statistically significant advantage for breastfed children on tests of language and cognition with differences in performance noted between feeding groups to age 5 years, these are very small in magnitude and not of clinical relevance at these ages. Our findings reveal a short-term advantage for breastfed children over soy formula-fed in motor development as well as more long-term significant differences between children fed breast milk and those fed cow's milk formula and soy formula in language development and cognition when accounting for important confounders.

Technical Abstract: To investigate the effects of infant feeding mode on childhood cognitive and language skills as the differential effects of infant feeding on development remain understudied. Breastfed [BF, 174], cow's milk-based formula fed [MF, 169], or soy protein-based formula fed [SF, 161] children age 3 to 60 months were tested for cognitive and language measures. Data were analyzed by mixed models while adjusting for sex, race, gestational age, parental education, maternal IQ, and cohesion score. Standard scores were within established norms for all groups. There were no differences in mental development to age 24 months, yet BF children had significantly higher motor development scores at age 3 months than SF children (99.1 vs. 97.2). BF children had significantly higher composite intelligence scores at 48 months than MF and SF children (113.4 vs. 109.6 and 108.4, respectively) and higher verbal intelligence scores than SF children at 48 (105.6 vs. 100.7) and 60 months (109.8 vs. 105.9). Greater total language scores at ages 36 and 48 months were found in BF children compared to children fed MF or SF (p<0.001). Higher total language scores at age 60 months were found between BF and SF as well (105.0 vs. 100.1). Breastfeeding during infancy led to small, but statistically significant, differences in children between ages 3 and 5 years in the areas of verbal intelligence, expressive communication, and auditory comprehension with the latter having potential sexual dimorphic effects. In general, MF and SF did not significantly differ.