Reducing bottle use doesn’t prevent toddler weight gain

Toddlers who continue to use bottles beyond 12 to 15 months of age tend to be overweight. But simply switching them to sippy cups may not prevent extra weight gain, a new study finds.

Doctors recommend introducing sippy cups at six months and weaning toddlers off bottles completely by the time they’re 15 months old.

But 20 percent of two-year-olds and 10 percent of three-year-olds in the U.S. continue to use bottles, often drinking five bottles of whole milk every day, researchers said.

“Bottles can become a vessel for extra, or ‘stealth’ calories, because they are often used indiscriminately. For example, while in a stroller, or to put a child to bed,” Karen Bonuck told Reuters Health in an email. She led the new study at Albert Einstein College of Medicine in Bronx, New York.

“Before you know it, a child can take in 150 calories of whole milk in a bottle on top of their regular diet,” Bonuck said.

The researchers wanted to see if giving parents educational materials as part of a program called ‘Proud to Be Bottle Free’ and a sippy cup would reduce the number of bottles kids used and the calories they consumed.

They enrolled 300 pairs of parents and 12-month-olds at two Bronx Women, Infants, and Children (WIC) sites.

Reducing bottle use doesn't prevent toddler weight gain To be eligible for the study, children had to be consuming more than two bottles of milk or juice every day. The participants were randomly split into two groups: a bottle-weaning group that received the materials and sippy cup and a comparison group that did not.

The research team checked in with parents over the next year to find out how many bottles kids were consuming every day, as well as what else they ate and drank.

One hundred and four parent and child pairs completed the study.

After three months, bottle usage had dropped from 4.6 bottles per day to two bottles per day among kids in the bottle-weaning program. There was a smaller drop in the comparison group, from 4.4 bottles per day to 2.7, on average.

Sippy cup usage increased more in the bottle-weaning group.

By one year, toddlers in both groups were averaging about one bottle per day.

Kids in the bottle-weaning program consumed slightly fewer calories - 1,090 calories per day, on average, versus 1,186 among comparison children. But the difference was small enough that it could have been due to chance.

The program did not lower toddlers’ chances of being overweight, according to results published in The Journal of Pediatrics.

“At first we were surprised that there was no effect upon overweight status,” Bonuck said, “but looking at the data more closely, this seems partially attributable to the substitution of sippy cups for bottles in the intervention group.”

She thought the program’s benefits might also have been clearer had fewer families left the study early.

“Had we achieved our optimal sample size, and included messages about sippy cups, I would suspect this would have affected our overweight status outcomes,” Bonuck said.

She said the advice to wean toddlers off bottles by 15 months should be extended to sippy cups.

“They seem to just substitute for bottles well into the second and third years of life. In addition, we need to develop guidelines for liquid intake - including the proper balance of liquid versus solids during the second year of life,” she said.

“Around one year of age, a child should be getting much of his/her nutrition through food,” Angela Lemond told Reuters Health in an email.

A dietician and spokesperson for the Academy of Nutrition and Dietetics, she was not involved in the new research.

Lemond said breast milk, toddler formulas, whole milk and four to six ounces of 100-percent juice each day are all good choices for toddlers.

Beverages not on the recommended list for toddlers include low-fat milk or sweetened flavored milks like chocolate or strawberry, sport drinks, soda and other caffeinated beverages.

The World Health Organization recommends exclusive breastfeeding - without any formula, other milk or solid food - until a baby is six months old, followed by breastfeeding with the addition of appropriate foods through age two.

SOURCE: The Journal of Pediatrics, online November 4, 2013


Bottle-Weaning Intervention and Toddler Overweight

To evaluate 3 research questions: (1) Does a Women, Infants, and Children (WIC)-based counseling intervention reduce (milk) bottle use?; (2) Does this intervention reduce energy intake from bottles?; and (3) Does this intervention reduce the risk of a child being >85th percentile weight-for-length?

Study design
Parents of n = 300 12-month-olds consuming >2 bottles/d were randomized to a bottle-weaning intervention or control group. Nutritionists at WIC Supplemental Feeding Program sites delivered the intervention. Researchers assessed dietary intake and beverage container use via computer-guided 24-hour recalls, and anthropometrics at 15, 18, 21, and 24 months old. Intent-to-treat analyses controlled for baseline measures of outcomes and months post-baseline.

At 1 year follow-up, the intervention group had reduced use of any bottles (OR = 0.23, 95% CI = 0.08-0.61), calories from milk bottles (OR = 0.36, 95% CI = 0.18-0.74), and total calories (β = −1.15, P = .043), but did not differ from controls in risk of overweight status (ie, >85th percentile weight-for-length (OR = 1.02, 95% CI = 0.5-2.0). The intervention group’s decreased bottle usage at 15 and 18 months was paralleled by increased “sippy cup” usage.

A brief intervention, during WIC routine care, reduced early childhood risk factors for overweight - bottle use and energy intake - but not risk of overweight. The intervention group’s increased use of sippy cups may have attenuated an intervention effect upon risk of overweight. Toddlers consume a high proportion of their calories as liquid. Parents should be counseled about excess intake from bottles and sippy cups. WIC is an ideal setting for such interventions.

  Karen Bonuck, Phd,
  Sivan Ben Avraham, MS,
  Yungtai Lo, PhD,
  Richard Kahn, PhD,
  Christel Hyden, EdD

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