VERY HIGH WEIGHT GAIN IN EXCLUSIVELY BREASTFED INFANTS

Background: Breastfed infants have, except for the first two months, lower weight gain and are shorter and thinner at 12 mo compared to formula-fed infants. Lower protein content in breastmilk and better appetite regulation have been suggested as causes. Furthermore, breastfed infants gain more fat during the first 6 mo and more lean mass from 6-12 mo, compared to formula fed infants. A high weight gain during early infancy is associated with later obesity, but it is not known how breastfeeding influence this association. A recent case report (Grunewald Ann Nutr Metab 2014) showed excessive weight gain during full breastfeeding and suggested that the high protein and adiponectine content they found in milk at one year could be the cause. We present two cases referred to us because of excessive weight gain during exclusive breastfeeding.
Methods: Weight and length were measured by health visitors, family doctors and at our institute. Breastmilk intake was estimated by weighing (using prefeeding and postfeeding infant weighing) during 2-4 24h periods (Tanita BD 815 MA). Breastmilk macronutrient content was measured by mid-infrared human milk analyzer (Miris AB, Sweden).
Results: Case 1: boy, birth weight 3.8 kg. Weight-for-age curve in Fig 1. Exclusively breastfed until 5 mo, and stopped breastfeeding at 11 mo. At 5.5 mo milk intake was about 1100 ml (91ml/kg) and milk macronutrient content (4 samples foremilk and 4 hindmilk (g/100 ml)): fat foremilk 0.4-2.1, hindmilk 4.3-6.9, protein foremilk: 0.6-0.8. Case 2: girl, birth weight 4.45 kg. Weight-for-age curve in Fig 2. Exclusively breastfed until 5 mo Still partially breastfed at last measurement at 8 mo. At 4 mo milk intake was about 1500 ml (128ml/kg) and milk macronutrient content (g/100 ml) measured on 4 complete emptying of a breast: fat 2.4-3.8, protein 0.7-0.8.
None of the infants had clinical signs of syndromes. Weight was plotted on WHO Growth Standards.