Formula Overfeeding and Weight Status Among Infants and Toddlers from a WIC Clinic in Puerto Rico
Authors: Amaro‐Rivera Kiara , Palacios Cristina 
Published: November 2023

ObjectiveSeveral studies have shown that formula‐fed or mixed‐fed infants have an increased risk of being overweight or obese later in childhood. This study evaluated the association between formula overfeeding and weight status in a sample of Hispanic infant and toddler participants of the WIC program.MethodsA convenience sample of 296 infants and toddlers aged 0 to 24 months were recruited from a WIC clinic in Trujillo Alto, Puerto Rico. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ). For descriptive analyses, frequency was used. To assess differences between infants and toddlers who were formula‐fed or breastfed/given other milks, a t‐test was done. A Pearson Correlation was used to assess the association between milk‐feeding, sociodemographic characteristics, and weight‐for‐length z‐score to adjust for the final model. A multiple linear regression was done to assess the relationship between formula feeding as well as formula overfeeding and weight‐for‐length z‐scores for these infants and toddlers.ResultsAmong the 296 infants and toddlers, 292 complied with our inclusion criteria. From the total sample, 54.3% percent were boys, 19.0% were at risk of overweight, and 7.6% were overweight or obese. At the moment of the questionnaire, 53.4% were formula‐fed, while 46.7% were non‐formula‐fed (breastfed or drank other milks such as cow's milk, soy milk or others). There was a significant difference between the formula‐fed and non‐formula‐fed groups for age of the baby and education of the parents (p‐value <0.05), as younger children drank more formula and parents of formula‐fed infants had lower education than parents of the other group. When associated with weight status, no significant difference was found between both groups. Among the formula‐fed group, 14.8% had intake above the recommendations. When the overfed group was compared to the formula‐fed group, no significant differences were found, even when analyzed by age groups. No associations were found for overfed infants and toddlers and weight status.ConclusionNo association was found between formula overfeeding and weight status in this sample. Parents of infants and toddlers who were formula fed had less education than parents who were breastfeeding or giving their children other milks. As overweight and obesity are a public health issue affecting more children from minorities and lower income populations in the United States, it is important to understand this problem in order to create effective interventions to encourage healthy eating practices. Future studies should evaluate parents' knowledge regarding formula feeding in infants.Support or Funding InformationThis study was conducted with support from University of Puerto Rico Central Administration Grant, Capacity Advancement in Research Infrastructure, UPR‐MFP 6251123 and in part by Awards 8G12MD007600 and 2U54MD007587 from the National Institute on Minority Health and Health Disparities. There is no conflict of interest to disclose.