Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

Jigna M Dharod; Jeffrey D Labban; Helen Tadese; Valerie L Flax; Maureen M Black; Alice S Ammerman

doi:10.1016/j.tjnut.2024.05.004

Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

J Nutr. 2024 May 11:S0022-3166(24)00278-5. doi: 10.1016/j.tjnut.2024.05.004. Online ahead of print.

Authors

Jigna M Dharod¹, Jeffrey D Labban², Helen Tadese², Valerie L Flax³, Maureen M Black⁴, Alice S Ammerman⁵

Affiliations

¹ Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, United States. Electronic address: jmdharod@uncg.edu.
² Office of Research in the School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, United States.
³ RTI International, Research Triangle Park, NC, United States.
⁴ RTI International, Research Triangle Park, NC, United States; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States.
⁵ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

PMID: 38740186
DOI: 10.1016/j.tjnut.2024.05.004

Abstract

Background: Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied.

Objectives: This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo.

Methods: This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end.

Results: Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05).

Conclusions: Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

Keywords: WIC; food assistance cycle; formula feeding; infants; low-income.