Duration of Breastfeeding, but Not Timing of Solid Food, Reduces the Risk of Overweight and Obesity in Children Aged 24 to 36 Months: Findings from an Australian Cohort Study.
ABSTRACT: This study aimed to determine whether breastfeeding duration and the timing of solid food were independently associated with being overweight or obese in early childhood. Subjects were 953 children participating in the Study of Mothers and Infants Life Events Affecting Oral Health (SMILE) birth cohort study, based in Adelaide, Australia. Socio-demographic information and data on breastfeeding duration and age of introduction of solid food were collected at birth, 3, 4, 6, 12, and 24 months via mailed or online questionnaires completed by mothers. The weight and height of children were measured at a dental examination when children were aged between 24 and 36 months. Body mass index was calculated, and children were categorised into weight groups according to the World Health Organization growth standards. Multivariable logistic regression analysis was conducted, adjusting for maternal age at birth, education, socio-economic status, pre-pregnancy weight, smoking in pregnancy, method of delivery, and child's birthweight. Risk of overweight/obesity was independently associated with maternal pre-pregnancy BMI, smoking in pregnancy, and birthweight. Children that were breastfed for 12 months or more had a significantly lower risk of being overweight/obese than those breastfed for less than 17 weeks (AOR 0.49; 95%CI 0.27, 0.90; p for trend =0.009). Age of introduction of solid food, however, was not associated with the risk of being overweight/obese at 24 to 36 months. This study provides further evidence of an inverse relationship between breastfeeding and risk of overweight/obesity, however, no association with the timing of solid food was detected.
Project description:Research on the association between breastfeeding and childhood obesity and research on racial/ethnic differences in breastfeeding both show inconsistencies. The current study examines: 1) whether immigrant Hispanic women have higher rates of breastfeeding compared to non-Hispanic (three separate groups: African-American, Asian/Pacific Islander, and White) and U.S.-born Hispanic women; 2) whether children who were breastfed are less likely to be overweight/obese compared to children who were not breastfed; and 3) whether associations between breastfeeding and weight status vary by race/ethnicity/nativity. The study builds on prior literature using representative data from the Geographic Research On Wellbeing study (GROW, 2012-2013) and focusing on ages 5-10 years, an age group that has not been well studied (N = 2675 mother/child dyads). Logistic regression was used to investigate the odds of child obesity (?95th%) and child overweight (?85th%) in a series of models: unadjusted (each variable individually), demographic (child's sex, child's age, mother's age, mother's race/ethnicity, and mother's marital status), socioeconomic status (mother's education and family income), and full model (mother's BMI); with breastfeeding included in all models. Interactions between race/ethnicity and breastfeeding duration were also examined. African-American (9.54%) and white (32.8%) women had the lowest and highest rates of ever breastfeeding, respectively. White women breastfed the longest (M = 10.52 months, SE = 0.028) and U.S.-born Hispanic women breastfed the shortest (M = 7.05 months, SE = 0.41), on average. Children of African-American and U.S.-born Hispanic mothers had higher odds of being overweight/obese (74-75%) compared with children of white mothers. No associations were found between breastfeeding duration and child's weight status in adjusted models, nor was there a significant interaction between mother's race/ethnicity and breastfeeding duration on child's weight status; however, mother's own weight status was a significant driver of child's weight status and explained the racial/ethnic disparities. These results provide evidence in favor of there being no association between breastfeeding and childhood obesity.
Project description:<h4>Introduction</h4>Adverse prenatal development is a contributor to obesity susceptibility in children. Dietary behavior is one mechanism through which adverse prenatal development may promote obesity, but evidence for the role of prenatal overnutrition in dietary intake in young children is scant.<h4>Methods</h4>We used data from the National Health and Nutrition Examination Survey 2009-2014. Our study sample included 1782 U.S. children 2-5 years old with available birth weight and two 24-h dietary recalls. We used linear and Poisson regression to examine the association of birth weight (LBW < 2500 g, HBW > 4100 g) and 2-day average intake of dietary variables. We tested interactions between birthweight and breastfeeding (breastfed > 5 months vs. not breastfed or breastfed 0-5 months), and report breastfeeding-specific results.<h4>Results</h4>In multivariable regression analysis, in boys, LBW was associated with 2.4 (95% CI - 4.3, - 0.5) lower percent of kcal from solid fat; lower sugar intake, marginally lower saturated and total fat intake, and 0.6 cup (95% CI 0.1, 1.0) greater vegetable consumption; HBW was marginally associated with lower fat. Birth weight was unrelated to diet in girls. Breastfeeding modified associations between birth weight and dietary intake, but the direction of modification was mixed.<h4>Discussion</h4>Our findings do not support the hypothesis that LBW or HBW are associated with adverse diet consumption in preschool age U.S. children. Improved understanding of the role of early life development of dietary behavior requires further research on the development of appetitive traits and the role of the family and preschool food environments.
Project description:<h4>Background</h4>In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity.<h4>Objectives</h4>It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children.<h4>Method</h4>Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed.<h4>Results</h4>The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ?6 months (94.4%) and exclusively breastfed for ?6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ?6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies.<h4>Conclusion</h4>The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.
Project description:Postpartum weight retention (PWR) is a risk factor for future obesity. The role of breastfeeding in reducing PWR is not fully understood. We examined the relationship between PWR and the duration of exclusive/partial breastfeeding in 52,367 postpartum women from 2012-2016 Taiwan national breastfeeding surveys. The women were interviewed at 7-14 months postpartum. Non-linear models were fit to examine the association between PWR and breastfeeding duration. PWR adjusted means and 95% confidence intervals were plotted and compared for the duration of exclusive/partial breastfeeding in the total sample and between pre-pregnancy body-mass index (BMI) groups (underweight, normal, overweight, and obese). Women who breastfed exclusively for >30 days showed significantly lower PWR than those who did not breastfeed and those who breastfed partially for the same duration, thereafter each additional duration of 30 days being associated with an average of 0.1-0.2 kg less PWR. Women who breastfed partially for 120 days showed lower PWR than those who did not or those who ceased to breastfeed, thereafter each additional duration of 30 days being associated with an average of 0.1 kg less PWR. Duration of breastfeeding needed to achieve significantly less PWR differed between pre-pregnancy BMI groups, but the effect of exclusive breastfeeding appeared earlier in the normal weight group. Women with obesity who breastfed exclusively for >30 or partially for >180 days, had lower PWR than non-obese groups. The observed dose-response relationship between breastfeeding duration and PWR supports the "every feeding matters" approach in breastfeeding promotion. The larger effect of exclusive and partial breastfeeding on PWR in women with obesity may draw special attention of breastfeeding promotion.
Project description:<b>Background:</b>Globally, the prevalence of child stunting has been decreasing over the past decades. However, in low- and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting.<br><br><b>Objective:</b>To examine the association between breastfeeding (defined as never breastfed, any breastfeeding for <6 months, and any breastfeeding for ?6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under -2 standard deviations of the World Health Organization child growth standards' median) in Mexico.<br><br><b>Methods:</b>Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6-35 months with information on previously identified risk and protective factors for stunting. We conducted fixed- and mixed-effects logistic regression models sequentially controlling for each level of factors.<br><br><b>Findings:</b>Overall, 12.3% of children were stunted and 71.1% were breastfed for ?6 months. Any breastfeeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models.<br><br><b>Conclusions:</b>According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.
Project description:<h4>Background</h4>Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany.<h4>Methods</h4>We analyzed retrospectively collected data on breastfeeding from children aged 3-17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity.<h4>Results</h4>Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for >4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71–0.92]) and obesity (OR 0.75 [95% CI 0.61–0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration [corrected].Further analyses stratified by age group showed that the association was strongest in children aged 7-10 years (OR 0.67 [95% CI 0.53-0.84] for overweight and OR 0.56 [95% CI 0.39-0.81] for obesity), while no significant effect could be seen in other age groups.<h4>Discussion</h4>Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.
Project description:OBJECTIVE:The objective of the study is to determine the status of infant and young child feeding (IYCF) in Sub-Saharan Africa (SSA) based on multiple indicators. DESIGN:Secondary data analysis of 32 Demographic and Health Surveys conducted in SSA since 2010. SETTING:Thirty-two countries in SSA. PARTICIPANTS:151 575 infants and young children born in the preceding 2 years of the surveys. INDICATORS DETERMINED:Eight core and six optional IYCF indicators. RESULTS:Majority (95.8%) of the children born in the preceding 24 months were ever breastfed, and 50.5% initiated breastfeeding within the first hour of birth. Among infants 0-5 months of age, 72.3% were predominantly breastfed and 41.0% were exclusively breastfed. Continued breastfeeding at 1 year (89.5%) was reasonably high, but only 53.7% continued breastfeeding at 2 years and 60.4% had age-appropriate breastfeeding. About two-thirds (69.3%) of infants 6-8 months of age received solid, semisolid or soft food over the previous day across the countries. Among children 6-23 months of age, 41.9% met the minimum recommended meal frequency, while smaller proportions satisfied the minimum dietary diversity (21.0%) and acceptable diet (9.8%). About one-third (37.6%) of children 6-23 months of age consumed iron-rich or iron-fortified food over the previous day. Among non-breastfed children, only 15.0% received the recommended two or more milk feedings. Thirteen per cent were fed with a bottle with a nipple in the previous day. Country-level estimates for most indicators showed remarkable variations. Yet the minimum dietary diversity and acceptable diet indicators were consistently low. CONCLUSION:Most breastfeeding-related indicators, except exclusive and early initiation of breastfeeding, are in an acceptable level in SSA. However, complementary feeding indicators are generally low.
Project description:<h4>Background</h4>Cumulative evidence indicates an association between maternal overweight and gestational diabetes with delayed breastfeeding initiation; however, the presence of both conditions simultaneously has been little explored. This study aims to investigate the interaction between maternal overweight/obesity and gestational diabetes on breastfeeding initiation.<h4>Methods</h4>This study comprises data from the IVAPSA Birth Cohort, a prospective follow-up of mothers and their newborns. Two of the five groups from IVAPSA were evaluated, considering women with and without gestational diabetes. These women were further categorized according to their pre-pregnancy body mass index as normal weight or overweight/obese.<h4>Results</h4>219 women were evaluated, 53.4% of them had pre-pregnancy overweight/obesity and 32% had gestational diabetes. Most women were able to initiate breastfeeding within 12 hours from delivery (92.7%) and only eight (3.7%) women had not breastfed in the first 24 hours postpartum. Of these, seven were overweight/obese (77.8%) and five had gestational diabetes (66.7%), with four of them having overweight/obesity and gestational diabetes concomitantly. Women with both adverse conditions had an adjusted relative risk of delayed breastfeeding initiation of 1.072 (95% CI 1.006; 1.141), p = 0.032.<h4>Conclusions</h4>The results indicate an additive interaction between maternal pre-pregnancy overweight/obesity and gestational diabetes on delayed breastfeeding initiation.
Project description:Breastfeeding rates in the United States are low, and one possible reason may be the high prevalence of overweight/obesity among women of childbearing age. This analysis examined the association between pregravid body mass index and breastfeeding duration, and explored whether depressive symptoms, perceived stress and anxiety during pregnancy mediated this relationship. Participants (n = 550) in the Pregnancy, Infection and Nutrition Postpartum Study were recruited through prenatal clinics prior to 20 weeks gestation and followed to 12 months post-partum. Duration of any breastfeeding was categorized as none, less than 4 months, 4-6 months, 7-12 months and more than 12 months (referent). Exclusive breastfeeding was categorized as less than 1 month, 1 to less than 4 months and 4 months or more (referent). Being overweight/obese before pregnancy (35.7% of 550) was inversely associated with the durations of any and exclusive breastfeeding. Women who entered pregnancy overweight or obese were more likely to not initiate breastfeeding [relative risk ratio (RRR)=5.39 (95% confidence interval: 2.41, 12.04)] and to breastfeed less than 4 months [RRR=2.38 (1.33, 4.27)] compared with women of normal weight status. Among women who initiated breastfeeding, being overweight or obese vs. normal weight was related to exclusively breastfeeding less than 1 month [RRR=2.09 (1.24, 3.51)]. We did not find evidence to support mediation by depressive symptoms, perceived stress or anxiety during pregnancy. Future research needs to explore the reasons behind the association between overweight/obesity and breastfeeding duration.
Project description:<h4>Introduction</h4>Exclusive breastfeeding is among the most effective interventions for preventing child mortality. The objectives of this paper are to describe infant feeding knowledge and practices in Boucle du Mouhoun, Burkina Faso; to identify predictors of exclusive breastfeeding among infants <6 months, and consumption of soft, semi-solid or solid food among infants 6-11 months; to describe mothers' sources of information regarding breastfeeding.<h4>Methods</h4>A cross-sectional survey (n = 2288) of a representative sample of women aged 15-49 years with at least one live birth in past year took place during June and July 2015. Crude and multivariable random-effects logistic regressions were used to identify factors predictive of exclusive breastfeeding and consumption of soft, semi-solid or solid food.<h4>Results</h4>30% of infants <6 months were exclusively breastfed; 67% of infants age 6-11 months consumed soft, semi-solid or solid food the day and night before the interview. 2% of infants age 6-11 months had a minimum acceptable diet. There was strong evidence of a positive association between knowledge and practice of exclusive breastfeeding, nonetheless 60% of mothers who correctly identified that an infant should be exclusively breastfed for 6 months did not breastfeed their infant exclusively. Only 42% of mothers reported receiving advice on breastfeeding from a health worker, despite all mothers having contact with a health worker at least once during pregnancy or postpartum.<h4>Conclusion</h4>Given poor practices and low levels of knowledge, targeted interventions are needed to improve infant nutrition in Boucle du Mouhoun during antenatal, delivery and postnatal care. Most women now deliver in a facility in Burkina Faso; increased attention should be paid to ensuring that existing guidelines relating to support and counselling for infant feeding are adhered to. Factors such as social norms are also important and these should be investigated in more detail using qualitative methods.