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3 Heart Research Center, Oregon Health and Science University, Portland, OR 97239; 4 MRC Epidemiology Resource Center, University of Southampton, SO16 6YD Southampton, UK; 5 National Public Health Institute, FIN 00300 Helsinki, Finland; and 6 University of Helsinki, FIN-00014 Helsinki, Finland
* To whom correspondence should be addressed. E-mail: djpbarker{at}gmail.com.
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ABSTRACT |
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 TOP ABSTRACT Breast-Feeding and ObesityMethodsResultsDiscussionLITERATURE CITED |
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Breast-Feeding and Obesity |
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TOPABSTRACTBreast-Feeding and ObesityMethodsResultsDiscussionLITERATURE CITED |
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Different types of analyses have been done to avoid confounding variables. One example is sibling analysis (2,6). Gillman et al. (2) reported that observations on siblings discordant for duration of breast-feeding supported the hypothesis that breast-feeding was protective against overweight in adolescence. Sibling analysis controls for many maternal variables, but the issue remains unresolved. Kramer et al. (7) presented results in this symposium showing that, in an interventional trial, prolonged and exclusive breast-feeding was unrelated to BMI in childhood. There are few data linking the duration of breast-feeding with body composition in adult life.
In Hertfordshire, UK, in the 1920s and 1930s, a health visitor routinely visited each baby and collected information on breast-feeding, infant weights, and growth (8). A sample of men born in Hertfordshire was examined at the mean age of 70 y. There was no difference in the BMI of those who had been bottle-fed, breast- and bottle-fed, or exclusively breast-fed, and neither was there a difference in the BMI of those exclusively breast-fed for <1 y or >1 y (9). Compared with men who were weaned off breast milk before 1 y of age, those who were not weaned had higher total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B concentrations and higher death rates from coronary heart disease. Here we present data from the Helsinki Birth Cohort, in which we examined the association between duration of breast-feeding and later BMI and adiposity by comparing people with their siblings breast-fed for different lengths of time.
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Methods |
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TOPABSTRACTBreast-Feeding and ObesityMethodsResultsDiscussionLITERATURE CITED |
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Eighty-four percent of sibling pairs in the full cohort had been breast-fed. We excluded anyone who had not been breast-fed from further analysis. This resulted in 1823 breast-fed individuals belonging to sibships. Of those participants that responded to the questionnaire, 831 had been breast-fed and belonging to sibships. When only 1 individual of a sibling pair responded, neither sibling was included in the questionnaire analysis. Similar criteria were employed for the clinic visit data, resulting in the analysis of 129 clinic attendees in sibships.
Statistical analysis
We divided individuals into 4 categories based on the duration of breast-feeding; <2 mo, 3 to 4 mo, 5 to 7 mo, or >8 mo. We compared siblings who were discordant for the duration of breast-feeding using a linear mixed model that allowed for the correlation of BMI and percentage body fat among members of the same sibship. Indicator variables for breast-feeding groups were included as fixed effects in the linear mixed model, with the 5- to 7-mo group as the baseline for comparison. A P-value of <0.05 was considered significant for a linear or quadratic trend. All data were adjusted for sex, year of birth and sibship size.
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Results |
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TOPABSTRACTBreast-Feeding and ObesityMethodsResultsDiscussionLITERATURE CITED |
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We investigated the relation between the duration of breast-feeding and BMI during childhood (Table 1). At age 1 y, there was a progressive fall in BMI with increasing length of breast-feeding (P < 0.05 for linear trend). This association had disappeared by age 7 (P = 0.50). Breast-feeding had no effect on height in childhood (data not shown).
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Among those subjects who had attended clinics where BMI and percentage body fat had been recorded, a U-shaped association was found between duration of breast-feeding and current BMI (Table 3). The highest BMIs were observed in those siblings breast-fed for the shortest period, <2 mo, or for the longest, 8 mo or more (P = 0.08 for quadratic trend). There is a significant U-shaped association between duration of breast-feeding and percentage body fat (P = 0.03 for quadratic trend).
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Discussion |
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TOPABSTRACTBreast-Feeding and ObesityMethodsResultsDiscussionLITERATURE CITED |
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Consistent with other studies of babies born 60 and more years ago, we found that those in poorer families tended to be breast-fed for longer (9). One reason for this is that breast-feeding was used as a method of contraception (9). In those days women who breast-fed their babies for different periods of time differed in many respects. Reported associations between length of breast-feeding and BMI in childhood and adolescence could therefore be the result of confounding variables including diet and physical activity in childhood. Sibling analysis controls for many potential confounding variables. The limitation of our analyses is that only siblings who are discordant for the length of breast-feeding contribute information.
Breast-feeding for 2 mo or less could have been deleterious because the alternative feeding was harmful. We have no information on what foods other than breast milk were given to the infants in our study. The infants were born before modern formulas became available and at a time when there were food shortages in Finland. Another possible explanation for the association between short duration of breast-feeding and high BMI and fat mass is that there are growth factors or hormones in breast milk that program the baby in ways that protect against excessive fat deposition in later life.
An explanation for the association between prolonged breast-feeding and high body fat is that prolonged exposure to maternal hormones in breast milk may permanently reset lipid metabolism. In the Hertfordshire cohort, prolonged breast-feeding is associated with high serum cholesterol concentrations in later life (9). Hertfordshire women breast-fed for longer than 1 y had increased free thyroxine concentrations (12). Thyroid hormones have been implicated in the regulation of circulating lipoprotein concentrations (13). Studies in baboons have shown that, 1 y after weaning, those who were breast-fed had higher thyroxine concentrations than those who were bottle-fed (14). When given a high-cholesterol diet, these breast-fed baboons had alterations in cholesterol metabolism that were more atherogenic than those in baboons that had been formula-fed (15). We speculate that the association between prolonged breast-feeding, beyond the usually recommended period, is associated with persisting alterations in lipid metabolism, which become evident as a high fat mass and atherogenic lipid profile in later life.
Other articles in this supplement include references (16–18).
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FOOTNOTES |
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2 Supported by the British Heart Foundation, the Academy of Finland, the Paivikki and Sakari Sohlberg Foundation, the Finnish Diabetes Research Foundation, the Finnish Foundation for Cardiovascular Research, the Finnish Medical Society Duodecim, Yrjo Jahnsson Foundation, and Finska Lakaresällskapet. This substudy was funded by the International Formula Council.
3 Author disclosures: P. O'Tierney received compensation from the Infant Formula Council for speaking at the symposium; D. J. P. Barker and E. Kajantie received funding for this research from the International Formula Council; C. Osmond and J. G. Eriksson, no conflicts of interest.
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LITERATURE CITED |
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TOPABSTRACTBreast-Feeding and ObesityMethodsResultsDiscussionLITERATURE CITED |
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1. Weyermann M, Rothenbacher D, Brenner H. Duration of breastfeeding and risk of overweight in childhood: a prospective birth cohort study from Germany. Int J Obes (Lond). 2006;30:1281–7.[Medline]
2. Gillman MW, Rifas-Shiman SL, Camargo CA Jr, Berkey CS, Frazier AL, Rockett HR, Field AE, Colditz GA. Risk of overweight among adolescents who were breastfed as infants. JAMA. 2001;285:2461–7.
3. Grummer-Strawn LM, Mei Z. Does breastfeeding protect against pediatric overweight? Analyis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance Sytem. Pediatrics. 2004;113:e81–6.
4. Mayer-Davis EJ, Rifas-Shiman SL, Zhou L, Hu FB, Colditz GA, Gillman MW. Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Diabetes Care. 2006;29:2231–7.
5. Owen CG, Martin RM, Whincup PH, Davey Smith G, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115:1367–77.
6. Nelson MC, Gordon-Larsen P, Adair LS. Are adolescents who were breast-fed less likely to be overweight? Analyes of sibling pairs to reduce confounding. Epidemiology. 2005;16:247–53.[CrossRef][Medline]
7. Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z, Dzikovich I, Shishko G, Collet JP, et al. Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial. Am J Clin Nutr. 2007;86:1717–21.
8. Syddall HE, Aihie SA, Dennison EM, Martin HJ, Barker DJ, Cooper C. Cohort profile: the Hertfordshire cohort study. Int J Epidemiol. 2005;34:1234–42.
9. Fall CH, Barker DJ, Osmond C, Winter PD, Clark PM, Hales CN. Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease. BMJ. 1992;304:801–5.
10. Eriksson J, Forsen T, Osmond C, Barker D. Obesity from cradle to grave. Int J Obes Relat Metab Disord. 2003;27:722–7.[CrossRef][Medline]
11. Eriksson J, Forsen T, Tuomilehto J, Osmond C, Barker D. Size at birth, childhood growth and obesity in adult life. Int J Obes Relat Metab Disord. 2001;25:735–40.[CrossRef][Medline]
12. Phillips DI, Barker DJ, Osmond C. Infant feeding, fetal growth and adult thyroid function. Acta Endocrinol (Copenh). 1993;129:134–8.
13. Heimberg M, Olubadewo JO, Wilcox HG. Plasma lipoproteins and regulation of hepatic metabolism of fatty acids in altered thyroid states. Endocr Rev. 1985;6:590–607.
14. Mott GE, Lewis DS, Jackson EM, McMahan CA. Preweaning diet programs postweaning plasma thyroxine concentrations in baboons. Proc Soc Exp Biol Med. 1996;212:342–8.[CrossRef][Medline]
15. Lewis DS, Mott GE, McMahan CA, Masoro EJ, Carey KD, McGill HC Jr. Deferred effects of preweaning diet on atherosclerosis in adolescent baboons. Arteriosclerosis. 1988;8:274–80.
16. Butte NF. Impact of infant feeding practices on childhood obesity. J Nutr. 2009;139:412–6.
17. Adair LS. Methods appropriate for studying the relationship of breast-feeding to obesity. J Nutr. 2009;139:408–11.
18. Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z, Dzikovich I, Shishko G, Collet J-P, et al. A randomized breast-feeding promotion intervention did not reduce child obesity in Belarus. J Nutr. 2009;139:417–21.
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