Breast Fed Babies Fat Intake 5-7 Mins at Risk
Child Obes. 2022 Jul 1; 14(5): 327–337.
Total Breastfeeding and Obesity in Children: A Prospective Study from Birth to 6 Years
Juan Antonio Ortega-García
onePediatric Environmental Health Speciality Unit, Laboratory of Ecology and Human Health (A5), Department of Paediatrics, Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Espana.
Nicole Kloosterman
anePediatric Ecology Health Speciality Unit, Laboratory of Environmental and Human Health (A5), Section of Paediatrics, Establish of Biomedical Enquiry, IMIB-Arrixaca, Virgen de la Arrixaca Academy Infirmary, Academy of Murcia, Murcia, Espana.
Lizbeth Alvarez
1Pediatric Environmental Wellness Speciality Unit, Laboratory of Environmental and Man Health (A5), Section of Paediatrics, Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Infirmary, Academy of Murcia, Murcia, Espana.
Esther Tobarra-Sánchez
1Pediatric Environmental Health Speciality Unit, Laboratory of Environmental and Human Wellness (A5), Department of Paediatrics, Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca Academy Hospital, Academy of Murcia, Murcia, Spain.
Alberto Cárceles-Álvarez
iPediatric Environmental Wellness Speciality Unit, Laboratory of Environmental and Human Health (A5), Section of Paediatrics, Plant of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Kingdom of spain.
Rebeca Pastor-Valero
onePediatric Environmental Health Speciality Unit of measurement, Laboratory of Ecology and Human Wellness (A5), Department of Paediatrics, Found of Biomedical Enquiry, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain.
Fernando Antonio López-Hernández
2Departamento de Métodos Cuantitativos e Informáticos. Universidad Politécnica de Cartagena, Cartagena, Spain.
Manuel Sánchez-Solis
1Pediatric Environmental Health Speciality Unit of measurement, Laboratory of Environmental and Human Wellness (A5), Section of Paediatrics, Found of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, Academy of Murcia, Murcia, Spain.
Luz Claudio
3Sectionalization of International Health, Mount Sinai School of Medicine, New York, NY.
Abstruse
Background: Obesity is a major public health crunch among both children and adults and contributes to meaning physical, psychological, and economical burden. We aim to investigate the issue of duration of breastfeeding on excessive weight and obesity at six years of age.
Subjects/Methods: Information on breastfeeding and child anthropometric measurements were collected in a nascency-accomplice study in Murcia, Spain (n = 350). Breastfeeding status and body mass index (BMI) were established according to WHO definitions. Other factors potentially related to children's weight were considered. Multiple log-linear and ordinal regressions were used to analyze the effects of breastfeeding on overweight and obesity when considering potential confounders.
Results: 33% and 17.three% of children in the study were of backlog weight and obesity, respectively. Univariate predictors of BMI in children anile 6 were as follows: pregestational maternal BMI (kg/m2) (R two = 0.127, p < 0.01); full breastfeeding (weeks) R 2 = −0.035, p < 0.01); infant weight gain (kg) (R ii = 0.348, p < 0.01); and maternal alcohol consumption during pregnancy (thou/day) (R 2 = 0.266, p < 0.01) at age half dozen. In the ordinal logistic regression, full breastfeeding was associated with a significant decrease in obesity −0.052 (95% CI, −0.ten to −0.003).
Conclusions: The delay of bottle feeding introduction may take a protective effect confronting obesity at 6 years of age. Our findings reinforce the need for greater back up of breastfeeding and to promote a healthy environment and antipoverty interventions during pregnancy and infancy, alongside other strategies for obesity prevention.
Keywords: : breastfeeding, babyhood obesity, babyhood overweight, cohort study, Kingdom of spain
Introduction
Obesity is a major public wellness crisis among both children and adults and contributes to significant physical, psychological, and economic brunt.1 The prevalence of childhood obesity is increasing in both depression- and high-income countries.2,3 In 2010, around one in 3 children in the EU aged 6–nine years were overweight or obese and rates take been increasing since.4 In Espana from 2011 to 2012, the prevalence of babyhood excess weight and obesity was 29.7% and 9%, respectively.five Obesity at an early age ofttimes continues into adulthood and confers a major gamble for insulin resistance, dumb glucose tolerance, hypertension, dyslipidemia, cardiovascular disease, and cancer.6–9
A mounting torso of prove suggests that breastfeeding may besides play a office in programming noncommunicable disease risk afterwards in life. Evidence in the literature analyzing the protective furnishings of breastfeeding against childhood adiposity has yielded controversial conclusions. Some studies have found no significant correlation between breastfeeding and different measures of overweight.10,11 However, other authors accept establish that children who had not been breastfed12,13 or who were breastfed for a shorter period of timexiv,15 showed increased risk of overweight and obesity. Table 1 half-dozen–8,10–24 describes various cohort studies on this topic. Identifying modifiable determinants of babyhood obesity, such as breastfeeding, are critical for developing constructive intervention strategies for this chronic disease.
Table 1.
Accomplice Studies Analyzing Breastfeeding and Other Factors on Obesity6–8,10–24
| Author | Land | Sample size | Report design | Age at measurement | Comparing groups | Outcomes (reference) | OR (CI 95%) |
|---|---|---|---|---|---|---|---|
| O'Callaghan et al.10 | Australia | 2034 | PC | v years | Always breastfed vs. never breastfed | Obesity BMI </ = 94th percentile | 0.71 (0.43–1.25) |
| Armstrong et al.13 | Scottland | 32,200 | RC | 39–42 months | Exclusively breastfed vs. bottle fed at 6–eight months | Obesity (BMI </ = 95th percentile) | 0.72 (0.65–0.79) |
| Bergmann et al.12 | Germany | 1314 | PC | six years | Breastfed for ≥3 months vs. Breastfed for <3 months | Obesity (BMI >97th percentile | 0.46 (0.23–0.92) |
| Grummer-Strawn et al.viii | US | 12,587 | RC | 4 years | Breastfed for ≥12 months vs. Never breastfed | Overweight or Obesity (CDC) | 0.72 (0.65–0.eighty) |
| Burke et al.16 | Australia | 1672 | PC | 1–eight years | Breastfed for ≥12 months vs. Never breastfed | Obesity (CDC) | 1.83 (1.xx–two.78) |
| Dubois et al.17 | Canada | 2103 | PC | 4.v years | Breastfed for >/ = 3 months vs. breastfed for <3 months | Obesity (CDC) | 1.0 (0.7–i.5) |
| Scholtens et al.xviii | Netherlands | 2043 | PC | viii years | Breastfed for >sixteen weeks vs. Breastfed for ≤xvi weeks | Overweight or Obesity (IOTF) | 0.70 (0.27–1.74) |
| Huus et al.eleven | Sweeden | 14,244 | PC | v years | Exclusively breastfed for ≥4 months vs. Exclusively breastfed for <4 months | Obesity (WHO) | 0.82 (0.55–1.23) |
| Kwok et al.19 | People's republic of china | 7026 | PC | seven years | Exclusively breastfed for ≥3 months vs. Never breastfed | Overweight or Obesity (IOTF) | one.09 (0.83–i.43) |
| Shields et al.twenty | Australia | 2533 | PC | 21 years | Breastfed for >iv months vs. Never breastfed | Obesity (WHO) | 0.93 (0.63–one.39) |
| Van Rossem et al.21 | United states | 1579 | PC | 3 years | Exclusively breastfed vs. Mixed vs. canteen fed at 6 months | Obesity (IOTF) | .98 (.87–1.11) |
| McCrory et al.22 | Ireland | 3177 | RC | ix years | Breastfed for ≥26 weeks vs. Never breastfed | Overweight and Obesity (IOTF) | 0.62 (0.39–0.99) |
| Jwa et al.6 | Nippon | 41,572 | PC | 5.v, vii and 8 years | Exclusively breastfed vs. Mixed vs. bottle fed at half-dozen months | Overweight and Obesity (IOTF) | 0.68 (0.53–0.87) |
| Shi et al.vii | Canada | 968 | PC | 6–11 years | Exclusive vs. Non exclusive vs. No breastfeeding at 6 months | Overweight and Obesity (WHO) | 0.44 (0.31–0.63) |
| Yamakawa et al.xiv | Japan | thirty,780 | PC | 7 and 8 years | Partial vs. exclusive breastfeeding at 6–7 months | Overweight and obesity (IOTF) | 0.85 (0.69–one.05) |
| Moss et al.23 | The states | 14,150 | PC | 2 and four years | Breastfed vs. not breastfed measured at 9 months | Obesity (CDC) | 0.64 (0.51–0.80) |
| Wallby et al.15 | Sweeden | 30,508 | PC | 4 years | Breastfed for ≥12 months vs. Never breastfed | Obesity (WHO) | 0.55 (0.34–0.ninety) |
| Wang et al.24 | Us | 1234 | PC | 5 years | Breastfed for ≥6 months vs. Never breastfed | Overweight and Obesity (CDC) | 0.58 (0.36–0.94) |
The mechanisms underlying the association between breastfeeding and obesity highlight iii protective furnishings which may lead to lower body fatty levels in breastfed infants. Breastfeeding helps encourage cocky-regulation of intake, reduce interference of caregivers in creating positive feeding behaviors, and providing necessary chemical components to regulate energy metabolism.25 Human milk contains hormones that moderate free energy metabolism and food intake. Diverse hormones, including leptin, insulin, adiponectin, and obestatin, tin can actuate various pathways that regulate hunger, depending on energy requirements, possibly also via epigenetic processes.26,27Also, the benign effects of breastfeeding on obesity could exist mediated partly by programming a healthier composition of gut microbiome, inducted by some breast milk components (nondigestible oligosaccharides).28 Differences in hormone and protein content betwixt breast milk and formula may play a role in increasing risk of excess weight and obesity.26 Also, recommendations have been made to study way of administration and its impact on childhood obesity to make up one's mind its role in appetite regulation regardless of substance consumed.15
This commodity uses the MALAMA (Medio Ambiente y Lactancia Materna) longitudinal population-based accomplice to analyze the relationship between breastfeeding and babyhood outcomes.29,30 In this study, nosotros examined the relationship betwixt the elapsing of breastfeeding and body mass index (BMI) at 6 years of historic period in a Mediterranean Region, accounting for other factors that influence obesity.
Materials and Methods
Study Participants
Murcia is a European region located in southeast Kingdom of spain, with a total population of 1,472,000 inhabitants (259,083 < fifteen years) in 2013.31 The study was conducted within 4 health areas (one, half dozen, seven, and 9) whose reference maternity hospital is the Clinical Academy Hospital "Virgen de la Arrixaca" with a reference population of 747,233 persons and 8150 newborns per twelvemonth.
MALAMA is an ongoing longitudinal, prospective cohort written report from birth until 18 years of age that examines the relationship betwixt breastfeeding elapsing and childhood evolution. The MALAMA projection follows 430 female parent–child pairs, from 2 population-based nativity cohorts.29,30,32 This report was based on the second de novo MALAMA cohort, where 350 mother–kid pairs were randomly selected ane out of ii subsequently giving nascence at Clinical University Hospital "Virgen de la Arrixaca" between June 10 and July 20, 2009.thirty,32 The central location of the maternity hospital facilitates ease of admission to cohort for follow-upwardly for all newborns and family in the written report. The MALAMA project was approved by the Ideals Committee and the Institutional Review Board of the Clinical University Hospital "Virgen de la Arrixaca."
The participants included in this report were good for you newborns built-in total-term (>37 weeks of gestation), weighing >2500 yard at the study hospital, offset built-in, and with Apgar test given at i minute and 5 minutes with a minimum score of 7 and 8, respectively. Participants were excluded from the study if a telephone number was unavailable to contact the parents, newborns were admitted to the neonatal unit during the first 48 hours, and a linguistic barrier was nowadays that was unable to be overcome either due to the lack of an available interpreter or the inability to hold a conversation.
Recruitment and the first interview were conducted contiguous with either the mother or both parents nowadays at the fourth dimension of neonatal discharge. In add-on, face-to-face interviews were conducted at both the first month and the 24th month. They were interviewed by a nurse trained in breastfeeding and research methodology, utilizing a advisedly developed questionnaire known as "la hoja verde" or the "green page" (GP). GP on reproductive environmental health includes the standard clinical record of meaning or lactant women and constitutes a serial of curtailed and basic question through which the healthcare professional person identifies environmental exposure during these periods.33–35 Follow-upwards was done through a series of phone calls at 1, 3, half dozen, and 12 months. Up to five phone calls were placed to establish contact with the study participants earlier lost to follow-up. A scheduled well-child care physical examination includes anthropometric measures at 1, ii, 4, and half-dozen years old. The anthropometric measurements of children at vi years were obtained from a growth monitoring plan inside the pediatric primary care unit of measurement from the kid ambulatory history. Well-child visit programs are an of import tool utilized by healthcare providers to screen for medical and developmental bug.36
From the 350 mother–newborn dyads randomly recruited, 15 did non encounter the inclusion criteria and 327 dyads (97.6%) agreed to participate in the written report. There were three couples (1%) who were lost to follow-up at 1 year and 1 (0.3%) that abandoned the study at 1 year. Of the remaining children, 324 provided information regarding full breastfeeding, and data regarding BMI at vi-year marking was available in 231 (71.iii%) children for the study.
Baby Feeding Practice
Information were collected on breastfeeding, every bit defined by the World Wellness Arrangement (WHO) recommendations. "Exclusive breastfeeding" (EBF) ways that the baby receives only breast milk, no other liquids or solids are given, and "Full breastfeeding" (FBF) includes exclusive (no other liquid or solid is given to the infant) and most exclusive (vitamins, mineral h2o, juice, or ritualistic feeds are given infrequently in addition to breastfeeds or non-nutritive foods).37 The duration of full breastfeeding was noted until the date bottle-feeding was first introduced. Any Breastfeeding (ABF) is the elapsing of lactation. The analysis of breastfeeding duration was used as a continuous quantitative variable measured equally days that mother spent: EBF, FBF, and ABF.
Child'southward Overweight and Obesity Status
Anthropometric measurements, obtained from well-child examinations, included weight and peak. To counterbalance and mensurate children, standardized measurement procedures were used with the following equipments: <2 years: baby calibration SECA 717 (to the nearest two g) with measuring rod 231 (to the nearest one mm) and >2 years: apartment calibration SECA 872 (to the nearest l yard) and mobile stadiometer SECA 217 (to the nearest 1 mm).
BMI was calculated using the following formula: weight (kg)/height (1000)2. Childhood excess weight and obesity was defined using kid growth standards established by the WHO. Using this measure, childhood excess weight is divers every bit BMI > one standard deviation body mass alphabetize (BMI) for age and sex, overweight is divers equally values betwixt one and 2 standard deviations BMI for historic period and sex activity, and obesity defined as BMI > two standard deviations BMI for age and sex.38
Covariates
The following sociodemographic and exposure factors studied were obtained from GP: sex, nascence weight, weight gain in first year of life, maternal age, pregestational maternal BMI, mother'due south booze consumption during pregnancy (during 2d–3rd trimester), and smoking during early pregnancy and one-year postpartum. In addition, nationality (native/foreign), parental education level (no education-primary/secondary/university), family income in euros (€) per month (<800/800–1500 €/1501–2500 €/>2500 €), and maternal employment type during periconceptional catamenia were studied.
Statistical Analysis
The information analysis was computed utilizing the Statistical Package for the Social Sciences version 21(SPSS, Chicago, IL)39 and the mgcv R package. First, univariate analyses were performed. To obtain predictor variables, the comparisons of all variables with excess weight and obesity were fabricated using Chi-squared tests, ANOVA test, Pearson's correlation, and Spearman'due south rho correlation. Significant results are reported alongside descriptive statistics in Tabular array 2. A log-linear regression analysis was performed, in which the outcome variable was BMI at 6 years old. Analyses included variables that were significantly (p < 0.05) associated with backlog weight or obesity in the univariate analyses at age 6. We use Generalized Condiment Models (GAMs) to identify circuitous nonlinear relationships betwixt the response and explanatory variables.twoscore Using results from the GAM model, nosotros used an ordinal logistic regression to model the nonlinear human relationship between variables. For both the log-linear regression and ordinal logistic regressions, nosotros utilized 192 participants for whom we had responses for all variables and anthropomorphic measurements. Nosotros found no statistically significant differences in socioeconomic status (SES), "Full breastfeeding" and mother pregestational BMI between this group and those lost during the follow-upwardly. Effects were considered statistically meaning with p-value <0.05 and ORs with a 95% CI that did not include 1.
Table 2.
Descriptive Statistics of Written report Sample
| Variable | n | N (%) | Hateful (CI 95%) | Correlations a , p-value | ANOVA t-examination | RR (CI 95%) univariate |
|---|---|---|---|---|---|---|
| Child BMI at six years | 231 | n.a. | 16.36 (xvi.06–16.67) | n.a. | n.a. | northward.a. |
| Obesity status at 6 years | ||||||
| Normal weight | 156 | (67.five) | northward.a. | north.a. | n.a. | n.a. |
| Overweight | 35 | (fifteen.two) | n.a. | north.a. | north.a. | north.a. |
| Obese | forty | (17.3) | n.a. | n.a. | n.a. | n.a. |
| EBF (weeks) b | 324 | n.a. | vii.56 (6.55–eight.58) | −0.16, 0.01 | n.a. | −0.04 (−0.07 to −0.01) |
| FBF (weeks) b | 324 | n.a. | eleven.64 (ten.45–12.84) | −0.17, <0.01 | n.a. | −0.04 (−0.06 to −0.01) |
| ABF (weeks) | 323 | due north.a. | 27.96 (25.45–thirty.46) | 0.02, 0.76 | n.a. | |
| Sexual practice of kid | 324 | 0.24 | ||||
| Male | 177 (54.7) | n.a. | north.a. | north.a. | ||
| Female | 147 (45.iii) | n.a. | n.a. | n.a. | ||
| Birth weight (g) | 324 | n.a. | 3270 (3230–3320) | 0.10, 0.14 | north.a. | northward.a. |
| Weight gain start year (kg) b | 287 | north.a. | 6.86 (half-dozen.71–seven.01) | 0.26, 0.01 | northward.a. | 0.48 (0.24–0.72) |
| Maternal origin | 324 | 0.52 | ||||
| Native built-in | 262 (81) | northward.a. | n.a. | n.a. | ||
| Strange born | 62 (xix) | n.a. | n.a. | n.a. | ||
| Maternal age (y) | 324 | north.a. | 31.57 (31.00–32.14) | −0.06, 0.34 | northward.a. | northward.a. |
| Maternal Pre-Gestational BMI b | 219 | n.a. | 24.59 (23.96–25.23) | 0.26, <0.01 | n.a. | 0.48 (0.24–0.72) |
| Maternal smoking | ||||||
| Periconceptional b | 324 | |||||
| Smoking | 204 (63.0) | n.a. | northward.a. | 0.03 | 0.69 (0.06–1.32) | |
| Non Smoking | 120 (37.0) | north.a. | northward.a. | n.a. | northward.a. | |
| Cigarettes/calendar week | n.a. | 27.90 (22.66–33.13) | 0.twenty, <0.01 | n.a. | 0.01 (0.00–0.02) | |
| Postnatal (1 year) b | 323 | |||||
| Smoking | 84 (26.0) | n.a. | northward.a. | 0.01 | 0.88 (0.xix–1.58) | |
| Not smoking | 239 (74.0) | north.a. | n.a. | n.a. | north.a. | |
| Cigarettes/week | n.a. | 12.79 (9.55–xvi.04) | −0.06, 0.67 | n.a. | n.a. | |
| Maternal booze intake (Pregnancy) b | 324 | 0.xvi | ||||
| Yes | 37 (11.4) | 5.09 (3.24–6.94) | n.a. | north.a. | ||
| No | 287 (88.half dozen) | north.a. | due north.a. | |||
| Alcohol (Grams/Mean solar day) | n.a. | 0.23, <0.01 | 0.21 (0.09–0.32) | |||
| Maternal Occupation | 324 | 0,fifteen | ||||
| outside the home | 158 (48.9) | due north.a. | n.a. | due north.a. | ||
| at dwelling | 165 (51.i) | n.a. | n.a. | n.a. | ||
| Education level: Mother b | 324 | 70 (21.6) | n.a. | −0.17, 0.01 | 0.05 | Ref |
| None/Primary | 154 (47.5) | n.a. | −0.thirteen (−0.93 to | |||
| Secondary | n.a. | 0.67) | ||||
| University | 100 (thirty.9) | −0.86 (−1.75 to −0.02) | ||||
| Instruction level: Male parent b | 324 | −0.nineteen, <0.01 | 0.04 | |||
| None/principal | 93 (29.8) | n.a. | Ref | |||
| Secondary | 144 (46.ii) | due north.a. | −0.37 (−ane.01 to 0.34) | |||
| University | 75 (24.0) | n.a. | −ane.08 (−1.96 to −0.24) | |||
| Family internet income (€/month) b | 323 | −0.26, <0.01 | <0.01 | |||
| <800 | 38 (11.8) | north.a. | i.64 (0.46–2.81) | |||
| 800–1499 | 124 (38.4) | due north.a. | 1.31 (0.50–ii.xiii) | |||
| 1500–2500 | 93 (28.8) | north.a. | 0.61 (−0.22 to 1.44) | |||
| >2500 | 68 (21.1) | n.a. | Ref | |||
Results
The median elapsing of FBF was 63.5 days and 21% of children were FBF at least half dozen months. The prevalence of ABF at 12 months was 19.ii%. At vi years of age, 32.eight% and 17.7% of children were categorized equally beingness of excess weight and obesity, respectively. Descriptive statistics of sociodemographic variables are shown in Table 2. Children who had high weight proceeds in their first year of life and whose mothers who had higher BMI, smoked, or drank alcohol during pregnancy, parents with low educational attainment were more likely to be of excess weight than those who didn't take these factors. Children who were exclusive or full breastfed were less likely to be of excess weight or obese at this age in the univariate analysis.
Predictors variables of BMI in children aged 6 years by log-linear regression are shown in Table 3. Pregestational maternal log BMI (kg/grand2) (R 2 = 0.127, p < 0.01); total breastfeeding (weeks) R two = −0.035, p < 0.01); babe weight gain (kg) (R 2 = 0.348, p < 0.01); and maternal booze consumption during pregnancy (g/24-hour interval) (R two = 0.266, p < 0.01) were found to be predictive of excess weight at historic period half dozen.
Table 3.
Log-Linear Regression of Trunk Mass Index with Predictor Variables in Children Anile half dozen Years
| Predictor variable | Regression coefficient | 95% confidence interval | p value |
|---|---|---|---|
| Exclusive BF (weeks) | 0.021 | −0.028 to 0.070 | 0.44 |
| FBF (weeks) | −0.035 | −0.065 to −0.006 | 0.01 |
| Whatsoever BF (weeks) | 0.007 | −0.007 to 0.028 | 0.28 |
| Maternal BMI (kg/g2) | 0.127 | 0.058–0.197 | <0.01 |
| Infant weight gain (kg) | 0.348 | 0.072–0.624 | 0.01 |
| Alcohol consumption during pregnancy (g/d) | 0.266 | 0.123–0.408 | <0.01 |
| Mother smoking during periconceptional (cig/w) | 0.004 | −0.005 to 0.013 | 0.41 |
| Female parent smoking (dichotomous) | −0.191 | −i.314 to 0.933 | 0.74 |
| Female parent education | −0.004 | −0.604 to 0.596 | 0.99 |
| Father pedagogy | 0.186 | −0.368 to 0.739 | 0.51 |
| Cyberspace income | −0.396 | −0.860 to 0.068 | 0.09 |
Effigy 1 shows results from GAM model that analyzed linear trends or functional human relationship between log BMI and four variables. Maternal pregestational BMI, infant weight gain, and maternal consumption were constitute to have a nonlinear relationship (r or the polish term >2). Because of this a multivariate ordinal logistic assay was conducted and results tin be seen in Table four. An increment in full breastfeeding (expressed in weeks) was associated with a decrease in overweight/obese of −0.052 (95% CI, −0.x to −0.003). Maternal BMI and weight proceeds in the first twelvemonth of life were also associated with an increment in overweight/obese of 0.093 (95% CI, 0.023 to −0.163) and .407 (95% CI, 0.172 to −0.642), respectively. Family income and parental educational activity were not statistically significant in this model. However, information technology is observed an inverse relationship between level of income at birth and average BMI at 6 years old. In our written report, 12% of children belong to families living in relative poverty in 2009; and the proportion of obese is significantly higher amongst the poor (33.3%) than rich individuals (eleven.5%). While not pregnant, we observed a growing risk of high BMI as income declines.
GAMs to identify the form of the functional relationship betwixt the log BMI at 6 years and the explanatory variables. (A) There is a linear relationship with full breastfeeding (r = 1); There is a nonlinear human relationship (r >/ = ii) with (B) maternal pregestational BMI (C) infant weight proceeds and (D) maternal booze consumption. BMI, body mass alphabetize; GAM, generalized additive model.
Table four.
Ordinal Regression: Take chances Factors Associated with Overweight/Obesity at 6 Years
| CI 95% | |||||
|---|---|---|---|---|---|
| Variable | Wald | Significance | Regression coefficient | Min | Max |
| EBF (weeks) | 0.912 | 0.34 | 0.027 | −0.29 | 0.083 |
| FBF (weeks) a | 4.151 | 0.04 | −0.052 | −0.x | −0.003 |
| ABF (weeks) | 2.626 | 0.11 | 0.015 | −0.003 | 0.032 |
| Maternal BMI (Kg/thou2) | half dozen.791 | <0.01 | 0.093 | 0.023 | 0.163 |
| Weight proceeds first year of life (m) a | 5.731 | 0.01 | 0.407 | 0.172 | 0.642 |
| Booze intake during pregnancy (chiliad/d) | three.637 | 0.05 | 0.136 | 0.024 | 0.236 |
| Periconceptional maternal smoking (cig/week) | 0.001 | 0.97 | 0.003 | −0.003 | 0.009 |
| Monthly net income <800 € | i.592 | 0.17 | 1.173 | −0.594 | two.739 |
| 800–1499 € | 1.149 | 0.28 | 0.575 | −0.597 | ii.039 |
| 1500–2500 € | 0.383 | 0.53 | 0.051 | −0.881 | i.560 |
| Maternal University Education (Yes/No) | 0.134 | 0.71 | −0.160 | −1.020 | 0.700 |
| Paternal University Education (Yep/No) | 0.007 | 0.93 | −0.036 | −0.907 | 0.835 |
Discussion
Our study shows that childhood obesity is a significant public wellness concern in the Region of Murcia: 1/3 of children had excess weight, similar to other results in this region.41 Nosotros observed a small, yet statistically pregnant, protective effect of FBF on obesity in 6-year-one-time children. A reduction of 3.5% of BMI in 6-year-quondam children past each week increase of FBF was observed, while the other variables in the model are held constant. More complex is the interpretation of ordinal regression model coefficients. Example of FBF, i calendar week increase in FBF resulted in a 5.two% decrease in the ordered log-odds of being in a college BMI category, while the other variables in the model are held constant. The protective dose–response effect of breastfeeding on overweight or obesity is observed even for relatively short periods of breastfeeding. In add-on, maternal BMI, children'south weight proceeds in the commencement twelvemonth of life, and exposure to alcohol and poverty increase the risk of excess weight and/or obesity after in childhood.
The benefits of breastfeeding on both kid and maternal health are well known. In US Surgeon General's Call to Activeness to support breastfeeding, it is noted that late weaning is associated with a protective event in children against infections, eczema, hospitalization, SIDS, and chronic diseases such as leukemia, type two diabetes, asthma, and obesity.42 The WHO likewise establish significant association between the duration of breastfeeding and blazon 2 diabetes, cholesterol, and performance in intelligence tests.43 In their analysis, they suggest that there is a small reduction in prevalence in childhood weight proceeds (10%) in children exposed to longer durations of breastfeeding, but warn about lack of adjustments for confounding factors which may attribute to this effect.43 Enquiry conducted throughout various countries accept yielded inconclusive results regarding the protective effects of breastfeeding on childhood adiposity.6–eight,10–24
In the study, maternal BMI was significantly associated with BMI, overweight and obesity in 6-twelvemonth-old children. Our findings are consistent with previous literature that identifies maternal obesity status as an of import factor in childhoodxi,15,17 and adulthood20 BMI. Mechanisms explaining this relationship include inheritance of genes that make kid susceptible to excess weight, mother's function in shaping eating habits and action surroundings, and the effects of maternal obesity every bit a fetal modulating environmental cistron during pregnancy.44,45 Intrauterine environment can alter metabolism through changes in factor expression.46
Our results found that prolonging the introduction of formula feeding decreased the run a risk of excessive weight and obesity. Nosotros utilized variables that have been standardized by the WHO for both obesity and breastfeeding. We observed significant results with FBF, a variable that is a more realistic measure out than exclusive breastfeeding, which is more demanding and difficult to get practise by definition. Nonetheless, we did not observe a similar significant effect with ABF. The employ of a standardized definition for breastfeeding is critical to evaluate the human relationship between breastfeeding and obesity on an international scale. While the outcome of 1 24-hour interval of FBF was small, it was significant in providing an firsthand and accumulative protective issue. The effect of breastfeeding on obesity has been studied in cohorts ranging from 2 years23 to 21 years,20 and a protective effect has been observed upward to half-dozen–11 years.7 Most of the studies analyzing breastfeeding and obesity apply dichotomous variables.7,12,13,17,18,21,23,24,47,48 Our results are consistent with multiple studies that have found significant inverse associations betwixt breastfeeding type and duration and child'southward weight condition.6,8,14–16,22 However, some studies have found nonsignificant associations betwixt breastfeeding and babyhood overweight.eleven,19,20 These differences in results may be attributed to cultural differences in the population analyzed, differences in definitions of breastfeeding, obesity, and covariates, and also differences in age at which BMI was measured.
In our study, periconceptional and postnatal smoking was significantly associated with backlog weight in the univariate analysis. Exposure to smoking during pregnancy has been associated with babyhood overweight and correlated with child obesity, although the biological mechanism for this epidemiological link is not fully understood.xv,17,49 Maternal smoking is related to depression nascency weight, which is associated with catch-upwards growth early on in life, which is associated with overweight and obesity in childhood.12,17 Mothers who smoke during pregnancy are more likely to be less educated and not breastfeed than nonsmoking mothers.11,fourteen,29,xxx,49 Exposure to nicotine in utero has been associated with increased body fat and weight.50 Maternal smoking in pregnancy has also been suggested to affect the ambition regulation arrangement in the developing encephalon, making it a possible contained risk gene for overweight in children and tin be a proxy for other ecology factors present during postnatal development such every bit diet and physical action.49 We also plant a significant clan betwixt increased maternal alcohol consumption during pregnancy and increased babyhood BMI. While maternal smoking during pregnancy is studied as a risk factor for child obesity, the effects of alcohol consumption on weight outcomes are non as scrutinized.47,49 Evidence is available showing that children with partial fetal alcohol syndrome feel higher overweight and obesity rates.51 Animal studies, demonstrate that prenatal alcohol exposure leads to insulin resistance and leads to glucose intolerance.52 Similar to our study, information technology is important for future studies to evaluate the interaction between smoking and booze consumption for meliorate understanding of their impact on babyhood obesity.
Also, our findings showed an association betwixt weight gain in the first year and childhood BMI and backlog weight at half dozen years one-time. In a systematic review that analyzed rapid infancy weight gain and subsequent obesity, 21 studies reported a significant positive association.53 DuBois' cohort study institute that weight gain in the first five months was associated with overweight at 4.5 years.17 Although there is noted effect of early infant weight gain on childhood BMI, results were not as consistent with other measures of adiposity such as skinfold thickness.21 Rapid weight gain in the first ii years of life has been linked to obesity, particularly in infants with low birth weight and size (Perng). Although weight proceeds in the first year of life as part of "catch-up growth" is associated with adverse metabolic effects, there may likewise be sure benefits to this type of growth in certain groups.54 The mechanism explaining how early infant weight gain influences weight condition afterward on in life is unclear. Yet, it is well understood that early development non only is extremely susceptible to environmental influences simply as well is influential in later health outcomes.55 Infant weight change in the starting time 6 months of life is associated with both breastfeeding and babyhood BMI.21 One possible interaction between breastfeeding and weight gain in the first year of life can be explained past differing levels of protein content with breastfeeding and formula feeding.56 In a study conducted in five European countries, they constitute that high protein intake induced increased weight proceeds velocity during the showtime months of life, resulting in increased torso fatty deposition.57
Although nosotros observed in the univariate analysis a human relationship of parental education levels on childhood overweight and obesity, the effect was non seen in the multivariable regressions. Previous studies accept analyzed the furnishings of parental teaching and its result on obesity at different ages. While maternal instruction was found to have a significant effect on childhood obesity,12,14,16,xx,21 fewer studies considered paternal education.half dozen Occupational status was as well analyzed in previous studies, but differed in the mode it was measured.12,xix In a Swedish written report, they found that maternal employment for less than 3 months during pregnancy was associated with short-term breastfeeding.eleven Our study assessed the activity level associated with maternal occupation, simply did not detect a divergence between mother'south occupation and risk of childhood excess weight and obesity at half dozen years old.
We institute the economical level of the families to be associated with BMI in children but only in the univariate analysis. Socioeconomic disparities are a considerable chance cistron for obesity and the abandonment of breastfeeding.31 Children of depression SES are more likely to be obese than high-SES children and their rates of obesity are increasing at a much faster charge per unit.58 This is particularly important to analyze in Murcia, which is the region with the fifth everyman Gdp per capita in Spain.59
Extensive information gathered regarding breastfeeding during infancy, earlier outcomes were measured, allows united states to take detailed information almost kid's feeding habits. Multiple follow-up sessions took place both over the phone and contiguous almost breastfeeding habits, particularly in the first ii years of life. By treating each type of breastfeeding and its duration in a continuous mode, using days as unit of measurement of measurement, we have data on the exact timing that infants were introduced to bottle feeding at home. The careful and exhaustive data drove on BF minimizes the likelihood of recall bias in the study.
Several limitations must be considered in our study. First, the sample size was limited compared with that of previous studies. Secondly, it is important to consider both recall and selection bias. We take attempted to compensate these limitations by contacting participants with increased frequency to retrieve more authentic information and decrease bias. Our extensive information collection provided us with results that are largely consistent with the rest of the literature. Attrition during follow-up created loss of growth data and maternal BMI limiting the number of participants with completed records in parts of the assay. Previous studies have noted similar limitations regarding loss of data and high compunction rates in longitudinal studies.xiv,15,20 Finally, a common limitation of observational studies is the inability to conform for all confounding variables.half dozen,8,13,14,19,21
Notwithstanding, the covariables discussed in this study are representative of some of the major underlying risk factors for obesity considered in previous studies. There are some factors, such as heredity and lifestyle factors (diet, physical activity, time spent watching TV/playing reckoner games/slumber), that were not analyzed in this study. In hereafter studies, we volition comprise some of these variables. As well, we will conduct a developmental cess of these children at viii and 12 years old.
Analysis of overweight and obesity could have been improved by using other effective methods to measure out adiposity along with BMI. Both X-ray absorptiometry21 and skinfold thickness12,21,49 have been suggested and used to better analyze the human relationship between breastfeeding and obesity. Even so, BMI is nonetheless considered an inexpensive and noninvasive way to measure body fat that is internationally accepted.nine,lx
Conclusions
In our written report, we established a dose-dependent relationship between FBF duration and weight status in early babyhood. The early introduction of bottle feeding increased risk for childhood excess weight and obesity. The utilize of standardized measures, particularly of breastfeeding, will go a long way in improve agreement this protective effect internationally. While evidence is nonetheless being gathered on this topic, prevention programs confronting childhood obesity should promote prolonged breastfeeding, the cosmos of healthier environments during pregnancy, and infancy free of tobacco and alcohol and consider antipoverty interventions.
Acknowledgments
This piece of work was supported past Mount Sinai International Exchange Program for Minority Students (grant MD001452) from the National Center on Minority Health and Wellness Disparities of the U.Southward. National Institutes of Health; and the Nacer & Crecer sin OH Programme Regional Coordination of DG Public Health and Drug Addiction, The Regional Ministry of Health, Murcia, Spanish National Plan on Drugs, Ministry of Health, Social Services and Equality, Madrid, Spain. The authors as well thank Programa de Ayudas a Grupos de Excelencia de la Región de Murcia, Fundación Séneca (#19884-GERM-xv) and MINECO/FEDER (ECO-2015-65758-P).
Author Disclosure Statement
No competing financial interests exist.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066191/
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