Breastfeeding associated with decreased risk of childhood obesity

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1. In a large prospective analysis of schoolchildren in Japan, breastfeeding was associated with a decreased risk of childhood obesity. 

2. A trend was observed whereby the prevalence of being overweight and obese at ages 7 and 8 years decreased as the frequency of breastfeeding before 6 months of age increased. 

Evidence Rating Level: 1 (Excellent)       

Study Rundown: This prospective cohort study of schoolchildren in Japan found that breast-feeding was associated with decreased risk of being overweight or obese at 7 and 8 years of age. While the protective association between breast-feeding and childhood obesity has been widely discussed, most studies have been done in Western populations such that this is the first to assess the benefits of breastfeeding in an Asian population. Additionally, this is one of the first prospective studies on the topic.

The prospective, population-based longitudinal cohort study design is a major strength. One limitation is that while researchers controlled for potential confounders of family income, maternal education, television/game time, they were unable to control for maternal obesity, which is highly likely to confound the associations observed in this investigation. Future investigations might evaluate this association in other ethnic populations and stratify by or perform matched analyses by maternal BMI.

Click to read the study in JAMA Pediatrics

Click to read an accompanying editorial in JAMA Pediatrics

Relevant Reading: Uptodate: Infant benefits of breastfeeding

In-Depth [prospective longitudinal survey]: Researchers analyzed data from a Japanese national cohort of all infants born during two distinct weeks in 2001 who completed initial and annual follow-up questionnaires. Of the 53,575 neonates born in the two-week time period, there was an 88% response rate to the initial survey and 43,367 (81%) children provided enough information to be included in the final analysis. Participants were categorized by feeding status at 6 months of age to one of three categories: formula feeding (reference), partial breast-feeding, or exclusive breast-feeding. The main outcome was BMI at 7 and 8 years of age.

At 7 years of age, children who were exclusively breastfed as infants were less likely to be overweight (OR:0.85, CI:0.69-1.05) and obese (OR:0.55, CI:0.39-0.78), compared with children who were formula fed. At 8 years of age, children who were exclusively breastfed as infants were less likely to be obese children (OR:0.44, CI:0.31-0.63). A trend was observed whereby the prevalence of being overweight and obese at ages 7 and 8 years decreased as the frequency of breastfeeding before 6 months of age increased.

By Maren Shapiro and Leah Hawkins, MD, MPH

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