Breastfeeding and Cardiometabolic Profile in Childhood How Infant Feeding, Preterm Birth, Socioeconomic Status, and Obesity May Fit Into the Puzzle

Centers for Disease Control and Prevention, Atlanta, GA.
Circulation (Impact Factor: 14.43). 12/2013; 129(3). DOI: 10.1161/CIRCULATIONAHA.113.006941
Source: PubMed


Although the observed association between breastfeeding and cardiometabolic profile in childhood and adolescence in previous studies (refs) has biological plausibility, the precise mechanism and magnitude remains far from being fully understood.(1) Early nutrition and epigenetic programming(2), anti-inflammatory properties(3), and cardiorespiratory fitness(4) are among numerous hypotheses that are currently being actively investigated. In this issue of Circulation, Martin et al.(5) reported in the paper "Effects of promoting longer term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial". The intervention study started in 1996-1997 in 31 Belarussian maternity hospitals and affiliated outpatient clinics with an enrollment of 17,046 breastfeeding mothers of healthy term infants. The trial was originally designed to assess the effects of a breastfeeding promotion and support intervention on duration of breastfeeding. Duration of both exclusive (infant only receives breast milk without any additional food or drink, not even water) and any breastfeeding (includes non-exclusive and exclusive) were assessed in the intervention and non-intervention groups.(6) The planned 11.5 year follow-up of about 80% of study participants who had fasted for the follow-up assessment and did not have diabetes allowed authors to test whether an intervention to improve breastfeeding duration and exclusivity also influenced cardiometabolic risk factors in childhood. No significant differences between intervention and control groups were found in levels of blood pressure, fasting insulin, adiponectin, glucose, apolipoprotein A1, and metabolic syndrome.

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    ABSTRACT: Background: Our aim was to determine the influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction (FGR). Methods: A cohort study including 81 children with birthweight <10 centile (FGR) and 121 with adequate fetal growth (AGA). Cardiovascular end-points were left ventricular sphericity index (LVSI), carotid intima-media thickness (cIMT) and blood pressure (BP) at 4-5 years of age. The combined effect of FGR and postnatal variables -including breastfeeding, fat dietary intake and body-mass index (BMI)- on cardiovascular end-points was assessed by linear and robust regressions. Results: FGR was the strongest predictor of cardiovascular remodeling in childhood, leading to lower LVSI and increased cIMT and BP as compared to AGA. Breastfeeding>6 months (coefficient 0.0982) and healthy-fat dietary intake (coefficient -0.0128) showed an independent beneficial effect on LVSI and cIMT respectively. Overweight/obesity induced an additional increment of 1SD on cIMT in FGR children (interaction coefficient 0.0307) when compared with its effect in AGA. BMI increased systolic BP (coefficient 0.7830) while weight catch-up increased diastolic BP (coefficient 4.8929). Conclusions: Postnatal nutrition ameliorates cardiovascular remodeling induced by FGR. Breastfeeding and healthy-fat dietary intake improved while increased BMI worsened cardiovascular end-points, which opens opportunities for targeted postnatal interventions from early life.Pediatric Research (2015); doi:10.1038/pr.2015.182.
    Pediatric Research 09/2015; DOI:10.1038/pr.2015.182 · 2.31 Impact Factor