Owen CG, Martin RM, Whincup PH, Davey-Smith G, Gillman MW, Cook DG et al.. The effect of breastfeeding on mean body mass index throughout life: a quantitative review of published and unpublished observational evidence. Am J Clin Nutr 82, 1298-1307

Division of Community Health Sciences, St George's, University of London, London, United Kingdom.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 12/2005; 82(6):1298-307.
Source: PubMed


Evidence from observational studies has suggested that breastfeeding may reduce the prevalence of obesity in later life.
The objective was to examine whether initial breastfeeding is related to lower mean body mass index (BMI; in kg/m(2)) throughout life.
The study was a systematic review of published studies investigating the association between infant feeding and a measure of obesity or adiposity in later life, which was supplemented with data from unpublished sources. Analyses were based on the mean differences in BMI between those subjects who were initially breastfed and those who were formula-fed (expressed as breastfed minus bottle-fed), which were pooled by using fixed-effects models throughout.
From 70 eligible studies, 36 mean differences in BMI (from 355 301 subjects) between those breastfed and those formula-fed (reported as exclusive feeding in 20 studies) were obtained. Breastfeeding was associated with a slightly lower mean BMI than was formula feeding (-0.04; 95% CI: -0.05, -0.02). The mean difference in BMIs appeared larger in 15 small studies of <1000 subjects (-0.19; 95% CI: -0.31, -0.08) and smaller in larger studies of >or=1000 subjects (-0.03; 95% CI: -0.05, -0.02). An Egger test was statistically significant (P = 0.002). Adjustment for socioeconomic status, maternal smoking in pregnancy, and maternal BMI in 11 studies abolished the effect (-0.10; 95% CI: -0.14, -0.06 before adjustment; -0.01; 95% CI: -0.05, 0.03 after adjustment).
Mean BMI is lower among breastfed subjects. However, the difference is small and is likely to be strongly influenced by publication bias and confounding factors. Promotion of breastfeeding, although important for other reasons, is not likely to reduce mean BMI.

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    • "The association between breastfeeding and childhood obesity is uncertain, and results are inconsistent: some studies show a strong association between breastfeeding and childhood obesity [11] [13] [14] while others do not [16– 18]. There are clinical studies that show that breastfeeding decreases the risk for adulthood obesity [8] [9] [10] [11]. "
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    ABSTRACT: Objective: The objective of this study was to evaluate whether duration of breastfeeding is associated with a lower prevalence of metabolic syndrome in obese children. Methods: A retrospective analysis of obese children aged 3 to 18 years followed at a pediatric outpatient clinic at a single center between the years 2008 and 2012. The children were divided according to their breastfeeding duration: no breastfeeding, a short period of breastfeeding, and a long term breastfeeding. Also, they were divided into metabolic and nonmetabolic syndrome groups, based on physical examination and laboratory tests. Results: Out of 4642 children who visited the clinic, 123 were obese and were included in the study. About half of them matched the metabolic syndrome criteria. There was no correlation between the prevalence of metabolic syndrome and the duration of breastfeeding. Hypertension, abnormal low levels of HDL, high levels of HbA1c, and high fasting triglyceride levels were very common in our study population, yet no statistical significance was noted among the different breastfeeding groups. Conclusion: In this study, breastfeeding was not associated with a reduced risk for metabolic syndrome, compared with formula feeding, in children who are obese.
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    • "Cow's milk requires modification in order for it to be the basis of IF since it contains two to three times the level of total protein compared with human breast milk, and has a different protein composition. Whether high-protein IFs may exceed infant requirements is widely debated, with discussion focused on later development of obesity and associated noncommunicable diseases (NCDs) (Michaelsen et al., 2012), although systematic reviews examining associations between early feeding and later-life obesity or BMI are not conclusive (Owen et al., 2005a,b). "
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    • "Other potential outcomes were not included in this study because of limitations of the existing evidence (diabetes [24], meningitis [25]) or little importance to global disease burden estimates or policy (eczema [11,26]). There is consistent evidence linking suboptimal breastfeeding with childhood and adult obesity [27]; however, this risk-outcome pairing was excluded from this analysis because obesity itself is considered a risk factor rather than a health outcome with associated disease burden. Only developing countries were included in this analysis because the effect size estimates used in this analysis were taken from studies done in developing countries, and they are not thought to be generalizable to developed countries where pathogen exposure levels are much lower. "
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    ABSTRACT: In 2010 more than 7.7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries, and recent estimates have attributed hundreds of thousands of these deaths to suboptimal breastfeeding. This study estimated prevalence of suboptimal breastfeeding for 137 developing countries from 1990 to 2010. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These prevalence estimates were disaggregated by wealth quintile and linked with child mortality rates to assess how improved rates of breastfeeding may affect child health inequalities. In 2010, the prevalence of exclusive breastfeeding ranged from 3.5% in Djibouti to 77.3% in Rwanda. The proportion of child Disability Adjusted Life Years (DALYs) attributable to breastfeeding is 7.6% at the global level and as high as 20.2% in Swaziland. Breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within most countries, breastfeeding prevalence rates do not vary considerably across wealth quintiles. Breastfeeding is an effective child health intervention that does not require extensive health system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries.
    Full-text · Article · Dec 2013 · BMC Medicine
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