4-6 Months of Exclusive Breast Feeding Associated With Lower Obesity Risk Across 8 European Countries
Tuesday, August 28, 2012
Regular readers may recall a recent post on the efforts to increase breast feeding in Canada. Notably, a recent media report had NYCs Mayor Bloomberg (of banning oversize pop fame) to demand that clinics lock up baby formula in an attempt to increase breast feeding, as a further measure to prevent obesity.
But how long should infants be breast fed to prevent obesity?
This question was addressed in a paper by Hunsberger and colleagues from 8 European countries (Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain) published in Public Health Nutrition.
The researchers assessed the potential impact of exclusive breast-feeding on childhood overweight in cross-sectional datathe longitudinal cohort study IDEFICS. The analysis included 14 726 children aged 2-9 years for whom early feeding practices were reported by parents in standardized questionnaires.
After controlling for education, income and other potential confounders, breast-feeding exclusively for 4-6 months were about 30% less likely to be overweight when compared with children never exclusively breast-fed. This association could not be explained by socio-economic characteristics or maternal overweight.
Thus, the authors conclude that exclusive breast-feeding for 4-6 months may confer protection against overweight in addition to other known benefits. Exclusive breast feeding beyond 6 months did not appear to have any additional benefit in this regard.
While association studies do not prove causality, there are certainly a number of biologically plausible hypotheses that would explain the beneficial effect of breast feeding on the development of childhood obesity, so certainly this is a finding that should not be simply dismissed.
I wonder though how feasible exclusive breastfeeding for 4-6 months would actually be in most settings.
AMS
Edmonton, Alberta
photo credit: c r z via photo pin cc
Hunsberger M, Lanfer A, Reeske A, Veidebaum T, Russo P, Hadjigeorgiou C, Moreno LA, Molnar D, De Henauw S, Lissner L, & Eiben G (2012). Infant feeding practices and prevalence of obesity in eight European countries – the IDEFICS study. Public health nutrition, 1-9 PMID: 22916704
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Tuesday, August 28, 2012
How strange. Why would they neglect paternal obesity as a factor in who ends up fat? Half our genes are from our dads, and whether or not blaming moms for fat kids has some kind of special validity (I have my doubts), studies have indicated that a father’s body size is also predictive of childrens’ eventual size.
I always notice this type of assumption, because I have a thin mom and a fat dad, and a larger body size is definitely something that runs on my dad’s side of the family more than my mom’s.
Tuesday, August 28, 2012
The problem with studies like this is that the model is too simple. I think often of Sleeping Beauty and the fact that despite all of her efforts to keep her daughter from the fate of pricking her finger on a spindle, it happened anyway. And I wonder how that fairy tale mother felt, because she did everything right.
I exclusively breastfed both of my my children for the first 6 months, did not add in solids until they were a bit past 6 months and then continued to breastfeed. I did everything right. And both of my children inherited my family body type anyway, especially my daughter.
What evidence is there really — I mean solid data from longitudinal studies — that obesity can be prevented? I have not seen any. But I have seen more and more ways to induce guilt in the mothers of children who become larger than the expected average despite mother have done everything right.
Tuesday, August 28, 2012
I think the shift back to breastfeeding will take another generation in Canada (at least). For me, the hardest part was getting started and then dealing with changes like growth spurts (@6 weeks, in particular). The biggest missing support component was mentorship. Until breastfeeding is seen as the “norm” and most women have a mother, aunt, sister or close friend who is experienced and can support them (and spouses, fathers, uncles, brothers who are comfortable with breastfeeding in their presence), the barriers and challenges will seem bigger than they need to be. We are very lucky in Ontario to have a “Breastfeeding Buddy” program through the Public Health Units – volunteers who provide phone support and mentorship. Without my buddy and the Laleche League hotline (I was discharged on Friday and abundance of milk came in overnight – Buddy was not in place until following week) my strong commitment to breastfeeding might not have been enough to get me through.
Tuesday, August 28, 2012
Leave “civilization”, and the average period of breast feeding is 3 years. I was Mr. Mom for three years thanks to a breast pump. Breast feeding is also healthful in many ways other than obesity.
To answer your question, a significant period of breast feeding is probably not feasible as long as avoiding a little inconvenience is more important to parents than the health of their child.
Tuesday, August 28, 2012
This is very interesting. My question is whether the link is with the ingestion of breast milk (which could be achieved in most settings) or with the close physical connection with the mother (which may not be achievable).
Tuesday, August 28, 2012
What about the ‘Barker Hypothesis’?
Besides which, what percentage of children who were never breastfed are ‘less likely’ to be overweight?
To make the statement that 30% of children who were exclusively breastfed for 4 to 6 months were ‘less likely to be overweight’ is NOTHING! First off the definition of ‘less likely’ needs to be clarified or it is not science. It is instead slushy, meaningless verbiage.
What percentage of children by age 9 who were never breastfed were ‘less likely to be overweight’? This would provide meaningful comparison. Without this, the claim is of no merit.
What is the incidence of overweight children in these societies/countries overall?
I support the breastfeeding of babies/toddlers until all of their deciduous teeth erupt because breastfeeding encourages the optimal development of the facial structures. Exclusive breastfeeding cannot realistically be continued for more than 6 months depending on the size of the child. At some point a child will want to eat what the parent is putting in their own mouth. Gradually the diet changes over from exclusive breastfeeding to mixed diet which includes breastfeeding.
A serious consideration is the incidence of haemorrhagic disease of the newborn: mothers who breastfeed exclusively may not produce enough vitamin K in their breastmilk. The vitamin K1 injection given at birth will not provide sufficient vitamin K for the production of blood coagulation proteins for 4 to 6 months. The mother’s diet must be rich in foods which contain vitamins K1 and K2. Baby formulas contain rather large amounts of vitamin K1. When used as supplemental feeding for babies which are mostly breastfed, it prevents bleeding should a mother not be consuming a diet which would provide adequate vitamin K in her breastmilk.
We do not see as much haemorrhagic disease in babies anymore because many mothers are providing some supplemental formula feeding to their babies. To imply that mothers should exclusively breastfeed for at least 6 months is unwise unless these mothers are also provided with dietary information. All breastmilk is not alike in nutritional value to a baby. Mothers need to be informed as to how they can optmize the quality of the milk they produce.
Wednesday, August 29, 2012
My question (as a mother who fed her children formula) is how they control for the overall approach to feeding. Breastfeeding is inherently opaque–you can’t see how much the baby is getting at every feeding. Bottle-feeding is different, and being able to see that formula left over and pouring all that money down the drain might push parents to a “clean your plate” mentality.
There are bottle-fed babies, though, who are held close during feedings, fed on demand and not on a schedule, and not encouraged to consume past satiety. I wonder what the data would look like if you controlled for those feeding behaviors, rather than just the substance fed to the baby.
Wednesday, August 29, 2012
Breastfeeding is becoming more common, yet it seems that mothers who choose not to breastfeed are facing a great deal of stigma. Also, a huge barrier to exclusive breastfeeding is that not all moms are able to take a one-year maternity leave.