Infant Feeding in Leicester City - East Midlands Public Health ...

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31Owen et al (2005)(35) analysed the results from 61 studies to evaluate the extent to which infant feedinginfluences overweight. This found that there was consistent evidence of a relationship betweenbreastfeeding and reduced risk of obesity. Overall, infants were 13% less likely to be defined as obese ifthey had been breastfed compared to those that had been formula-fed. As differences in obesityprevalence may be due to a number of social and lifestyle factors it is necessary to take these into accountduring analysis. Such factors include socio-economic status, parental BMI and maternal smoking status.This adjustment was seen to reduce the protective effect of breastfeeding such that infants were now only7% less likely to be obese if breastfed, but the association was still reported to be significant. Duration ofbreastfeeding was also an important factor. Infants who were breastfed for over two months were nearly20% less likely to be obese than those formula fed.Harder et al(36) analysed the results from 17 studies and reported that infants who were breastfed for atleast four to six months were 24% less likely to be overweight than those breastfed for less than onemonth. After one month, the risk of becoming overweight in childhood continuously decreased and eachadditional month of breastfeeding was associated with a 4% decrease in the prevalence of overweight at alater age. This effect was prevalent up to nine months of breastfeeding. This relationship was reported tobe true regardless of the age at which the infant was followed up in childhood, some of which were notfollowed up until age 14. Koletzko et al(33) also showed that breastfeeding had a protective effect againstoverweight and obesity. Children that had been breastfed were 21% and 25% less likely to be overweightand obese, respectively, at age five to six compared to those that had not been breastfed.Using subjects from the Millennium Cohort Study (MCS), Hawkins et al(8) examined various individual,family and community-level factors and the risk of overweight at three years of age. Breastfeeding wasseen to have a protective effect against overweight, and infants who were breastfed for greater than fourmonths were 25% less likely to be overweight at age three than those who were never breastfed. Thisprotective effect still remained, albeit reduced, even when all other factors were taken into account,including birth weight, ethnicity, maternal smoking, and parental weight. This study found that individual andfamily-level factors, which include breastfeeding duration, were more important in predicting overweight inearly childhood than community level factors, such as access to play areas/garden/food shops andsatisfaction with local area. They hypothesised that different factors may be more important at specific lifestages. It is likely that breastfeeding is more important in early childhood than wider social factors, andthese may become more important later in childhood.A number of studies have challenged this association between breastfeeding and overweight. They arguethat it is other lifestyle factors associated with the likelihood to breastfed that are responsible for thedifferences reported in obesity prevalence rather than breastfeeding having a direct effect on weight.
32Mangrio et al(37) found no significant association with ever having been breastfed and overweight at fouryears. The same study did report a significant association with obesity at four years but this was removedwhen parental BMI was taken into account. A similar pattern was seen in a study from the US(38). Ashorter duration of breastfeeding was associated with an increased likelihood to be overweight in childhoodbut once other lifestyle factors were taken into account, such as gestational age and weight gain in firstyear, this relationship was removed. This suggests that such factors need to be considered and also playan important role in childhood.Lamb et al(38) also found no association between exclusive breastfeeding and childhood BMI. Theyreported that it is likely there are inter-relationships between different predictors of childhood BMI. Weightgain in the first year of life was seen to be a significant predictor of overweight in childhood. Theysuggested that breastfeeding may lead to slower infant weight gain in the first year and this is how it isassociated with later childhood weight.Kramer et al(39) reported that prolonged, exclusive breastfeeding was not protective against increased BMIor other measures of adiposity in six-year old children. They found that differences in BMI between childrencould be explained by social or lifestyle factors, rather than incidence of breastfeeding. This study justlooked at duration of breastfeeding rather than comparing breastfeeding to formula feeding, and so justrefutes that longer duration is beneficial to a shorter breastfeeding time.Burdette et al(40) argue that BMI should not be used as a marker of overweight as it overestimates theeffect of breastfeeding. They argue that other measures of adiposity should be used, e.g. percentage fatmass, as these are more important predictors of poor health outcomes related to obesity than weight alone.This study found that there was no significant difference in the percentage fat mass at three years betweenchildren who had been breastfed and those who were not. When using BMI as an indicator, breastfeedingwas seen to have a protective effect against overweight but this disappeared after taking other factors intoaccount, such as ethnicity, birth weight, income and education.Based on the information available, breastfeeding does have a protective effect against overweight andobesity in childhood but the strength of this association is unclear. Consideration of additional lifestyle andsocial factors is seen to reduce or remove the benefits of breastfeeding on childhood weight. This makes itdifficult to determine the true nature of the relationship. Numerous factors influence overweight and obesitydevelopment. It is likely that breastfeeding does play a role but in conjunction with other lifestylebehaviours. It is possible that each is important at different stages of growth/development withbreastfeeding being an important factor in early life.
Page 6 and 7: 5Notes.The data used cover the time
Page 8 and 9: 7More support is needed for mothers
Page 11 and 12: 10Local Variation.Fig.3Breastfeedin
Page 15 and 16: 14Table 1Initiation6-8 week prevale
Page 17 and 18: 16Demographics; Age of Mother.Fig.7
Page 19 and 20: 18over 35. It can be seen that the
Page 21 and 22: Breast Feednig RatesBreast Feednig
Page 23 and 24: 22When calculating deprivation quin
Page 25 and 26: 24Health Outcomes; Gastroenteritis.
Page 27 and 28: 26was associated with a reduced ris
Page 29 and 30: 28A number of studies have shown th
Page 31: 30Health Outcomes; Obesity in Recep
Page 35 and 36: 34model has been applied specifical
Page 37 and 38: 36given the same support in differe
Page 39 and 40: 38References1. Bolling, K., Grant,
Page 41 and 42: 4032. Contribution of Early Weight

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