Does breast-feeding protect against childhood obesity?

A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research

RESEARCH QUESTIONS

What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children?

OBJECTIVES

Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children.

METHODS

The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed.

RESULTS

Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health).

CONCLUSIONS

Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.

IV. The cognitive implications of obesity and nutrition in childhood

The prevalence of childhood obesity in the United States has tripled since the 1980s and is strongly linked to the early onset of several metabolic diseases. Recent studies indicate that lower cognitive function may be another complication of childhood obesity. This review considers the research to date on the role of obesity and nutrition on childhood cognition and brain health. Although a handful of studies point to a maladaptive relationship between obesity and aspects of cognitive control, remarkably little is known regarding the impact of fat mass on brain development and cognitive function. Further, missing from the literature is the role of nutrition in the obesity-cognition interaction. Nutrition may directly or indirectly influence cognitive performance via several pathways including provision of key substrates for optimal brain health, modulation of gut microbiota, and alterations in systemic energy balance. However, in the absence of malnutrition, the functional benefits of specific nutrient intake on particular cognitive domains are not well characterized. Here, we examine the literature linking childhood obesity and cognition while considering the effects of nutritional intake. Possible mechanisms for these relationships are discussed and suggestions are made for future study topics. Although childhood obesity prevalence rates in some developed countries have recently stabilized, significant disparities remain among groups based on sex and socioeconomic status. Given that the elevated prevalence of pediatric overweight and obesity may persist for the foreseeable future, it is crucial to develop a comprehensive understanding of the influence of obesity and nutrition on cognition and brain health in the pediatric population.

Exclusive breastfeeding, complementary feeding, and food choices in UK infants

BACKGROUND

Limited data exist that explore the association between exclusive breastfeeding and dietary behaviors related to key food choices in later infancy.

OBJECTIVE

This study aimed to examine the relationship between exclusive breastfeeding at 3 months with age of starting complementary feeding and key complementary feeding data collected at 8 to 10 months.

METHODS

Secondary data analysis was performed on the UK Infant Feeding Survey 2005.

RESULTS

After adjusting for maternal characteristics, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was positively associated with giving homemade infant foods (adjusted odds ratio [AOR] = 1.41; 95% confidence interval [CI], 1.19-1.66), vegetables (AOR = 1.46; 95% CI, 1.25-1.72), fruits (AOR = 1.73; 95% CI, 1.42-2.11), and fresh foods frequently (AOR = 2.24; 95% CI, 1.41-3.56) at 8 to 10 months of age. Conversely, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was negatively associated with very early complementary feeding (AOR = 0.35; 95% CI, 0.30-0.42) and giving the following foods at 8 to 10 months of age: baby food from jar (AOR = 0.78; 95% CI, 0.66-0.92), powdered baby food (AOR = 0.73; 95% CI, 0.57-0.94), canned baby food (AOR = 0.48; 95% CI, 0.32-0.71), and ready-made bought meals (AOR = 0.67; 95% CI, 0.57-0.78).

CONCLUSION

Exclusively breastfeeding for 3 months compared to mixed or formula feeding was positively associated with the introduction of complementary feeding after 4 months and giving infants fruits, vegetables, and homemade infant foods frequently at 8 to 10 months.

The association of breastfeeding duration with later maternal feeding styles in infancy and toddlerhood: a cross-sectional analysis

Background

Breastfeeding modestly reduces obesity risk, yet the mechanisms are not well understood. The goal of the current research was to evaluate the association of breastfeeding duration with a wide range of maternal feeding approaches in late infancy and toddlerhood.

Methods

A secondary analysis of cross-sectional data from an ethnically-diverse sample of 154 mothers of infants (aged 7–11 months) and toddlers (aged 12–24 months) was performed. Breastfeeding history was self-reported where 75% of mothers had weaned by the time of the interview. Multiple dimensions of maternal feeding approaches were measured using the Infant Feeding Styles Questionnaire which assesses pressuring, restriction, responsive, laissez-faire, and indulgent approaches to feeding. Analyses were performed separately for infants and toddlers and adjusted for maternal education level, ethnicity, and marital status.

Results

Mothers of infants who breastfed for longer durations tended to report greater responsiveness to infant satiety cues (p≤0.01) and reduced pressuring in feeding complementary foods (p<0.05). Mothers of toddlers who breastfed for longer durations tended to report reduced pressuring in feeding complementary foods (p<0.01).

Conclusion

These results suggest that breastfeeding may shape maternal feeding approaches related to responsiveness to infant cues as infants enter a period of complementary feeding, even after considering a range of demographic characteristics previously associated with breastfeeding behaviors. That responsiveness to feeding cues was not associated with breastfeeding duration in the toddler sample suggests that some aspects of this association might be isolated to infancy.

Factors associated with duration of breastfeeding in ireland: potential areas for improvement

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

Prevalence of metabolic syndrome in obese children and adolescents using three different criteria and evaluation of risk factors

OBJECTIVE

To compare the prevalence of the metabolic syndrome (MS) in Turkish obese children and adolescents by using three different definitions and to assess the risk factors through a retrospective evaluation of anthropometric and laboratory parameters.

METHODS

Sixty hundred and fourteen obese patients (307 male, 307 female; mean age: 11.3±2.5 years) were included in the study. Medical history, physical examination, anthropometric measurements, results of biochemical and hormonal assays were obtained from the hospital records. MS was diagnosed according to the modified World Health Organization (WHO), Cook and the International Diabetes Federation (IDF) consensus criteria.

RESULTS

The prevalence of MS was found to be 39%, 34% and 33% according to the modified WHO, Cook and the IDF consensus criteria, respectively. MS prevalence in patients aged 12-18 years was significantly higher than that in patients between 7 and 11 years of age (p<0.05). Pubertal patients had a significantly higher MS prevalence than the non-pubertal cases (p<0.05). MS prevalence was also significantly higher in children who had a family history of heart disease, diabetes, obesity and hypertension as well as in those who had not been breast-fed (p<0.05).

CONCLUSION

The use of the modified WHO criteria was found to result in a slightly higher prevalence rate for MS as compared to the other criteria. The prevalence of MS in our study population was higher than that reported in most previous studies in Turkey. A positive family history, puberty and not being breastfed in infancy were shown to be significant risk factors for MS in childhood.

The obesity epidemic

Obesity has reached epidemic proportions in the United States, with 35.1% of adults being classified as obese. Obesity affects every segment of the US population and continues to increase steadily, especially in children. Obesity increases the risk for many other chronic diseases, including diabetes mellitus, cardiovascular disease, and nonalcoholic fatty liver disease, and decreases overall quality of life. The current US generation may have a shorter life expectancy than their parents if the obesity epidemic is not controlled, and there is no indication that the prevalence of obesity is decreasing. Because of the complexity of obesity, it is likely to be one of the most difficult public health issues our society has faced.

Breast-feeding and overweight in Singapore school children

BACKGROUND

Studies from developed Western countries have shown inconsistent associations between breast-feeding and overweight/obesity in children and adolescents. Few data are available from Asian populations. The purpose of the present study was therefore to evaluate the association between breast-feeding and overweight/obesity in a study of 10-12-year-old children in Singapore.

METHODS

A total of 797 school children (49% girls, 76% Chinese) who participated in the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) were examined. Overweight/obesity (n = 179) was defined as age-sex-specific body mass index (BMI) cut-offs corresponding to BMI of 25 kg/m(2) for overweight and 30 kg/m(2) for obesity at age 18 based on the International Obesity Task Force (IOTF) reference.

RESULTS

The prevalence of overweight/obesity was 22.5%. Overall, breast-feeding was not found to be associated with overweight/obesity. After adjusting for potential confounders, the multivariable odds ratio (95% confidence interval) of overweight/obesity was 1.14 (0.80-1.63) for ever breast-fed compared with never breast-fed, 1.00 (0.57-1.72) for breast-fed for >3 months compared to < or =3 months and 0.79 (0.47-1.34) for exclusive/mostly breast-fed compared to partly breast-fed.

CONCLUSIONS

No significant associations were detected among breast-feeding, its type, and duration with overweight/obesity in this Asian cohort of 10-12-year-old children.

Relationship of parental characteristics and feeding practices to overweight in infants and young children in Beijing, China

Background

Childhood obesity has become a major public health problem in many countries. To explore the risk factors of overweight in infants and young children might be helpful in developing an early overweight intervention strategy.

Objective

To assess the prevalence of overweight and the relationship of parental characteristics and feeding practices to overweight in infants and young children in Beijing, China.

Design

Data on weight and length/height were collected on 4654 children aged 1–35 months in twelve communities in Beijing from a cross-sectional study. Overweight was defined as weight-for-length/height ≥2sd above the median of the WHO reference. Two hundred and fifteen families with overweight children and 215 families with normal-weight children were interviewed using a questionnaire to obtain feeding practices.

Results

The overall prevalence of overweight was 4·7 %. Both parental overweight and low parental education were significantly higher among overweight than normal-weight children. The total energy intake was significantly higher in overweight than in normal-weight children at 12–35 months of age. Compared with normal-weight children, significantly fewer overweight children were breast-fed for at least 4 months. Overweight children were also more likely to have been introduced to infant formula and semi-solid foods during the first 4 months.

Conclusion

Early prevention strategies should include feeding practices identified as putting children at risk of obesity. These include early cessation of breast-feeding and premature introduction of other foods.

Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year

OBJECTIVES

Our goal was to determine why women stop breastfeeding at various times during their infant's first year.

METHODS

We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers approximately 2, 3, 4, 5, 6, 7, 9, 10 1/2, and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding.

RESULTS

The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%-55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of <350% of the federal poverty level. Mothers' concerns about lactation and nutrition issues were the most frequently cited reasons for stopping breastfeeding during the first 2 months. Starting from the third month, self-weaning reasons were increasingly cited as important, with the statements "My baby began to bite" (31.7%), "My baby lost interest in nursing or began to wean himself or herself" (47.3%), and "Breast milk alone did not satisfy my baby" (43.5%) cited as the top 3 reasons at > or = 9 months of age.

CONCLUSIONS

Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.

Birthweight, breast-feeding, parental weight and prevalence of obesity in schoolchildren aged 10-12 years, in Greece; the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study

BACKGROUND

The purpose of the present study was to determine the prevalence of overweight and obesity in a sample of Greek children aged 10-12 years, and to evaluate these rates in relation to parental weight and birthweight.

METHODS

During the 2005-2006 school period, 700 schoolchildren (323 boys, 377 girls) were randomly recruited from 18 schools, in Athens. Height and weight were measured and body mass index (BMI) was calculated. Cut-off points for BMI defining obesity and overweight for gender and age were calculated in accordance with international standards.

RESULTS

Overall, 8.6% of boys and 9.0% of girls were obese, and 33.9% of boys and 22.1% of girls were overweight. Having an obese parent increased the odds of having an overweight or obese child (P < 0.01). Compared to non-breast-fed, boys who were breast-fed for >3 months had 70% lower likelihood of being overweight or obese (P < 0.01) and breast-fed girls had 80% lower odds (P < 0.01). Excessive birthweight (>3500 g) increased by 2.5-fold the likelihood of being overweight or obese only in girls (P < 0.05).

CONCLUSIONS

Parental weight, lack of breast-feeding and excess birthweight (in girls) were significant predictors of overweight or obesity in Greek children aged 10-12 years.

Breastfeeding helps explain racial and socioeconomic status disparities in adolescent adiposity

OBJECTIVES

Studies suggest that breastfeeding is protective for later obesity; however, this association has not held among all racial and socioeconomic status groups. Racial and socioeconomic status differences in breastfeeding behavior have also been noted. In this study, we formally test whether breastfeeding mediates the relationship between race and socioeconomic status with adolescent adiposity.

METHODS

Data were analyzed from 739 black and white 10- to 19-year-old adolescents who participated in a large, school-based study. Parents provided information on parental education, used to measure socioeconomic status, and whether the child was breastfed as an infant. BMI was used to measure adolescent adiposity and was analyzed as a continuous measure (BMI z score) using linear regression and categorically (BMI > or = 85th and > or = 95th percentile) using logistic regression.

RESULTS

Black adolescents and those without a college-educated parent were less likely to have been breastfed for > 4 months. Race and parental education were each independent predictors of BMI z score and of having BMI > or = 85th percentile or BMI > or = 95th percentile. When added to the model, being breastfed for > 4 months was also independently associated with lower BMI z score and lower odds of having BMI > or = 85th percentile or BMI > or = 95th percentile. Inclusion of being breastfed for > 4 months resulted in a 25% decrease in racial and parental education differences in adolescent BMI z score, supporting partial mediation. CONCLUSIONS; Having been breastfed for > 4 months was associated with lower adolescent BMI z score and lower odds of having a BMI > or = 85th percentile or BMI > or = 95th percentile, independent of race or parental education. Furthermore, these analyses suggest that being breastfed for > 4 months partially explains the relationship between social disadvantage and increased adiposity. Increasing breastfeeding duration could result in lower adolescent adiposity for all racial and socioeconomic status groups and potentially minimize socioeconomic disparities in adiposity.

Taking the long view: the prenatal environment and early adolescent overweight

The purpose of this study was to assess the independent effects of the prenatal environment and cumulated social risks on the likelihood of being overweight at age 12/13 years. Maternal prepregnancy weight and smoking during pregnancy were the measures of prenatal exposures. Average lifetime per capita income and mother's lifetime marital status were the measures of cumulative social risks. Analysis of data from the National Longitudinal Survey of Youth's Child-Mother file indicated that exposures to tobacco smoke in utero, maternal prepregnancy overweight/obesity, and maternal unmarried status were significant risks for adolescent overweight. The risk for overweight was reduced by breastfeeding if the mother was overweight/obese prepregnancy. Prenatal and early life factors were related to adolescent overweight, providing an important window for intervention.

O papel da amamentação ineficaz na gênese da obesidade infantil: um aspecto para a investigação de enfermagem

OBJETIVO: Verificar a amamentação ineficaz como um fator que possibilitaria a gênese da obesidade infantil. MÉTODOS: Foram avaliadas 90 crianças entre dois e cinco anos de idade numa creche de Fortaleza. RESULTADOS: Essa avaliação revelou a seguinte condição nutricional: 57,7% (eutróficas), 14,4% (com sobrepeso), 13,3% (obesas), 11,1% (com baixo peso) e 3,3% (desnutridas). O cenário que envolvia as crianças com sobrepeso ou obesidade foi o seguinte: 60% tiveram um padrão de amamentação ineficaz (< 6 meses e não mamou); 60% viviam em famílias com uma renda mensal de menos de um salário mínimo. CONCLUSÃO: O estudo possibilitou visualizar o aleitamento materno como uma ação importante no cenário da prevenção da obesidade infantil.

Duration of breastfeeding and risk of overweight in childhood: a prospective birth cohort study from Germany

BACKGROUND

Whereas a recently published meta-analysis showed that ever breastfeeding reduces the risk of obesity in childhood significantly, the recent literature describing the relationship between duration of breastfeeding and risk of overweight or obesity in childhood remains inconclusive.

METHODS

Between November 2000 and November 2001, all mothers and their newborns were recruited after delivery at the Department of Gynecology and Obstetrics at the University of Ulm, Germany. Active follow-up was performed at the age of 12 months and 24 months.

RESULTS

Of the 1066 children included in the baseline examination, information on body mass index was available for 855 (80%) at the 2-year follow-up. At this age 72 children (8.4%) were overweight and 24 (2.8%) were severely overweight. Whereas 76 children (8.9%) were never breastfed, 533 children (62.3%) were breastfed for at least 6 months, and 322 children (37.7%) were exclusively breastfed for at least 6 months. Compared to children who were breastfed for less than 3 months, the adjusted odds ratio (OR) for overweight was 0.4 (95% confidence interval (CI) 0.2-0.8) in children who were breastfed for at least 6 months. When considering the time of exclusive breastfeeding, the adjusted OR for overweight was 0.8 (95% CI 0.4; 1.5) in children who were exclusively breastfed for at least 3 but less than 6 months and 0.4 (95% CI 0.2; 0.9) in children who were exclusively breastfed for at least 6 months compared to children who were exclusively breastfed less than 3 months.

CONCLUSION

These results highlight the importance of prolonged breastfeeding for the prevention of overweight in children.

Breast-feeding in women with hypertensive disorders in pregnancy

AIMS

Breast feeding is particularly important and difficult in children born prematurely, especially after hypertensive diseases in pregnancies (HDP). Therefore, we aimed to investigate breast feeding in women who developed HDP.

METHODS

Data on breast-feeding was collected within a nationwide research project on psychosocial factors in HDP. A self-administered questionnaire was given to 2600 women with a suspected history of HDP and 1233 controls. After matching and confirming diagnosis according to ISSHP criteria, 877 women with HDP and 623 controls were included into the study.

RESULTS

Control women initiated (48.9/39.2%; P<0.001) and continued (42.2/37.2%; P<0.005) breast-feeding significantly more often than women with HDP. This holds particularly for women who developed HELLP syndrome (48.9/34.7%; P<0.0001, 42.2/33.5%; P<0.0001). A delivery before the 32(nd) gestational week (19.5/81.8%; P<0.0001) and a birth weight of less than 1500 g (18.8/75%; P<0.0001) were associated with the decision not to breast-feed.

CONCLUSIONS

Women affected by HDP breast fed significantly less often than control women. This effect is at least partly caused by the increased rate of prematurity. Encouraging and supporting these women in breast-feeding is important to improve neonatal physical and mental development.

Surveys of Norwegian youth indicated that breast feeding reduced subsequent risk of obesity

BACKGROUND AND OBJECTIVE

Breast-feeding protects against overweight in childhood, while it is uncertain if it is protective against adolescent and adult overweight. The objective of this study was to examine whether having been breast fed protects against adolescent and adult overweight and obesity.

METHODS

Participants in the Oslo Youth study examined in 1979/1981 (n=635, mean age 13.1 years) and in 1999. Weight and height were measured in 1979/1981 and self-reported in 1999. Breast-feeding information was provided by the parents in 1979/1981. Potential confounders adjusted for included parents' body mass index and education, mother's smoking habits, participants' physical activity, smoking status, education and energy intake.

RESULTS

Comparing those having been breast fed more than 3 months with those never breast fed, the adjusted odds ratios (95% confidence interval [CI]) between the two groups were 0.27 (0.13-0.56) for being overweight and 0.15 (0.03-0.72) for being obese in adolescent. In adulthood, the corresponding odds ratios were 0.64 (0.33-1.26) and 0.34 (0.12-1.01), respectively.

CONCLUSION

Breast feeding during infancy appears to protect against adolescent overweight and obesity, while the effect on adult weight status is weaker. With increasing age, the impact of any protective physiologic mechanisms of breast feeding seen earlier in life tends to diminish.

Determinantes do desmame precoce no distrito noroeste de Campinas

OBJETIVO: Investigar as características do desmame precoce no distrito Noroeste da cidade de Campinas, SP. MÉTODOS: Durante a Campanha Nacional de Vacinação de 8 de junho de 2001, estudo transversal foi conduzido junto a 385 crianças menores de dois anos (10% do atendimento). O responsável pela criança foi questionado sobre características sociodemográficas e assistenciais, idade e motivo da introdução de outros alimentos e do desmame. Considerou-se desmame precoce a interrupção total da oferta de leite materno antes de seis meses de idade. A associação entre desmame e fatores causais e/ou de risco foi investigada por correlação bivariada. Para determinar se a associação persistia, regressão logística foi executada para identificação do(s) melhor(es) preditor(es) do desmame. Para a identificação das causas alegadas de desmame precoce, utilizou-se o teste de diferença de proporções. RESULTADOS: O desmame precoce atingiu 63,6% das crianças. O tempo de estudo materno se mostrou associado ao desmame precoce, conforme teste "t" (p=0,04). Não houve diferença quanto à idade, estado marital e trabalho materno, número de pessoas na família, renda, tipo de assistência e sexo da criança. A regressão logística indicou a idade de introdução de leite não materno (p<0,0001) como preditor do desmame. Os motivos alegados para o desmame precoce foram: o fato de o leite ter secado; rejeição pelo bebê; trabalho materno; doença materna; dores ao amamentar; problemas na mama e doença da criança. CONCLUSÃO: Os resultados apontaram a introdução precoce de leites e fórmulas como preditor do desmame precoce.

Family Environment and Pediatric Overweight: What Is a Parent to Do?

Although the causes of pediatric overweight are many and the levels of intervention required to prevent overweight in children extend from the child's immediate environment to the larger societal level, one critical intervention target is the parent. Scientific evidence points to specific dietary and physical activity/inactivity behaviors that families can adopt to encourage healthful weight status. Dietary recommendations include providing children with ample access to nutrient-dense foods and beverages and high-fiber foods, both at meals and snack times, reducing children's access to high-calorie, nutrient-poor beverages and foods both when eating at home and at restaurants, avoiding excessive food restriction or use of food as a reward, and encouraging children to eat breakfast on a daily basis. Physical activity recommendations include providing opportunities and encouragement for children to be physically active while reducing children's television and video game time. Parental modeling of healthful eating and physical activity practices is recommended to reinforce these patterns in youth. Dietetics professionals, physicians, and other health care professionals can assist parents in their efforts to prevent pediatric overweight by providing information and supporting these key behaviors, while working to create environments that support healthful lifestyle changes.

Prevalência do aleitamento materno na região noroeste de Campinas, São Paulo, Brasil, 2001

OBJETIVO: Calcular a prevalência do aleitamento materno entre crianças menores de dois anos de idade, residentes na região Noroeste de Campinas, São Paulo. MÉTODOS: Estudo transversal foi conduzido, em 2001, junto a 4 103 crianças, questionando sobre data de nascimento, sexo, alimentação e serviço de saúde utilizado. O questionário foi aplicado em 42 postos de vacinação durante a Campanha Nacional de Vacinação contra Poliomielite (Campólio). A dieta foi classificada em amamentação exclusiva, predominante, continuada e aleitamento artificial. RESULTADOS: No primeiro semestre, a prevalência de aleitamento materno exclusivo foi de 31,6% e a de aleitamento total 74,5%. Das crianças com idade entre 6 e 12 meses, 38,0% recebiam leite materno. No segundo ano, a prevalência de aleitamento materno foi reduzida para 22,1%. O aleitamento materno exclusivo passou de 72,2% aos 7 dias de idade para 53,8% aos 15 dias, 33,3% aos 3 meses, 10,0% aos 4 meses e 5,7% aos 6 meses. A prevalência do aleitamento materno total foi de 100,0% aos 7 dias; 79,1% aos 3 meses; 54,3% aos 6; 34,4% aos 12 meses; 26,1% aos 18 e zero aos 24 meses. A mediana de amamentação exclusiva foi de 67 dias e a de amamentação total foi de 6,6 meses. Das crianças vinculadas ao Sistema Único de Saúde, 42,2% receberam aleitamento materno, em contraste com 34,4% das usuárias de serviços privados (p<0,00001). Após controle pela idade, o efeito protetor do Sistema Único de Saúde se manteve, só desaparecendo quando se incluiam as variáveis renda familiar e escolaridade materna. CONCLUSÃO: A prevalência de aleitamento materno está abaixo das recomendações oficiais.

A life course approach to diet, nutrition and the prevention of chronic diseases

OBJECTIVE

To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease.

DESIGN

A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments.

SETTING

International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition.

CONCLUSIONS

The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

Prevalência da amamentação em crianças menores de dois anos vacinadas nos centros de saúde escola

OBJETIVO: Neste trabalho foi desenvolvido estudo transversal com o objetivo de verificar a prevalência da amamentação em 1 708 crianças menores de dois anos em Campinas, São Paulo. MÉTODOS: As informações sobre idade, sexo, serviço de saúde utilizado e alimentação foram obtidas por entrevistas com mães ou responsáveis durante a Campanha de Multivacinação de 2001. A amamentação foi classificada como exclusiva, predominante (incluindo outros líquidos, exceto leites), complementar (incluindo outros alimentos e/ou leites) e total (soma de exclusivo, predominante e complementar). RESULTADOS: A análise demonstrou que a mediana de amamentação exclusiva foi de 68 dias e a de amamentação total foi de 6,4 meses. No primeiro semestre de vida, 38,1% das crianças estavam em amamentação exclusiva; 23,0% em predominante e 14,9% em complementar. No segundo semestre, 36,5% das crianças recebiam leite materno; no terceiro 26,4% e no quarto 13,9%. Crianças usuárias dos serviços públicos e das unidades locais de saúde apresentaram menor risco de desmame do que as usuárias dos serviços privados e de serviços não locais (p<0,005). CONCLUSÃO: Salienta-se a necessidade de estabelecimento de metas visando à amamentação exclusiva até seis meses de idade e total até dois anos ou mais, conforme recomendação da Organização Mundial da Saúde e do Ministério da Saúde.

Guidelines help clinicians identify risk factors for overweight in children

The pediatric office has an important role in national efforts to reverse rising trends in the prevalence of childhood overweight. Overweight may be established at a young age and is difficult to reverse. Lifestyle choices associated with overweight are common and their development may begin in very young children. Therefore, there is a necessity to apply a preventive strategy that addresses all children to promote healthy lifestyle choices from birth onward and to develop an intervention strategy that works by changing family habits so that healthy lifestyle habits are reinforced. It is crucial to develop, evaluate, and apply new systems and practical approaches to aid in this effort in the pediatric practice setting.

Anthropometry and body composition of 18 year old men according to duration of breast feeding: birth cohort study from Brazil

OBJECTIVE

To assess the association between duration of breast feeding and measures of adiposity in adolescence.

DESIGN

Population based birth cohort study.

SETTING

Pelotas, a city of 320 000 inhabitants in a relatively developed area in southern Brazil.

PARTICIPANTS

All newborn infants in the city's hospitals were enrolled in 1982; 78.8% (2250) of all male participants were located at age 18 years when enrolling in the national army.

MAIN OUTCOME MEASURES

Weight, height, sitting height, subscapular and triceps skinfolds, and body composition (body fat, lean mass).

RESULTS

Neither the duration of total breast feeding nor that of predominant breast feeding (breast milk plus non-nutritive fluids) showed consistent associations with anthropometric or body composition indices. After adjustment for confounding factors, the only significant associations were a greater than 50% reduction in obesity among participants breast fed for three to five months compared with all other breastfeeding categories (P = 0.007) and a linear decreasing trend in obesity with increasing duration of predominant breast feeding (P = 0.03). Similar significant effects were not observed for other measures of adiposity. Borderline direct associations also occurred between total duration of breast feeding and adult height (P = 0.06).

CONCLUSIONS

The significant reduction in obesity among children breast fed for three to five months is difficult to interpret, as no a priori hypothesis existed regarding a protective effect of intermediate duration of breast feeding. The findings indicate that, in this population, breast feeding has no marked protective effect against adolescent adiposity.

Can perinatal supplementation of long-chain polyunsaturated fatty acids prevent diabetes mellitus?

It is suggested that the negative correlation between breast-feeding and insulin resistance and diabetes mellitus can be related to the presence of significant amounts of long-chain polyunsaturated fatty acids in the human breast milk. Based on this, it is proposed that provision of adequate amounts of long chain polyunsaturated fatty acids during the critical periods of brain growth and development can prevent or postpone the development diabetes mellitus.

Is metabolic syndrome X an inflammatory condition?

It is suggested that metabolic syndrome X is a low-grade systemic inflammatory condition.

Is type 2 diabetes mellitus a disorder of the brain?

I propose that type 2 diabetes mellitus is due to damage to neurons in the ventromedial hypothalamus or to a defect in the action or properties of insulin or insulin receptors in the brain. These neuronal abnormalities are probably secondary to a marginal deficiency of long-chain polyunsaturated fatty acids during the critical periods of brain growth and development. Hence, supplementation of adequate amounts of long-chain polyunsaturated fatty acids during the third trimester of pregnancy to 2 y postterm can prevent or postpone the development of diabetes mellitus.

The lipids that matter from infant nutrition to insulin resistance

Breast-fed infants showed decreased incidence of obesity, hypertension, diabetes mellitus, and coronary heart disease in later life and higher cognitive function. Breast milk is rich in long-chain polyunsaturated fatty acids (LCPUFAs) and brain preferentially accumulates LCPUFAs during the last trimester of pregnancy and the first few months of life. Breast-fed infants showed significantly lower plasma glucose levels and higher percentage of docosahexaenoic acid and total percentages of LCPUFAs in their skeletal muscle biopsies compared with formula fed. LCPUFAs suppress the production of pro-inflammatory cytokines, regulate the function of several neurotransmitters, enhance the number of insulin receptors in the brain and other tissues, and decrease insulin resistance. LCPUFAs may enhance the production of bone morphogenetic proteins (BMPs), which participate in neurogenesis. It is proposed that the beneficial effects of breast feeding in later life can be attributed to its rich LCPUFA content. It is likely that inadequate breast feeding results in marginal deficiency of LCPUFAs during the critical stages of development, which can lead to insulin resistance. Hence, promoting prolonged breast feeding and/or supplementing LCPUFAs during the critical stages of development may be beneficial in preventing insulin resistance.

Breastfeeding

A large and growing body of scientific evidence suggests that breastfeeding provides immediate and long-lasting health advantages for the mother and her infant. In the United States, breastfeeding rates currently are the highest recorded in 30 years, although premature weaning owing to the largely avoidable problems of breast pain and concern about adequate milk supply is still common. The advantages of breastfeeding will be more widely appreciated when all health care professionals acquire competence in evidence-based lactation management strategies. These strategies include helping women to position and attach their newborns correctly, encouraging frequent and effective feedings at the breast from birth onward, teaching new parents the signs of adequate milk intake, and providing the resources for promoting breastfeeding without the competition of commercial product promotion.

Is obesity an inflammatory condition?

Obesity may be a low-grade systemic inflammatory disease. Overweight and obese children and adults have elevated serum levels of C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and leptin, which are known markers of inflammation and closely associated with cardiovascular risk factors and cardiovascular and non-cardiovascular causes of death. This may explain the increased risk of diabetes, heart disease, and many other chronic diseases in the obese. The complex interaction between several neurotransmitters such as dopamine, serotonin, neuropeptide Y, leptin, acetylcholine, melanin-concentrating hormone, ghrelin, nitric oxide, and cytokines and insulin and insulin receptors in the brain ultimately determines and regulates food intake. Breast-feeding of more than 12 mo is associated with decreased incidence of obesity. Breast milk is a rich source of long-chain polyunsaturated fatty acids (LCPUFAs) and brain is especially rich in these fatty acids. LCPUFAs inhibit the production of proinflammatory cytokines and enhance the number of insulin receptors in various tissues and the actions of insulin and several neurotransmitters. LCPUFAs may enhance the production of bone morphogenetic proteins, which participate in neurogenesis, so these fatty acids might play an important role in brain development and function. It is proposed that obesity is a result of inadequate breast feeding, which results in marginal deficiency of LCPUFAs during the critical stages of brain development. This results in an imbalance in the structure, function, and feedback loops among various neurotransmitters and their receptors, which ultimately leads to a decrease in the number of dopamine and insulin receptors in the brain. Hence, promoting prolonged breast feeding may decrease the prevalence of obesity. Exercise enhances parasympathetic tone, promotes antiinflammation, and augments brain acetylcholine and dopamine levels, events that suppress appetite. Acetylcholine and insulin inhibit the production of proinflammatory cytokines and provide a negative feedback loop for postprandial inhibition of food intake, in part, by regulating leptin action. Statins, peroxisome proliferator-activated receptor-gamma binding agents, non-steroidal antiinflammatory drugs, and infant formulas supplemented with LCPUFAs, and LCPUFAs themselves, which suppress inflammation, may be beneficial in obesity.

Ethnic issues in the epidemiology of childhood obesity

Childhood obesity may be seen as a marker for high-risk dietary and physical inactivity practices. Recent increases in the prevalence of overweight and obesity among American children are not limited to one age, gender, or ethnic group, which suggests that unique behaviors of the members of various racial or ethnic subgroups of the population are unlikely to be the major contributing factors. Rather, it seems that environmental changes promoting increased energy intake and decreased energy output are occurring and have widespread impact on children from various backgrounds. Although no ethnic group is immune from the current shift in energy balance, differential rates of overweight seem to exist among ethnic groups. National probability samples of African-American, Hispanic, and white children in the United States provide clear evidence that white children are at lower risk for childhood overweight than are African-American or Hispanic children. Of concern is the lack of national data on the prevalence of overweight and obesity for Native-American and Asian-American groups. Also of concern is the aggregation of racial and ethnic subgroups, which may render prevalence rates meaningless. This possibility is clearly true with some surveys of weight status that combine diverse populations, such as Asians and Pacific Islanders, into one group. The high rates of obesity in African-American, Hispanic, and Native-American children are of concern. Although parental SES is associated inversely with childhood obesity among whites, higher SES does not seem to protect African-American and Hispanic children against obesity. In these groups, childhood obesity does not seem to be associated significantly with parental income and education. Health consequences of childhood obesity include a higher prevalence of type 2 diabetes and an increased risk for adverse levels of lipids, lipoproteins, and blood pressure. The effects of recently reported unprecedented levels of childhood overweight on subsequent risk for obesity in middle age are not known until future longitudinal data can be collected. It seems likely, however, that future health consequences of current early and severe childhood obesity will be staggering. Funding for adult follow-up of longitudinal studies of high-risk African American, Hispanic, and Native-American children is needed urgently to provide information on the long-term effects of childhood obesity. Halting the obesity epidemic is a formidable task, but the success in recent decades of drastically reducing childhood undernutrition offers hope and should spur similar action and leadership efforts. Promotion of efforts to reduce excess caloric intake with efforts to increase energy expenditure should receive paramount attention in the design of health programs. Given the relatively few published obesity-prevention and treatment studies that are designed to address specific cultural issues, it is important to promote the development of culturally appropriate intervention strategies that are shown to be effective among youth of diverse backgrounds. Although the dietary and activity goals will be similar, parental, family, and community messages and techniques grounded in cultural traditions and norms will be different for each ethnic group. This approach is crucial in the United States, a country with an increasingly diverse population.