The Association of Breastfeeding Duration and Early Childhood Cardiometabolic Risk

Childhood Nutritional Factors and Cardiometabolic Outcomes at 9-11 y of Age: Findings from the ROLO Longitudinal Birth Cohort Study

BACKGROUND

Childhood represents a critical period of nutritional risk in the programming of later chronic disease. Few longitudinal studies have explored repeated measures of nutrition throughout the first decade of life in relation to preteen cardiometabolic outcomes.

OBJECTIVES

This research aimed to explore associations of early feeding practices (human milk exposure and duration and timing of introduction to solids) and childhood dietary quality and inflammatory scores (at 5 and 9-11 y and change during childhood) on preteen cardiometabolic outcomes.

METHODS

This is an analysis of children from the ROLO longitudinal birth cohort study (n = 399). Information on early feeding practices were obtained at postnatal study visits. Food frequency questionnaires collected maternal-reported dietary intakes for each child at 5 and 9-11 y of age. Healthy Eating Index (HEI)-2015 and the Children's Dietary Inflammatory Index (C-DII) scores were calculated. Anthropometry, body composition, blood pressure, heart rate, cardiorespiratory endurance, and blood biomarkers were obtained at 9-11 y. Crude and adjusted linear regression models examined nutritional exposure associations with preteen cardiometabolic outcomes.

RESULTS

In the adjusted model, any human milk exposure was associated with lower body fat (%) at 9-11 y (β: -2.86; 95% confidence interval [CI]: -5.46, -0.27; P = 0.03), than never receiving human milk. At 5 y, diet scores were favorably associated with lean mass at 9-11 y (P < 0.05 for both). Higher preteen HEI-2015 scores were associated with lower preteen leptin levels (tertile 3 compared with tertile 1-β: -2.92; 95% CI: -5.64, -0.21; P = 0.03). Diet quality significantly deteriorated (HEI-2015 score decreased) and became more proinflammatory (C-DII score increased) from 5 to 9-11 y of age. Diet quality/inflammation deterioration (compared with improvement) or overall change in dietary scores were not related to preteen cardiometabolic outcomes.

CONCLUSIONS

Exposure to human milk in early life was associated with lower preteen adiposity, irrespective of duration. Diet quality/inflammatory potential deteriorated between early childhood and the preteen years, highlighting a potential period for intervention.

Are There Benefits to Breastfeeding for Long Durations That Continue after Breastfeeding Has Stopped? An Analysis of Acute Respiratory Illness in Nigerian Children

Background: While an abundance of evidence exists regarding infectious outcomes in children as they relate to the short-term benefits of breastfeeding, there is limited evidence related to similar impacts beyond one year and after breastfeeding has stopped. Specifically, little is known about the long-term benefits of breastfeeding for acute health outcomes after infancy, particularly in Nigeria. Methods: The Nigeria Demographic and Health Survey data was used in this study. We utilized data (n = 5391) on children who had stopped breastfeeding for at least 12 months before the survey. Breastfeeding duration was categorized into 1-6 months, 7-12 months, 13-18 months, 18-24 months, and > 24 months. Any recent incident of acute respiratory illness in children was operationalized using the responses to related questions (recent incidents of fever, cough, running nose, and short, rapid, or difficulty breathing in children). Adjusted logistic regression was used to estimate odds ratios, and statistical significance was determined at p ≤ 0.05. Results: Post-infancy and after breastfeeding had stopped, the odds of recent acute respiratory illness were significantly less (AOR = 0.37, 95% CI [0.15-0.79], p = 0.04) in children breastfed for 19-24 months compared to those breastfed for 1-6 months. No significant association was found between the other durations and ARI post-infancy (p > 0.05). Conclusions: These findings indicate that breastfeeding for up to 24 months has a long-term protective effect from an acute health condition that contributes to the high under-five mortality rates recorded for decades in Nigeria specifically, and more broadly, in sub-Saharan Africa.

Associations of breastfeeding duration with serum lipid values from infancy until age 20 years - the STRIP study

BACKGROUND AND AIMS

The effect of breastfeeding duration on childhood lipid levels has remained controversial. In this study, we aimed to establish the long-term associations of breastfeeding duration with future levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol and low-density lipoprotein cholesterol. In addition, we report lipid levels at the age of seven months depending on the child receiving any breastmilk.

METHODS

The sample comprised 999 children participating in the prospective Special Turku Coronary Risk Factor Intervention Project (STRIP). Serum lipid profile was studied at the ages of seven months and 13 months, and annually thereafter until the age of 20 years. Duration of breastfeeding was inquired, and infants were divided into those who received or did not receive any breast milk at the age of seven months (n=533 and n=466, respectively). In addition, breastfeeding duration groups (any breastfeeding for 0-4 months, 4-6 months, 6-9 months, and >9 months) were formed.

RESULTS

At the age of seven months infants who at that time received breast milk had higher serum HDL cholesterol (0.95±0.21mmol/l vs. 0.90±0.19 mmol/l; p=0.0018), non-HDL cholesterol (3.38±0.78 mmol/l vs. 3.01±0.67 mmol/l; p<0.001) and total cholesterol levels (4.33±0.80 mmol/l vs. 3.91±0.69 mmol/l; p<0.001) than their peers who did not receive breast milk. From two to 20 years of age serum lipid levels showed no consistent differences between the breastfeeding duration groups.

CONCLUSIONS

Our long-term data showed that duration of breastfeeding has no consistent associations with serum lipid concentrations in healthy individuals aged two to 20 years.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov, unique identifier NCT00223600.

Assessing the impact of concurrent high-fructose and high-saturated fat diets on pediatric metabolic syndrome: A review

High-saturated fat (HF) or high-fructose (HFr) consumption in children predispose them to metabolic syndrome (MetS). In rodent models of MetS, diets containing individually HF or HFr lead to a variable degree of MetS. Nevertheless, simultaneous intake of HF plus HFr have synergistic effects, worsening MetS outcomes. In children, the effects of HF or HFr intake usually have been addressed individually. Therefore, we have reviewed the outcomes of HF or HFr diets in children, and we compare them with the effects reported in rodents. In humans, HFr intake causes increased lipogenesis, hypertriglyceridemia, obesity and insulin resistance. On the other hand, HF diets promote low grade-inflammation, obesity, insulin resistance. Despite the deleterious effects of simultaneous HF plus HFr intake on MetS development in rodents, there is little information about the combined effects of HF plus HFr intake in children. The aim of this review is to warn about this issue, as individually addressing the effects produced by HF or HFr may underestimate the severity of the outcomes of Western diet intake in the pediatric population. We consider that this is an alarming issue that needs to be assessed, as the simultaneous intake of HF plus HFr is common on fast food menus.

Fetal programming and lactation: modulating gene expression in response to undernutrition during intrauterine life

BACKGROUND

Adverse environmental conditions during intrauterine life, known as fetal programming, significantly contribute to the development of diseases in adulthood. Fetal programming induced by factors like maternal undernutrition leads to low birth weight and increases the risk of cardiometabolic diseases.

METHODS

We studied a rat model of maternal undernutrition during gestation (MUN) to investigate gene expression changes in cardiac tissue using RNA-sequencing of day 0-1 litters. Moreover, we analyzed the impact of lactation at day 21, in MUN model and cross-fostering experiments, on cardiac structure and function assessed by transthoracic echocardiography, and gene expression changes though qPCR.

RESULTS

Our analysis identified specific genes with altered expression in MUN rats at birth. Two of them, Agt and Pparg, stand out for being associated with cardiac hypertrophy and fibrosis. At the end of the lactation period, MUN males showed increased expression of Agt and decreased expression of Pparg, correlating with cardiac hypertrophy. Cross-fostering experiments revealed that lactation with control breastmilk mitigated these expression changes reducing cardiac hypertrophy in MUN males.

CONCLUSIONS

Our findings highlight the interplay between fetal programming, gene expression, and cardiac hypertrophy suggesting that lactation period is a potential intervention window to mitigate the effects of fetal programming.

IMPACT

Heart remodeling involves the alteration of several groups of genes and lactation period plays a key role in establishing gene expression modification caused by fetal programming. We could identify expression changes of relevant genes in cardiac tissue induced by undernutrition during fetal life. We expose the contribution of the lactation period in modulating the expression of Agt and Pparg, relevant genes associated with cardiac hypertrophy. This evidence reveal lactation as a crucial intervention window for preventing or countering fetal programming.

Adherence to a healthy lifestyle behavior composite score and cardiometabolic risk factors in Spanish children from the CORALS cohort

To assess the associations between the adherence to a composite score comprised of 6 healthy lifestyle behaviors and its individual components with several cardiometabolic risk factors in Spanish preschool children. Cross-sectional analyses were conducted in 938 participants included in the CORALS cohort aged 3-6 years. Six recognized healthy lifestyle behaviors (breastfeeding, sleep duration, physical activity, screentime, adherence to the Mediterranean diet, and eating speed) were assessed in a composite score. Multiple linear and logistic regression models were fitted to assess the associations with cardiometabolic risk factors (weight status, waist circumference, fat mass index, blood pressure, fasting plasma glucose, and lipid profile). In the adjusted multiple linear and logistic regression models, compared with the reference category of adherence to the healthy lifestyle behavior composite score, those participants in the category of the highest adherence showed significant decreased prevalence risk of overweight or obesity [OR (95% CI), 0.4 (0.2, 0.6)] as well as significant lower waist circumference, fat mass index (FMI), systolic blood pressure and fasting plasma glucose concentration [β (95% CI), - 1.4 cm (- 2.5, - 0.4); - 0.3 kg/m2 (- 0.5, - 0.1); and - 3.0 mmHg (- 5.2, - 0.9); - 1.9 mg/dL (- 3.5, - 0.4), respectively]. Slow eating speed was individually associated with most of the cardiometabolic risk factors.   Conclusions: Higher adherence to the healthy lifestyle behavior composite score was associated with lower waist circumference, FMI, other cardiometabolic risk factors, and risk of overweight or obesity in Spanish preschool children. Further studies are required to confirm these associations. What is Known: • Lifestyle is a well-recognized etiologic factor of obesity and its comorbidities. • Certain healthy behaviors such as adhering to a healthy diet, increasing physical activity, and decreasing screentime are strategies for prevention and treatment of childhood obesity. What is New: • Higher adherence to the healthy lifestyle behavior composite score to 6 healthy behaviors (breastfeeding, sleep duration, physical activity, screentime, eating speed, and adherence to the Mediterranean diet) was associated with decreased adiposity, including prevalence risk of overweight or obesity, and cardiometabolic risk in preschool children. • Slow eating and greater adherence to the Mediterranean diet were mainly associated to lower fasting plasma and serum triglycerides concentration, respectively.

Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis

OBJECTIVE

To investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents.

STUDY DESIGN

This study included 634 offsprings aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates.

RESULTS

Median breastfeeding duration was 7 months (minimum = 0, maximum = 36). Boys in the second quartile (median breastfeeding = 5 months) had lower total fat mass % (β (SE) -3.2 (1.5) P = .037), and higher lean mass % (3.1 (1.6) P = .049) and skeletal muscle mass % (1.8 (0.8) P = .031) compared with the reference group (median breastfeeding = 2 months). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) P = .035) was found among girls. No association was found with other cardiometabolic indicators.

CONCLUSION

Despite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.

Breastfeeding is associated with reduced risks of central obesity and hypertension in young school-aged children: a large, population-based study

BACKGROUND

Previous studies examined the effects of breastfeeding on measured values of body circumferences or blood pressure during childhood. However, limited data are available for the association between child feeding and a specific disease diagnosed as central obesity or hypertension. Hence, we aimed to examine whether the type and duration of breastfeeding are associated with obesity/central obesity or hypertension in young school-aged children.

METHODS

We matched the data obtained from a cross-sectional survey in 2019 with retrospective breastfeeding information recorded in the database. Heights, weights, waist circumferences, and blood pressures of 8480 children in first grade of primary schools in Shanghai, China were measured to diagnose obesity, central obesity, and hypertension. Data on child feeding was collected retrospectively from clinical records. Associations between the type/duration of breastfeeding and children's measured values of body mass index, waist circumference, and blood pressure were analysed by linear regression. Associations between the type/duration of breastfeeding and risks of obesity, central obesity, and hypertension were analysed by generalised linear models.

RESULTS

Breastfeeding duration was inversely associated with blood pressure values in children in the first grade. Each month's increase in the duration of any breastfeeding was associated with a 0.07 mmHg decrease in systolic blood pressure (P < 0.01) and a 0.05 mmHg decrease in diastolic blood pressure (P < 0.01). Any breastfeeding > one month was associated with a reduced risk of hypertension (adjusted risk ratio 0.84; 95% CI 0.73, 0.96, P = 0.01). Exclusive breastfeeding > one month was associated with a reduced risk of central obesity (adjusted risk ratio 0.76; 95% CI: 0.60, 0.96, P = 0.02). Any breastfeeding > 12 months was linked with a lower risk of hypertension (adjusted risk ratio 0.83; 95% CI 0.70, 0.98, P = 0.03).

CONCLUSIONS

Lack of breastfeeding is associated with higher risks of central obesity and hypertension during middle childhood. As a potential component of the public health strategy to reduce population levels of metabolic and cardiovascular diseases, breastfeeding could be a vital prevention strategy.

Slower Growth during Lactation Rescues Early Cardiovascular and Adipose Tissue Hypertrophy Induced by Fetal Undernutrition in Rats

Low birth weight (LBW) and accelerated growth during lactation are associated with cardiometabolic disease development. LBW offspring from rats exposed to undernutrition during gestation (MUN) develops hypertension. In this rat model, we tested if slower postnatal growth improves early cardiometabolic alterations. MUN dams were fed ad libitum during gestation days 1–10, with 50% of the daily intake during days 11–21 and ad libitum during lactation. Control dams were always fed ad libitum. Pups were maintained with their own mother or cross-fostered. Body weight and length were recorded weekly, and breastmilk was obtained. At weaning, the heart was evaluated by echocardiography, and aorta structure and adipocytes in white perivascular fat were studied by confocal microscopy (size, % beige-adipocytes by Mitotracker staining). Breastmilk protein and fat content were not significantly different between groups. Compared to controls, MUN males significantly accelerated body weight gain during the exclusive lactation period (days 1–14) while females accelerated during the last week; length growth was slower in MUN rats from both sexes. By weaning, MUN males, but not females, showed reduced diastolic function and hypertrophy in the heart, aorta, and adipocytes; the percentage of beige-type adipocytes was smaller in MUN males and females. Fostering MUN offspring on control dams significantly reduced weight gain rate, cardiovascular, and fat hypertrophy, increasing beige-adipocyte proportion. Control offspring nursed by MUN mothers reduced body growth gain, without cardiovascular modifications. In conclusion, slower growth during lactation can rescue early cardiovascular alterations induced by fetal undernutrition. Exclusive lactation was a key period, despite no modifications in breastmilk macronutrients, suggesting the role of bioactive components. Our data support that lactation is a key period to counteract cardiometabolic disease programming in LBW and a potential intervention window for the mother.

Mealtime media use and cardiometabolic risk in children

OBJECTIVES

To examine the association between mealtime media use and non-HDL-cholesterol as well as other markers of cardiometabolic risk (CMR) in children.

DESIGN

A repeated measures study design was used to examine the association between mealtime media use and CMR outcomes. Multivariable linear regression with generalised estimating equations was used to examine the association between mealtime media use and CMR outcomes. Analyses were stratified a priori by age groups (1-4 and 5-13 years).

SETTING

The TARGet Kids! Practice-based research network in Toronto, Canada.

PARTICIPANTS

2117 children aged 1-13 years were included in the analysis.

RESULTS

After adjusting for covariates, there was no evidence that total mealtime media use was associated with non-HDL-cholesterol in 1-4 year olds (P = 0·10) or 5-13 year olds (P = 0·29). Each additional meal with media per week was associated with decreased HDL-cholesterol in 5-13 year olds (-0·006 mmol/l; 95 % CI -0·009, -0·002; P = 0·003) and log-TAG in 1-4 year olds (β = -0·004; 95 % CI -0·008, -0·00009; P = 0·04). Media use during breakfast was associated with decreased HDL-cholesterol in 5-13 year olds (-0·012 mmol/l; 95 % CI -0·02, -0·004; P = 0·002), while media during lunch was associated with decreased log-TAG (-0·01 mmol/l; 95 % CI -0·03, -0·002; P = 0·03) in children aged 1-4 years. Total mealtime media use was not associated with total cholesterol, glucose or insulin in either age group.

CONCLUSIONS

Mealtime media use may be associated with unfavourable lipid profiles through effects on HDL-cholesterol in school-aged children but likely not in pre-schoolers.

ASSOCIATION BETWEEN BREASTFEEDING AND OVERWEIGHT/OBESITY IN SCHOOLCHILDREN AGED 7-14 YEARS

Objective:

To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years.

Methods:

This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (<Z score+1) and overweight/obesity (≥Z score+1). The adjusted analysis was performed by logistic regression in two age strata (age groups of 7-10 and 11-14 years).

Results:

6.6% of schoolchildren had never breastfed; 16.8% had been breastfed for ≤3 months; 16.7%, for 4-6 months; and 59.9%, for ≥7 months. No statistically significant differences were found in the occurrence and duration of BF between the age groups. The prevalence of overweight/obesity was 34.2%. For age groups (7-10 and 11-14 years), the prevalence of overweight/obesity was 36.7% and 29.8%, respectively. Chance of overweight/obesity for the age group of 7-10 years was lower among schoolchildren who were breastfed (OR=0.54; 95%CI 0.33-0.88), when compared with those who never breastfed. When categorized, the chance of overweight/obesity in the age group of 7-10 years was lower for duration of BF ≤3 months (OR=0.41; 95%CI 0.20-0.83), and 4-6 months (OR=0.48; 95%CI 0.28-0.82) when compared with children who never breastfed.

Conclusions:

BF for at least six months was associated with a lower chance of overweight/obesity for schoolchildren aged 7-10 years. No association was found for schoolchildren aged 11-14 years.

The association between body mass index trajectories and cardiometabolic risk in young children

BACKGROUND

Rapid growth is associated with increased cardiometabolic risk (CMR) in adolescence and adulthood. Little is known about whether the association between rapid growth and increased CMR originates in early childhood.

OBJECTIVES

To identify age and sex standardized body mass index (zBMI) trajectories and to examine the association between zBMI trajectories and CMR outcomes in children 0 to 60 months.

STUDY DESIGN

A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) in Toronto, Canada. Participants had repeated measures of weight and length or height performed from birth to 60 months of age. Latent class mixed modelling was used to identify the zBMI trajectories. Linear regressions were performed to determine the association between zBMI trajectories and the primary outcome, a CMR score, quantified as the sum of age- and sex- standardized waist circumference, systolic blood pressure, glucose, log-triglycerides and negative high-density lipoprotein cholesterol (HDL-C), divided by √5. Secondary outcomes were the individual components of the CMR formula as well as diastolic blood pressure and non-HDL-C.

RESULTS

Four BMI trajectories were identified among the 1166 children. After adjusting for all covariates, children in the rapidly accelerating trajectory had increased total CMR score (β = 1.38, 95% CI 0.77; 1.99, P < .001) and increased waist circumference score (β = 2.39, 95% CI 1.92; 2.86, P < .001) compared to the stable low group.

CONCLUSIONS

Rapid growth during early childhood is associated with increased CMR in preschool children, largely driven by larger waist circumference.

Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children

OBJECTIVE

Health care policy positions breastfeeding as an important part of the solution to household food insecurity; however, there are critical gaps in our knowledge of the relationship between breastfeeding duration (exposure variable) and household food insecurity (outcome variable). Our objective was to examine this relationship.

METHODS

A cross-sectional study was conducted from 2008 to 2016 of healthy urban children (N = 3838) who were 0 to 3 years old and recruited from The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Total breastfeeding duration was collected from parent-reported questionnaires. Household food insecurity was measured using 1-item and 2-item food insecurity screens. Multivariable regression analysis was performed adjusting for prespecified covariates.

RESULTS

The median total breastfeeding duration was 10.5 months (interquartile range, 6.0-14.0), and 14.7% of households were food insecure. After adjusting for child characteristics (age, sex), maternal characteristics (age, ethnicity, education, employment), and family characteristics (number of children, single parent family, neighborhood equity score), there was no significant association between total breastfeeding duration and household food insecurity (odds ratio, 0.99; 95% confidence interval, 0.98-1.01). Although low-income families had an increased odds of being household food insecure (P ≤ .001), we found no significant association between total breastfeeding duration and household food insecurity at varying income levels.

CONCLUSIONS

We found no association between breastfeeding duration and household food insecurity, regardless of family income. Although breastfeeding is associated with improved child health outcomes and considered to be part of the solution to household food insecurity, interventions focused on social determinants may provide more promising targets for the prevention of household food insecurity.

Prevention of Obesity and Metabolic Syndrome in Children

In recent decades, the prevalence of overweight and obesity has become increasingly common such that it is now the major nutritional problem worldwide. Obesity occurs when dietary energy intake exceeds energy expenditure and has arisen in many societies due to an increasingly "obesogenic" environment in which physical activity has declined and yet children continue to be exposed to unhealthy, energy-dense diets. Additional risks for the development of obesity also include psychological issues and genetic factors. Obesity has many adverse health consequences including development of insulin resistance, Type 2 diabetes, and the metabolic syndrome. There are also important genetic influences on the likelihood of developing insulin resistance. Given the limited success of therapeutic interventions to treat obesity and the metabolic syndrome, there has been an increased interest in preventative strategies. These are likely to be most successful when targeting the young and will require a combination of approaches which will need inter-disciplinary collaborations across health and local government to target families, schools, and local environments to facilitate behavior changes which influence young people's eating behaviors and habitual levels of physical activity.