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Holstad Y, Johansson B, Lindqvist M, Westergren A, Poromaa IS, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Wikström AK, Bay A. Breastfeeding in primiparous women with congenital heart disease - a register study. Int Breastfeed J 2024; 19:19. [PMID: 38509505 PMCID: PMC10956229 DOI: 10.1186/s13006-024-00627-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The number of pregnant women with congenital heart disease (CHD) is rising, and the disease poses increased risks of cardiovascular and obstetric complications during pregnancy, potentially impacting breastfeeding success. This study aimed to investigate breastfeeding in primiparous women with CHD compared to primiparous women without CHD, and to examine potential hindering factors for breastfeeding in women with CHD. METHODS The data were gathered between 2014 and 2019 and obtained by merging the Swedish Congenital Heart Disease Register (SWEDCON) with the Swedish Pregnancy Register. Primiparous women ≥ 18 years of age with CHD (n = 578) were matched by age and municipality to 3049 women without CHD, giving birth after 22 gestational weeks. Multivariable logistic regression analysis was used to identify factors associated with non-breastfeeding in women with CHD. RESULTS Fewer women with CHD breastfed than women without CHD two days (94% vs. 97%, p = 0.001) and four weeks after birth (84% vs. 89%, p = 0.006). When all women were analysed, having CHD was associated with non-breastfeeding at both two days and four weeks after birth. For women with CHD, body mass index (BMI) ≥ 30 (OR 3.1; 95% CI 1.4, 7.3), preterm birth (OR 6.4; 95% CI 2.1, 19.0), self-reported history of psychiatric illness (OR 2.4; 95% CI 1.2, 5.1), small for gestational age (OR 4.2; 95% CI 1.4, 12.2), and New York Heart Association Stages of Heart Failure class II - III (OR 6.0; 95% CI 1.4, 26.7) were associated with non-breastfeeding two days after birth. Four weeks after birth, factors associated with non-breastfeeding were BMI ≥ 30 (OR 4.3; 95% CI 2.1, 9.0), self-reported history of psychiatric illness (OR 2.2; 95% CI 1.2, 4.2), and preterm birth (OR 8.9; 95% CI 2.8, 27.9). CONCLUSIONS The study shows that most women with CHD breastfeed, however, at a slightly lower proportion compared to women without CHD. In addition, factors related to the heart disease were not associated with non-breastfeeding four weeks after birth. Since preterm birth, BMI ≥ 30, and psychiatric illness are associated with non-breastfeeding, healthcare professionals should provide greater support to women with CHD having these conditions.
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Affiliation(s)
- Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Lindqvist
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | | | | | | | - Mikael Dellborg
- Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
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Mulu A, Neupane S. The Association of Maternal BMI with Overweight among Children Aged 0-59 Months in Kenya: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1413. [PMID: 36674176 PMCID: PMC9859472 DOI: 10.3390/ijerph20021413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Childhood overweight is a growing global public health challenge and is prevalent in many countries. We aimed at exploring the prevalence of childhood overweight and the association of maternal body mass index (BMI), maternal demographic factors, and child-related factors with childhood overweight among Kenyan children aged 0-59 months. This study utilized Kenya's 2014 demographic and health survey, which was based on national representative cross-sectional data. A total of 8316 children and their mothers' data were analyzed. Overweight in children and maternal BMI were defined using WHO standard criteria. Multivariate logistics regression models were used to study the association of maternal BMI and childhood overweight. Nationally 5% of Kenyan children aged 0-59 months are overweight (5.5% male vs. 3.8% female). The highest prevalence in overweight among children was found in Central region (6.9%) and lowest in North Eastern (3.1%) which could be explained by the various economic disparities. Maternal BMI with underweight was associated with lower odds (OR 0.30, 95% CI 0.14-0.64) whereas, overweight and obesity were associated with higher odds of overweight (OR for overweight 1.64, 95% CI 1.28-2.11 and OR for obesity 1.74, 95% CI 1.22-2.47) among their children compared to normal weight mothers. Overweight among children is of great concern and therefore initiatives to tackle both child and maternal health are urgently needed.
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Affiliation(s)
| | - Subas Neupane
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland
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3
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Muñoz-Esparza NC, Vásquez-Garibay EM, Guzmán-Mercado E, Larrosa-Haro A, Comas-Basté O, Latorre-Moratalla ML, Veciana-Nogués MT, Vidal-Carou MC. Influence of the Type of Breastfeeding and Human Milk Polyamines on Infant Anthropometric Parameters. Front Nutr 2022; 8:815477. [PMID: 35071304 PMCID: PMC8770740 DOI: 10.3389/fnut.2021.815477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022] Open
Abstract
Feeding choices in the early months of life are key determinants of growth during infancy. Polyamines participate in cell proliferation and differentiation, and it has also been suggested that polyamine metabolism plays a role in adipogenesis. As the main exogenous source of polyamines in the infant is human milk, the aim of this work was to study if the type of breastfeeding received and the polyamine intake from human milk has an influence on infant anthropometric parameters. A cohort of 78 full-term healthy newborns was followed up until 4 months of age; 55 were fully and 23 partially breastfed. Anthropometric measurements were taken at 2 and 4 months, when human milk samples were also collected for analysis of polyamine content by UHPLC-FL. Fully breastfed infants had a better anthropometric profile than those partially breastfed (p < 0.05). Furthermore, polyamine intake in partially breastfed infants was significantly lower compared to those fully breastfed. However, only two of the 15 anthropometric indicators evaluated (triceps skinfold and mean upper arm circumference) showed a significant inverse association with polyamine content in human milk and intake (p < 0.05). Infant growth and body composition differ according to the type of breastfeeding received. Based on the weak associations between polyamines and anthropometric indicators, it is not possible to conclude the influence of polyamines in infant growth and body composition.
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Affiliation(s)
- Nelly C Muñoz-Esparza
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, Campus de l'Alimentació de Torribera, Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària (INSA·UB), Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Xarxa d'Innovació Alimentària (XIA), Barcelona, Spain.,Instituto de Nutrición Humana, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | - Oriol Comas-Basté
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, Campus de l'Alimentació de Torribera, Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària (INSA·UB), Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Xarxa d'Innovació Alimentària (XIA), Barcelona, Spain
| | - M Luz Latorre-Moratalla
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, Campus de l'Alimentació de Torribera, Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària (INSA·UB), Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Xarxa d'Innovació Alimentària (XIA), Barcelona, Spain
| | - M Teresa Veciana-Nogués
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, Campus de l'Alimentació de Torribera, Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària (INSA·UB), Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Xarxa d'Innovació Alimentària (XIA), Barcelona, Spain
| | - M Carmen Vidal-Carou
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, Campus de l'Alimentació de Torribera, Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària (INSA·UB), Universitat de Barcelona, Santa Coloma de Gramenet, Spain.,Xarxa d'Innovació Alimentària (XIA), Barcelona, Spain
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Arredondo A, Lugo OBR, Orozco E, Rosa CPTDL. Breastfeeding and feeding practices in the first year of life and its association with overweight and obesity of children in Mexico. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate feeding practices in the first year of life and their association with the development of overweight and obesity in children in Mexico. Methods: the association between overweight and obesity with different feeding practices were evaluated. The data was processed using the statistical package Stata version 14 using logistic regression models. Results: 396 children were evaluated; the prevalence of overweight and obesity was 6% and 7.7% presented a possible risk of overweight. 6.9% had exclusive breastfeeding in the first 6 months of life and 71.7% were fed infant formula. The variables significantly associated with the development of overweight and obesity in the first year of life were the age of the child (p =0.043, RR=0.57), the introduction of fluids in the first three days of life (p=0.02, RR=2.90), consumption of foods with a high sugar content (p =0.01, RR=0.25), consumption of milk other than breast (p =0.02, RR3.25) and egg consumption (p =0.05; RR=0.28). Conclusions: our results show that it is essential to attend complementary feeding practices and reinforce exclusive breastfeeding in the first year of life, as measures to prevent overweight and obesity to improve health in childhood.
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Using a lactation room at the workplace is associated with longer breastfeeding duration in working mothers. NUTR HOSP 2021; 37:918-925. [PMID: 32960635 DOI: 10.20960/nh.03242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction IIntroduction: maternal employment after childbirth is associated with abandonment of breastfeeding; however, lactation rooms in the workplace increase the practice of breastfeeding. Objective: to compare the frequency and duration of breastfeeding among working mothers based on the presence of lactation rooms in their workplaces. Methods: we included mothers from different institutions whose infants were between 6 and 35 months (n = 158), and an ad hoc questionnaire was applied to assess breastfeeding, exclusive breastfeeding (EBF), partial breastfeeding (PBF), and use of human milk substitutes (HMS). Two groups were compared: working mothers with a lactation room at their workplace (n = 76) versus working mothers without this resource (n = 82). Results: breastfeeding duration (7.5 vs. 5.0 months, p < 0.001) and EBF (3.0 vs. 1.2 months, p = 0.005) were higher in mothers who had a lactation room. HMS use was shorter in mothers who had a lactation room (2.5 vs. 10.0 months, p = 0.001). There were more working mothers who breastfed for more than six months (75.0 % vs. 48.8 %) [OR = 3.15 (95 % CI, 1.60-6.19), p = 0.001] and 12 months (31.6 % vs. 14.6 %) [OR = 2.69 (95 % CI, 1.23-5.87), p = 0.014] when lactation rooms were available in their workplaces. Conclusion: the presence of a lactation room in the workplace was associated with a higher frequency and duration of breastfeeding.
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Childhood obesity: Is it related to feeding type of the infant? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.810439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Echevarría-Castro N, Matayoshi-Pérez A, Alvarado GF. Association between Maternal Depressive Symptoms with Overweight/Obesity among Children Aged 0-5 Years According to the 2016 Demographic and Family Health Survey. Child Obes 2020; 16:307-315. [PMID: 32429683 DOI: 10.1089/chi.2019.0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Overweight and obesity among children under the age of 5 have become a public health problem. The worldwide prevalence is 4.9% and 6.0%, whereas in Peru it is 7.4% and 1.9%, respectively. The causes of these problems are multifactorial and must be studied to prevent the multiple consequences on children's health. Methods: Secondary data analysis of the 2016 Demographic and Family Health Survey (DHS). The sample size was 7935 children and their mothers. The dependent variable was childhood overweight/obesity, measured according to the Z-score of the BMI >2 standard deviation (SD), while the main independent variable consisted of the maternal depressive symptoms (DS) (Patient Health Questionnaire-9 score >10 points). The software STATA/MP 14.0 was used for statistical analysis. Results: The prevalence of overweight/obesity among children aged 0-5 years was 4.5% and the prevalence of moderate and severe maternal DS was 7.1%. No maternal depressive symptoms were found to be associated with the outcome [adjusted PR = 1.36 95% confidence interval (CI) = 0.59-3.09 p = 0.47]. An association was found between socioeconomic status (SES) Q3 (adjusted PR = 3.86 95% CI = 1.9-7.6 p < 0.0001), Q4 (adjusted PR = 5.53 95% CI = 2.76-11.1 p < 0.0001), Q5 (adjusted PR = 6.9 95% CI = 3.24-14.7 p = < 0.0001), maternal BMI (adjusted PR = 1.06 95% CI = 1.03-1.08 p < 0.0001), and cesarean delivery (adjusted PR = 1.42 95% CI = 1.01-1.99 p = 0.042). Conclusions: No association was found between maternal depressive symptoms and overweight/obesity among children aged 0-5 years. The upper SES quintiles, maternal BMI, and cesarean delivery were associated with the outcome.
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Affiliation(s)
- Nataly Echevarría-Castro
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Scientific Society of Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Andrea Matayoshi-Pérez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Scientific Society of Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Germán F Alvarado
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Zhao L, Ke H, Xu H, Wang GD, Zhang H, Zou L, Xiang S, Li M, Peng L, Zhou M, Li L, Ao L, Yang Q, Shen CKJ, Yi P, Wang L, Jiao B. TDP-43 facilitates milk lipid secretion by post-transcriptional regulation of Btn1a1 and Xdh. Nat Commun 2020; 11:341. [PMID: 31953403 PMCID: PMC6969145 DOI: 10.1038/s41467-019-14183-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/13/2019] [Indexed: 12/31/2022] Open
Abstract
Milk lipid secretion is a critical process for the delivery of nutrition and energy from parent to offspring. However, the underlying molecular mechanism is less clear. Here we report that TDP-43, a RNA-binding protein, underwent positive selection in the mammalian lineage. Furthermore, TDP-43 gene (Tardbp) loss induces accumulation of large lipid droplets and severe lipid secretion deficiency in mammary epithelial cells to outside alveolar lumens, eventually resulting in lactation failure and pup starvation within three weeks postpartum. In human milk samples from lactating women, the expression levels of TDP-43 is positively correlated with higher milk output. Mechanistically, TDP-43 exerts post-transcriptional regulation of Btn1a1 and Xdh mRNA stability, which are required for the secretion of lipid droplets from epithelial cells to the lumen. Taken together, our results highlights the critical role of TDP-43 in milk lipid secretion, providing a potential strategy for the screening and intervention of clinical lactation insufficiency. Milk lipid secretion is a critical process for the delivery of nutrition and energy from parent to offspring. Here the authors found that TDP-43, a RNA-binding protein, is required for milk lipid secretion by post-transcriptional regulation of Btn1a1 and Xdh mRNA stability.
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Affiliation(s)
- Limin Zhao
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, 650223, Kunming, China
| | - Hao Ke
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, 650223, Kunming, China
| | - Haibo Xu
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, 650223, Kunming, China
| | - Guo-Dong Wang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China.,Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, 650223, Kunming, China
| | - Honglei Zhang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China
| | - Li Zou
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China
| | - Shu Xiang
- The First Hospital of Kunming, Calmette International Hospital, 650011, Kunming, China
| | - Mengyuan Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, 401120, Chongqing, China
| | - Li Peng
- Yubei District Maternal and Child Health Care Hospital, 401120, Chongqing, China
| | - Mingfang Zhou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, 401120, Chongqing, China
| | - Lingling Li
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China.,School of Life Sciences, University of Science and Technology of China, 230026, Hefei, China
| | - Lei Ao
- Kunming Angel Women's and Children's Hospital, 650032, Kunming, China
| | - Qin Yang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China
| | - Che-Kun James Shen
- Institute of Molecular Biology, Academia Sinica, 11529, Taipei, Nankang, Taiwan
| | - Ping Yi
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, 401120, Chongqing, China.
| | - Lu Wang
- State Key Laboratory for Conservation and Utilization of Bio-resources in Yunnan, Yunnan University, 650091, Kunming, China.
| | - Baowei Jiao
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China. .,Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, 650223, Kunming, China. .,KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, 650223, Kunming, China.
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9
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Palaska E, Lykeridou A, Zyga S, Panoutsopoulos G. Association Between Breastfeeding and Obesity in Preschool Children. Mater Sociomed 2020; 32:117-122. [PMID: 32843859 PMCID: PMC7428923 DOI: 10.5455/msm.2020.32.117-122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Childhood obesity is a significant problem nowadays, with breastfeeding being one of many factors responsible for this issue. Breastfeeding as a natural way of feeding infants has many benefits for the child, the mother, and society. Aim The present study aimed to investigate the association between overweight children in preschool age and breastfeeding duration. Methods The current study included 674 preschool children aged 2-5 who attended various municipal kindergartens in South Athens. Questionnaires were given to parents where they recorded the child's personal and body data, parenting, and questions about pregnancy and lactation. The effect of BMI on the duration of breastfeeding in children was examined by the chi-square independence test. Fisher's and Monte Carlo simulations were also used. For data processing, Z scores and percentiles BMI for the first, second until fifth year of the child were found and based on these values the following categorization was performed; for values below -2 as low weight, values from -2 to 1 as normal weight, from 2 to 3 as overweight and over 3 as obese children. The Corresponding categorization was based on the 3rd, 85th, 97th, and 99.9th percentage position. Results The percentage of children at preschool age who have been breastfed for over six months and had normal weight was higher than those who breastfed below six months. Moreover, the proportion of children who were low weight, overweight and obese was lower in children who had been breastfed more than six months compared to those who breastfed for a shorter period. Additionally, a statistically significant difference was found for the effect of breastfeeding on childhood obesity in children aged 2 to 5 years. Conclusion There is a statistical association between breastfeeding duration and body weight in preschool age. Breastfeeding for more than six months has a positive impact on the child's weight.
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Affiliation(s)
- Ermioni Palaska
- Midwifery Department, Faculty of Health and Caring Professions, University of West Attika, Egaleo, Athens, Greece.,Laboratory of Physiology- Pharmacology, Department of Nursing, Faculty of Life Sciences, University of Peloponnese, Tripoli, Greece
| | - Aikaterini Lykeridou
- Midwifery Department, Faculty of Health and Caring Professions, University of West Attika, Egaleo, Athens, Greece
| | - Sofia Zyga
- Laboratory of Physiology- Pharmacology, Department of Nursing, Faculty of Life Sciences, University of Peloponnese, Tripoli, Greece
| | - Georgios Panoutsopoulos
- Laboratory of Physiology- Pharmacology, Department of Nursing, Faculty of Life Sciences, University of Peloponnese, Tripoli, Greece
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