Association of Breast Feeding and Birth Weight with Anthropometric Measures and Blood Pressure in Children and Adolescents: The CASPIAN-IV Study

The association of breastfeeding duration on metabolic syndrome among children and adolescents, stratified by birth weight for gestational age

BACKGROUND AND OBJECTIVES

This study aimed to examine the associations between breastfeeding duration and metabolic syndrome (MetS) in adolescents and to further investigate the role of birth weight for gestational age (GA) on these associations.

METHODS

A total of 10 275 participants aged 7 to 18 years were included applying multistage cluster random sampling from a Chinese national survey. Birth weight was classified into small for GA (SGA), appropriate for GA (AGA) and large for GA (LGA). Information was collected through a self-administered questionnaire, physical examination and blood biochemical examination. Multivariable linear regression, logistic regression models, restricted cubic spline models were applied to assess the relationships of breastfeeding duration and MetS with different birth weight for GA.

RESULTS

The prevalence of non-breastfeeding, 0-5, 6-12 and >12 months groups were 16.2%, 23.1%, 42.5% and 18.2%, and the prevalence of SGA and LGA was 11.9% and 12.7%, respectively. Prolonged breastfeeding duration was associated with higher odds of MetS (β: 0.08, 95% CI: 0.03, 0.13), WC (β: 3.49, 95% CI: 2.82, 4.16) and SBP (β: 2.34, 95% CI: 1.80, 2.89). SGA and prolonged breastfeeding synergistically increased MetS risks, but LGA appeared to offset the adverse effects of prolonged breastfeeding.

CONCLUSION

Prolonged breastfeeding may increase children's MetS risks. SGA synergies with prolonged breastfeeding increased MetS burden in children and adolescents, while LGA mitigated the risks. This reminds us that intensive attention should be paid to both early birth weight and subsequent living environment for children and adolescents' lifelong health.

Systematic review and meta-analysis of breastfeeding and later overweight or obesity expands on previous study for World Health Organization

AIM

To update a systematic review and meta-analysis of the association of breastfeeding with overweight or obesity that had been commissioned by the World Health Organization. We also assessed the likelihood of residual confounding.

METHODS

Two independent reviewers searched MEDLINE, LILACS and Web of Science for manuscripts published between August 2014 and May 2021. Studies that only evaluated infants were excluded. Random-effects models were used to pool the estimates.

RESULTS

The review comprised 159 studies with 169 estimates on the association of breastfeeding with overweight or obesity, and most of the studies were carried out among individuals aged 1-9 years (n = 130). Breastfeeding protected against overweight or obesity (pooled odds ratio:0.73, 95% confidence interval:0.71; 0.76). And, even among the 19 studies that were less susceptible to publication bias, residual confounding and misclassification, a benefit was observed (pooled odds ratio:0.85, 95% confidence interval:0.77; 0.93). Among those studies that were clearly susceptible to positive confounding by socioeconomic status, a benefit of breastfeeding was observed even after adjusting for socioeconomic status (pooled odds ratio:0.76, 95% confidence interval: 0.69; 0.83).

CONCLUSION

Breastfeeding reduced the odds of overweight or obesity, and this association was unlikely to be due to publication bias and residual confounding.

Breastfeeding Duration and High Blood Pressure in Children and Adolescents: Results from a Cross-Sectional Study of Seven Provinces in China

This study was aimed to investigate the associations between breastfeeding duration and blood pressure (BP) levels, BP Z scores and high BP (HBP) in children and adolescents. A total of 57,201 participants including 29,491 boys and 27,710 girls aged 7−18 years were recruited from seven provinces in China in 2012. HBP was defined as BP levels of ≥95th percentiles of the referent age-, sex-, and height-specific population. Breastfeeding duration was divided into non-breastfeeding, 0−5 months, 6−12 months, and >12 months. Information on demographic, parental or family factors and dietary behaviors was collected through a self-administered questionnaire. Multivariable linear regression and logistic regression models were applied to assess the relationships of breastfeeding duration with BP levels and BP Z scores and with HBP, respectively. Stratified analyses were performed to further investigate the potential subgroup-specific associations. The reported prolonged breastfeeding (>12 months) rate was 22.53% in the total population. After full adjustment, compared to the non-breastfeeding group, breastfeeding for 6−12 months was correlated with 0.43 (95% CI: −0.75, −0.11) and 0.36 (95% CI: −0.61, −0.12) mmHg lower levels of SBP and DBP, respectively. Similar decrease trends were found for BP Z scores. Prolonged breastfeeding (>12 months) was associated with 1.33 (95% CI: 1.12, 1.58) and 1.12 (95% CI: 0.94, 1.33) higher odds of HBP in boys and girls, respectively. Based on nationally representative data, there was no evidence that a longer duration of breastfeeding is protective against childhood HBP. Breastfeeding for 6−12 months may be beneficial to BP, while prolonged breastfeeding durations might increase the odds of HBP in children and adolescents.

The Prevalence Rate of Malnutrition in Children Younger than 5 in Iran in 2018

Context:

The first stage of Universal Health Coverage (UHC) was founded Iran to achieve better access to needed health services.

Aims:

The aim of present study was to illustrate the prevalence rate of malnutrition's subtypes in under 5-year old children after UHC in comparison with before that.

Settings and Design:

In a cross-sectional study in 2018, anthropometric indices of 970 under 5 years old children in rural and small towns of Isfahan province were gathered from their health files by cluster randomized sampling method.

Methods:

Children whose weight for age, height for age, and weight for height were lower than -2SD based on Z score, were marked as underweight, stunting, and wasting, respectively. Children, whose weight for age was upper than +2SD, were marked as overweight.

Statistical Analysis Used:

The T-test, Chi-square, and logistic regression tests were used for determination of association between malnutrition's subtypes and demographic variables.

Results:

A total of 78 (8.04%) of under 5 years old children were wasting, 74 (7.63%) were underweight, and 82 (8.45%) were stunting. Also, 12 (1.23%) of the children from the same group were overweight.

Conclusions:

The prevalence rate of underweight and stunting in under 5 years old children were less than before UHC implementation period. The prevalence rate of overweight children below 5 in Isfahan province's villages and small towns was low.

Classification of psychiatric symptoms using deep interaction networks: the CASPIAN-IV study

Identifying the possible factors of psychiatric symptoms among children can reduce the risk of adverse psychosocial outcomes in adulthood. We designed a classification tool to examine the association between modifiable risk factors and psychiatric symptoms, defined based on the Persian version of the WHO-GSHS questionnaire in a developing country. Ten thousand three hundred fifty students, aged 6–18 years from all Iran provinces, participated in this study. We used feature discretization and encoding, stability selection, and regularized group method of data handling (GMDH) to classify the a priori specific factors (e.g., demographic, sleeping-time, life satisfaction, and birth-weight) to psychiatric symptoms. Self-rated health was the most critical feature. The selected modifiable factors were eating breakfast, screentime, salty snack for depression symptom, physical activity, salty snack for worriedness symptom, (abdominal) obesity, sweetened beverage, and sleep-hour for mild-to-moderate emotional symptoms. The area under the ROC curve of the GMDH was 0.75 (CI 95% 0.73–0.76) for the analyzed psychiatric symptoms using threefold cross-validation. It significantly outperformed the state-of-the-art (adjusted p < 0.05; McNemar's test). In this study, the association of psychiatric risk factors and the importance of modifiable nutrition and lifestyle factors were emphasized. However, as a cross-sectional study, no causality can be inferred.

Nutritional status and related factors of schoolchildren in Çorum, Turkey

OBJECTIVE

We aimed to determine nutritional status and related factors among schoolchildren in Çorum, Central Anatolia, Turkey.

DESIGN

Schoolchildren's height and weight were measured to calculate BMI and BMI Z-scores. Height, weight and BMI Z-scores were analysed and nutritional status classified according to the WHO.

SETTING

Central Anatolia, Turkey.ParticipantsSchoolchildren aged 5-17 years (n 1684) participated in study.

RESULTS

Of children, 4·2% were stunted, 6·9% thin, 13·8% overweight and 6·6% were obese. Proportions of stunting, thinness and overweight/obesity were significantly higher in children aged &gt;10 years (78·6, 75·0 and 64·9%, respectively) than in those aged ≤10 years (21·4, 25·0 and 35·1%, respectively; all P &lt;0·001). Median (range) birth weight and breast-feeding duration in children with stunting (2750 (1400-3600)g; 10 (0-36) months) were significantly lower and shorter, respectively, than those of normal height (3200 (750-5500)g; 15 (0-72) months) and tall children (3500 (2500-4900)g; 18 (0-36) months; P &lt;0·001, &lt;0·001, 0·011 and 0·016, respectively). The same relationship was observed in thin children (3000 (1000-4500)g; 12 (0-36) months) compared with normal-weight (3200 (750-5500)g; 15 (0-72) months) and overweight/obese children (3300 (1200-5500)g; 16 (0-48) months; P=0·026, &lt;0·001, 0·045 and 0·011, respectively).

CONCLUSIONS

Overweight and obesity are health problems that must be addressed in schoolchildren. Adolescents also have a risk of double malnutrition. Promoting normal birth weight and encouraging long duration of breast-feeding are important to support normal growth in children.

Breastfeeding and Risk of Metabolic Syndrome in Children and Adolescents: A Systematic Review

BACKGROUND

The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence for the association between being breastfed and the development of metabolic syndrome in children and adolescents.

METHODS

Articles were obtained from searches using PubMed and Embase databases, as well as from secondary searches through reference lists. Study quality was assessed using a three-level quality rating system.

RESULTS

Of 11 studies reviewed, 7 found a protective association between breastfeeding and metabolic syndrome and 4 found no association. There was no clear dose-response relationship between duration of breastfeeding and metabolic syndrome risk and insufficient evidence to demonstrate an added effect of being exclusively breastfed. The overall quality of the articles was moderate. In general, lower quality articles found no significant association, whereas higher quality articles found a significant association.

CONCLUSION

Our review demonstrated a limited amount of high-quality research on the relationship between being breastfed and development of metabolic syndrome in children and adolescents. The evidence presented in this review suggests that being breastfed may be protective against metabolic syndrome, but further research with improvements in study design, such as improved measurement of breastfeeding and the use of prospectively collected data, will improve our understanding of this relationship.

Childhood Overweight and Obesity and Associated Factors in Iranian Children and Adolescents: A Multilevel Analysis; the CASPIAN-IV Study

Objective: The purpose of this paper is to explore multidimensional factors related to childhood obesity and overweight based on the data gathered on different aspects of the general health status were assessed among a large number of Iranian children and adolescents in the fourth phase of the "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease" survey. It also aims to determine the degree to which each ecological context contributes to childhood overweight/obesity. Method: A total of 14,880 students and their parents were recruited. They filled out a questionnaire on their relationship with peers, body image, and psychosocial environment of school, dietary habits, life-style habits, physical activity pattern and socioeconomic status (SES). Their height, weight, was measured and body mass index (BMI) was calculated. Obesity and overweight was defined based on the WHO growth chart. Multilevel modeling using three-level random intercept logistic regression models were used to assess predictors of overweight and obesity. In our hierarchical models, children (first level) were conceptualized as being nested within provinces (second level) and provinces within quad regions (third level). Result: From among the 13,486 recruited students, 9.7% were overweight and 11.9% were obese. In multivariate model (adjusted model), being boy (OR:1.58), living in urban area (OR:1.58), having positive family history of obesity (OR = 2.04), breakfast skipping (OR: 1.46), socioeconomic status (OR _{moderateSES/lowSES} = 1.44 and OR _{highSES/lowSES} = 1.89), and birth weight (BW) (OR _{normalBW/lowBW} = 1.33 and OR _highBW/lowBW = 1.8) were associated with childhood obesity. Increasing age was the only factor in the obesity model that had a significant preventive effect on the odds of becoming obese (OR = 0.96, P < 0.001). In multivariate model, living in urban area, increasing age, high and moderate SES, high BW and family history of obesity were the significant predictors of overweight. Conclusion: Our findings show that high BW, sociodemographic characteristics, breakfast skipping, and family history of obesity are associated with childhood obesity and overweight. Therefore, developing strategies that consider the effects of diverse sociodemographic and environmental factors on childhood overweight and obesity would be the most effective way to prevent and manage this multifactorial health concern.

Association of birth weight with abdominal obesity and weight disorders in children and adolescents: the weight disorder survey of the CASPIAN-IV Study

Introduction: This study aims to evaluate the association of birth weight (BW) with weight disorders in a national sample of Iranian pediatric population. Methods: This nationwide survey was conducted among 25000 student's aged 6-18 year-old students, who were selected using multistage cluster random sampling from 30 provinces of Iran in 2011-2012. Anthropometric measures were measured under standard protocols by using calibrated instruments. Abdominal obesity was defined based on waist circumference (WC) ≥90th percentile value for age and sex. The WHO criterion was used to categorize BMI. Students' BW was asked from parents using validate questionnaire and was categorized as low BW (LBW) (BW <2500 g), normal BW (NBW) (BW: 2500-4000 g) and high BW (HBW) (BW>4000 g). Results: This national survey was conducted among 23043 school students (participation rate: 92.6%). The mean age of participants (50.8% boys) was 12.54 ± 3.31 years. Results of multivariate logistic regression show that LBW increased odds of underweight (OR [odds ratio]: 1.61; 95% CI: 1.37, 1.89) and students with HBW had decreased odds of underweight (OR: 0.74; 95% CI: 0.58, 0.93) compared to students with NBW. Students with LBW compared to student with NBW had decreased odds of overweight (OR: 0.83; 95% CI: 0.69, 0.98) and general obesity (OR: 0.73; 95% CI: 0.56, 0.95). On the other hand, HBW increased odd of overweight (OR: 1.28; 95% CI: 1.09, 1.50), generalized obesity (OR: 1.59; 95% CI: 1.29, 1.96) and abdominal obesity (OR: 1.29; 95% CI: 1.11, 1.49) compared to NBW group. Conclusion: BW is a determinant of weight disorders and abdominal obesity in childhood and adolescence. This finding underscores the importance of prenatal care as well as close monitoring of the growth pattern of children born with low or high BW.

Influence of breastfeeding in the first months of life on blood pressure levels of preschool children

OBJECTIVE

To investigate whether breastfeeding in early life affects blood pressure of preschoolers.

METHODS

Cross-sectional study nested in a cohort from a municipality in the state of Minas Gerais, Brazil. All children in the cohort were invited for this study. Thus, between 2009 and 2010, blood pressure of 230 preschool children and their mothers, in addition to anthropometric variables, previous history, and socioeconomic status were evaluated. Blood pressure measurement was assessed in the morning, using automatic Omron^® HEM-714INT and HEM-781INT devices to measure the blood pressure of preschool children and their mothers, respectively. Logistic regression was used to study the association between breastfeeding and blood pressure. The significance level was set at 5%.

RESULTS

This study identified 19 (8.26%) preschool children with high blood pressure (values above the 90th percentile). High systolic blood pressure was associated with low birth weight (OR=5.41; 95% CI=1.45-20.23) and total breastfeeding duration of less than six months (OR=4.14; 95% CI=1.40-11.95). High diastolic blood pressure was not associated with any variable, whereas high systolic blood pressure/diastolic blood pressure ratio was associated with breastfeeding duration of less than six months (OR=3.48; 95% CI=1.34-9.1).

CONCLUSION

The results of this study indicate that preschoolers breastfed for a period of less than six months were more likely to have high blood pressure when compared to those breastfed for a longer period, suggesting a protective effect of breastfeeding against high blood pressure in this population.