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Huang Y, Zhang L, Ainiwan D, Alifu X, Cheng H, Qiu Y, Zhou H, Liu H, Yu Y. Breastfeeding, Gestational Diabetes Mellitus, Size at Birth and Overweight/Obesity in Early Childhood. Nutrients 2024; 16:1351. [PMID: 38732598 PMCID: PMC11085597 DOI: 10.3390/nu16091351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Breastfeeding appears to reduce the risk of childhood overweight/obesity. However, it remains unclear whether this protective effect persists among high-risk populations. This study aims to investigate the association of breastfeeding with the risk of overweight/obesity in early childhood and whether this association is altered by gestational diabetes mellitus (GDM) or size at birth. Methods: Feeding practices during the first 12 months of age and weight and length at 12-36 months of age were collected. Full breastfeeding includes exclusive and predominant breastfeeding. Children with body mass index (BMI) values greater than 1 standard deviation from the mean of sex- and age-specific BMI were classified as overweight/obese. Multiple generalized estimating equations models were applied to analyze the associations of full breastfeeding duration with overweight/obesity risk. Results: Among all participants (n = 9329), infants with a longer full-breastfeeding duration had a reduced risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Infants exposed to GDM and those born large for gestational age (LGA) had a higher risk of overweight/obesity in early childhood. Among infants of mothers with GDM (n = 1748), infants with full breastfeeding for greater than 6 months (aOR: 0.58; 95% CI: 0.44, 0.78) showed a decreased risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Among LGA infants (n = 1279), infants with full breastfeeding for 3-5 months (aOR: 0.66; 95% CI: 0.57, 0.76) and greater than 6 months (aOR: 0.70; 95% CI: 0.56, 0.88) showed a decreased risk of overweight/obesity in early childhood. Similar results were observed among LGA infants of mothers with GDM. Conclusions: Initiating and prolonging breastfeeding would reduce the risk of overweight/obesity in early childhood, and LGA infants and infants born to mothers with GDM would experience greater benefits.
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Affiliation(s)
- Ye Huang
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Libi Zhang
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Diliyaer Ainiwan
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xialidan Alifu
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haoyue Cheng
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yiwen Qiu
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haibo Zhou
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Hui Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China;
| | - Yunxian Yu
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
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Pathirana MM, Ali A, Lassi ZS, Arstall MA, Roberts CT, Andraweera PH. Protective Influence of Breastfeeding on Cardiovascular Risk Factors in Women With Previous Gestational Diabetes Mellitus and Their Children: A Systematic Review and Meta-Analysis. J Hum Lact 2022; 38:501-512. [PMID: 34609211 DOI: 10.1177/08903344211034779] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is evidence that breastfeeding may provide protection against cardiovascular risk factors in mothers with a history of gestational diabetes mellitus and their children who were exposed in utero. RESEARCH AIM To perform a systematic review and meta-analysis of observational studies to ascertain the effects of breastfeeding on cardiovascular risk factors in women with previous gestational diabetes mellitus and their children exposed in utero. METHODS Studies assessing conventional cardiovascular risk factors in women with previous gestational diabetes mellitus and children exposed in utero stratified by breastfeeding/no breastfeeding or breastfed/not breastfed were included. Gestational diabetes mellitus was defined based on the International Association of Diabetes in Pregnancy Study Group definition or previous accepted definitions. Breastfeeding was defined as reported in each study. RESULTS The literature search yielded 260 titles, of which 17 studies were selected to be in the review. Women with previous gestational diabetes mellitus who did not breastfeed had higher blood glucose (SMD: 0.32, 95% CI [0.12, 0.53]) and a greater risk of developing Type 2 diabetes mellitus (RR: 2.08 95% CI [1.44, 3.00]) compared to women with no history. There were not enough studies to conduct a meta-analysis on the effects of breastfeeding on risk factors for cardiovascular disease among children exposed to gestational diabetes mellitus in utero. CONCLUSION Breastfeeding appears to be protective against cardiovascular risk factors among women who experience gestational diabetes mellitus.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Health Performance and Policy Research Unit, Basil Hetzel Institute, University of Adelaide, Woodville South, SA, Australia.,Adelaide G-TRAC Centre & CRE Frailty & Healthy Ageing Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zohra S Lassi
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret A Arstall
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Prabha H Andraweera
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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Ong YY, Pang WW, Huang JY, Aris IM, Sadananthan SA, Tint MT, Yuan WL, Chen LW, Chan YH, Karnani N, Velan SS, Fortier MV, Choo J, Ling LH, Shek L, Tan KH, Gluckman PD, Yap F, Chong YS, Godfrey KM, Chong MFF, Chan SY, Eriksson JG, Wlodek ME, Lee YS, Michael N. Breastfeeding may benefit cardiometabolic health of children exposed to increased gestational glycemia in utero. Eur J Nutr 2022; 61:2383-2395. [PMID: 35124728 PMCID: PMC7613060 DOI: 10.1007/s00394-022-02800-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE There is altered breastmilk composition among mothers with gestational diabetes and conflicting evidence on whether breastfeeding is beneficial or detrimental to their offspring's cardiometabolic health. We aimed to investigate associations between breastfeeding and offspring's cardiometabolic health across the range of gestational glycemia. METHODS We included 827 naturally conceived, term singletons from a prospective mother-child cohort. We measured gestational (26-28 weeks) fasting plasma glucose (FPG) and 2-h plasma glucose (2 hPG) after an oral glucose tolerance test as continuous variables. Participants were classified into 2 breastfeeding categories (high/intermediate vs. low) according to their breastfeeding duration and exclusivity. Main outcome measures included magnetic resonance imaging (MRI)-measured abdominal fat, intramyocellular lipids (IMCL), and liver fat, quantitative magnetic resonance (QMR)-measured body fat mass, blood pressure, blood lipids, and insulin resistance at 6 years old (all continuous variables). We evaluated if gestational glycemia (FPG and 2 hPG) modified the association of breastfeeding with offspring outcomes after adjusting for confounders using a multiple linear regression model that included a 'gestational glycemia × breastfeeding' interaction term. RESULTS With increasing gestational FPG, high/intermediate (vs. low) breastfeeding was associated with lower levels of IMCL (p-interaction = 0.047), liver fat (p-interaction = 0.033), and triglycerides (p-interaction = 0.007), after adjusting for confounders. Specifically, at 2 standard deviations above the mean gestational FPG level, high/intermediate (vs. low) breastfeeding was linked to lower adjusted mean IMCL [0.39% of water signal (0.29, 0.50) vs. 0.54% of water signal (0.46, 0.62)], liver fat [0.39% by weight (0.20, 0.58) vs. 0.72% by weight (0.59, 0.85)], and triglycerides [0.62 mmol/L (0.51, 0.72) vs. 0.86 mmol/L (0.75, 0.97)]. 2 hPG did not significantly modify the association between breastfeeding and childhood cardiometabolic risk. CONCLUSION Our findings suggest breastfeeding may confer protection against adverse fat partitioning and higher triglyceride concentration among children exposed to increased glycemia in utero.
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Affiliation(s)
- Yi Ying Ong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonathan Y Huang
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Suresh Anand Sadananthan
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Mya-Thway Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ling-Wei Chen
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Neerja Karnani
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - S Sendhil Velan
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore
| | - Marielle V Fortier
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jonathan Choo
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Lynette Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter D Gluckman
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mary F-F Chong
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Johan G Eriksson
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Mary E Wlodek
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore
- Department of Physiology, University of Melbourne, Melbourne, Australia
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore.
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.
| | - Navin Michael
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, 30 Medical Drive, Singapore, 117609, Singapore.
- , 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore.
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