The Association between Breastfeeding Duration and Lipid Profile among Children and Adolescents

Childhood nutritional factors and cardiometabolic outcomes at 9-11 years 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.

OBJECTIVE

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-years and change during childhood) on preteen cardiometabolic outcomes.

METHODS

Secondary analysis of 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-years of age. Healthy Eating Index-2015 (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-years. 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-years (B=-2.86, 95% CI=-5.46, -0.27, p=0.03), compared to never receiving human milk. At 5-years, diet scores were favourably associated with lean mass at 9-11-years (p<0.05 for both). Higher preteen HEI-2015 scores were associated with lower leptin levels (Tertile 3 compared to Tertile 1, B=-2.92, 95% CI=-5.64, -0.21, p=0.03). Diet quality significantly deteriorated (HEI-2015 decreased) and became more pro-inflammatory (C-DII score increased) from 5 to 9-11-years of age. Diet quality/inflammation deterioration (compared to improvement) or overall change in dietary scores were not related to preteen cardiometabolic outcomes.

CONCLUSION

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

The association between human milk fatty acid composition in mothers with an elevated body mass index and infant growth changes

BACKGROUND & AIMS

Few studies have investigated alternations in human milk polyunsaturated fatty acid (PUFA) composition in the context of maternal obesity and its effects on infant growth trajectories. This study explored whether maternal weight status and breastfeeding type influence human milk FA composition and infant anthropometry during the first six months of life.

METHODS

Mother-infant dyads were enrolled from the Prediction of Allergies in Taiwanese Children birth cohort study. Data concerning maternal pre-pregnancy weight, infants' breastfeeding practices, and anthropometric data were obtained regularly. We identified and compared between the composition of 30 FAs in the colostrum and 2-month milk, respectively, in obese/overweight (OB/OW) and normal-weight (NW) mothers. Multiple linear regression analyses were performed to determine the association between PUFA composition at different lactation stages and infant anthropometric parameter changes and to identify the independent variables for body mass index (BMI) z-scores by six months of age.

RESULTS

We included 338 mother-infant dyads (OB/OW mothers, 16.9 %). OB/OW mothers exhibited lower total n-3 PUFAs (P = 0.035), higher ratios of arachidonic acid (C20:4n-6)/eicosapentaenoic acid (C20:5n-3) + docosahexaenoic acid (C22:6n-3), and n-6/n-3 PUFA in colostrum (P = 0.037 and 0.011, respectively), and their offspring had higher body weight and BMI z-scores. Nevertheless, no PUFA composition or n-6/n-3 PUFA ratios in colostrum and 2-month milk were associated with anthropometric parameter changes by age 6 months. Infant birth weight z-scores were independently associated with BMI outcomes at age 6 months (adjusted β = 0.16, 95 % confidence interval (0.05-0.35), P = 0.010) CONCLUSION: Neither n-3 nor n-6 PUFA profiles nor n-6/n-3 PUFA ratios at different lactation stages were found to be associated with anthropometric changes by age 6 months, suggesting that human milk PUFA composition may not be an important determinant of early infant growth trajectories.

Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs

Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.

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.

Associations between Breastfeeding Duration and Obesity Phenotypes and the Offsetting Effect of a Healthy Lifestyle

Background: Additional metabolic indicators ought to be combined as outcome variables when exploring the impact of breastfeeding on obesity risk. Given the role of a healthy lifestyle in reducing obesity, we aimed to assess the effect of breastfeeding duration on different obesity phenotypes according to metabolic status in children and adolescents, and to explore the offsetting effect of healthy lifestyle factors on the associations between breastfeeding duration and obesity phenotypes. Methods: A total of 8208 eligible children and adolescents aged 7–18 years were recruited from a Chinese national cross-sectional study conducted in 2013. Anthropometric indicators were measured in the survey sites, metabolic indicators were tested from fasting blood samples, and breastfeeding duration and sociodemographic factors were collected by questionnaires. According to anthropometric and metabolic indicators, obesity phenotypes were divided into metabolic healthy normal weight (MHNW), metabolic unhealthy normal weight (MUNW), metabolic healthy obesity (MHO), and metabolic unhealthy obesity (MUO). Four common obesity risk factors (dietary consumption, physical activity, screen time, and sleep duration) were used to construct a healthy lifestyle score. Scores on the lifestyle index ranged from 0 to 4 and were further divided into unfavorable lifestyles (zero or one healthy lifestyle factor), intermediate lifestyles (two healthy lifestyle factors), and favorable lifestyle (three or four healthy lifestyle factors). Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the associations between breastfeeding duration and obesity phenotypes. Furthermore, the interaction terms of breastfeeding duration and each healthy lifestyle category were tested to explore the offsetting effect of lifestyle factors. Results: The prevalence of obesity among Chinese children and adolescents aged 7–18 years was 11.0%. Among the children and adolescents with obesity, the prevalence of MHO and MUO was 41.0% and 59.0%, respectively. Compared to the children and adolescents who were breastfed for 6–11 months, prolonged breastfeeding (≥12 months) increased the risks of MUNW (OR = 1.35, 95% CI: 1.19–1.52), MHO (OR = 1.61, 95% CI: 1.27–2.05), and MUO (OR = 1.46, 95% CI: 1.20–1.76). When stratified by healthy lifestyle category, there was a typical dose–response relationship between duration of breastfeeding over 12 months and MUNW, MHO, and MUO, with an increased risk of a favorable lifestyle moved to an unfavorable lifestyle. Conclusions: Prolonged breastfeeding (≥12 months) may be associated with increased risks of MUNW, MHO, and MUO, and the benefits of breastfeeding among children and adolescents may begin to wane around the age of 12 months. The increased risks may be largely offset by a favorable lifestyle.

Prevalence and associated factors of metabolic body size phenotype in children and adolescents: A national cross-sectional analysis in China

BACKGROUND

Metabolically healthy obesity (MHO) is a group of subjects with overweight/obesity who present a metabolically healthy profile; however, associated factors are complex and are far from completely understood. The aim of the current study was to estimate the prevalence of different metabolic body size phenotypes and investigate the associated factors in Chinese children and adolescents.

METHODS

A cross-sectional survey was conducted of 12,346 children and adolescents aged 7-18 years from seven provinces in China in 2013. Anthropometric, blood pressure, and biochemical measurements were obtained. A multi-component questionnaire covering demographic, neonatal, and lifestyle characteristics was administered. The classification of metabolic body size phenotype based on three definitions was compared. With metabolically healthy with normal weight (MHNW) as a reference group, logistic regression analyses were used to estimate the potential effects of associated risk factors, with adjustment for age, sex, single-child status, and residence area.

RESULTS

The prevalence of MHNW, MHO, metabolically unhealthy with normal weight (MUNW), and metabolically unhealthy overweight/obesity (MUO) phenotype was 68.6%, 2.0%, 26.4%, and 3.0%, respectively. There were 39.3% MHO and 60.7% MUO among obese participants and 72.2% MHNW and 27.8% MUNW among those with normal weight. Compared to cardiometabolic risk factor (CMRF) criteria and metabolic syndrome (MetS) component definition, the application of the 2018 consensus-based definition may identify more children with abnormal cardiovascular risks, independent of weight status. Compared to younger children, older-aged adolescents were positively associated with higher risks of MUNW (odds ratio (OR) = 1.38, 95% CI = 1.27-1.50) and MUO (OR = 1.29, 95% CI = 1.04-1.60), while factors positively associated with MHO were younger age, single-child status, urban residence, high birth weight, prolonged breastfeeding duration, parental overweight/obesity status, long screen time, and less physical activity.

CONCLUSION

There were still a high proportion of children and adolescents at high cardiometabolic risk in China. Our findings reinforce the need for cardiometabolic risk prevention in children and adolescents irrespective of their weight statuses, such as parental educational programs and healthy lifestyle interventions.