Overweight Infants Still Risk Obesity Even if Breast-fed

Beth Skwarecki

June 16, 2015

Exclusive breast-feeding for the first 3 months of life did not change children's risk of becoming overweight by age 5 to 6 years in a population-based prospective birth cohort study from the Netherlands.

The results, published online June 4 in the Archives of Disease in Childhood, join a body of sometimes contradictory findings on breast-feeding and the risk for obesity.

"In the last decades the prevalence of childhood overweight has increased substantially. Even though the prevalence in more developed countries seems to be plateauing, overweight in children is a major cause of adverse health consequences such as cardiovascular disease, asthma and type 2 diabetes. In addition to these physical consequences, psychological and social problems may occur, such as a lower self-esteem, depression, stigmatization and discrimination," Esmee van der Willik, from the Department of Public and Occupational Health at the VU University Medical Center, Amsterdam, the Netherlands, and colleagues write.

"This issue will never be completely resolved, because it will always look different in different populations," Steven Abrams, MD, from the Department of Pediatrics at Dell Medical School at the University of Texas at Austin, told Medscape Medical News. Dr Abrams was not involved in the study. He noted that the Dutch mothers in the study come from a population with a higher income level, a more homogeneous ethnic makeup, and a higher incidence of breast-feeding than their counterparts in the United States.

The Dutch study involved 3367 children who were part of a larger population-based child health study and who were singletons without congenital malformations (as these can affect growth patterns). The researchers excluded 2776 children whose feeding type or weight status were unknown.

Children who were overweight at age 6 months were four times (95% confidence interval [CI], 2.91 to 5.78) more likely than their thinner peers to be overweight at the 5- to 6-year mark. Feeding type did not change that association. Of the babies in the study, 42.3% were exclusively breast-fed for at least 3 months. At age 6 months, 11.4% of those breast-fed babies were overweight, which was statistically indistinguishable from the 12.6% of formula-fed or mixed-fed infants who were overweight at that age. By 5 to 6 years of age, overweight children made up 10.1% of those who had been breast-fed, and 11.2% of those in the formula or mixed feeding groups, which again was not a statistically significant difference. There was still no association after adjusting for confounding factors including maternal body mass index, smoking during pregnancy, ethnicity, and birth weight.

"[W]e should be worried about overweight exclusively breastfed babies. Overweight from [exclusive breast-feeding] is just as disadvantageous as overweight from [mixed feeding] or [formula feeding]," the researchers write. They emphasize that providers should monitor infants' weight, and that diet and exercise are "probably more promising" as preventative measures than breast-feeding.

Dr Abrams agrees. "It's important not to say things like, 'if you breast-feed your baby, he will not become obese.' " He recommended speaking with parents about the health benefits of breast-feeding that extend beyond possible obesity prevention. "It may, because intake is regulated, help decrease the risk of overweight. But in and of itself, it doesn't keep a baby — or later a child — from being overweight."

The authors and Dr Stevens have disclosed no relevant financial relationships.

Arch Dis Child. Published online June 4, 2015. Abstract

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