Breast Milk Feeding and Lipoprotein Profile in Adolescents Born Preterm: Follow Up of a Prospective, Randomized Study

Abstract

Previous studies showed that breast-feeding correlates with lower cholesterol levels later in life but have not used a randomized design. This prospective study sought to test the proposal that breast milk feeding makes for a better lipoprotein profile in adolescents born preterm. Preterm infants were randomly assigned in 2 parallel trials to receive (in trial 1) either donated banked breast milk or preterm formula; or (in trial 2) either standard term formula or preterm formula. In both trials, the assigned preparation constituted the entire diet or supplemented mother’s milk. During follow up of 216 adolescents 13 to 16 years of age, measurements were made of the ratio of low-density to high-density lipoprotein cholesterol (LDL to HDL); the ratio of apolipoprotein B to apolipoprotein A-1 (apoB to apoA-1); and the concentration of C-reactive protein (CRP), a marker of the inflammatory process in atherosclerosis. The mean LDL to HDL ratio was 14% lower in adolescents who had received banked breast milk compared with those given preterm formula, a significant difference. CRP levels also were significantly lower in the former group. No differences were noted between the banked breast milk and preterm formula groups in HDL cholesterol, apoA-1, triglyceride, or the apoB to apoA-1 ratio. Differences in LDL cholesterol and apoB were of borderline significance. The LDL to HDL ratio remained significantly lower in the banked breast milk group after adjusting for age, gender, body mass index, social class, birth weight, and gestation. There were no significant differences in the lipoprotein profile or CRP levels between infants randomized to receive term formula and those given preterm formula, even after adjusting for possible confounding factors. Consuming a larger proportion of human milk was associated with lower LDL to HDL and apoB to apoA-1 ratios, independently of gestation and potential confounding factors. Concentrations of CRP correlated positively with both lipoprotein ratios. The type of infant nutrition permanently influences the lipoprotein profile in adolescence. Breast milk feeding would appear to lower the risk of atherosclerosis and cardiovascular disease later in life.