The Role of Children\u2019s Dietary Pattern and Physical Activity in the Association Between Breastfeeding and BMI at Age 5: The GECKO Drenthe Cohort

Petra Corianne Vinke,Leanne Karen Küpers,Eva Corpeleijn,Carolien Tigelaar

doi:10.1007/s10995-020-03063-6

Abstract

ObjectivesBreastfeeding is protective against childhood obesity, but the role of childhood lifestyle in this association is unclear. We investigated whether physical activity and dietary pattern at age 5 differed between breastfed and non-breastfed children, and how they relate to Body Mass Index (BMI) Z-scores.Methods1477 children of the Dutch GECKO Drenthe birth cohort were included. At one month, children were categorized as breastfed (receiving breast milk exclusively or in combination with formula milk) or non-breastfed (receiving formula milk exclusively). At age 5, height and weight were objectively measured, physical activity was measured by ActiGraph GT3x and dietary patterns were assessed with a parent-reported food pattern questionnaire, assessing the consumption frequency of selected food items at seven occasions over the day.ResultsNon-breastfed children had higher BMI Z-scores (0.36 ± 0.90 vs. 0.20 ± 0.80 SD, p = 0.002), more frequently consumed sugar-sweetened beverages (25.0 ± 10.5 vs. 22.5 ± 9.71 times per week, p < 0.001), and consumed relatively less whole-wheat or brown bread (p = 0.007). Differences in sugar-sweetened beverage consumption were most pronounced during main meals. Total fruit consumption, sedentary time and moderate-to-vigorous physical activity levels did not differ between the groups. Multivariable adjusted linear regression analyses showed that the differences in BMI-z score between non-breastfed and breastfed children were not explained by the differences in sugar-sweetened beverages or type of bread consumed.ConclusionsInfant breastfeeding itself is indicative of healthy dietary behaviors in early life, and is also more likely to be followed by a favorable dietary pattern at toddler age. However, the differences in dietary habits between breastfed and non-breastfed children did not explain the difference in BMI Z-score at the age of 5.

Highlights

The rising worldwide prevalence of childhood obesity is one of the main challenges of the twenty-first century (Ng et al 2014)
We examined to what extent the beneficial association between breastfeeding and body mass index (BMI) was related to differences in these lifestyle components
Parents of non-breastfed children differed in age, income and education, and in lifestyle characteristics, i.e. they had a higher BMI, and mothers who did not breastfeed their child smoked more frequently during pregnancy

Summary

Introduction

The rising worldwide prevalence of childhood obesity is one of the main challenges of the twenty-first century (Ng et al 2014). A meta-analysis regarding the long-term consequences of breastfeeding calculated a 26% lower overweight and obesity risk for breastfed compared to non-breastfed children in studies including children between the age of 1 and 9. For studies in adolescents, aged 10–19, this was 37%, and for studies in adults, aged ≥ 20, this was 12% In this metaanalysis, subjects were classified as either breastfed or non-breastfed according to the criteria used in each study, which included various cut-offs within the first year after birth (Horta et al 2015). Most studies investigating the association between breastfeeding and childhood obesity take into account potential confounding factors such as birth weight, maternal BMI and socioeconomic status (SES) (Yan et al 2014), little is known about the role of children’s lifestyle in this association

Objectives

Methods

Results

Conclusion