Original ArticleExclusive breastfeeding and partial breastfeeding reduce the risk of overweight in childhood: A nationwide longitudinal study in Korea
Introduction
Childhood obesity is regarded as a public health priority due to its many long-term adverse effects [1]. Overweight children have a high risk of being obese in adulthood [2]. In addition, major chronic diseases including cardiovascular diseases, hypertension, and type 2 diabetes originate from being overweight [3], [4].
Breastfeeding is known to reduce the risk of childhood obesity [5], [6]. However, it remains uncertain which mechanism of breastfeeding can protect against overweight and obesity. Dietz [7] suggested that breastfed infants may have more discretion over the amount of milk consumed than formula fed infants and that the differential endocrine response to formula fed infants may promote increased body fat deposition. Breast milk provides adequate energy and nutrients, and it is considered to be the ideal food for infants under 6 months [8]. Infant formula has higher protein/nitrogen contents compared to breast milk and it can cause metabolic responses such as increased insulin and insulin like growth factor-1 secretion in formula-fed infants, leading to excessive weight gain [9]. Moreover, breast milk contains hormones such as leptin, adiponectin, and ghrelin which can affect long-term appetite signalling [10]. Breastfed infants also gain less weight than formula-fed infants in early life, leading to lower risks of obesity in childhood and adulthood [11], [12]. Infant formula can result in faster weight gain and increased adiposity, along with other adverse cardio-metabolic effects [13], [14].
Several meta-analysis studies published in Western countries have reported that breastfeeding can reduce the risk of childhood overweight and obesity [15], [16]. However, the relationship between breastfeeding and child obesity remains controversial across many countries. A longitudinal nationwide study from Japan showed that breastfeeding decreases the risk of overweight and obesity [17]. On the other hand, the Hong Kong’s children birth cohort and the Chinese birth cohort study did not show the association between breastfeeding and child adiposity [18], [19]. A British cohort revealed that breastfeeding is associated with lower BMI, whereas a Brazilian cohort revealed the opposite [20]. These differences appear to be due to variations in ethnicity, sample size, definitions of overweight and obesity, and adjusted confounding factors such as socioeconomic status, parental obesity, and birth weight, etc.
The prevalence of childhood overweight in Korea has stabilised from early 2000s but the rate of overweight is still high. The overweight rate of children at 2–9 years old was 18.1% in boys and 16.4% in girls according to the Korea National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2012 [21]. Due to rapid industrialisation and the increase in women’s social participation, the exclusive breastfeeding rate in Korea decreased sharply in the early 1990s (90% in 1970, 10.2% in 1994). Fortunately, the breastfeeding rate increased to 32.3% in 2012 [22]. Which is lower than the breastfeeding rate in South-East Asia (43%) but higher than that in Europe (11%) [23].
The aim of this study was to examine the relationship between breastfeeding types and childhood overweight incidence risk using nationwide longitudinal data.
Section snippets
Study population
The Korea National Health Insurance Corporation (KNHIC) provides medical insurance for all Koreans. All Koreans are legally obliged to become members of KNHIC, and all members of KNHIC are eligible for the Korea National Health Check-up every 2 years. KNHIC conducted the National Children’s Health Examination (NCHE) in 2007. All infants and children under 6 years of age in Korea were included. NCHE was composed of seven health examinations by age groups (4–6 months, 9–12 months, 18–24 months,
Results
Baseline characteristics of the three feeding groups (exclusive formula feeding, exclusive breastfeeding, and partial breastfeeding) are summarised in Table 1. Overall, 34.6% of infants were formula fed exclusively at 4–6 months, 46.0% were breastfed exclusively, and 19.4% were breastfed partially.
The percentage of exclusive breastfeeding was higher in girls than boys (48.4% vs 43.8%). The mean birth weight of the exclusive breastfeeding group was 3.22 kg, which was higher than that of the
Discussion
The present study was conducted to examine the relationship between breastfeeding types and childhood overweight incidence risk using longitudinal representative nationwide data. This study showed that the exclusively breastfed at 4–6 months group had a 22% lower risk of being overweight and that the partially breastfed group had a 4% lower risk of being overweight than the exclusively formula feeding group.
In a cross-sectional Korean study, ever breastfed infants had lower obesity prevalence
Acknowledgements
This study was supported by the Korea National Health Insurance Corporation (Grant no, 20150454064-00) and partly supported by Korea Food Research Institute (E0164500-01), Republic of Korea.
References (35)
- et al.
Childhood obesity: public-health crisis, common sense cure
Lancet
(2002) - et al.
Breastfeeding and lowering the risk of childhood obesity
Lancet
(2002) - et al.
Update on breast milk hormones: leptin, ghrelin and adiponectin
Clin Nutr
(2008) - et al.
The effect of breastfeeding on mean body mass index throughout life: a quantitative review of published and unpublished observational evidence
Am J Clin Nutr
(2005) - et al.
Comparison of obesity rates in early childhood (4 to 80 months) by parental socioeconomic status using national cohort dataset in Korea
Asian Nurs Res
(2016) - et al.
Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial
Am J Clin Nutr
(2007) - et al.
The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis
Health Technol Assess
(2015) - et al.
Perinatal predictors of overweight at infancy and preschool childhood: the GENESIS study
Int J Obes
(2008) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report
Pediatrics
(2007)- et al.
Body mass index, adiposity rebound and early feeding in a longitudinal cohort (Raine Study)
Int J Obes
(2010)
Breastfeeding may help prevent childhood overweight
JAMA
Breastfeeding and obesity: a meta-analysis
Open J Prev Med
Could associations between breastfeeding and insulin-like growth factors underlie associations of breastfeeding with adult chronic disease? The Avon longitudinal study of parents and children
Clin Endocrinol (Oxf)
Commentary: breastfeeding and obesity—the 2011 scorecard
Int J Epidemiol
Association between infant breastfeeding and overweight in young children
JAMA
Breast-feeding and childhood obesity—a systematic review
Int J Obes Relat Metab Disord
Duration of breastfeeding and risk of overweight: a meta-analysis
Am J Epidemiol
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