Breastfeeding and risk of overweight in childhood and beyond: a systematic review with emphasis on sibling-pair and intervention studies

Abstract

Background Breastfeeding is associated with a lower risk of subsequent overweight or obesity, but it is uncertain whether this is a causal relation because most studies have not adequately reduced risk of bias due to confounding. Objectives The aim of this review was to examine whether 1) ever compared with never consuming human milk and 2) different durations of human milk consumption among infants fed human milk are related to later risk of overweight or obesity, with emphasis on sibling-pair and intervention studies. Methods The 2020 Dietary Guidelines Advisory Committee, together with the Nutrition Evidence Systematic Review team, conducted a systematic review of articles relevant to healthy full-term infants in countries with a high or very high level of human development. We searched PubMed, Embase, Cochrane, and CINAHL; dual-screened the results using predetermined criteria; extracted data from and assessed the risk of bias for each included study; qualitatively synthesized the evidence; developed conclusion statements; and graded the strength of the evidence. Results The review included 42 articles, including 6 cohorts with sibling-pair analyses and 1 randomized controlled trial of a breastfeeding promotion intervention. Moderate evidence suggested that ever, compared with never, consuming human milk is associated with a lower risk of overweight and obesity at ages 2 y and older, particularly if the duration of human milk consumption is >6 mo. However, residual confounding cannot be ruled out. Evidence was insufficient to determine the relation between the duration of any human milk consumption, among infants fed human milk, and overweight and/or obesity at age 2 y and older. Conclusions Further research, using strong study designs, is needed to disentangle the complex relation between infant feeding practices and the risk of subsequent overweight or obesity, as well as the biological and behavioral mechanisms if the relation is causal.

Obesity in children and adolescents: epidemiology, causes, assessment, and management

“…Meta-analyses from systematic reviews suggest that breastfeeding has a modest but protective effect against later child obesity. 53 , 54 There is some evidence suggesting that the very early introduction of complementary foods and beverages, before the age of 4 months, especially in formula-fed babies, is associated with higher odds of overweight and obesity. 55 Parental approaches to feeding, especially in the preschool age group (aged 1–4 years), might influence obesity risk, with a systematic review showing a small but significant association between controlling child feed practices (eg, restriction of specific foods or the overall amount of food) and higher child weight.…”

Environmental risk factors in puppies and kittens for developing chronic disorders in adulthood: A call for research on developmental programming

“…In humans, breast feeding has a protective effect against childhood obesity compared with feeding formula milk (73), which might in part be associated with the presence of leptin in breast milk. Leptin is a hormone produced by adipose tissue that inhibits food intake and modulates glucose metabolism; the main source for neonates may be maternal milk (74).…”

Gestational Diabetes Mellitus Is Associated with Differences in Human Milk Hormone and Cytokine Concentrations in a Fully Breastfeeding United States Cohort

“…Exclusive breastfeeding for the first 6 months of life is recommended for all infants because it is associated with reduced risk of infant wheeze and asthma [ 7 , 8 ], gastrointestinal infection [ 9 ], and possibly childhood overweight and obesity [ 10 ]. However, the composition of human milk is not uniform among women, and the impact of maternal clinical factors on this variation is now being investigated [ 11 ].…”