Breastfeeding duration, age of starting solids and high BMI risk and adiposity in Indian children

Abstract

This study utilized data from a prospective birth cohort study on 568 Indian children, to determine whether a longer duration of breast-feeding and later introduction of solid feeding was associated with a reduced higher body mass index (BMI) and less adiposity. Main outcomes were high BMI (>90 th within-cohort sex-specific BMI percentile) and sum of skinfold thickness (triceps and subscapular) at age 5. Main exposures were breast-feeding (6 categories from 1-4 to ≥21 months) and age of starting regular solid feeding (4 categories from ≤3 to ≥6 months). Data on infant feeding practices, socioeconomic and maternal factors were collected by questionnaire. Birthweight, maternal and child anthropometry were measured. Multiple regression analysis which accounted for potential confounders, demonstrated a small magnitude of effect for breastfeeding duration or introduction of solid feeds on the risk of high BMI but not for lower skinfold thickness. Breast-feeding duration was strongly negatively associated with weight gain (0-2 years) (adjusted β= −0.12 SD 95% CI: −0.19 to −0.05 per category change in breast-feeding duration, p=0.001) and weight gain (0-2 years) was strongly associated with high BMI at 5 years (adjusted OR = 3.8, 95 % CI: 2.53 to 5.56, p<0.001). In our sample, findings suggest that longer breastfeeding duration and later introduction of solids has a small reduction on later high BMI risk and a negligible effect on skinfold thickness. However, accounting for sampling variability, these findings cannot exclude the possibility of no effect at the population-level.

Milk Feeding, Solid Feeding, and Obesity Risk: A Review of the Relationships Between Early Life Feeding Practices and Later Adiposity

“…Other results from Indian populations have suggested that children introduced to solid foods later (comparing ≤ 3, 4, 5, ≥ 6 month olds) tended to have a slightly lower risk of a high BMI at age 5, however the differences between the groups were negligible after adjusting for confounding factors (16). Various mechanisms have been proposed to account for how very early introduction to solid foods may impact on child weight gain (if any relationship can be consistently identified), for example: through the intake of excess protein during infancy which may increase insulin like growth factor -1 levels and promote earlier adiposity rebound; or through altering the secretion of hormones such as ghrelin; or levels of gut flora resulting in epigenetic modifications of metabolic programming (15).…”

“…However, other research has found that a significant relationship between the duration of exclusive breastfeeding and an increased risk of child overweight at age 10 disappears when confounding variables are controlled for (15). Similarly, other authors acknowledge that factors such as sampling variability may nullify the reported associations at a population level (16).…”

“…Future research should consider not simply the age of introduction to solid foods but also what nutrition is given during the period of 4/6 -24 months in populations with greater prevalence of child overweight to allow for meaningful comparisons (16). In summary various authors have suggested that guidelines should be used flexibly and it may not be that one size fits all in terms of determining when solid foods are offered to infants (33).…”

The influence of breastfeeding duration and introduction of animal source foods, fruit juice and vegetables on the risk of weight gain in Thai children

“…A recent meta-analysis review using five cohorts in low-and middle-income countries 23 reported that prolonged BF was associated with lower risk of hypertension, diabetes or overweight even in adults, while two cohort studies in USA 5 and Denmark 24 reported no relationships in adulthood 5,24 . Meanwhile, although the protective effect was reported in India 22 and China 20 , studies in early childhood were mostly conducted in high income countries 6,18,19,21 . In highincome settings, highly educated mothers tend more to breastfeed exclusively than those less educated and their infants are less likely to become overweight or obesity.…”

Breastfeeding and complementary feeding associated with body composition in 18–19 years old adolescents in the 1993 Pelotas Birth Cohort

“…The association of introduction of complementary foods and body composition in childhood was assessed in some studies [17][18][19] . Although there is scant evidence regarding introduction of complementary foods and body composition on later periods such adolescence and adulthood based on prospective studies [20].…”