Infant milk-feeding practices and diabetes outcomes in offspring: a systematic review

Abstract

Background During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations. Objectives The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) feeding a lower versus higher intensity of human milk to mixed-fed infants with type 1 and type 2 diabetes in offspring. Methods The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980–March 2016, dual-screened the results according to 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 4 systematic reviews included 21, 37, 18, and 1 articles, respectively. Observational evidence suggests that never versus ever feeding human milk (limited evidence) and shorter versus longer durations of any (moderate evidence) and exclusive (limited evidence) human milk feeding are associated with higher type 1 diabetes risk. Insufficient evidence examined type 2 diabetes. Limited evidence suggests that the durations of any and exclusive human milk feeding are not associated with intermediate outcomes (e.g., fasting glucose, insulin resistance) during childhood. Conclusions Limited to moderate evidence suggests that feeding less or no human milk is associated with higher risk of type 1 diabetes in offspring. Limited evidence suggests no associations between the durations of any and exclusive human milk feeding and intermediate diabetes outcomes in children. Additional research is needed on infant milk-feeding practices and type 2 diabetes and intermediate outcomes in US populations, which may have distinct metabolic risk.

The importance of nutrition in pregnancy and lactation: lifelong consequences

“…5,6 For the infant milk topics, four received a grade indicating moderate evidence, ten had limited evidence, and a grade was not assignable for 21 questions. 7…”

Metabolic Conditions Including Obesity, Diabetes, and Polycystic Ovary Syndrome: Implications for Breastfeeding and Breastmilk Composition

“…Despite a high and increasing worldwide prevalence of maternal metabolic disease (PCOS, GDM, T1DM, and T2DM), there is currently a limited understanding of how these conditions influence lactogenesis and breastmilk composition, and how this in turn may alter infant outcomes. This is of considerable importance, not only because the offspring of women with pregestational or gestational diabetes are likely at increased risk of future T2DM (and likely also T1DM 146 ), but also because epidemiological evidence has shown long-term protective effects of breastfeeding against obesity, 14,15 T1DM, [18][19][20] and T2DM in the offspring. 21,22 Lactogenesis delay is common in women with all forms of diabetes in pregnancy, and in women with obesity, and likely has pathophysiological as well as practical explanations.…”

“…16,17 Several large cohort studies suggest that breastfeeding may protect the offspring from developing T1DM in adolescence and adulthood, 18,19 an observation which has been supported in systematic reviews. 20 Multiple meta-analyses show that breastfed offspring also have a reduced risk of developing T2DM in adulthood, although the effect may in part be mediated by reduced obesity rates. 21,22 Breastfeeding also modifies metabolic risk in the mother.…”

Epigenome-Wide Association Study of Infant Feeding and DNA Methylation in Infancy and Childhood in a Population at Increased Risk for Type 1 Diabetes

“…Breastfeeding and complementary feeding are important early exposures that may have important long-term effects. Longer breastfeeding duration has been associated with decreased risk of obesity [1], type 2 diabetes (T2D) [2] and type 1 diabetes (T1D) [3]. It is also recommended to introduce solid foods by 6 months to avoid nutrient deficiencies, such as iron, protein, and vitamins [4].…”