Longer lactation duration is associated with decreased prevalence of non-alcoholic fatty liver disease in women

Abstract

Background & Aims: Lactation lowers blood glucose and triglycerides, and increases insulin sensitivity. We hypothesized that a longer duration of lactation would be associated with lower prevalence of non-alcoholic fatty liver disease (NAFLD), which is the leading cause of chronic liver disease in the United States. Methods: Participants from the Coronary Artery Risk Development in Young Adults cohort study who delivered ≥ 1 child post-baseline (Y0: 1985–1986), and underwent CT quantification of hepatic steatosis 25 years following cohort entry (Y25: 2010–2011) were included (n = 844). The duration of lactation was summed for all post-baseline births, and NAFLD at Y25 was assessed by central review of CT images and defined by liver attenuation ≤ 40 Hounsfield Units after exclusion of other causes of hepatic steatosis. Unadjusted and multivariable logistic regression analyses were performed using an a priori set of confounding variables; age, race, education, and baseline body mass index. Results: Of 844 women who delivered after baseline (48% black, 52% white, mean age 49 years at Y25 exam), 32% reported lactation duration of 0 to 1 month, 25% reported >1 to 6 months, 43% reported more than 6 months, while 54 (6%) had NAFLD. Longer lactation duration was inversely associated with NAFLD in unadjusted logistic regression. For women who reported >6 months lactation compared to those reporting 0–1 month, the odds ratio for NAFLD was 0.48 (95% Cl 0.25–0.94; p = 0.03) and the association remained after adjustment for confounders (adjusted odds ratio 0.46; 95% Cl 0.22–0.97; p = 0.04). Conclusions: A longer duration of lactation, particularly greater than 6 months, is associated with lower odds of NAFLD in midlife and may represent a modifiable risk factor for NAFLD.

Lifetime duration of lactation and chronic inflammation among middle-aged women with a history of gestational diabetes

“…In addition, we report no significant association between lactation duration and lipid profile in middle-aged women, which is consistent with previous finding in younger women. 18 Because longer lactation duration has been recently associated with lower risk for non-alcoholic fatty liver disease in women with mean age 49 years 20 and because liver enzyme biomarkers are predictors for CVD risk, 21 we investigated the association between lactation duration and liver enzyme biomarkers in middle-aged women with a history of GDM. However, no significant association between lactation duration and liver enzyme biomarkers was evident among these high-risk women in the current investigation.…”

“…Longer lactation duration was recently associated with lower risk for non-alcoholic fatty liver disease in women. 20 Since elevated liver enzyme biomarkers are known predictors for CVD risk, 21 they may also be a marker for identifying the specific pathways implicated in cardiometabolic health benefits among high-risk women who breast feed. Therefore, we examined the associations of lifetime duration of lactation with cardiometabolic biomarkers, potentially involved in cardiometabolic pathogenic pathways such as inflammatory, 22 liver enzyme, 21 and lipid metabolic biomarkers, 23 among middle-aged women with a history of GDM.…”

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

“…(218) Breastfeeding and duration of lactation have been associated with a lower incidence of future metabolic complications, including NAFLD, presumably related to postpartum weight loss and return of blood glucose, lipid, and insulin concentrations to pre-pregnancy levels. (219,220) Breastfeeding may have a protective effect on development and severity of NAFLD in children. (221)(222)(223) The cornerstone of NAFLD management is lifestyle modification to achieve optimal weight and treatment of metabolic comorbidities.…”

Mucosal Immunity and Liver Metabolism in the Complex Condition of Lactation Insufficiency

“…For example, the "reset hypothesis" proposes that lactation is critical for the metabolic health of a new mother by decreasing insulin resistance, a potentially powerful biology in reducing the development of diabetes (Stuebe & Rich-Edwards, 2009). Also, a lactation duration of 6 months or longer has been associated with reduced incidence of non-alcoholic fatty liver disease and breast cancer (Ajmera et al, 2019;Palmer et al, 2014). Therefore, lactation represents a significant opportunity to potentially make inroads in the treatment of multiple health problems that disproportionately affect women, including breast cancer, liver disease, autoimmune disorders and, of course, lactation insufficiency.…”