Long-term impact of neonatal breastfeeding on childhood adiposity and fat distribution among children exposed to diabetes in utero

Tessa L Crume, Lorraine Ogden, MaryBeth Maligie, Shelly Sheffield, Kimberly J Bischoff, Robert McDuffie, Stephen Daniels, Richard F Hamman, Jill M Norris, Dana Dabelea, Tessa L Crume, Lorraine Ogden, MaryBeth Maligie, Shelly Sheffield, Kimberly J Bischoff, Robert McDuffie, Stephen Daniels, Richard F Hamman, Jill M Norris, Dana Dabelea

Abstract

Objective: To evaluate whether breastfeeding attenuates increased childhood adiposity associated with exposure to diabetes in utero.

Research design and methods: Retrospective cohort study of 89 children exposed to diabetes in utero and 379 unexposed youth with measured BMI, waist circumference, skinfolds, visceral (VAT) and subcutaneous (SAT) abdominal fat. A measure of breast milk-months was derived from maternal self-report and used to categorize breastfeeding status as low (<6) and adequate (≥ 6 breast milk-months). Multiple linear regression was used to model the relationship between exposure to diabetes in utero and offspring adiposity outcomes among youth stratified according to breastfeeding status.

Results: Adequate (vs. low) breastfeeding status was associated with significantly lower BMI, waist circumference, SAT, and VAT at ages 6-13 years. Among youth in the low breastfeeding category, exposure to diabetes in utero was associated with a 1.7 kg/m(2) higher BMI (P = 0.03), 5.8 cm higher waist circumference (P = 0.008), 6.1 cm(2) higher VAT (P = 0.06), 44.6 cm(2) higher SAT (P = 0.03), and 0.11 higher ratio of subscapular-to-triceps skinfold ratio (P = 0.008). Among those with adequate breastfeeding in infancy, the effect of prenatal exposure to diabetes on childhood adiposity outcomes was not significant.

Conclusions: Adequate breastfeeding protects against childhood adiposity and reduces the increased adiposity levels associated with exposure to diabetes in utero. These data provide support for mothers with diabetes during pregnancy to breastfeed their infants in order to reduce the risk of childhood obesity.

Figures

Figure 1
Figure 1
A–E: Effect of exposure to diabetes in utero on mean levels of childhood adiposity parameters. Stratified by breastfeeding (BF) status, data are adjusted for age, sex, race/ethnicity, Tanner stage, and age × Tanner stage interaction. A: BMI: P = 0.03 for youth with low breastfeeding; P = 0.4 for youth with adequate breastfeeding. B: Waist circumference (WC): P = 0.008 for youth with low breastfeeding; P = 0.10 for youth with adequate breastfeeding. C: VAT: P = 0.06 for youth with low breastfeeding; P = 0.40 for youth with adequate breastfeeding. D: SAT: P = 0.03 for youth with low breastfeeding; P = 0.11 for youth with adequate breastfeeding. E: STR: P = 0.008 for youth with low breastfeeding; P = 0.14 for youth with adequate breastfeeding.

References

    1. Petitt DJ, Bennett PH, Knowler WC, Baird HR, Aleck KA. Gestational diabetes mellitus and impaired glucose tolerance during pregnancy. Long-term effects on obesity and glucose tolerance in the offspring. Diabetes 1985;34(Suppl. 2):119–122
    1. Dabelea D, Pettitt DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Pediatr Endocrinol Metab 2001;14:1085–1091
    1. Silverman BL, Rizzo T, Green OC, et al. Long-term prospective evaluation of offspring of diabetic mothers. Diabetes 1991;40(Suppl. 2):121–125
    1. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007;30:2287–2292
    1. Freinkel N. Of pregnancy and progeny (review). Banting Lecture 1980. Diabetes 1980;29:1023–1036
    1. Stettler N, Stallings VA, Troxel AB, et al. Weight gain in the first week of life and overweight in adulthood: a cohort study of European American subjects fed infant formula. Circulation 2005;111:1897–1903
    1. Dewey KG. Growth characteristics of breast-fed compared to formula-fed infants. Biol Neonate 1998;74:94–105
    1. Arenz S, Rückerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity—a systematic review. Int J Obes Relat Metab Disord 2004;28:1247–1256
    1. Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol 2005;162:397–403
    1. Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. Am J Clin Nutr 2006;84:1043–1054
    1. National Diabetes Data Group Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039–1057
    1. Gartner LM, Morton J, Lawrence RA, et al. American Academy of Pediatrics Section on Breastfeeding Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506
    1. Kark JD, Troya G, Friedlander Y, Slater PE, Stein Y. Validity of maternal reporting of breast feeding history and the association with blood lipids in 17 year olds in Jerusalem. J Epidemiol Community Health 1984;38:218–225
    1. Vobecky JS, Vobecky J, Froda S. The reliability of the maternal memory in a retrospective assessment of nutritional status. J Clin Epidemiol 1988;41:261–265
    1. Marshall WA, Tanner JM. Growth and physiological development during adolescence. Annu Rev Med 1968;19:283–300
    1. Naumova EN, Must A, Laird NM. Tutorial in biostatistics: evaluating the impact of ‘critical periods’ in longitudinal studies of growth using piecewise mixed effects models. Int J Epidemiol 2001;30:1332–1341
    1. de Ridder CM, Thijssen JHH, Bruning PF, Van den Brande JL, Zonderland ML, Erich WBM. Body fat mass, body fat distribution, and pubertal development: a longitudinal study of physical and hormonal sexual maturation of girls. J Clin Endocrinol Metab 1992;75:442–446
    1. Plagemann A, Harder T, Franke K, Kohlhoff R. Long-term impact of neonatal breast-feeding on body weight and glucose tolerance in children of diabetic mothers. Diabetes Care 2002;25:16–22
    1. Rodekamp E, Harder T, Kohlhoff R, Franke K, Dudenhausen JW, Plagemann A. Long-term impact of breast-feeding on body weight and glucose tolerance in children of diabetic mothers: role of the late neonatal period and early infancy. Diabetes Care 2005;28:1457–1462
    1. Kerssen A, Evers IM, de Valk HW, Visser GH. Effect of breast milk of diabetic mothers on bodyweight of the offspring in the first year of life. Eur J Clin Nutr 2004;58:1429–1431
    1. Mayer-Davis EJ, Rifas-Shiman SL, Zhou L, Hu FB, Colditz GA, Gillman MW. Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Diabetes Care 2006;29:2231–2237
    1. Pettitt DJ, Knowler WC. Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care 1998;21(Suppl. 2):B138–B141
    1. Stettler N, Zemel BS, Kumanyika S, Stallings VA. Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics 2002;109:194–199
    1. Lucas A, Boyes S, Bloom SR, Aynsley-Green A. Metabolic and endocrine responses to a milk feed in six-day-old term infants: differences between breast and cow’s milk formula feeding. Acta Paediatr Scand 1981;70:195–200
    1. Savino F, Nanni GE, Maccario S, Costamagna M, Oggero R, Silvestro L. Breast-fed infants have higher leptin values than formula-fed infants in the first four months of life. J Pediatr Endocrinol Metab 2004;17:1527–1532

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться