PEDIATRICS Vol. 113 No. 2 February 2004, pp. e81-e86
Does Breastfeeding Protect Against Pediatric Overweight? Analysis of
Longitudinal Data From the Centers for Disease Control and Prevention Pediatric
Nutrition Surveillance System
Laurence M. Grummer-Strawn, PhD and Zuguo Mei, MD
From the Maternal and Child Nutrition Branch, Division of Nutrition and
Physical Activity, National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Objective. To examine whether increasing duration of breastfeeding is
associated with a lower risk of overweight in a low-income population of 4-year-olds
in the United States.
Methods. Visit data were linked to determine prospectively the duration of
breastfeeding (up to 2 years of age) and weight status at 4 years of age.
Overweight among 4-year-old children was defined as a body mass index (BMI)-for-age
at or above the 95th percentile based on the 2000 Centers for Disease Control
and Prevention growth charts. Logistic regression was performed, controlling
for gender, race/ethnicity, and birth weight. In a subset of states, links to
maternal pregnancy records also permitted regression analysis controlling for
mother’s age, education, prepregnancy BMI, weight gain during pregnancy, and
postpartum smoking. Data from the Pediatric Nutrition Surveillance System, which
extracts breastfeeding, height, and weight data from child visits to public
health programs, were analyzed. In 7 states, data were linked to Pregnancy
Nutrition Surveillance System data. A total of 177 304 children up to 60 months of
age were included in our final pediatric-only analysis, and 12 587 were
included in the pregnancy-pediatric linked analysis.
Results. The duration of breastfeeding showed a dose-response, protective
relationship with the risk of overweight only among non-Hispanic whites; no
significant association was found among non-Hispanic blacks or Hispanics. Among
non-Hispanic whites, the adjusted odds ratio of overweight by breastfeeding for 6
to 12 months versus never breastfeeding was 0.70 (95% confidence interval:
0.50–0.99) and for >12 months versus never was 0.49 (95% confidence interval:
0.25–0.95). Breastfeeding for any duration was also protective against
underweight (BMI-for-age below the 5th percentile).
Conclusion. Prolonged breastfeeding is associated with a reduced risk of
overweight among non-Hispanic white children. Breastfeeding longer than 6 months
provides health benefits to children well beyond the period of breastfeeding.
Received for publication Jul 1, 2002; accepted Oct 16, 2003.
http://pediatrics.aappublications.org/cgi/content/abstract/113/2/e81?etoc
PEDIATRICS Vol. 113 No. 2 February 2004, pp. 361-367
Ultrasound Imaging of Milk Ejection in the Breast of Lactating Women Donna T.
Ramsay, Dip*, Jacqueline C. Kent, PhD*, Robyn A. Owens, PhD and Peter E.
Hartmann, PhD*
* Department of Biochemistry and Molecular Biology, School of Biomedical and
Chemical Sciences, Faculty of Life and Physical Sciences
School of Computer Science and Software Engineering, Faculty of Engineering,
Computing and Mathematics, University of Western Australia, Crawley WA 6009,
Australia
Objective. Currently, the methods for assessing milk ejection in women
include serial sampling of plasma oxytocin and measurement of intraductal pressure,
both of which are invasive and may induce stress. We hypothesized that milk
ejection would cause an increase in milk-duct diameter that could be observed
noninvasively with ultrasound, and this could be used to investigate the
physiology of milk ejection in women.
Methods. One milk duct was scanned in the unsuckled breast in 2 groups of
mothers: group BB (n = 21) for the beginning of a breastfeed and group EB (n =
24) for the entire breastfeed. A duct also was monitored for a 5-minute period
on 2 separate days in the absence of factors that may induce milk ejection in
group EB to provide a baseline duct diameter. Milk intake at a breastfeed was
measured by test weighing.
Results. A significant increase in milk-duct diameter was observed when milk
ejection was sensed and/or the infant changed its swallowing pattern in both
groups. Multiple increases and decreases (mean: 2.5 per breastfeed; standard
deviation: 1.5; n = 62) in duct diameter occurred in group EB. Duct diameter
remained relatively stable between breastfeeds (coefficient of variation: 1.4%–
8.3%). Infant milk intake was positively related to the number of milk ejections
(r2 = .365; n = 57).
Conclusions. Ultrasound is an objective, noninvasive technique for detecting
milk ejection by observing an increase in milk-duct diameter. However, this
technique requires an experienced ultrasonographer, adequate imaging time, and
surroundings conducive to breastfeeding. Multiple milk ejections were common
during breastfeeding, although they were not sensed by mothers. The number of
milk ejections influenced the amount of milk the infant consumed.
Received for publication Jun 4, 2003; accepted Oct 13, 2003.
http://pediatrics.aappublications.org/cgi/content/abstract/113/2/361?etoc
Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services
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