Breastfeeding in the Prevention of Chronic Diseases

8/12/2019 Breastfeeding in the Prevention of Chronic Diseases

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Breastfeeding in the

Prevention of ChronicDiseasesJuliet Sio Aguilar, M.D., M.Sc.(Birm)

Professor of PediatricsUniversity of the Philippines Manila

Wellstart Associate

Presented at the XXIII International Congress of the Fetus as a Patient International Society16 March 2007, EDSA Shangri-LA Manila


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Impact of Breastfeeding

Fetal Origins of Adult Diseases

Obesity

Diabetes

Allergic Disorders


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Does breastfeeding protect

against obesity in children

and on to adulthood?


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Martorell R, Stein AD, Schroeder DG. J Nutr2001; 131:874S.

Fig. Hypotheses about early childhood nutrition and later adiposity.

Early Nutrition and

Later Obesity


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Undernutrition and Later Obesity:

Possible Mechanisms Development of disproportionately high fat mass in a

setting of low muscle mass

Overgrowth of limited cell mass during period ofcatch-up growth

Persistence of secretion of hormones (insulin,insulin-like growth factor 1, growth hormone)established in utero

Eriksson JG, Forsn T, Tuomilehto J, Winter PD, Osmond C, Barker DJP.

BMJ1999; 318: 427.


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Growth Patterns in Breastfed and

Formula-fed Infants

DARLING Study

Breastfed infants

Leaner with mean weight-for-length at 12mos = 0.2-0.6 SD below NCHS median

Formula-fed infants

Larger skinfold thicknesses in later infancy(9-15 mos)

Dewey KG et al.AJCN 1992; 56: 1012.


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Breastfeeding and Childhood

Obesity: A Meta-analysis

Nine studies with >69,000 participants withprospective study protocol Early feeding mode

Result Breastfeeding reduced risk of obesity in

childhood significantly

AOR = 0.78[95% CI: 0.71, 0.85]

Arenz S, Rckerl R, Koletzko B, von Kries R. Int J Obes2004; 28: 1247.


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Duration of Breastfeeding and Risk of

Overweight: A Meta-analysis

17 studies with 120,828

subjects Meta-regression analysis

Duration of BF inversely

associated with risk of

overweight [r=0.94, 95%

CI: 0.89, 0.98]

Harder T, Bergmann R, Kallischnigg G, Plagemann A.Am J Epidemiol2005; 162: 397.


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Duration of Breastfeeding and Risk of

Overweight: A Meta-analysis

Duration of Breastfeeding9 mos

Odds ratio for

overweight1.0 0.81 0.76 0.67 0.68

95% CI0.65,

1.55

0.74,

0.88

0.67,

0.86

0.55,

0.82

0.50,

0.91

No. of duration-specific study

estimates

5 14 15 11 7

Harder T, Bergmann R, Kallischnigg G, Plagemann A.Am J Epidemiol2005; 162: 397.

Dose-response Relationship between Duration of BF and Risk of Overweight


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Effect of Breastfeeding on the Risk of Obesity Across

the Life Course

[28 studies; 298,900 subjects]

Parsons et al (33)Poulton & Williams (26)

Tulldahl et al (16)

Kramer (15)

Kramer (15)

Elliot et al (15)

Gillman et al (12)

Sung et al (11)

Toschke et al (6-14)

Liese et al (10)

Frye and Heinrich (10)

Maffeis et al (10)

Li et al (8)

Eid (8)

Strbak et al (1-7)

Richter (7)

Wadsworth et al (6)

Von Kries et al (6)

Bergman et al (6)

Scaglioni et al (5)

OCallaghan et al (5)

Neyzi et al (5)Hediger et al (4)

Grummer-Strawn & Mei (4)

Armstrong & Reilly (3)

Thorogood et al (1)

Dewey et al (1)

Yeung et al (0.5)

Taitz (0)

Breastfeeding better ODDS of OBESITY

Owen C et al.

Pediat r ics 2005; 115: 1367.

Combined OR = 0.87[95%CI: 0.85, 0.89]Mean ages (in yrs) at which

obesity status was measured 0.5 1 1.5

Formula feeding better


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Exclusivity of Breastfeeding and Risk of

Obesity Across the Life Course: Subgroup

Analysis

Protective effect of BF over obesity stronger

and more homogeneous if exclusively BF n = 37,170

OR = 0.76[95% CI: 0.70, 0.83]

Hediger ML et al. JAMA2001; 285: 2453.

Armstrong J, Reilly JJ. Lancet2002; 359: 2003.

Liese AD et al. Int J Obes Relat Metab Disord. 2001; 25: 1644.

Neyzi G et al. Human Growth and Development. New York: Plenum; 1984: 603.


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Why BF Protects vs. Obesity:

Plausible Mechanisms Learned self-regulation of energy intake

Metabolic programmingin early life higher protein intake stimulate higher insulin secretion higher plasma insulin in formula-fed infants

stimulate fat deposition and early development ofadipocytes

Properties in breast milk bioactive factorswhich modulate EGF and TNF

inhibit adipocyte differentiation

Dewey KG. J Hum Lact2003; 19:9.

Von Kries R et al. BMJ1999; 319:147.


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Does breastfeeding alter

the risk of


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Breastfeeding and Type 2 Diabetes in

Later Life: Quantitative Analysis

23 studies

Results among BF vs formula-fed

Lower risk of type 2 DM in later life 7 studies with 76,744 subjects

OR = 0.61[95% CI: 0.44, 0.85] p=0.003

Lower mean preprandial blood glucose 12 studies with 560 subjects

Mean diff = -0.17 mmol/L [95%CI: -0.28, -0.05] p=0.005

Lower mean insulin concentration 7 studies with 291 subjects

Mean diff = -2.86 pmol/L [95%CI: -5.76, 0.04] p=0.054

Owen CG et al.Am J Clin Nutr2006; 84: 1043.


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Breastfeeding and

Genetic Risk of IDDM 2,949 Finnish infants with increased genetic risk of

IDDM (HLA typing)

monitored 3-6-mo intervals for four islet cell antibodies

65 infants seropositive before 4 yr-old compared to 390

controls seronegative

Exclusive BF >4moslowers risk of seroconversion

OR = 0.17 [95% CI: 0.03, 0.86]

Introduction of cow milk


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Why Breastfeeding

Decreases Diabetes Risk Diabetes risk related more to early exposure to cow

milk

Bovine albuminserves as trigger Ab to bovinealbumin react with pancreatic -cell surface protein

Karjalainen J et al. NEJM1992; 327: 302.

Bovine -caseintargets humoral and cellularimmune responses of IDDM pts Ab to bovine -casein elevated in IDDM and babies fed with

cow milk but not in babies exclusively breastfed for 4 mosMonetini L et al. Diabetes Metab Res Rev2001; 17: 51.


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Does breastfeeding reduce

the risk for developing allergicdiseases?


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Allergic Diseases

Increased prevalence in last decades

Its development depends on complex interaction

between genetic and environmental factors Environmental factors: food and inhalant allergens;

non-specific adjuvant factors (e.g., tobacco smoke, air

pollution, infections)

Genetics: account for ~50% of allergic diseases


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Exclusive Breastfeeding (>3m) and Allergic

Diseases: Meta-analyses

Atopic

Dermatitis

Allergic

RhinitisAsthma

Summary Odds Ratio 0.68 0.74 0.70

95% CI 0.52, 0.88 0.54, 1.01 0.60, 0.81

Odds ratio for FH atopy 0.58 0.87 0.52

95% CI 0.42, 9.92 0.48, 1.58

No. of prospective studies(period of review) 18(1966-2000) 6(1966-2000) 12(1966-1999)

Gdalevich M et al. J Am Acad Dermatol2001; 45: 520.

Mimouni BA et al.Acta Pediatr2002; 9: 275.

Gdalevich M et al. J Pediatr2001; 139: 261.


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Other Observations in

Allergic Disease Reduction Partial BF (>6m)

reduced risk of asthma AOR = 0.69[95% CI: 0.52, 0.91] up to age 2 yrs

reduced risk of multiple allergic disease AOR = 0.69[95% CI: 0.50, 0.95] up to age 2 yrs

Exclusive BF (>4m) reduced risk of multiple allergic disease

AOR = 0.66[95% CI: 0.48, 0.90] up to age 2 yrs

Kull I, Wickman M et al.Arch Dis Child 2002; 87: 478.


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Breastfeeding, Maternal IgE and

Total serum IgE in Childhood

Prospective study of 664 children with 1,457

observations

Tucson Childrens Respiratory Study

enrolled at birth serum IgE assessed

Results

Kids with mothers in lower tertiles of IgE

BFassoc with lower total serum IgE at 6 yrs old vs

never BF (24.2 vs 44.3 IU/ml)

Kids with mothers in highest tertile of IgE

BF > 4mwith higher IgE vs no BF or BF < 4m (97.0

vs 38.9 IU/ml)

Wright AL et al. J Allergy Clin Immunol1999; 104: 589.


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How BF Reduces Allergic Diseases and

the Implications

Early onset of atopic dermatitis

predictive of asthma later in childhood

Asthma with other allergic diseases in early life Increases risk of having disease over many decades

Wright AL et al. Thorax2001; 56: 192.

Protective effectdue to:

immunological components of breast milk (i.e., sIgA) alter

susceptibility to infection

growth factors in breast milk facilitate maturation of organs(including lung)

Kull I, Wickman M et al.Arch Dis Child 2002; 87: 478.


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Impact of Breastfeeding in

Disease Prevention

Exclusive breastfeeding for at least 6 mos


Breastfeed for at least 6 mos

Caution in severe maternal asthma


Delay introduction of cows milk until 4 mos


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Lets all help bring back the

breastfeeding culture.

Breastfeeding in the Prevention of Chronic Diseases

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