title: Does initial breastfeeding lead to lower blood cholesterol in adult life? A quantitative review of the evidence.
abstract: BACKGROUND
  Earlier studies have suggested that infant feeding may program long-term changes in cholesterol metabolism.
  
  
  OBJECTIVE
  We aimed to examine whether breastfeeding is associated with lower blood cholesterol concentrations in adulthood.
  
  
  METHODS
  The study consisted of a systematic review of published observational studies relating initial infant feeding status to blood cholesterol concentrations in adulthood (ie, aged >16 y). Data were available from 17 studies (17 498 subjects; 12 890 breastfed, 4608 formula-fed). Mean differences in total cholesterol concentrations (breastfed minus formula-fed) were pooled by using fixed-effect models. Effects of adjustment (for age at outcome, socioeconomic position, body mass index, and smoking status) and exclusion (of nonexclusive breast feeders) were examined.
  
  
  RESULTS
  Mean total blood cholesterol was lower (P = 0.037) among those ever breastfed than among those fed formula milk (mean difference: -0.04 mmol/L; 95% CI: -0.08, 0.00 mmol/L). The difference in cholesterol between infant feeding groups was larger (P = 0.005) and more consistent in 7 studies that analyzed "exclusive" feeding patterns (-0.15 mmol/L; -0.23, -0.06 mmol/L) than in 10 studies that analyzed nonexclusive feeding patterns (-0.01 mmol/L; -0.06, 0.03 mmol/L). Adjustment for potential confounders including socioeconomic position, body mass index, and smoking status in adult life had minimal effect on these estimates.
  
  
  CONCLUSIONS
  Initial breastfeeding (particularly when exclusive) may be associated with lower blood cholesterol concentrations in later life. Moves to reduce the cholesterol content of formula feeds below those of breast milk should be treated with caution.
authors.affiliation: Division of Community Health Sciences, St George's, University of London, London, United Kingdom. cowen@sgul.ac.uk
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Owen
authors.forename: Peter H
authors.initials: PH
authors.lastname: Whincup
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Kaye
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
authors.forename: Erik
authors.initials: E
authors.lastname: Bergstrom
authors.forename: Stephanie
authors.initials: S
authors.lastname: Black
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Wadsworth
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Fall
authors.forename: Jo L
authors.initials: JL
authors.lastname: Freudenheim
authors.forename: Jing
authors.initials: J
authors.lastname: Nie
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Huxley
authors.forename: Sanja
authors.initials: S
authors.lastname: Kolacek
authors.forename: C Paul
authors.initials: CP
authors.lastname: Leeson
authors.forename: Mark S
authors.initials: MS
authors.lastname: Pearce
authors.forename: Olli T
authors.initials: OT
authors.lastname: Raitakari
authors.forename: Irina
authors.initials: I
authors.lastname: Lisinen
authors.forename: Jorma S
authors.initials: JS
authors.lastname: Viikari
authors.forename: Anita C
authors.initials: AC
authors.lastname: Ravelli
authors.forename: Alicja R
authors.initials: AR
authors.lastname: Rudnicka
authors.forename: David P
authors.initials: DP
authors.lastname: Strachan
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001942:Breast Feeding; D002784:Cholesterol / Q000097:blood / Q000378:metabolism*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000453:epidemiology; D007223:Infant; D007225:Infant Food; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008895:Milk, Human; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors
chemical_list: D002784:Cholesterol