Infant feeding in Sweden: socio-demographic determinants and associations with adiposity in childhood and adolescence.
BACKGROUND
Recent reviews and meta-analyses conclude that breastfeeding constitutes a small but consistent protective effect against obesity or higher values of body mass index (BMI) in children, though in some studies this effect was weakened after adjustment for potential confounders. The aim of this study was to explore the socio-demographic determinants of the duration of breastfeeding in Sweden and the associations between breastfeeding duration and adiposity in childhood and adolescence.


METHODS
This was a cross-sectional study of Swedish children. Height, weight and waist circumference were measured and the sum of five skin fold measurements were obtained in 1137 9- and 15-year old children. Breastfeeding data were retrospectively obtained from the medical records for 812 (71.4%) children. Multiple ordinal logistic regression was applied to study individual effects of the maternal characteristics on the duration of breastfeeding. The relationship between children's anthropometric characteristics and duration of breastfeeding was studied by multiple linear regression. Associations between the odds of being overweight or obese and the duration of breastfeeding were studied by multiple logistic regression. Both linear and logistic models were adjusted for children's age, gender, birth weight, maternal education and parental BMI in 1998 as well as maternal age and smoking status at childbirth.


RESULTS
Maternal education was positively associated with the duration of breastfeeding in both 1983 and 1989. Non-smoking mothers were more likely to breastfeed longer than smokers in 1989 (OR = 1.9, 95%CI: 1.3, 3.0). Fifteen-year old children breastfed for shorter than 2 months had 1.2 kg/m(2) (95%CI: 0.1, 2.4) higher BMI, 3.2 cm (95%CI: 0.2, 6.2) higher waist circumference and 10.6 mm (95%CI: 1.7, 19.6) higher sum of five skin fold measurements compared to those breastfed for 6 months or longer when adjusted for children's characteristics and maternal characteristics in 1998. Adjustment for maternal age and smoking status at childbirth weakened these associations to non-significant levels (0.9 kg/m(2), 95%CI: -0.4, 2.1; 1.4 cm, 95%CI: -1.5, 4.4 and 5.1 mm, 95%CI: -4.0, 14.2, respectively). In the 9-year olds, the associations were less pronounced, but in the same direction. No trends between duration of breastfeeding and children's anthropometric characteristics were observed in any of the age groups.


CONCLUSIONS
Maternal education and smoking were significant predictors of breastfeeding duration in Sweden in the 1980s. Associations with measures of adiposity were observed only in 15-year old children between the children with shortest and longest breastfeeding duration, which were weakened after adjustment for maternal characteristics at childbirth.
Grjibovski
Andrej M
AM
Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, SE-141 57, Huddinge, Stockholm, Sweden. andrei.grjibovski@fhi.no
Ehrenblad
Bettina
B
Yngve
Agneta
A
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