title: Association of breast-feeding and feeding on demand with child weight status up to 4 years.
abstract: OBJECTIVE
  The mechanisms underlying the protective effect of breast-feeding on the development of childhood overweight are unclear. This study examines the association of breast-feeding with weight gain in the first year, and body mass index (BMI) and overweight up to 4 years. In addition, we examine possible mechanisms of this effect (i.e., feeding pattern, eating style, unhealthy snacking behavior).
  
  
  METHODS
  Data originated from the KOALA Birth Cohort Study (N = 2 834). Questionnaires assessed breast-feeding duration up to 12 months, feeding pattern (i.e., feeding on demand or feeding to schedule) at 3 months, BMI at 1, 2 and 4 years, eating style (e.g., slow eating) at age 1, and unhealthy snacking at age 2. Linear and logistic regression analyses were used to examine the association of breast-feeding and feeding pattern with eating style, unhealthy snacking, BMI z-scores and overweight.
  
  
  RESULTS
  Each additional month of breast-feeding was associated with less weight gain in the first year (regression coefficient B = -37.6 g, p < 0.001), a lower BMI z-score at age 1 (B = -0.02, p < 0.01), and a lower odds of being overweight at age 1 (odds ratio = 0.96, p < 0.05). Breast-feeding was associated with fewer unhealthy snacking occasions per week at age 2 (B = -0.19 for each month of breast-feeding, p < 0.001), but was unrelated to eating style. Feeding pattern was unrelated to all outcome variables after adjustment for breast-feeding duration.
  
  
  CONCLUSIONS
  The study showed a short-term protective effect of breast-feeding against overweight development. Possible mechanisms through which breast-feeding may protect against overweight include less unhealthy snacking behavior, but not feeding pattern or child's eating style.
authors.affiliation: Department of Health Promotion, Maastricht University Medical Centre, Maastricht, the Netherlands. Jessica.Gubbels@gvo.unimaas.nl
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Gubbels
authors.forename: Carel
authors.initials: C
authors.lastname: Thijs
authors.forename: Annette
authors.initials: A
authors.lastname: Stafleu
authors.forename: Stef
authors.initials: S
authors.lastname: van Buuren
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D001942:Breast Feeding; D002652:Child Behavior; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D005247:Feeding Behavior; D005260:Female; D006184:Habits; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007227:Infant Nutritional Physiological Phenomena; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009426:Netherlands; D016017:Odds Ratio; D050177:Overweight / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015430:Weight Gain