title: Is the association of breastfeeding with child obesity explained by infant weight change?
abstract: OBJECTIVE
  Breastfeeding and infant weight change are both associated with adiposity. We examined the extent to which infant weight change mediates the association between breastfeeding and adiposity at age 3 years.
  
  
  METHODS
  We studied 884 children in a prospective cohort study. We determined breastfeeding status in the first 6 months. Our primary outcomes at 3 years were body mass index (BMI) z score and the sum of subscapular and triceps skinfold thicknesses (SS + TR); we also assessed obesity. We defined infant weight change as change in weight-for-age z score between birth and 6 months. We performed multivariable regression analyses.
  
  
  RESULTS
  At age 6 months, 25.0% of infants were fully breastfed. At age 3 years, mean (standard deviation) BMI z score was 0.45 (1.03). In linear regression analyses adjusted for mother's educational level, race/ethnicity, smoking, BMI, pregnancy weight gain and birth weight (adjusted for gestational age), the BMI z score of fully breastfed children was 0.17 (95% CI: -0.43, 0.09) units lower than never breastfed children. After additional adjustment for infant weight change, the estimate was attenuated (-0.03, 95% CI: -0.27, 0.20). Adjustment for infant weight change only modestly attenuated estimates for SS + TR (from -1.48 mm [95% CI: -2.52, -0.44] to -1.16 mm [95% CI: -2.18, -0.14]), and for the odds of being obese (from 0.21 [95% CI: 0.07, 0.68] to 0.29 [95% CI: 0.08, 1.05]).
  
  
  CONCLUSIONS
  Infant weight change between birth and 6 months mediates associations of breastfeeding with BMI, but only partially with indicators of child adiposity.
authors.affiliation: The Generation R Study Group, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands. l.vanrossem@erasmusmc.nl
authors.forename: Lenie
authors.initials: L
authors.lastname: van Rossem
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: Ken P
authors.initials: KP
authors.lastname: Kleinman
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
mesh_terms: D050154:Adiposity; D000328:Adult; D000367:Age Factors; D001724:Birth Weight; D015992:Body Mass Index; D001942:Breast Feeding; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D009765:Obesity / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012885:Skinfold Thickness; D015430:Weight Gain