title: The Terneuzen Birth Cohort. Longer exclusive breastfeeding duration is associated with leaner body mass and a healthier diet in young adulthood.
abstract: BACKGROUND
  Breastfeeding (BF) is protective against overweight and is associated with dietary behaviour. The aims of our study were to assess the relationship between exclusive BF duration and BMI, waist circumference (WC) and waist-hip ratio (WHR) at adulthood, and to study whether dietary behaviour could explain the relationship between BF duration and the proxies of fat mass.
  
  
  METHODS
  In 2004-2005, 822 subjects from the Terneuzen Birth Cohort (n = 2,604), aged 18-28 years, filled in postal questionnaires including sociodemographic factors and aspects of dietary behaviour (dietary pattern, and consumption of fruit and vegetables, snacks, sweetened beverages and alcohol); 737 subjects also underwent anthropometric measurements of weight, height, and waist and hip circumference. The relationship between exclusive BF duration and dietary outcomes was investigated by logistic regression analysis. The relationships of BF duration with the anthropometric measures were investigated by linear regression analyses. All results were corrected for age, gender and possible confounders. Finally, regression analyses were performed to investigate if diet factors had a mediating effect on the relationship between BF duration and fat mass.
  
  
  RESULTS
  A significant inverse dose-response relationship of BF duration was found for BMI (β-0.13, SE 0.06), WC (β-0.39, SE 0.18) and WHR (β-0.003, SE 0.001), after correction for age, gender and confounders. The odds ratio (OR) of exclusive BF duration in months for a breakfast frequency of at least 5 times a week was 1.16 (95%CI 1.06-1.27), and for snack consumption of less than twice a week was 1.15 (95%CI 1.06-1.25). Both ORs were corrected for age, gender and confounders. For other dietary outcomes, the results point in the same direction, i.e. a positive relationship with BF duration, but these were not statistically significant. A mediating effect of the diet factors on the association between BF and anthropometric outcomes was not shown.
  
  
  CONCLUSIONS
  Exclusive BF duration had a significant inverse dose-response relationship with BMI, WC and WHR at young adulthood. BF duration was positively related to a healthier diet at adulthood, but this did not explain the protective effect of BF against body fat. Our results underline the recommendation of the WHO to exclusively breastfeed for 6 months or longer.
authors.affiliation: Department of Public and Occupational Health, The EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. ml.dekroon@vumc.nl
authors.forename: Marlou L A
authors.initials: ML
authors.lastname: De Kroon
authors.forename: Carry M
authors.initials: CM
authors.lastname: Renders
authors.forename: Michelle P J
authors.initials: MP
authors.lastname: Buskermolen
authors.forename: Jacobus P
authors.initials: JP
authors.lastname: Van Wouwe
authors.forename: Stef
authors.initials: S
authors.lastname: van Buuren
authors.forename: Remy A
authors.initials: RA
authors.lastname: Hirasing
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D001837:Body Weights and Measures; D001942:Breast Feeding / Q000706:statistics & numerical data; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009035:Mothers; D011795:Surveys and Questionnaires; D013997:Time Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio; D055815:Young Adult