title: Selective protection against extremes in childhood body size, abdominal fat deposition, and fat patterning in breastfed children.
abstract: OBJECTIVE
  To determine whether the effect of breastfeeding on childhood measures of adiposity differs across percentiles of childhood body mass index (BMI), subcutaneous (SAT) and visceral (VAT) adipose tissue deposition, ratio of subcutaneous to triceps skinfold (STR), and intramyocellular lipid accumulation (IMCL).
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Denver, Colorado.
  
  
  METHODS
  Four hundred forty-two children and adolescents aged 6 to 13 years participating in the Exploring Perinatal Outcomes Among Children study (EPOCH) with material recall of infant diet.
  
  
  METHODS
  Adequate (≥6 breast milk-months) vs low (<6 breast milk-months) neonatal breastfeeding status.
  
  
  METHODS
  Mean and percentile differences in BMI, SAT, VAT, STR, and IMCL between children who had adequate compared with low levels of breastfeeding.
  
  
  RESULTS
  No significant differences in mean levels of childhood adiposity levels between adequate and low breastfeeding status were detected using linear regression models. However, in quantile regression models, adequate breastfeeding was associated with lower levels of adiposity levels for those in the upper percentiles (>60th percentile for VAT, 85th and 95th percentiles for BMI, and 95th percentiles for SAT and STR) and a null effect for those at the 50th percentile or lower. These effects were independent of sociodemographic, perinatal, and current lifestyle factors. We found no relationship between breastfeeding and IMCL at any percentile of the distribution.
  
  
  CONCLUSIONS
  Rather than shifting the entire distribution of adiposity-related measures in childhood, breastfeeding selectively protects against extremes in body size and fat deposition, reinforcing the American Academy of Pediatrics recommendation for 6 months of exclusive breastfeeding as the optimal infant diet.
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Aurora, CO 80045, USA. tessa.crume@ucdenver.edu
authors.forename: Tessa L
authors.initials: TL
authors.lastname: Crume
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Bahr
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mayer-Davis
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hamman
authors.forename: Ann L
authors.initials: AL
authors.lastname: Scherzinger
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stamm
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
mesh_terms: D050153:Abdominal Fat; D050154:Adiposity; D000293:Adolescent; D015992:Body Mass Index; D001942:Breast Feeding; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000517:prevention & control; D012189:Retrospective Studies; D057566:Self Report; D012885:Skinfold Thickness; D050151:Subcutaneous Fat; D013851:Thinness / Q000517:prevention & control; D013997:Time Factors