title: Breastfeeding and food pattern in overweight children in the Caribbean.
abstract: BACKGROUND
  As in most countries around the globe, overweight and obesity are a major threat to public health on the Caribbean island of Aruba. Increasing evidence confirms that breastfeeding protects against overweight and obesity. However, little is known about the mechanism underlying the association between breastfeeding and obesity. One possibility is that breastfed infants are better able to control their meal size and intervals than formula-fed infants. This might lead to a healthier diet in later life and protect against overweight and obesity.
  
  
  OBJECTIVE
  To determine the relationship between breastfeeding, food pattern and being overweight in the Caribbean.
  
  
  METHODS
  In a cross-sectional school-based study in 2004-2005, weight and height were measured by two research assistants in 1776 children aged 6-11 years on Aruba, an island in the Caribbean. BMI was defined according to guidelines by the International Obesity Task Force. Parents completed a questionnaire pertaining to breastfeeding and dietary food pattern.
  
  
  RESULTS
  1451/1776 (81·7%) children were breastfed; 851/1766 (47·9%) children were breastfed for <4 months, 227/1776 (12·8%) for 4-6 months and 373/1776 (21·0%) for ≥6 months. Children who were breastfed for ≥4 months had lower odds (OR 0·32, 95%CI 0·25-0·40) of being overweight including obesity than those who either were not breastfed or who were breastfed for <4 months. Children who were breastfed for ≥4 months were more likely to have a structured food pattern of six eating moments a day (OR 7·43, 95% CI 5·87-9·39, P<0·001) and to have breakfast every day (OR 2·86, 95% CI 2·17-3·78, P<0·001) than those who were not or who were breastfed for <4 months.
  
  
  CONCLUSIONS
  Breastfeeding for ≥4 months is associated with a structured food pattern (six eating moments a day including a daily breakfast) and carries a strikingly lower risk of overweight in children. Promoting prolonged breastfeeding together with a focus on a subsequent structured food pattern could be a cheap method of preventing overweight.
authors.affiliation: Departments of Health Sciences, the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Grêaux
authors.forename: Luuk
authors.initials: L
authors.lastname: Schwiebbe
authors.forename: Carry M
authors.initials: CM
authors.lastname: Renders
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Doak
authors.forename: Richard
authors.initials: R
authors.lastname: Visser
authors.forename: Joana Kist-van
authors.initials: JK
authors.lastname: Holthe
authors.forename: Remy A
authors.initials: RA
authors.lastname: HiraSing
mesh_terms: D015992:Body Mass Index; D001942:Breast Feeding; D002648:Child; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014900:West Indies / Q000453:epidemiology