title: Breast, Formula and Combination Feeding in Relation to Childhood Obesity in Nova Scotia, Canada.
abstract: Breastfeeding has been rigorously studied in relation to childhood obesity prevention. Few studies have examined whether combination feeding—breast milk and formula—may also be protective against obesity. This study aimed to investigate the relationship between breastfeeding duration, combination feeding and overweight and obesity among Canadian school children. We analyzed data from a 2011 cross-sectional, population based survey (n = 5,560), which included self-reported infant feeding behaviours, a food frequency questionnaire and measured height and weight. Multilevel regression methods were used to examine the association between breastfeeding duration and overweight and obesity adjusting for socioeconomic status, diet quality and physical activity. Thirty-four percent of children were breastfed for <1 week or never while 32% were breastfed for at least 6 months. In the fully adjusted model, children who were only formula fed or who were combination fed for <6 months were more likely to be overweight or obese relative to children who were only breastfed (OR 1.29, 95% CI 1.04-1.60 and OR 1.35, 95% CI 1.09-1.69, respectively). When examining overweight and obese children separately, those who were only formula fed were more likely obese (OR 1.57, 95% CI 1.10-2.25) relative to their peers who were only breastfed. And those who were combination fed for <6 months relative to those only breastfed were more likely to be overweight (OR 1.29, 95% CI 1.01-1.66). Breastfeeding, in the absence of formula feeding, appears to have a protective effect on childhood obesity. While combination feeding confers less benefit than only breastfeeding, it is more desirable than formula feeding alone. Strategies and social policies are needed to promote exclusive and longer breastfeeding duration and should be integrated with comprehensive efforts to prevent childhood obesity and to reduce the burden of chronic diseases in the long term.
authors: Department of Applied Human Sciences, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada, mdrossiter@upei.ca.
authors: Melissa D
authors: MD
authors: Rossiter
authors: Cynthia K
authors: CK
authors: Colapinto
authors: Mohammad K A
authors: MK
authors: Khan
authors: Jessie-Lee D
authors: JL
authors: McIsaac
authors: Patricia L
authors: PL
authors: Williams
authors: Sara F L
authors: SF
authors: Kirk
authors: Paul J
authors: PJ
authors: Veugelers
mesh_terms: D015992:Body Mass Index; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D041943:Infant Formula / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D008297:Male; D009674:Nova Scotia / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology*; D057566:Self Report
references: Breastfeed Med. 2009 Mar;4(1):25-30
references: 19196037
references: Pediatrics. 2005 May;115(5):1367-77
references: 15867049
references: CMAJ. 2000 Nov 28;163(11):1429-33
references: 11192647
references: Obes Rev. 2010 Oct;11(10):695-708
references: 20331509
references: Am J Epidemiol. 2005 Feb 1;161(3):289-96
references: 15671261
references: BMJ. 2000 May 6;320(7244):1240-3
references: 10797032
references: J Epidemiol Community Health. 1992 Jun;46(3):203-6
references: 1645071
references: J Am Assoc Nurse Pract. 2014 Jul;26(7):386-401
references: 24170411
references: J Health Psychol. 2013 Aug;18(8):1023-35
references: 22904154
references: Am J Epidemiol. 2005 Sep 1;162(5):397-403
references: 16076830
references: J Midwifery Womens Health. 2007 Nov-Dec;52(6):631-7
references: 17984001
references: Women Birth. 2010 Dec;23(4):135-45
references: 20299299
references: Breastfeed Med. 2006 Winter;1(4):225-35
references: 17661603
references: Pediatrics. 2010 Jul;126(1):e18-25
references: 20566605
references: N Engl J Med. 1992 Nov 5;327(19):1350-5
references: 1406836
references: PLoS One. 2013 Jun 05;8(6):e64542
references: 23755127
references: Int J Obes (Lond). 2007 Jul;31(7):1078-85
references: 17452993
references: Nutr Rev. 2005 Apr;63(4):103-10
references: 15869124
references: Int J Pediatr Obes. 2010;5(1):88-96
references: 19565401
references: Soc Sci Med. 2014 May;109:55-65
references: 24698713
references: Am J Clin Nutr. 2007 Jun;85(6):1578-85
references: 17556696
references: Am J Clin Nutr. 2007 Dec;86(6):1717-21
references: 18065591
references: Int J Obes Relat Metab Disord. 2004 Oct;28(10):1247-56
references: 15314625
references: Birth. 2009 Jun;36(2):122-32
references: 19489806
references: Pediatr Clin North Am. 2001 Feb;48(1):105-23, ix
references: 11236719
references: Pediatrics. 2010 Jun;125(6):e1386-93
references: 20457676
references: J Nutr. 2003 Nov;133(11):3476-84
references: 14608061
references: J Pediatr. 2011 Aug;159(2):186-91
references: 21429512
references: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001141
references: 17253455
references: Obes Rev. 2011 Jun;12(6):397-405
references: 20977603
references: J Am Diet Assoc. 1995 Mar;95(3):336-40
references: 7860946
references: Med Sci Sports Exerc. 2008 Apr;40(4):767-72
references: 18317366
references: Public Health Nutr. 2013 Feb;16(2):219-27
references: 22916704
references: Int J Obes Relat Metab Disord. 2002 Apr;26(4):538-43
references: 12075581
references: J Hum Lact. 2014 Jun 11;30(3):298-309
references: 24919510
references: Adv Nutr. 2012 Sep 01;3(5):675-86
references: 22983846
references: Prev Med. 2013 Dec;57(6):934-40
references: 23891787
references: CMAJ. 2002 Jan 8;166(1):21-8
references: 11800243
references: Am J Clin Nutr. 1998 Jun;67(6):1111-8
references: 9625081
references: CMAJ Open. 2014 Mar 03;2(1):E18-26
references: 25077121
references: JAMA. 2001 May 16;285(19):2461-7
references: 11368698
references: Int J Environ Res Public Health. 2012 Apr;9(4):1308-18
references: 22690194
references: Cochrane Database Syst Rev. 2012 Aug 15;(8):CD003517
references: 22895934
references: Can J Diet Pract Res. 2012 Winter;73(4):204
references: 23217450
references: Am J Clin Nutr. 2005 Dec;82(6):1298-307
references: 16332664