title: Associations of breast-feeding patterns and introduction of solid foods with childhood bone mass: The Generation R Study.
abstract: Breast-feeding has been associated with later bone health, but results from previous studies are inconsistent. We examined the associations of breast-feeding patterns and timing of introduction of solids with bone mass at the age of 6 years in a prospective cohort study among 4919 children. We collected information about duration and exclusiveness of breast-feeding and timing of introduction of any solids with postnatal questionnaires. A total body dual-energy X-ray absorptiometry scan was performed at 6 years of age, and bone mineral density (BMD), bone mineral content (BMC), area-adjusted BMC (aBMC) and bone area (BA) were analysed. Compared with children who were ever breast-fed, those never breast-fed had lower BMD (-4·62 mg/cm2; 95 % CI -8·28, -0·97), BMC (-8·08 g; 95 % CI -12·45, -3·71) and BA (-7·03 cm2; 95 % CI -12·55, -1·52) at 6 years of age. Among all breast-fed children, those who were breast-fed non-exclusively in the first 4 months had higher BMD (2·91 mg/cm2; 95 % CI 0·41, 5·41) and aBMC (3·97 g; 95 % CI 1·30, 6·64) and lower BA (-4·45 cm2; 95 % CI -8·28, -0·61) compared with children breast-fed exclusively for at least 4 months. Compared with introduction of solids between 4 and 5 months, introduction <4 months was associated with higher BMD and aBMC, whereas introduction between 5 and 6 months was associated with lower aBMC and higher BA. Additional adjustment for infant vitamin D supplementation did not change the results. In conclusion, results from the present study suggest that ever breast-feeding compared with never breast-feeding is associated with higher bone mass in 6-year-old children, but exclusive breast-feeding for 4 months or longer was not positively associated with bone outcomes.
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Edith H
authors: EH
authors: van den Hooven
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Mounira
authors: M
authors: Gharsalli
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Denise H M
authors: DH
authors: Heppe
authors: 4Department of Public Health,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Hein
authors: H
authors: Raat
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Albert
authors: A
authors: Hofman
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Oscar H
authors: OH
authors: Franco
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Fernando
authors: F
authors: Rivadeneira
authors: 1Department of Epidemiology,Erasmus MC,University Medical Center Rotterdam,PO Box 2040,3000 CA Rotterdam,The Netherlands.
authors: Vincent W V
authors: VW
authors: Jaddoe
mesh_terms: D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000517:prevention & control*; D001942:Breast Feeding; D002648:Child; D002657:Child Development; D015362:Child Nutrition Disorders / Q000517:prevention & control; D015988:Cohort Effect; D015331:Cohort Studies; D005248:Feeding Methods / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007225:Infant Food; D007228:Infant Nutrition Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D010012:Osteogenesis; D011446:Prospective Studies
keywords: BA bone area; BMC bone mineral content; BMD bone mineral density; Bone mineral density; Breast-feeding; Childhood; Cohorts; DXA dual-energy X-ray absorptiometry; Introduction of solids; aBMC area-adjusted bone mineral content