title: Associations between exclusive breastfeeding and physical fitness during childhood.
abstract: OBJECTIVE
  Exposure to breastfeeding improves the survival, health, and development of children; therefore, breast milk is recommended as the exclusive nutrient source for feeding term infants during the first 6 months. This cross-sectional study aimed to determine the possible association between exposure to exclusive breastfeeding and physical fitness performance in children and, if so, whether this association is influenced by the breastfeeding duration.
  
  
  METHODS
  A total of 2853 (52.3 % girls) European children from the IDEFICS study aged 6-11 years with complete data on physical fitness (cardiorespiratory fitness, muscular strength, flexibility, balance, speed) and exclusive breastfeeding duration (never, 1-3, 4-6, 7-12 months) were included in the present study. Multivariate and mixed linear regression models were estimated and adjusted for sex, age, birth weight, diet, physical activity, body mass index, and parental factors (age, body mass index, educational attainment).
  
  
  RESULTS
  We found a positive association between exclusive breastfeeding and lower-body explosive strength (β = 0.034) as well as flexibility (β = 0.028). We also found a positive association between breastfeeding and balance in boys (β = 0.039), while this association was negative in girls (β = -0.029). To improve lower-body explosive strength, 1-3 months of exclusive breastfeeding were enough; a longer duration did not lead to increasing benefit. In contrast, 4-6 months of breastfeeding were necessary to have any benefit on flexibility or balance, although this became nonsignificant after adjustment for body mass index and physical activity.
  
  
  CONCLUSIONS
  Exclusive breastfeeding seems a natural way of slightly improving some physical fitness components (mainly lower-body muscle strength) and thus future health.
authors: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, Belgium. mahmoud.zaqout@ugent.be.
authors: Mahmoud
authors: http://orcid.org/0000-0002-8195-2884
authors: M
authors: Zaqout
authors: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, Belgium.
authors: Nathalie
authors: N
authors: Michels
authors: Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany.
authors: Wolfgang
authors: W
authors: Ahrens
authors: Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany.
authors: Claudia
authors: C
authors: Börnhorst
authors: Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
authors: Dénes
authors: D
authors: Molnár
authors: GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
authors: Luis A
authors: LA
authors: Moreno
authors: Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Gabriele
authors: G
authors: Eiben
authors: Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
authors: Alfonso
authors: A
authors: Siani
authors: Research and Education Institute of Child Health, Strovolos, Cyprus.
authors: Stalo
authors: S
authors: Papoutsou
authors: Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.
authors: Toomas
authors: T
authors: Veidebaum
authors: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, Belgium.
authors: Stefaan
authors: S
authors: De Henauw
mesh_terms: D015992:Body Mass Index; D001942:Breast Feeding; D000072599:Cardiorespiratory Fitness; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D024510:Muscle Development; D053580:Muscle Strength; D009749:Nutrition Surveys; D050177:Overweight / Q000453:epidemiology / Q000517:prevention & control*; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010809:Physical Fitness; D015995:Prevalence; D012189:Retrospective Studies
keywords: Balance; Children; Exclusive breastfeeding; Flexibility; Muscle strength; Physical fitness