Cope M B, Allison D B
Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL, USA.
Obes Rev. 2008 Nov;9(6):594-605. doi: 10.1111/j.1467-789X.2008.00504.x. Epub 2008 Jun 12.
Obesity among children and adults has become a highly recognized public health concern and there is an increasing need to discover causes and evaluate preventative measures. One putatively causal influence on obesity is breastfeeding (BF). The World Health Organization (WHO) recently published a report (WR) on 'Evidence of the Long-Term Effects of Breastfeeding: Systematic Reviews and Meta-Analysis' and concluded 'that the evidence suggests that breastfeeding may have a small protective effect[emphasis added] on the prevalence of obesity . . . [and] the effect of breastfeeding was not likely to be due to publication bias or confounding.' Here we provide a critical overview of the WR's section on BF and obesity by addressing eight questions: Q1: Is there sufficient evidence to conclude that BF is associated with lower rates of obesity in children? Q2: Is there sufficient evidence to conclude that BF is associated with lower rates of obesity among breastfed offspring once they reach adulthood? Q3: If there are such associations, what are their magnitudes in comparison with other putatively causal factors and with respect to the potential impact on individual or population levels of obesity? Q4: Is there sufficient evidence to conclude that BF causes a reduction in risk of obesity during childhood? Q5: Is there sufficient evidence to conclude that BF does not cause a reduction in risk of obesity during childhood? Q6: Is there sufficient evidence to conclude that BF causes a long-term reduction in risk of obesity that persists into adulthood? Q7: Is there sufficient evidence to conclude that BF does not cause a long-term reduction in risk of obesity that persists into adulthood? Q8: What further research might be done to address these questions? We conclude that, while BF may have benefits beyond any putative protection against obesity, and benefits of BF most likely outweigh any harms, any statement that a strong, clear or consistent body of evidence shows that BF causally reduces the risk of overweight or obesity is unwarranted at this time.
儿童和成人肥胖已成为备受关注的公共卫生问题，人们越来越需要找出其成因并评估预防措施。母乳喂养（BF）被认为是对肥胖有潜在因果影响的一个因素。世界卫生组织（WHO）最近发表了一份关于“母乳喂养长期影响的证据：系统评价和荟萃分析”的报告（WR），并得出结论：“有证据表明母乳喂养可能对肥胖患病率有轻微的保护作用[重点补充]……[并且]母乳喂养的影响不太可能是由于发表偏倚或混杂因素。”在此，我们通过回答八个问题，对WR中关于母乳喂养与肥胖的部分进行批判性综述：问题1：是否有足够的证据得出母乳喂养与儿童肥胖率较低相关的结论？问题2：是否有足够的证据得出母乳喂养的后代成年后肥胖率较低的结论？问题3：如果存在这样的关联，与其他假定的因果因素相比，以及就对个体或人群肥胖水平的潜在影响而言，它们的程度如何？问题4：是否有足够的证据得出母乳喂养可降低儿童期肥胖风险的结论？问题5：是否有足够的证据得出母乳喂养不会降低儿童期肥胖风险的结论？问题6：是否有足够的证据得出母乳喂养可长期降低肥胖风险并持续至成年的结论？问题7：是否有足够的证据得出母乳喂养不会长期降低肥胖风险并持续至成年的结论？问题8：为解决这些问题还可以进行哪些进一步的研究？我们的结论是，虽然母乳喂养可能有除预防肥胖之外的益处，且母乳喂养的益处很可能超过任何危害，但目前尚无充分证据表明母乳喂养能显著、明确或一致地降低超重或肥胖风险。
