Division of Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London SW17 ORE, UK.
Proc Nutr Soc. 2011 Nov;70(4):478-84. doi: 10.1017/S0029665111000590. Epub 2011 Aug 1.
This paper considers the body of observational evidence examining the association of being breast-fed to cardiovascular risk factors and outcomes in later life, and whether any potentially advantageous findings are causal. Early cardiovascular consequences/correlates of breast-feeding, compared to being formula fed, include markedly higher levels of total blood cholesterol, lower levels of pre-prandial blood glucose and insulin and lower levels of adiposity. However, a key issue is whether these early differences at a period of rapid development programme/influence cardiovascular risk factors and outcomes in later life. Evidence of long-term effects of early feeding, largely from observational studies, has shown that those breast-fed have lower levels of blood total cholesterol, lower risk of type-2 diabetes and marginally lower levels of adiposity and blood pressure in adult life. There is no strong evidence to suggest effects of early feeding on adult levels of blood glucose, blood insulin and CHD outcomes, although further data are needed. However, the influence of confounding factors, such as maternal body size, maternal smoking and socio-demographic factors, and exclusivity of early feeding on these potentially beneficial associations needs to be considered before inferring any causal effects. Moreover, fewer studies have examined whether duration of exclusive breast-feeding has a graded influence on these risk factors and outcomes; such data would help further in deciding upon causal associations. While strong observational evidence suggests nutritional programming of adult cholesterol levels, associations with other markers of cardiometabolic risk and their consequences in later life need to be confirmed in well-conducted observational and experimental studies.
本文考虑了观察性证据，这些证据研究了母乳喂养与晚年心血管危险因素和结局的关系，以及任何潜在有利的发现是否具有因果关系。与配方奶喂养相比，母乳喂养的早期心血管后果/相关因素包括总胆固醇水平明显升高、餐前血糖和胰岛素水平降低以及肥胖程度降低。然而，一个关键问题是，这些在快速发育时期的早期差异是否会影响晚年的心血管危险因素和结局。早期喂养的长期影响的证据主要来自观察性研究，表明母乳喂养的人血液总胆固醇水平较低，患 2 型糖尿病的风险较低，成年期的肥胖程度和血压水平也略低。虽然还需要更多的数据，但没有强有力的证据表明早期喂养对成年血糖、胰岛素和冠心病结局水平有影响。然而，在推断任何因果效应之前，需要考虑早期喂养对这些潜在有益关联的混杂因素（如母体体型、母体吸烟和社会人口因素）以及母乳喂养的排他性的影响。此外，很少有研究检查母乳喂养的持续时间是否对这些危险因素和结局有分级影响；这些数据将有助于进一步确定因果关系。虽然强有力的观察证据表明，成人胆固醇水平存在营养编程，但需要在精心设计的观察性和实验研究中证实与其他心血管代谢风险标志物及其对晚年的影响之间的关联。
