Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.
Sick Kids Research Institute, Toronto, Ontario, Canada.
Am J Clin Nutr. 2018 Aug 1;108(2):354-362. doi: 10.1093/ajcn/nqy124.
Little is known about nutrition outcomes in preschoolers associated with breastfeeding duration beyond 12 mo of age.
The aim was to examine the association between total breastfeeding duration and nutrition outcomes at 3 to 5 y of age.
A cross-sectional study in healthy children, ages 3-5 y, recruited from 9 primary care practices in Toronto was conducted through the TARGet Kids! (The Applied Research Group for Kids) research network. Parents completed standardized surveys, including the Nutrition Screening for Every Preschooler (NutriSTEP) used to assess nutrition risk.
A total of 2987 children were included. Ninety-two percent of children were breastfed, and the mean ± SD breastfeeding duration was 11.4 ± 8.4 mo. The prevalence of nutrition risk (score >20) was 17.0%. We examined breastfeeding duration as a continuous variable. With the use of restricted cubic spline modeling, we confirmed a nonlinear relation between breastfeeding duration and NutriSTEP score, dietary intake and eating behavior subscores, and sugar-sweetened beverage and sweet-savory snack consumption. Segmented linear regression was used to examine this nonlinear relation in a piecewise approach. We found a decreasing trend in NutriSTEP score for children who were breastfed for 0-6 mo (β = -0.14; 95% CI: -0.29, 0.004), a significant decrease in NutriSTEP score for children breastfed for 6-12 mo (β = -0.20; 95% CI: -0.33, -0.07), and no significant change after 12 mo (β = 0.09; 95% CI: -0.07, 0.24) and beyond. The mean ± SD NutriSTEP scores were 17.1 ± 7.4 for no breastfeeding, 15.9 ± 6.5 for breastfeeding >0-6 mo, 13.9 ± 6.2 for >6-12 mo, 13.7 ± 6.3 for >12-18 mo, 14.6 ± 6.7 for >18-24 mo, and 14.3 ± 6.8 for >24-36 mo.
Breastfeeding for ≤12 mo was associated with decreased nutrition risk and healthier eating behaviors and dietary intake at 3-5 y of age. We found insufficient evidence of additional benefit for breastfeeding beyond 12 mo of age. The TARGet Kids! practice-based research network is registered at www.clinicaltrials.gov as NCT01869530.
对于 12 个月以上的母乳喂养持续时间与学龄前儿童营养结果的关系，人们知之甚少。
本研究旨在探讨总母乳喂养持续时间与 3 至 5 岁儿童营养状况之间的关系。
通过 TARGet Kids！（儿童应用研究小组）研究网络，在多伦多的 9 个初级保健机构招募健康的 3-5 岁儿童进行了一项横断面研究。父母完成了标准化的调查，包括用于评估营养风险的营养筛查工具（NutriSTEP）。
共纳入 2987 名儿童。92%的儿童接受母乳喂养，母乳喂养的平均持续时间为 11.4±8.4 个月。营养风险（评分>20）的发生率为 17.0%。我们将母乳喂养持续时间作为连续变量进行分析。通过受限立方样条模型，我们确认了母乳喂养持续时间与 NutriSTEP 评分、饮食摄入和饮食行为子评分、含糖饮料和甜食零食消费之间的非线性关系。分段线性回归用于分段方法检查这种非线性关系。我们发现，母乳喂养 0-6 个月的儿童 NutriSTEP 评分呈下降趋势（β=-0.14；95%CI：-0.29，0.004），母乳喂养 6-12 个月的儿童 NutriSTEP 评分显著下降（β=-0.20；95%CI：-0.33，-0.07），而 12 个月后（β=0.09；95%CI：-0.07，0.24）及之后母乳喂养没有明显变化。未母乳喂养的儿童的平均（±SD）NutriSTEP 评分为 17.1±7.4，母乳喂养>0-6 个月的儿童为 15.9±6.5，母乳喂养>6-12 个月的儿童为 13.9±6.2，母乳喂养>12-18 个月的儿童为 13.7±6.3，母乳喂养>18-24 个月的儿童为 14.6±6.7，母乳喂养>24-36 个月的儿童为 14.3±6.8。
12 个月内母乳喂养与 3-5 岁时降低营养风险和改善饮食行为和饮食摄入有关。我们发现，12 个月后母乳喂养没有额外的益处。TARGet Kids！实践基础研究网络在 www.clinicaltrials.gov 上注册，注册号为 NCT01869530。
