Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
Public Health Foundation Enterprises-Special Supplemental Nutrition Program for Women, Infants and Children (PHFE-WIC), Irwindale, California, USA.
J Epidemiol Community Health. 2020 Oct;74(10):785-791. doi: 10.1136/jech-2019-213574. Epub 2020 Jul 1.
Research has found breastfeeding to be protective of obesity; however, this link remains contentious. We examined longitudinal associations between exclusive breastfeeding duration, growth trajectories and obesity at 4 years among children participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and whether these associations differed in the context of the 2009 WIC food package change, implemented to improve alignment with dietary guidelines and promote breastfeeding.
Longitudinal data from 260 935 WIC-participating children in Los Angeles County, California, 2003-2016, were used to assess the relationship between duration of receipt of the fully breastfeeding package (an exclusive breastfeeding proxy) with childhood growth and obesity using mixed effects and Poisson regression models.
Children exclusively breastfed for longer duration had healthier growth trajectories and lower obesity risk at age 4. Compared with infants with no fully breastfeeding package receipt, any receipt (a breastfeeding initiation proxy) was associated with reduced obesity risk. Obesity risk was lowest for boys and girls exclusively breastfed for 7 (risk ratio (RR)=0.73, 95% CI=0.64 to 0.82) and 13 months (RR=0.63, 95% CI=0.58 to 0.69), respectively. Exclusive breastfeeding duration increased, but associations between exclusive breastfeeding duration and growth and obesity were not modified, following the 2009 WIC food package change.
Increased duration of exclusive breastfeeding was associated with reduced obesity risk. The greatest incremental benefit was observed going from none to any exclusive breastfeeding, and the maximum cumulative benefit was among children receiving the fully breastfeeding package for more than 6 months. Breastfeeding promotion in WIC remains important for obesity prevention.
研究发现母乳喂养对肥胖有保护作用，但这一联系仍存在争议。我们研究了参与妇女、婴儿和儿童特别补充营养计划（WIC）的儿童在 4 岁时纯母乳喂养持续时间、生长轨迹与肥胖之间的纵向关联，以及这些关联在 2009 年 WIC 食品包变化的背景下是否存在差异，该变化旨在更好地与饮食指南保持一致并促进母乳喂养。
使用来自加利福尼亚州洛杉矶县 260935 名 WIC 参与者的纵向数据，使用混合效应和泊松回归模型评估完全母乳喂养方案（纯母乳喂养的替代指标）持续时间与儿童生长和肥胖之间的关系。
长时间纯母乳喂养的儿童生长轨迹更健康，4 岁时肥胖风险较低。与未接受完全母乳喂养方案的婴儿相比，任何接受（母乳喂养起始的替代指标）都与降低肥胖风险相关。男孩和女孩分别接受 7 个月（风险比（RR）=0.73，95%置信区间（CI）=0.64 至 0.82）和 13 个月（RR=0.63，95%CI=0.58 至 0.69）纯母乳喂养的肥胖风险最低。2009 年 WIC 食品包变化后，纯母乳喂养持续时间增加，但纯母乳喂养持续时间与生长和肥胖之间的关联并未改变。
增加纯母乳喂养持续时间与降低肥胖风险有关。从没有到任何纯母乳喂养的增量收益最大，而从接受完全母乳喂养方案超过 6 个月的儿童中获得的累积收益最大。WIC 中的母乳喂养促进仍然是预防肥胖的重要措施。
