Department of Obstetrics & Gynecology, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Korea.
Department of Pediatrics, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea.
Int Breastfeed J. 2024 May 14;19(1):33. doi: 10.1186/s13006-024-00642-z.
Breastfeeding resets insulin resistance caused by pregnancy however, studies on the association between breastfeeding and diabetes mellitus (DM) have reported inconsistent results. Therefore, we aimed to investigate the risk of DM according to breastfeeding duration in large-scale population-based retrospective study. In addition, machine-learning prediction models for DM and hemoglobin A1c (HbA1c) were developed to further evaluate this association.
We used the Korean National Health and Nutrition Examination Surveys database, a nationwide and population-based health survey from 2010 to 2020. We included 15,946 postmenopausal women with a history of delivery, whom we divided into three groups according to the average breastfeeding duration: (1) no breastfeeding, (2) < 12 months breastfeeding, and (3) ≥ 12 months breastfeeding. Prediction models for DM and HbA1c were developed using an artificial neural network, decision tree, logistic regression, Naïve Bayes, random forest, and support vector machine.
In total, 2248 (14.1%) women had DM and 14,402 (90.3%) had a history of breastfeeding. The prevalence of DM was the lowest in the < 12 breastfeeding group (no breastfeeding vs. < 12 months breastfeeding vs. ≥ 12 months breastfeeding; 161 [10.4%] vs. 362 [9.0%] vs. 1,725 [16.7%], p < 0.001). HbA1c levels were also the lowest in the < 12 breastfeeding group (HbA1c: no breastfeeding vs. < 12 months breastfeeding vs. ≥ 12 months breastfeeding; 5.9% vs. 5.9% vs. 6.1%, respectively, p < 0.001). After adjustment for covariates, the risk of DM was significantly increased in both, the no breastfeeding (adjusted odds ratio [aOR] 1.29; 95% CI 1.29, 1.62]) and ≥ 12 months of breastfeeding groups (aOR 1.18; 95% CI 1.01, 1.37) compared to that in the < 12 months breastfeeding group. The accuracy and the area under the receiver-operating-characteristic curve of the DM prediction model were 0.93 and 0.95, respectively. The average breastfeeding duration was ranked among the top 15 determinants of DM, which supported the strong association between breastfeeding duration and DM. This association was also observed in a prediction model for HbA1c.
Women who did not breasted had a higher risk of developing DM than those who breastfed for up to 12 months.
母乳喂养可重置妊娠引起的胰岛素抵抗，但关于母乳喂养与糖尿病（DM）之间关联的研究结果并不一致。因此，我们旨在通过大规模的基于人群的回顾性研究，调查母乳喂养持续时间与 DM 风险之间的关系。此外，还开发了用于 DM 和糖化血红蛋白（HbA1c）的机器学习预测模型，以进一步评估这种关联。
我们使用了韩国国家健康和营养检查调查数据库，这是一项 2010 年至 2020 年期间的全国性和基于人群的健康调查。我们纳入了 15946 名有分娩史的绝经后妇女，根据平均母乳喂养持续时间将她们分为三组：（1）无母乳喂养，（2）<12 个月母乳喂养，（3）≥12 个月母乳喂养。使用人工神经网络、决策树、逻辑回归、朴素贝叶斯、随机森林和支持向量机开发了 DM 和 HbA1c 的预测模型。
共有 2248 名（14.1%）妇女患有 DM，14402 名（90.3%）有母乳喂养史。DM 的患病率在<12 个月母乳喂养组最低（无母乳喂养组与<12 个月母乳喂养组与≥12 个月母乳喂养组；161 [10.4%] vs. 362 [9.0%] vs. 1725 [16.7%]，p<0.001）。HbA1c 水平在<12 个月母乳喂养组也最低（HbA1c：无母乳喂养组与<12 个月母乳喂养组与≥12 个月母乳喂养组；5.9% vs. 5.9% vs. 6.1%，均 p<0.001）。调整了混杂因素后，无母乳喂养组（调整后的优势比[aOR]1.29；95%置信区间[CI]1.29，1.62]）和≥12 个月母乳喂养组（aOR 1.18；95% CI 1.01，1.37）发生 DM 的风险均显著高于<12 个月母乳喂养组。DM 预测模型的准确性和受试者工作特征曲线下面积分别为 0.93 和 0.95。母乳喂养持续时间在 DM 的前 15 个决定因素中排名较高，这支持了母乳喂养持续时间与 DM 之间的强关联。在 HbA1c 的预测模型中也观察到了这种关联。
与母乳喂养至 12 个月的妇女相比，不进行母乳喂养的妇女发生 DM 的风险更高。
