Abstract
Objectives. The mechanisms underlying the protective effect of breast-feeding on the development of childhood overweight are unclear. This study examines the association of breast-feeding with weight gain in the first year, and body mass index (BMI) and overweight up to 4 years. In addition, we examine possible mechanisms of this effect (i.e., feeding pattern, eating style, unhealthy snacking behavior). Methods. Data originated from the KOALA Birth Cohort Study (N = 2 834). Questionnaires assessed breast-feeding duration up to 12 months, feeding pattern (i.e., feeding on demand or feeding to schedule) at 3 months, BMI at 1, 2 and 4 years, eating style (e.g., slow eating) at age 1, and unhealthy snacking at age 2. Linear and logistic regression analyses were used to examine the association of breast-feeding and feeding pattern with eating style, unhealthy snacking, BMI z-scores and overweight. Results. Each additional month of breast-feeding was associated with less weight gain in the first year (regression coefficient B = −37.6 g, p < 0.001), a lower BMI z-score at age 1 (B = −0.02, p < 0.01), and a lower odds of being overweight at age 1 (odds ratio = 0.96, p < 0.05). Breast-feeding was associated with fewer unhealthy snacking occasions per week at age 2 (B = −0.19 for each month of breast-feeding, p < 0.001), but was unrelated to eating style. Feeding pattern was unrelated to all outcome variables after adjustment for breast-feeding duration. Conclusions. The study showed a short-term protective effect of breast-feeding against overweight development. Possible mechanisms through which breast-feeding may protect against overweight include less unhealthy snacking behavior, but not feeding pattern or child's eating style.
Declaration of interest and financial disclosure
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Financial support for the KOALA Birth Cohort Study was provided by the Triodos Foundation, Royal FrieslandCampina, Suikerstichting Netherlands, the Dutch Ministry of Economic Affairs, University Hospital Maastricht, and funds unrelated to commercial organizations (Iona Foundation, Phoenix Foundation, Foundation for the Advancement of Heilpedagogiek), all in the Netherlands. All research by J. S. Gubbels is financed by NUTRIM School for Nutrition, Toxicology and Metabolism. None of the funding sources had any influence on the data analyses, interpretation and presentation.