Clinical research study
Breastfeeding in Infancy and Adult Cardiovascular Disease Risk Factors

https://doi.org/10.1016/j.amjmed.2008.11.034Get rights and content

Abstract

Background

Public health recommendations advocate breastfeeding in infancy as a means to reduce obesity in later life. Several prior studies relating breastfeeding to cardiovascular risk factors have been limited by lack of adjustment for maternal and participant confounding factors.

Methods

We ascertained breastfeeding history via questionnaire from mothers enrolled in the Framingham Offspring Study. In their young to middle-aged adult children enrolled in the Framingham Third Generation, we examined the relations between maternal breastfeeding history (yes, no) and cardiovascular risk factors, including body mass index (BMI), high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, fasting blood glucose, and systolic and diastolic blood pressure levels. We applied generalized estimating equations to account for sibling correlations and adjusted for maternal and participant lifestyle, education, and cardiovascular risk factors.

Results

In Third Generation participants (n = 962, mean age = 41 years, 54% were women), 26% of their mothers reported breastfeeding. Compared with non-breastfed individuals, breastfed adult participants had lower multivariable-adjusted BMI (26.1 kg/m2 vs 26.9 kg/m2, P = .04) and higher HDL cholesterol levels (HDL 56.6 mg/dL vs 53.7 mg/dL, P = .01). On additional adjustment for BMI, the association between breastfeeding and HDL cholesterol was attenuated (P = .09). Breastfeeding was not associated with total cholesterol, triglycerides, fasting blood glucose, systolic blood pressure, or diastolic blood pressure.

Conclusion

Breastfeeding in infancy is inversely associated with adult BMI and positively associated with HDL cholesterol. Associations between breastfeeding and BMI may mediate the association between breastfeeding and HDL cholesterol.

Section snippets

Study Sample

Participants for this study were part of the Third Generation cohort of the Framingham Heart Study; their mothers were members of the Offspring cohort. The Original Framingham Heart Study Cohort13 and Framingham Offspring cohorts have been described.14 Between July 1996 and May 1997, a breast health survey was mailed to Offspring cohort women that included questions regarding breastfeeding history of each of their children. The design and selection criteria for women chosen to receive the

Third Generation Participant Characteristics

Study sample characteristics grouped by breastfeeding status are shown in Table 1. Twenty-six percent of participants were reported by mothers to have been breastfed in infancy. Of those individuals who were breastfed, the median breastfeeding duration was 4 months (range 1-22 months), and 29.6% were breastfed for more than 6 months. A higher prevalence of breastfed individuals had higher education levels and a lower prevalence of diabetes (Table 1).

Maternal Characteristics

Characteristics of mothers by whether they

Summary of Findings

In a community-based sample of 962 men and women in early to middle age, maternal report of breastfeeding was associated with modestly lower participant BMI and higher participant HDL cholesterol concentrations. Maternal report of breastfeeding was not significantly associated with offspring total cholesterol, triglycerides, fasting blood glucose, or systolic or diastolic blood pressure levels. Breastfeeding was associated with higher mean HDL cholesterol concentrations even after accounting

Strengths and Limitations

Direct and routine assessment of cardiovascular risk factors for 2 generations of participants to account for both maternal covariates and offspring cardiovascular disease risk factors is a unique strength of our study. Risk factors were measured in offspring in adulthood, whereas most prior reports examined the relation of breastfeeding to childhood risk factors. Several limitations should be acknowledged as well. Breastfeeding assessment was done decades after the birth of participants, which

Implications and Directions for Future Study

Our findings confirm previous reports of a protective association between breastfeeding and later-life adiposity (as measured by BMI). Although the net reductions in BMI demonstrated in our study are modest, the beneficial effect at the population level may have important public health relevance. The risk of death from cardiovascular disease and congestive heart failure has been demonstrated to increase even with small incremental increases in BMI,52, 53 suggesting that even modest differences

Conclusions

Breastfeeding in infancy was associated with a modestly reduced BMI and elevated HDL cholesterol levels in adulthood after accounting for several participant and maternal characteristics. The association between breastfeeding and HDL cholesterol was attenuated on accounting for participant BMI. Studies elucidating the mechanisms underlying nutrition in early life and adiposity in later life are warranted.

References (54)

  • Primary care interventions to promote breastfeeding: U.S. Preventive Services Task Force recommendation statement

    Ann Intern Med

    (2008)
  • R.M. Martin et al.

    Breast feeding and cardiovascular disease risk factors, incidence, and mortality: the Caerphilly study

    J Epidemiol Community Health

    (2005)
  • C.G. Owen et al.

    Infant feeding and blood cholesterol: a study in adolescents and a systematic review

    Pediatrics

    (2002)
  • C.G. Owen et al.

    Effect of breast feeding in infancy on blood pressure in later life: systematic review and meta-analysis

    BMJ

    (2003)
  • A.C. Ravelli et al.

    Infant feeding and adult glucose tolerance, lipid profile, blood pressure, and obesity

    Arch Dis Child

    (2000)
  • A.R. Rudnicka et al.

    The effect of breastfeeding on cardiorespiratory risk factors in adult life

    Pediatrics

    (2007)
  • J.W. Rich-Edwards et al.

    Breastfeeding during infancy and the risk of cardiovascular disease in adulthood

    Epidemiology

    (2004)
  • R.M. Martin et al.

    Does breast-feeding in infancy lower blood pressure in childhood?The Avon Longitudinal Study of Parents and Children (ALSPAC)

    Circulation

    (2004)
  • K.B. Michels et al.

    A longitudinal study of infant feeding and obesity throughout life course

    Int J Obes (Lond)

    (2007)
  • T.R. Dawber et al.

    An approach to longitudinal studies in a community: the Framingham Study

    Ann N Y Acad Sci

    (1963)
  • J.M. Murabito et al.

    Family breast cancer history and mammography: Framingham Offspring Study

    Am J Epidemiol

    (2001)
  • W.B. Kannel et al.

    An investigation of coronary heart disease in familiesThe Framingham Offspring Study

    Am J Epidemiol

    (1979)
  • W.T. Friedewald et al.

    Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge

    Clin Chem

    (1972)
  • Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence ReportNational Institutes of Health

    Obes Res

    (1998)
  • Obesity: Preventing and Managing the Global Epidemic

    (2000)
  • W.B. Kannel et al.

    Some health benefits of physical activityThe Framingham Study

    Arch Intern Med

    (1979)
  • L.A. Cupples et al.

    Some risk factors related to the annual incidence of cardiovascular disease and death using pooled repeated biennial measurements: Framingham Study, 30-year follow-up

  • Cited by (73)

    • Human Milk

      2023, Principles of Neonatology
    View all citing articles on Scopus

    Funding: Supported by a National Institute of Health/National Heart, Lung, and Blood Institute, contract N01-HC-25195, 2K24 HL 04334 (RSV).

    Conflict of Interest: None.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

    View full text