Paediatrica Indonesiana

VOLUME 52 January NUMBER 1

Original Article

Breastfeeding and decreased risk for childhood obesity

Aspri Sulanto, Setya Wandita, Madarina Julia

O
Abstract
besity has become a global problem
Background Breast mil! promotes in"ant gro#th an$ appropriate #eight gain% minimi&ing the ris! "or malnutrition% an$ possibly "or obesity Objective 'o $etermine the in"luence o" in"ant breast"ee$ing practices on the ris! "or obesity in chil$ren age$ ( to ) years Methods *e con$ucte$ a case+control stu$y comparing breast"ee$ing practices bet#een obese an$ non+obese chil$ren
2

' he 1 ,ub-ects #ere selecte$ "rom t#o elementary schools in .ogya!arta

gen$er to the case sub-ects ,ub-ects/ mothers "ille$ 0uestionnaires on their breast"ee$ing practices

a ris! "actor "or a$ult obesity% an$ a ris! "actor "or Results
pairs o" obese an$ non+ obese sub-ects% $uration o" breast"ee$ing in the obese group #as shorter than

*e recruite$ ()

Obesity is a con$ition #hich is $i""icult to manage% are important

1

ha$ signi"icantly higher o$$s "or obesity compare$ to that o"

o" breast"ee$ing in re$ucing the ris! "or obesity in

"ee$ing 'he ris! "or obesity also $ecline$ #ith longer $urations

e""ect o" breast"ee$ing on the ris! o" chil$hoo$ an$

o" breast"ee$ing

a$olescent obesity Conclusion

o" breast"ee$ing lo#ere$ the ris! "or chil$hoo$ obesity in chil$ren age$ (+) years [Paediatr Indones !"#!$%!&#'%( Keywords : breastfeeding, children, obesity, Indonesia
,chool% ,ar$-ito 2ospital% .ogya!arta% 3n$onesia )eprint re*uests to& 4esehatan no 1% .ogya!arta% 3n$onesia E+mail5 dr.aspri@gmail.com

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"spri # lanto et al: Breast"ee$ing an$ $ecrease$ ris! "or chil$hoo$ obesity

possible mechanism associating breast"ee$ing to the

E0uipment #as calibrate$ at the Bureau o" Metrology% .ogya!arta Bo$y #eights an$ heights #ere measure$ once

thereby in"luencing early programming o" glucose #ere #eighe$ in their uni"orms or in light clothing metabolism 3n a$$ition% breast mil! is consi$ere$ 11 the best source o" in"ant nutrition "or appropriate $uring measurement 2eight #as measure$ #ith the in"ant gro#th an$ #eight gain% #hile minimi&ing stu$ents stan$ing erect% "acing "or#ar$% bac! to the con$itions that may in$uce obesity #all an$ hea$ in 6ran!"urt plane *e calculate$ bo$y 12 mass in$ices 7BM38% then ran$omly selecte$ () obese chil$ren "or the case group 9ontrols #ere non+obese sub-ects selecte$ "rom the same school% an$ matche$ 'here"ore% research "or age an$ gen$er to the case sub-ects 11 on the bene"its o" breast"ee$ing% especially that o" :uestionnaires on in"ant "ee$ing history #ere breast"ee$ing e""ects in the 3n$onesian pe$iatric breast"ee$ing as inta!e o" breast mil! only% #ithout population 'he aim o" this stu$y #as to $etermine a$$itional "oo$ or $rin! "or the "irst si; months o" the in"luence o" breast"ee$ing practices on the ris! "or obesity in chil$ren age$ ( to ) years plus "ormula "ee$ing be"ore the baby reache$ the age o" si; months 6ormula "ee$ing #as $e"ine$ as "ee$ing #ith co# or soy mil! in"ant "ormula Length

Methods
*e con$ucte$ a case +control stu$y "rom ,eptember+ o" breast"ee$ing #as $etermine$ by the age o" the chil$ at the cessation o" breast"ee$ing% assuming they ha$ breast"e$ since birth

schools because they ha$ stu$ents "rom "amilies o" participation ,ub-ects #ere obese an$ non+obese chil$ren the association bet#een breast"ee$ing an$ obesity age$ ( to ) years 6or the obese group% #e inclu$e$ ,tatistical signi"icance #as analy&e$ by 9hi+s0uare test 'he non+obese group 15

)esults
9hil$ren #ith physical abnormalities #hich might such as paralysis% paraplegia% thalassemia an$ e$ema% #ere e;clu$e$ *e estimate$ the re0uire$ sample si&e using a obese sub-ects "or the case group% an$ () non+obese "ormula "or case+control stu$ies *e estimate$ a control sub-ects% matche$ "or age an$ gen$er "rom 1( minimum sample si&e to be () sub-ects in each group the same school 9haracteristics o" sub-ects an$ their 'o obtain the sub-ects% #e screene$ all stu$ents mothers are presente$ in +able # 'he mean $uration o" breast"ee$ing in obese chil$ren #as shorter than measuring their #eights an$ heights *eight #as measure$ using an electronic $igital scale an$ height #as measure$ by microtoise% #ith a sho#n in 'able8

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"spri # lanto et al: Breast"ee$ing an$ $ecrease$ ris! "or chil$hoo$ obesity

,iscussion +able !
ha$ ( times increase$ o$$s "or obesity% compare$ to 7$e"ine$ as partial breast"ee$ing an$ "ormula "ee$ing groups combine$8 ha$ almost 5 times increase$ o$$s "or obesity Ris! o" obesity also ten$e$ to $ecline #ith longer $urations o" breast"ee$ing% although the $i""erence #as not signi"icant 7 +able - 8 breast"ee$ing lo#ere$ the ris! o" obesity in chil$hoo$ et al

et al also conclu$e$ that e""ect on the inci$ence o" obesity

et +able # 9haracteristics o" the stu$y sub-ects an$ their

mothers
9haracteristic Obese Mean age% years 7,=8 ,e; 7n < ()8 > 2 7? ))8 > 2 7? )(8 7n < ()8

al inci$ence o" obesity in chil$ren age$ 1 to 1) years

Non+obese

critical perio$ or $epen$ent on other co"actors @"ter a$-usting "or se;% parent/s BM3% maternal smo!ing
Male% n 7A8 1> 7(B8 1> 7(B8

$uring pregnancy% birth #eight% an$ social class% they

21 7C18 Mean #eight% !g 7,=8 Mean height% cm 7,=8 Mean BM3% !gDm2 7,=8 2igh school or less% n 7A8 9ollege% n 7A8 Maternal occupation 1? 2 7> 1)8 2C B 7C B(8 12) C 7> ?)8 12? > 75 )?8 21 7C18

6emale% n 7A8

or obesity% nor $i$ they "in$ any $ose+$epen$ent tren$

21 1 72 B(8 1( 1 71 )58

in $i""erent age groups @$-ustment "or con"oun$ing

1) 72(8 5? 7>18 25 7C>8

Maternal e$ucation

"actors $i$ not alter these "in$ings

1C 7(C8

years by 2e$iger et al also conclu$e$ that breast mil!

7A8 2ouse#i"e% n 7A8 Maternal nutritional status Obese% n 7A8 Non+obese% n 7A8 2> 71?8 2C 7C18 11 7(?8 15 7((8

*or!s outsi$e home% n

3n their stu$y% breast"ee$ing an$ its $uration #ere not

> 71?8 1 7(8 (1 7B?8 (1 7B18

+able ! 9omparison o" e;clusiEe breast"ee$ing to "ormula "ee$ing% partial breast"ee$ing or non+ e;clusiEe breast"ee$ing until age ( months "or the inci$ence o" obesity in chil$ren age$ ( to ) years
Obese Non+obese 7n<()8 7n<()8 OR B5A 93 E;clusiEe breast"ee$ing% n 7A8 1? 7158 C1 71(8 1 ? 7re"erence8 F 6ormula "ee$ing% n 7A8 ) 7128 1 7(8 ( 2? 71 (> to > >C8 Gartial breast"ee$ing% n7A8H 5? 7>18 CC 71B8 1 >? 7C B( to 5 1C8 Non+e;clusiEe breast"ee$ing% n 7A8HH 5) 7)58 C> 7518 1 )( 71 1C to 5 5B8 H Breast mil! an$ "ormula "ee$ing until the age o" ( months HHGartial breast"ee$ing group plus "ormula "ee$ing group

+able - Various $urations o" breast"ee$ing compare$ to breast"ee$ing "or I B months "or the ris! o" obesity in chil$ren age$ ( to ) years
Non+obese =uration o" breast"ee$ing Obese 7n<()8 7n<()8 OR B5A 93 NeEer breast"e$ or breast"e$ J 1 mo% n 7A8 ) 7128 1 7(8 2 1> ? (B to ) )1 1 to C mos% n 7A8 > 71?8 1 7(8 2 1( ? 5) to > B1 1 to ( mos% n 7A8 11 71(8 ) 7128 1 >? ? (2 to 1 (5 > to B mos% n 7A8 1 7(8 5 7>8 ? BB ? 21 to C B1 I B mos% n 7A8 C) 75(8 1> 7(B8 1 ? 7re"erence8 F

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"spri # lanto et al: Breast"ee$ing an$ $ecrease$ ris! "or chil$hoo$ obesity

race% se;% age group% mother/s BM3 status% an$ the timing o" intro$uction o" soli$ "oo$s% the stu$y conclu$e$ that maternal obesity superse$e$ in"ant early chil$hoo$% suggesting share$ "amilial $ietary $epen$ent e""ect "or $uration o" breast"ee$ing an$ ris! breast"e$ chil$ren "or maternal obesity 'hough breast"ee$ing continues 3n conclusion% to be strongly recommen$e$% it #as not consi$ere$ the o$$s "or obesity in chil$ren age$ ( to ) years becoming obese 'he mechanism o" ho# breast"ee$ing re$uces $ecline$ #ith longer $uration o" breast"ee$ing #ho #ere breast"e$ a$-uste$ better to inta!e o" high+calorie "oo$s Breast"e$ chil$ren learne$ to socioeconomic status "amilies 'here"ore% our results re"lect the con$ition o" chil$ren coming "rom such "amilies ,tu$ies in poorer "amilies might result in

)eferences
non+breast"e$ in"ants Breast"e$ in"ants also a$apte$ more rea$ily to ne# "oo$s% in"luencing the subse0uent caloric $ensity o" their $iet ( Breast"ee$ing may lea$ to lo#er bo$y #eight $uring the critical neonatal perio$ an$ may be associate$ #ith a lo#er mean caloric inta!e in breast"e$ in"ants compare$ to "ormula+"e$ neonates 3n animal e;periments% the type o" neonatal

sel"+regulate caloric inta!e better than

5+year "ollo#+up stu$y in urban 3n$onesian chil$ren 2orm

o" neuroen$ocrine circuits in the me$iobasal hypothalamus that regulate appetite control an$ bo$y #eight% #ith long+term conse0uences "or the ris! o" obesity 'hese mechanisms might e;plain #hy a longer $uration o" breast"ee$ing #as associate$ #ith a $ecrease$ ris! o" obesity later in li"e 1) Breast"e$ an$ "ormula+"e$ in"ants ha$ $i""erent hormonal responses to "ee$ing 6ormula+"ee$ing in earlier "at $eposition @nother possibility is that higher protein inta!e in "ormula+"e$ in"ants ha$ a programming e""ect on glucose metabolism ( @ limitation o" this stu$y #as that breast"ee$ing history #as obtaine$ by relying only on mothers/ mothers #ere able to remember the history o" @nother limitation o" this stu$y #as that #e $i$ not assess other
a$olescents #ho ha$ been breast"e$ as in"ants J@M@

"actors that might a""ect the inci$ence o" obesity% such

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"spri # lanto et al: Breast"ee$ing an$ $ecrease$ ris! "or chil$hoo$ obesity
http:$$%%%. nicef.org$Indonesia$breastfeeding "ee$ing #ith an$ #ithout "ormula use on the ris! o" obesity school+age$ chil$ren an$ a$olescents Bulletin o" the *2O http:$$%%%.%ho.int$b lletin$&ol mes$'5$($!)*!+,+()$en 1( Ma$iyono B% Moeslichan ,% ,astroasmoro ,% Bu$iman 3% .

L% % 4uc&mars!i RJ% Ruan *J

http:$$ecl-c.ohs.acf.hhs.go&$hslc$tta*system$ analysis @m J Epi$emiol . family$.or/2!Parents$01pectant/2!2others$3reastfeeding$ 4he5omprehensi&e.htm breast"ee$ing $uration by el$erly #omen @m J Epi$emiol

o" nutritional status in chil$ren un$er t#o years o" age in t#o .

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