Running head: INTEGRATIVE LITERATURE REVIEW 1

Integrative Literature Review

Jordan Woods

Bon Secours Memorial College of Nursing

NUR 4122: Nursing Research

Christine Turner, PhD

April 8, 2018

I pledge…
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INTEGRATIVE LITERATURE REVIEW

Abstract

Purpose: The purpose of this integrative review is to determine if breastfeeding an

infant has a protective effect against childhood obesity later on in life.

Background: Breastfeeding an infant has many health benefits for both mother and

infant. In the hospital setting it is always encouraged that mothers exclusively

breastfeed, if able to, during the first few days of life. This integrative review

provides additional information to educate new mothers with regards to

breastfeeding.

Method: This integrative review represents research collected exclusively through

online database searches. All articles chosen for review met a specific set of criteria

and are quantitative research studies. The information collected from these studies

is utilized to determine if breastfeeding can prevent childhood obesity.

Limitations: The greatest limitation of this integrative review is the writer’s lack of

experience and limited knowledge on the topic.

Results and Findings: Throughout the research process for this integrative review,

the research shows that breastfeeding an infant for greater than one month can

have a protective effect on childhood obesity.

Implications and Recommendations: Knowledge gained from this integrative

review can be utilized when educating new mothers about the benefits of

breastfeeding and has the potential to lower childhood obesity rates globally. The

writer of this integrative review recommends that further research be done with

more limited dependent variables to confirm that breast milk is the cause of lower

obesity rates and not confounding variables.

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INTEGRATIVE LITERATURE REVIEW

Integrative Literature Review

The purpose of this integrated review is to determine the effects of

breastfeeding on childhood obesity. Breastfeeding an infant has many health

benefits for both mother and baby. Breast milk has the proper nutrient balance

designed just for your infant, it is easier for an infant to digest breast milk than it is

for them to digest formula, breast milk contains antibodies to help an infant’s

immature immune system, and breastfeeding may help a new mom lose weight

(mayoclinic.org, 2018). It is also known that childhood obesity is a growing

problem globally and contributes to adult obesity and many serious health concerns

into and throughout adulthood as well (Assuncao et al, 2015). In the last forty years,

the incidence of obesity in children ages five to 19 has increased by five times (Chica

et al., 2015). Childhood obesity is a disease with multiple contributing factors, but it

has been shown that breastfeeding might help to protect children against obesity

into childhood (Chica et al., 2015). Human milk contains a glucocorticoid called

cortisol, which regulates glucose storage and metabolism, whereas formula only

contains trace amounts of the metabolic boosting element. Infants exposed to

higher levels of cortisol have a lower incidence of obesity as children, due to their

metabolism maturing at an earlier age (Chung et al., 2016). Nurses are the frontline

force when educating new mothers about the benefits of breastfeeding, including

that breastfeeding an infant can reduce the risk of childhood obesity. The aim of this

Integrative Review study is to review the published data related to the researcher’s

PICO question: For infants does breastfeeding reduce the future risk of childhood

obesity compared with non-breastfed infants?

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INTEGRATIVE LITERATURE REVIEW

Design and Search Methods

When conducting research for this integrated review the search engines

Google Scholar and PubMed databases we utilized to locate studies and articles.

Breastfeeding and Childhood Obesity were the main search words and phrases that

were used throughout the research. Additionally the phrase “effects of breastfeeding

on childhood obesity” was utilized but did not achieve high volumes of relevant

articles. While solely searching Breastfeeding and Childhood Obesity, 753 article

results were generated. For quality purposes, the search was narrowed to free, full

text articles, articles that were peer-reviewed, quantitative or qualitative studies,

and studies published within the last five years. Studies that were not written in

English were excluded. With these inclusion and exclusion criteria, the search

generated 168 results. Articles were required to relate to the researcher’s PICO

question of, “for infants does breastfeeding reduce the future risk of childhood

obesity compared with non-breastfed infants?” The research articles were then

selected based on the criteria of the independent variable of breastfeeding,

dependent variables of weight or BMI and infants being exclusively breastfed. The

final five articles were selected for use based on the inclusion and exclusion criteria

and relevance to the researcher’s PICO question. All five articles selected are

quantitative study articles.

Findings and Results

The findings and results of the five studies concluded that there is a positive

correlation between exclusively breastfeeding an infant and lowering the risk for

childhood obesity (Acerini et al., 2016; Assuncao et al., 2015; Barbour et al., 2017;
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INTEGRATIVE LITERATURE REVIEW

Chung et al., 2016; Gonzales-Chica et al., 2015). A synopsis of the five research

articles reviewed is located in the appendix labeled Article Evaluation Tables.

Throughout the remainder of this section is an overview of each of the five research

articles’ results and findings.

Macronutrients in Breast Milk

Macronutrients and elements in human breast milk was a common theme

between three of the articles reviewed. Chung et al. (2016) found that the

glucocorticoid, Cortisol, could be associated with a lower risk for childhood obesity

(Chung et al., 2016). Barbour et al. (2017) discussed and found that the fatty acid

content in breast milk is reflective of the mother’s dietary fatty acid content and is

associated with the way that infants deposit adipose tissue while being breastfed

(Barbour et al., 2017). The study conducted by Acerini et al. (2016) also related to

macronutrients in breast milk and found that breast milk high in the macronutrients

fat and triglycerides is associated with rapid infant growth rates, whereas breast

milk with more even distribution of macronutrients is associated with a more

sustained infant growth rate, which is consistent with lower BMI later on in life

(Acerini et al., 2016).

Breastfeeding Duration

The common theme between the remaining two articles was duration of

breastfeeding related to childhood BMI. Gonzalez-Chica et al. (2015) determined

that breastfeeding an infant for any length of time longer than one month has a

protective factor against obesity later in life, but the incidence of childhood obesity

was 44% lower in children breastfed for more than 12 months (Gonzalez-Chica et
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INTEGRATIVE LITERATURE REVIEW

al., 2015). Assuncao et al. (2015) found that exclusively breastfeeding an infant for

greater than six months does have a preventative factor against childhood obesity

(Assuncao et al. 2015).

Chung et al. (2016) conducted a study to compare and analyze the

relationship between early cortisol exposures and childhood BMI. The design was a

quantitative random effects model that focused on determining infant cortisol

exposure and comparing it to the child’s BMI. The sample included 51 breastfeeding

mothers who gave birth at full term to singleton infants, 25 male and 26 female.

Mothers were chosen based on prior enrollment in a larger study researching early

life influences on childhood development. Data was collected at various ages from 3

to 24 months of age using standardized length, weight, and BMI methods. A digital

infant scale was used for weight and supine length measurement performed on a

pediatric exam table and growth standard percentiles were retrieved from the

World Health Organization. Mother’s expressed breast milk was collected and tested

for cortisol levels to determine the amount of cortisol the infant is receiving.

Growth curve modeling was utilized to analyze the trends in infant growth with all

variables accounted for. Linear regression testing was performed to identify and

rule out confounding variables. The researchers determined that an infant’s early

exposure to the glucocorticoid, cortisol, found in human breast milk can be

associated with a lower childhood BMI (Chung et al., 2016).

Gonzales-Chica et al. (2015) performed a study to determine an association

between duration of breastfeeding and obesity in children. The design was a

quantitative cross-sectional study linking the age an infant stopped breastfeeding to

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INTEGRATIVE LITERATURE REVIEW

childhood BMI. A randomized sample of 2,826 children ages seven to 14 was

obtained. Data was collected via a questionnaire that was sent out to parents and

guardians of the randomly selected children inquiring about gender, breastfeeding

habits as infants, age they discontinued breastfeeding, and current lifestyle choices.

Height, weight, and BMI data was collected via standardized procedures in a

doctor’s office and according to the WHO growth curves. Logistic regression

analysis was utilized with consideration for confounding variables. The researchers

determined that breastfeeding for any period of time longer than one month of age

can be protective against childhood obesity, but the incidence of childhood obesity

was 44% lower in children who were breastfed for greater than 12 months of age

(Gonzalez-Chica et al., 2015).

Barbour et al. (2017) sought to determine a relationship between fatty acid

content in breast milk and infant adipose tissue deposition. The design of the study

was a correlational analysis to see if fatty acid content in mother’s breast milk was a

driving force behind infant adipose tissue deposition and BMI. A sample of 48

mother and infant couplets of varying maternal BMI who breastfed during the first

four months of life, were a singleton fetus and were otherwise healthy were chosen

for the study. A mother with a BMI of over 40, was diagnosed with gestational

diabetes or delivered at less than 37 weeks were excluded from the study. Data

collection consisted of an office visit at two weeks of the infant’s life and four

months of the infant’s life where mother’s venous blood was collected for maternal

fatty acid levels and 20 mL of breastmilk was collected mid-feed for fatty acid

analysis. Infant measurements and body composition assessments were also

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INTEGRATIVE LITERATURE REVIEW

obtained at these office visits. Pearson correlation analysis and multivariable linear

regression was utilized for data analysis. The researchers determined that exposure

to DHA and fatty acid in breast milk during the first four months of life is reflective

of maternal dietary fatty acid content and contributes to the way that infants deposit

adipose tissue (Barbour et al., 2017).

Acernini et al. (2016) conducted a study with the goal of determining that

nutrients in breast milk can reduce rapid infant weight gain, therefore reducing the

risk of childhood obesity later on. The design of the study was a Cambridge Baby

Growth Study that focused on infancy growth determinants and the Dumas method

used for quantitative determination of nutrient levels in breast milk. A sample of

614 mother/ singleton infant couplets who were delivered after 36 weeks of

gestation and were able to provide breast milk samples was used for this study.

Data collection was obtained at birth, three months of age, and 12 months of age

through infant measurements of weight, length and skinfold thickness. Manually

expressed breast milk samples, totaling 100 mL, were collected over a two-week

time frame and kept frozen for macronutrient analysis. A Seca 757 electronic baby

scale was used to obtain weight, a Seca 416 infantometer was used to measure

length, a Holtian Tanner/ Whitehouse Skinfold Caliper was used to measure skinfold

thickness, and a Nuclear Magnetic Resonance spectra was used to measure

macronutrients in breast milk. The Cambridge Baby Growth Study cohort analyzed

the data and found that breast milk macronutrients varied from mother to mother.

The results of this study showed a positive correlation between breast milk with

high fat and triglyceride composition and rapid infant growth (Acerini et al., 2016).
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INTEGRATIVE LITERATURE REVIEW

Assuncao et al. (2015) sought to determine that infants exposed exclusively

to breast milk for greater than 6 months had a lower incidence of being overweight

in the second year of life in more socially deprived areas of Brazil. The quantitative

study was based on data collected from a health and nutrition survey given out at

local vaccine centers. Multi-stage sampling was utilized to obtain a sample size.

Two vaccine centers per state were randomly selected to conduct and surveyed

2,209 children ages 12-24 months. Only children whose parents were able to

provide information regarding the child’s breastfeeding habits were selected. Data

was collected by survey to determine infant’s breastfeeding duration, education

level of parents, and family economic status. A CARCI infantometer was used to

collect child’s length and an electric scale with a 150kg capacity was used to collect

child’s weight. Data was analyzed by Levene’s test to verify variance, a crude

analysis was done, and the Poisson regression model was utilized. The researchers

found that exclusively breastfeeding an infant for greater than six months does have

a preventative factor against childhood obesity (Assuncao et al., 2015).

Discussion/ Implications

Throughout the studies that were selected there was consensus that

indicates breastfeeding can have a protective effect and lower the risk of childhood

obesity. In one of the studies, the researchers found that there was a 44% lower

incidence of obesity in children who breastfed for greater than twelve months

(Gonzales-Chica et al., 2015). It was also found to be true that there was a positive

correlation between components of human milk and infant growth compared to

higher fat content in formula (Acerini et al. 2016). Overall, the studies concurred
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INTEGRATIVE LITERATURE REVIEW

that breastfeeding an infant for any time frame can protect against childhood

obesity later on in life but that the longer an infant is breastfed, the higher the

protective quality is (Acerini et al., 2016; Assuncao et al., 2015; Barbour et al., 2017;

Chung et al., 2016; Gonzales-Chica et al., 2015).

Childhood obesity is a continually growing problem in the United States and

across the globe. In the last forty years, the childhood obesity rate has multiplied by

five (Chica et al., 2015). Every study that was reviewed utilized weight, height and

BMI in children as the dependent variables and being breastfed as an infant as the

independent variable (Acerini et al., 2016; Assuncao et al., 2015; Barbour et al.,

2017; Chung et al., 2016; Gonzales-Chica et al., 2015). The healthcare industry is

aware of the consequences and complications of obesity in adults and are also

aware that being obese as a child puts them at greater risk to be obese in adulthood.

In the healthcare industry, obesity is a driving force in the attempt to improve

preventative medicine and these studies found that breastfeeding an infant can be

preventative to childhood obesity, which can in turn be preventative to obesity in

adulthood. The writer of this paper believes that further research on this topic

should be conducted to get a better understanding of the connection between

breastfeeding and lower risk of childhood obesity. Research has shown that there is

a positive correlation between breastfeeding and lower incidence of childhood

obesity but the exact reasoning behind why this is true is varied (Acerini et al., 2016;

Assuncao et al., 2015; Barbour et al., 2017; Chung et al., 2016; Gonzales-Chica et al.,

2015).
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INTEGRATIVE LITERATURE REVIEW

Limitations

When conducting research for this integrative review the writer of this paper

encountered varying limitations, many related to lack of experience writing an

integrative review. The writer’s limited amount of experience brought difficulty

when selecting articles for review. The writer’s lack of qualifications might also

affect the ability to conduct a reliable review and discussion related to the topic and

PICO question.

Selecting articles for review was a limitation throughout the research

process. Filtering articles during research to obtain articles that were within five

years, had a full-text option, and included variables related to the PICO question

were also limitations the writer deemed challenging. A few of the studies

themselves came with limitations as well. Some studies had smaller sample sizes,

which can affect the strength of the study, and one study had many variables being

tested that made findings and results confusing. These limitations should be

considered when conducting further research on the topic.

Conclusion

The evidence found in the research for this integrative review concurs that

breastfeeding an infant for any time frame longer than one month has a protective

effect against childhood obesity (Acerini et al., 2016; Assuncao et al., 2015; Barbour

et al., 2017; Chung et al., 2016; Gonzales-Chica et al., 2015). These findings relate

directly to the writer’s PICO question of “for infants does breastfeeding reduce the

future risk of childhood obesity compared with non-breastfed infants”? In future

research, the writer would recommend variables studied be limited in research

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design for clarity purposes and to rule out potential confounding variables. When

applying these findings to practice the writer of this integrative review recommends

that education for mothers be the nurses’ primary utilization. Nurses and lactation

consultants can take the knowledge gained from these studies and use it to enhance

breastfeeding education when referring to benefits of breastfeeding a new infant.

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INTEGRATIVE LITERATURE REVIEW

References

Acerini, C., Dunger, D., Hughes, I., Ong, K., Prentice, P., Schoemaker, M., . . . Vervoort,

J. (2016). Breast milk nutrient content and infancy growth. Acta Paediatrica.

Retrieved, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949511/.

Assuncao, M., Coutinho, S., Ferreiro, H., Horta, B., & Santos, L. (2015). Protective effect

of breastfeeding against overweight can be detected at the second year of

life. Journal of Health, Population and Nutrition.

Barbour, L., Friedman, J., Hernandez, T., Krebs, N., Lemas, D., MacLean, P., . . . Young,

B. (2017). Early infant adipose deposition is positively associated with the n-6

and n-3 fatty acid ratio in human milk. International Obesity. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380514/.

Chung, A., Davis, E. P., PhD, Glynn, L., PhD, Hahn-Holbrook, J., PhD, & Le, T. B.

(2016). Cortisol in human milk predicts child BMI. Obesity. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400496/.

Gonzales-Chica, D., Guedes de Vasconcelos, F., & Pudla, K. (2015). Effect of

breastfeeding on obesity of schoolchildren: Influence of maternal

education. Pediatria.

Mayo Clinic Staff. (2018). Breastfeeding tips: What new moms need to know. Retrieved

fromhttps://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-

depth/breast-feeding/art-20047138

INTEGRATIVE LITERATURE REVIEW
Appendix- Article Evaluation Tables
First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data
Collection Method
Data Analysis
Findings/Discussion
14
Chung, A., Davis, E. P., PhD, Glynn, L., PhD, Hahn-Holbrook, J., PhD, &
Le, T. B. (2016). Cortisol in Human Milk Predicts Child
BMI. Obesity. Retrieved February 22, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400496/.
● Early exposure to cortisol in human breast milk can help to
modulate infant BMI trajectories over the first two years of life.
● No theoretical framework utilized.
● Researchers wanted to prove that early exposure to cortisol in
breast milk could help modulate childhood BMI.
● Quantitative Random- effects growth curve modeling.
● A comparison was done to analyze the relationship of early
exposure to cortisol to childhood BMI.
● Sample of 51 breastfeeding mothers who have birth at full term to
singleton infants, 25 male infants and 26 female.
● Infants who were already enrolled in a larger study researching
early life influences on child development were chosen.
● Institutional Review Board at the University of California gave
approval for the study.
● Researchers did not state whether or not the participants gave
consent or if they were disclosed risks and benefits but it is
implied due to the approval status.
● Cortisol in breast milk exposure
● Childhood BMI
● Length, weight and growth percentile measured at 3, 6, 12 and 24
months of age.
● Mother’s breast milk tested to determine cortisol concentrations.
● Growth curve modeling was used to analyze data results with all
variable accounted for.
● Linear regression testing was performed to address and rule out
confounding variables.
● An early exposure to the glucocorticoid cortisol found in human
breast milk can be associated with lower childhood BMI.
● The findings were favorable toward exposing infants to human
breast milk throughout the first two years of life to help prevent
childhood obesity.
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INTEGRATIVE LITERATURE REVIEW

Appraisal/Worth to practice ● This study is valuable to the nursing practice because it gives us
additional education that we can provide to new parents about the
benefits of breast-feeding.

First Author (Year)/Qualifications Gonzales-Chica, D., Guedes de Vasconcelos, F., & Pudla, K. (2015).
Effect of breastfeeding on obesity of schoolchildren: Influence of
maternal education. Pediatria. Retrieved March 22, 2018.

Background/Problem Statement ● There has been a significant increase in childhood obesity ages 5-
19 in the last 40 years.
● Identify an associated between duration of breastfeeding and
obesity in schoolchildren.

Conceptual/theoretical ● No theoretical framework utilized.

Framework ● Researchers goal is to determine an association between duration
of breastfeeding and childhood obesity.
Design/ ● Quantitative cross-sectional study.
Method/Philosophical ● Breastfeeding duration was determined by questionnaire sent to
Underpinnings parents/ guardians.

Sample/ Setting/Ethical ● Randomized sample of 2826 schoolchildren ages 7-14.

Considerations ● Height and weight measured, data concerning breastfeeding was
gathered by questionnaire sent to parents.
Major Variables Studied (and their ● Breastfeeding duration
definition), if appropriate ● Height, weight, BMI

Measurement Tool/Data ● Height, weight and BMI measured by standardized procedures

Collection Method based on gender according to the WHO reference curves.
● Breastfeeding questionnaire sent out to families to determine
breastfeeding duration and lifestyle choices for the children.

Data Analysis ● Logistic regression with considerations for confounding variables.

Findings/Discussion ● Findings were shown to determine that breastfeeding for any

period longer than one month can be protective against
childhood obesity.
● The chance of obesity was 44% lower in children breastfed
for longer than 12 months.

INTEGRATIVE LITERATURE REVIEW
Appraisal/Worth to practice
First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data
Collection Method
16
● Obesity is multifactorial and associated with some severe
health problems.
● We as nurses can educate mothers that breast milk has a
different composition and elicits a different hormonal
response when compared to formula or other milks.
Barbour, L., Friedman, J., Hernandez, T., Krebs, N., Lemas, D., MacLean,
P., . . . Young, B. (2017). Early infant adipose deposition is positively
associated with the n-6 and n-3 fatty acid ratio in human
milk. International Obesity. Retrieved March 29, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380514/.
● Relationship between maternal dietary fatty acid influenced
changes in breastfeeding infant adipose tissue deposition
between 2 weeks and 4 months old.
● No theoretical framework utilized.
● Researchers wanted to determine the fatty acids in a
breastfeeding mother’s diet were a driving force behind
infant adipose deposition.
● Correlational analysis
● The comparison was done to analyze the relationship
between maternal dietary fatty acid levels and BMI in
breastfeeding infants.
● 48 infant and mother couplets who were breastfed during
the first four months of life.
● Mothers varied from normal weight, overweight and obese
BMI.
● Mothers were required to have a BMI of less than 40,
carrying a singleton fetus and be otherwise health.
● Women diagnosed with gestational diabetes or delivered at
less than 37 weeks were excluded from the study.
● The Colorado Multiple Institutional Review Board approved
the study.
● Maternal BMI
● Fatty acids in breast milk
● Infant body composition
● Mother/infants assessed at 2 weeks and 4 months, mother
venous blood collected at fasting and mid feed for fatty acid
measurements.
● Breast milk collected halfway through a feeding. 20mL was
collected for future fatty acid analysis.

INTEGRATIVE LITERATURE REVIEW
Data Analysis
Findings/Discussion
Appraisal/Worth to practice
First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
17
● Pearson correlation analysis
● Multivariable linear regression
● Exposure to DHA and fatty acid during the first four months
of life is reflective of maternal dietary fatty acid and
contributes to the way infants deposit adipose tissue.
● The value of the study to nursing practice is the ability for us
to provide additional education regarding the benefits of
breastfeeding.
Acerini, C., Dunger, D., Hughes, I., Ong, K., Prentice, P., Schoemaker,
M., . . . Vervoort, J. (2016). Breast milk nutrient content and infancy
growth. Acta Paediatrica. Retrieved March 29, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949511/.
● Nutrients in breast milk can help avoid rapid infancy weight
gain and later on childhood obesity.
● No theoretical framework utilized.
● Researchers wanted to study the nutrients in breast milk to
measure the effects of nutrients on infant weight gain.
● The Cambridge Baby Growth Study (birth cohort focused on
infancy growth determinants).
● Dumas method (analytical chemistry for quantitative
determination of elements in substances)
● 614 mother/ singleton infant couplets born at greater than 36
weeks who were able to provide breast milk samples
● infants were measured by weight, length and skinfold
thickness (measured at tricep, subscapular, flank and
quadriceps on the baby’s left side) at birth, 3 months of age
and 12 months of age.
● Breast milk samples of 100mL expressed over a 2 week
period and kept frozen were collected and a macronutrient
analysis was done on them.
● Cambridge Local Research Ethics Committee gave approval
and all mothers gave written informed consent.
● Infant length, weight and skinfold thickness
● Macronutrient levels in breast milk (triglycerides, lactose,
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total fats, protein)

Measurement Tool/Data ● Seca 757 electronic baby scale for weight
Collection Method ● Seca 416 Infantometer for length
● Holtain Tanner/ Whitehouse Skinfold Caliper for skinfold
thickness analysis
● Manual expression of breast milk for collection of milk
● Nuclear Magnetic Resonance spectra used for
macronutrient analysis

Data Analysis ● Cambridge Baby Growth Study cohort

Findings/Discussion ● Milk analysis showed variation in milk macronutrients

● Showed positive correlation between milk composition and
rapid infant growth.

Appraisal/Worth to practice ● This study is valuable to the nursing practice because it gives us
additional education that we can provide to new parents about the
benefits of breast-feeding.

First Author (Year)/Qualifications Assuncao, M., Coutinho, S., Ferreiro, H., Horta, B., & Santos, L. (2015).
Protective Effect of Breastfeeding against Overweight Can Be Detected at
the Second Year of Life. Journal of Health, Population and Nutrition.
Retrieved March 29, 2018.

Background/Problem Statement ● Article from a socially deprived area of Brazil

● Malnutrition and obesity co-exist
● This study aims to determine that infants exposed
exclusively to breast milk for greater than 6 months had
lower incidence of being overweight in the second year of
life.

Conceptual/theoretical ● No theoretical framework utilized

Framework ● Researchers wanted to prove that infants exposed to 100%
breast milk for greater than six months that it could protect
them against childhood obesity.
Design/ ● The design was based upon data recorded from the “Health
Method/Philosophical and Nutrition Day” survey that evaluated nutritional status of
Underpinnings children living in more rural areas of Brazil.
● Crude analysis
Sample/ Setting/Ethical ● Multi stage sampling- two vaccination centers were
Considerations randomly selected per state to conduct the surveys.
● 2,209 children ages 12-24 months whose parents were able

INTEGRATIVE LITERATURE REVIEW
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data
Collection Method
Data Analysis
Findings/Discussion
Appraisal/Worth to practice
19
to provide information regarding duration of being breastfed.
● Research Ethics Committee of the National School of Public
Health at Fundacao Oswaldo Cruz approved the “Health and
Nutrition Day” study protocol.
● Purpose of study was explained to all parents and data was
collected after they had signed an informed consent.
● Duration of infant being breastfed
● Birth weight
● Current weight, length, age and gender.
● Level of education parent’s had
● Economic status level of parents
● Survey
● CARCI infantometer to assess length
● Scale with capacity of 150 kg and precision of 100g
● Levene’s test to verify variance
● Crude analysis
● Poisson regression model
● The study found that an infant being exclusively breastfed
for greater than six months does have a protective factor
against childhood overweight in children living in the semi-
arid region of Brazil.
● This study provides additional evidence to nurses when
educating about the benefits of exclusively breast feeding an
infant.