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Duration of Lactation and Maternal Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis.
Tørris, C, Bjørnnes, AK
Nutrients. 2020;(9)
Abstract
Cardiovascular disease (CVD) is the leading cause of death of women across all ages, and targeting modifiable risk factors, such as those comprised in metabolic syndrome (MetS) (e.g., waist circumference, lipid profile, blood pressure, and blood glucose), is of great importance. An inverse association between lactation and CVD has been suggested, and lactation may decrease the risk of MetS. This systematic review and meta-analysis examined how lactation may affect the development and prevalence of MetS in women. A literature search was performed using Cinahl, Embase, Web of Science, and PubMed. A total of 1286 citations were identified, and finally, ten studies (two prospective and eight cross-sectional) were included. Seven studies (two prospective and five cross-sectional) revealed associations between lactation and MetS, suggesting that breastfeeding might prevent or improve metabolic health and have a protective role in MetS prevention. This protective role might be related to the duration of lactation; however, a lack of controlling for potential confounders, such as parity, might inflict the results. The pooled effect was non-conclusive. Additional research is required to further explore the duration of lactation and its potential role in improving or reversing MetS and its components.
2.
Breastfeeding and Risk of Metabolic Syndrome in Children and Adolescents: A Systematic Review.
Wisnieski, L, Kerver, J, Holzman, C, Todem, D, Margerison-Zilko, C
Journal of human lactation : official journal of International Lactation Consultant Association. 2018;(3):515-525
Abstract
BACKGROUND The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence for the association between being breastfed and the development of metabolic syndrome in children and adolescents. METHODS Articles were obtained from searches using PubMed and Embase databases, as well as from secondary searches through reference lists. Study quality was assessed using a three-level quality rating system. RESULTS Of 11 studies reviewed, 7 found a protective association between breastfeeding and metabolic syndrome and 4 found no association. There was no clear dose-response relationship between duration of breastfeeding and metabolic syndrome risk and insufficient evidence to demonstrate an added effect of being exclusively breastfed. The overall quality of the articles was moderate. In general, lower quality articles found no significant association, whereas higher quality articles found a significant association. CONCLUSION Our review demonstrated a limited amount of high-quality research on the relationship between being breastfed and development of metabolic syndrome in children and adolescents. The evidence presented in this review suggests that being breastfed may be protective against metabolic syndrome, but further research with improvements in study design, such as improved measurement of breastfeeding and the use of prospectively collected data, will improve our understanding of this relationship.
3.
Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial.
Martin, RM, Patel, R, Kramer, MS, Vilchuck, K, Bogdanovich, N, Sergeichick, N, Gusina, N, Foo, Y, Palmer, T, Thompson, J, et al
Circulation. 2014;(3):321-9
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Abstract
BACKGROUND The duration and exclusivity of breastfeeding in infancy have been inversely associated with future cardiometabolic risk. We investigated the effects of an experimental intervention to promote increased duration of exclusive breastfeeding on cardiometabolic risk factors in childhood. METHODS AND RESULTS We followed-up children in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. In 1996 to 1997, 17 046 breastfeeding mother-infant pairs were enrolled from 31 Belarusian maternity hospitals and affiliated polyclinics (16 intervention versus 15 control sites); 13 879 (81.4%) children were followed up at 11.5 years, with 13 616 (79.9%) who had fasted and did not have diabetes mellitus. The outcomes were blood pressure; fasting insulin, adiponectin, glucose, and apolipoprotein A1; and the presence of metabolic syndrome. Analysis was by intention to treat, accounting for clustering within hospitals/clinics. The intervention substantially increased breastfeeding duration and exclusivity in comparison with the control arm (43% versus 6% and 7.9% versus 0.6% exclusively breastfed at 3 and 6 months, respectively). Cluster-adjusted mean differences at 11.5 years between experimental versus control groups were as follows: 1.0 mm Hg (95% confidence interval, -1.1 to 3.1) for systolic and 0.8 mm Hg (-0.6 to 2.3) for diastolic blood pressure; -0.1 mmol/L (-0.2 to 0.1) for glucose; 8% (-3% to 34%) for insulin; -0.3 μg/mL (-1.5 to 0.9) for adiponectin; and 0.0 g/L (-0.1 to 0.1) for apolipoprotein A1. The cluster-adjusted odds ratio for metabolic syndrome, comparing experimental versus control groups, was 1.21 (0.85 to 1.72). CONCLUSIONS An intervention to improve breastfeeding duration and exclusivity among healthy term infants did not influence cardiometabolic risk factors in childhood. CLINICAL TRIAL REGISTRATION Current Controlled Trials: ISRCTN37687716 (http://www.controlled-trials.com/ISRCTN37687716). URL: http://clinicaltrials.gov. Unique identifier: NCT01561612.
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Impact of breastfeeding on maternal metabolism: implications for women with gestational diabetes.
Gunderson, EP
Current diabetes reports. 2014;(2):460
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Abstract
Lactating compared with nonlactating women display more favorable metabolic parameters, including less atherogenic blood lipids, lower fasting and postprandial blood glucose as well as insulin, and greater insulin sensitivity in the first 4 months postpartum. However, direct evidence demonstrating that these metabolic changes persist from delivery to postweaning is much less available. Studies have reported that longer lactation duration may reduce long-term risk of cardiometabolic disease, including type 2 diabetes, but findings from most studies are limited by self-report of disease outcomes, absence of longitudinal biochemical data, or no assessment of maternal lifestyle behaviors. Studies of women with a history gestational diabetes mellitus (GDM) also reported associations between lactation duration and lower the incidence of type 2 diabetes and the metabolic syndrome. The mechanisms are not understood, but hormonal regulation of pancreatic β-cell proliferation and function or other metabolic pathways may mediate the lactation association with cardiometabolic disease in women.
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Infant feeding and obesity risk in the child.
Oddy, WH
Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia. 2012;(2):7-12
Abstract
Early nutrition in infancy may influence later child health outcomes including overweight through 'programming'. Systematic reviews suggest that breastfeeding is associated with a modest reduction in the risk of later overweight and obesity. This commentary explores some of these mechanisms behind this association. Generally breastfed infants are leaner than artificially (formula)-fed infants and behavioural and hormonal mechanisms may explain this difference. The theory is that a high nutrient diet in infancy adversely programs the principal components of the metabolic syndrome in the child (body mass index, blood pressure and blood lipids) by promoting growth acceleration, whereas slower growth benefits later cardiovascular disease and its risk factors. Artificial-feeding stimulates a higher postnatal growth velocity with the adiposity rebound occurring earlier in those children who have greater fatness later, whereas breastfeeding has been shown to promote slower growth. The adverse long-term effects of early growth acceleration emerge as fundamental in later overweight and obesity. The higher protein content of artificial baby milk compared to the lower protein content in breastmilk is responsible for the increased growth rate and adiposity during the influential period of infancy of formula-fed infants. Breastfeeding, on the other hand, has a protective effect on child overweight and obesity by inducing lower plasma insulin levels, thereby decreasing fat storage and preventing excessive early adipocyte development. Plausible biological mechanisms underlying the protective effect of breastfeeding against obesity are based on the unique composition of human milk and the metabolic and physiological responses to human milk.