Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Original Article
  • Published:

The impact of neonatal breast-feeding on growth trajectories of youth exposed and unexposed to diabetes in utero: the EPOCH Study

Abstract

Objective:

To evaluate the influence of breast-feeding on the body mass index (BMI) growth trajectory from birth through 13 years of age among offspring of diabetic pregnancies (ODP) and offspring of non-diabetic pregnancies (ONDP) participating in the Exploring Perinatal Outcomes Among Children Study.

Subjects:

There were 94 ODP and 399 ONDP who had multiple BMI measures obtained from birth throughout childhood. A measure of breast milk-months was derived from maternal self-report to categorize breast-feeding status as adequate (6 breast milk-months) or low (<6 breast milk-months). Mixed linear-effects models were constructed to assess the impact of breast-feeding on the BMI growth curves during infancy (birth to 27 months) and childhood (27 months to 13 years).

Results:

ODP who were adequately breast-fed had a slower BMI growth trajectory during childhood (P=0.047) and slower period-specific growth velocity with significant differences between 4 and 6 years of age (P=0.03) and 6 to 9 years of age (P=0.01) compared with ODP with low breast-feeding. A similar pattern was seen in the ONDP, with adequate breast-feeding associated with lower average BMI in infancy (P=0.03) and childhood (P=0.0002) and a slower growth trajectory in childhood (P=0.0002). Slower period-specific growth velocity was seen among the ONDP associated with adequate breast-feeding with significant differences between 12–26 months (P=0.02), 4–6 years (P=0.03), 6–9 years (P=0.0001) and 9–13 years of age (P<0.0001).

Conclusion:

Our study provides novel evidence that breast-feeding is associated with long-term effects on childhood BMI growth that extend beyond infancy into early and late childhood. Importantly, these effects are also present in the high-risk offspring, exposed to overnutrition during pregnancy. Breast-feeding in the early postnatal period may represent a critical opportunity to reduce the risk of childhood obesity.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Purchase on Springer Link

Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. de Onis M, Blossner M, Borghi E . Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92: 1257–1264.

    Article  CAS  Google Scholar 

  2. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH . Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337: 869–873.

    Article  CAS  Google Scholar 

  3. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA . Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 2005; 116: e125–e144.

    Article  Google Scholar 

  4. Catalano PM, Thomas A, Huston-Presley L, Amini SB . Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol 2003; 189: 1698–1704.

    Article  Google Scholar 

  5. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ . Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007; 30: 2287–2292.

    Article  Google Scholar 

  6. Silverman BL, Rizzo T, Green OC, Cho NH, Winter RJ, Ogata ES et al. Long-term prospective evaluation of offspring of diabetic mothers. Diabetes 1991; 40 (Suppl 2): 121–125.

    Article  Google Scholar 

  7. Crume TL, Ogden L, Daniels S, Hamman RF, Norris JM, Dabelea D . The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: The EPOCH Study. J Pediatr 2011; 158: 941–946.

    Article  Google Scholar 

  8. Sachdev HS, Fall CH, Osmond C, Lakshmy R, Dey Biswas SK, Leary SD et al. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr 2005; 82: 456–466.

    Article  CAS  Google Scholar 

  9. McCarthy A, Hughes R, Tilling K, Davies D, Smith GD, Ben-Shlomo Y . Birth weight; postnatal, infant, and childhood growth; and obesity in young adulthood: evidence from the Barry Caerphilly Growth Study. Am J Clin Nutr 2007; 86: 907–913.

    Article  CAS  Google Scholar 

  10. Harder T, Bergmann R, Kallischnigg G, Plagemann A . Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol 2005; 162: 397–403.

    Article  Google Scholar 

  11. Arenz S, Ruckerl R, Koletzko B, von Kries R . Breast-feeding and childhood obesity-a systematic review. Int J Obes 2004; 28: 1247–1256.

    Article  CAS  Google Scholar 

  12. National Diabetes in Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28: 1039–1057.

    Article  Google Scholar 

  13. Crume TL, Ogden L, Maligie M, Sheffield S, Bischoff KJ, McDuffie R et al. Long-term impact of neonatal breastfeeding on childhood adiposity and fat distribution among children exposed to diabetes in utero. Diabetes Care 2011; 34: 641–645.

    Article  Google Scholar 

  14. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ et al. Breastfeeding and the use of human milk. Pediatrics 2005; 115: 496–506.

    Article  Google Scholar 

  15. Kark JD, Troya G, Friedlander Y, Slater PE, Stein Y . Validity of maternal reporting of breast feeding history and the association with blood lipids in 17 year olds in Jerusalem. J Epidemiol Community Health 1984; 38: 218–225.

    Article  CAS  Google Scholar 

  16. Vobecky JS, Vobecky J, Froda S . The reliability of the maternal memory in a retrospective assessment of nutritional status. J Clin Epidemiol 1988; 41: 261–265.

    Article  CAS  Google Scholar 

  17. Block G, Murphy M, Roullet J, Wakimoto P, Crawford P, Block T . Pilot validation of a FFQ for children 8–10 years. The Fourth International Conference on Dietary Assessment Methods 2000.

  18. Pate R, Ross R, Dowda F, Trost SG, Sirard J . Validation of a three-day physical activity recall instrument in female youth. Pediatr Exerc Sci 2003; 15: 257–265.

    Article  Google Scholar 

  19. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B et al. Evidence based physical activity for school-age youth. J Pediatr 2005; 146: 732–737.

    Article  Google Scholar 

  20. U.S. Department of Health and Human Services. Healthy People 2010, 2nd edn. U.S. Government Printing Office: Washington, DC, 2000.

  21. Crume TL, Ogden L, Daniels S, Hamman RF, Norris JM, Dabelea D . The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: The EPOCH Study. J Pediatr 2011; 158: 941–946.

    Article  Google Scholar 

  22. Rolland-Cachera MF, Deheeger M, Guilloud-Bataille M, Avons P, Patois E, Sempe M . Tracking the development of adiposity from one month of age to adulthood. Ann Hum Biol 1987; 14: 219–229.

    Article  CAS  Google Scholar 

  23. Dewey KG, Peerson JM, Brown KH, Krebs NF, Michaelsen KF, Persson LA et al. Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth. Pediatrics 1995; 96 (Pt 1): 495–503.

    CAS  PubMed  Google Scholar 

  24. Dewey KG, Heinig MJ, Nommsen LA, Peerson JM, Lonnerdal B . Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING Study. Pediatrics 1992; 89 (Pt 1): 1035–1041.

    CAS  PubMed  Google Scholar 

  25. Rzehak P, Sausenthaler S, Koletzko S, Bauer CP, Schaaf B, von Berg A et al. Period-specific growth, overweight and modification by breastfeeding in the GINI and LISA birth cohorts up to age 6 years. Eur J Epidemiol 2009; 24: 449–467.

    Article  Google Scholar 

  26. Dewey KG, Heinig MJ, Nommsen LA, Peerson JM, Lonnerdal B . Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING Study. Pediatrics 1992; 89 (Pt 1): 1035–1041.

    CAS  PubMed  Google Scholar 

  27. van Beusekom CM, Zeegers TA, Martini IA, Velvis HJ, Visser GH, van Doormaal JJ et al. Milk of patients with tightly controlled insulin-dependent diabetes mellitus has normal macronutrient and fatty acid composition. Am J Clin Nutr 1993; 57: 938–943.

    Article  CAS  Google Scholar 

  28. Plagemann A, Harder T, Franke K, Kohlhoff R . Long-term impact of neonatal breast-feeding on body weight and glucose tolerance in children of diabetic mothers. Diabetes Care 2002; 25: 16–22.

    Article  Google Scholar 

  29. Rodekamp E, Harder T, Kohlhoff R, Franke K, Dudenhausen JW, Plagemann A . Long-term impact of breast-feeding on body weight and glucose tolerance in children of diabetic mothers: role of the late neonatal period and early infancy. Diabetes Care 2005; 28: 1457–1462.

    Article  CAS  Google Scholar 

  30. Pettitt DJ, Knowler WC . Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care 1998; 21 (Suppl 2): B138–B141.

    PubMed  Google Scholar 

  31. Mayer-Davis EJ, Rifas-Shiman SL, Zhou L, Hu FB, Colditz GA, Gillman MW . Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Diabetes Care 2006; 29: 2231–2237.

    Article  Google Scholar 

  32. Kramer MS, Guo T, Platt RW, Vanilovich I, Sevkovskaya Z, Dzikovich I et al. Feeding effects on growth during infancy. J Pediatr 2004; 145: 600–605.

    Article  Google Scholar 

  33. Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z et al. Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial. Am J Clin Nutr 2007; 86: 1717–1721.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by RO1 DK068001. The study sponsor had no role in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T L Crume.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crume, T., Ogden, L., Mayer-Davis, E. et al. The impact of neonatal breast-feeding on growth trajectories of youth exposed and unexposed to diabetes in utero: the EPOCH Study. Int J Obes 36, 529–534 (2012). https://doi.org/10.1038/ijo.2011.254

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2011.254

Keywords

This article is cited by

Search

Quick links