Breast feeding and obesity: cross sectional study

BMJ 1999;319:147-150 ( 17 July )

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Breast feeding and obesity: cross sectional study

Rüdiger von Kries, professor of paediatrics, ^a Berthold Koletzko, professor of paediatrics, ^b Thorsten Sauerwald, senior house officer, ^b Erika von Mutius, reader in paediatrics, ^b Dietmar Barnert, statistician, ^a Veit Grunert, statistician, ^a Hubertus von Voss, professor of paediatrics. ^a

^a Institute for Social Paediatrics and Adolescent Medicine, Ludwig Maximilians University, Heiglhofstr 63, D-81377 Munich, Germany, ^b Dr von Haunersches Kinderspital, Ludwig Maximilians University, Lindwurmstr 4, D-80337 Munich

Correspondence to: R von Kries ag.epi{at}lrz.uni-muenchen.de

Objective: To assess the impact of breast feeding onthe risk of obesity and risk of being overweight in children atthe time of entry toschool.
Design: Cross sectional survey
Setting: Bavaria, southernGermany.
Methods: Routine data were collected on the heightand weight of 134 577 children participating in the obligatoryhealth examination at the time of school entry in Bavaria. Ina subsample of 13 345 children, early feeding, diet, and lifestylefactors were assessed using responses to a questionnaire completedbyparents.
Subjects: 9357 children aged 5 and 6 who had Germannationality.
Main outcome measures: Being overweight was defined as having a bodymass index above the 90th centile and obesity was defined as bodymass index above the 97th centile of all enrolled German children.Exclusive breast feeding was defined as the child being fed nofood other than breastmilk.
Results: The prevalence of obesity in children whohad never been breast fed was 4.5% as compared with 2.8% in breastfedchildren. A clear dose-response effect was identified for theduration of breast feeding on the prevalence of obesity: the prevalencewas 3.8% for 2 months of exclusive breast feeding, 2.3% for 3-5months, 1.7% for 6-12 months, and 0.8% for more than 12 months.Similar relations were found with the prevalence of being overweight.The protective effect of breast feeding was not attributable todifferences in social class or lifestyle. After adjusting forpotential confounding factors, breast feeding remained a significantprotective factor against the development of obesity (odds ratio0.75, 95% CI 0.57 to 0.98) and being overweight (0.79, 0.68 to0.93).
Conclusions: In industrialised countries promoting prolongedbreast feeding may help decrease the prevalence of obesity inchildhood. Since obese children have a high risk of becoming obeseadults, such preventive measures may eventually result in a reductionin the prevalence of cardiovascular diseases and other diseasesrelated toobesity.

Key messages

Obesity is the most frequent nutritional disorder in children, and is an important risk factor for cardiovascular disease in adulthood
Preventing obesity in children should be a useful strategy in preventing later heart disease because weight loss interventions in obese children are costly and rarely successful
Data from a cross sectional study in Bavaria suggest that the risk of obesity in children at the time of school entry can be reduced by breast feeding: a 35% reduction occurs if children are breastfed for 3 to 5 months
Preventing obesity and its consequences may be an important argument in the drive to encourage breast feeding in industrialised countries

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