Breast feeding and obesity
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7224.1576 (Published 11 December 1999) Cite this as: BMJ 1999;319:1576All rapid responses
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In his comment on the paper by Von Kries at al (1) on breast feeding
and obesity Hebebrand considers that prolonging breast feeding "might put
a considerable strain on both mother and child." (2) No matter how I read
his letter I fail to see how such a conclusion can justifiably be drawn
for the simplest and most effective form of infant feeding. My wife is
mystified why it should have been a considerable strain for her. Our 3
children certainly did not appear to find it a burden in any way
whatsoever.
The evidence for the positive benefits of breast feeding surely outweighs
any negative speculation and the detrimental effect this may have on
initiation and continuation of breast feeding.
Christopher D E Morris
General Practitioner
Oakeswell Health Centre, Wednesbury, West Midlands, WS10 9HP
(1)Von Kries R, Koletzko B, Sauerwald T, von Mutius E, Barnert D,
Grunert V, et al. Breast feeding and obesity: cross sectional study. BMJ
1999;319:147-50. (17 July)
(2) Hebebrand J. Prolonging breast feeding to reduce obesity may be a
burden. Letters BMJ 1999;319:1576. (11 December)
Competing interests: No competing interests
Considering that 43% of women were told to bottle feed when they
expressed concerns about their milk supply, as opposed to evaluating the
baby to determine if in fact it actually was underfed, I believe that it
is more accurate to surmise that 43% of the women where given poor medical
advice rather than assisted with their perceived feeding difficulties.
To leap to the conclusion that breastfeeding was a burden, without any
apparent evidence showing so, perhaps shows the authors own personal bias
rather than a logical deduction from the available facts. It appears more
likely that 43% of the women had doctors who were unqualified to manage
breastfeeding patients.
Competing interests: No competing interests
Breast feeding and obesity
Von Kries et. al. [1] have recently suggested that breast feeding is an important risk factor for obesity. These findings have been questioned on grounds of potential confounding by maternal overweight [2] and insufficient adjustment for social class [3].
The data collected in the 5th Nation-wide Anthropological Survey of Children and Adolescents 1991, Czech Republic, reflect the experience of children grown up during the communist regime where man was equal by definition (at least most had the same low salary).
In this data set information on early feeding, lifestyle factors and parents' data (including maternal and paternal BMI) were assessed using a parent questionnaire (response rate 97,7%). We have used this data set to confirm or refute the hypothesis that breast feeding protects against childhood obesity.
In a sample of 2511 children aged 6 years (total: n= 131 825 [4]) length and weight were measured by their gym teachers in a standardised (Martin-Saller method). These schools had been selected at random from a list of all schools in the Czech Republic.
Being obese was defined as having a BMI above the 97th percentile. Breast feeding was defined as ever breast fed. Information on gender, birthweight (<_2500g own="own" bedroom="bedroom" education="education" of="of" father="father" mother="mother" _="_"/>=12 years), maternal/paternal smoking status (yes-no) and high BMI father/mother (>=30) were available and were considered as potential confounders. Data were analysed by chi square-testing and logistic regression models and carried out with SAS,6.12.
Breast feeding was very common those days in the Czech Republic: 94% were breastfed for at least up to one month and only 6 % were never breastfed. The prevalence of obesity was 8% in non breastfed children against 3% in breastfed children. The respective odds ratios for obesity by breastfeeding are shown in the table. Only maternal and paternal obesity (BMI>=30) were significantly (p<_005 associated="associated" with="with" both="both" breast="breast" feeding="feeding" and="and" childhood="childhood" obesity.="obesity." even="even" following="following" adjustment="adjustment" for="for" maternal="maternal" paternal="paternal" obesity="obesity" reduced="reduced" the="the" risk="risk" by="by" _57="_57" ci95="ci95" _17-78.="_17-78." p="p"/>These results confirm our previous findings in a population where differences in social class were minimal. In this setting maternal obesity could only explain the effect of breast feeding on obesity partially.
The research is supported by Internal Grant Agency of Ministry of Health, Czech Republic, grant no. 3979-3.
References:
[1] Von Kries R, Koletzko B, Sauerwald T, von Mutius E, Barnert D, Grunert V, von Voss H., Breast feeding and obesity: cross sectional study, BMJ 1999; 147-150
[2] Hebebrand J, Prolonging breast feeding to reduce obesity may be a burden, BMJ 1999;319:1576
[3] Wadsworth M, Marshall S, Hardy R,Paul A, Breast feeding and obesity, BMJ 1999;319:1576
[4] Statistical yearbook 1992, Federalni statisticky urad -Federal statistical office, Praha
Ing. Jana Vignerova, PhD
Ing. Zdenek Roth, PhD
Dept. of mathematical statistics and programming
National Institute of Public Health, Srobarova 48, 100 42 Praha 10, Czech
republic
jana.vignerova@szu.cz
Michael Toschke, MD
Rüdiger von Kries, professor for paediatrics
Institute for Social Paediatrics and Adolescent Medicine, Ludwig
Maximilians University, Heiglhofstr. 63, D-81377 Munich, Germany
ag.epi@lrz.uni-muenchen.de
Competing interests: Table : Crude and adjusted odds ratios (OR) [95% confidence limits] in the final logistic regression model containing breast feeding, high mother’s and father’s BMI for 2511 children aged 6 years._______________________________________________________________________Being obese crude OR Adj. OR _______________________________________________________________________Ever breast fed (n=2351;94%) 0,31 [0,17-0,58] 0,43 [0,22-0,83]High BMI mother (>=30)(n=132;5%) 9,35 [5,63-15,53] 7,51 [4,42-12,78]High BMI father (>=30)(n=215;9%) 3,64 [2,15-6,14] 2,37 [1,34-4,18]________________________________________________________________________