Breastfeeding and risk of overweight in childhood and beyond: a systematic review with emphasis on sibling-pair and intervention studies

Kathryn G Dewey; Darcy Güngör; Sharon M Donovan; Emily M Madan; Sudha Venkatramanan; Teresa A Davis; Ronald E Kleinman; Elsie M Taveras; Regan L Bailey; Rachel Novotny; Nancy Terry; Gisela Butera; Julie Obbagy; Janet de Jesus; Eve Stoody

doi:10.1093/ajcn/nqab206

Breastfeeding and risk of overweight in childhood and beyond: a systematic review with emphasis on sibling-pair and intervention studies

Am J Clin Nutr. 2021 Nov 8;114(5):1774-1790. doi: 10.1093/ajcn/nqab206.

Authors

Kathryn G Dewey¹, Darcy Güngör^{2

3}, Sharon M Donovan⁴, Emily M Madan^{2

3}, Sudha Venkatramanan^{2

3}, Teresa A Davis⁵, Ronald E Kleinman⁶, Elsie M Taveras^{6

7}, Regan L Bailey⁸, Rachel Novotny⁹, Nancy Terry¹⁰, Gisela Butera^{2

3}, Julie Obbagy³, Janet de Jesus¹¹, Eve Stoody¹²

Affiliations

¹ Department of Nutrition, University of California, Davis, CA, USA.
² Panum Group, Bethesda, MD, USA.
³ Nutrition Evidence Systematic Review team, Nutrition Guidance and Analysis Division (NGAD), Center for Nutrition Policy and Promotion (CNPP), Food and Nutrition Service (FNS), US Department of Agriculture (USDA), Alexandria, VA, USA.
⁴ Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA.
⁵ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
⁶ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Harvard T. H. Chan School of Public Health, Boston, MA, USA.
⁸ Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.
⁹ Department of Human Nutrition Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Manoa, HI, USA.
¹⁰ National Institutes of Health Library, Office of Research Services, US Department of Health and Human Services (HHS), Bethesda, MD, USA.
¹¹ Office of Disease Prevention and Health Promotion, HHS, Rockville, MD, USA.
¹² NGAD, CNPP, FNS, USDA, Alexandria, VA, USA.

Abstract

Background: Breastfeeding is associated with a lower risk of subsequent overweight or obesity, but it is uncertain whether this is a causal relation because most studies have not adequately reduced risk of bias due to confounding.

Objectives: The aim of this review was to examine whether 1) ever compared with never consuming human milk and 2) different durations of human milk consumption among infants fed human milk are related to later risk of overweight or obesity, with emphasis on sibling-pair and intervention studies.

Methods: The 2020 Dietary Guidelines Advisory Committee, together with the Nutrition Evidence Systematic Review team, conducted a systematic review of articles relevant to healthy full-term infants in countries with a high or very high level of human development. We searched PubMed, Embase, Cochrane, and CINAHL; dual-screened the results using predetermined criteria; extracted data from and assessed the risk of bias for each included study; qualitatively synthesized the evidence; developed conclusion statements; and graded the strength of the evidence.

Results: The review included 42 articles, including 6 cohorts with sibling-pair analyses and 1 randomized controlled trial of a breastfeeding promotion intervention. Moderate evidence suggested that ever, compared with never, consuming human milk is associated with a lower risk of overweight and obesity at ages 2 y and older, particularly if the duration of human milk consumption is >6 mo. However, residual confounding cannot be ruled out. Evidence was insufficient to determine the relation between the duration of any human milk consumption, among infants fed human milk, and overweight and/or obesity at age 2 y and older.

Conclusions: Further research, using strong study designs, is needed to disentangle the complex relation between infant feeding practices and the risk of subsequent overweight or obesity, as well as the biological and behavioral mechanisms if the relation is causal.

Keywords: breastfeeding; child; human milk; infant; obesity; overweight; sibling; systematic review; toddler.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Systematic Review

MeSH terms

Adolescent
Adolescent Health
Adult
Breast Feeding*
Child
Child Development
Child, Preschool
Humans
Infant
Overweight / etiology*
Pediatric Obesity / etiology*

Grants and funding

P30 DK111022/DK/NIDDK NIH HHS/United States