Effects of Promoting Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like Growth Factor-I at Age 11.5 Years A Randomized Trial
Effects of Promoting Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like Growth Factor-I at Age 11.5 Years A Randomized Trial
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DOI：
10.1001/jama.2013.167
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发表时间：
2013-03-13
影响因子：
120.7
通讯作者：
Oken, Emily
中科院分区：
文献类型：
--
作者：
Martin, Richard M.;Patel, Rita;Oken, Emily
重要性长期和纯母乳喂养可降低儿童肥胖风险的证据是基于观察性研究，这些研究易于混淆。目的探讨干预措施对促进母乳喂养持续时间和排他性增加儿童肥胖和调节生长的循环胰岛素样生长因子（IGF）-I的影响。设计，设置，参与者在31家Be-larusian妇产医院及其附属诊所进行的随机对照试验，随机分为2组：母乳喂养促进干预组（n=16）或常规做法组（n=15）。研究对象为1996年和1997年登记的17046对母乳喂养的母婴，其中13 879人2008年1月至2010年12月期间，81.4%的患者接受了随访，中位年龄为11.5岁。（世界卫生组织/联合国儿童基金会）。主要结果测量身体质量指数（BMI）、脂肪和无脂肪质量指数（FMI和FFMI）、身体脂肪百分比、腰围、三头肌和肩胛下皮褶厚度、超重和肥胖以及全血IGF-I。主要分析是基于修改后的意向治疗（无插补），占集群内的医院和clinics.Results实验干预大大增加母乳喂养的持续时间和排他性相比，与对照组（43%与6%纯母乳喂养3个月和7.9%与0.6%，6个月）。在11.5岁时，实验组与对照组之间的结果经医生校正的平均差异为：0.19 BMI（95% CI，-0.09至0.46）; 0.12（-0.03至0.28）对于FMI; 0.04 FFMI（-0.11至0.18）; 0.47%（-0.11%至1.05%）体脂百分比; 0.30 cm腰围为-0.07 mm（-1.71至1.57），肩胛下皮褶厚度为-0.02 mm（-0.79至0.75）; IGF-I为-0.02标准差（-0.12至0.08）。超重/肥胖的聚类调整比值比（BMI >= 85 vs = 95 vs
Importance Evidence that longer-term and exclusive breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding.Objective To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I, which regulates growth.Design, Setting, and Participants Cluster-randomized controlled trial in 31 Be-larusian maternity hospitals and their affiliated clinics, randomized into 1 of 2 groups: breastfeeding promotion intervention (n=16) or usual practices (n=15). Participants were 17 046 breastfeeding mother-infant pairs enrolled in 1996 and 1997, of whom 13 879 (81.4%) were followed up between January 2008 and December 2010 at a median age of 11.5 years.Intervention Breastfeeding promotion intervention modeled on the WHO/UNICEF Baby-Friendly Hospital Initiative (World Health Organization/United Nations Children's Fund).Main Outcome Measures Body mass index (BMI), fat and fat-free mass indices (FMI and FFMI), percent body fat, waist circumference, triceps and subscapular skinfold thicknesses, overweight and obesity, and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat (without imputation), accounting for clustering within hospitals and clinics.Results The experimental intervention substantially increased breastfeeding duration and exclusivity when compared with the control (43% vs 6% exclusively breast-fed at 3 months and 7.9% vs 0.6% at 6 months). Cluster-adjusted mean differences in outcomes at 11.5 years of age between experimental vs control groups were: 0.19 (95% CI, -0.09 to 0.46) for BMI; 0.12 (-0.03 to 0.28) for FMI; 0.04 (-0.11 to 0.18) for FFMI; 0.47% (-0.11% to 1.05%) for percent body fat; 0.30 cm (-1.41 to 2.01) for waist circumference; -0.07 mm (-1.71 to 1.57) for triceps and -0.02 mm (-0.79 to 0.75) for subscapular skinfold thicknesses; and -0.02 standard deviations (-0.12 to 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight/obesity (BMI >= 85th vs = 95th vs