Early determinants of childhood overweight and adiposity in a birth cohort study:: role of breast-feeding
Early determinants of childhood overweight and adiposity in a birth cohort study:: role of breast-feeding
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DOI：
10.1038/sj.ijo.802200
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发表时间：
2003-02-01
影响因子：
4.9
通讯作者：
Wahn, U
中科院分区：
文献类型：
--
作者：
Bergmann, KE;Bergmann, RL;Wahn, U
背景：儿童肥胖症的患病率正在增加。母乳喂养是否如横断面研究所示具有保护作用？目的：在一项纵向出生队列研究中，我们测试了母乳喂养超过2个月是否对6岁时超重和肥胖有预防作用。设计：在6个分娩单位的1314名儿童中，918名可随访至6岁。在定期访视时测量身高、体重和皮褶厚度。作为儿童超重、肥胖和肥胖的标准，使用BMI和皮肤褶皱值的第90和第97位数。父母的BMI等于或高于第90百分位数，即27 kg/m2或更高，被认为是超重。婴儿从出生起就用奶瓶喂养或母乳喂养不到3个月的被归类为“奶瓶喂养”（BO），母乳喂养3个月及以上的被归类为“母乳喂养”（BR）。应用SAS 6.12进行单变量比较和logistic回归分析。最终的logistic模型包括480例病例，所有变量的完整数据均可用。失访的潜在影响进行了分析的Cochran-Mantel-Haenzel测试：结果并没有显着影响失访follow-up.Results：在出生时BMI几乎是相同的，在两组。到3个月时，BO的BMI和皮肤褶皱明显高于BR。从6个月开始，与BR相比，BO儿童超过BMI和皮褶厚度参考值的第90和第97百分位数的比例始终较高。从4岁到5岁和6岁，BO的肥胖患病率分别增加了近一倍和两倍。由于BR中肥胖患病率的变化很小，组间BMI和皮褶厚度的差异具有统计学意义。Logistic回归分析显示，母亲超重、母亲孕期吸烟、母乳喂养和社会地位低下仍是6岁时超重和肥胖的重要危险因素。结论：母亲BMI ≥ 27、母乳喂养、母亲孕期吸烟和社会地位低下是6岁时超重和肥胖的危险因素。早期奶瓶喂养会导致肥胖反弹，预示着以后的肥胖。
BACKGROUND: The prevalence of adiposity in childhood is increasing. Is breast-feeding protective as suggested by cross-sectional studies?OBJECTIVE: In a longitudinal birth cohort study, we tested whether breast-feeding for more than 2 months has preventive effects against overweight and adiposity at 6y.DESIGN: Of 1314 children representing the catchment areas of six delivery units, 918 could be followed up to the age of 6y. Height, weight, and skin-fold thickness were measured at regular visits. As the criteria of overweight, obesity, and adiposity in the children, the 90th and the 97th percentiles of BMI and skin-fold values were used. Parents with a BMI at or above the 90th percentile, which was 27 kg/m(2) or more, were considered overweight. Infants bottle-fed from birth or breast-fed for less than 3 months were classified as 'bottle-fed' (BO), and those breast-fed for 3 months and more as 'breast-fed' (BR). Univariate comparisons and logistic regression analysis were performed applying SAS 6.12. The final logistic model consisted of the 480 cases for whom complete data for all variables were available. The potential effect of loss to follow-up was analysed by the Cochran-Mantel-Haenzel test: the outcomes were not significantly influenced by loss to follow-up.RESULTS: At birth BMIs were nearly identical in both groups. By 3 months, BO had significantly higher BMIs and thicker skin folds than BR. From 6 months on, compared to BR, a consistently higher proportion of BO children exceeded the 90th and the 97th percentile of BMI and skin-fold thickness reference values. From the age of 4y to 5 and 6y, in BO the prevalence of obesity nearly doubled and tripled, respectively. With only minor changes of obesity prevalence in BR, the difference of BMI and skin-fold thickness between groups became statistically significant. Logistic regression analysis revealed that overweight of the mother, maternal smoking during pregnancy, bottle feeding, and low social status remained important risk factors for overweight and adiposity at 6y of age.CONCLUSION: A maternal BMI of greater than or equal to27, bottle-feeding, maternal smoking during pregnancy, and low social status are risk factors for overweight and adiposity at 6y of age. Early bottle-feeding brings forward the obesity rebound, predictive of obesity in later life.