Breastfeeding and Childhood Obesity: Shift of the Entire BMI Distribution or Only the Upper Parts?
Breastfeeding and Childhood Obesity: Shift of the Entire BMI Distribution or Only the Upper Parts?
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DOI：
10.1038/oby.2008.432
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发表时间：
2008-12-01
期刊：
影响因子：
6.9
通讯作者：
von Kries, Ruediger
中科院分区：
文献类型：
--
作者：
Beyerlein, Andreas;Toschke, Andre M.;von Kries, Ruediger
使用Logistic回归的Meta分析报告了母乳喂养对超重的保护作用(二元)，而使用线性回归和BMI(连续)的研究发现没有显著的关联。为了评估这些差异与不同结果分类的关系，我们在一个相当大的横截面数据集中比较了线性、Logistic和分位数回归模型的结果。德国南部巴伐利亚州在1999年和2002年入学考试期间收集了9368名学龄前儿童的身高、体重和问卷数据。我们计算了具有BMI、超重、肥胖和BMI分位数的多变量线性、逻辑和分位数回归模型(视情况而定)。模型考虑了母乳喂养(母乳喂养与非母乳喂养)、性别、年龄、孕期吸烟、看电视、母亲BMI、父母教育和婴儿早期体重增加的协变量。在线性回归模型中没有发现显著的相关性。在Logistic模型中，观察到肥胖与显著相关(优势比：0.72(95%可信区间0.55，0.94))。在分位数回归中，0.4-0.8的百分位数没有观察到显着的点估计。然而，母乳喂养使第90和第97百分位数的儿童BMI分别平均下降-0.23(95%CI-0.39，-0.07)和-0.26(95%CI-0.45，-0.07)kg/m(2)。相比之下，母乳喂养与BMI分位数为0.03和从0.1到0.3的较高BMI值的低转变显著相关。检测母乳喂养和儿童身体成分之间的关联可能与反应变量的编码(连续或二进制)和所使用的统计方法(线性、逻辑回归或分位数回归)有关。在这类研究中，还应使用分位数回归。
A protective effect of breastfeeding on overweight (binary) has been reported by meta-analyses using logistic regression, whereas studies using linear regression and BMI (continuous) detected no significant association. To assess the relationship of these differences with different outcome classification, we compared results for linear, logistic, and quantile regression models in a cross-sectional data set of considerable size. Height, weight, and questionnaire data on 9,368 preschool children were collected during school-entry examinations in 1999 and 2002 in Bavaria, Southern Germany. We calculated multivariable linear, logistic, and quantile regression models with outcomes BMI, overweight, obesity, and BMI quantiles (as appropriate). Models considered the covariates breastfeeding (breastfed vs. never breastfed), gender, age, smoking in pregnancy, TV watching, maternal BMI, parental education, and early infant weight gain. No significant association was found in the linear regression model. In the logistic model, a significant association was observed for obesity (odds ratio: 0.72 (95% confidence interval (CI) 0.55, 0.94)). In quantile regression no significant point estimates were observed for the percentiles of 0.4-0.8. However, breastfeeding reduced the BMI of children having values on the 90th and 97th percentiles by -0.23 (95% CI -0.39, -0.07) and -0.26 (95% CI -0.45, -0.07) kg/m(2), respectively, on average. In contrast, breastfeeding was significantly associated with a low shift toward higher BMI values for BMI quantiles of 0.03 and from 0.1 to 0.3. The detection of associations between breastfeeding and childhood body composition might be related to the coding of the response variable (continuous or binary) and the statistical method used (linear, logistic, or quantile regression). Quantile regression should additionally be applied in such studies.