Childhood Obesity and Formula Feeding —

When formula fattens more than the bottom line


The prevalence of child obesity is increasing rapidly worldwide. It is associated with several risk factors for later heart disease and other chronic diseases including hyperlipidaemia, hyperinsulinaemia , hypertension, and early atherosclerosis.

—Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. BMJ 320; 1240, 2000



Kwaavik E, Tell GS, Klepp K-I. Surveys of Norwegian youth indicated that breast feeding reduced subsequent risk of obesity. J of Clin Epidemiol 58; 849-855, 2005


There is evidence that breastfeeding protects against childhood obesity and this Norwegian study shows that the risk for obesity during adolescence and adulthood is also lowered. The researchers used data from the 1979-1981 Oslo Youth Study that included information on breastfeeding. By comparing those who had been breastfed for three months or longer to those who had never been breastfed, it was determined that breastfeeding had a protective effect against overweight and obesity. This effect was strongest during adolescence and with increasing age this effect was less strong.





Kalies H, Heinrich J, Borte N, Schaaf B, von Berg A, von Kries R, Wichmann HE, Bolte G; LISA Study Group. The effect of breastfeeding on weight gain in infants: results of a birth cohort study. Eur J Med Res.10; 36-42, 2005


What impact does the duration of exclusive breastfeeding have on elevated weight gain in infants during the first two years of life? To find the answer a prospective cohort study of 2624 healthy term German neonates were followed from birth to 2 years of age. Those exclusively breastfed for less than 6 months had a greater risk of elevated weight gain at the age of 2 years than children breastfed for 6 months and more (OR (95% CI): 1.65 (1.17, 2.30)). Duration of exclusive breastfeeding was inversely associated with the risk of elevated weight gain in a strongly duration-dependent way. Infants who were exclusively breastfed for only 1 month had twice the elevated weight gain (OR (95% CI): 1.99 (1.34, 2.97)) compared to infants breastfed for at least 6 months. The outcome demonstrates that exclusive breastfeeding protects against elevated weight gain during infancy and early childhood.





Bergmann KE, Bergmann RL, Von Kries R, Bohm O, Richter R, Dudenhausen JW, Wahn U. Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding. Int J Obes Relat Metab Disord. 27;162-172, 2003


In a longitudinal birth cohort study of 918 German children, the authors tested whether breast- feeding for more than 2 months has preventive effects against overweight at 6 years of age. Height, weight, and skin-fold  thickness were measured at regular visits. Infants bottle-fed from birth or breast-fed for less than 3 months were classified as ‘bottle-fed’, and those breast-fed for 3 months and more as ‘breast-fed’.

     At birth Body Mass Indexes (BMI) were nearly identical in both groups. By 3 months, those who had been bottle fed had significantly higher BMIs and thicker skin folds than those breastfed. From 6 months on, compared to breastfed, a consistently greater proportion of bottle fed children exceeded the 90th and the 97th percentile of BMI and skin-fold thickness reference values. From the age of 4 years to 5 and 6 years, the prevalence of obesity nearly doubled and tripled, respectively for those bottle fed. Whereas those who had been breastfed had only minor obesity prevalence. Logistic regression analysis also showed that overweight of the mother, maternal smoking during pregnancy, bottle feeding, and low social status remained important risk factors for overweight and adiposity at 6 years of age. The authors concluded that "Early bottle-feeding brings forward the obesity rebound, predictive of obesity in later life."





Burke V, Beilin LJ, Simmer K, Oddy WH, Blake KV, Doherty D, Kendall GE, Newnham JP, Landau LI, Stanley FJ. Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort. J Pediatr. 147; 56-61, 2005


Longitudinal analysis in an Australian birth cohort determined that breastfeeding for less than 4 months was associated with the greatest risk of overweight. Repeated  surveys were done from 16 weeks gestation to 8 years in a cohort (N = 2087) recruited through antenatal clinics. At 1 year, infants breastfed for more than 12 months were the leanest group. From 1 to 8 years, children breastfed less than 4 months had the greatest risk of overweight and the highest prevalence of maternal obesity, smoking, and lower education.





Gillman MW, Rifas-  himan SL, Camargo CA Jr, Berkey CS, Frazier AL, Rockett HR, Field AE, Colditz GA. Risk of overweight among adolescents who were breastfed as infants. JAMA. 285; 2461-2467, 2001


"Can breastfeeding lower the risk of subsequent obesity in adolescence?" this US survey asks. To examine the extent to which overweight status among adolescents is associated with the type of infant feeding and duration of breastfeeding the authors surveyed 8186 girls and 7155 boys, aged 9 to 14 years. In the first 6 months of life, 62% were only or mostly fed breastmilk, and 31% were only or mostly fed infant formula. At ages 9 to 14, the subjects who had been only or mostly fed breast milk, compared with those only or mostly fed formula, were 22 per cent less likely to become overweight as adolescents. The authors reported a dose dependent effect – those who had been breastfed for at least 7 months had a lower risk than those who reported breastfeeding for three months or less. Timing of introduction of solid foods, infant formula, or cow’s milk was not related to risk of being overweight. They concluded that "infants who were fed breast milk more than infant formula, or who were breastfed for longer periods, had a lower risk of being overweight during older childhood and adolescence."





Bogen DL, Hanusa BH, Whitaker RC. The effect of breastfeeding with and without formula use on the risk of obesity at 4 years of age. Obes Res. 12; 1527-1535, 2004


What minimal duration of breast-feeding is required to protect against later obesity? Will concurrent use of formula (mixed feeding) lessen any protective effect of breastfeeding? were some of the questions asked by these US researchers.


     To find the answers they surveyed retrospectively a cohort of 73,458 white and black low-income children from birth through to 4 years of age. They found that at age 4 years, the prevalence of obesity was 11.5%. Only 16% of children were breastfed 8 weeks or longer. Breastfeeding was associated with a reduced risk of obesity only in white children whose mothers had not smoked in pregnancy. In this subgroup, the reduction in obesity risk (adjusted odds ratio, 95% confidence interval), compared with those never breastfed, occurred only for children who were breastfed at least 16 weeks without  formula (0.71, 0.56 to 0.92) or at least 26 weeks with concurrent formula (0.70, 0.61 to 0.81). Among whites whose mothers smoked in pregnancy and among blacks, breast-feeding was not associated with a reduced risk of obesity at age 4 years. In conclusion they determined that  "in a population of low-income children, breast-feeding was associated with a reduced risk of obesity at age 4 years only among whites whose mothers did not smoke in pregnancy and only when breast-feeding continued for at least 16 weeks without formula or at least 26 weeks with formula." 



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