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Original Investigation
May 1, 2017

Effects of Promoting Long-term, Exclusive Breastfeeding on Adolescent Adiposity, Blood Pressure, and Growth TrajectoriesA Secondary Analysis of a Randomized Clinical Trial

Author Affiliations
  • 1School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
  • 2University Hospitals Bristol National Health Services Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, United Kingdom
  • 3Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
  • 4Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
  • 5Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
  • 6National Research and Applied Medicine Mother and Child Centre, Minsk, Republic of Belarus
JAMA Pediatr. Published online May 1, 2017. doi:10.1001/jamapediatrics.2017.0698
Key Points

Question  What is the effect of a randomized intervention that increased breastfeeding duration and exclusivity on growth, adiposity, and blood pressure at age 16 years?

Findings  This secondary analysis of a randomized clinical trial showed that mean body mass index was higher in the intervention vs control groups, with no differences in mean systolic or diastolic blood pressures.

Meaning  A randomized intervention that increased breastfeeding intensity was not associated with reduced obesity or lower blood pressure levels at age 16 years.

Abstract

Importance  Evidence that breastfeeding reduces child obesity risk and lowers blood pressure (BP) is based on potentially confounded observational studies.

Objective  To investigate the effects of a breastfeeding promotion intervention on adiposity and BP at age 16 years and on longitudinal growth trajectories from birth.

Design, Setting, and Participants  Cluster-randomized Promotion of Breastfeeding Intervention Trial. Belarusian maternity hospitals and affiliated polyclinics (the clusters) were allocated into intervention (n = 16) or control arms (n = 15) in 1996 and 1997. The trial participants were 17 046 breastfeeding mother-infant pairs; of these, 13 557 children (79.5%) were followed up at 16 years of age between September 2012 and July 2015.

Interventions  Breastfeeding promotion, modeled on the Baby-Friendly Hospital Initiative.

Main Outcomes and Measures  Body mass index (BMI, calculated as weight in kilograms divided by height in meters squared); fat and fat-free mass indices and percentage of body fat from bioimpedance; waist circumference; overweight and obesity; height; BP; and longitudinal growth trajectories. The primary analysis was modified intention-to-treat (without imputation for losses to follow-up) accounting for within-clinic clustering.

Results  We examined 13 557 children at a median age of 16.2 years (48.5% were girls). The intervention substantially increased breastfeeding duration and exclusivity compared with the control arm (exclusively breastfed: 45% vs 6% at 3 months, respectively). Mean differences at 16 years between intervention and control groups were 0.21 (95% CI, 0.06-0.36) for BMI; 0.21 kg/m2 (95% CI, −0.03 to 0.44) for fat mass index; 0.00 kg/m2 (95% CI, −0.21 to 0.22) for fat-free mass index; 0.71% (95% CI, −0.32 to 1.74) for percentage body fat; −0.73 cm (−2.48 to 1.02) for waist circumference; 0.05 cm (95% CI, −0.85 to 0.94) for height; −0.54 mm Hg (95% CI, −2.40 to 1.31) for systolic BP; and 0.71 mm Hg (95% CI, −0.68 to 2.10) for diastolic BP. The odds ratio for overweight/obesity (BMI ≥85th percentile vs <85th percentile) was 1.14 (95% CI, 1.02-1.28) and the odds ratio for obesity (BMI ≥95th percentile vs <95th percentile) was 1.09 (95% CI, 0.92-1.29). The intervention resulted in a more rapid rate of gain in postinfancy height (1 to 2.8 years), weight (2.8 to 14.5 years), and BMI (2.8 to 8.5 years) compared with the control arm. The intervention had little effect on BMI z score changes after 8.5 years.

Conclusions and Relevance  A randomized intervention that increased the duration and exclusivity of breastfeeding was not associated with lowered adolescent obesity risk or BP. On the contrary, the prevalence of overweight/obesity was higher in the intervention arm. All mothers initiated breastfeeding, so findings may not apply to comparisons of the effects of breastfeeding vs formula feeding.

Trial Registration  isrctn.org: ISRCTN37687716; and clinicaltrials.gov: NCT01561612.

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