Pediatric Nutrition in Practice

74 Koletzko

Infant feeding has also been shown to have

lasting programming effects on later obesity risk.

We evaluated the potential long-term impact of

breastfeeding on later body weight in a large

cross-sectional sur vey of >9,000 children partici-

pating in the obligatory school health examina-

tion in Bavaria, Germany [9]. An assessment of

early feeding, diet and lifestyle factors revealed a

clearly higher prevalence of obesity in children

who had never been breastfed (4.5%) than in

breastfed children (2.8%), with an inverse dose-

response effect between the duration of breast-

feeding and the prevalence of later obesity. The

protective effect of breastfeeding was not attrib-

utable to differences in social class or lifestyle.

After adjusting for potential confounding fac-

tors, breastfeeding remained a significant protec-

tive factor against the development of obesity

(OR 0.75; 95% CI: 0.57–0.98) and overweight (OR

0.79; 95% CI: 0.68–0.93), with a dose-response

relation between breastfeeding duration and lat-

er risk of overweight and obesity, respectively

( fig. 3 ).

Environment

Lifestyle

Genes

Adiposity/diabetes

Fetal overnutrition

e.g. maternal obesity, high

pregnancy weight gain, diet in

pregnancy, gestational diabetes

Postnatal overnutrition

e.g. overfeeding, short breast-

feeding, excessive protein supply

Visceral adiposity

Metabolic syndrome

Insulin resistance

Hypertension, coronary

heart disease, stroke

Asthma

Fetal undernutrition and

postnatal overnutrition

e.g. maternal malnutrition,

placental dysfunction

Fuel-mediated

in utero hypothesis

Mismatch

hypothesis

Accelerated

postnatal

growth hypothesis

<2 3–5 6 –12 >12

0.75

0.50

0.25

1.00

0

Duration of breastfeeding (months)

Adjusted OR

Fig. 2. Key hypotheses on the early nutritional programming of adiposity, diabetes and associated

non-communicable diseases. Reproduced from Koletzko et al. [3] , with permission.

Fig. 3. Longer duration of breastfeeding is linked to a
lower adjusted OR of obesity at the early school age. Data
from a cross-sectional study on >9,000 children in Bavar-
ia, Germany. Reproduced from Koletzko et al. [3] , with
permission.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 72–77

DOI: 10.1159/000369235