Breastfeeding in Infancy Is Associated with Body Mass Index in Adolescence: A Retrospective Cohort Study Comparing American Indians/Alaska Natives and Non-Hispanic Whites

Abstract

Background American Indians and Alaska Natives (AI/ANs) have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI) is not well understood. Previous studies have investigated the association between breastfeeding in infancy and offspring BMI, but rarely included AI/ANs. Objective This study investigated the association between breastfeeding in infancy and BMI in AI/AN and non-Hispanic White (NHW) adolescents and young adults. Design Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994–2008). Participants Adolescent respondents who self-identified as AI/AN or NHW, reported their height and weight, and whose parents completed the parental questionnaire. The final sample included 655 AI/AN and 10,305 NHW respondents. Statistical analyses performed Generalized estimating equations were used to measure the mean differences, 95% confidence intervals, and p-values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables. Results The length of breastfeeding was inversely associated with BMI in both populations. AI/ANs that were breastfed 6 to 12 months or more than 12 months had an average BMI 2.69 (95% CI −3.46, −1.92; p<0.01) and 1.54 (95% CI −2.75, −0.33; p<0.05) units lower than those that were never breastfed. NHWs that breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI 0.71 (95% CI −0.93, −0.50; p<0.01), 0.68 (95% CI −0.87, −0.50; p<0.01), and 0.85 (95% CI −1.09, −0.62; p<0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (p<0.01). Conclusion Breastfeeding in infancy is associated with a lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in AI/ANs can prevent increasing BMI.

Grandmother and health care professional breastfeeding perspectives provide opportunities for health promotion in an American Indian community

“…Although a prevalent mode of infant feeding, consumption of formula contributes to acute and chronic illnesses not limited to gastrointestinal infection, asthma, childhood obesity, and diabetes mellitus type II (American Academy of Pediatrics (2012); US Department of Health and Human Services (HHS), 2011). Methods to increase the likelihood for breastfeeding in American Indian (AI) communities are needed as breastfeeding may be a key component to reducing high obesity rates (Zamora-Kapoor et al, 2017).…”

Caring for American Indian and Alaska Native Children and Adolescents

“…For example, in a retrospective cohort study, a lower BMI was reported among AI/AN adolescents breastfed for .6 months. 37 Breastfeeding promotion is needed in AI/AN tribal communities and would ideally be coordinated by tribal entities and would involve community members, elders, and health care providers, including paraprofessionals. 38,39…”