Influence of breastfeeding in the first months of life on blood pressure levels of preschool children

Breastfeeding is associated with reduced risks of central obesity and hypertension in young school-aged children: a large, population-based study

BACKGROUND

Previous studies examined the effects of breastfeeding on measured values of body circumferences or blood pressure during childhood. However, limited data are available for the association between child feeding and a specific disease diagnosed as central obesity or hypertension. Hence, we aimed to examine whether the type and duration of breastfeeding are associated with obesity/central obesity or hypertension in young school-aged children.

METHODS

We matched the data obtained from a cross-sectional survey in 2019 with retrospective breastfeeding information recorded in the database. Heights, weights, waist circumferences, and blood pressures of 8480 children in first grade of primary schools in Shanghai, China were measured to diagnose obesity, central obesity, and hypertension. Data on child feeding was collected retrospectively from clinical records. Associations between the type/duration of breastfeeding and children's measured values of body mass index, waist circumference, and blood pressure were analysed by linear regression. Associations between the type/duration of breastfeeding and risks of obesity, central obesity, and hypertension were analysed by generalised linear models.

RESULTS

Breastfeeding duration was inversely associated with blood pressure values in children in the first grade. Each month's increase in the duration of any breastfeeding was associated with a 0.07 mmHg decrease in systolic blood pressure (P < 0.01) and a 0.05 mmHg decrease in diastolic blood pressure (P < 0.01). Any breastfeeding > one month was associated with a reduced risk of hypertension (adjusted risk ratio 0.84; 95% CI 0.73, 0.96, P = 0.01). Exclusive breastfeeding > one month was associated with a reduced risk of central obesity (adjusted risk ratio 0.76; 95% CI: 0.60, 0.96, P = 0.02). Any breastfeeding > 12 months was linked with a lower risk of hypertension (adjusted risk ratio 0.83; 95% CI 0.70, 0.98, P = 0.03).

CONCLUSIONS

Lack of breastfeeding is associated with higher risks of central obesity and hypertension during middle childhood. As a potential component of the public health strategy to reduce population levels of metabolic and cardiovascular diseases, breastfeeding could be a vital prevention strategy.

Breastfeeding Duration and High Blood Pressure in Children and Adolescents: Results from a Cross-Sectional Study of Seven Provinces in China

This study was aimed to investigate the associations between breastfeeding duration and blood pressure (BP) levels, BP Z scores and high BP (HBP) in children and adolescents. A total of 57,201 participants including 29,491 boys and 27,710 girls aged 7−18 years were recruited from seven provinces in China in 2012. HBP was defined as BP levels of ≥95th percentiles of the referent age-, sex-, and height-specific population. Breastfeeding duration was divided into non-breastfeeding, 0−5 months, 6−12 months, and >12 months. Information on demographic, parental or family factors and dietary behaviors was collected through a self-administered questionnaire. Multivariable linear regression and logistic regression models were applied to assess the relationships of breastfeeding duration with BP levels and BP Z scores and with HBP, respectively. Stratified analyses were performed to further investigate the potential subgroup-specific associations. The reported prolonged breastfeeding (>12 months) rate was 22.53% in the total population. After full adjustment, compared to the non-breastfeeding group, breastfeeding for 6−12 months was correlated with 0.43 (95% CI: −0.75, −0.11) and 0.36 (95% CI: −0.61, −0.12) mmHg lower levels of SBP and DBP, respectively. Similar decrease trends were found for BP Z scores. Prolonged breastfeeding (>12 months) was associated with 1.33 (95% CI: 1.12, 1.58) and 1.12 (95% CI: 0.94, 1.33) higher odds of HBP in boys and girls, respectively. Based on nationally representative data, there was no evidence that a longer duration of breastfeeding is protective against childhood HBP. Breastfeeding for 6−12 months may be beneficial to BP, while prolonged breastfeeding durations might increase the odds of HBP in children and adolescents.

Association of breastfeeding duration, birth weight, and current weight status with the risk of elevated blood pressure in preschoolers

BACKGROUND/OBJECTIVES

Few studies have examined the effects of the weight status at birth and preschool age on the risk of elevated blood pressure (EBP) in early childhood, and whether the effects can be modified by breastfeeding duration remains unclear. We aimed to evaluate the effects of high birth weight (HBW) with overweight/obese or abdominal obesity on the risk of EBP in preschoolers, and further evaluate the effects classified by breastfeeding duration (<6 and ≥6 months).

SUBJECTS/METHODS

This cross-sectional study was conducted in 2018 in Zhuhai, China. Out of 2390 3-4-year-old preschoolers originally recruited, a total of 1899 were included in the analysis. Logistic regression analysis was performed to examine the effects of the weight status at the two age points and breastfeeding duration on the risk of EBP.

RESULTS

Preschoolers with current overweight/obese had a 1.13-fold increased risk of EBP than those with persistent normal weight, irrespective of their birth weight. However, the preschoolers with HBW had no increased risk of EBP, when they became normal weight (OR 1.70, 0.78-3.72). Similar results were found for the current abdominal obesity and the risk of EBP. In addition, the EBP risk of obese status was minimized if preschoolers were breastfed for ≥6 months.

CONCLUSIONS

Obesity status at preschool age can increase the risk of EBP, irrespective of birth weight. However, this EBP risk can be mitigated if HBW changes to current normal weight. Longer breastfeeding duration can partially offset the risk of EBP in preschoolers with obesity status.

Prevalence and risk factors of childhood hypertension from birth through childhood: a retrospective cohort study

The prevalence of childhood hypertension is recognized as an important parameter of cardiovascular risk in adults. This retrospective study aimed to ascertain the prevalence and risk factors for hypertension from birth through childhood as of 2014. Stratified cluster sampling was used to select 17,007 participants (5971 with biochemical indexes available) aged 6-12 years on two avenues per region in urban, suburban, and rural areas. The prevalence of hypertension was 12.55%; children with obesity combined with rural residence, low family income, birth weight (<3000 g) (BWP₂₅) or >10 months of breastfeeding had a significantly elevated prevalence of hypertension (37.06%, 30.41%, 30.04%, and 30.84%, respectively). Obesity and heart rate were the significant anthropometric determinants; gestational hypertension, BWP25 and >10 months of breastfeeding were the significant perinatal determinants; rural residence was the significant socioeconomic determinant; fasting blood glucose, triglycerides, and low-density lipoprotein cholesterol were the significant serum biochemical determinants; and red blood cell counts and platelet counts were the significant haematological determinants of childhood hypertension. The adjusted R² values were 14.45% and 24.88% in the full models excluding and including serum indexes, respectively. We observed a notable prevalence of hypertension in a large paediatric sample. Obesity, high heart rate, BWP25, >10 months of breastfeeding, low family income, rural residence, abnormal lipid metabolism, and abnormal blood counts were associated with an increased risk of hypertension.

Prevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study

OBJECTIVE

The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China.

METHODS

Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6∼12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model.

RESULTS

The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R ² values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively.

CONCLUSIONS

The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension.

Breastfeeding in children born small for gestational age and future nutritional and metabolic outcomes: a systematic review

OBJECTIVE

To systematically review evidence related to nutritional and cardiometabolic outcomes in children born at term and small for gestational age and the association with breastfeeding.

SOURCE OF DATA

Two independent reviewers searched the MEDLINE, LILACS, SciELO, and Embase databases without time or language restrictions. The PRISMA tool was used, and studies that evaluated infants born at term and small for gestational age, breastfed, and with an evaluation of cardiometabolic outcomes were included. Studies with preterm infants, those that did not have information on breastfeeding, and those with lack of evaluation of the outcome variables were excluded. Also excluded were review articles, editorials, and series of cases.

SUMMARY OF DATA

Only seven articles were found that met the abovementioned criteria. There was a great variability in the type of evaluation, as well as in the age of these children. It was demonstrated that breastfeeding promoted growth without body composition alteration and without increased insulin resistance in children with exclusive breastfeeding, when compared to children receiving a higher calorie formula, except for one article that observed an increase in fat mass in exclusively breastfed children.

CONCLUSION

Breastfeeding seems to be a safe feeding practice for infants born at term and small for gestational age, showing no association with deleterious short-term outcomes. Breastfeeding stimulation in these populations seems to be a way of preventing the health problems associated with the high risk of chronic noncommunicable diseases and obesity.

Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy

OBJECTIVE

To describe and analyze indicators of feeding practices related to breastfeeding and factors associated with exclusive breastfeeding (EBF) in a subnormal urban cluster (slums) in Pernambuco, Brazil.

METHODS

Four breastfeeding indicators were used to interview mothers of children under 3 years of age. An inventory of the families' socioeconomic and environmental factors, maternal obstetric history, and basic health care access was undertaken. The sample consisted of all 310 children under the age of 3 years from Coelhos, PE, Brazil. Spearman's correlation was carried out, as well as crude and adjusted prevalence ratios for a final statistical model that showed associated factors with the main outcome at a level of 0.05.

RESULTS

The prevalence of breastfeeding in the first hour of life, exclusive breastfeeding up to 6 months, continued breastfeeding at 1 year, and continued breastfeeding at 2 years were 60.2%, 32.9%, 45.9, and 35.9%, respectively. A correlation was observed between start of pacifier use and duration of either exclusive (r_s=0.358 [p<0.001]) or non-exclusive breastfeeding (r_s=0.248 [p=0.006]). Maternal age over 35 years (p<0.001), home visit in the first week after birth (p=0.003), having had a male baby (p=0.029), and not using a pacifier (p<0.001) remained protective factors in the final model.

CONCLUSION

The prevalence rates of exclusive breastfeeding at 6 months were well above the results obtained by other Brazilian authors. Home visit and maternal age prevailed as protective factors, while pacifier use was shown to be a discouraging practice.

Systemic arterial hypertension, blood pressure levels and associated factors in schoolchildren

Summary Introduction: Hypertension is a major public health problem in contemporary times and it has high prevalence throughout the world. Objective: To investigate the situation of Systemic Arterial Hypertension in schoolchildren aged 6 to 10 years in Divinópolis/MG-Brazil and associated factors. Method: This is a cross-sectional, epidemiological, descriptive and analytical study, whose population was children aged 6 to 10 years enrolled in public schools in Divinópolis-MG-Brazil. Data collection was conducted from October 2014 to May 2015. Multivariate linear regressions were used to test associations between blood pressure, socioeconomic, anthropometric, dietary and physical activity. Results: The prevalence of hypertension was 15.2% in a sample of 284 children and mean values of systolic blood pressure of 101.7 (±13.2) mmHg and diastolic blood pressure of 66.0 (±11.2) mmHg. The body fat percentage showed significant differences between the genders, with 24.2 and 26.2%, respectively for boys and girls. Significant associations were made between blood pressure levels, body weight, body mass index, waist circumference, body fat percentage, consumption of yogurt, beef /chicken, beans, pizza, sandwich and some behaviors variables. Conclusion: The presented data show important aspects of school profile in the age range 6-10 years, especially related to the behavior of blood pressure.