Caesarean delivery is associated with an absolute increase in the prevalence of overweight in the offspring: The SENDO project

Breastfeeding Is Associated with Higher Adherence to the Mediterranean Diet in a Spanish Population of Preschoolers: The SENDO Project

OBJECTIVE

To assess whether breastfeeding during the first months of life is associated with adherence to the Mediterranean dietary (MedDiet) pattern in preschool children.

DESIGN

The Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project is an ongoing pediatric cohort with open recruitment, started in 2015 in Spain. Participants, recruited when they are 4 to 5 years old at their primary local health center or school, are followed annually through online questionnaires. For this study, 941 SENDO participants with full data on study variables were included. Breastfeeding history was collected retrospectively at baseline. Adherence to the Mediterranean diet was assessed with the KIDMED index (range -3 to 12).

RESULTS

After accounting for multiple sociodemographic and lifestyle confounders, including parental attitudes and knowledge about dietary recommendations for children, breastfeeding was independently associated with a higher adherence to the MedDiet. Compared with children who were never breastfed, children breastfed for ≥6 months had a one-point increase on their mean KIDMED score (Mean difference +0.93, 95%confidence interval [CI]. 0.52-1.34, p for trend <0.001). The odds ratio of high adherence to the MedDiet (KIDMED index ≥8) was 2.94 (95%CI 1.50-5.36) in children who were breastfed for at least 6 months, as compared to their peers who were never breastfeed. Children who were breastfed for less than 6 months exhibited intermediate levels of adherence (p for trend <0.01).

CONCLUSION

Breastfeeding for 6 months or longer is associated with a higher adherence to the Mediterranean diet during the preschool years.

Cesarean delivery and insulin sensitivity in the older adult: The Microbiome and Insulin Longitudinal Evaluation Study

The present study was designed to evaluate if mode of delivery at birth is associated with body mass index (BMI) and glucose homeostasis traits in later life, controlling for possible confounders, including maternal history of diabetes. Data were obtained through a racially diverse, prospective cohort study of nondiabetic, older adults, the Microbiome and Insulin Longitudinal Evaluation Study (MILES). We used generalized linear models to estimate the association between mode of delivery and glycemic status, BMI (kg/m²), waist circumference (cm), fasting glucose, fasting insulin, insulin secretion, insulin sensitivity, and insulin clearance. Further, we estimated the direct and indirect effects of cesarean delivery on glucose and insulin-related traits, as mediated by BMI status. Relative to vaginal delivery, cesarean delivery was associated with a significantly higher BMI (adjusted beta [aβ] 3.53 kg/m²; 95% CI 0.15, 6.91) and fasting glucose (aβ 5.12; 95% CI 0.01, 10.23), a 14% decrease in insulin sensitivity (aβ –0.14; 95% CI –0.28, –0.01), and a 58% increased risk (adjusted relative risk [aRR] 1.58; 95% CI 1.08, 2.31) for prediabetes/diabetes. Associations were mediated in part by BMI, with the strongest evidence observed for glycemic status (proportion mediated 22.6%; P = .03), fasting insulin (proportion mediated 58.0%; P = .05), and insulin sensitivity index (proportion mediated 45.9%; P = .05). Independent of mediation, a significant direct effect of cesarean delivery on glycemic status was observed (aRR 1.88; 95% CI 1.16, 2.60). Cesarean delivery may lead to reduced insulin sensitivity and, ultimately, increased risk for developing prediabetes and diabetes.