Medical Perspectives | Cardio-Metabolic, Others

February 20, 2020



Marie Angela M. Gochangco, M.D.

The World Health Organization (WHO) strongly advocates breastfeeding in infancy as a means to reduce childhood infections and to protect against adverse adult health outcomes.1 This article highlights the effects of breastfeeding and raises awareness on its positive impact to health, especially obesity which is a known global burden.

 

Breastfeeding: Why It Matters?

                                                

            Breastfeeding has been well established to have beneficial effects for mothers and babies. The WHO recommends exclusive breastfeeding for 6 months and continuation of breastfeeding for 2 years and beyond.1 Breast milk is an important source of energy, protein, and other nutrients.

           

            According to the National Health Service (NHS), breastfeeding provides long-term benefits for infants. It reduces infections, diarrhea and vomiting, sudden infant death syndrome, obesity, and cardiovascular diseases in childhood.2 The WHO and the American Pediatric Association (APA), states that the timing for introducing supplementary food to babies is 6 months. Exclusive breastfeeding up to 6 months is associated with decrease in early childhood weight and obesity3.

 

            The protective effect of breastfeeding against mortality and morbidity from respiratory infections has been widely studied. Direct breastfeeding offers the most favorable protection against asthma development in infants compared with formula feeding. Expressed breast milk facilitates intermediate protection.4

 

            The prevalence of obesity remains to be a public health issue. This can lead to cardiovascular diseases, hyperlipidemia, and diabetes mellitus. Substantial energy expenditure of 500 kilocalories per day is involved in breastfeeding and thus can help mobilize the weight gained by mothers during pregnancy.9

 

            Longer duration of breastfeeding (more than 12 months) was also associated with 35% reduction of breast and ovarian carcinoma than those with shorter duration of breastfeeding (less than 12 months) and those who never breastfed.5

 

Abdominal Obesity and Waist Circumference: How are they related?

 

            Obesity remains to be a complex health issue. Poor diet, family history, medication use, sedentary lifestyle, and lack of physical activity are risk factors. Obesity is a serious concern because it is associated with reduced quality of life and poorer health outcomes.

 

            The American Heart Association (AHA) defines abdominal obesity as having a waist circumference of ≥102cm for men and ≥88 cm for women. Measuring waist circumference is the most common and convenient method of assessing abdominal obesity.6

 

            Measurement of waist circumference is useful for recognizing individuals who have an increased risk for metabolic complications.7 Waist circumference is used as an indirect measure of visceral fat because it is strongly associated with the amount of visceral fat.

            Abdominal adiposity, which reflects the amount of visceral fat mass, has been known to increase chronic systemic inflammation and risk of metabolic disease. It has been shown to be associated with several diseases including cardiovascular diseases, type 2 diabetes, cancer, dementia, and depression. The amount of abdominal fat and not that of total body fat is the factor that triggers an increase in both chronic systemic inflammation and risk of metabolic disease.8

 

            Healthy diet, physical activity, and other positive lifestyle choices, which are preventive measures against morbidity and mortality, should be practiced to limit weight gain and obesity.

 

The Link between Breastfeeding and Abdominal Obesity

           

            This article primarily stresses the beneficial effect of breastfeeding with obesity. Previous studies have observed an inverse association between breastfeeding and maternal waist circumference (WC) in the years after pregnancy.

 

            In the Study of Women’s Health Across the Nation (SWAN) study, it was observed that among premenopausal or early perimenopausal mothers, those who never breastfed had 28% greater visceral adiposity, 4.7% greater waist-hip ratio, and 6.49 cm greater waist circumference than mothers who breastfed all of their children for ≥3 months9.

            It was revealed in the Pregnancy Outcomes and Community Health (POUCH) study that women who breastfed for more than 6 months had lower BMI, systolic and diastolic blood pressures, and smaller waist and hip circumference 7 to 15 years after delivery compared to those who breastfed for less than 6 months. Women with waist circumference of <88 cm had a mean average of 6.4 months of breastfeeding, compared to 3.9 months of breastfeeding for women with WC ≥88 cm.10

 

            The Women and Infant Study of Healthy Hearts (WISH) is a cross-sectional study that examined the correlation between lactation and maternal visceral adiposity among women after 7 years postpartum. Abdominal adiposity was assessed by computed tomography. Mothers who breastfed for 3 months or less had greater visceral fat deposits than mothers who breastfed more than 3 months after birth.11

            Breastfeeding for a longer duration has a protective effect on excess body weight in both mothers and their children two years after birth as observed in the Predictors of Maternal and Infant Excess Body Weight (PREDI) cohort study. The risk of having excess body weight in mother and child increases as breastfeeding duration decreases.

 

The Statistics

 

            Breastfeeding postpartum is a commonly observed practice in the Philippines. The latest data on Philippine National Demographic and Health Survey (NDHS) done by Philippine Statistics Authority (PSA) in 2017 revealed that the breastfeeding rates was 85% in infants under 6 months of age and 60% in children 12-23 months of age. These data are comparable with the NDHS done in 2013 which showed breastfeeding rates of 85% in infants less than 6 months of age and 51% in children 12-23 months of age.12

 

The Continuing Challenge

 

            Breastfeeding has a positive influence in promoting good health of both mother and baby. Therefore, breastfeeding practices should be continuously encouraged in all institutions through support and encouragement of mothers. Awareness and knowledge should also be fostered to grasp a better understanding of breastfeeding.

 

References:

1. Horta, B. et al. (2013). Long-term Effects of Breastfeeding. World Health Organization.Retrieved from https://apps.who.int/iris/bitstream/handle/10665/79198/9789241505307_eng.pdf;

sequence=1

 

2. Chowdury, R., et al. Breastfeeding and Maternal Health Outcomes: A Systematic Review and Meta-analysis. Acta Pediatrica. 2015.

3. Ardic, C., et al. Effects of Infant Feeding Practices and Maternal Characteristics on Early Childhood Obesity. Archives of Pediatrics and Adolescent Medicine. 2019.

 

4. Klopp, A., et al. Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study. Journal of Pediatrics. 2017.

 

5. Benefits of Breastfeeding. (2017). Retrieved March 1, 2019, from https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/.

 

6. Kim, D., et al. (January 3, 2019). Factors Affecting Obesity and Waist Circumference Among US Adults.Centers for Disease Control and Prevention.Retrieved from https://www.cdc.gov/pcd/issues...

 

7. Anuradha, R., et al. The Waist Circumference Measurement: A Simple Method for Assessing the Abdominal Obesity. Journal of Clinical and Diagnostic Research. 2012.

               

8. Wendell-Neergaard, A., et al. Low Fitness Is Associated with Abdominal Adiposity and Low-grade Inflammation Independent of BMI. PLOS One. 2018.

               

9. McClure, C., et al. Breastfeeding and Subsequent Maternal Visceral Adiposity. Obesity (Silver Spring). 2011.

 

10. Synder, G., et al. Breastfeeding Greater than 6 Months Is Associated with Smaller Maternal Weight Circumference Up to One Decade After Delivery. Journal of Women’s Health. 2018.

11. McClure C., et al. Maternal Visceral Adiposity by Consistency of Lactation. Maternal and Child Health Journal. 2012.

 

12. Philippines National Demographic and Health Survey 2017 Key Indicators Report. (2017). Retrieved March 1, 2019 from http://www.psa.gov.ph/sites/default/files/Philippines%20NDHS%20KIR.pd.

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