Breastfeeding during infancy and the risk of cardiovascular disease in adulthood.
Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hu FB, Michels KB, Willett WC.
Department of Ambulatory Care and Prevention, HarvardMedicalSchool and Harvard Pilgrim Health Care, Boston, Massachusetts02215, USA.
BACKGROUND: Numerous studies have reported associations between the type of feeding during infancy and subsequent cardiovascular risk factors. Only 2 studies have evaluated the relation between having been breastfed and the risk of adult cardiovascular events. METHODS: We examined this association among 87,252 female participants of the longitudinal Nurses' Health Study. Participants (all born between 1921 and 1946) reported in 1992 whether and for how long they were breastfed. During 8 years of follow up, there were 1099 cases of coronary heart disease and 940 strokes among women who knew whether they had been breastfed. We used proportional hazards models to estimate hazard ratios for cardiovascular events, adjusting for changing adult risk factors. RESULTS: Compared with women who were never breastfed, women who were breastfed had hazard ratios of 0.92 (95% confidence interval = 0.80-1.05) for coronary heart disease and 0.91 (0.79-1.06) for stroke, after adjustment for age, birthweight, and smoking. When body mass index was also included in the model, the results were similar. Looking within subgroups of stroke, hazard ratios were 0.86 (0.70-1.07) for ischemic stroke and 1.01 (0.70-1.46) for hemorrhagic stroke. Comparing women who were breastfed at least 9 months with those who were not breastfed, the hazard ratios were 0.84 (0.69-1.03) for coronary heart disease and 1.00 (0.81-1.23) for stroke. Breastfeeding history was not associated with high blood pressure in adulthood. CONCLUSIONS: These data suggest, but cannot establish, that breastfeeding in infancy may be associated with a small reduction in risk of ischemic cardiovascular disease in adulthood.
European Journal of Clinical Nutrition advance online publication 20February2008; doi: 10.1038/ejcn.2008.17
Breast feeding in infancy and arterial endothelial function later in life. The Cardiovascular Risk in Young Finns Study
M JJärvisalo1,2,3, NHutri-Kähönen4, MJuonala2,3, VMikkilä5, LRäsänen5, TLehtimäki6, JViikari2 and O TRaitakari1
- 1Department of Clinical Physiology, University of Turku, Turku, Finland
- 2Department of Medicine, University of Turku, Turku, Finland
- 3Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- 4Department of Pediatrics, TampereUniversityHospital and the MedicalSchool, Tampere, Finland
- 5Division of Nutrition, University of Helsinki, Helsinki, Finland
- 6Department of Clinical Chemistry, TampereUniversityHospital and the MedicalSchool, Tampere, Finland
Correspondence: Professor OT Raitakari, Department of Clinical Physiology, TurkuUniversityHospital, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland. E-mail:
Received 18December2007; Accepted 20January2008; Published online 20February2008.
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Abstract
Background/Objectives:
Breast feeding in infancy may be associated with reduced cardiovascular morbidity in adulthood. We examined the association between breast feeding in infancy and arterial function and structure in adulthood in a population-based cohort of Finnish adults.
Subjects/Methods:
Noninvasive ultrasound was used to measure brachial artery flow-mediated dilatation (FMD), carotid artery intima-media thickness (IMT) and carotid artery compliance (CAC) in 1667 young adults participating in the Cardiovascular Risk in Young Finns Study with data on early nutrition.
Results:
Maximal FMD was higher in breast-fed men compared to formula-fed men (7.24.0 vs 5.93.4%, P=0.029) while no differences were seen between breast-fed and formula-fed women (8.94.5 vs 8.85.0%, P=0.84). In men, the multivariable correlates of FMD included the group variable for breast feeding (P=0.014), birth weight (P=0.043), waist circumference (P<0.001) and baseline brachial artery diameter (P<0.001). In women, the multivariable correlates of FMD were birth weight (P=0.02), waist circumference (P<0.001) and brachial artery baseline diameter (P<0.001). Breast feeding was not significantly associated with IMT or CAC in multivariable models.
Conclusions:
Adult men who have been breast fed have better brachial endothelial function compared to men who have been formula fed.
Keywords:
arteries, atherosclerosis, breast feeding, risk factors, ultrasound
Abstract 3498: The Association of Breastfeeding in Infancy and Adult Cardiovascular Disease Risk Factors: The Framingham Third Generation Cohort
Nisha I Parikh1; Shih-Jen Hwang2; Erik Ingelsson3; Emelia J Benjamin4; Caroline S Fox5; Ramachandran S Vasan6; Joanne M Murabito7
1 Framingham Heart Study, Framingham, MA
2 NHLBI and Framingham Heart Study, Framingham, MA
3 Framingham Heart Study, Framingham, MA
4 Boston Univ Sch of Medicine, Framingham Heart Study, Framingham, MA
5 NHLBI and Framingham Heart Study, Framingham, MA
6 Boston Univ Sch of Medicine and Framingham Heart Study, Framingham, MA
7 Framingham Heart Study, Framingham, MA
Background: Public health recommendations advocate breastfeedingin infancy as a means to reducing later-life obesity. Howevermany prior studies relating breastfeeding to cardiovascular(CVD) risk factors have been limited by lack of adjustment formaternal and participant confounding factors.
Methods: In 962 Framingham Third Generation participants (meanage = 41 yrs, 54% women) we related history of breastfeeding(yes vs. no) and CVD risk factors in young-mid adulthood. Breastfeedingdata was ascertained via questionnaire from mothers enrolledin the Framingham Offspring Study. Dependent variables werebody mass index (BMI), HDL-cholesterol (HDL-c), total cholesterol,triglycerides, fasting blood glucose, C-reactive protein (CRP),systolic (SBP) and diastolic blood pressure (DBP). Covariatesfor multivariable adjustment were age, sex, hypertension medications,lipid treatment, smoking, birth order, oral contraceptives,hormone replacement, physical activity, education, maternalsmoking, maternal education, and maternal BMI. Low HDL was definedas < 50 mg/dL (women) and < 40 mg/dL(men). Adiposity categorieswere defined by BMI normal [< 25], overweight [ 25 to <30] and obese [ 30 kg/m2]. Generalized estimating equations(GEE) were used to account for sibling correlations.
Results: Overall 26% of participants were reported by theirmother to have been breastfed. Compared to non-breastfed individuals,breastfed offspring had lower adult BMI [adjusted mean 26.1kg/m2 vs. 26.9 kg/m2, p = 0.04) and higher adult HDL-c levels[adjusted mean HDL 56.6 mg/dL relative to 53.7 mg/dL p = 0.01]in multivariable-adjusted models. Breastfeeding was not associatedwith other examined adult CVD risk factors. Upon adjustmentfor BMI the association between breastfeeding and HDL was attenuated(p = 0.09). Breastfeeding was associated with high versus lowHDL (multivariable-adjusted OR = 1.55, p = 0.04) but not withoverweight or obesity versus normal weight (p = 0.26, 0.13 respectively).
Conclusions: Breastfeeding in infancy is inversely associatedwith adult BMI and positively associated with HDL-c. Associationsbetween breastfeeding and BMI appear to mediate most of theassociation with HDL-c.