ASSOCIATION BETWEEN BREASTFEEDING AND OVERWEIGHT/OBESITY IN SCHOOLCHILDREN AGED 7-14 YEARS

Wagner, Katia Jakovljevic Pudla; Rossi, Camila Elizandra; Hinnig, Patrícia de Fragas; Alves, Mariane de Almeida; Retondario, Anabelle; Vasconcelos, Francisco de Assis Guedes de

doi:10.1590/1984-0462/2021/39/2020076

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Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 39 • 2021 • https://doi.org/10.1590/1984-0462/2021/39/2020076 copy

ASSOCIATION BETWEEN BREASTFEEDING AND OVERWEIGHT/OBESITY IN SCHOOLCHILDREN AGED 7-14 YEARS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years.

Methods:

This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (<Z score+1) and overweight/obesity (≥Z score+1). The adjusted analysis was performed by logistic regression in two age strata (age groups of 7-10 and 11-14 years).

Results:

6.6% of schoolchildren had never breastfed; 16.8% had been breastfed for ≤3 months; 16.7%, for 4-6 months; and 59.9%, for ≥7 months. No statistically significant differences were found in the occurrence and duration of BF between the age groups. The prevalence of overweight/obesity was 34.2%. For age groups (7-10 and 11-14 years), the prevalence of overweight/obesity was 36.7% and 29.8%, respectively. Chance of overweight/obesity for the age group of 7-10 years was lower among schoolchildren who were breastfed (OR=0.54; 95%CI 0.33-0.88), when compared with those who never breastfed. When categorized, the chance of overweight/obesity in the age group of 7-10 years was lower for duration of BF ≤3 months (OR=0.41; 95%CI 0.20-0.83), and 4-6 months (OR=0.48; 95%CI 0.28-0.82) when compared with children who never breastfed.

Conclusions:

BF for at least six months was associated with a lower chance of overweight/obesity for schoolchildren aged 7-10 years. No association was found for schoolchildren aged 11-14 years.

Keywords:
Breastfeeding; Obesity; Overweight; Child nutrition sciences; Adolescent

Characteristics	Total (n=2,506)		7-10 years (n=1,531; 61%)		11-14 years (n=975; 39%)		p-value*
Characteristics	n (%)	95%CI	n (%)	95%CI	n (%)	95%CI	p-value*
Student’s sex (2,506)
Male	1,090 (43.5)	40.4-46.6	687 (44.9)	40.9-49.0	404 (41.1)	36.7-45.7	0.188
Female	1,416 (56.5)	53.4-59.6	844 (55.1)	51.0-59.1	571 (58.9)	54.3-63.3	0.188
Per capita income (2,152)**
1^st tertile	676 (31.4)	26.5-36.8	404 (30.5)	24.7-36.9	273 (33.0)	27.8-38.8	0.669
2^nd tertile	740 (34.4)	28.1-41.2	466 (35.2)	27.7-43.5	273 (33.0)	27.2-39.2
3^rd tertile	736 (34.2)	25.5-44.2	454 (34.3)	23.5-47.2	282 (34.0)	27.3-41.4
Birth weight ≤2999 g (2,335)
Yes	670 (28.7)	26.4-31.1	423 (29.2)	26.2-32.3	247 (27.8)	24.3-31.7	0.573
No	1,665 (71.3)	68.9-73.6	1025 (70.8)	67.7-73.8	640 (72.2)	68.3-75.7	0.573
Gestational age <37 weeks (2,238)
Yes	461 (20.6)	18.6-22.8	254 (18.3)	16.1-20.8	209 (24.7)	21.2-28.5	0.004
No	1,777 (79.4)	77.2-81.4	1136 (81.6)	79.2-83.9	639 (75.3)	71.5-78.8	0.004
Type of school (2,506)
Public	1591 (63.5)	52.9-72.9	934 (61.0)	48.7-72.0	661 (67.8)	57.9-76.3	0.173
Private	915 (36.5)	27.1-47.1	597 (39.0)	28.0-51.3	314 (32.2)	23.7-42.1	0.173
Maternal breastfeeding (2,423)
No	160 (6.6)	5.1-8.4	102 (6.8)	4.9-9.4	58 (6.2)	4.1-9.1	0.728
Yes	2,263 (93.4)	91.6-94.9	1393 (93.2)	90.6-95.1	870 (93.8)	90.9-95.9	0.728
Breastfeeding duration (2,423)
Never breastfed	160 (6.6)	5.1-8.4	102 (6.8)	4.9-9.4	58 (6.2)	4.1-9.1	0.508
≤3 months	407 (16.8)	14.6-19.3	234 (15.7)	13.0-18.9	175 (18.9)	15.9-22.2
4 to 6 months	405 (16.7)	14.6-19.0	252 (16.9)	14.6-19.4	152 (16.4)	13.3-20.1
≥7 months	1,451 (59.9)	56.8-62.9	907 (60.6)	57.1-64.1	543 (58.5)	53.8-63.1
Nutritional status of schoolchildren (2,484)
Normal weight	1,634 (65.8)	63.5-68.1	963 (63.3)	59.9-66.5	675 (70.2)	65.9-74.1	0.024
Overweight/obesity	850 (34.2)	31.9-36.5	559 (36.7)	33.5-40.1	287 (29.8)	25.9-34.1	0.024
Sexual maturation (952)
Early	34 (3.6)	22.9-33.4	-	-	34 (3.6)	1.3-9.9	-
Normal	824 (86.6)	64.9-70.8	-	-	824 (86.6)	84.5-88.4
Late	94 (9.8)	1.9-9.2	-	-	94 (9.8)	6.4-14.8

Characteristics	Total (n=2,506)		7-10 years (n=1,531; 61%)		11-14 years (n=975; 39%)		p-value*
Characteristics	n (%)	95%CI	n (%)	95%CI	n (%)	95%CI	p-value*
Maternal age (2,325)
20-29 years	335 (14.4)	11.9-17.4	268 (18.7)	14.8-23.4	61 (6.9)	5.2-9.0	<0.001
30-39 years	1,153 (49.6)	46.6-52.6	729 (50.8)	47.4-54.2	424 (47.6)	41.7-53.5
≥40 years	837 (36.0)	32.0-40.1	438 (30.5)	26.4-34.8	405 (45.5)	39.3-52.0
Maternal schooling (2,389)
0-8 years	317 (24.6)	5.6-64.3	326 (22.1)	4.2-64.6	264 (29.0)	8.4-64.6	0.120
9-11 years	865 (36.2)	17.8-59.7	526 (35.6)	16.4-60.9	339 (37.2)	20.3-58.0
≥12 years	1,207 (39.3)	6.4-85.9	625 (42.3)	7.0-87.7	309 (33.8)	5.3-82.5
Maternal nutritional status (2,286)
Underweight/normal weight	1,344 (56.8)	52.4-61.0	829 (58.2)	53.2-63.1	467 (54.2)	49.2-59.1	0.198
Pre-obesity	640 (28.0)	24.8-31.5	397 (27.9)	24.0-32.0	244 (28.3)	24.2-32.9
Obesity	302 (15.2)	12.9-17.8	198 (13.9)	11.2-17.1	151 (17.5)	13.9-21.8

Characteristics	7-10 years (n=1,531)				11-14 years (n=975)
	Normal weight		Overweight/Obesity		Normal weight		Overweight/Obesity
	n (%)	95%CI	n (%)	95%CI	n (%)	95%CI	n (%)	95%CI
Student’s sex (2,506)
Male	414 (42.5)	34.2-51.1	269 (49.2)	45.7-52.7	261 (38.2)	27.9-49.6	133 (47.8)	38.4-57.4
Female	561 (57.5)	48.8-65.8	278 (50.8)	47.3-54.3	422 (61.9)	50.4-72.1	146 (52.2)	42.6-61.6
p-value*	0.054				0.027
Maternal age (2,325)
20-29 years	178 (19.5)	6.7-44.9	87 (16.9)	5.4-42.3	53 (8.6)	3.2-21.5	7 (2.6)	0.9-7.4
30-39 years	468 (51.2)	48.8-58.7	257 (50.1)	39.0-61.3	277 (44.7)	26.5-64.5	141 (54.2)	35.2-72.1
≥40 years	268 (29.3)	12.0-55.6	168 (32.9)	24.8-42.3	289 (46.6)	22.3-72.7	113 (43.1)	24.6-63.7
p-value*	0.404				0.008
Maternal schooling (2,389)
0-8 years	218 (23.2)	4.9-64.0	105 (19.8)	3.2-65.1	168 (26.6)	7.9-60.3	91 (33.8)	8.7-73.4
9-11 years	346 (36.9)	17.6-61.5	178 (33.6)	14.2-60.9	241 (38.1)	19.0-61.7	95 (35.5)	19.4-55.7
>12 years	374 (39.9)	6.4-86.6	247 (46.5)	8.1-89.6	224 (35.4)	5.6-83.4	82 (30.7)	4.5-80.7
p-value*	0.065				0.246
Maternal nutritional status (2,286)
Underweight/Normal weight	603 (66.5)	42.2-84.3	226 (44.5)	26.5-64.1	370 (61.8)	39.0-80.3	94 (37.1)	25.3-50.7
Pre-obesity	199 (21.9)	13.0-34.7	194 (38.1)	22.9-56.0	152 (25.4)	14.5-40.6	89 (35.2)	20.4-53.5
Obesity	105 (11.6)	3.6-31.6	88 (17.4)	13.7-21.9	77 (12.8)	3.9-34.7	71 (27.7)	12.4-50.8
p-value*	< 0.001				< 0.001
Per capita income (2,152)
1^st tertile	273 (32.7)	8.5-71.6	129 (26.8)	5.8-68.7	185 (32.2)	9.5-68.2	82 (33.6)	9.6-70.6
2^nd tertile	290 (34.7)	15.9-59.8	173 (36.0)	14.7-64.7	193 (33.6)	15.9-57.5	78 (31.9)	20.4-46.2
3^rd tertile	273 (32.7)	31.5-87.9	179 (37.2)	4.1-89.0	195 (34.2)	4.6-85.0	83 (34.5)	6.0-81.2
p-value*	0.127				0.921
Birth weight ≤2999g (2,335)
Yes	304 (33.1)	28.7-37.9	117 (22.5)	13.4-35.3	165 (26.7)	24.6-28.9	79 (30.8)	20.2-43.8
No	613 (66.9)	62.1-71.3	405 (77.5)	64.7-86.6	453 (73.3)	71.1-75.4	178 (69.3)	56.2-79.8
p-value*	0.004				0.336
Gestational age <37 weeks (2,238)
Yes	160 (18.1)	12.3-26.0	92 (18.4)	9.8-31.8	141 (24.3)	17.5-32.7	64 (25.2)	22.9-27.7
No	723 (81.9)	74.0-87.7	407 (81.6)	68.2-90.2	441 (75.7)	67.3-82.5	190 (74.8)	72.3-77.1
p-value*	0.942				0.813
Type of school (2,506)
Public	618 (63.4)	3.7-98.7	310 (56.7)	2.6-98.5	455 (66.6)	4.5-98.8	196 (70.4)	4.7-99.1
Private	357 (36.6)	12.7-96.3	237 (43.3)	1.5-97.4	228 (33.4)	1.2-95.5	83 (29.6)	0.9-95.3
p-value*	0.038				0.440
Maternal breastfeeding (2,423)
No	53 (5.6)	3.6-8.6	47 (8.8)	3.6-19.8	41 (6.4)	2.9-13.3	15 (5.7)	2.5-12.2
Yes	897 (94.4)	91.4-96.4	489 (91.3)	80.2-96.4	603 (93.6)	86.7-97.1	256 (94.3)	87.8-97.5
p-value*	0.058				0-678
Breastfeeding duration (2,423)
Never breastfed	53 (5.6)	3.6-8.6	47 (8.8)	3.6-19.8	41 (6.4)	2.9-13.3	15 (5.7)	2.5-12.2
≤3 months	161 (16.9)	10.6-25.7	74 (13.8)	10.0-18.7	120 (18.7)	11.8-28.3	54 (19.9)	13.1-29.0
4 to 6 months	174 (18.3)	14.7-22.6	78 (14.5)	11.7-17.8	105 (16.3)	14.4-14.8	45 (16.5)	10.7-24.7
≥7 months	388 (59.3)	55.7-62.7	337 (62.9)	53.2-71.7	378 (58.6)	55.5-61.7	157 (57.9)	44.5-70.2
p-value*	0.086				0.960
Sexual maturation (952)
Early	-	-	-	-	30 (4.4)	1.5.12.1	5 (1.8)	0.2-17.3
Normal	-	-	-	-	592 (87.7)	85.3-89.8	230 (83.9)	82.7-85.0
Late	-	-	-	-	53 (7.9)	4.7-12.4	39 (14.2)	9.7-20.5
p-value*	-				0.118

Characteristics**	Crude OR# (95%CI)	Adjusted OR#1 (95%CI)	Adjusted OR#2 (95%CI)
Maternal breastfeeding (1,486)
Yes	0.62 (0.36-1.02)	0.54 (0.33-0.88)	-
Breastfeeding duration (1,486)
≤3 months	0.52 (0.27-0.98)	-	0.41 (0.20-0.83)
4 to 6 months	0.51 (0.29-0.89)	-	0.48 (0.28-0.82)
≥7 months	0.68 (0.41-1.31)	-	0.61 (0.37-1.00)
Student’s sex (1,522)
Female	0.76 (0.58-1.00)	0.70 (0.49-0.99)	0.70 (0.49-0.97)
Maternal age (1,427)
30-39 years	1.13 (0.80-1.58)	0.88 (0.62-1.25)	0.87 (0.62-1.24)
≥40 years	1.29 (0.93-1.80)	1.02 (0.70-1.49)	1.00 (0.68-1.47)
Maternal schooling (1,468)
9-11 years	1.07 (0.74-1.53)	1.14 (0.74-1.73)	1.15 (0.75-1.76)
≥12 years	1.36 (0.94-1.99)	1.46 (0.86-2.48)	1.53 (0.88-2.67)
Maternal nutritional status (1,415)
Pre-obesity	2.59 (1.95-3.44)	2.93 (2.15-3.99)	2.98 (2.17-4.09)
Obesity	2.24 (1.37-3.67)	2.40 (1.36-4.25)	2.51 (1.46-4.32)
Birth weight ≤2999 g (1,439)
Yes	0.59 (0.42-0.82)	0.58 (0.41-0.84)	0.58 (0.42-0.85)
Gestational age <37 weeks (1,382)
Yes	1.02 (0.65-1.60)	-	-
Type of school (1,522)
Private	1.32 (1.02-1.71)	0.58 (0.41-0.84)	1.29 (0.89-1.25)

Characteristics**	Crude OR# (95%CI)	Adjusted OR#1 (95%CI)	Adjusted OR#2 (95%CI)
Maternal breastfeeding (915)
Yes	1.13 (0.61-2.09)	1.63 (0.70-3.78)	-
Breastfeeding duration (915)
≤3 months	1.20 (0.60-2.37)	-	1.85 (0.78-4.39)
4 to 6 months	1.14 (0.51-2.54)	-	1.67 (0.61-4.60)
≥7 months	1.11 (0.60-2.04)	-	1.54 (0.65-3.64)
Student’s sex (962)
Female	0.67 (0.48-0.94)	0.67 (0.47-0.95)	0.67 (0.47-0.96)
Maternal age (880)
30-39 years	3.91 (1.61-9.47)	3.13 (1.42-7.75)	3.26 (1.39-7.62)
≥40 years	2.98 (1.17-7.59)	2.61 (1.07-6.35)	2.63 (1.08-6.37)
Maternal schooling (901)
9-11 years	0.73 (0.40-1.34)	0.71 (0.39-1.28)	0.72 (0.40-1.29)
≥12 years	0.68 (0.36-1.29)	0.87 (0.42-1.80)	0.88 (0.42-1.84)
Maternal nutritional status (853)
Pre-obesity	2.31 (1.47-3.62)	2.09 (1.34-3.27)	2.12 (1.35-3.33)
Obesity	3.60 (2.05-6.31)	3.65 (2.01-6.63)	3.65 (2.00-6.62)
Birth weight ≤2999 g (875)
Yes	1.22 (0.82-1.80)	-	-
Gestational age <37 weeks (836)
Yes	1.05 (0.69-1.60)	-	-
Type of school (962)
Private	0.84 (0.53-1.33)	1.11 (0.68-1.80)	1.11 (0.69-1.79)
Sexual maturation (949)
Normal	2.28 (0.81-6.37)	2.07 (0.62-6.90)	2.11 (0.63-7.02)
Late	4.31 (1.48-12.54)	3.82 (1.6-12.54)	3.93 (1.21-12.80)

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[1] *Corresponding author. E-mail: katia.wagner@ufsc.br (K.J.P. Wagner).