Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Breast-feeding and childhood obesity—a systematic review

Abstract

OBJECTIVE: To investigate the relationship between breast-feeding and obesity in childhood.

DESIGN: Systematic review and meta-analysis of published epidemiological studies (cohort, case–control or cross-sectional studies) comparing early feeding-mode and adjusting for potential confounding factors. Electronic databases were searched and reference lists of relevant articles were checked. Calculations of pooled estimates were conducted in fixed- and random-effects models. Heterogeneity was tested by Q-test. Publication bias was assessed from funnel plots and by a linear regression method.

OUTCOME MEASURES: Odds ratio (OR) for obesity in childhood defined as body mass index (BMI) percentiles.

RESULTS: Nine studies with more than 69 000 participants met the inclusion criteria. The meta-analysis showed that breast-feeding reduced the risk of obesity in childhood significantly. The adjusted odds ratio was 0.78, 95% CI (0.71, 0.85) in the fixed model. The assumption of homogeneity of results of the included studies could not be refuted (Q-test for heterogeneity, P>0.3), stratified analyses showed no differences regarding different study types, age groups, definition of breast-feeding or obesity and number of confounding factors adjusted for. A dose-dependent effect of breast-feeding duration on the prevalence of obesity was reported in four studies. Funnel plot regression gave no indication of publication bias.

CONCLUSION: Breast-feeding seems to have a small but consistent protective effect against obesity in children.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Kramer MS . Do breast-feeding and delayed introduction of solid foods protect against subsequent obesity? J Pediatr 1981; 98: 883–887.

    Article  CAS  Google Scholar 

  2. Armstrong J, Reilly JJ . Breastfeeding and lowering the risk of childhood obesity. Lancet 2002; 359: 2003–2004.

    Article  Google Scholar 

  3. Bergmann KE, Bergmann RL, Von Kries R, Bohm O, Richter R, Dudenhausen JW, Wahn U . Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding. Int J Obes Relat Metab Disord 2003; 27: 162–172.

    Article  CAS  Google Scholar 

  4. Gillman MW, Rifas-Shiman SL, Camargo Jr CA, Berkey CS, Frazier AL, Rockett HR, Field AE, Colditz GA . Risk of overweight among adolescents who were breastfed as infants. JAMA 2001; 285: 2461–2467.

    Article  CAS  Google Scholar 

  5. Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ . Association between infant breastfeeding and overweight in young children. JAMA 2001; 285: 2453–2460.

    Article  CAS  Google Scholar 

  6. Liese AD, Hirsch T, von Mutius E, Keil U, Leupold W, Weiland SK . Inverse association of overweight and breast feeding in 9 to 10-y-old children in Germany. Int J Obes Relat Metab Disord 2001; 25: 1644–1650.

    Article  CAS  Google Scholar 

  7. Poulton R, Williams S . Breastfeeding and risk of overweight. JAMA 2001; 286: 1449–1450.

    CAS  PubMed  Google Scholar 

  8. Toschke AM, Vignerova J, Lhotska L, Osancova K, Koletzko B, Von Kries R . Overweight and obesity in 6- to 14-year-old Czech children in 1991: protective effect of breast-feeding. J Pediatr 2002; 141: 764–769.

    Article  Google Scholar 

  9. von Kries R, Koletzko B, Sauerwald T, von Mutius E, Barnert D, Grunert V, von Voss H . Breast feeding and obesity: cross sectional study. BMJ 1999; 319: 147–150.

    Article  CAS  Google Scholar 

  10. Li L, Parsons TJ, Power C . Breast feeding and obesity in childhood: cross sectional study. BMJ 2003; 327: 904–905.

    Article  CAS  Google Scholar 

  11. Victora CG, Barros F, Lima RC, Horta BL, Wells J . Anthropometry and body composition of 18 year old men according to duration of breast feeding: birth cohort study from Brazil. BMJ 2003; 327: 901.

    Article  Google Scholar 

  12. Dewey KG . Is breastfeeding protective against child obesity? J Hum Lact 2003; 19: 9–18.

    Article  Google Scholar 

  13. Egger M, Schneider M, Davey Smith G . Spurious precision? Meta-analysis of observational studies. BMJ 1998; 316: 140–144.

    Article  CAS  Google Scholar 

  14. Liberatos P, Link BG, Kelsey JL . The measurement of social class in epidemiology. Epidemiol Rev 1988; 10: 87–121.

    Article  CAS  Google Scholar 

  15. Normand SL . Meta-analysis: formulating, evaluating, combining, and reporting. Stat Med 1999; 18: 321–359.

    Article  CAS  Google Scholar 

  16. DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–188.

    Article  CAS  Google Scholar 

  17. Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

    Article  CAS  Google Scholar 

  18. O'Callaghan MJ, Williams GM, Andersen MJ, Bor W, Najman JM . Prediction of obesity in children at 5 years: a cohort study. J Paediatr Child Health 1997; 33: 311–316.

    Article  CAS  Google Scholar 

  19. Agras WS, Kraemer HC, Berkowitz RI, Hammer LD . Influence of early feeding style on adiposity at 6 years of age. J Pediatr 1990; 116: 805–809.

    Article  CAS  Google Scholar 

  20. Agras WS, Kraemer HC, Berkowitz RI, Korner AF, Hammer LD . Does a vigorous feeding style influence early development of adiposity? J Pediatr 1987; 110: 799–804.

    Article  CAS  Google Scholar 

  21. Elliott KG, Kjolhede CL, Gournis E, Rasmussen KM . Duration of breastfeeding associated with obesity during adolescence. Obes Res 1997; 5: 538–541.

    Article  CAS  Google Scholar 

  22. Frye C, Heinrich J . Trends and predictors of overweight and obesity in East German children. Int J Obes Relat Metab Disord 2003; 27: 963–969.

    Article  CAS  Google Scholar 

  23. Haschke F, van't Hof M . The influence of nutritional and genetic factors on growth and BMI until 5 years of age. Monatsschr Kinderheilk 2003; 151 (Suppl 1): S54–S57.

    Article  Google Scholar 

  24. Ivanovic D, Ivanovic R, Buitron C . Nutritional status, birth weight and breast feeding of elementary first grade Chilean students. Nutr Rep Int 1987; 36: 1347–1361.

    CAS  PubMed  Google Scholar 

  25. Langnase K, Mast M, Danielzik S, Spethmann C, Muller MJ . Socioeconomic gradients in body weight of German children reverse direction between the ages of 2 and 6 years. J Nutr 2003; 133: 789–796.

    Article  CAS  Google Scholar 

  26. Parsons TJ, Power C, Manor O . Infant feeding and obesity through the lifecourse. Arch Dis Child 2003; 88: 793–794.

    Article  CAS  Google Scholar 

  27. Ravelli AC, van der Meulen JH, Osmond C, Barker DJ, Bleker OP . Infant feeding and adult glucose tolerance, lipid profile, blood pressure, and obesity. Arch Dis Child 2000; 82: 248–252.

    Article  CAS  Google Scholar 

  28. Richter J . Influence of duration of breast-feeding on body-weight-development. Arztl Jugendkd 1981; 72: 166–169.

    CAS  PubMed  Google Scholar 

  29. Scaglioni S, Agostoni C, Notaris RD, Radaelli G, Radice N, Valenti M, Giovannini M, Riva E . Early macronutrient intake and overweight at five years of age. Int J Obes Relat Metab Disord 2000; 24: 777–781.

    Article  CAS  Google Scholar 

  30. Strbak V, Skultetyova M, Hromadova M, Randuskova A, Macho L . Late effects of breast-feeding and early weaning: seven-year prospective study in children. Endocr Regul 1991; 25: 53–57.

    CAS  PubMed  Google Scholar 

  31. Tanasescu M, Ferris AM, Himmelgreen DA, Rodriguez N, Perez-Escamilla R . Biobehavioral factors are associated with obesity in Puerto Rican children. J Nutr 2000; 130: 1734–1742.

    Article  CAS  Google Scholar 

  32. Tulldahl J, Pettersson K, Andersson SW, Hulthen L . Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence. Obes Res 1999; 7: 431–437.

    Article  CAS  Google Scholar 

  33. Wadsworth M, Marshall S, Hardy R, Paul A . Breast feeding and obesity. Relation may be accounted for by social factors. BMJ 1999; 319: 1576.

    Article  CAS  Google Scholar 

  34. Wolman PG . Feeding practices in infancy and prevalence of obesity in preschool children. J Am Diet Assoc 1984; 84: 436–438.

    CAS  PubMed  Google Scholar 

  35. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  36. Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A . Body mass index variations: centiles from birth to 87 years. Eur J Clin Nutr 1991; 45: 13–21.

    CAS  Google Scholar 

  37. Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruef T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E . Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001; 285: 413–420.

    Article  CAS  Google Scholar 

  38. Koletzko B, von Kries R . Are there long term protective effects of breast feeding against later obesity? Nutr Health 2001; 15: 225–236.

    Article  CAS  Google Scholar 

  39. Flegal KM, Troiano RP . Changes in the distribution of body mass index of adults and children in the US population. Int J Obes Relat Metab Disord 2000; 24: 807–818.

    Article  CAS  Google Scholar 

  40. Kalies H, Lenz J, von Kries R . Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982–1997. Int J Obes Relat Metab Disord 2002; 26: 1211–1217.

    Article  CAS  Google Scholar 

  41. Blettner M, Sauerbrei W, Schlehofer B, Scheuchenpflug T, Friedenreich C . Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol 1999; 28: 1–9.

    Article  CAS  Google Scholar 

  42. Tang JL, Liu JL . Misleading funnel plot for detection of bias in meta-analysis. J Clin Epidemiol 2000; 53: 477–484.

    Article  CAS  Google Scholar 

  43. Sterne JA, Egger M, Smith GD . Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323: 101–105.

    Article  CAS  Google Scholar 

  44. Dietz WH . Breastfeeding may help prevent childhood overweight. JAMA 2001; 285: 2506–2507.

    Article  CAS  Google Scholar 

  45. Lucas A, Sarson DL, Blackburn AM, Adrian TE, Aynsley-Green A, Bloom SR . Breast vs bottle: endocrine responses are different with formula feeding. Lancet 1980; 1: 1267–1269.

    Article  CAS  Google Scholar 

  46. Hauner H, Röhrig K, Petruschke T . Effects of epidermal growth factor (EGF), platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF) on human adipocyte development and function. Eur J Clin Invest 1995; 25: 90–96.

    Article  CAS  Google Scholar 

  47. Petruschke T, Röhrig K, Hauner H . Transforming growth factor beta (TGF-beta) inhibits the differentiation of human adipocyte precursor cells in primary culture. Int J Obes Relat Metab Disord 1994; 18: 532–536.

    CAS  PubMed  Google Scholar 

  48. Whitehead RG . For how long is exclusive breast-feeding adequate to satisfy the dietary energy needs of the average young baby? Pediatr Res 1995; 37: 239–243.

    Article  CAS  Google Scholar 

  49. Rolland-Cachera MF, Deheeger M, Akrout M, Bellisle F . Influence of macronutrients on adiposity development: a follow up study of nutrition and growth from 10 months to 8 years of age. Int J Obes Relat Metab Disord 1995; 19: 573–578.

    CAS  Google Scholar 

  50. Desai M, Hales CN . Role of fetal and infant growth in programming metabolism in later life. Biol Rev Camb Philos Soc 1997; 72: 329–348.

    Article  CAS  Google Scholar 

  51. Burns SP, Desai M, Cohen RD, Hales CN, Iles RA, Germain JP, Going TC, Bailey RA . Gluconeogenesis, glucose handling, and structural changes in livers of the adult offspring of rats partially deprived of protein during pregnancy and lactation. J Clin Invest 1997; 100: 1768–1774.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study has been carried out with support from the Bavarian Ministry for Environment, Health and Consumer Protection, Germany and partial financial support from the Commission of the European Communities, specific RTD programme ‘Quality of Life and Management of Living Resources’, QLK1-2001-00389 ‘Childhood Obesity: Early Programming by Infant Nutrition?’ (CHOPIN). It does not necessarily reflect its views and in no way anticipates the Commission's future policy in this area.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R von Kries.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arenz, S., Rückerl, R., Koletzko, B. et al. Breast-feeding and childhood obesity—a systematic review. Int J Obes 28, 1247–1256 (2004). https://doi.org/10.1038/sj.ijo.0802758

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0802758

Keywords

This article is cited by

Search

Quick links