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Maternal Child

Maternal Child Health ‹ Breastfeeding ‹ Diabetes

Breastfeeding, Diabetes and Obesity

Diabetes Prevention and Breastfeeding

Type 2 diabetes used to be called Adult Onset Diabetes Mellitus (AODM). It is no longer an adult disease.

  • Centers for Disease Control and Prevention (CDC) states that children born in 2000 have a one in three chance of developing diabetes as adults. (* 1,2)
  • Diabetes in American Indian/Alaska Native (AI/AN) youth increased 71% between 1980 and 1998 . (* 21)

Type 2 diabetes is increasing:

  • Since 1980, type 2 diabetes in the US has more than doubled (* 1,2).
  • Type 2 diabetes is most common in AI/AN communities. The chart below shows the rates of diabetes by population in the US. In each age and gender group, AI/AN have the greatest prevalence. (* 3,4,5)

 

 

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Diabetes hurts lifetimes

  • People with diabetes have a lower life expectancy and often reduced life quality. According to CDC, if a person is diagnosed with diabetes at age 40, they will lose:
    • For men - 11.6 life-years and 18.6 quality adjusted life-years.
    • For women - 14.3 life-years and 22.0 quality-adjusted life-years. (* 2)

Diabetes is expensive

  • A study by the American Diabetes Association showed that the health care cost was 500% greater for those with diabetes. Using 2002 health cost dollars, the expense per person was:
    • $13,243 for those with diabetes
    • $2560 for those without. (* 1)

It is easy to be at risk for diabetes:

  • Exposure before birth - A baby born to a mother who had either gestational diabetes mellitus (GDM) or pre-existing diabetes has much higher risk of developing diabetes (* 6,7,8) and obesity (* 9) as a young adult.
  • Becoming overweight or obese greatly increases risk:
    • The current obesity and overweight rates in all age and ethnic groups is a serious health problem. Rates are increasing exponentially in most parts of the world. (* 10-17)
    • 60% of adults in the US are obese or overweight. (* 18)
    • Since the 1990’s, obesity and overweight have been identified as major problems in AI/AN communities. (* 19) A large sample study of AI/AN youth showed that there was more obesity and overweight in almost every age category of AI/AN youth when compared to the general US population. (* 20)

How does breastfeeding fit in?

Breastfeeding could make a difference for moms and babies.

  • In 1997, the National Institutes of Health (NIH) reported a study done on the Gila River Pima Indian Community. The study showed that breastfeeding for 2 months or longer is associated with a 40% risk reduction for the baby developing diabetes by age 40. (* 23)
  • In 2002, Young et al also reported reduced diabetes risk for Native Canadian babies if they were breastfed. (* 24)
  • In 2006, Stueben et al reported that breastfeeding meant less risk of diabetes for mothers. Using health surveys of almost ¼ million nurses, it was found that for every year of breastfeeding, a mother had 14-15% less risk of developing diabetes 15 years later. (* 53). Possible causes are the maternal metabolic cost of breastfeeding and healthy endocrine responses associated with breastfeeding (* 54-56).

Breastfed babies have less risk of obesity and overweight for children and adolescents.

  • Since 1999, many studies and reviews have linked breastfeeding with reduced risk of obesity for children and adolescents (* 25-35) and offspring of GDMs (* 36).
  • Published analysis and reviews of the obesity research (* 37-41) have shown that to varying degrees, breastfeeding has a protective effect against later obesity and overweight.

But how does breastfeeding make a difference?

It is not well understood. Some possible links are:

  • Human hormones, leptin, ghrelin, and insulin are found only in breast milk.
    • These hormones effect many metabolic processes like appetite, satiety and blood sugar. The same hormones may shape healthy responses that impact many parts of the life cycle. (* 42-44)
  • The eating behavior that is learned in the first part of life could shape later eating patterns.
    • Breastfed babies control their own intake. Appetite self-management is a habit found in healthy, lean adults. It may be that the appetite self- management behaviors that are learned at the breast are retained into adulthood. (* 45,46)
  • Breastfed babies gain weight differently than formula fed babies.
    • Research has described the early weight gain patterns that are unique to breastfed infants (* 47) as being protective of obesity. (* 48).
  • Since breastfed babies tend to be leaner as they grow up, the moderation of obesity/overweight could be the difference in diabetes risk. The NIH/NIDDK Clinical Trials, 1996-2002, showed that lifestyle intervention and medication could prevent or delay the onset of diabetes. Moderate weight loss (7%) was a key factor in reducing risk. (* 22)

What about the other factors that influence weight and diabetes?

Risk factors that are not related to early infant feeding include:

  • Parental obesity
  • Low or high birth weight
  • Inutero exposure to maternal malnutrition
  • Maternal smoking at or about 26 weeks
  • Excessive weight gain patterns in early childhood
  • Lifestyle habits:
    • Less physical activity and more television, videos, and computer use
    • Large servings of food
    • Food choices that are high sugar/fat foods and drinks instead of lower fat/sugar/calorie foods (* 33, 49-52)

In Summary:

  • Breastfeeding is a safe, effective, and short term way to reduce risk of diabetes and obesity. Supporting breastfeeding in infancy could mean healthier lifetimes.
  • Breastfeeding may be like an immunization, a brief, but potent intervention.

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Footnotes

Each footnote is followed by an abstract number that corresponds to the abstract found on www.pubmed.gov (ie. 2003; 26: 917-32)

To find the abstract on PubMed, copy (ctrl+c) then paste (ctrl+v) the abstract number into the search field on PubMed.  You can also type the name of the author(s) into the search field.

1. Hogan P, Dall T, Nikolov P, American Diabetes Association. Economic costs of diabetes in the U.S. in 2002. Diabetes Care. 2003; 26: 917-32.

2. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime Risk for Diabetes Mellitus in the United States. JAMA. 2003; 290: 1884-90.

3. Gahagan S, Silverstein J, Committee on Native American Child Health and Section on Endocrinology. Prevention and treatment of type 2 diabetes mellitus in children with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health. Pediatrics. 2003;112(4): e328-e347.

4. Burrows NR, Geiss LS, Englegau MM, Acton KJ. Prevalence of diabetes among Native Americans and Alaska Natives, 1990-1997: an increasing burden. Diabetes Care. 2000 Dec;23(12):1786-90.

5. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Glefal KM, Engelgau MM, Saydah, SH, Williams DE, Geiss LS, Gregg EW. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999-2002.Diabetes Care. 2006 June; 29(6):1263-8.

6. Dabelea D. Knowler WC, Pettitt DJ. Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians. J Matern Fetal Med. 2000 Jan-Feb;9(1):83-8.

7. Dabelea D. Pettitt DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Pediatr Endocrinol Metab. 2001 Sep-Oct; 14(8):1085-91.

8. Pettitt DJ, Knowler WC. Long-term effects of the intraunterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care. 1998 Aug;21 Suppl 2:B138-41.

9. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood:association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005 Mar; 115(3): e290-6.

10. Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci. 2006 Apr; 331(4):166-74.

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17. Swinburn BA, Caterson I, Seidell JC, James WP. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr. 2004 Feb; 7(1A0:123-46.

18. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM, Prevalence of overweight and obesity among US children adolescents, and adults, 199-2002. JAMA. 2004 Jun 16 (291(23): 2847-50.

19. Story M, Evans M, Fabsitz RR, Clay T, Holy Rock B, Broussard B, The epidemic of obesity in American Indian communities and the need for childhood obesity-prevention programs. Am J Clin Nutr. 1999; 69(4 suppl):747S-54S.

20. Zephier E, Himes JH, Story M, Zhou X. Increasing prevalences of overweight and obesity in Northern Plains American Indian children. Arch Pediatr Adolesc Med. 2006 Jan; 160(1):34-9.

21. Acton KJ, Burrows NR, Moore K, Querec L, Geiss LS, Engelgau MM. Trends in diabetes prevalence among American Indian and Alaska Native children, adolescents, and young adults. Am J Public Health. 2002; 92(9):1485-90.

BF and DM

22. Knowler WC, Barrett-Conner E, Fowler SE, Hamman RF, Lachin JM, Walker EA. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7; 346(6):393-403.

23. Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH. Breastfeeding and the Incidence of non-insulin-dependent diabetes mellitus in Pima Indians. The Lancet. 1997; 350:166-168.

24. Young TK, Martens PJ, Taback SP, Sellers EAC, Dean HJ, Cheang M, Flett B. Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among Native Canadians. Arch Pediatr Adolesc Med. 2002; 156:651-655.

25. Gilman MW, Rifas-Shiman SL, Camargo CA, Berkey CS, Frazier AL, Rockett HRH, Field AE, Colditz FA. Risk of overweight among adolescents who were breastfed as infants. JAMA 2001;285:2461-67.

26. Hediger ML, Overpeck MD, Kuczmarski RG, Ruan WJ. Association between infant breastfeeding and overweight in young children., JAMA 2001; 285;2453-60.

27. Armstrong J, Reilly JJ. Breastfeeding and lowering the risk of childhood obesity. The Lancet. 8 June 2002; 359:2003-04.

28. Liese AD, Hirsch T. von Mutius E, Keil U, Leupold W, Weiland SK, Inverse association of overweight and breastfeeding in 9 to 10-y-old children in Germany. Int J Obesity 2001;25:1644-50/

29. Toschke AM, Vignerova J, Lhotska L, Osancova K, Koletzko B, von Kries J. Overweight and obesity in 6- to 14-year-old-Czech children in 1991: protective effect of breast-feeding. J Pediatr. 2002 Dec;141(6):764-9.

30. Stettler N, Zemel BS, Kumanyika S. Stallings VA. Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics 2002; 109:1994-99.

31. v on Kries R, Koletzko B, Sauerwaald T, von Mutiut E, Barnert D, Grunert V, von Voss H. Breast feeding and obesity: cross sectional study. BMJ 1999;319:147-50.

32. Bergmann KE, Bergmann RL, von Kries R, O Bohm, Richter R, Dudenhausen JW, Wahn U. Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding. International Journal of Obesity 2003; 27:162-72.

33. Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity – a systematic review. International Journal of Obesity 2004; 28:1247-56.

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36. Schaefer-Graf UM, Hartmann R, Pawliczak J. Passow D, Abou-Dakn M, Vetter K, Kordonouri O. Association of breast-feeding and early childhood overweight in children from mothers with gestational diabetes mellitus. Diabetes Care. May 2006; 29(5): 1105-1107.

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

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39. Owen CG, Martin RM, Whincup PH, Davey-Smith G, Cook DG. Effect of infant feeding on the risk of obesity across the life course: A quantitative review of published evidence. Pediatrics 2005;115:1367-77.

40. Owen CG, Martin RM, Whincup PH, Davey-Smith, G, Gillman MW, Cook DG. The effect of breastfeeding on mean body mass index throughout life: a quantitative review of published and unpublished observational evidence. Am J Clin Nutr 2005; 82:1298-307.

41. Grummer LM, Mei Z. Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics. 2004 Feb; 113(2):e81-6.

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43. Cripps RL, Martin-Gronert MS, Ozanne SE, Fetal and perinatal programming of appetite. The Biochemical Society. Clinical Science 2005, 109:1-11.

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45. Fisher JO, Birth LL, Smiciklas-Wright H. Picciano MF. Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes. J Am Diet Assoc. 2000 Jun; 100(6):641-6.

46. Taveras EM, Scanlon KS, Birch L, Rifas-Shiman SL, Rich-Edwards JW, Gillman MW. Association of breastfeeding with maternal control of infant feeding at age 1 year. Pediatrics 2004; 114: 577-83.

47. Dewey KG, Growth characteristics of breast-fed compared to formula-fed infants. Biol Neonate. 1998;74:94-105.

48. Stettker N, Stallings VA, Troxel AB, Jing Zhao J, Schinnar R, Nelson SE, Ziegler EE, Strom BL. Weight gain in the first week of life and overweight in adulthood: a cohort study of european american subjects fed infant formula. Circulation. 2005; 111:1897-1903.

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50. Oken E, Gillman MW. Fetal origins of obesity. Obes Res 2003 Apr;11(4):496-506.

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56. Kjos SI, Henry O, Lee RM, Buchanan TA, Mishell DR, The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol 1993; 82:451-55.

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