Breastfeeding, Diabetes and Obesity
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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)
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.
- 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.
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.
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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.
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BF and DM
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