Exploring breastfeeding as a means to preventing childhood overweight and obesity: a systematic review

Abstract

Abstract Simple overweight and obesity have become one of the most significant and burdensome problems affecting both the health and wellbeing of children, worldwide, and notably the development of excess weight in childhood persists into adulthood in most cases, presenting additional burden upon global populations. Given that weight gain can be preventive in the majority of cases, efforts to prevent or manage childhood obesity have been implemented into routine practice, although with limited efficacy. Previous research has shown that a novel means to preventing childhood overweight and obesity status is the provision of breastfeeding during infantile life. However, a growing body of evidence exploring the effects of breastfeeding upon child weight has emerged in recent times and therefore, this systematic review sought to summarise the status of the most recent evidence. The databases of MEDLNE, EMBASE, the Cochrane library and CINAHL were searched in July 2020 using appropriate terms and eligible studies were restricted to publication 2015-2020, English language and peer-review. Studies were appraised using CASP and the association between breastfeeding and weight status in childhood was analysed and synthesised narratively. A total of 10 studies were included in this review and whilst these were prospective cohort studies, there was a high risk of bias that was mostly due to residual confounding. The results showed that breastfeeding administered after the age of four months and for a duration exceeding four months and ideally, 6->12 months led to the greatest protective effects against overweight and obesity status. The overall risk reduction was approximately 20-30% when compared to never breastfeeding, non-exclusive breastfeeding and breastfeeding for durations <2-4 months. There was also a dose-response relationship demonstrated for breastfeeding where progressive increases in the duration of breastfeeding (1-4 weekly increments) were associated with 1-3% decreases on overweight and obesity risk. Overall, the findings of this review are supported by previous reviews and primary evidence, which helps to overcome any uncertainty in the direction and size of the effects reported. The implications of the review are clear – breastfeeding does provide protection from overweight and obesity status but mostly for children of preschool age (<=5 years). Practice and guideline revisions are required to optimise education for mothers concerning breastfeeding and the influence upon child weight, as well as to promote uptake and adherence to prolonged breastfeeding durations, in order to benefit child health. This will require policy level support and finally, future viii research is needed to address the limitations of the current primary evidence and to explore whether breastfeeding provides protection against overweight and obesity status during older adolescence.