Does Breastfeeding Help to Reduce the Risk of Childhood Overweight and Obesity? A Propensity Score Analysis of Data from the KiGGS Study

<div><p>Background</p><p>Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany.</p><p>Methods</p><p>We analyzed retrospectively collected data on breastfeeding from children aged 3–17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity.</p><p>Results</p><p>Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for <4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71–0.92]) and obesity (OR 0.75 [95% CI 0.61–0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration. Further analyses stratified by age group showed that the association was strongest in children aged 7–10 years (OR 0.67 [95% CI 0.53–0.84] for overweight and OR 0.56 [95% CI 0.39–0.81] for obesity), while no significant effect could be seen in other age groups.</p><p>Discussion</p><p>Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.</p></div

Distribution of propensity scores before and after matching.

<p>Distribution of propensity scores with overlaid kernel density estimate of study participants in the breastfed and non-breastfed groups before and after the matching procedure.</p

Distribution of propensity scores in matched and unmatched groups.

<p>Distribution of propensity scores of study participants in the breastfed and non-breastfed groups who could be matched and remained in the dataset and of those who could not be matched and were removed.</p

Flow chart of KiGGS study participants included in the analyses.

<p>Flow chart of KiGGS study participants included in the analyses.</p

Association between breastfeeding and childhood overweight and obesity, stratified by age groups.

<p>*matched sample (n = 8034), adjusted for sex, socioeconomic status, and parental overweight</p><p>Association between breastfeeding and childhood overweight and obesity, stratified by age groups.</p

Characteristics of the 13163 study participants, according to breastfeeding status.

<p>^aTo obtain p values we used t-tests for continuous variables (age in years, mother’s age at childbirth) and chi-square test for categorical variables; p values are two-sided.</p><p>Characteristics of the 13163 study participants, according to breastfeeding status.</p

Association between breastfeeding and childhood overweight and obesity.

<p>*adjusted for age group, sex, socioeconomic status, and parental overweight</p><p>Association between breastfeeding and childhood overweight and obesity.</p

Health and health risk behaviour of adolescents—Differences according to family structure. Results of the German KiGGS cohort study

<div><p>Objective</p><p>This study’s aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities.</p><p>Methods</p><p>We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003–2006, follow-up: 2009–2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models.</p><p>Results</p><p>We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents’ health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower.</p><p>Conclusions</p><p>Because the direct effects of family structure on adolescents’ health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents’ health, prevention programmes and interventions should be directed towards the parent–adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.</p></div

Sample characteristics.

<p>Sample characteristics.</p

Results from the logistic regression models on heavy episodic drinking.

<p>Adolescents aged 14 to 17 years.</p