Breastfeeding during infancy and the risk of
cardiovascular disease in adulthood.
Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hu FB, Michels KB,
Willett WC.
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard
Pilgrim Health Care, Boston, Massachusetts 02215, USA. Janet_RichEdwards@harvardpilgrim.org
BACKGROUND: Numerous studies have reported associations between the type of
feeding during infancy and subsequent cardiovascular risk factors. Only 2 studies have
evaluated the relation between having been breastfed and the risk of adult cardiovascular
events. METHODS: We examined this association among 87,252 female participants of
the longitudinal Nurses' Health Study. Participants (all born between 1921 and 1946)
reported in 1992 whether and for how long they were breastfed. During 8 years of follow
up, there were 1099 cases of coronary heart disease and 940 strokes among women who
knew whether they had been breastfed. We used proportional hazards models to estimate
hazard ratios for cardiovascular events, adjusting for changing adult risk factors.
RESULTS: Compared with women who were never breastfed, women who were
breastfed had hazard ratios of 0.92 (95% confidence interval = 0.80-1.05) for coronary
heart disease and 0.91 (0.79-1.06) for stroke, after adjustment for age, birthweight, and
smoking. When body mass index was also included in the model, the results were similar.
Looking within subgroups of stroke, hazard ratios were 0.86 (0.70-1.07) for ischemic
stroke and 1.01 (0.70-1.46) for hemorrhagic stroke. Comparing women who were
breastfed at least 9 months with those who were not breastfed, the hazard ratios were 0.84
(0.69-1.03) for coronary heart disease and 1.00 (0.81-1.23) for stroke. Breastfeeding
history was not associated with high blood pressure in adulthood. CONCLUSIONS:
These data suggest, but cannot establish, that breastfeeding in infancy may be associated
with a small reduction in risk of ischemic cardiovascular disease in adulthood.
European Journal of Clinical Nutrition advance online publication 20 February 2008;
doi: 10.1038/ejcn.2008.17
Breast feeding in infancy and arterial endothelial
function later in life. The Cardiovascular Risk in Young
Finns Study
M J Järvisalo1,2,3, N Hutri-Kähönen4, M Juonala2,3, V Mikkilä5, L Räsänen5,
T Lehtimäki6, J Viikari2 and O T Raitakari1
1.
2.
3.
1
Department of Clinical Physiology, University of Turku, Turku, Finland
Department of Medicine, University of Turku, Turku, Finland
3
Research Centre of Applied and Preventive Cardiovascular Medicine, University
of Turku, Turku, Finland
4. 4Department of Pediatrics, Tampere University Hospital and the Medical School,
Tampere, Finland
5. 5Division of Nutrition, University of Helsinki, Helsinki, Finland
6. 6Department of Clinical Chemistry, Tampere University Hospital and the Medical
School, Tampere, Finland
2
Correspondence: Professor OT Raitakari, Department of Clinical Physiology, Turku
University Hospital, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland. E-mail:
olli.raitakari@utu.fi
Received 18 December 2007; Accepted 20 January 2008; Published online
20 February 2008.
Top of page
Abstract
Background/Objectives:
Breast feeding in infancy may be associated with reduced cardiovascular morbidity in
adulthood. We examined the association between breast feeding in infancy and arterial
function and structure in adulthood in a population-based cohort of Finnish adults.
Subjects/Methods:
Noninvasive ultrasound was used to measure brachial artery flow-mediated dilatation
(FMD), carotid artery intima-media thickness (IMT) and carotid artery compliance
(CAC) in 1667 young adults participating in the Cardiovascular Risk in Young Finns
Study with data on early nutrition.
Results:
Maximal FMD was higher in breast-fed men compared to formula-fed men (7.2 4.0 vs
5.9 3.4%, P=0.029) while no differences were seen between breast-fed and formula-fed
women (8.9 4.5 vs 8.8 5.0%, P=0.84). In men, the multivariable correlates of FMD
included the group variable for breast feeding (P=0.014), birth weight (P=0.043), waist
circumference (P<0.001) and baseline brachial artery diameter (P<0.001). In women, the
multivariable correlates of FMD were birth weight (P=0.02), waist circumference
(P<0.001) and brachial artery baseline diameter (P<0.001). Breast feeding was not
significantly associated with IMT or CAC in multivariable models.
Conclusions:
Adult men who have been breast fed have better brachial endothelial function compared
to men who have been formula fed.
Keywords:
arteries, atherosclerosis, breast feeding, risk factors, ultrasound
Abstract 3498: The Association of Breastfeeding in
Infancy and Adult Cardiovascular Disease Risk
Factors: The Framingham Third Generation Cohort
Nisha I Parikh1; Shih-Jen Hwang2; Erik Ingelsson3; Emelia J Benjamin4; Caroline S Fox5;
Ramachandran S Vasan6; Joanne M Murabito7
1
Framingham Heart Study, Framingham, MA
NHLBI and Framingham Heart Study, Framingham, MA
3
Framingham Heart Study, Framingham, MA
4
Boston Univ Sch of Medicine, Framingham Heart Study, Framingham, MA
5
NHLBI and Framingham Heart Study, Framingham, MA
6
Boston Univ Sch of Medicine and Framingham Heart Study, Framingham, MA
7
Framingham Heart Study, Framingham, MA
2
Background: Public health recommendations advocate breastfeeding in infancy as a
means to reducing later-life obesity. However many prior studies relating breastfeeding to
cardiovascular (CVD) risk factors have been limited by lack of adjustment for maternal
and participant confounding factors.
Methods: In 962 Framingham Third Generation participants (mean age = 41 yrs, 54%
women) we related history of breastfeeding (yes vs. no) and CVD risk factors in youngmid adulthood. Breastfeeding data was ascertained via questionnaire from mothers
enrolled in the Framingham Offspring Study. Dependent variables were body mass index
(BMI), HDL-cholesterol (HDL-c), total cholesterol, triglycerides, fasting blood glucose,
C-reactive protein (CRP), systolic (SBP) and diastolic blood pressure (DBP). Covariates
for multivariable adjustment were age, sex, hypertension medications, lipid treatment,
smoking, birth order, oral contraceptives, hormone replacement, physical activity,
education, maternal smoking, maternal education, and maternal BMI. Low HDL was
defined as < 50 mg/dL (women) and < 40 mg/dL(men). Adiposity categories were
defined by BMI normal [< 25], overweight [ 25 to < 30] and obese [ 30 kg/m2].
Generalized estimating equations (GEE) were used to account for sibling correlations.
Results: Overall 26% of participants were reported by their mother to have been
breastfed. Compared to non-breastfed individuals, breastfed offspring had lower adult
BMI [adjusted mean 26.1 kg/m2 vs. 26.9 kg/m2, p = 0.04) and higher adult HDL-c levels
[adjusted mean HDL 56.6 mg/dL relative to 53.7 mg/dL p = 0.01] in multivariableadjusted models. Breastfeeding was not associated with other examined adult CVD risk
factors. Upon adjustment for BMI the association between breastfeeding and HDL was
attenuated (p = 0.09). Breastfeeding was associated with high versus low HDL
(multivariable-adjusted OR = 1.55, p = 0.04) but not with overweight or obesity versus
normal weight (p = 0.26, 0.13 respectively).
Conclusions: Breastfeeding in infancy is inversely associated with adult BMI and
positively associated with HDL-c. Associations between breastfeeding and BMI appear to
mediate most of the association with HDL-c.