Can breastfeeding practices explain sociodemographic disparities in childhood obesity and healthy eating? Results from NHANES 2005-2018.

This study aims to review and analyze the relationship between early childhood breastfeeding, nutrition, and weight status in children. We hypothesized (a) that differences in breastfeeding practices may explain sociodemographic disparities in children's overweight and obesity, and (b) that breastfeeding practices may also explain sociodemographic disparities in children's diet quality. Data from N = 7180 children aged 2 to 6 years from NHANES (2005-2018) were classified based on weight status (normal weight, overweight, obesity, severe obesity), breastfeeding, and in terms of healthy eating (using the Healthy Eating Index). We used multinomial logistic and linear regressions to determine pathways between sociodemographic variables, breastfeeding, and weight status, as well as between sociodemographic and breastfeeding variables and healthy eating scores. Sociodemographic factors were significantly associated with childhood weight status, breastfeeding history, and healthy eating. Weight status increased with child male gender, Mexican American and Other Hispanic ethnicity, lower education, lower income, and single marital status; breastfeeding decreased with child age, Non-Hispanic Black ethnicity, lower education, and single marital status, but increased with Mexican American ethnicity and higher income. A mediation analysis showed indirect pathways from sociodemographic variables to weight status via breastfeeding duration. Similar patterns emerged for healthy eating. The results indicate that breastfeeding is associated with modestly lower odds of severe obesity and improved diet scores in early childhood, even after accounting for socioeconomic and demographic differences. Breastfeeding appears to be a meaningful early-life factor with a significant impact on weight and healthy dietary outcomes.