Infant Feeding Practices Are Associated with Cardiovascular Profiles in Early Childhood: Findings from a Prospective Australian Cohort Study.

BACKGROUND

Breastfeeding is associated with reduced risk of childhood obesity, but associations with cardiovascular risks in childhood are less well understood.

OBJECTIVES

This study investigated associations between infant feeding practices and cardiovascular profiles in early childhood and the potential mediating role of infant rapid weight gain (RWG).

DESIGN

This secondary data analysis was conducted using data from the Barwon Infant Study, an ongoing prospective pre-birth cohort in Australia commenced between 2010 and 2017, recruited through an unselected antenatal sampling frame.

PARTICIPANTS/

SETTING

Children aged 4 years (n=606) who participated in the 4-year cardiovascular risk assessment follow-up.

MAIN OUTCOMES: Infant feeding variables, including breastfeeding duration, exclusive breastfeeding at 3 months, and predominant breastfeeding at 6 months, were collected via caregiver questionnaires at 1, 3, 6, 9, and 12 months, and 2 years post-birth. Latent profile analysis, including 4-7 cardiovascular risk markers measured at age 4 years, was used to derive cardiovascular profiles.

STATISTICAL ANALYSES: Multivariable logistic regression with adjustment for gestational age, maternal education, and pre-pregnancy maternal body mass index (BMI), examined the association between infant feeding practices and cardiovascular profiles, and whether these associations were mediated by RWG in infancy.

RESULTS

Three cardiovascular profiles of 'Low' (44.1% of children), 'Medium' (46.4%), and 'High' (9.5%) were identified at age 4 years. Infants who were exclusively breastfed at age 3 months and predominantly breastfed at age 6 months were less likely to belong to the 'Medium' versus 'Low' cardiovascular profile (RRR 0.51, 95% CI 0.27 to 0.95, p= 0.034; and RRR 0.43, 95% CI 0.18 to 0.99, p= 0.048, respectively) than those who were not. No significant association was observed for the 'High' versus 'Low' cardiovascular profile or between breastfeeding duration and cardiovascular profiles. Mediation analyses suggested indirect associations between infant feeding practices and cardiovascular profiles involving infant RWG.

CONCLUSIONS

Exclusive breastfeeding to age 3 months and predominant breastfeeding to age 6 months were linked with a more favorable cardiovascular profile at age 4 years. Mediation analyses suggested that infant RWG may partly account for these associations. Further studies are needed to investigate the mechanisms that may underlie the observed associations between breastfeeding practices and cardiovascular profiles.