Maternal and Child Health Journal

, Volume 23, Issue 2, pp 228–239 | Cite as

Association Between Breastfeeding and Childhood Cardiovascular Disease Risk Factors

  • Amna UmerEmail author
  • Candice Hamilton
  • Roger A. Edwards
  • Lesley Cottrell
  • Peter GiacobbiJr.
  • Kim Innes
  • Collin John
  • George A. Kelley
  • William Neal
  • Christa Lilly


Introduction The immediate benefits of breastfeeding are well-established but the long-term health benefits are less well-known. West Virginia (WV) has a higher prevalence of cardiovascular disease (CVD) and lower breastfeeding rates compared to national averages. There is a paucity of research examining the relationship between breastfeeding and subsequent childhood CVD risk factors, an issue of particular relevance in WV. Methods This study used longitudinally linked data from three cross-sectional datasets in WV (N = 11,980). The information on breastfeeding was obtained retrospectively via parental recall when the child was in the fifth grade. The outcome variables included blood pressure measures [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), non-HDL, and triglycerides (TG)]. Multiple regression analyses were performed, adjusting for childhood body mass index (BMI) and additional covariates. Results Only 43% of mothers self-reported ever breastfeeding. The unadjusted analysis showed that children who were ever vs. never breastfed had significantly lower SBP (b = − 1.39 mmHg; 95% CI − 1.97, − 0.81), DBP (b = − 0.79 mmHg; 95% CI − 1.26, − 0.33), log-TG (b = − 0.08; 95% CI − 0.1, − 0.05), and higher HDL (b = 0.95 mg/dL; 95% CI 0.33, 1.56). After adjustment for the child’s BMI, socio-demographic and lifestyle factors, log-TG remained significantly associated with breastfeeding (b = − 0.04; 95% CI − 0.06, − 0.01; p = 0.01). Conclusion The observed protective effect of any breastfeeding on childhood TG level was small but significant. This finding provides some support for a protective effect of breastfeeding on later CVD risk.


Breastfeeding Cardiovascular disease Childhood Blood pressure Lipid(s) Triglycerides Rural 



The West Virginia WATCH/Birth Score Program is funded under an agreement with the West Virginia Department of Health and Human Resources, Bureau for Public Health, Office of Maternal, Child and Family Health. The CARDIAC project is funded by the West Virginia Bureau of Public Health. The authors wish to thank the children and families who have participated in the CARDIAC Project and the Birth Score Project. The authors would like to thank Cris Britton, data manager of WATCH/Birth Score Project for providing the matched data. GA Kelley and C Lilly were partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award no. U54GM104942. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.


  1. AAP. (2012). Section on breastfeeding. Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841. Scholar
  2. Amorim Rde, J., Coelho, A. F., de Lira, P. I., & Mde, L. C. (2014). Is breastfeeding protective for blood pressure in schoolchildren? A cohort study in northeast Brazil. Breastfeed Medicine, 9(3), 149–156. Scholar
  3. Bartick, M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics, 125(5), e1048–e1056. Scholar
  4. Bekkers, M. B., Brunekreef, B., Smit, H. A., Kerkhof, M., Koppelman, G. H., Oldenwening, M., et al. (2011). Early-life determinants of total and HDL cholesterol concentrations in 8-year-old children; the PIAMA birth cohort study. PLoS ONE, 6(9), e25533. Scholar
  5. CDC. (2016). Division of nutrition, physical activity, and obesity, national center for chronic disease prevention and health promotion. Avaiable at
  6. Chen, X., & Wang, Y. (2008). Tracking of blood pressure from childhood to adulthood: A systematic review and meta-regression analysis. Circulation, 117(25), 3171–3180. Scholar
  7. de Jonge, L. L., van Osch-Gevers, L., Geelhoed, J. J., Hofman, A., Steegers, E. A., Helbing, W. A., et al. (2010). Breastfeeding is not associated with left cardiac structures and blood pressure during the first two years of life. The Generation R Study. Early Human Development, 86(8), 463–468. Scholar
  8. Durmus, B., Heppe, D. H., Gishti, O., Manniesing, R., Abrahamse-Berkeveld, M., van der Beek, E. M., et al. (2014). General and abdominal fat outcomes in school-age children associated with infant breastfeeding patterns. The American Journal of Clinical Nutrition, 99(6), 1351–1358. Scholar
  9. Fall, C. H., Borja, J. B., Osmond, C., Richter, L., Bhargava, S. K., Martorell, R., et al. (2011). Infant-feeding patterns and cardiovascular risk factors in young adulthood: Data from five cohorts in low- and middle-income countries. International Journal of Epidemiology, 40(1), 47–62. Scholar
  10. Friedewald, W. T., Levy, R. I., & Fredrickson, D. S. (1972). Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry, 18(6), 499–502.Google Scholar
  11. Gaillard, R., Rurangirwa, A. A., Williams, M. A., Hofman, A., Mackenbach, J. P., Franco, O. H., et al. (2014). Maternal parity, fetal and childhood growth, and cardiometabolic risk factors. Hypertension, 64(2), 266–274. Scholar
  12. Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., & Schanler, R. J. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506. Scholar
  13. Horta, B. L., de Mola, L., C., & Victora, C. G. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis. Acta Paediatrica Supplement, 104(467), 30–37. Scholar
  14. Horta, B. L., Victora, C. G., Lima, R. C., Goncalves, H., Guimaraes, B. E., & Barros, F. C. (2006). Breastfeeding duration and blood pressure among Brazilian adolescents. Acta Paediatrica, 95(3), 325–331. Scholar
  15. Hosaka, M., Asayama, K., Staessen, J. A., Ohkubo, T., Hayashi, K., Tatsuta, N., et al. (2013). Breastfeeding leads to lower blood pressure in 7-year-old Japanese children: Tohoku study of child development. Hypertension Research, 36(2), 117–122. Scholar
  16. Huang, R. C., Mori, T. A., & Beilin, L. J. (2012). Early life programming of cardiometabolic disease in the Western Australian pregnancy cohort (Raine) study. Clinical and Experimental Pharmacology and Physiology, 39(11), 973–978. Scholar
  17. Izadi, V., Kelishadi, R., Qorbani, M., Esmaeilmotlagh, M., Taslimi, M., Heshmat, R., et al. (2013). Duration of breast-feeding and cardiovascular risk factors among Iranian children and adolescents: The CASPIAN III study. Nutrition, 29(5), 744–751. Scholar
  18. Juhola, J., Magnussen, C. G., Viikari, J. S., Kahonen, M., Hutri-Kahonen, N., Jula, A., et al. (2011). Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: The cardiovascular risk in young finns study. The Journal of Pediatrics, 159(4), 584–590. Scholar
  19. Kark, J. D., Troya, G., Friedlander, Y., Slater, P. E., & Stein, Y. (1984). Validity of maternal reporting of breast feeding history and the association with blood lipids in 17 year olds in Jerusalem. Journal of Epidemiology and Community Health, 38(3), 218–225.Google Scholar
  20. Kolacek, S., Kapetanovic, T., Zimolo, A., & Luzar, V. (1993). Early determinants of cardiovascular risk factors in adults. A. Plasma lipids. Acta Paediatrica, 82(8), 699–704.Google Scholar
  21. Kramer, M. S. (2010). “Breast is best”: The evidence. Early Human Development, 86(11), 729–732. Scholar
  22. Kramer, M. S., Matush, L., Vanilovich, I., Platt, R. W., Bogdanovich, N., Sevkovskaya, Z., et al. (2007). Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 years: Evidence from a large randomized trial. The American Journal of Clinical Nutrition, 86(6), 1717–1721.Google Scholar
  23. Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., et al. (2002). 2000 CDC growth charts for the United States: Methods and development. Vital and Health Statistics, 11(246), 1–190.Google Scholar
  24. Kwok, M. K., Leung, G. M., & Schooling, C. M. (2013). Breastfeeding and adolescent blood pressure: Evidence from Hong Kong’s “children of 1997” birth cohort. American Journal of Epidemiology, 178(6), 928–936. Scholar
  25. Lawlor, D. A., Najman, J. M., Sterne, J., Williams, G. M., Ebrahim, S., & Smith, D., G (2004). Associations of parental, birth, and early life characteristics with systolic blood pressure at 5 years of age: Findings from the Mater-University study of pregnancy and its outcomes. Circulation, 110(16), 2417–2423. Scholar
  26. Liburd, L. C., Giles, H. W., & Mensah, G. A. (2006). Looking through a glass, darkly: Eliminating health disparities. Preventing Chronic Disease, 3(3), A72.Google Scholar
  27. Mamun, A. A., O’Callaghan, M., Callaway, L., Williams, G., Najman, J., & Lawlor, D. A. (2009). Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: Evidence from a birth cohort study. Circulation, 119(13), 1720–1727. Scholar
  28. Martin, R. M., Ben-Shlomo, Y., Gunnell, D., Elwood, P., Yarnell, J. W., & Smith, D. G. (2005). Breast feeding and cardiovascular disease risk factors, incidence, and mortality: The Caerphilly study. Journal of Epidemiology and Community Health, 59(2), 121–129. Scholar
  29. Martin, R. M., Gunnell, D., & Smith, G. D. (2005). Breastfeeding in infancy and blood pressure in later life: Systematic review and meta-analysis. American Journal of Epidemiology, 161(1), 15–26. Scholar
  30. Martin, R. M., Ness, A. R., Gunnell, D., Emmett, P., Davey Smith, G., & Team, A. S. (2004). Does breast-feeding in infancy lower blood pressure in childhood? The Avon Longitudinal Study of Parents and Children (ALSPAC). Circulation, 109(10), 1259–1266. Scholar
  31. McMurray, R. G., Harrell, J. S., Levine, A. A., & Gansky, S. A. (1995). Childhood obesity elevates blood pressure and total cholesterol independent of physical activity. International Journal of Obesity and Related Metabolic Disorders, 19(12), 881–886.Google Scholar
  32. Mensah, G. A., & Brown, D. W. (2007). An overview of cardiovascular disease burden in the United States. Health Affairs, 26(1), 38–48. Scholar
  33. Muratova, V. N., Demerath, E. W., Spangler, E., Ogershok, P., Elliott, E., Minor, V. E., et al. (2002). The relation of obesity to cardiovascular risk factors among children: The CARDIAC project. West Virginia Medical Journal, 98(6), 263–267.Google Scholar
  34. Myrskyla, M., & Fenelon, A. (2012). Maternal age and offspring adult health: Evidence from the health and retirement study. Demography, 49(4), 1231–1257. Scholar
  35. National Immunization Survey (NIS). (2002–2013). Division of nutrition, physical activity, and obesity, national center for chronic disease prevention and health promotion. Avaiable at
  36. Owen, C. G., Whincup, P. H., Gilg, J. A., & Cook, D. G. (2003). Effect of breast feeding in infancy on blood pressure in later life: Systematic review and meta-analysis. BMJ, 327(7425), 1189–1195. Scholar
  37. Owen, C. G., Whincup, P. H., Kaye, S. J., Martin, R. M., Smith, D., Cook, G., Williams, D. G., S. M (2008). Does initial breastfeeding lead to lower blood cholesterol in adult life? A quantitative review of the evidence. The American Journal of Clinical Nutrition, 88(2), 305–314.Google Scholar
  38. Owen, C. G., Whincup, P. H., Odoki, K., Gilg, J. A., & Cook, D. G. (2002). Infant feeding and blood cholesterol: A study in adolescents and a systematic review. Pediatrics, 110(3), 597–608.Google Scholar
  39. Plagemann, A., & Harder, T. (2005). Breast feeding and the risk of obesity and related metabolic diseases in the child. Metabolic Syndrome and Related Disorders, 3(3), 222–232.Google Scholar
  40. Plancoulaine, S., Charles, M. A., Lafay, L., Tauber, M., Thibult, N., Borys, J. M., et al. (2000). Infant-feeding patterns are related to blood cholesterol concentration in prepubertal children aged 5–11 years: The Fleurbaix-Laventie Ville Sante study. European Journal of Clinical Nutrition, 54(2), 114–119.Google Scholar
  41. Rodrigues, A. N., Abreu, G. R., Resende, R. S., Goncalves, W. L., & Gouvea, S. A. (2013). Cardiovascular risk factor investigation: A pediatric issue. International Journal of General Medicine, 6, 57–66. Scholar
  42. Rudnicka, A. R., Owen, C. G., & Strachan, D. P. (2007). The effect of breastfeeding on cardiorespiratory risk factors in adult life. Pediatrics, 119(5), e1107–e1115. Scholar
  43. Thorsdottir, I., Gunnarsdottir, I., & Palsson, G. I. (2003). Association of birth weight and breast-feeding with coronary heart disease risk factors at the age of 6 years. Nutrition, Metabolism and Cardiovascular Diseases, 13(5), 267–272.Google Scholar
  44. Umer, A., Hamilton, C., Britton, C. M., Mullett, M. D., John, C., Neal, W., et al. (2015). Association between breastfeeding and childhood obesity: Analysis of a linked longitudinal study of rural Appalachian fifth-grade children. Childhood Obesity, 11(4), 449–455. Scholar
  45. United Health Foundation (UHF). (2014). America’s health ranking. Available at
  46. US Census Bureau. (2011). U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, American Community Survey, Census of Population and Housing, State and County Housing Unit Estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits vol. 2014.Google Scholar
  47. van den Berg, G., van Eijsden, M., Galindo-Garre, F., Vrijkotte, T. G., & Gemke, R. J. (2013). Explaining socioeconomic inequalities in childhood blood pressure and prehypertension: The ABCD study. Hypertension, 61(1), 35–41. Scholar
  48. van Rossem, L., Oenema, A., Steegers, E. A., Moll, H. A., Jaddoe, V. W., Hofman, A., et al. (2009). Are starting and continuing breastfeeding related to educational background? The generation R study. Pediatrics, 123(6), e1017–e1027. Scholar
  49. Victora, C. G., Horta, B. L., Post, P., Lima, R. C., De Leon Elizalde, J. W., Gerson, B. M., et al. (2006). Breast feeding and blood lipid concentrations in male Brazilian adolescents. Journal of Epidemiology and Community Health, 60(7), 621–625. Scholar
  50. WATCH, P. (2013). West Virginia birth score project. This program is funded under an agreement with the West Virginia Department of Health and Human Resources, Bureau for Public Health, Office of Maternal, Child and Family Health. Available at 2013 at
  51. Weng, S. F., Redsell, S. A., Swift, J. A., Yang, M., & Glazebrook, C. P. (2012). Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Archives of Disease in Childhood, 97(12), 1019–1026. Scholar
  52. Wilcox, A. J. (2001). On the importance—and the unimportance of birthweight. International Journal of Epidemiology, 30(6), 1233–1241.Google Scholar
  53. WVDHHR. (2015). West Virginia Vital Statistics. Health statistics center. Room 165, 350 Capitol Street Charleston, WV 25301-3701. DHHR. Avaiable at:

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Amna Umer
    • 1
    Email author
  • Candice Hamilton
    • 1
  • Roger A. Edwards
    • 2
  • Lesley Cottrell
    • 1
  • Peter GiacobbiJr.
    • 3
  • Kim Innes
    • 4
  • Collin John
    • 1
  • George A. Kelley
    • 5
  • William Neal
    • 1
  • Christa Lilly
    • 5
  1. 1.Department of Pediatrics, School of MedicineWest Virginia UniversityMorgantownUSA
  2. 2.Department Health Professions Education Program, Center for Interprofessional Studies and InnovationMGH Institute of Health ProfessionsBostonUSA
  3. 3.Department of Social and Behavioral Sciences, School of Public Health, Robert C. Byrd Health Sciences CenterWest Virginia UniversityMorgantownUSA
  4. 4.Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences CenterWest Virginia UniversityMorgantownUSA
  5. 5.Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences CenterWest Virginia UniversityMorgantownUSA

Personalised recommendations