Breastfeeding as the sole source of milk for 6 months and adolescent bone mineral density
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Little is known regarding the relationship between early life factors and bone mineral density (BMD). We found a positive association between breastfeeding for at least 6 months, without formula supplementation, and whole body adolescent BMD z-score.
The aim of the study is to assess the role of breastfeeding BF on adolescent bone mineral density (BMD) in a cohort prospectively followed since infancy.
We studied 679 participants from an infancy iron deficiency anemia preventive trial in Santiago, Chile, followed to adolescence. Breast and bottle feeding were ascertained weekly from 4 to 12 months. At 16 years, whole body BMD was assessed by DEXA. Using linear regression, we evaluated associations between BF duration and BF as the sole source of milk and adolescent BMD z-score, adjusting for possible infancy, adolescent, and background confounders.
Mean birth weight and length were 3.5 (0.3) kg and 50.7 (1.6) cm. For at least 6 months, BF was the sole source of milk for 26.3% and with supplementation for 36.7%. For 37%, BF was provided for less than 6 months. Mean 16-year BMD z-score was 0.25 (1.0). Covariates included male sex, birth length, and gestational age. BF as the sole source of milk ≥6 months, compared to BF < 6 months, was associated with higher adolescent BMD z-score adjusting for covariates (β = 0.29, p < 0.05). Mixed BF was not significantly related to adolescent BMD z-score (β = 0.06, p = 0.47). For every 30 days of BF as the sole source of milk, adolescent BMD z-score increased by 0.03 (p = 0.01).
BF without formula supplementation for at least 6 months was associated with higher adolescent BMD z-score and a suggestive trend in the same direction for BMD suggests that exclusivity and duration of BF may play a role in adolescent bone health.
KeywordsBone health Developmental origins of disease Lactation Osteoporosis
Bone mineral density
Dual energy X-ray absorptiometry
- IGF I
Insulin-like growth factor I
National Health and Nutrition Examination Survey
World Health Organization
Authors would like to thank the study participants and their families for their on-going commitment to the project.
Compliance with ethical standards
The study was approved by the Institutional Review Boards at the University of California, San Diego, University of Michigan, Ann Arbor, and the Institute of Nutrition and Food Technology (INTA), University of Chile, the study site in Chile.
National Institutes of Health, Heart, Lung, and Blood Institute (HL088530, PI: Gahagan) and the National Institute of Child Health and Human Development (HD14122 and HD33487, PI: Lozoff). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest
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