Читать книгу Nutrition and Growth - Группа авторов - Страница 34

Hui LL^1,2, Kwok MK², Nelson EAS¹, Lee SL³, Leung GM², Schooling CM^2,4

¹Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; ³Department of Pediatrics and Adolescent Medicine and ²School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; ⁴CUNY, School of Public Health, New York, NY, USA

Pediatrics 2019;143:e20183075

Objective: Breast milk has higher cholesterol than formula. Infants who are breastfed have different cholesterol synthesis and metabolism in infancy than infants who are formula fed. Little is known as to whether breastfeeding is associated with subsequent lipid profile, independent of adiposity. We assessed the association of breastfeeding in early infancy with lipid profile and adiposity at ∼17.5 years in a setting where exclusive breastfeeding is not associated with higher socioeconomic position.

Methods: We used multivariable linear regression with multiple imputation and inverse probability weighting to examine the associations of contemporaneously reported feeding in the first 3 months of life (exclusive breastfeeding [7.5%], mixed feeding [40%], or always formula feeding [52%]) with lipids and adiposity at ∼17.5 years in 3,261 participants in the Hong Kong Chinese birth cohort children of 1997, adjusting for sex, birth weight, gestational weeks, parity, pregnancy characteristics, parents’ highest education, mother’s place of birth, and age at follow-up.

Results: Exclusive breastfeeding, but not mixed feeding at 0–3 months, compared with formula feeding was associated with lower total cholesterol and low-density lipoprotein cholesterol but not with high-density lipoprotein cholesterol at ∼17.5 years. BMI and fat percentage measured by bioimpedance did not differ by type of infant feeding.

Conclusions: Exclusive breastfeeding in early infancy may promote a healthier lipid profile in late adolescence through mechanisms unrelated to adiposity, implicating its potential long-term benefits for cardiovascular health.

Reprinted with permission from the American Academy of Pediatrics (AAP).

Comments

High plasma concentrations of cholesterol are a principal risk factor for atherogenesis and thus a major cause of cardiovascular disease. Animal and epidemiological evidence suggest that exposures acting in early life may play a role in cardiovascular disease risk, and infant nutrition is one early-life factor that has generated much interest amongst life course researchers in recent years.Breast milk has higher cholesterol than formula [8]. Infants who are breastfed have different cholesterol synthesis and metabolism in infancy than infants who are formula fed, with higher plasma cholesterol and less endogenous cholesterol synthesis in those who are breastfed [9].Such early changes in cholesterol metabolism may program subsequent cholesterol homeostasis and lipid profile in adulthood.This study reveals that the impact of breastfeeding on lipids is independent of adiposity because being exclusively breastfed was not associated with a lower BMI or fat percentage, suggesting that the long-term impact of exclusive breastfeeding in early infancy could be independent of mediating pathways related to adiposity.Potential mechanisms could involve changes in the expression of 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase and LDL receptors. The genetic variant related to expression of HMG-CoA reductase (rs12916 in HMGCR) is associated with LDL-C but not with HDL-C, whereas genetic variants related to LDL receptors (rs11613352 [LRP1], rs3136441 [LRP4], and rs11206510 [PCSK4]) are associated with changes in both LDL-C and HDL-C.Thus, the observation of the study that lower LDL-C, but not lower HDL-C, in individuals who are exclusively breastfed appears to be more consistent with the role of HMGCoA reductase in the programing effect of early cholesterol exposure, if any. Such a programing effect may explain the change in lipid profile but not in markers of adiposity by type of infant feeding observed here.However, evidence is still lacking as to whether such a change in synthesis or metabolism of cholesterol in the neonatal period persists beyond weaning and into adulthood. Whether other differences between breast and formula milk (e.g., a higher phytosterol, protein, or galactose level in formula milk) could program lipid metabolism requires further research to elucidate.The strengths of the study include the large number of patients included, the long-term follow-up, and the setting of the study where exclusive breastfeeding is not associated with higher socioeconomic position (which is also linked to better health). The study is limited by the lack of data about maternal lipid profile that also may have an impact on maternal diet and breast milk. Also, there is a lack of information on diet after early infancy and on whether types of solid food given after weaning differed by mode of infant feeding. A higher proportion of participants who were exclusively breastfed had later solid food introduction, so we cannot rule out the possibility that the association of early infant feeding with lipids is due to subsequent dietary factors and that early exposure to breast milk has an effect on dietary behavior in later life (behavioral programming).In conclusion, here we have another potential benefit of breastfeeding, and therefore, it should be advocated, when possible, as the preferred method of feeding in early life.

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