Breastfeeding duration and eating behavior in early childhood: a systematic review

Ergang, Barbara Cristina; Caprara, Gabriele Luiza; Machado, Mirian Benites; Moreira, Paula Ruffoni; Hagen, Martine Elizabeth Kienzle; Bernardi, Juliana Rombaldi

doi:10.1590/1806-9304202300000074-en

Barbara Cristina Ergang

writing

data analysis

review of the manuscript

approved the final version of the article and declare no conflict of interest

Programa de Pós-Graduação em Alimentos, Nutrição e Saúde. Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2400. Santa Cecilia. Porto Alegre, RS, Brazil. CEP: 90.035-002. Email:

http://orcid.org/0000-0003-2618-8606

Gabriele Luiza Caprara

writing

data analysis

review of the manuscript

approved the final version of the article and declare no conflict of interest

Programa Pós-Graduação em Saúde da Criança e do Adolescente. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil

http://orcid.org/0000-0002-4365-1300

Mirian Benites Machado

writing

data analysis

review of the manuscript

approved the final version of the article and declare no conflict of interest

Programa Pós-Graduação em Saúde da Criança e do Adolescente. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil

http://orcid.org/0000-0001-8624-8151

Paula Ruffoni Moreira

approved the final version of the article and declare no conflict of interest

writing and review of the manuscript

Programa de Pós-Graduação em Alimentos, Nutrição e Saúde. Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2400. Santa Cecilia. Porto Alegre, RS, Brazil. CEP: 90.035-002. Email:

http://orcid.org/0000-0001-9972-3652

Martine Elizabeth Kienzle Hagen

review of the manuscript

approved the final version of the article and declare no conflict of interest

Programa de Pós-Graduação em Alimentos, Nutrição e Saúde. Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2400. Santa Cecilia. Porto Alegre, RS, Brazil. CEP: 90.035-002. Email:

http://orcid.org/0000-0002-3838-3866

Juliana Rombaldi Bernardi

review of the manuscript

research guidance

approved the final version of the article and declare no conflict of interest

Programa de Pós-Graduação em Alimentos, Nutrição e Saúde. Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2400. Santa Cecilia. Porto Alegre, RS, Brazil. CEP: 90.035-002. Email:

http://orcid.org/0000-0002-6803-4472

Associated Editor: Ana Ortigoza

Population	Healthy children
Exposure	More exposure to exclusive and total breastfeeding
Comparison	Less exposure to exclusive and total breastfeeding
Outcome	Eating behavior aged two to six years

Nº	Cohort studies	1	2	3	4	5	6	7	8	9	10	11	Overall appraisal
01	Möller et al.²⁵25 Möller LM, Hoog ML, van Eijsden M, Gemke RJ, Vrijkotte TG. Infant nutrition in relation to eating behaviour and fruit and vegetable intake at age 5 years. Br J Nutr. 2013 Feb; 109 (3): 564-71.	Y	Y	Y	Y	Y	Y	Y	Y	Y	NA	Y	Include
02	Barse et al.²⁶26 Barse LM, Jansen PW, Edelson-Fries LR, Jaddoe VWV, Franco OH, Tiemeier, et al. Infant feeding and child fussy eating: The Generation R Study. Appetite. 2017 Jul; 114: 374-81.	Y	Y	Y	Y	Y	Y	Y	U	Y	NA	Y	Include
03	Specht et al.²⁷27 Specht IO, Rohde JF, Olsen NJ, Heitmann BL. Duration of exclusive breastfeeding may be related to eating behaviour and dietary intake in obesity prone normal weight young children. PLoS One. 2018 Jul; 13 (7): e0200388.	Y	Y	Y	Y	Y	Y	U	Y	Y	NA	Y	Include
04	Pang et al.²⁸28 Pang WW, McCrickerd K, Quah PL, Fogel A, Aris IM, Yuan WL, et al. Is breastfeeding associated with later child eating behaviours? Appetite. 2020 Jul; 150: 104653.	Y	Y	Y	Y	Y	Y	Y	Y	Y	NA	Y	Include
Nº	Cross-sectional studies	1	2	3	4	5	6	7	8	Overall appraisal
05	Shim et al.²⁹29 Shim JE, Kim J, Mathai RA; STRONG Kids Research Team. Associations of infant feeding practices and picky eating behaviors of preschool children. J Am Diet Assoc. 2011 Sep; 111 (9): 1363-8.	Y	U	N	U	Y	Y	Y	Y	Include
06	Borkhoff et al.⁴4 Borkhoff CM, Dai DWH, Jairam JA, Wong PD, Cox KA, Maguire JL, et al. Breastfeeding to 12 mo and beyond: nutrition outcomes at 3 to 5 y of age. Am J Clin Nutr. 2018 Aug; 108 (2): 354-62.	Y	Y	U	N	Y	N	Y	Y	Include
07	Maranhão et al.³⁰30 Maranhão HS, Aguiar RC, Lira DTJ, Sales MUF, Nóbrega NADN. Feeding difficulties in preschool children, previous feeding practices, and nutritional status. Rev Paul Pediatr. 2017 Oct; 36 (1): 7.	Y	Y	N	Y	Y	Y	Y	Y	Include

Author/year	Country	Sample and design	Main purpose	Exposure and instrument	Outcome and instrument	Age (years)	Statistical Analysis	Main results
Specht et al.²⁷27 Specht IO, Rohde JF, Olsen NJ, Heitmann BL. Duration of exclusive breastfeeding may be related to eating behaviour and dietary intake in obesity prone normal weight young children. PLoS One. 2018 Jul; 13 (7): e0200388. 2018	Denmark	263 Cohort	Investigate if exclusive breastfeeding duration was associated with pickiness or intake of vegetables, fruit, starchy foods or sugar-sweetened beverages in obesity prone normal weight children.	Exclusive breastfeeding duration Own questionnaire	Eating behavior Own questionnaire	Two to six	Logistic regression analyses	- 20.2% of the children were only exclusively breastfed until age 0-1 month, and 14.8% were exclusively breastfed until age 6-10 months; 52.9% of the children were exclusively breastfed until age 4-5 months. - Picky eating behavior was observed in 16.0% of the children and 46.4% were a little picky at baseline. - It was observed a lower OR of picky eating behavior among those exclusively breastfed until 4-5 months and those exclusively breastfed for 0-1 month in both crude (OR crude = 0.51; CI95%=0.27; 0.98, p=0.04) and adjusted analyses (OR adjusted = 0.35; CI95%=0.16; 0.76; p=0.008).
Barse et al.²⁶26 Barse LM, Jansen PW, Edelson-Fries LR, Jaddoe VWV, Franco OH, Tiemeier, et al. Infant feeding and child fussy eating: The Generation R Study. Appetite. 2017 Jul; 114: 374-81. 2017	The Netherlands.	4,779 Prospective cohort	Investigate if a longer duration of any breastfeeding as well as early complementary feeding would be related to less fussy eating at four years of age.	Breastfeeding duration Own questionnaire.	Fussy eating behavior CEBQ	Four	Linear regression and sensitivity analyses	- The mean duration of breastfeeding was 5.1 months (SD=3.8 months). - It was observed a dose-response relation between any breastfeeding duration and fussy eating (OR= -0.06; CI95%=-0.10; -0.02) - Never breastfed children did not differ in their food fussiness score from children with a recommended breastfeeding duration (≥6 months). - Children who were breastfed between 2 and 4 months or between 4 and 5 months did not differ from children who were breastfed for at least 6 months either in their food fussiness score. - Children who were breastfed for a short period of time (between 1 day and 2 months) had 0.70 points higher food fussiness score (CI95%=0.27; 1.12) than children with a breastfeeding duration of 6 months or longer. - Children who were exclusively breastfed for at least 4 months did not differ significantly in their food fussiness scores from children who were partially breastfed at 4 months (OR=0.33; CI95%=-0.04; 0.70) or never breastfed (OR=-0.32; CI95%=-1.01; 0.38).
Möller et al.²⁵25 Möller LM, Hoog ML, van Eijsden M, Gemke RJ, Vrijkotte TG. Infant nutrition in relation to eating behaviour and fruit and vegetable intake at age 5 years. Br J Nutr. 2013 Feb; 109 (3): 564-71. 2012	The Netherlands	3,624 Prospective birth cohort	Investigate if a long exclusive breastfeeding duration and late introduction of solid foods would be associated with healthy eating behavior.	Exclusive breastfeeding duration Own questionnaire	Eating behavior CEBQ	Five	χ²2 LaCaille L. Eating Behavior. In: Gellman MD, Turner JR (eds) Encyclopedia of Behavioral Medicine. New York: Springer; 2013. p. 641-2. test, ANOVA and linear regression analyses	- 467 children were exclusive breastfed for 6 months. - In the crude analyses and after adjustment for maternal and child factors, children who were exclusively breastfed for 3-6 months scored higher on food responsiveness than children who received exclusive breastfeeding for at least 6 months. - Exclusive breastfeeding duration was not associated with later eating behavior.
Pang et al.²⁸28 Pang WW, McCrickerd K, Quah PL, Fogel A, Aris IM, Yuan WL, et al. Is breastfeeding associated with later child eating behaviours? Appetite. 2020 Jul; 150: 104653. 2020	Singapore	970 Cohort	Examine the relationship between breastfeeding exposure and subsequent eating behaviors	Breastfeeding duration Own questionnaire	Eating behaviors PFQ and CEBQ	three and six	Linear regression	- The majority of study children had either low or intermediate exposure to breastfeeding during infancy (44.3% and 43.5%, respectively); 12.2% had high breastfeeding exposure. - At 3 years, mothers in the high breastfeeding group reported less difficulty in child feeding than those in the low breastfeeding group. - It found no significant associations between breastfeeding exposure and the CEBQ measure of satiety responsiveness at 3 or 6 years. - Children in the high breastfeeding group had significantly lower levels of reported food fussiness at 3 years than those in the low breastfeeding group; this trend was weaker and no longer significant at the age of 6 years.
Shim et al.²⁹29 Shim JE, Kim J, Mathai RA; STRONG Kids Research Team. Associations of infant feeding practices and picky eating behaviors of preschool children. J Am Diet Assoc. 2011 Sep; 111 (9): 1363-8. 2011	United States	129 Cross-sectional	Investigate the association between infant-feeding practices and picky eating behavior in preschool-aged children	Exclusive and total breastfeeding duration Own questionnaire	Picky eating behavior Oregon Research Institute Child Eating Behavior Inventory	two to three	Logistic regression model	- Children who had been exclusively breastfed for 3 months in infancy had reduced the OR of presenting a preference for specific food-preparation methods during their preschool years. - Exclusive breastfeeding during the first 6 months had lowered the OR of each indirect measure of limited variety: preference for specific food preparation methods by 78%, food rejection by 81%, and food neophobia by 75%. - Any breastfeeding and breastfeeding initiation showed only a statistically insignificant tendency of risk reduction in the development of picky eating behavior.
Borkhoff et al.⁴4 Borkhoff CM, Dai DWH, Jairam JA, Wong PD, Cox KA, Maguire JL, et al. Breastfeeding to 12 mo and beyond: nutrition outcomes at 3 to 5 y of age. Am J Clin Nutr. 2018 Aug; 108 (2): 354-62. 2018	Canada	2,987 Cross-sectional	Examine the association between total breastfeeding duration up to 36 months of age and later nutrition outcomes at three to five years of age.	Total breastfeeding duration Own questionnaire	Nutrition outcomes NutriSTEP	Three to five	Linear regression and restricted cubic spline modeling	- The majority of children were breastfed (92%) and the mean total breastfeeding duration was 11 months. - Every 1 month increase in total breastfeeding duration was associated with a decrease in eating behaviors score of -0.03 (CI95%=-0.04; -0.02). - It was confirmed a nonlinear relationship between total breastfeeding duration and NutriSTEP eating behavior subscores.
Maranhão et al.³⁰30 Maranhão HS, Aguiar RC, Lira DTJ, Sales MUF, Nóbrega NADN. Feeding difficulties in preschool children, previous feeding practices, and nutritional status. Rev Paul Pediatr. 2017 Oct; 36 (1): 7. 2018	Brazil	301 Cross-sectional	Identify the prevalence of feeding difficulties in preschoolers, its association with epidemiological factors and past eating practices, as well as its repercussion on nutritional status.	Breastfeeding duration Own questionnaire	Feeding difficulties Kerzner’s criteria	Two to six	χ²2 LaCaille L. Eating Behavior. In: Gellman MD, Turner JR (eds) Encyclopedia of Behavioral Medicine. New York: Springer; 2013. p. 641-2. test, t-student and linear regression	- Half of the children were exclusively breastfed until 4 months of age (49.7%) and 6.7% never received breast milk. - The occurrence of child feeding difficulties was reported by 25.1% of mothers. - Specific feeding difficulty was found in 37.2% of cases, with a predominance of “highly selective intake” (25.4%). - Feeding practices in the infant period were not associated with current feeding difficulties.

[1] Associated Editor: Ana Ortigoza

Brasil

Brasil

Breastfeeding duration and eating behavior in early childhood: a systematic review

Abstract

Objectives:

Methods:

Results:

Conclusion: