Elsevier

The Lancet

Volume 350, Issue 9072, 19 July 1997, Pages 166-168
The Lancet

Articles
Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians

https://doi.org/10.1016/S0140-6736(96)12103-6Get rights and content

Summary

Background

Early exposure to cow's milk has been implicated in the occurrence of insulin-dependent diabetes mellitus but there is little information about infant-feeding practices and subsequent non-insulin-dependent diabetes mellitus (NIDDM). We examined the association between breastfeeding and NIDDM in a population with a high prevalence of this disorder, the Pima Indians.

Methods

Glucose-tolerance status was obtained from a 75 g oral glucose-tolerance test. A standard questionnaire given to mothers was used to classify infant-feeding practices for the first 2 months of life into three groups; exclusively breastfed, some breastfeeding, or exclusively bottlefed. The association between the three infant-feeding groups and NIDDM was analysed by multiple logistic regression.

Findings

Data were available for 720 Pima Indians aged between 10 and 39 years. 325 people who were exclusively bottlefed had significantly higher age-adjusted and sex-adjusted mean relative weights (146%) than 144 people who were exclusively breastfed (140%) or 251 people who had some breastfeeding (139%) (p=0·019). People who were exclusively breastfed had significantly lower rates of NIDDM than those who were exclusively bottlefed in all age-groups (age 10–19, 0 of 56 vs 6 [3·6%] of 165; age 20–29, 5 [8·6%] of 58 vs 17 [14·7%] of 116]; age 30–39, 6 [20·0%] of 30 vs 13 [29·6%] of 44). The odds ratio for NIDDM in exclusively breastfed people, compared with those exclusively bottlefed, was 0·41 (95% CI 0·18–0·93) adjusted for age, sex, birthdate, parental diabetes, and birthweight.

Interpretation

Exclusive breastfeeding for the first 2 months of life is associated with a significantly lower rate of NIDDM in Pima Indians. The increase in prevalence of diabetes in some populations may be due to the concomitant decrease in breastfeeding.

Introduction

The last trimester of gestation and the early months of life are critical periods in the development of body size and metabolism.1 Children who are breastfed have a lower weight for their age than bottlefed children.2, 3, 4, 5 Certain patterns of infant feeding have been associated with adult obesity.3, 4 In the first year of life, breastfeeding has many benefits,6, 7, 8, 9 but apart from effects on growth, the possible long-term metabolic effects of the type of infant feeding have not been studied.

Although cow's milk formulas have been implicated in the aetiology of insulin-dependent diabetes mellitus (IDDM),10, 12 no study has described an association with non-insulin-dependent diabetes mellitus (NIDDM). Obesity, however, is a strong risk factor for NIDDM, and we investigated the association between infant-feeding practices and NIDDM in later life among Pima Indians. This population has a high prevalence of NIDDM, but IDDM has not been found.13, 15

Section snippets

Methods

Infant-feeding data on 933 Pima Indian people, born between 1950 and 1978, were provided by their mothers in 1978 as detailed previously.16, 17, 18 Briefly, trained interviewers recorded data about each child from women aged between 15 and 44 years. These data included details about the duration of breastfeeding and time of introduction of bottlefeeding.

741 individuals were examined between the ages of 10 and 39 years as part of a longitudinal study of diabetes.13 Height and weight were

Results

Characteristics of the 720 people included in this study are shown in Table 1. Among those who were exclusively breastfed, formula feeds were started at (median [interquartile range]) 4 months (2–6). Table 2 shows the age-specific rate of diabetes by infant-feeding group. The rate of diabetes increases with age and, within each age group, is lower in exclusively breastfed people. The odds ratios for diabetes from the logistic regression model are shown in Table 3. The odds ratio for the

Discussion

Exclusive breastfeeding for at least 2 months is associated with a lower rate of NIDDM in Pima Indians aged 40 years or less. This effect persists when other well-known diabetes risk factors are taken into account. The infant-feeding data were collected by means of a detailed questionnaire administered by trained interviewers to the mothers in 1978 irrespective of the health status of their offspring and before most had developed diabetes.16, 17, 18 Thus, the infant-feeding data were not biased

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