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Infant nutrition, maternal obesity affect risk for NAFLD in adolescents
Breastfeeding for at least the first 6 months of life, while avoiding infant formula consumption, and normal maternal pre-pregnancy BMI may reduce the later risk for developing nonalcoholic fatty liver disease during adolescence, according to results of a longitudinal prospective study.
“Maternal obesity has been associated with shorter durations of breastfeeding, early introduction of supplementary formula milk and complementary food, possibly unhealthy food preferences in childhood and later obesity,” Oyekoya T. Ayonrinde, MBBS, FRACP, from the University of Western Australia, Perth, and colleagues wrote. “We report an inverse association between the duration of infant breastfeeding as well as the age at introducing supplementary formula milk on the subsequent diagnosis of NAFLD in adolescence.”
The researchers followed adolescent patients between July 2006 and June 2009, performing liver ultrasound, and anthropometric, clinical and biochemical measurements, and conducting questionnaires at age 17. The study comprised 1,167 patients, 177 of whom had NAFLD.
Compared with patients without NAFLD, the mothers of those with NAFLD were younger when pregnant (27.9 vs. 28.9 years; P = .04), had higher pre-pregnancy weight (64.3 vs. 58.8 kg; P < .001), had higher pre-pregnancy BMI (23.8 vs. 21.9 kg/m2; P < .001) and were more likely to smoke (27.8% vs. 20.5%; P = .03). Additionally, patients with NALFD had a shorter duration of breastfeeding (5 vs. 7 months; P = .01) and were a younger age when they started using formula milk (3 vs. 4 months; P = .006).
Patients who were exclusively breastfed for 4 months or longer, compared with those who began supplementary formula intake at that time, had a lower prevalence of NAFLD (12.1% vs. 17.1%; P = .02) and reduced odds for NAFLD after adjusting for maternal obesity (OR = 0.67; 95% CI, 0.48-0.96).
Researchers observed an association between exclusive breastfeeding for 6 months or longer and reduced odds for NAFLD after adjusting for adolescent and maternal obesity (aOR = 0.64; 95% CI, 0.43-0.94), healthy and Western dietary patterns during adolescence (aOR = 0.6; 95% CI, 0.41-0.87), and complementary solid food intake (11.1% vs. 17.6%; P = .002), compared with those who breastfed exclusively for less than 6 months.
The significant risk factors associated with adolescent diagnosis of NAFLD included exclusive breastfeeding for less than 4 months (OR = 0.67; 95% CI, 0.47-0.95), supplementary formula intake starting before age 6 months (OR = 1.71; 95% CI, 1.2-2.43), a pre-pregnancy BMI of 30 kg/m2 or higher (OR = 3.16; 95% CI, 1.83-5.44), mother’s age (OR = 0.97; 95% CI, 0.95-0.999), female sex in infants (OR = 2.05; 95% CI, 1.47-2.85), smoking during pregnancy (OR = 1.5; 95% CI, 1.04-2.16), neonate bottle feeding on discharge from hospital (OR = 1.88; 95% CI, 1.06-3.33), breastfeeding with no supplementary formula at 6 months or longer (OR = 0.57; 95% CI, 0.4-0.82), infants consuming breast milk at 12 months (OR = 0.45; 95% CI, 0.27-0.74), and annual family income below $35,000 (OR = 0.69; 95% CI, 0.43-1.09).
“The explanation of the protective effect of breastfeeding is in line with the pathogenetic role of gut microbiota in NAFLD development in both adults and children,” Anna Alisi, PhD, from the Bambino Gesù Children’s Hospital in Italy, and Pietro Vajro, MD, from the University of Salerno, Italy, wrote in a related editorial. “In fact, the breast milk could be the vehicle to transfer probiotic bacteria from the mother to the infant, thus contributing to the early gut colonization. The microbiota in the intestine of breastfed infants was described to contain higher proportions of healthy Bifidobacterium spp. and Lactobacillus spp. than formula-fed infants. Interestingly, identical strains of Bifidobacterium and Lactobacillus are present in breast milk suggesting that this might confer benefits to the infant.”– by Talitha Bennett
Disclosure: The researchers and editorial authors report no relevant financial disclosures.