Research Original Research| Volume 117, ISSUE 7, P1049-1056, July 2017

Breastfeeding in Infancy Is Associated with Body Mass Index in Adolescence: A Retrospective Cohort Study Comparing American Indians/Alaska Natives and Non-Hispanic Whites

Published:January 10, 2017DOI:



      American Indians and Alaska Natives have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI; calculated as kg/m2) is not well understood. Previous studies have investigated the association between breastfeeding in infancy and offspring BMI, but rarely included American Indians and Alaska Natives.


      This study investigated the association between breastfeeding in infancy and BMI in American Indians and Alaska Native and non-Hispanic white adolescents and young adults.


      Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994 to 2008).


      Adolescent respondents who self-identified as American Indians and Alaska Native or non-Hispanic white, and whose parents completed the parental questionnaire, reported their height and weight. The final sample included 655 American Indians and Alaska Native and 10,305 non-Hispanic white respondents.

      Statistical analyses performed

      Generalized estimating equations were used to measure the mean differences, 95% CIs, and P values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables.


      The length of breastfeeding was inversely associated with BMI in both populations. American Indians and Alaska Natives that were breastfed for 6 to 12 months or for more than 12 months had a mean BMI of 2.69 (95% CI −3.46 to −1.92; P<0.01) and 1.54 (95% CI −2.75 to −0.33; P<0.05) units lower than those that were never breastfed. Non-Hispanic whites that were breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI of 0.71 (95% CI −0.93 to −0.50; P<0.01), 0.68 (95% CI −0.87 to −0.50; P<0.01), and 0.85 (95% CI −1.09 to −0.62; P<0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (P<0.01).


      Breastfeeding in infancy is associated with lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in American Indians and Alaska Natives can prevent increasing BMI.


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      1. Centers for Disease Control and Prevention. Survey health statistics for US adults: National Health Interview Survey 2011. Accessed July 22, 2016.

        • Flegal K.M.
        • Wei R.
        • Ogden C.L.
        • Freedman D.S.
        • Johnson C.L.
        • Curtin L.R.
        Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts.
        Am J Clin Nutr. 2009; 90: 1314-1320
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Story M.
        • Stevens J.
        • Himes J.
        • et al.
        Obesity in American-Indian children: Prevalence, consequences, and prevention.
        Prev Med. 2003; 37: S3-S12
        • Caballero B.
        • Clay T.
        • Davis S.M.
        • et al.
        Pathways: A school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren.
        Am J Clin Nutr. 2003; 78: 1030-1038
        • Stone E.J.
        • Norman J.E.
        • Davis S.M.
        • et al.
        Design, implementation, and quality control in the Pathways American-Indian multicenter trial.
        Prev Med. 2003; 37: S13-S23
        • Adams A.
        • Prince R.
        Correlates of physical activity in young American Indian children: Lessons learned from the Wisconsin Nutrition and Growth Study.
        J Public Health Manag Pract. 2010; 16: 394-400
        • De Long A.J.
        • Larson N.I.
        • Story M.
        • Neumark-Sztainer D.
        • Weber-Main A.M.
        • Ireland M.
        Factors associated with overweight among urban American Indian adolescents: Findings from the project EAT.
        Ethn Dis. 2008; 18: 317-323
        • Holm J.E.
        • Lilienthal K.R.
        • Poltavski D.V.
        • Vogeltanz-Holm N.
        Relationships between health behaviors and weight status in American Indian and white rural children.
        J Rural Health. 2013; 29: 349-359
        • Jollie-Trottier T.
        • Holm J.E.
        • McDonald J.D.
        Correlates of overweight and obesity in American Indian children.
        J Pediatr Psychol. 2009; 34: 245-253
        • Ness M.
        • Barradas D.T.
        • Irving J.
        • Manning S.E.
        Correlates of overweight and obesity among American Indian/Alaska Native and non-Hispanic white children and adolescents: National Survey of Children's Health, 2007.
        Matern Child Health J. 2012; 16: 268-277
        • Story M.
        • Strauss K.F.
        • Zephier E.
        • Broussard B.A.
        Nutritional concerns in American Indian and Alaska Native children: Transitions and future directions.
        J Am Diet Assoc. 1998; 98: 170-176
        • Seal N.
        • Broome M.E.
        Prepregnancy body mass index and feeding practices in relation to infants' growth.
        J Nurse Pract. 2013; 9: 270-276
        • Eckhardt C.L.
        • Lutz T.
        • Karanja N.
        • Jobe J.B.
        • Maupome G.
        • Ritenbaugh C.
        Knowledge, attitudes, and beliefs that can influence infant feeding practices in American Indian mothers.
        J Acad Nutr Diet. 2014; 114: 1587-1593
        • Karanja N.
        • Lutz T.
        • Ritenbaugh C.
        • et al.
        The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: A feasibility and efficacy study.
        J Community Health. 2010; 35: 667-675
        • Lindberg S.M.
        • Adams A.K.
        • Prince R.J.
        Early predictors of obesity and cardiovascular risk among American Indian children.
        Matern Child Health J. 2012; 16: 1879-1886
        • Horta B.L.
        • Victora C.G.
        Long-Term Effects of Breastfeeding: A Systematic Review.
        World Health Organization, Geneva2013
        • Harder T.
        • Bergmann R.
        • Kallischnigg G.
        • Plagemann A.
        Duration of breastfeeding and risk of overweight: A meta-analysis.
        Am J Epidemiol. 2005; 162: 397-403
        • Cope M.B.
        • Allison D.B.
        Critical review of the World Health Organization's (WHO) 2007 report on 'evidence of the long-term effects of breastfeeding: Systematic reviews and meta-analysis' with respect to obesity.
        Obes Rev. 2008; 9: 594-605
        • Owen C.G.
        • Martin R.M.
        • Whincup P.H.
        • Davey-Smith G.
        • Gillman M.W.
        • Cook D.G.
        The effect of breastfeeding on mean body mass index throughout life: A quantitative review of published and unpublished observational evidence.
        Am J Clin Nutr. 2005; 82: 1298-1307
        • Horta B.L.
        • Loret de Mola C.
        • Victora C.G.
        Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis.
        Acta Paediatr. 2015; 104: 30-37
      2. National Longitudinal Study of Adolescent Health (Add Health), 1994-2008. Accessed October 28, 2013.

        • Dietz W.H.
        • Robinson T.N.
        Clinical practice. Overweight children and adolescents.
        N Engl J Med. 2005; 352: 2100-2109
        • McDade T.W.
        • Metzger M.W.
        • Chyu L.
        • Duncan G.J.
        • Garfield C.
        • Adam E.K.
        Long-term effects of birth weight and breastfeeding duration on inflammation in early adulthood.
        Proc Biol Sci. 2014; 281: 20133116
      3. R: A language and environment for statistical computing [computer program]. Accessed May 11, 2015.

      4. Brownstein N, Kalsbeek WD, Tabor J, Entzel P, Daza E, Harris KM. Non-response in wave IV of the National Longitudinal Study of Adolescent Health. Accessed on May 22, 2015.

        • Albrecht S.S.
        • Gordon-Larsen P.
        Ethnic differences in body mass index trajectories from adolescence to adulthood: A focus on Hispanic and Asian subgroups in the United States.
        PLoS One. 2013; 8: e72983
        • Cortese S.
        • Falissard B.
        • Pigaiani Y.
        • et al.
        The relationship between body mass index and body size dissatisfaction in young adolescents: Spline function analysis.
        J Am Diet Assoc. 2010; 110: 1098-1102
        • Robbins J.M.
        • Bridges M.D.
        • Childers E.M.
        • Harris R.M.
        • McElfish P.A.
        Lessons from prenatal care provider-based recruitment into the National Children's Study.
        Pediatr Rep. 2015; 7: 65-70
        • Radler B.T.
        • Ryff C.D.
        Who participates? Accounting for longitudinal retention in the MIDUS national study of health and well-being.
        J Aging Health. 2010; 22: 307-331
        • Stevens E.E.
        • Patrick T.E.
        • Pickler R.
        A history of infant feeding.
        J Perinat Educ. 2009; 18: 32-39
        • American Academy of Pediatrics
        Breastfeeding and the use of human milk.
        Pediatrics. 2012; 115: e827-e841
      5. World Health Organization. Infant and young child feeding. Acceessed on January 4, 2016.

      6. Centers for Disease Control and Prevention. Healthy People 2020. Accessed on January 3, 2016.

      7. US Department of Health and Health Services. The Surgeon General's Call to Action to Support Breastfeeding. Accessed on January 11, 2016.

        • Owen C.G.
        • Martin R.M.
        • Whincup P.H.
        • Smith G.D.
        • Cook D.G.
        Effect of infant feeding on the risk of obesity across the life course: A quantitative review of published evidence.
        Pediatrics. 2005; 115: 1367-1377
        • Chapman D.J.
        Exclusive breastfeeding through 6 months: Infant intake and growth patterns.
        J Hum Lact. 2012; 28: 132-133
        • McDonald S.D.
        • Pullenayegum E.
        • Chapman B.
        • et al.
        Prevalence and predictors of exclusive breastfeeding at hospital discharge.
        Obstet Gynecol. 2012; 119: 1171-1179
        • Haisma H.
        • Coward W.A.
        • Albernaz E.
        • et al.
        Breast milk and energy intake in exclusively, predominantly, and partially breast-fed infants.
        Eur J Clin Nutr. 2003; 57: 1633-1642
        • Gibbs B.G.
        • Forste R.
        Socioeconomic status, infant feeding practices and early childhood obesity.
        Pediatr Obes. 2014; 9: 135-146
        • Huh S.Y.
        • Rifas-Shiman S.L.
        • Taveras E.M.
        • Oken E.
        • Gillman M.W.
        Timing of solid food introduction and risk of obesity in preschool-aged children.
        Pediatrics. 2011; 127: e544-e551
        • Moorcroft K.E.
        • Marshall J.L.
        • McCormick F.M.
        Association between timing of introducing solid foods and obesity in infancy and childhood: A systematic review.
        Matern Child Nutr. 2011; 7: 3-26
        • Shields L.
        • O'Callaghan M.
        • Williams G.M.
        • Najman J.M.
        • Bor W.
        Breastfeeding and obesity at 14 years: A cohort study.
        J Paediatr Child Health. 2006; 42: 289-296
        • Victora C.G.
        • Barros F.
        • Lima R.C.
        • Horta B.L.
        • Wells J.
        Anthropometry and body composition of 18 year old men according to duration of breast feeding: Birth cohort study from Brazil.
        BMJ. 2003; 327: 901
        • Huus K.
        • Ludvigsson J.F.
        • Enskar K.
        • Ludvigsson J.
        Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: A prospective cohort study.
        BMC Pediatr. 2008; 8: 42
        • Hawkins S.S.
        • Cole T.J.
        • Law C.
        • Millennium Cohort Study Child Health Group
        An ecological systems approach to examining risk factors for early childhood overweight: Findings from the UK Millennium Cohort Study.
        J Epidemiol Community Health. 2009; 63: 147-155
        • Bentley M.E.
        • Dee D.L.
        • Jensen J.L.
        Breastfeeding among low income, African-American women: Power, beliefs and decision making.
        J Nutr. 2003; 133: 305S-309S
        • Meyerink R.O.
        • Marquis G.S.
        Breastfeeding initiation and duration among low-income women in Alabama: The importance of personal and familial experiences in making infant-feeding choices.
        J Hum Lact. 2002; 18: 38-45
        • Sipsma H.L.
        • Divney A.A.
        • Magriples U.
        • Hansen N.
        • Gordon D.
        • Kershaw T.
        Breastfeeding intentions among pregnant adolescents and young adults and their partners.
        Breastfeed Med. 2013; 8: 374-380
        • Sipsma H.L.
        • Magriples U.
        • Divney A.
        • Gordon D.
        • Gabzdyl E.
        • Kershaw T.
        Breastfeeding behavior among adolescents: Initiation, duration, and exclusivity.
        J Adolesc Health. 2013; 53: 394-400
        • Hadley C.
        • Lindstrom D.
        • Belachew T.
        • Tessema F.
        Ethiopian adolescents' attitudes and expectations deviate from current infant and young child feeding recommendations.
        J Adolesc Health. 2008; 43: 253-259
        • Hannon P.R.
        • Willis S.K.
        • Bishop-Townsend V.
        • Martinez I.M.
        • Scrimshaw S.C.
        African-American and Latina adolescent mothers' infant feeding decisions and breastfeeding practices: A qualitative study.
        J Adolesc Health. 2000; 26: 399-407
        • Bartok C.J.
        • Ventura A.K.
        Mechanisms underlying the association between breastfeeding and obesity.
        Int J Pediatr Obes. 2009; 4: 196-204
        • Caldwell J.Y.
        • Davis J.D.
        • Du Bois B.
        • et al.
        Culturally competent research with American Indians and Alaska Natives: Findings and recommendations of the first symposium of the work group on American Indian Research and Program Evaluation Methodology.
        Am Indian Alsk Native Ment Health Res. 2005; 12: 1-21
        • Norton I.M.
        • Manson S.M.
        Research in American Indian and Alaska Native communities: Navigating the cultural universe of values and process.
        J Consult Clin Psychol. 1996; 64: 856-860
        • Sherry B.
        • Jefferds M.E.
        • Grummer-Strawn L.M.
        Accuracy of adolescent self-report of height and weight in assessing overweight status: A literature review.
        Arch Pediatr Adolesc Med. 2007; 161: 1154-1161
        • Disantis K.I.
        • Collins B.N.
        • Fisher J.O.
        • Davey A.
        Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle?.
        Int J Behav Nutr Phys Act. 2011; 8: 89
        • Gillespie B.
        • d'Arcy H.
        • Schwartz K.
        • Bobo J.K.
        • Foxman B.
        Recall of age of weaning and other breastfeeding variables.
        Int Breastfeed J. 2006; 1: 4
        • Israel B.A.
        • Schulz A.J.
        • Parker E.A.
        • Becker A.B.
        Review of community-based research: assessing partnership approaches to improve public health.
        Annu Rev Public Health. 1998; 19: 173-202


      A. Zamora-Kapoor is an assistant research professor, Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, and an affiliate assistant professor, Department of Pediatrics, University of Washington, Seattle.


      A. Omidpanah is a biostatistician, Initiative for Research and Education to Advance Community Health, Washington State University, Seattle.


      L. A. Nelson is an assistant professor, Initiative for Research and Education to Advance Community Health, Washington State University, Seattle.


      R. Harris is a communications manager, Initiative for Research and Education to Advance Community Health, Washington State University, Seattle.


      D. S. Buchwald is a professor and a director, Initiative for Research and Education to Advance Community Health, Washington State University, Seattle.


      A. A. Kuo is an associate professor, Department of Pediatrics, University of California-Los Angeles, Los Angeles.