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Matthew W. Gillman, MD,SM; Sheryl L. Rifas-Shiman, MPH; Carlos A. Camargo, Jr, MD,DrPH; Catherine S. Berkey, ScD; A. Lindsay Frazier, MD,MPH; Helaine R. H. Rockett, MS,RD; Alison E. Field, ScD; Graham A. Colditz, MD,DrPH

JAMA. 2001;285:2461-2467.

Context  Overweight during adolescence predicts short- and long-term morbidity as well as obesity in adulthood. The prevalence of overweight among adolescents is high and continues to increase. Physiological and behavioral mechanisms and preliminary epidemiologic data suggest that breastfeeding could lower the risk of subsequent obesity in adolescence.

Objective  To examine the extent to which overweight status among adolescents is associated with the type of infant feeding (breast milk vs infant formula) and duration of breastfeeding.

Design, Setting, and Subjects  Survey of 8186 girls and 7155 boys, aged 9 to 14 years, who are participants in the Growing Up Today Study, a nationwide cohort study of diet, activity, and growth. In the fall of 1996 we mailed a questionnaire to each of the subjects, and in the spring of 1997, we mailed a supplemental questionnaire to their mothers, who are participants in the Nurses' Health Study II.

Main Outcome Measure  Overweight status defined as body mass index exceeding the 95th percentile for age and sex from US national data.

Results  In the first 6 months of life, 9553 subjects (62%) were only or mostly fed breast milk, and 4744 (31%) were only or mostly fed infant formula. A total of 7186 subjects (48%) were breastfed for at least 7 months while 4613 (31%) were breastfed for 3 months or less. At ages 9 to 14 years, 404 girls (5%) and 635 boys (9%) were overweight. Among subjects who had been only or mostly fed breast milk, compared with those only or mostly fed formula, the odds ratio (OR) for being overweight was 0.78 (95% confidence interval [CI], 0.66-0.91), after adjustment for age, sex, sexual maturity, energy intake, time watching television, physical activity, mother's body mass index, and other variables reflecting social, economic, and lifestyle factors. Compared with subjects who had been breastfed for 3 months or less, those who had been breastfed for at least 7 months had an adjusted OR for being overweight of 0.80 (95% CI, 0.67-0.96). Timing of introduction of solid foods, infant formula, or cow's milk was not related to risk of being overweight.

Conclusion  Infants who were fed breast milk more than infant formula, or who were breastfed for longer periods, had a lower risk of being overweight during older childhood and adolescence.

Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (Dr Gillman and Ms Rifas-Shiman); the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (Drs Camargo, Berkey, Frazier, Field, and Colditz and Ms Rockett); the Department of Emergency Medicine, Massachusetts General Hospital (Dr Camargo) and the Dana Farber Cancer Institute (Dr Frazier), Harvard Medical School; and the Departments of Nutrition (Dr Gillman), Epidemiology (Dr Colditz), and Health Policy and Management (Dr Berkey), Harvard School of Public Health; Boston, Mass.

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