search text   Advanced Search

This Article Abstract Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via ISI Web of Science (24) Citing Articles via Google Scholar Google Scholar Articles by Grummer-Strawn, L. M. Articles by Mei, Z. Search for Related Content PubMed PubMed Citation Articles by Grummer-Strawn, L. M. Articles by Mei, Z. Related Collections Nutrition & Metabolism

Does Breastfeeding Protect Against Pediatric Overweight? Analysis of Longitudinal Data From the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System

From the Maternal and Child Nutrition Branch, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

	ABSTRACT

TOP ABSTRACT METHODS RESULTS DISCUSSION REFERENCES

 
Objective. To examine whether increasing duration of breastfeeding is associated with a lower risk of overweight in a low-income population of 4-year-olds in the United States.

Methods. Visit data were linked to determine prospectively the duration of breastfeeding (up to 2 years of age) and weight status at 4 years of age. Overweight among 4-year-old children was defined as a body mass index (BMI)-for-age at or above the 95th percentile based on the 2000 Centers for Disease Control and Prevention growth charts. Logistic regression was performed, controlling for gender, race/ethnicity, and birth weight. In a subset of states, links to maternal pregnancy records also permitted regression analysis controlling for mother’s age, education, prepregnancy BMI, weight gain during pregnancy, and postpartum smoking. Data from the Pediatric Nutrition Surveillance System, which extracts breastfeeding, height, and weight data from child visits to public health programs, were analyzed. In 7 states, data were linked to Pregnancy Nutrition Surveillance System data. A total of 177 304 children up to 60 months of age were included in our final pediatric-only analysis, and 12 587 were included in the pregnancy-pediatric linked analysis.

Results. The duration of breastfeeding showed a dose-response, protective relationship with the risk of overweight only among non-Hispanic whites; no significant association was found among non-Hispanic blacks or Hispanics. Among non-Hispanic whites, the adjusted odds ratio of overweight by breastfeeding for 6 to 12 months versus never breastfeeding was 0.70 (95% confidence interval: 0.50–0.99) and for >12 months versus never was 0.49 (95% confidence interval: 0.25–0.95). Breastfeeding for any duration was also protective against underweight (BMI-for-age below the 5th percentile).

Conclusion. Prolonged breastfeeding is associated with a reduced risk of overweight among non-Hispanic white children. Breastfeeding longer than 6 months provides health benefits to children well beyond the period of breastfeeding.

Key Words: breastfeeding • overweight • obesity • longitudinal • preschool children • body mass index

Abbreviations: BMI, body mass index • CDC, Centers for Disease Control and Prevention

The increasing prevalence of overweight among preschool-age children in the United States has been described as an epidemic.^1,2 Overweight children are at increased risk of being overweight adults.^3,4 In addition, children who are overweight already show related signs of morbidity, including elevated blood pressure, cholesterol, triglyceride, and insulin levels.^5,6 Thus, prevention of pediatric overweight is important for the long-term prevention of chronic disease.

Evidence in the literature has been contradictory regarding whether breastfeeding is associated with a reduction in the risk of overweight.⁷ A number of authors have found no significant correlation between breastfeeding and various measures in children of mean adiposity,^8–10 fatness,¹¹ or overweight.^12–14 Agras et al¹⁵ actually found a higher mean body mass index (BMI) for children who were breastfed the longest durations. Conversely, many researchers have observed a greater risk of overweight in children and adolescents who had not been breastfed compared with those who had^16,17 or who were breastfed a shorter rather than longer duration.^18–25 On the basis of a review of 11 studies, Dewey²⁶ concluded that "the evidence to date suggests that breastfeeding reduces the risk of child overweight to a moderate extent."

Many of these studies suffered from small sample sizes—especially for breastfeeding durations longer than 6 months—and were underpowered to detect substantively important effects. Also, several of the studies used mean BMI or mean skinfold as an indicator of adiposity. Breastfeeding has been shown to be protective against undernutrition.^27,28 If breastfeeding protects against underweight as well as overweight, then one would not expect to see an effect on the central tendency of adiposity but only on the extremes. Nearly all of the studies to date that have shown a protective relationship between breastfeeding and overweight were conducted in predominantly white, non-Hispanic populations. Infant feeding patterns in the United States are known to differ dramatically by race and ethnicity.²⁹ We examined whether an increasing duration of breastfeeding is associated with a lower risk of overweight among a low-income population of 4-year-olds. Advantages of this study include its large sample size, its examination of breastfeeding beyond 12 months of age, and its stratification by racial/ethnic group.

	METHODS

TOP ABSTRACT METHODS RESULTS DISCUSSION REFERENCES

 
The data for this analysis were drawn from the Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance System.³⁰ This system aggregates data on growth and anemia from low-income children who attend public health clinics across the United States. Data are derived from the Special Supplemental Nutrition Program for Women, Infants, and Children and the Maternal and Child Health Block Grant. Children are seen at a clinic an average of twice a year and have their height and weight measured each time. For children under the age of 2 years, data are also collected on whether the child was ever breastfed and, if so, for how long.

Records for children who are enrolled in these programs were linked by a data processing team based on child identifier and date of birth to create a longitudinal series of heights and weights for each child. Individual identifiers were stripped from the data files before transmission to the researchers. For this analysis, we included only children who had at least 1 visit for each single year of age up to age 5, to guarantee that all of the records with the same identification did in fact come from the same child. We included children who were born between 1988 and 1992 and thus used records for 1988–1997. A total of 246 371 children were examined. We excluded all children for whom breastfeeding duration was not assessed (n = 58 009) or for whom the reported duration of breastfeeding was inconsistent from one visit to the next (n = 10 315). We also excluded children who did not have data on height, weight, gender, race/ethnicity, and birth weight (n = 743). A total of 177 304 children were included in our analysis.

In a subset of 7 states, we also had access to maternal pregnancy records from the CDC Pregnancy Nutrition Surveillance System. This system collects data on risk factors during pregnancy in the same public health programs previously described. Data processors linked pregnancy and pediatric records using child identifier and date of birth. The mother’s age, educational attainment, self-reported prepregnancy weight, height as measured at the first prenatal visit, weight gain during pregnancy, and postpartum smoking were attached to the child’s records. The mother’s prepregnancy BMI (kg/m²) was computed. Pregnancy weight gain was categorized as less than ideal, ideal, and greater than ideal as recommended by the Institute of Medicine.³¹ Smoking was categorized as none, <10 cigarettes per day, and 10 cigarettes per day. A total of 12 587 mother-child pairs were included in this subanalysis.

Breastfeeding duration was categorized into 6 categories: never, <1 month, 1 to 2 months, 3 to 5 months, 6 to 11 months, and 12 months. No information was collected in this system on the introduction of solid foods or other milks. Overweight among 4-year-old children was defined as having a BMI-for-age above the 95th percentile based on the 2000 CDC growth reference.^32,33 When a child had >1 clinic visit while 4 years old, only 1 visit was selected at random. Because we were also concerned about whether breastfeeding affects only overweight or actually shifts the entire BMI distribution, we also looked at underweight, defined as a BMI-for-age below the 5th percentile.

We conducted a logistic regression on the odds of being overweight by the 6 breastfeeding categories. In this analysis, we controlled for gender, race/ethnicity, and birth weight. In the subset of states in which linkage to maternal records was possible, we also controlled for mother’s age, educational attainment, prepregnancy BMI, weight gain during pregnancy, and postpartum smoking. Finally, we tested for interactions between breastfeeding duration and each of the covariates.

	RESULTS

TOP ABSTRACT METHODS RESULTS DISCUSSION REFERENCES

 
The population studied had a high percentage of overweight children (13.3%) and a high proportion of non-Hispanic blacks (29.0%; Table 1). The percentage of low birth weight was slightly higher than that found nationally, but this was to be expected because our sample included only low-income children (<185% of poverty). Fewer than 30% of the children were ever breastfed, and only 6.1% were breastfed for >6 months. Among the 2.5% of children who were excluded because of missing or inconsistent breastfeeding duration, the prevalence of overweight was slightly higher (14.4% vs 13.3%). These excluded children were more likely to be from an "other" racial/ethnic group (14.0% vs 5.0%). The subsample of children who were linked to maternal data in the 7 states was more likely to be Hispanic and had a higher rate of breastfeeding and the mothers were generally poorly educated (43.6% had not completed high school) and had a high prevalence of overweight before their pregnancy (41.7% with BMI >25).

	DISCUSSION

TOP ABSTRACT METHODS RESULTS DISCUSSION REFERENCES

 
Our study documented lower rates of overweight among children who were breastfed for longer durations. This finding is consistent with several previous articles that concluded that breastfeeding is protective against pediatric overweight.^19–25 Each of those reports describes primarily non-Hispanic white populations. In our study, breastfeeding was protective among non-Hispanic whites but not other racial/ethnic groups.

Few of the previous studies examined prolonged breastfeeding, that is, breastfeeding for >1 year. The 2 studies that did report separately for those who were breastfed for at least 1 year found relatively large effects. Von Kries et al¹⁹ found a 57% reduction in the adjusted odds of being overweight at 5 or 6 years of age when contrasting those who were breastfed for at least 12 months with those who were never breastfed. Liese et al²³ found even stronger effects contrasting >1 year of breastfeeding with those who were not breastfed, a 71% reduction in odds. Among white children, we found a 51% reduction for a similar comparison.

We did not find any protection against overweight among those who were breastfed for short durations (<3 months). Although never significant, there is even some suggestion of slightly higher rates of overweight among those who were breastfed for only a few months compared with those who were never breastfed, particularly among non-Hispanic blacks. Gillman et al²⁰ similarly documented slightly higher rates of overweight among those who were breastfed for <3 months compared with those who were never breastfed. Apparently, the protective effects of breastfeeding are gained only when breastfeeding continues for at least 3 months.

Our study also showed that longer breastfeeding is not associated with a decrease in mean BMI but rather with a decrease in the standard deviation of the BMI, leading to simultaneously lower rates of underweight and overweight. Thus, our results are also consistent with previous studies that demonstrated no association between breastfeeding and various measures of central tendency of weight or adiposity.^8–10 Breastfeeding seems to protect against overweight not by uniformly reducing BMI in all children but by reducing the variability in BMI.

A number of strengths distinguish our study. It is one of the largest studies conducted to date examining breastfeeding and overweight. Unlike many previous studies, it controls for maternal BMI and a number of other factors known to be associated with both breastfeeding and overweight. All participants were low-income and thus relatively homogeneous in socioeconomic status. It stratifies the analyses by race/ethnicity and demonstrates differential effects by racial/ethnic group.

However, there are a few limitations as well. Women who breastfeed for longer durations could be different from women who do not breastfeed in ways not measured by the variables that we considered. As Gillman³⁴ pointed out, "The most important question about these studies is whether residual confounding could explain the results" (p. 749). By controlling for the child’s gender, race/ethnicity, and birth weight, and for the mother’s age, education, prepregnancy BMI, weight gain during pregnancy, and postpartum smoking, we attempted to minimize the effect of confounding variables, but it is possible that factors indirectly related to breastfeeding and overweight are responsible for the association. Perhaps most important, we could not control for nutrition and physical activity behaviors in the children as they grew older. Furthermore, the sample was not representative of all low-income children in the United States but only of those enrolled in public health programs. Such children may have characteristics that set them apart from nonparticipants. We did not have data on the exclusivity of breastfeeding or on other aspects of infant feeding. Also, we were unable to examine effects of breastfeeding after the age of 4 years, for which Dewey²⁶ pointed out that effects seem to be even stronger.

The link between long-term breastfeeding and lower rates of overweight could operate through several possible biological mechanisms. Birch and Fisher³⁵ showed that children who were breastfed are better able to adjust intake at a meal in response to a high calorie preload; thus, breastfed children may learn to self-regulate caloric intake better than nonbreastfed infants do. Also, breastfed and formula-fed infants have a different hormonal response to feeding: formula feeding provokes a greater insulin response, possibly resulting in earlier fat deposition.^36,37 Another possibility is that the higher protein intake in formula-fed infants has a programming effect on glucose metabolism.³⁸ Finally, breastfed infants adapt more readily to new foods such as vegetables, thus influencing the subsequent caloric density of their diet.

That effects were found consistently only in non-Hispanic whites suggests that the association may be mediated by behavioral factors that differ across racial/ethnic groups. For example, Hispanic children are at nearly twice the risk of becoming overweight than are non-Hispanic whites, probably because of different dietary and physical activity patterns. Prolonged breastfeeding may be insufficient to overcome these powerful lifestyle issues. Furthermore, the exclusivity of breastfeeding or the age of introduction of solid foods may differ by ethnic group, such that the effects of breastfeeding are weaker in black or Hispanic children. We could not characterize the intensity of breastfeeding, as no data on supplementation with other milks or solid foods were available in this data set. It is also possible that infant formula is used differently in the different ethnic groups. For example, if whites are more insistent that their infants finish off a predetermined quantity of formula, then this may inhibit a formula-fed infant’s ability to self-regulate intake. These hypotheses clearly will require additional examination.

The multiple benefits of breastfeeding are well documented in the United States.^39,40 Much of the current evidence on the health effects of breastfeeding has been concentrated on shorter durations of breastfeeding, however. The importance of long-term breastfeeding (longer than 12 months) has not been documented extensively in developed countries. This study highlights 1 consequence of prolonged breastfeeding and reinforces the rationale for recommendations to breastfeed an infant for at least a full year.

	FOOTNOTES

 
Received for publication Jul 1, 2002; Accepted Oct 16, 2003.

Reprint requests to (L.M.G.-S.), Centers for Disease Control and Prevention, Mailstop K-25, 4770 Buford Hwy, Atlanta, GA 30341-3724. E-mail: lgrummer-strawn{at}cdc.gov

	REFERENCES

TOP ABSTRACT METHODS RESULTS DISCUSSION REFERENCES

 

1. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA.2002; 288 :1728 –1732[Abstract/Free Full Text]
2. Mei Z, Scanlon KS, Grummer-Strawn LM, Freedman DS, Yip R, Trowbridge FL. Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995. Pediatrics.1998; 101(1) . Available at: www.pediatrics.org/cgi/content/full/101/1/e12
3. Whitaker RC, Wright JA, Pepes MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood and parental obesity. N Engl J Med.1997; 337 :869 –873[Abstract/Free Full Text]
4. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr.1994; 59 :810 –819[Abstract/Free Full Text]
5. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics.1999; 103 :1175 –1182[Abstract/Free Full Text]
6. Becque MD, Katch VL, Rocchini AP, Marks CR, Moorehead C. Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics.1988; 81 :605 –612[Abstract/Free Full Text]
7. Butte NF. The role of breastfeeding in obesity. Pediatr Clin North Am.2001; 48 :189 –198[CrossRef][ISI][Medline]
8. Fomon SJ. Factors influencing food consumption in the human infant. Int J Obes.1980; 4 :348 –350[ISI][Medline]
9. Baranowski T, Bryan GT, Rassin DK, Harrison JA, Henske JC. Ethnicity, infant-feeding practices, and childhood adiposity. J Dev Behav Pediatr.1990; 11 :23 –29
10. Zive MM, McKay H, Frank-Spohrer GC, Broyles SL, Nelson JA, Nader PR. Infant-feeding practices and adiposity in 4-y-old Anglo- and Mexican-Americans. Am J Clin Nutr.1992; 55 :1104 –1108[Abstract/Free Full Text]
11. Wolman PG. Feeding practices in infancy and prevalence of obesity in preschool children. J Am Diet Assoc.1984; 84 :436 –438[ISI][Medline]
12. Hediger ML, Overpeck MD, Kuczmarski RI, Ruan WJ. Association between infant breastfeeding and overweight in young children. JAMA.2001; 285 :2453 –2460[Abstract/Free Full Text]
13. Wadsworth M, Marshall S, Hardy R, Paul A. Breast feeding and obesity: relation may be accounted for by social factors. Br Med J.1999; 319 :1576[Free Full Text]
14. O’Callaghan MJ, Williams GM, Andersen MJ, Bor W, Najman JM. Prediction of obesity in children at 5 years: a cohort study. J Paediatr Child Health.1997; 33 :311 –316[ISI][Medline]
15. Agras WS, Kramer HC, Berkowitz RI, Hammer LD. Influence of early feeding style on adiposity at 6 years of age. J Pediatr.1990; 1 :116:805 –809
16. Kramer MS. Do breast-feeding and delayed introduction of solid foods protect against subsequent obesity? J Pediatr.1981; 98 :883 –887[CrossRef][ISI][Medline]
17. Toschke AM, Vignerova J, Lhotska L, Osancova K, Koletzko B, von Kries R. Overweight and obesity in 6- to 14-year old Czech children in 1991: protective effect of breast-feeding. J Pediatr.2002; 141 :764 –769[CrossRef][ISI][Medline]
18. Strbák V, Skultyova M, Hromadova M, Randuskova A, Macho L. Late effects of breast-feeding and early weaning: seven-year prospective in study in children. Endocr Regul.1991; 25 :53 –57[Medline]
19. Von Kries R, Koletzko B, Sauerwald T, et al. Breast feeding and obesity: cross sectional study. BMJ.1999; 319 :147 –150[Abstract/Free Full Text]
20. Gillman MW, Rifas-Shiman SL, Camargo CA, et al. Risk of overweight among adolescents who are breastfed as infants. JAMA.2001; 285 :2461 –2467[Abstract/Free Full Text]
21. Armstrong J, Reilly JJ, Child Health Information Team. Breastfeeding and childhood obesity risk. Lancet.2002; 359 :2003 –2004[CrossRef][ISI][Medline]
22. Bergmann KE, Bergmann RL, von Kries R, et al. Early determinants of childhood overweight and adiposity in a birth cohort study: role of breastfeeding. Int J Obes.2003; 27 :162 –172[CrossRef][ISI][Medline]
23. Liese AD, Hirsch T, von Mutius E, Keil U, Leupold W, Weiland SK. Inverse association of overweight and breast feeding in 9 to 10-y-old children in Germany. Int J Obes.2001; 25 :1644 –1650[CrossRef][ISI][Medline]
24. Poulton R, Williams S. Breastfeeding and risk of overweight. JAMA.2001; 286 :1449 –1450
25. Tulldahl J, Pettersson K, Andersson SW, Hulthen L. Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence. Obes Res.1999; 7 :431 –437[ISI][Medline]
26. Dewey KG. Is breastfeeding protective against child obesity? J Hum Lact.2003; 19 :9 –18[Abstract]
27. Kanaaneh H. The relationship of bottle feeding to malnutrition and gastroenteritis in a pre-industrial setting. J Trop Pediatr Environ Child Health.1972; 18 :302 –306[Medline]
28. Wray JD, Aguirre A. Protein-calorie malnutrition in Candelaria, Colombia. I. Prevalence: social and demographic causal factors. J Trop Pediatr.1969; 15 :76 –98[Free Full Text]
29. Li R, Zhao Z, Mokdad A, Barker L, Grummer-Strawn L. Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey. Pediatrics.2003; 111 :1198 –1201[Abstract/Free Full Text]
30. Centers for Disease Control and Prevention. Pediatric Nutrition Surveillance, 1997 Full Report. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 1998
31. Institute of Medicine. Nutrition during lactation. Report of the Subcommittee on Nutrition During Lactation, Committee on Nutritional Status During Pregnancy and Lactation. Food and Nutrition Board. Washington, DC: National Academy Press; 1991
32. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States. Adv Data.2000; 314 :1 –27[Medline]
33. Ogden CL, Kuczmarski RJ, Flegal KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics.2002; 109 :45 –60[Abstract/Free Full Text]
34. Gillman MW. Breast-feeding and obesity. J Pediatr.2002; 141 :749 –750 (editorial)[CrossRef][ISI][Medline]
35. Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics.1998; 101 :539 –548[Abstract/Free Full Text]
36. Lucas A, Sarson DL, Blackburn AM, Adrian TE, Aynsley-Green A, Bloom SR. Breast vs. bottle: endocrine responses are different with formula feeding. Lancet.1980; 1 :1267 –1269[CrossRef][ISI][Medline]
37. Lucas A, Boyes S, Bloom SR, Aynsley-Green A. Metabolic and endocrine responses to a milk feed in six-day-old term infants: differences between breast and cow’s milk formula feeding. Acta Paediatr Scand.1981; 70 :195 –200[ISI][Medline]
38. Burns SP, Desai M, Cohen RD, et al. Gluconeogenesis, glucose handling, and structural changes in livers of the adult offspring of rats partially deprived of protein during pregnancy and lactation. J Clin Invest.1997; 100 :1768 –1774[ISI][Medline]
39. American Academy of Pediatrics, Work Group on Breast-feeding. Breast-feeding and the use of human milk. Pediatrics.1997; 100 :1035 –1039[Abstract/Free Full Text]
40. US Department of Health and Human Services. HHS Blueprint for Action on Breastfeeding. Washington, DC: US Department of Health and Human Services, Office on Women’s Health; 2000

This article has been cited by other articles:

				E. J. Mayer-Davis, D. Dabelea, A. P. Lamichhane, R. B. D'Agostino Jr., A. D. Liese, J. Thomas, R. E. McKeown, and R. F. Hamman Breast-Feeding and Type 2 Diabetes in the Youth of Three Ethnic Groups: The SEARCH for Diabetes in Youth Case-Control Study Diabetes Care, March 1, 2008; 31(3): 470 - 475. [Abstract] [Full Text] [PDF]

				S. B. Procter and C. A. Holcomb Breastfeeding Duration and Childhood Overweight Among Low-Income Children in Kansas, 1998-2002 Am J Public Health, January 1, 2008; 98(1): 106 - 110. [Abstract] [Full Text] [PDF]

				J. B. Wolf Is Breast Really Best? Risk and Total Motherhood in the National Breastfeeding Awareness Campaign Journal of Health Politics Policy and Law, August 1, 2007; 32(4): 595 - 636. [Abstract] [PDF]

				E. P. Gunderson Breastfeeding After Gestational Diabetes Pregnancy: Subsequent obesity and type 2 diabetes in women and their offspring Diabetes Care, July 1, 2007; 30(Supplement_2): S161 - S168. [Full Text] [PDF]

				A. M Toschke, R. M Martin, R. von Kries, J. Wells, G. Davey Smith, and A. R Ness Infant feeding method and obesity: body mass index and dual-energy X-ray absorptiometry measurements at 9-10 y of age from the Avon Longitudinal Study of Parents and Children (ALSPAC) Am. J. Clinical Nutrition, June 1, 2007; 85(6): 1578 - 1585. [Abstract] [Full Text] [PDF]

				J. N. Davis, M. J. Weigensberg, G. Q. Shaibi, N. C. Crespo, L. A. Kelly, C. J. Lane, and M. I. Goran Influence of Breastfeeding on Obesity and Type 2 Diabetes Risk Factors in Latino Youth With a Family History of Type 2 Diabetes Diabetes Care, April 1, 2007; 30(4): 784 - 789. [Abstract] [Full Text] [PDF]

				R. T. Kimbro, J. Brooks-Gunn, and S. McLanahan Racial and Ethnic Differentials in Overweight and Obesity Among 3-Year-Old Children Am J Public Health, February 1, 2007; 97(2): 298 - 305. [Abstract] [Full Text] [PDF]

				R. C. Whitaker and S. M. Orzol Obesity Among US Urban Preschool Children: Relationships to Race, Ethnicity, and Socioeconomic Status Arch Pediatr Adolesc Med, June 1, 2006; 160(6): 578 - 584. [Abstract] [Full Text] [PDF]

				C. M. Gibson-Davis and J. Brooks-Gunn Couples' Immigration Status and Ethnicity as Determinants of Breastfeeding Am J Public Health, April 1, 2006; 96(4): 641 - 646. [Abstract] [Full Text] [PDF]

				D. Rose, J. N. Bodor, and M. Chilton Has the WIC Incentive to Formula-Feed Led to an Increase in Overweight Children? J. Nutr., April 1, 2006; 136(4): 1086 - 1090. [Abstract] [Full Text] [PDF]

				H. Haisma, J. C. K. Wells, W. A. Coward, D. D. Filho, C. G. Victora, R. J. Vonk, A. Wright, and G. H. Visser Complementary Feeding with Cow's Milk Alters Sleeping Metabolic Rate in Breast-Fed Infants J. Nutr., August 1, 2005; 135(8): 1889 - 1895. [Abstract] [Full Text] [PDF]

				J. L. Gerberding and J. S. Marks Making America Fit and Trim--Steps Big and Small Am J Public Health, September 1, 2004; 94(9): 1478 - 1479. [Full Text] [PDF]

This Article Abstract Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via ISI Web of Science (24) Citing Articles via Google Scholar Google Scholar Articles by Grummer-Strawn, L. M. Articles by Mei, Z. Search for Related Content PubMed PubMed Citation Articles by Grummer-Strawn, L. M. Articles by Mei, Z. Related Collections Nutrition & Metabolism

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2004 American Academy of Pediatrics. All rights reserved.