PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1765 (doi:10.1542/peds.2005-0730)
COMMENTARY |
Breastfeeding and Cardiovascular Disease: Where’s the Beef?
Department of Pediatrics
University of Wisconsin Medical School
Madison, WI 53715
One of many controversies over the benefits of breastfeeding has been the potentially positive impact of breastfeeding on the incidence of adult cardiovascular disease. Studies in infants, as confirmed by the article by Demmers et al1 in this issue of Pediatrics, have consistently found higher levels of total cholesterol as well as low-density lipoprotein cholesterol in breastfed infants versus those fed modern-day formulas. This should come as no surprise, because breast milk does not come in a "low-fat, zero-cholesterol" package. Thus, a major difference between formulas and breast milk is the much lower content of cholesterol in infant formulas. Some experts have even favored adding cholesterol to infant formulas. The implication has been that the exposure to higher cholesterol levels during the period of breastfeeding programs or imprints favorable cholesterol metabolism later in life. This in turn will impact on the incidence of adult cardiovascular disease. Interestingly enough, this theory has persisted despite repeated epidemiologic studies showing no effect of breastfeeding on cholesterol and low-density lipoprotein levels in adolescents.2 Adult epidemiologic studies of this type have many confounders including the changing socioeconomic status of the breastfeeding versus the nonbreastfeeding population during the 20th century, as well as the evolution of artificial feeding to include formulas with relatively low cholesterol levels compared with human milk during this same time period. Be that as it may, 7 of 9 adult epidemiologic studies on the impact of breastfeeding on adult cholesterol levels have shown an effect, although very modest, of breastfeeding on lowering total cholesterol levels. Thus, total cholesterol levels are 0.18 mmol/L lower in adults who were breastfed compared with adults who were formula fed as infants (95% confidence interval: –0.30 to –0.06 mmol/L).2
Demmers et al have attempted to find a physiologic explanation for the modest effects of breastfeeding on serum cholesterol levels later in life. In their study, it was hypothesized that breastfed infants, compared with standard formula-fed infants, would have a significantly lower fractional synthesis rate of cholesterol at 4 months of age and that this lower fractional synthesis rate of cholesterol would persist through 18 months of age, a time at which the diets of both groups of infants would be similar. A lower fractional synthesis rate of cholesterol is one explanation that has been proposed to explain the lower cholesterol levels observed in adults who were breastfed as infants. Unfortunately, the authors failed to show that the decreased endogenous rate of cholesterol synthesis in breastfed infants, compared with formula-fed infants at 4 months of age, persisted at 18 months. In other words, cholesterol synthesis in children at 18 months of age did not seem to be programmed by the exposure to the higher cholesterol levels found in human milk early in life. Additional research identifying a metabolic explanation for the lower cholesterol levels seen in epidemiologic studies in adults who were breastfed in infancy are needed before the existence of a protective effect of breastfeeding on the incidence of adult cardiovascular disease is convincing.
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FOOTNOTES |
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Accepted Mar 30, 2005.
Address correspondence to Frank R. Greer, MD, Wisconsin Perinatal Center, Meriter Hospital, 202 S Park St, Madison, WI 53715. E-mail: frgreer{at}wisc.edu
No conflict of interest declared.
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REFERENCES |
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 TOP REFERENCES |
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- Demmers TA, Jones PJH, Wang Y, Krug S, Creutzinger V, Heubi JE. Effects of early cholesterol intake on cholesterol biosynthesis and plasma lipids among infants until 18 months of age.
Pediatrics. 2005;115
:1594
–1601
[Abstract/Free Full Text] - Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG. Infant feeding and blood cholesterol: a study in adolescents and a systematic review.
Pediatrics. 2002;110
:597
–608
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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