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The mediation effect of breastfeeding duration on the relationship between maternal preconception BMI and childhood nutritional risk

European Journal of Clinical Nutrition volume 78, pages 427–435 (2024)Cite this article

Subjects

Abstract

Background

Higher maternal preconception body mass index (BMI) is associated with lower breastfeeding duration, which may contribute to the development of poor child eating behaviours and dietary intake patterns (components of nutritional risk). A higher maternal preconception BMI has been found to be associated with higher child nutritional risk. This study aimed to determine whether breastfeeding duration mediated the association between maternal preconception BMI and child nutritional risk.

Methods

In this longitudinal cohort study, children ages 18 months to 5 years were recruited from The Applied Research Group for Kids (TARGet Kids!) in Canada. The primary outcome was child nutritional risk, using The NutriSTEP®, a validated, parent-reported questionnaire. Statistical mediation analysis was performed to assess whether total duration of any breastfeeding mediated the association between maternal preconception BMI and child nutritional risk.

Results

This study included 4733 children with 8611 NutriSTEP® observations. The mean (SD) maternal preconception BMI was 23.6 (4.4) and the mean (SD) breastfeeding duration was 12.4 (8.0) months. Each 1-unit higher maternal preconception BMI was associated with a 0.081 unit higher nutritional risk (95% CI (0.051, 0.112); p < 0.001) (total effect), where 0.011(95% CI (0.006, 0.016); p < 0.001) of that total effect or 13.18% (95% CI: 7.13, 21.25) was mediated through breastfeeding duration.

Conclusion

Total breastfeeding duration showed to mediate part of the association between maternal preconception BMI and child nutritional risk. Interventions to support breastfeeding in those with higher maternal preconception BMI should be evaluated for their potential effect in reducing nutritional risk in young children.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request pending application and approval.

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Acknowledgements

We thank the following sources of support; Clinician Scientist Training Program Scholarship (CSTP), Canadian Institute of Health Research (CIHR) and the Edwin S.H. Leong Centre for Healthy Children. We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network.

Members of the TARGet Kids! Collaboration:

Co-Leads: Catherine S. Birken, MD, and Jonathon L. Maguire, MD.

Executive Committee: Christopher Allen, BSc; Laura N. Anderson, PhD; Danielle D’Annunzio, BA, LLM, PMP; Mateenah Jaleel, BSc; Charles Keown-Stoneman, PhD; Natricha Levy McFarlane, MPhil; Jessica A. Omand RD, PhD; and Sharon Thadani, MLA/T.

Investigators and Trainees: Mary Aglipay, MSc; Imaan Bayoumi, MD MSc; Cornelia M. Borkhoff, PhD; Sarah Carsley, PhD; Alice Charach, MD; Katherine Cost, PhD; Curtis D’Hollander RD MSc; Anne Fuller, MD; Laura Kinlin, MD MPH; Michaela Kucab RD, MSc; Patricia Li, MD MSc; Pat Parkin, MD; Nav Persaud, MD MSc; Sarah Rae, BHSc, MSc; Izabela Socynska, RD MSc; Shelley Vanderhout, RD PhD; Leigh Vanderloo, PhD; and Peter Wong, MD PhD.

Research Staff: Piyumi Konara Mudiyanselage, MSc; Xuedi Li, MSc; Jenny Liu, BHSc; Michelle Mitchell, BA; Yulika Yoshida-Montezuma, MPH; and Nusrat Zaffar, MBBS.

Clinical Site Research Staff: Trudy-Ann Buckley, BSc; Pamela Ruth Flores, MD; Kardelen Kurt, BSc; Sangeetha Loganathan, BPT; Tarandeep Mali, BSc; and Laurie Thompson, MLT.

Parent Partners: Jennifer Batten; Jennifer Chan; John Clark; Amy Craig; Kim De Castris-Garcia; Sharon Dharman; Sarah Kelleher; Salimah Nasser; Tammara Pabon; Michelle Rhodes; Rafael Salsa; Julie Skelding; Daniel Stern; Kerry Stewart; Erika Sendra Tavares; Shannon Weir; and Maria Zaccaria Cho.

Offord Centre for Child Studies Collaboration: Principal Investigator: Magdalena Janus, PhD; Co-investigator: Eric Duku, PhD; Research Team: Caroline Reid-Westoby, PhD; Patricia Raso, MSc; and Amanda Offord, MSc.

Site Investigators: Emy Abraham, MD; Sara Ali, MD; Kelly Anderson, MD; Gordon Arbess, MD; Jillian Baker, MD; Tony Barozzino, MD; Sylvie Bergeron, MD; Gary Bloch, MD; Joey Bonifacio, MD; Ashna Bowry, MD; Caroline Calpin, MD; Douglas Campbell, MD; Sohail Cheema, MD; Elaine Cheng, MD; Brian Chisamore, MD; Evelyn Constantin, MD; Karoon Danayan, MD; Paul Das, MD; Viveka De Guerra, MD; Mary Beth Derocher, MD; Anh Do, MD; Kathleen Doukas, MD; Anne Egger, BScN; Allison Farber, MD; Amy Freedman, MD; Sloane Freeman, MD; Sharon Gazeley, MD; Karen Grewal, MD; Charlie Guiang, MD; Dan Ha, MD; Curtis Handford, MD; Laura Hanson, BScN, RN; Leah Harrington, MD; Sheila Jacobson, MD; Lukasz Jagiello, MD; Gwen Jansz, MD; Paul Kadar, MD; Lukas Keiswetter, MD; Tara Kiran, MD; Holly Knowles, MD; Bruce Kwok, MD; Piya Lahiry, MD; Sheila Lakhoo, MD; Margarita Lam-Antoniades, MD; Eddy Lau, MD; Denis Leduc, MD; Fok-Han Leung, MD; Alan Li, MD; Patricia Li, MD; Roy Male, MD; Aleks Meret, MD; Elise Mok, MD; Rosemary Moodie, MD; Katherine Nash, BScN, RN; James Owen, MD; Michael Peer, MD; Marty Perlmutar, MD; Navindra Persaud, MD; Andrew Pinto, MD; Michelle Porepa, MD; Vikky Qi, MD; Noor Ramji, MD; Danyaal Raza, MD; Katherine Rouleau, MD; Caroline Ruderman, MD; Janet Saunderson, MD; Vanna Schiralli, MD; Michael Sgro, MD; Hafiz Shuja, MD; Farah Siam, MD; Susan Shepherd, MD; Cinntha Srikanthan, MD; Carolyn Taylor, MD; Stephen Treherne, MD; Suzanne Turner, MD; Fatima Uddin, MD; Meta van den Heuvel, MD; Thea Weisdorf, MD; Peter Wong, MD; John Yaremko, MD; Ethel Ying, MD; Elizabeth Young, MD; and Michael Zajdman, MD.

Applied Health Research Centre: Esmot Ara Begum, PhD; Peter Juni, MD, University of Toronto, Gurpreet Lakhanpal, MSc, CCRP, PMP; Gerald Lebovic, PhD, University of Toronto, Ifeayinchukwu (Shawn) Nnorom, BSc; Marc Denzel Nunez, HBSc; Audra Stitt, MSc; and Kevin Thorpe, MMath.

Mount Sinai Services Laboratory: Raya Assan, MSc, MLT; Homa Bondar, BSc; George S. Charames, PhD, FACMG; Andrea Djolovic, MSc, CCGC; Chelsea Gorscak-Dunn; Mary Hassan, MLT; Rita Kandel, MD; and Michelle Rodrigues, BSc, MLT.

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Authors and Affiliations

  1. Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Kate E. Braddon, Jonathon L. Maguire, Deborah L. O’Connor & Catherine S. Birken

  2. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada

    Kate E. Braddon, Xuedi Li, Jessica A. Omand & Catherine S. Birken

  3. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Charles D. G. Keown-Stoneman, Cindy-Lee Dennis & Jonathon L. Maguire

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Charles D. G. Keown-Stoneman

  5. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Cindy-Lee Dennis

  6. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Cindy-Lee Dennis

  7. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Jonathon L. Maguire & Catherine S. Birken

  8. Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Jonathon L. Maguire & Catherine S. Birken

  9. Department of Pediatrics, St. Michael’s Hospital, Toronto, ON, Canada

    Jonathon L. Maguire

  10. Translational Medicine, SickKids Research Institute, Toronto, ON, Canada

    Deborah L. O’Connor

  11. Department of Paediatrics, Mount Sinai Health, Toronto, ON, Canada

    Deborah L. O’Connor

  12. School of Nutrition, Toronto Metropolitan University, Toronto, ON, Canada

    Jessica A. Omand

  13. Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada

    Janis Randall Simpson

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Contributions

KEB, CDGK-S, CSB, DLOC, JLM: Designed research (project conception, development of overall research plan, and study oversight); KEB: Conducted research; CKS, JRS: Provided essential materials (research database, questionnaires); KEB, CDGK-S, XL: Preformed statistical analyses; KEB: Wrote paper; KEB, CSB: Had primary responsibility for final content; CLD, JAO, JRS, XL, CDGK-S, CSB, DLOC, JLM: provided expertise review and feedback on manuscript content; All authors read and approved manuscript.

Corresponding author

Correspondence to Kate E. Braddon.

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Competing interests

CSB reported receiving research funding from the Canadian Institute for Health Research Heart and Stroke Foundation of Canada, Physician Services Inc, The Edwin S.H. Leong Centre for Healthy Children, University of Toronto and Hospital for Sick Children, Centre for Addictions and Mental Health, Ontario Child Health Support Unit (OCHSU) Impact Child Health Award, and a Walmart Community Grant through the SickKids Foundation for a study on food insecurity in the inpatient hospital setting. JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and D drops provided non-financial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). CLD reported receiving research funding from the Canadian Institute for Health Research. JRS reported receiving grant support from the Canadians Institutes of Health Research, the Danone Institute of Canada, the Canadian Foundation for Dietetic Research, and the Canadian Home Economics Foundation. The other authors had no conflicts of interest relevant to this article to disclose. The funding agencies had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, or the preparation, review, and approval of the manuscript.

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Braddon, K.E., Keown-Stoneman, C.D.G., Dennis, CL. et al. The mediation effect of breastfeeding duration on the relationship between maternal preconception BMI and childhood nutritional risk. Eur J Clin Nutr 78, 427–435 (2024). https://doi.org/10.1038/s41430-024-01420-0

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