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      The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence

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          Abstract

          Chronic non-communicable diseases (NCDs), including cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, etc., are the major causes of mortality in the world, notably in low- and middle-income countries. A growing body of evidence suggests that NCDs have a complex etiology resulting from the interaction of genetic factors, gender, age, ethnicity, and the environmental factors. It is well-documented that chronic diseases in adulthood origins in early life. In recent years, much attention has been focused on primordial and primary prevention of NCD risk factors. There are many biological and epidemiological studies on beneficial effects of breastfeeding during infancy on chronic diseases in adulthood, particularly on hypertension, obesity, diabetes, hypercholesterolemia, and cardiovascular diseases. This review article aims to summarize the current literature on the long-term effects of breastfeeding on prevention of NCDs and their risk factors.

          The current literature is controversial about these effects; however, a growing body of evidence suggests that breastfeeding has protective roles against obesity, hypertension, dyslipidemia, and type II diabetes mellitus during adulthood. In addition to its short-term benefits, encouraging breastfeeding can have long-term beneficial health effects at individual and population levels.

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          Most cited references55

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          The global burden for disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020

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            Low nutrient intake and early growth for later insulin resistance in adolescents born preterm.

            In animals, acceleration of neonatal growth is thought to increase the later propensity to insulin resistance and non-insulin-dependent diabetes, whereas slow growth as a consequence of undernutrition is thought to have a beneficial effect. To test this hypothesis in people, we measured fasting concentrations of 32-33 split proinsulin, a marker of insulin resistance, in adolescents born preterm who had participated in randomised intervention trials of neonatal nutrition, and in adolescents born at term. We determined fasting 32-33 split proinsulin concentration in participants aged 13-16 years born preterm and randomised to receive a nutrient-enriched or lower-nutrient diet (n=216) or in a reference group born at term (n=61). Fasting 32-33 split proinsulin concentration was greater in children given a nutrient-enriched diet (geometric mean 7.2 pmol/L, 95% CI 6.4-8.1) than in those given the lower-nutrient diet (5.9 pmol/L [5.2-6.4]; mean difference 20.6% [5.0-36.3]; p=0.01). Healthy babies born at term had similar fasting 32-33 split proinsulin concentrations (6.9 pmol/L; 6.0-8.2) to the nutrient-enriched group. In non-randomised analyses, fasting 32-33 split proinsulin concentration was associated with greater weight gain the first 2 weeks of life (13.2% [5.4-20.9] change per 100 g weight increase; p=0.001) independent of birthweight, gestation, neonatal morbidity, and demographic, anthropometric, and socioeconomic factors. Our results suggest that relative undernutrition early in life in children born preterm may have beneficial effects on insulin resistance.
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              By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?

              To estimate by how much and how quickly a given reduction in serum cholesterol concentration will reduce the risk of ischaemic heart disease. Data on the incidence of ischaemic heart disease and serum cholesterol concentration were analysed from 10 prospective (cohort) studies, three international studies in different communities, and 28 randomised controlled trials (with mortality data analysed according to allocated treatment to ensure the avoidance of bias). Decrease in incidence of ischaemic heart disease or mortality for a 0.6 mmol/l (about 10%) decrease in serum cholesterol concentration. For men results from the cohort studies showed that a decrease of serum cholesterol concentration of 0.6 mmol/l (about 10%) was associated with a decrease in incidence of ischaemic heart disease of 54% at age 40 years, 39% at age 50, 27% at 60, 20% at 70, and 19% at 80. The combined estimate from the three international studies (for ages 55-64 years) was 38% (95% confidence interval 33% to 42%), somewhat greater than the cohort study estimate of 27%. The reductions in incidence of ischaemic heart disease in the randomised trials (for ages 55-64 years) were 7% (0 to 14%) in the first two years, 22% (15% to 28%) from 2.1-5 years, and 25% (15% to 35%) after five years, the last estimate being close to the estimate of 27% for the long term reduction from the cohort studies. The data for women are limited but indicate a similar effect. The results from the cohort studies, international comparisons, and clinical trials are remarkably consistent. The cohort studies, based on half a million men and 18,000 ischaemic heart disease events, estimate that a long term reduction in serum cholesterol concentration of 0.6 mmol/l (10%), which can be achieved by moderate dietary change, lowers the risk of ischaemic heart disease by 50% at age 40, falling to 20% at age 70. The randomised trials, based on 45,000 men and 4000 ischaemic heart disease events show that the full effect of the reduction in risk is achieved by five years.
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                Author and article information

                Journal
                Adv Biomed Res
                Adv Biomed Res
                ABR
                Advanced Biomedical Research
                Medknow Publications & Media Pvt Ltd (India )
                2277-9175
                2014
                09 January 2014
                : 3
                : 3
                Affiliations
                [1]Professor of Pediatrics, Child Growth and Development Research Center, Isfahan, Iran
                [1 ]MSc of Nutrition, Faculty of Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Address for correspondence: Prof. Roya Kelishadi, Professor of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: kelishadi@ 123456med.mui.ac.ir
                Article
                ABR-3-3
                10.4103/2277-9175.124629
                3929058
                24600594
                c2814c36-f15d-4fff-8b39-3065beca77d0
                Copyright: © 2014 Kelishadi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 03 August 2013
                : 21 August 2013
                Categories
                Review Article

                Molecular medicine
                breastfeeding,chronic diseases,diabetes,dyslipidemia,hypertension,obesity,prevention
                Molecular medicine
                breastfeeding, chronic diseases, diabetes, dyslipidemia, hypertension, obesity, prevention

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