Breastfeeding duration, mixed feeding and health risk in Costa Rican children and adolescents

Objective: to analyze the associations between breastfeeding duration and mixed feeding (breast milk and formula) with obesity, cardiometabolic risk (WHtR), body fat, and dietary and physical activity risk behaviors in children and adolescents. Subjects and Method: cross-sectional study carried out with 1,467 students in Costa Rica. An interview was conducted with parents and children to gather information on socioeconomic status, education, dietary and physical activity risk behaviors of the youth, including breastfeeding duration and mixed feeding. Body mass index, waist circumference, and body fat were assessed by bioelectrical impedance analysis and cardiometabolic risk was measured with the waist-to-height ratio (WHtR >= 0.5) by trained personnel. Descriptive statistics and logistic regression models were applied. Results: the average age was 11.4 +/- 2.6 years and 50.9% were male. 55.5% of the population was middle class; 60% were sedentary, and 16% presented obesity. Around 20% were breastfed without the introduction of formula before 6 months, 13% were never breastfed, and more than 60% were breastfed for >= 6 months. Those children who were fed only with breast milk or in combination with formula for >= 6 months presented a lower percentage of obesity than those who received formula feeding only (60.8 vs 39.2; p < 0.005). Children with cardiometabolic risk (WHtR >= 0.50), unhealthy diet, sedentary lifestyle, and who were fed only with formula are at higher risk of developing obesity (OR = 18.8, 95% CI 13.2-26.0). Conclusions: these results are consistent with other studies and reinforce the evident protection of breastfeeding against the development of obesity.