Association between Breast Feeding and
Childhood Obesity among Pakistani SchoolGoing Children
Ms.Saima Sachwani, Dr.Rozina Karmaliani, Ms.Shela Hirani,
Mr.Asif Raza Khowaja
Aga Khan University School of Nursing Midwifery,
Karachi, Pakistan
1
Study Background: Pakistani Context
o Obesity trend from Pakistan, reported an almost two-fold
rise of obesity from 3% to 5.7% in ten years’ time
(Jafar, et al., 2008)
o The duration of total, and exclusive breast feeding in
Pakistan falls short of World Health Organization’s
recommendations.
(PDHS, 2007)
o Substantial body of evidences have indicated breast
feeding to be modestly protective against childhood obesity
o No study has been conducted to explore association
between breast feeding and childhood obesity in Pakistan
2
Study Question
Q1.
Is there an association between breast feeding
(history and duration), and childhood obesity in
school-going children (5-16 years of age) in Karachi,
Pakistan?
Q2.
Is there an association between exclusive breast
feeding (history and duration), and childhood obesity
in school-going children (5-16 years of age) in
Karachi, Pakistan?
3
Methodology
Study Design
Matched case-control study design
Study Population
School going-children (5-16 years of age)
Study Setting
2 Public and 1 private schools of Karachi, Pakistan
Sample size
Cases: Controls
132 : 396
Total : 528
4
Inclusion / Exclusion Criteria
Inclusion Criteria
Exclusion Criteria
Age: 5-16 years of age
Hormonal treatment, secondary
obesity (hypothyroidism) or
serious illness.
For Cases: BMI > 85 percentile Diabetes Miletus or co-morbid
affecting weight
For Control: BMI < 85
Not a resident of Karachi for at
percentile
least 6 months
Resident of Karachi for at least Not willing to participate
6 months
Willingness to participate
5
Data Collection: Study Instrument
o Control of Blood Pressure and Risk AttenuationCOBRA TRIAL
(Jafar et al., 2008)
- Student’s Demographic Profile
- Nutritional Profile (Food Frequency Questionnaire)
- Physical Activity Profile (International Physical
Activity Questionnaire)
- Anthropometric measurements (height and weight)
o Mother’s Demographic Profile
o Breast Feeding History Profile
(Novotny et al., 2007)
6
Study Results
Demographic Characteristics of School-Going Children
43.2%
56.8%
5 - 10 years
Age
10 - 14 years
7
Study Results
Demographic Characteristics of School-Going Children
70
62.1%
60
Percentages
50
37.9%
40
Case
Control
30
20
10
0
Male
Female
Gender
8
9
Discussion
o In the present study we found out the longer duration of
breast feeding and exclusive breast feeding was
associated with lower BMI.
o The finding are consistent with several studies
o There could be two possible reasons
1. Nutritional programming
2. Behavioral programming
(Savino, Lupica, Liguori, Fissore, & Silvestro, 2012).
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Recommendations
Efforts should be made to improve the rate of optimal
duration of breast feeding, and exclusive breast feeding for
at least 6 months.
1. Education/Service
a. All health disciplines should incorporate breast
feeding as a ―frontier in preventing childhood
obesity in their curriculum.
b. Mothers should be educated about infant‘s signs of
hunger and satiety.
c. All the practicing health care professionals should be
educated about full scope of breast feeding benefits.
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Recommendations (cont … )
3. Policy
a. All maternal and child health care agencies must be
monitored for their compliance to baby-friendly policies.
b. Work-places should ensure supportive environment
towards nursing mothers such as allowing flexible work
schedules that promotes optimal breast feeding for the
infant.
c. The role of lactation consultant should be introduced.
12
Recommendations (cont …)
4. Research
a. Further researches should be conducted, to study
the association of breast feeding and childhood
obesity in school age children from different parts
of country.
b. Prospective studies should be done to assess the
cause and effect, and temporal relationship
between breast feeding and childhood obesity.
13
References
•
Fall, C. H. D., Borja, J. B., Osmond, C., Richter, L., Bhargava, S. K., Martorell, R.,
et al. (2010). Infant-feeding patterns and cardiovascular risk factors in young
adulthood: data from five cohorts in low- and middle-income countries.
International Journal of Epidemiology, 40(1), 47-62.
•
Jafar, T. H., Qadri, Z., Islam, M., Hatcher, J., Bhutta, Z. A., &Chaturvedi, N.
(2008a). Rise in childhood obesity with persistently high rates of undernutrition
among urban school-aged Indo-Asian children. Archives of Disease in Childhood,
93(5), 373-378
•
Jafar, T. H., Qadri, Z., &Chaturvedi, N. (2008b). Coronary artery disease epidemic
in Pakistan: more electrocardiographic evidence of ischaemia in women than in
men. Heart, 94(4), 408.
•
Jafar, T. H., Chaturvedi, N., & Pappas, G. (2006).Prevalence of overweight and
obesity and their association with hypertension and diabetes mellitus in an IndoAsian population.CMAJ, 175(9), 1071-1077.
•
Jafar, T. H. (2006). Women in Pakistan have a greater burden of clinical
cardiovascular risk factors than men. International Journal of Cardiology, 106(3),
14
348-354
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Discussion (cont...)
o Moderate or lower extent of participation in moderate to
vigorous physical activity was protective against
childhood obesity.
This could be due to:
o Cases in the study were more physically active.
o Cases in the study were more engaged in sedentary
activities.
(Leatherdale, and Wong, 2009)
o Children’ s have limited ability to recall physical activity
beyond 2 days.
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(McMurray, Ring, Treuth, Welk, Pate, Schmitz, et al. 2004)