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Breastfeeding and ApoB in late adolescence: a Hong Kong birth cohort study

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Abstract

Breastfeeding is widely promoted. Experimental evidence concerning long-term benefits is limited. Observational studies are open to bias from confounding by socio-economic position. We assessed the association of breastfeeding with late adolescent lipid sub-fractions, particularly apolipoprotein B (ApoB) and non-high-density lipoprotein cholesterol (non-HDL-c), overall and by sex. We took advantage of a setting where breastfeeding has little association with higher socio-economic position and where several results from randomized controlled trials of breastfeeding promotion have been replicated. We used the population-representative “Children of 1997” birth cohort comprising 88% of births in Hong Kong in April and May 1997. Associations of breastfeeding in the first 3 months of life (never, mixed, exclusive) with lipid sub-fractions were obtained using linear regression adjusted for potential confounders including parental socio-economic position, maternal place of birth, type of delivery, gestational age, and birth weight. Differences by sex were assessed. Multiple imputation and inverse probability weighting were used to recover the original sample. Of the 3462 participants included, mean age was 17.6 years and 48.8% were girls. Mean ApoB was 0.74 g/L (standard deviation 0.15). Exclusive versus never breastfeeding was associated with lower ApoB (−0.027 g/L, 95% confidence interval (CI)−0.046 to−0.007, p = 0.007) and lower non-HDL-c (−0.143 mmol/L, 95% CI−0.237 to−0.048) with similar estimates by sex.

Conclusion: Breastfeeding may provide some population-level lifelong protection against cardiovascular disease. This study supports policies promoting breastfeeding as a modifiable exposure that contributes to a healthy start in life as an investment for lifelong cardiovascular disease prevention.

What is Known:

• Apolipoprotein B (ApoB) is a recognized risk factor for cardiovascular disease, but whether breastfeeding affects ApoB in later life overall and by sex is unknown.

What is New:

• Exclusive breastfeeding in the first 3 months of life was associated with lower ApoB in late adolescence, with similar estimates for both sexes.

• The inverse association of breastfeeding with ApoB suggests that breastfeeding could reduce cardiovascular disease and overall mortality over the lifespan.

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Data availability

The data used here is available on request.

Abbreviations

ApoB:

Apolipoprotein B

HDL-c:

High-density lipoprotein cholesterol

LDL-c:

Low-density lipoprotein cholesterol

MCHC:

Maternal and Child Health Centre

Q-Q:

Quantile-quantile

SHS:

Second-hand smoking

US:

United States

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Acknowledgements

This study was supported by the Health and Medical Research Fund, Food and Health Bureau, Hong Kong SAR Government (#17181271). This work is a sub-study of the “Children of 1997” birth cohort which was initially supported by the Health Care and Promotion Fund, Health and Welfare Bureau, Government of the Hong Kong SAR (HCPF Grant # 216106) and re-established in 2005 funded by the Health and Health Services Research Fund (HHSRF Grant # 03040771, 05060671, 07080751, 07080841) and the Research Fund for the Control of Infectious Diseases in Hong Kong (RFCID Grant # 04050172, 06060592), Government of the Hong Kong SAR. The birth cohort has also received funding from the University Research Committee Strategic Research Theme (SRT) of Public Health Granted Research, The University of Hong Kong. The most recent follow-up was partly funded by the WYNG Foundation; analysis of the follow-up was partly funded by a pre-emptive retention/Start up fund, LKS Faculty of Medicine, The University of Hong Kong (S.L.A.Y). We are very grateful to the “Children of 1997” birth cohort participants for their invaluable contribution and to the legions of people who have made this study possible by building this birth cohort over almost 30 years, including the late Dr. Connie O for coordinating the project and all the fieldwork for the initial study in 1997–1998.

Funding

This study was supported by the Health and Medical Research Fund, Food and Health Bureau, Hong Kong SAR Government (#17181271).

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Authors and Affiliations

  1. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China

    C. Mary Schooling, Shiu Lun Au Yeung, Man Ki Kwok & Gabriel M. Leung

  2. CUNY School of Public Health, 55 West 125Th St, 10027, New York, NY, USA

    C. Mary Schooling

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  1. C. Mary Schooling
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Contributions

CMS designed the study and wrote the analysis plan, performed the data analyses, and interpreted the results, with feedback from SLAY, MK, and GML. CMS wrote the first draft of the manuscript with feedback from SLAY, MK, and GML. All authors gave final approval of the version to be published. CMS is the guarantor of work.

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Correspondence to Man Ki Kwok.

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Communicated by Gregorio Milani.

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Schooling, C., Au Yeung, S.L., Kwok, M.K. et al. Breastfeeding and ApoB in late adolescence: a Hong Kong birth cohort study. Eur J Pediatr 182, 3733–3741 (2023). https://doi.org/10.1007/s00431-023-05033-w

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