Cholesterol Level in Adolescence and Breastfeeding
by Anne Eglash MD, IBCLC, FABM
Past studies have observed that adults who were breastfed as infants have healthier cholesterol profiles as compared to those who were formula fed. However several of these studies were done in high resource countries, so have been criticized for confounders because people who are wealthier and have higher education are more likely to have been breastfed. This population also has greater access to a healthier diet, so is it the breastfeeding or the healthier lifestyle that is associated with lower cholesterol as an adult?
The study for this week regarding breastfeeding and cholesterol was done using data from the Hong Kong Children of 1997 cohort monitoring 8327 participants, covering 88% of all births in Hong Kong from April 1, 1997 to May 31, 1997. At that time, breastfeeding in Hong Kong was not associated with socioeconomic status. The researchers collected baseline demographic data on this population including pregnancy details, parental education, cigarette smoke exposure, birth weight, and gestational age. Infant feeding data, categorized as exclusive breastfeeding, mixed feeding, and formula fed, was collected at 3, 9 and 18 months of age. In 2013-2016 body weight, body fat, and fasting lipids were measured for 3261 participants, who were teens at that point.
The researchers found that the total cholesterol and LDL cholesterol (‘bad’ cholesterol) were lower among the teenagers who were exclusive breastfed for 3 months, as compared to those who received mixed feeding or formula in the first 3 months. This data is controlled for the teenager’s BMI, body fat percent, as well as other demographic data including maternal smoking, gestational diabetes, and parental education. The teens’ BMI and body fat percent were not associated with infant feeding type.
- Breastmilk is higher in cholesterol than formula.
- Breastfed infants have higher cholesterol levels than formula fed infants.
- Breastfed infants make less of their own cholesterol than formula fed infants.
- This study supports the recommendation that formula should contain more cholesterol.
- Partial breastfeeding as an infant is not associated with a lower cholesterol at age 17.
- Later introduction to solid food was not associated with the cholesterol level at age 17.
See the Answer
Breast milk has higher cholesterol than formula. Infants who are breastfed have abstract different cholesterol synthesis and metabolism in infancy than infants who are formula fed. Little is known as to whether breastfeeding is associated with subsequent lipid profile, independent of adiposity. We assessed the association of breastfeeding in early infancy with lipid profile and adiposity at ∼17.5 years in a setting where exclusive breastfeeding is not associated with higher socioeconomic position.
We used multivariable linear regression with multiple imputation and inverse probability weighting to examine the associations of contemporaneously reported feeding in the first 3 months of life (exclusive breastfeeding [7.5%], mixed feeding [40%], or always formula feeding [52%]) with lipids and adiposity at ∼17.5 years in 3261 participants in the Hong Kong Chinese birth cohort Children of 1997, adjusting for sex, birth weight, gestational weeks, parity, pregnancy characteristics, parents’ highest education, mother’s place of birth, and age at follow-up.
Exclusive breastfeeding, but not mixed feeding at 0 to 3 months, compared with formula feeding was associated with lower total cholesterol and low-density lipoprotein cholesterol but not with high-density lipoprotein cholesterol at ∼17.5 years. BMI and fat percentage measured by bioimpedance did not differ by type of infant feeding.
Exclusive breastfeeding in early infancy may promote a healthier lipid profile in late adolescence through mechanisms unrelated to adiposity, implicating its potential long-term benefits for cardiovascular health.
It is well established that breastmilk has more cholesterol than formula, and that infants who are breastfeeding have higher serum cholesterols than infants who are not breastfeeding. Cholesterol is vital to infant development, since it is essential for growth of all cells and organs, particularly the brain.
It is unclear if the more optimal lipid profiles among teens who were breastfed as infants has to do with the higher cholesterol exposure in breastmilk, or if there is something about formula that causes a more adverse cholesterol profile later. The research study reviewed here demonstrates that the cholesterol profile later in life is not associated with BMI or fat percent.
There is no evidence at this point that adding cholesterol to formula would help the situation.
This study associated exclusive breastfeeding at 3 months to more optimal cholesterol profiles at age 17. We don’t know if exclusive breastfeeding for 6 months would be even more beneficial, let’s hope that the research is forthcoming.