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Association of breastfeeding duration with cardiac structure and function in 4 years old

European Journal of Clinical Nutrition (2025)Cite this article

Subjects

Abstract

Background

Breast milk is an important source of nutrition for infant development. But few studies have investigated the relationship between breastfeeding duration and children’s cardiac structure and function.

Objectives

To assess the association of the duration of breastfeeding in infancy with cardiac structures and functions in 4-year-old children.

Methods

The study analyzed data from 891 mother-offspring pairs in the Shanghai Birth Cohort (SBC) with complete 4-year follow-up and breastfeeding questionnaires. It excluded children with congenital heart defects or missing echocardiography data at age 4. Breastfeeding duration, including exclusive and mixed feeding, was categorized into three groups (<6months, 6-12months, >12months) based on questionnaires at 3 days, 24 days, 6, 12, and 24 months. Echocardiographic data were measured following 2010 American Society of Echocardiography recommendations.

Results

The results showed that: compared to 4-year-old children who were breastfed for less than 6 months, those breastfed for more than 6 months had bigger left atrial and ventricular volume, including increased left atrial diastolic volume [LAVd (β: 2.09, 95% CI: 1.35, 2.83)], left atrial systolic volume [LAVs (β: 0.92, 95% CI: 0.53, 1.3)], left ventricular diastolic volume [LVEDV (β: 2.00, 95% CI: 0.36, 3.62)] and systolic volume [LVESV (β: 0.87, 95% CI: 0.17, 1.57)]. Children breastfed over 12 months showed similar cardiac structural changes as those breastfed 6-12 months. These findings were more pronounced in girls and low birthweight children.

Conclusions

Four-year-old children who were breastfed for six months or more had increased left heart volume, and this association was influenced by gender and birthweight.

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Fig. 1: Sex differences in the association between duration of breastfeeding and cardiovascular parameters at the age of 4 years.
Fig. 2: Birthweight differences in the association between duration of breastfeeding and cardiovascular parameters at the age of 4 years.

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Data availability

The data that support the findings of this study are available from Shanghai Birth Cohort but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Shanghai Birth Cohort.

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Acknowledgements

We thank all children and their families who were involved in this study. This study was partly funded by the Shanghai Municipal Health Commission (GWIII-26, GWIV-26, 2020CXJQ01) and the Shanghai Jiao Tong University School of Medicine, Xinhua Hospital and the National Human Genetic Resources Sharing Service Platform (2005DKA21300).

Funding

All phases of this study were supported by the National Natural Science Foundation of China (82100320), Shanghai Municipal Science and Technology Commission (23ZR1441600), Shanghai Municipal Health Commission (2020CXJQ01), and Shanghai Jiao Tong University School of Medicine, Xinhua Hospital (19XHCR06B).

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Author notes

  1. These authors contributed equally: Zhi Wang, Ling Yang.

Authors and Affiliations

  1. Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China

    Zhi Wang, Ling Yang, Bowen Du, Hualin Wang, Caifang Xu, Qianchuo Wang, Zhuoyan Li, Zhikang Xu, Kun Sun & Jian Wang

  2. Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China

    Zhi Wang, Caifang Xu, Zhuoyan Li, Zhikang Xu, Kun Sun & Jian Wang

  3. MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China

    Hui Wang

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Contributions

ZW, JW, LY, BD, HW, CX, QW, ZL, ZX, HW and KS contributed to the conceptualization and design of the study; ZW and LY recruited the patients and collected the data; ZW and LY contributed to the acquisition and analysis of data; ZW, LY, BD, HW, and CX contributed to the interpretation of data; ZW drafted the manuscript; JW and KS contributed to the funding acquisition. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Kun Sun or Jian Wang.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study complied with the guidelines of the Declaration of Helsinki. Informed consent was obtained from the patients or their legal representative. All methods were performed in accordance with the relevant guidelines and regulations.

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Wang, Z., Yang, L., Du, B. et al. Association of breastfeeding duration with cardiac structure and function in 4 years old. Eur J Clin Nutr (2025). https://doi.org/10.1038/s41430-025-01623-z

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