For example, mothers who breastfeed may differ from those who opt for formula in ways that cannot be fully measured or adjusted for. There are several potential reasons for these inconsistent effects. Further, a large cluster-randomized trial of breastfeeding promotion in Belarus even suggested that prolonged breastfeeding was associated with increased BMI in adolescence ( 10). When confounders such as maternal BMI, education, household income, and smoking are taken into account, associations between breastfeeding and childhood obesity are attenuated or eliminated ( 9). Potential benefits of breastfeeding on offspring BMI may be blunted in women with obesity or gestational diabetes mellitus ( 8). Several large studies have documented protective effects ( 4), but meta-analyses have found evidence of publication bias ( 5, 6) and mixed effects on obesity ( 7). Although breastfeeding has numerous benefits for maternal and infant health, the evidence on obesity prevention is contradictory at best. Breastfeeding is promoted by the American Academy of Pediatrics, Institute of Medicine, WHO, and other leading medical organizations as a way to curb childhood obesity ( 1–3).
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