Kozeta Miliku1, Trudy Voortman2, Hanneke Bakker1, Albert Hofman3, Oscar H Franco3, Vincent W V Jaddoe4. 1. The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 2. The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 3. Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 4. The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: v.jaddoe@erasmusmc.nl.
Abstract
BACKGROUND: Early life factors may influence kidney growth and function throughout the life course. We examined the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with kidney outcomes at school age. STUDY DESIGN: Prospective cohort study from fetal life onward. SETTING & PARTICIPANTS: 5,043 children in the Netherlands. PREDICTORS: Infant feeding was assessed prospectively using questionnaires. OUTCOMES & MEASUREMENTS: In children at a median age of 6.0 years, we measured kidney volume with ultrasound, estimated glomerular filtration rate (eGFR) from serum creatinine level, and microalbuminuria from urinary albumin and creatinine levels. RESULTS: 92% of all children were ever breastfed, of whom 27% were breastfed for more than 6 months and 21% were breastfed exclusively for at least 4 months. Compared with ever-breastfed children, never-breastfed children had smaller combined kidney volumes (-2.69 [95% CI, -4.83 to -0.56] cm(3)) and lower eGFRs (-2.42 [95% CI, -4.56 to -0.28] mL/min/1.73 m(2)) at school age. Among breastfed children, shorter duration of breastfeeding was associated with smaller combined kidney volume and lower microalbuminuria risk (P<0.05). Compared to exclusive breastfeeding for 4 months, nonexclusive breastfeeding in the first 4 months was associated with smaller combined kidney volume and lower eGFR (both P<0.05). Associations with eGFR were explained largely by kidney volume. Age at introduction of solid foods was not associated with any kidney outcome. LIMITATIONS: Observational study, so causality cannot be established. Follow-up measurements were available for 76% of children. CONCLUSIONS: These results suggest that breastfeeding is associated with subclinical changes in kidney outcomes in childhood. Further studies are needed to explore whether early life nutrition also affects the risk of kidney disease in adulthood.
BACKGROUND: Early life factors may influence kidney growth and function throughout the life course. We examined the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with kidney outcomes at school age. STUDY DESIGN: Prospective cohort study from fetal life onward. SETTING & PARTICIPANTS: 5,043 children in the Netherlands. PREDICTORS: Infant feeding was assessed prospectively using questionnaires. OUTCOMES & MEASUREMENTS: In children at a median age of 6.0 years, we measured kidney volume with ultrasound, estimated glomerular filtration rate (eGFR) from serum creatinine level, and microalbuminuria from urinary albumin and creatinine levels. RESULTS: 92% of all children were ever breastfed, of whom 27% were breastfed for more than 6 months and 21% were breastfed exclusively for at least 4 months. Compared with ever-breastfed children, never-breastfed children had smaller combined kidney volumes (-2.69 [95% CI, -4.83 to -0.56] cm(3)) and lower eGFRs (-2.42 [95% CI, -4.56 to -0.28] mL/min/1.73 m(2)) at school age. Among breastfed children, shorter duration of breastfeeding was associated with smaller combined kidney volume and lower microalbuminuria risk (P<0.05). Compared to exclusive breastfeeding for 4 months, nonexclusive breastfeeding in the first 4 months was associated with smaller combined kidney volume and lower eGFR (both P<0.05). Associations with eGFR were explained largely by kidney volume. Age at introduction of solid foods was not associated with any kidney outcome. LIMITATIONS: Observational study, so causality cannot be established. Follow-up measurements were available for 76% of children. CONCLUSIONS: These results suggest that breastfeeding is associated with subclinical changes in kidney outcomes in childhood. Further studies are needed to explore whether early life nutrition also affects the risk of kidney disease in adulthood.
Authors: Kozeta Miliku; Janine F Felix; Trudy Voortman; Henning Tiemeier; Darryl W Eyles; Thomas H Burne; John J McGrath; Vincent W V Jaddoe Journal: Matern Child Nutr Date: 2018-09-21 Impact factor: 3.092
Authors: Kozeta Miliku; Hanneke Bakker; Eiske M Dorresteijn; Karlien Cransberg; Oscar H Franco; Janine F Felix; Vincent W V Jaddoe Journal: Am J Nephrol Date: 2017-03-01 Impact factor: 3.754
Authors: K Miliku; T Voortman; O H Franco; J J McGrath; D W Eyles; T H Burne; A Hofman; H Tiemeier; V W V Jaddoe Journal: Eur J Clin Nutr Date: 2015-12-23 Impact factor: 4.016
Authors: Trudy Voortman; Hanneke Bakker; Sanaz Sedaghat; Jessica C Kiefte-de Jong; Albert Hofman; Vincent W V Jaddoe; Oscar H Franco; Edith H van den Hooven Journal: Pediatr Nephrol Date: 2015-05-09 Impact factor: 3.714
Authors: Hanneke Bakker; Romy Gaillard; Albert Hofman; Irwin K Reiss; Eric A P Steegers; Vincent W V Jaddoe Journal: Pediatr Nephrol Date: 2016-10-27 Impact factor: 3.714
Authors: Kozeta Miliku; Suzanne Vogelezang; Oscar H Franco; Albert Hofman; Vincent W V Jaddoe; Janine F Felix Journal: Pediatr Res Date: 2016-03-09 Impact factor: 3.756
Authors: Michael S Balzer; Mechthild M Gross; Ralf Lichtinghagen; Hermann Haller; Roland Schmitt Journal: PLoS One Date: 2015-11-16 Impact factor: 3.240
Authors: Kozeta Miliku; Anne Mesu; Oscar H Franco; Albert Hofman; Eric A P Steegers; Vincent W V Jaddoe Journal: Am J Kidney Dis Date: 2017-01-28 Impact factor: 8.860