| IntroduceObesity and malnutrition are the main factors of children healthy problem in our country. Recently, more and more children become fat ,even serious in some region. Malnutrition is a chronic disease for less of nutrition. The main cause of it is bad - feeding or other disease. Nowadays malnutrition is still a serious public health problem in developing country or country side in china.Breast - feeding is the most important factor of nutrition in infant or baby . It is the best food of baby. Recently some studies show a close relation between breast - feeding in baby and nutrition of children even adult. Articles show breast - feeding can prevent malnutrition or obesity in children. It is a double -side function . Otherwise the role of 4 to 6 months breast - feeding can prevent malnutrition is assured, but if prolonged breast - feeding is a risk factor to malnutrition is not testified. This study modifies the design , combines mode and time of breast - feeding to study the relationship between breast - feeding and o-besity or malnutrition in children .Materials and Methods1. The Object of study : 1 to 5 years old children in Shenyang2. The way of select sample : the city child is selected from Heping region , rural child is selected from Sujiatun and Faku region.Child aged from 1 to 3 are selected from street ,6 streets are selected from city, 12 streets selected from rural region(6 street in each region). 60 children are selected from each city street , 40 children are selected from each ruralstreet randomly.Child aged from 3 to 5 are selected from kindergarten , 16 kindergartens are selected from city, 18 kindergarten selected from rural region.40 children are selected from each city or rural kindergarten randomly.3. Content and standard of investigateWe measure the height and weight of child , inquire parents of child gender, age, race, manner of labor, breast - feeding, appetite, illness, health care, income of family et al,total 25 items.Regard BMI > 18 as fat , regard BMI < 15 as malnutrition, accordind to WHO rule , the way of breast - feeding in 4 months including pure breast - feeding , mixed breast - feeding and no breast - feeding.According to the way of breast - feeding in 4 months and time of breast -feeding , the mode of early child including pure breast - feeding and breast -feeding more than 9 months, pure breast - feeding and breast - feeding 7 to 9 months , pure breast - feeding and breast - feeding 4 to 6 months , mixed breast - feeding and breast - feeding more than 9 months, mixed breast - feeding and breast - feeding 7 to 9 months , mixed breast - feeding and breast - feeding 4 to 6 months, breast - feeding less than 4 months and no breast - feeding.4. Quality controlAll of attendee are medical careerman and are trained before survey, unite standard ,checkup strictly by 5%.5. The way of analysis:Using case - control way, EPI Info 3. 3. 2 is used to build database, SPSS13.0 is used to analysis data. No -conditioned binary Logistic model is used to analysis the difference of breastfeeding mode between fat or malnourished child and normal child . (All of other breastfeeding mode are compared to no -breastfeeding or breast - feeding less than 4 months) , other nutrition related factors are added into model to carry a mutil - factors analysis.Results1. BaselineWe investigate city child 994,among them , fat is 189,normal is 761 ,malnutrition is 47. There are on difference between fat group and normal group in sex, age, income and family number.We investigate rural child 1194, among them , fat is 30, normal is 998 , malnutrition is 166. there are on difference between malnutrition group and normal group in sex, age, income and family number.2. The relationship between breastfeeding mode and city child obesity.2.1 One factor analysisPure breast — feeding and breast - feeding more than 9 months ( OR = 0.518,95% C. I. ( 0. 313, 0. 859 ) , P = 0. Oil ) , pure breast - feeding and breast-feeding 7 to 9 months (OR =0. 607,95% C. I. ( 0.378, 0.977 ),P = 0. 040) are protective factors for obesity.Otherwise, father or mother has a high degree education, good appetite, middle appetite,add auxiliary food in time are protective factors for obesity. Born long,born weightily,icterus are risk factors for obesity.2. 2 Multi - factor analysisPure breast - feeding and breast - feeding more than 9 months, pure breast - feeding and breast - feeding 7 to 9 months are still protective factors for obesity. Mother has a high degree education ,add auxiliary food in time are protective factors for obesity. Born weightily are risk factors for obesity.3. The relationship between breastfeeding mode and rural child malnutrition.3. 1 One factor analysisPure breast - feeding and breast - feeding 4 to 6 months, pure breast -feeding and breast - feeding 7 to 9 months are protective factors for child malnutrition. Otherwise, mother has a high degree education, add auxiliary food in time ,good medical visit ,born weightily, are protective factors for malnutrition.3. 2 Multi - factor analysisPure breast - feeding and breast - feeding 4 to 6 months are still protective factors for malnutrition, mother has a high degree education, add auxiliary food in time , good medical visit , born weightily are still protective factors for malnutrition.DiscussionSince 2000, some articles discussed that mode of breastfeeding in 4months has a proactive function for child obesity.2004,a meta analysis was published to disscuss the problem, but till now some problem are stll disputed. Later some experts thinked more duration time of breastfeeding more low risk of obesity in child , there are dose - response relationship.We think a whole child breastfeeding should including breastfeeding in 4 months and " a mixed feeding" last for 1 or 2 years. Most of published studies studied them each other and ignored the combine function of those two period . Otherwise, these published studies all included malnutrition into the control. Since obesity and malnutrition are all nutrition - related disease, the two disease may have the same reason , do not expel malnutrition, it is easy to bring a mis -classed bias. There is also an obvious question that these studies seldom refered the define of breastfeeding is according to WHO. This study modify these design defect,pay attention to the relation between breastfeeding and 1 to 5 years old child obesity. The results show pure breast - feeding and breast - feeding more than 9 months, pure breast - feeding and breast - feeding 7 to 9 months are protective factors for obesity. The function of the latter is bigger. We think the res-onable explain is there are leption in the breastfeeding, level of leption is higher in breastfeeding baby than no breastfeeding baby. " First double" in 4 month and supply last for 1 to 2 years make baby has a high leption level in body just like the "steady blood concentration of drug" ,it can protcet child from obesity for a long time.To malnutrition , our results show pure breast - feeding and breast - feeding 4 to 6 months is a protective factors for malnutrition, this maybe the function of balanced - nutrition breastfeeding. However if the prolonged breastfeeding can bring malnutrition is discussed. Our study think published studies compared prolonged feeding and no prolonged feeding, they all include 4 to 6 month breastfeeding in the control, so it can not show the difference between prolonged feeding and breast - feeding less than 4 months or no breastfeeding. We comparethose two groups, the results show there is no difference between them. We think breastfeeding last for more than 6 months may disturb child intake other foods, this make the protective function of it is counteracted, but the result of it only equal to the breast - feeding less than 4 months or no breastfeeding, it can not bring more serious malnutrition. The cause of malnutrition may attribute to other factors ( such as add auxiliary food in time OR = - 0.529 ,P =0.003) .To testify the relationship between breastfeeding and nutritional condition of child further ,we should define the quantity of the breastfeeding and collect other influence factors to control bias . However the epidemiology of child is depended on the answer of parents,the believed degree of it is often questioned. We should invent some special questionnaire to know the children behavior just like the life quality questionnaire. Otherwise, inherit factors should be included in study, it is too simple only use birth length and weigh to control them , molecule - epidemiology combined with detection of gene and leptin may solve question more better .Conclusion1. Pure breast - feeding and breast - feeding 7 to 9 months and pure breast - feeding and breast - feeding more than 9 months are protective factors for obesity , the function of latter is bigger.2. Pure breast - feeding and breast - feeding 4 to 6 months is a protective factors for malnutrition. The function of breastfeeding more than 6 months to malnutrition is equal to breast - feeding less than 4 months or no breastfeeding. The prolonged of breast - feeding can not bring about more serious malnutrition. |
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