Public Health Nutrition

Hot topic – Childhood Obesity

Infant feeding practices and prevalence of obesity in eight European countries – the IDEFICS study

Monica Hunsbergera1 c1, Anne Lanfera2, Anna Reeskea2, Toomas Veidebauma3, Paola Russoa4, Charalampos Hadjigeorgioua5, Luis A Morenoa6, Dénes Molnara7, Stefaan De Henauwa8a9, Lauren Lissnera1 and Gabriele Eibena1

a1 Public Health Epidemiology Unit, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 454 SE-405 30, Gothenburg, Sweden

a2 Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany

a3 National Institute for Health Development, Tallinn, Estonia

a4 Institute for Food Sciences, Unit of Epidemiology and Population Genetics, National Research Council, Avellino, Italy

a5 Research and Education Institute of Child Health, Strovolos, Cyprus

a6 Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain

a7 Department of Pediatrics, Medical Faculty, University of Pécs, Budapest, Hungary

a8 Department of Public Health, Ghent University, Ghent, Belgium

a9 University College Ghent, Department of Nutrition and Dietetics, Faculty of Health Care ‘Vesalius’, Ghent, Belgium


Objective To assess the association between exclusive breast-feeding and childhood overweight.

Design Cross-sectional data are from the baseline survey of the longitudinal cohort study IDEFICS. Exclusive rather than partial breast-feeding is the focus of the study due to the theoretical relationship between exclusive breast-feeding and development of dietary self-regulation. Children's measured heights and weights were used to calculate weight status, while waist-to-height ratio (WtHR) and skinfold measures were examined as alternative indicators of adiposity and fat patterning.

Setting Examination centres in eight European countries (Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain).

Subjects The analysis included 14 726 children aged 2–9 years for whom early feeding practices were reported by parents in standardized questionnaires.

Results After controlling for education, income and other potential confounders, breast-feeding exclusively for 4–6 months was protective of overweight (including obesity) when compared with children never exclusively breast-fed (OR = 0·73; 95 % CI 0·63, 0·85) across all measures of overweight. Exclusively breast-feeding for 6 months offered slightly more protection than for 4 and 5 months combined (OR = 0·71; 95 % CI 0·58, 0·85). The associations could not be explained by socio-economic characteristics or maternal overweight.

Conclusions This multi-country investigation indicated that exclusive breast-feeding for 4–6 months may confer protection against overweight in addition to other known benefits. There was no demonstrated benefit of exclusive breast-feeding for more than 6 months or combination feeding for any duration across all measures of overweight examined.

(Received January 12 2012)

(Revised June 08 2012)

(Accepted July 16 2012)

(Online publication August 24 2012)


  • Breast-feeding;
  • Childhood overweight and obesity;
  • Socio-economic status


c1 Corresponding author: Email