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Does initial breastfeeding lead to lower blood cholesterol in adult life? A quantitative review of the evidence^1,2,3

¹ From the Division of Community Health Sciences, St George's, University of London, London, United Kingdom (CGO, PHW, SJK, DGC, ARR, and DPS); the Department of Social Medicine, University of Bristol, Bristol, United Kingdom (RMM and GDS); Public Health and Clinical Medicine, Umea University, Umea, Sweden (EB); the MRC National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free and University College Medical School, London, United Kingdom (SB and MEJW); the MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom (CHF); the Department of Preventive Medicine, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY (JLF and JN); The George Institute, Sydney, Australia (RRH); the University Department of Paediatrics, Children's Hospital Zagreb, Zagreb, Croatia (SK); the Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (CPL): the School of Clinical Medical Sciences, Newcastle University, and Sir James Spence Institute, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom (MSP); the Department of Clinical Physiology, Turku University Central Hospital, Turku, Finland (OTR and IL); the Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands (ACR); and the Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (SMW)

Background: Earlier studies have suggested that infant feeding may program long-term changes in cholesterol metabolism.

Objective: We aimed to examine whether breastfeeding is associated with lower blood cholesterol concentrations in adulthood.

Design: The study consisted of a systematic review of published observational studies relating initial infant feeding status to blood cholesterol concentrations in adulthood (ie, aged >16 y). Data were available from 17 studies (17 498 subjects; 12 890 breastfed, 4608 formula-fed). Mean differences in total cholesterol concentrations (breastfed minus formula-fed) were pooled by using fixed-effect models. Effects of adjustment (for age at outcome, socioeconomic position, body mass index, and smoking status) and exclusion (of nonexclusive breast feeders) were examined.

Results: Mean total blood cholesterol was lower (P = 0.037) among those ever breastfed than among those fed formula milk (mean difference: –0.04 mmol/L; 95% CI: –0.08, 0.00 mmol/L). The difference in cholesterol between infant feeding groups was larger (P = 0.005) and more consistent in 7 studies that analyzed "exclusive" feeding patterns (–0.15 mmol/L; –0.23, –0.06 mmol/L) than in 10 studies that analyzed nonexclusive feeding patterns (–0.01 mmol/L; –0.06, 0.03 mmol/L). Adjustment for potential confounders including socioeconomic position, body mass index, and smoking status in adult life had minimal effect on these estimates.

Conclusions: Initial breastfeeding (particularly when exclusive) may be associated with lower blood cholesterol concentrations in later life. Moves to reduce the cholesterol content of formula feeds below those of breast milk should be treated with caution.