The Role of Children's Dietary Pattern and Physical Activity in the Association Between Breastfeeding and BMI at Age 5: The GECKO Drenthe Cohort

Petra Corianne Vinke*, Carolien Tigelaar, Leanne Karen Küpers, Eva Corpeleijn

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
63 Downloads (Pure)


Objectives Breastfeeding is protective against childhood obesity, but the role of childhood lifestyle in this association is unclear. We investigated whether physical activity and dietary pattern at age 5 differed between breastfed and non-breastfed children, and how they relate to Body Mass Index (BMI) Z-scores. Methods 1477 children of the Dutch GECKO Drenthe birth cohort were included. At one month, children were categorized as breastfed (receiving breast milk exclusively or in combination with formula milk) or non-breastfed (receiving formula milk exclusively). At age 5, height and weight were objectively measured, physical activity was measured by ActiGraph GT3x and dietary patterns were assessed with a parent-reported food pattern questionnaire, assessing the consumption frequency of selected food items at seven occasions over the day. Results Non-breastfed children had higher BMI Z-scores (0.36 +/- 0.90 vs. 0.20 +/- 0.80 SD, p = 0.002), more frequently consumed sugar-sweetened beverages (25.0 +/- 10.5 vs. 22.5 +/- 9.71 times per week, p <0.001), and consumed relatively less whole-wheat or brown bread (p = 0.007). Differences in sugar-sweetened beverage consumption were most pronounced during main meals. Total fruit consumption, sedentary time and moderate-to-vigorous physical activity levels did not differ between the groups. Multivariable adjusted linear regression analyses showed that the differences in BMI-z score between non-breastfed and breastfed children were not explained by the differences in sugar-sweetened beverages or type of bread consumed. Conclusions Infant breastfeeding itself is indicative of healthy dietary behaviors in early life, and is also more likely to be followed by a favorable dietary pattern at toddler age. However, the differences in dietary habits between breastfed and non-breastfed children did not explain the difference in BMI Z-score at the age of 5.

Original languageEnglish
Pages (from-to)338–348
Number of pages11
JournalMaternal and child health journal
Early online date30-Nov-2020
Publication statusPublished - Feb-2021


  • Breast feeding
  • Childhood obesity
  • Healthy diet
  • Physical activity
  • Health literacy
  • TIME


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