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Does Breastfeeding Reduce the Risk of Diabetes?
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Type 2 Non-Insulin Dependent Diabetes (NIDDM) is characterized by insulin resistance and a relative decrease in insulin secretion. Although onset is usually in adulthood, Type 2 diabetes now accounts for about 30% of diabetes in childhood and adolescence. Primary risk factors are genetic susceptibility, obesity, lack of exercise and female gender. Unlike Type 1 diabetes, Type 2 diabetes does not appear to have either autoimmune or infectious causes. However, the life-threatening health consequences of Type 2 diabetes are similar. The incidence of Type 2 diabetes in the US is rising steadily, especially in African American, Hispanic and Native American women and children. Many Hispanic mothers with "gestational diabetes" actually have Type 2 diabetes with abnormal glucose tolerance persisting between pregnancies. In Pima Indians, who have the highest known rate of Type 2 diabetes in the world, breastfeeding is associated with a dose-related decrease in the risk of developing the disease; exclusive breastfeeding being most protective.4,5 Breastfeeding appears to reduce the risk of Type 2 diabetes indirectly by decreasing the risk of childhood obesity.
Conclusion: Exclusive breastfeeding for six months and continued breastfeeding for at least 12 months should be strongly recommended and supported for all infants born to diabetic mothers, diabetic fathers, families with diabetic siblings or those with a family history of diabetes. Breastfeeding is associated with a lower risk of developing both Type 1 and Type 2 diabetes. The reasons for this benefit are unclear. For genetically susceptible infants born to mothers or into families with Type 1 diabetes, it is
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possible, but not yet demonstrated, that reducing early exposure to intact cow's milk protein will decrease the infant's risk of developing Type 1 diabetes. For these high risk infants, the American Academy of Pediatrics recommends exclusive breastfeeding and avoiding commercial cow's milk and products containing intact cow's milk protein in the first year. Standard infant formula remains the recommended alternative to breastfeeding.1 Soy based formula is contraindicated. Maternal dietary exposure to cow's milk products need not be restricted as exposure to small amounts of cow's milk protein present in breastmilk does not appear deleterious. There is no rationale or evidence to suggest that avoiding cow's milk protein or the use of protein hydrolysate formulas will reduce the risk of Type 2 diabetes.
References:
- AAP Work Group: Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics 1994;94:752-754
- Kimpimaki T, et al. Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type 1 diabetes to progressive beta-cell autoimmunity. Diabetologia 2001;44:63-69
- Ellis TM, Atkinson MA. Early infant diets and insulin-dependent diabetes. Lancet 1996;347:1464-1465
- Pettitt DJ, Forman MR, Hanson RL, et al. Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 1997;350:166-168
- Simmons D. NIDDM and breastfeeding (ed). Lancet 1997;350:157
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