Volume 27, Issue 4 (6-2020)                   RJMS 2020, 27(4): 15-24 | Back to browse issues page

Research code: 8417
Ethics code: (1396.198.IR.ZAUMS.REC)

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Khammarnia M, Mortazavi Z, oudi M, dahmarde M, kasani A, Peyvand M. Relationship between breastfeeding and body mass index in children aged 6 to 12 years old studying at primary school in Zahedan. RJMS 2020; 27 (4) :15-24
URL: http://rjms.iums.ac.ir/article-1-5442-en.html
MSc of Epidemiology, Student Research Committee , mp.peyvand@yahoo.com
Abstract:   (4742 Views)
Background: Maintaining and promoting children's health in all physical, mental, social and spiritual dimensions requires proper nutrition. According to World Health Organization (WHO) reports, exclusive breastfeeding is the most effective way of feeding infants until 6 months of age. Breastfeeding is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breastfeeding provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life. Moreovre, appropriate nutrition could prevent obesity in adulthood. Breastfed perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers. Considering the protective effect of breastfeeding on children, which can prevent obesity in adulthood, and also considering the dangerous role of obesity in children, which is one of the most important causes of the spread of underlying diseases in adulthood, so the present study was conducted to determine the relationship between breastfeeding and body mass index (BMI) of 6-12 year old primary school children in Zahedan.
Methods: This cross-sectional study was conducted in Zahedan in 2017. Zahedan is the capital of Sistan and Baluchestan province as a developing region in the souetheast of Iran. The study population were all students of zahedan those who were studying in schools in the same year among them, 443 children at primary school aged 6-12 years old that were chosen randomly using cluster sampling method. Data were collected by a standard questionnaire about the factors related to the exclusive breastfeeding nutrition. the standard questionnaire included two sections: Demographic questions (including gender, age, birth rate, age at birth, weight at birth), Factors affecting the exclusive nutrition related to the mother (start time) postpartum breastfeeding, the duration of the child's exclusive feeding, the baby from birth to 6 months, the age of onset of complementary feeding, re-pregnancy during lactation, maternal education on the benefits of breastfeeding. In this study, in order to evaluate the validity of the questionnaire, the tools made were presented to 8 related experts, after announcing the opinion and applying the validity changes of the questionnaire, it was approved. Also, to measure the reliability of the instrument, a questionnaire was distributed among 30 samples and after analysis, it was confirmed using Cronbach's alpha test and a reliability coefficient of 0.89. After approving study plan by Ethic commite of Zahedan University of Medical Sciences (ZAUMS), the researches refer to Education Organization of Sistan and Baluchestan province and obtaining an agreement to conduct research, first among the schools of the two education districts of Zahedan (District 1 and 2) based on the sampling method and the entry criterion (children in primary school with an age range of 6 to 12 years, without underlying disease and the desire of their parents) and by inviting the parents of students, first to parents about the goals of the project, considerations Ethics, including confidentiality of information, voluntary participation, and the right to withdraw from research at any time possible, were explained. Ethical consideration: this study was approved by the ethic commite of ZAUMS (code; IR. ZAUMS.REC1396, 198(. After completing the informed consent form, the questions were asked to the parents in the form of an individual interview that lasted an average of 15 to 20 minutes, and were entered into the questionnaires by the researchers. To measure height, the German SECA meter was used with non-elastic properties and an accuracy of 0/1 cm. selected students without shoes and hats or scarves on their heads and standing upright with a straight forward view so that the five parts of the body including the the head, the front part of the back (shoulder), the buttocks, the back of the back the heel are all tangible. It was checked for height. The German Nova digital scale weighing 0.05 kg was also used to measure weight.
 Students' weights with the least amount of clothing (without coats, tents, coats, or jackets, and without shoes) were recorded as upright and stationary (without vibration) on the scales. In order to ensure the reliability of the scale, after placing the scale in a suitable place and before starting the weighing, the accuracy of its work with control weight of 2 kg control was repeated and this was repeated after every 5 measurements. For BMI collection use of the below for more formula (weight in kilograms) divided by (height to meter square) in SPSS software into four groups of thin (below 5 percent), normal (between 5 percent and 85 percent). Overweight (between 85% and 95%) and obese (above 95%) were calculated. After collecting the data, it was manually entered into the SPSS-v21 software and use of descriptive statistics and analytical test such as chi-square test.
Results: In this study 324 girls (73.1%) and 119 boys (26.9%) with an average weight of 30.3±10.4 kg were considered. About 39% of children were the first child in the family. About 6.4% of infants have breastfed for less than 3 months. Most of the children were in 9-12 old age and 378 of child was born in 37 pregency week (275 child or 62%) also about 313 child has normality. 248 infants (56.0%) were breastfed during the first hour after birth. 327 children (73.8%) were exclusively breastfed from birth to 6 months of age. Fourteen children (3.2%) were also breastfed, and 267 mothers (60/3%) were trained on the benefits of breastfeeding.  BMI with birth weight, infant feeding from neonatal to 6 months of age, mother's comorbidities in the first 6 months of life, showed a significant relationship (p<0.05). Birth rank, age at birth, mother’s healthcare during pregnancy and re-pregnancy during lactation did not show any significant relationship with BMI (p>0.05). The BMI with birth weight, duration of exclusive breastfeeding, how to feed the baby from birth to 6 months, mother-to-be with the underlying disease, showed a significant relationship (0.05<p). However, birth rate, age at birth, health care during pregnancy, age at the start of complementary feeding, re-pregnancy during lactation, and maternal education on the benefits of breastfeeding did not show a significant relationship with BMI (p>0.05).
Conclusion: Findings indicate that breastfeeding has a protective effect on the BMI in childhood. More precise education to parents specifically to mothers and also healthcare providers can help with optimization of exclusive breastfeeding nutrition leading to prevention of obese and overweighted children in the future. The results of this study indicate that breastfeeding has a significant relationship with BMI at school age. Also, exclusive breastfeeding from birth to twenty-four months (end of two years) is effective in children's BMI. Based on this, it may be possible to help parents, especially mothers, and health care providers help prevent overweight and obesity in the future by providing more and more accurate exclusive breastfeeding. At the end of a study in several provinces with a larger sample size to more closely examine the relationship between exclusive breastfeeding and BMI, taking into account the role of genetic factors, cultural factors, ethnicity and even climatic conditions in growth and development. Children and adolescents, along with other factors, are recommended to study the whole country simultaneously for a more detailed examination and generalization. The study, like other studies, faced limitations, including the non-cooperation of some schools for questioning, which was replaced by other schools in the same area of the city with the cooperation of the Education Organization, and the failure of some parents to fill out questionnaires students and other parents were selected. Another limitation of this study was the information collected based on the reminders of parents of children who may have made a mistake in recalling.
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Type of Study: Research | Subject: Public Health

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