1. Ms.Saima Sachwani, Dr.Rozina Karmaliani, Ms.Shela Hirani, Mr.Asif Raza Khowaja Aga Khan University School of Nursing Midwifery, Karachi, Pakistan 1 Association between Breast Feeding and Childhood Obesity among Pakistani School- Going Children

2. Study Background: Pakistani Context o Obesity trend from Pakistan, reported an almost two-fold rise of obesity from 3% to 5.7% in ten years’ time (Jafar, et al., 2008) o The duration of total, and exclusive breast feeding in Pakistan falls short of World Health Organization’s recommendations. (PDHS, 2007) o Substantial body of evidences have indicated breast feeding to be modestly protective against childhood obesity o No study has been conducted to explore association between breast feeding and childhood obesity in Pakistan 2

3. Study Question Q1. Is there an association between breast feeding (history and duration), and childhood obesity in school-going children (5-16 years of age) in Karachi, Pakistan? Q2.Is there an association between exclusive breast feeding (history and duration), and childhood obesity in school-going children (5-16 years of age) in Karachi, Pakistan? 3

4. Study Design Matched case-control study design Study Population School going-children (5-16 years of age) Study Setting 2 Public and 1 private schools of Karachi, Pakistan Sample size Cases: Controls 132 : 396 Total : 528 4 Methodology

5. Inclusion / Exclusion Criteria Inclusion CriteriaExclusion Criteria Age: 5-16 years of ageHormonal treatment, secondary obesity (hypothyroidism) or serious illness. For Cases: BMI > 85 percentileDiabetes Miletus or co-morbid affecting weight For Control: BMI < 85 percentile Not a resident of Karachi for at least 6 months Resident of Karachi for at least 6 months Not willing to participate Willingness to participate 5

6. o Control of Blood Pressure and Risk Attenuation- COBRA TRIAL (Jafar et al., 2008) -Student’s Demographic Profile -Nutritional Profile (Food Frequency Questionnaire) -Physical Activity Profile (International Physical Activity Questionnaire) -Anthropometric measurements (height and weight) o Mother’s Demographic Profile o Breast Feeding History Profile (Novotny et al., 2007) 6 Data Collection: Study Instrument

7. 7 Study Results Demographic Characteristics of School-Going Children

8. 8 Gender

9. 9

10. Discussion o In the present study we found out the longer duration of breast feeding and exclusive breast feeding was associated with lower BMI. o The finding are consistent with several studies o There could be two possible reasons 1. Nutritional programming 2. Behavioral programming (Savino, Lupica, Liguori, Fissore, & Silvestro, 2012). 10

11. Recommendations Efforts should be made to improve the rate of optimal duration of breast feeding, and exclusive breast feeding for at least 6 months. 1. Education/Service a.All health disciplines should incorporate breast feeding as a ―frontier in preventing childhood obesity in their curriculum. b.Mothers should be educated about infant‘s signs of hunger and satiety. c.All the practicing health care professionals should be educated about full scope of breast feeding benefits. 11

12. Recommendations (cont … ) 3. Policy a.All maternal and child health care agencies must be monitored for their compliance to baby-friendly policies. b.Work-places should ensure supportive environment towards nursing mothers such as allowing flexible work schedules that promotes optimal breast feeding for the infant. c.The role of lactation consultant should be introduced. 12

13. Recommendations (cont …) 4. Research a.Further researches should be conducted, to study the association of breast feeding and childhood obesity in school age children from different parts of country. b.Prospective studies should be done to assess the cause and effect, and temporal relationship between breast feeding and childhood obesity. 13

14. References Fall, C. H. D., Borja, J. B., Osmond, C., Richter, L., Bhargava, S. K., Martorell, R., et al. (2010). Infant-feeding patterns and cardiovascular risk factors in young adulthood: data from five cohorts in low- and middle-income countries. International Journal of Epidemiology, 40(1), 47-62. Jafar, T. H., Qadri, Z., Islam, M., Hatcher, J., Bhutta, Z. A., &Chaturvedi, N. (2008a). Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children. Archives of Disease in Childhood, 93(5), 373-378 Jafar, T. H., Qadri, Z., &Chaturvedi, N. (2008b). Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men. Heart, 94(4), 408. Jafar, T. H., Chaturvedi, N., & Pappas, G. (2006).Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo- Asian population.CMAJ, 175(9), 1071-1077. Jafar, T. H. (2006). Women in Pakistan have a greater burden of clinical cardiovascular risk factors than men. International Journal of Cardiology, 106(3), 348-354 14

15. 15

16. Discussion (cont...) o Moderate or lower extent of participation in moderate to vigorous physical activity was protective against childhood obesity. This could be due to: o Cases in the study were more physically active. o Cases in the study were more engaged in sedentary activities. (Leatherdale, and Wong, 2009) o Children’ s have limited ability to recall physical activity beyond 2 days. (McMurray, Ring, Treuth, Welk, Pate, Schmitz, et al. 2004) 16