All ETDs from UAB

Advisory Committee Chair

Paula C Chandler-Laney

Advisory Committee Members

José R FernαNdez

David A Fields

Barbara A Gower

Timothy R Nagy

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

The prevalence of both adult and child obesity continues to rise. Children born to mothers with obesity have a greater risk for future obesity and chronic disease. There is an increasing body of literature suggesting that pregnancy and infancy are critical periods influencing the child’s risk for obesity. However, little is known about whether consumption of breast milk from an obese mother might influence the child’s metabolic programming and growth. The purpose of this dissertation was to examine the association of maternal adiposity with insulin and leptin in breast milk and, in turn, whether breast milk insulin, leptin, and glucose were associated with infant growth and body composition. The studies were performed using data from a prospective, longitudinal cohort study of exclusively breastfeeding mothers and their infants assessed at 1 and 4 months postpartum. In separate multiple linear regression models, we found that maternal body mass index, and fat mass (FM) adjusted for fat-free mass, were positively associated with both breast milk insulin and leptin concentrations at 1 month postpartum. Longitudinally, greater maternal weight loss and FM loss from 1 to 4 months were associated with larger decreases in breast milk leptin, but not insulin, from 1 to 4 months in separate models. In separate linear regression models, greater increases in breast milk glucose from 1 to 4 months postpartum were correlated with larger increases in infant weight and FM from 1 to 4 months. Breast milk insulin and leptin were not significantly associated with infant weight or body composition. While preliminary, our findings suggest that it may be possible to manipulate the breast milk composition, particularly for leptin, through changes in maternal adiposity. Thus, weight management interventions targeting the postpartum period have the potential to be particularly impactful not only for reducing the mother’s obesity risk and preventing complications in future pregnancies, but also through potentially important modifications in the breast milk. Future studies in larger cohorts are needed to further characterize the roles glucose and other breast milk constituents may play in influencing infant growth and obesity risk.

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