Breastfeeding, Prepubertal Adiposity, and Development of Precocious Puberty
Authors' conclusion
In this nationwide, retrospective cohort study, breastfeeding during the first 4 to 6 months of life was associated with a lower risk of CPP in boys and girls. This association was partially mediated by prepubertal adiposity, highlighting the critical role of early-life nutrition in pubertal timing.
Study context
- Population
- Children with routine health checkups at 4 to 6 months and 66 to 71 months, South Korean National Health Insurance Service Database, 2007–2020; excluded comorbidities, death, missing information, central precocious puberty (CPP) before age 6 years58.1% girls
- Participants
- 322,731 children
- Exposure
- Formula feeding and mixed feeding vs exclusive breastfeeding at 4 to 6 months
- Outcome
- Incidence of CPP, defined by ICD diagnostic codes and administration of gonadotropin-releasing hormone agonists
Methodological detailsnationwide, health claims data, causal mediation analysis
- Nationwide
- Health claims data
- Causal mediation analysis
Main finding
As reported in the abstract
CPP
Each group vs exclusively breastfedAdjusted hazard ratio (95% CI)
Formula-fedboys
1.16(1.10–1.21)
Formula-fedgirls
1.60(1.24–2.06)
Mixed-fedboys
1.14(1.07–1.20)
Mixed-fedgirls
1.45(1.07–1.97)
Observational data: associations, not effects.
Further findings
Proportion of formula feeding–CPP association mediated by prepubertal adiposity
- Boys
- 7.2% (bootstrap 95% CI, 4.5%-12.1%)
- Girls
- 17.8% (bootstrap 95% CI, 6.6%-30.0%)
- Causal mediation analysis, counterfactual framework
Original publication
Breastfeeding, Prepubertal Adiposity, and Development of Precocious Puberty. JAMA Netw Open. Published 1 August 2025. doi:10.
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