Title: Breastfeeding history and the risk of overweight and obesity in middle-aged women
Version: 1 Date: 09 Jan 2021
Reviewer's report:
Overall: This is a timely and important research study considering the growing majority of
childbearing aged women are considered overweight or obese. Also, while some research
indicates breastfeeding has a protective effect on maternal cardiometabolic wellbeing, the role
of breastfeeding on long term maternal body weight is unclear. Please review the manuscript
for typos and English grammar. There are also many run-on sentences which must be revised
as the manuscript is difficult to read in its current state.
Abstract: The first sentence of the abstract does not make sense. As written, the authors suggest
breastfeeding stimulates fat reserves to produce milk, which is false. Please revise for clarity.
Introduction:
• Once again the following sentence: “Breastfeeding is considered to be a factor that
stimulates milk production from fat reserves accumulated during pregnancy” should be revised.
Breastfeeding does not stimulate milk production from fat…this does not make sense. Perhaps
the authors mean to say that breastfeeding helps to reduce maternal fat stores due to the increase
in metabolic activity needed to sustain breastfeeding and its associated milk production.
• Later in the introduction, the authors mention menopause. As written, it is unclear how
breastfeeding, maternal fatness, and menopause are linked together.
Methods:
• Please specify that this was a secondary data analysis.
• Was race or ethnicity controlled for as covariate? If not, this should be added to the model
as African American individuals have lower breastfeeding rates and higher risk of obesity
compared to other races.
• Please calculate the effect size able to be detected given the statistical tests used and sample
size.
Results:
• The authors state, “In the compared groups, no significant differences were found in the
time spent on Moderate-to-Vigorous physical activity and sitting time.” Please specify what the
compared groups were.
Discussion:
• Please provide more detail about the study referenced here: “The amount of visceral adipose
tissue measured by computed tomography was higher among mothers who breastfed for less
than 3 months after the birth of each child, compared to those who breastfed longer [7, 31].”
The reader has no context as to what type of study this was, where it was done, etc.
• Discuss further how low-calorie diets and physical activity is comparable to lactation with
regard to reducing visceral fat. This is mentioned in the article but not explained. I think the
authors need to provide some citation to back up this claim that lactation causes people to lose
visceral fat in same manner that calorie restriction and physical activity does.
• “This  result could have been due to the relatively small number of women who gave birth to
only one child, but breastfed more than 6 months.” Please provide the number of women in your
study who gave birth to 1 child but breastfed more than 6 months.
• Do not include results in the discussion section. Move to results section above and discuss
further here.
• Revise the following sentence. It is too long and impossible to follow when reading: “Similarly,
McClure et al., despite the fact that the amount of visceral adipose tissue, measured by computed
tomography 7 years after delivery, was greater among those mothers who breastfed for less than
3 months after the birth of each child, compared to those who breastfed longer, they did not
observe a similar association in relation to BMI and other body fat indices [7].”