No effect of circulating leptin on energy metabolism in normal weight or overweight/obese lactating mothers: The case-control Breastmilk and the Link to Overweight/Obesity and Maternal diet (BLOOM) study

Background & aims: Pregnancy and lactation are associated with metabolic changes, including alterations in energy metabolism, which are closely linked to body mass and composition due to hormonal status. Therefore, the objective of this study was to investigate the energy metabolism in exclusively or predominantly breastfeeding mothers with normal weight (NW) and overweight/obesity (OW/OB) and evaluate its associations with fasting serum leptin. Methods: This cross-sectional BLOOM study was conducted among 39 mothers (n n = 19 NW, n = 20 OW/ OB) in 15.5 +/- 1.2 weeks of lactation. The leptin was analyzed in a blood sample using an enzyme-linked immunosorbent assay, body composition was analyzed by dual-energy X-ray absorptiometry, and resting metabolic rate (RMR) was measured by indirect calorimetry method. Results: The average RMR for all groups was 1747.5 +/- 281.9 kcal/d, with a statistically significant difference between groups (1932.7 +/- 222.6 vs. 1550.5 +/- 190.6, p < 0.001, respectively in the OW/OB and NW group). The OW/OB mothers had higher oxygen uptake (VO2) and exhaled carbon dioxide (VCO2), but not respiratory quotient (RQ), carbohydrate (CHO%) and lipid oxidation (FAT%). When analyzing correlations stratified by BMI category, we found that serum leptin was correlated with CHO% negatively, and with FAT% positively in the NW but not in OW/OB mothers. Additionally, serum leptin was a significant predictor of RMR, VCO2, VO2, CHO%, and RMR/kg of total body weight. However, after adjusting for confounders, the observed associations were no longer statistically significant (RMR: beta = 0.113, 95% CI-0.354-0.319;- 0.319; VO2: beta = 0.141, 95% CI-0.462-0.744;- 0.744; VCO2: beta = 0.238, 95% CI-0.411-0.888;- 0.888; CHO%: beta =-0.146, 95% CI-0.151-0.444;- 0.444; RMR/kg of total body weight: beta =-0.294, 95% CI-0.831-0.24- 0.24 4). Conclusions: Our results did not support the hypothesis that leptin plays a role in regulating energy homeostasis during lactation. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. This is an open access article under the CC BY license (http://creativecommons.org/licenses/ by/4.0/).