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Smith JP, Borg B, Nguyen TT, Iellamo A, Pramono A, Mathisen R. Estimating carbon and water footprints associated with commercial milk formula production and use: development and implications of the Green Feeding Climate Action Tool. Front Nutr 2024; 11:1371036. [PMID: 38938671 PMCID: PMC11210426 DOI: 10.3389/fnut.2024.1371036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
Carbon offset frameworks like the UN Clean Development Mechanism (CDM) have largely overlooked interventions involving food, health, and care systems, including breastfeeding. The innovative Green Feeding Climate Action Tool (GFT) assesses the environmental impact of commercial milk formula (CMF) use, and advocates for breastfeeding support interventions as legitimate carbon offsets. This paper provides an overview of the GFT's development, key features, and potential uses. The offline and online GFT were developed using the DMADV methodology (Define, Measure, Analyze, Design, Verify). The GFT reveals that the production and use of CMF by infants under 6 months results in annual global greenhouse gas (GHG) emissions of between 5.9 and 7.5 billion kg CO2 eq. and consumes 2,562.5 billion liters of water. As a national example, in India, one of the world's most populous countries, CMF consumption requires 250.6 billion liters of water and results in GHG emissions ranging from 579 to 737 million kg CO2 eq. annually, despite the country's high breastfeeding prevalence among infants under 6 months. The GFT mainly draws on data for low- and middle-income countries (LMICs), as many high-income countries (HICs) do not collect suitable data for such calculations. Despite poor official data on breastfeeding practices in HICs, GFT users can input their own data from smaller-scale surveys or their best estimates. The GFT also offers the capability to estimate and compare baseline with counterfactual scenarios, such as for interventions or policy changes that improve breastfeeding practices. In conclusion, the GFT is an important innovation to quantify CMF's environmental impact and highlight the significance of breastfeeding for planetary as well as human health. Women's contributions to environmental preservation through breastfeeding should be recognized, and breastfeeding interventions and policies should be funded as legitimate carbon offsets. The GFT quantifies CMF's carbon and water footprints and facilitates financing breastfeeding support as a carbon offset initiative under CDM funding facilities.
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Affiliation(s)
- Julie P. Smith
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
- Crawford School of Public Policy, College of Asia and the Pacific, The Australian National University, Canberra, ACT, Australia
| | - Bindi Borg
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Tuan T. Nguyen
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, Vietnam
| | | | - Andini Pramono
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Roger Mathisen
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, Vietnam
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Lee JS, Shin JI, Kim S, Choi YS, Shin YH, Hwang J, Shin JU, Koyanagi A, Jacob L, Smith L, Jeong HE, Noh Y, Oh IS, Rhee SY, Min C, Cho SH, Turner S, Fond G, Boyer L, Suh DI, Acharya KP, Shin JY, Lee SW, Yon DK. Breastfeeding and impact on childhood hospital admissions: a nationwide birth cohort in South Korea. Nat Commun 2023; 14:5819. [PMID: 37730734 PMCID: PMC10511528 DOI: 10.1038/s41467-023-41516-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.
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Affiliation(s)
- Jeong-Seon Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunyeup Kim
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Republic of Korea
| | - Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Deparments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - In-Sun Oh
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Deparments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chanyang Min
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Cho
- Division of Allergy-Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Steve Turner
- Maternity and Child Health Division, NHS Grampian, Aberdeen, UK
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea.
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea.
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
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Yılmaz AÇ, Ünal N. Do dietary factors play a role in infantile urolithiasis? Pediatr Nephrol 2022; 37:3157-3163. [PMID: 35275274 DOI: 10.1007/s00467-022-05501-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Urolithiasis is a significant cause of morbidity that may be diagnosed at a young age. However, there is little research on the role of nutrition in pediatric urolithiasis, and research on the infantile period is extremely rare. The aim of this study is to investigate the effect of dietary factors on those diagnosed with "idiopathic" infantile urolithiasis. METHOD The study group included 44 infants without a proven etiological factor for urolithiasis. The control group consisted of 60 fully healthy infants of matched age and gender. The parents and caregivers of each infant in the patient and control groups were carefully questioned by the same researcher for their dietary characteristics. RESULT The duration of formula usage and daily volume of formula were statistically higher in the study group than the control group (p = 0.041 and p = 0.003, respectively). The urolithiasis group consumed significantly more cow's milk and dairy products (p = 0.033 and p = 0.001). There was no statistically meaningful difference between the two groups in terms of starting age for free water and salty food, as well as daily water intake. CONCLUSION We concluded that dietary conditions could also be a risk factor for idiopathic urolithiasis. We believe that nutritional factors for infantile urolithiasis should be better described, in addition to genetic, anatomical, and metabolic factors. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Aysun Çaltık Yılmaz
- Department of Pediatric Nephrology, Ankara Baskent University, Ankara, Turkey.
| | - Necla Ünal
- Department of Pediatrics, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
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Blythe S, Elcombe E, Peters K, Burns E, Gribble K. Australian foster carers' views of supporting maternal breastfeeding and attachment in out-of-home care. CHILD ABUSE & NEGLECT 2022; 130:105360. [PMID: 34688491 DOI: 10.1016/j.chiabu.2021.105360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/03/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Breastfeeding supports infant health, growth and development, and promotes maternal attachment and sensitive caregiving. Maternal separation due to child protection concerns can result in termination of breastfeeding with associated adverse outcomes. How to preserve breastfeeding when infants are placed in out-of-home care is an issue of concern. OBJECTIVE To consider the views of foster carers towards provision of breastmilk and breastfeeding for infants in their care. PARTICIPANTS AND SETTING Foster carers (including kinship carers), in Australia, who had cared for at least one infant in the years 2013-2018 completed an online survey. METHODS Foster carer's views were collected via an online survey and subjected to content analysis. RESULTS Respondents (n = 184) expressed mixed views about; mothers breastfeeding during contact visits, increased frequency of contact visits for breastfeeding; and the provision of expressed breastmilk to infants in their care. Concerns were raised about the safety of breastmilk from mothers abusing substances and the value of breastfeeding if reunification was not possible. Because of these concerns, some carers discarded expressed breastmilk and resisted frequent contact. Conversely, breastfeeding was also viewed positively as a way for mothers to maintain attachment with their infants, where reunification of the mother-infant dyad was the goal. CONCLUSIONS This study highlights foster carers' view of breastfeeding as a facilitator of attachment between mothers and their infants. While fosters carers were largely supportive of breastfeeding as a way to improve infant health and facilitate mother-infant attachment, they held concerns regarding the safety of breastmilk supplied to them.
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Affiliation(s)
- Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Australia; Translational Research and Social Innovation Group, Ingham Institute, Australia.
| | - Emma Elcombe
- School of Nursing and Midwifery, Western Sydney University, Australia; Translational Research and Social Innovation Group, Ingham Institute, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Australia
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Australia
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Australia
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Hamed NF, Alamri SA, Hamdi NH. Overview of the Updates in Nutrient Profiles, Types, Indications and Side Effects of Infant Formula. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/confqadrfw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Affiliation(s)
- Karleen D Gribble
- 6489 School of Nursing and Midwifery, Western Sydney University, Australia
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Videholm S, Wallby T, Silfverdal SA. Breastfeeding practice, breastfeeding policy and hospitalisations for infectious diseases in early and later childhood: a register-based study in Uppsala County, Sweden. BMJ Open 2021; 11:e046583. [PMID: 34059512 PMCID: PMC8169467 DOI: 10.1136/bmjopen-2020-046583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/13/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine the association between breastfeeding practice and hospitalisations for infectious diseases in early and later childhood, in particular, to compare exclusive breast feeding 4-5 months with exclusive breastfeeding 6 months or more. Thereby, provide evidence to inform breastfeeding policy. DESIGN A register-based cohort study. SETTING A cohort was created by combining the Swedish Medical Birth Register, the National Inpatient Register, the Cause of Death Register, the Total Population Register, the Longitudinal integration database for health insurance and labour market studies, with the Uppsala Preventive Child Health Care database. PATIENTS 37 825 term and post-term singletons born to women who resided in Uppsala County (Sweden) between 1998 and 2010. MAIN OUTCOME MEASURES Number of hospitalisations for infectious diseases in early (<2 years) and later childhood (2-4 years). RESULTS The risk of hospitalisations for infectious diseases decreased with duration of exclusive breastfeeding until 4 months of age. In early childhood, breast feeding was associated with a decreased risk of enteric and respiratory infections. In comparison with exclusive breast feeding 6 months or more, the strongest association was found between no breastfeeding and enteric infections (adjusted incidence rate ratios, aIRR 3.32 (95% CI 2.14 to 5.14)). In later childhood, breast feeding was associated with a lower risk of respiratory infections. In comparison with children exclusively breastfed 6 months or more, the highest risk was found in children who were not breastfed (aIRR 2.53 (95% CI 1.51 to 4.24)). The risk of hospitalisations for infectious diseases was comparable in children exclusively breastfed 4-5 months and children exclusively breastfed 6 months or more. CONCLUSIONS Our results support breastfeeding guidelines that recommend exclusive breastfeeding for at least 4 months.
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Affiliation(s)
- Samuel Videholm
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Thomas Wallby
- Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden
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8
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Haiek LN, LeDrew M, Charette C, Bartick M. Shared decision-making for infant feeding and care during the coronavirus disease 2019 pandemic. MATERNAL & CHILD NUTRITION 2021; 17:e13129. [PMID: 33404146 PMCID: PMC7883116 DOI: 10.1111/mcn.13129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
Despite decades of research establishing the importance of breastfeeding, skin-to-skin contact and mother-infant closeness, the response to the coronavirus disease 2019 (COVID-19) pandemic has underscored the hidden assumption that these practices can be dispensed with no consequences to mother or child. This article aims to support shared decision-making process for infant feeding and care with parents and health care providers during the unprecedented times of the pandemic. It proposes a structure and rationale to guide the process that includes (1) discussing with parents evidence-based information and the different options to feed and care for an infant and young child in the context of the pandemic as well as their potential benefits, risks and scientific uncertainties; (2) helping parents to recognize the sensitive nature of the decisions and to clarify the value they place on the different options to feed and care for their infant or young child; and (3) providing guidance and support needed to make and implement their decisions. A shared decision-making process will help parents navigate complex feeding and care decisions for their child as we face the different stages of the COVID-19 pandemic.
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Affiliation(s)
- Laura N. Haiek
- Direction générale de la santé publiqueMinistère de la Santé et des Services sociauxQuebecQuebecCanada
- Department of Family Medicine, MontrealMcGill UniversityMontrealQuebecCanada
- Queen Elizabeth Academic Family Medicine GroupMontrealQuebecCanada
| | - Michelle LeDrew
- National BCC Baby‐Friendly ProjectBreastfeeding Committee for CanadaSherwood ParkAlbertaCanada
| | - Christiane Charette
- Direction générale de la santé publiqueMinistère de la Santé et des Services sociauxQuebecQuebecCanada
- Département de pédiatrie, CISSS de la Montérégie‐EstUniversity of SherbrookeSaint‐HyacintheQuebecCanada
| | - Melissa Bartick
- Mount Auburn HospitalCambridgeMassachusetts02138USA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
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9
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Abstract
PURPOSE OF REVIEW Evidence suggests that the microbiome of the skin, gastrointestinal tract, and airway contribute to health and disease. As we learn more about the role that the microbiota plays in allergic disease development, we can develop therapeutics to alter this pathway. RECENT FINDINGS Epidemiologic studies reveal that an association exists between environmental exposures, which alter the microbiota, and developing atopic dermatitis, food allergy, and/or asthma. In fact, samples from the skin, gastrointestinal tract, and respiratory tract reveal distinct microbiotas compared with healthy controls, with microbial changes (dysbiosis) often preceding the development of allergic disease. Mechanistic studies have confirmed that microbes can either promote skin, gut, and airway health by strengthening barrier integrity, or they can alter skin integrity and damage gut and airway epithelium. In this review, we will discuss recent studies that reveal the link between the microbiota and immune development, and we will discuss ways to influence these changes.
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Affiliation(s)
- Andrea C Aguilera
- Department of Pediatrics, Indiana School of Medicine, 705 Riley Hospital Drive, RI 2606, Indianapolis, IN, 46202, USA
| | - Isabelle A Dagher
- Indiana University School of Medicine, 705 Riley Hospital Drive, RI 2606, Indianapolis, IN, 46202, USA
| | - Kirsten M Kloepfer
- Department of Pediatrics, Indiana School of Medicine, 705 Riley Hospital Drive, RI 2606, Indianapolis, IN, 46202, USA.
- Indiana University School of Medicine, 705 Riley Hospital Drive, RI 2606, Indianapolis, IN, 46202, USA.
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, RI 2606, Indianapolis, IN, 46202, USA.
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Franco‐Antonio C, Calderón‐García JF, Santano‐Mogena E, Rico‐Martín S, Cordovilla‐Guardia S. Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial. J Adv Nurs 2019; 76:888-902. [DOI: 10.1111/jan.14274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/28/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Cristina Franco‐Antonio
- Hospital Comarcal Don Benito‐Villanueva Badajoz Spain
- Nursing Department Nursing and Occupational Therapy College University of Extremadura Cáceres Spain
- Health and Care Research Group (GISyC) University of Extremadura Cáceres Spain
| | | | - Esperanza Santano‐Mogena
- Nursing Department Nursing and Occupational Therapy College University of Extremadura Cáceres Spain
- Health and Care Research Group (GISyC) University of Extremadura Cáceres Spain
| | - Sergio Rico‐Martín
- Nursing Department Nursing and Occupational Therapy College University of Extremadura Cáceres Spain
- Health and Care Research Group (GISyC) University of Extremadura Cáceres Spain
| | - Sergio Cordovilla‐Guardia
- Nursing Department Nursing and Occupational Therapy College University of Extremadura Cáceres Spain
- Health and Care Research Group (GISyC) University of Extremadura Cáceres Spain
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11
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Frank NM, Lynch KF, Uusitalo U, Yang J, Lönnrot M, Virtanen SM, Hyöty H, Norris JM. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr 2019; 19:339. [PMID: 31533753 PMCID: PMC6749679 DOI: 10.1186/s12887-019-1693-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although breastfeeding is touted as providing many health benefits to infants, some aspects of this relationship remain poorly understood. METHODS The Environmental Determinants of Diabetes in the Young (TEDDY) is a prospective longitudinal study that follows children from birth through childhood, and collects data on illness events, breastfeeding duration, and time to introduction of formula or foods at 3 month intervals up until 4 years of age and at 6 months intervals thereafter. Exclusive and non-exclusive breastfeeding is examined in relation to the 3-month odds of a respiratory or gastrointestinal infection for 6861 children between the ages of 3-18 months, and 5666 children up to the age of 4 years. Analysis was performed using logistic regression models with generalized estimating equation methodology. All models were adjusted for potential confounding variables. RESULTS At 3-6 months of age, breastfeeding was found to be inversely associated with the odds of respiratory infections with fever (OR = 0.82, 95% CI = 0.70-0.95), otitis media (OR = 0.76, 95% CI = 0.62-0.94), and infective gastroenteritis (OR = 0.55, 95% CI = 0.46-0.70), although the inverse association with respiratory illnesses was observed only for girls during the winter months. Between 6 and 18 months of age, breastfeeding within any 3 month period continued to be inversely associated with the odds of ear infection and infective gastroenteritis, and additionally with the odds of conjunctivitis, and laryngitis and tracheitis, over the same 3 month period within this age range. However, breastfeeding in this group was associated with increased reports of common cold. Duration of exclusive breastfeeding was inversely associated with the odds of otitis media up to 48 months of age (OR = 0.97, 95% CI = 0.95-0.99) after breastfeeding had stopped. CONCLUSIONS This study demonstrates that breastfeeding can be protective against multiple respiratory and gastrointestinal acute illnesses in some children up to at least 6 months of age, with duration of exclusive breastfeeding being somewhat protective of otitis media even after breastfeeding has stopped. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00279318 . Date of registration: January 17, 2006 (proactively registered). First Posted: January 19, 2006.
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Grants
- U01 DK063821 NIDDK NIH HHS
- UC4 DK063863 NIDDK NIH HHS
- U01 DK063861 NIDDK NIH HHS
- U01 DK63829, U01 DK63861, U01 DK63821, U01 DK63865, U01 DK63863, U01 DK63836, U01 DK63790, UC4 DK63829, UC4 DK63861, UC4 DK63821, UC4 DK63865, UC4 DK63863, UC4 DK63836, UC4 DK95300, UC4 DK100238, UC4 DK106955, UC4 DK112243, UC4 DK117483, and Contract No. HHSN267200700014C NIDDK NIH HHS
- HHSN267200700014C NLM NIH HHS
- U01 DK063836 NIDDK NIH HHS
- U01 DK063829 NIDDK NIH HHS
- U01 DK063865 NIDDK NIH HHS
- UC4 DK095300 NIDDK NIH HHS
- UC4 DK063861 NIDDK NIH HHS
- UC4 DK063829 NIDDK NIH HHS
- UC4 DK063821 NIDDK NIH HHS
- UC4 DK117483 NIDDK NIH HHS
- UL1 TR001082 NCATS NIH HHS
- UC4 DK063836 NIDDK NIH HHS
- UC4 DK112243 NIDDK NIH HHS
- UC4 DK063865 NIDDK NIH HHS
- U01 DK063863 NIDDK NIH HHS
- U01 DK063790 NIDDK NIH HHS
- UL1 TR000064 NCATS NIH HHS
- UC4 DK106955 NIDDK NIH HHS
- UC4 DK100238 NIDDK NIH HHS
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- National Institute of Child Health and Human Development
- National Institute of Environmental Health Sciences
- National Center for Injury Prevention and Control (US)
- Juvenile Diabetes Research Foundation United States of America
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Affiliation(s)
- Nicole M. Frank
- University of Virginia Children’s Hospital, Charlottesville, VA USA
| | - Kristian F. Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Maria Lönnrot
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Suvi M. Virtanen
- National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Heikki Hyöty
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - Jill M. Norris
- Department of Epidemiology, University of Colorado Denver, Colorado School of Public Health, Aurora, CO USA
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12
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Pandolfi E, Gesualdo F, Rizzo C, Carloni E, Villani A, Concato C, Linardos G, Russo L, Ferretti B, Campagna I, Tozzi A. Breastfeeding and Respiratory Infections in the First 6 Months of Life: A Case Control Study. Front Pediatr 2019; 7:152. [PMID: 31106183 PMCID: PMC6492465 DOI: 10.3389/fped.2019.00152] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Viral respiratory tract infections (VRI) are a major reason for hospitalization in children younger than 5 years. A case control study was conducted to investigate the potential role of breastfeeding in protecting children <1 year of age from VRI. Methods: Patients admitted for a respiratory tract infections routinely underwent a nasopharyngeal aspirate, which was tested with an RT-PCR for 14 respiratory viruses. Hospitalized infants positive for viruses were enrolled as cases; healthy controls were enrolled among patients admitted for ultrasound hip screening. The effect of breastfeeding on pertussis was investigated through multivariable analysis. Results: We enrolled a total of 496 patients: 238 cases and 258 healthy controls. Among cases, eighty-six patients (36.1%) had a rinovirus, 78 (32.8%) an RSV, 22 (9.2%) an adenovirus, and 37 (15.5%) a coinfections with multiple viruses. The number of households was significantly higher in cases (mean in cases 4.5; mean 3.7 in controls, p < 0.001) and the proportion of infants having siblings (79% in cases vs. 43% in controls, p < 0.001). Proportion of smoking mothers was higher in cases than in controls (21.4 vs. 10.1%, p = 0.001). Among cases 44.5% were exclusively breastfed at symptoms onset vs. 48.8% of healthy controls. According to the multivariable analysis, being exclusively breastfed at symptom onset was associated with a higher risk of viral respiratory infection (3.7; 95% CI 1.64-8.41), however a longer breastfeeding duration was protective (OR 0.98; 95% CI 0.97-0.99). Also having at least one sibling was associated to a higher risk (OR 3.6; 95% CI 2.14-5.92) as well as having a smoking mother (OR 2.6; 95% CI 1.33-4.89). Conclusions: Breastfeeding remains a mainstay of prevention for numerous diseases and its protective role increases with duration. However, being breastfed when mothers carry a respiratory infection may increase the risk of transmission, acting as a proxy for closer contacts. In future studies, potential confounding variables as pattern of contacts with other individuals, should be taken into account.
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Affiliation(s)
- Elisabetta Pandolfi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Francesco Gesualdo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Caterina Rizzo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Emanuela Carloni
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Alberto Villani
- Department of Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Carlo Concato
- Virology Unit, Laboratory Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Giulia Linardos
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Luisa Russo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Beatrice Ferretti
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Ilaria Campagna
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Alberto Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
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Wang S, Zhang C, Li C, Li D, He P, Su Z, Li Y, Ding Y, Lu A. Efficacy of Chinese herbal medicine Zengru Gao to promote breastfeeding: a multicenter randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:53. [PMID: 29409494 PMCID: PMC5801806 DOI: 10.1186/s12906-018-2121-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/30/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breastfeeding is recommended worldwide but not fully practiced. The first week after childbirth is regarded as a critical period for increasing breast milk production. The aim of the study was to investigate whether Chinese herbal medicine Zengru Gao would result in more women breastfeeding in the first week after childbirth. METHODS A multicenter randomized controlled trial was conducted of 588 mothers considering breastfeeding in China. Among the mothers of the intervention group, the intervention included Chinese herbal medicine Zengru Gao; among those of the control group, it did not. Primary outcomes were the percentages of fully and partially breastfeeding mothers. Secondary outcome was baby's daily formula intake. RESULTS At 3 d and 7 d after delivery, significant differences were found in favour of Zengru Gao group on the percentage of full/ partial breastfeeding (Z = - 3.0037, p = 0.0027). At day 7, the percentage of full/ partial breastfeeding of the active group increased to 71.48%/20.70% versus 58.67%/30.26% in the control group, the differences remained significant (Z = - 3.0037, p = 0.0027). No statistically significant differences were detected on primary measures at 1 d. While intake of formula differed between groups at 1 d and 3 d, this difference did not achieve statistical significance, but this difference was apparent by 7 d (55.45 ± 115.39 ml/day vs 90.66 ± 153.89 ml/day). CONCLUSION In conclusion, Chinese Herbal medicine Zengru Gao enhanced breastfeeding success during one week postpartum. The approach is acceptable to participants and merits further evaluation. TRIAL REGISTRATION ChiCTR-IPR-15007376 , December 11, 2015.
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Heterogeneity in coverage for measles and varicella vaccination in toddlers - analysis of factors influencing parental acceptance. BMC Public Health 2017; 17:724. [PMID: 28927384 PMCID: PMC5606112 DOI: 10.1186/s12889-017-4725-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In 2004, routine varicella vaccination was introduced in Germany for children aged 11-14 months. Routine measles vaccination had already been introduced in 1973 for the same age group, but coverage is still too low (<95%) in some areas to eliminate measles. The present study assessed varicella and measles vaccination coverage and determinants of parental acceptance in two study regions, situated in Northern and Southern Bavaria (Germany). METHODS From 2009 to 2011, annual cross-sectional parent surveys were performed on random samples of 600 children aged 18-36 months in the Bavarian regions of both Munich and Würzburg. Logistic regression models were used to identify factors associated with varicella and measles vaccination. RESULTS In 2009, 2010 and 2011, vaccination coverage was lower in Munich than in Würzburg, for both varicella (Munich 53%, 67%, 69% vs. Würzburg 72%, 81%, 83%) and for measles (Munich 88%, 89%, 91% vs. Würzburg 92%, 93%, 95%). Recommendation by the physician was the main independent factor associated with varicella vaccination in both regions (adjusted odd ratios (OR) with 95% confidence interval (CI): Munich OR 19.7, CI 13.6-28.6; Würzburg OR 34.7, CI 22.6-53.2). Attendance at a childcare unit was positively associated with a higher acceptance of varicella vaccination in Munich (OR 1.5, CI 1.1-2.2). Regarding measles vaccination, attendance at a childcare unit was positively associated in both regions (Munich OR 2.0; CI 1.3-3.0; Würzburg OR 1.8; CI 1.1-3.1), and a higher level of parental school education was negatively associated in Würzburg (OR 0.5, CI 0.3-0.9). CONCLUSIONS Vaccination rates differed between regions, with rates constantly higher in Würzburg. Within each region, vaccination rates were lower for varicella than for measles. Measles vaccination status was mainly dependent upon socio-demographic factors (attendance at a childcare unit, parental school education), whereas for the more recently introduced varicella vaccination recommendation by the physician had the strongest impact. Hence, different strategies are needed to further improve vaccination rates for both diseases.
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Brown LJ, Sear R. Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study. Evol Med Public Health 2017; 2017:120-135. [PMID: 29354262 PMCID: PMC5766197 DOI: 10.1093/emph/eox011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/31/2017] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.
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Affiliation(s)
- Laura J Brown
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Størdal K, Lundeby KM, Brantsæter AL, Haugen M, Nakstad B, Lund-Blix NA, Stene LC. Breast-feeding and Infant Hospitalization for Infections: Large Cohort and Sibling Analysis. J Pediatr Gastroenterol Nutr 2017; 65:225-231. [PMID: 28737571 PMCID: PMC5527760 DOI: 10.1097/mpg.0000000000001539] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Breast-feeding may protect against infections, but its optimal duration remains controversial. We aimed to study the association of the duration of full and any breast-feeding with infections the first 18 months of life. METHODS The Norwegian Mother and Child study (MoBa) is a prospective birth cohort which recruited expecting mothers giving birth from 2000 to 2009. We analyzed data from the full cohort (n = 70,511) and sibling sets (n = 21,220) with parental report of breast-feeding and infections. The main outcome measures were the relative risks (RRs) for hospitalization for infections from 0 to 18 months by age at introduction of complementary foods and duration of any breast-feeding. RESULTS Although we found some evidence for an overall association between longer duration of full breast-feeding and lower risk of hospitalizations for infections, 7.3% of breast-fed children who received complementary foods at 4 to 6 months of age compared to 7.7% of those receiving complementary foods after 6 months were hospitalized (adjusted RR 0.95, 95% confidence interval 0.88-1.03). Higher risk of hospitalization was observed in those breast-fed 6 months or less (10.0%) compared to ≥12 months (7.6%, adjusted RR 1.22, 95% confidence interval 1.14-1.31), but with similar risks for 6 to 11 months versus ≥12 months. Matched sibling analyses, minimizing the confounding from shared maternal factors, showed nonsignificant associations and were generally weaker compared with the cohort analyses. CONCLUSIONS Our results support the recommendation to fully breast-feed for 4 months and to continue breast-feeding beyond 6 months, and suggest that protection against infections is limited to the first 12 months.
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Affiliation(s)
- Ketil Størdal
- Norwegian Institute of Public Health, Box 4404 Nydalen, Oslo, Norway,Ostfold Hospital Trust, Paediatric Department, Grålum, Norway
| | | | | | - Margaretha Haugen
- Norwegian Institute of Public Health, Box 4404 Nydalen, Oslo, Norway
| | - Britt Nakstad
- Akershus Univ. Hospital, Dept Pediatric and Adolescent Medicine, Nordbyhagen, Norway
| | - Nicolai A Lund-Blix
- Oslo University Hospital, Department of Pediatric Research, Rikshospitalet, Oslo, Norway
| | - Lars C Stene
- Norwegian Institute of Public Health, Box 4404 Nydalen, Oslo, Norway
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Iron Status at Age 6 Months in Colombian Infants Exclusively Breast-fed for 4 to 5 Versus 6 Months. J Pediatr Gastroenterol Nutr 2017; 64:465-471. [PMID: 27467112 DOI: 10.1097/mpg.0000000000001301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The optimal age for introducing complementary feeding to breast-fed infants may differ depending on the setting. Prolonged exclusive breast-feeding (EBF) protects against infection but may increase the risk of iron deficiency (ID)/anaemia (IDA) in vulnerable infants. The aim of the present study was to compare haemoglobin (Hb), serum ferritin (SF), anaemia (Hb < 11 g/L), ID (SF < 12 μg/L) and IDA (Hb < 10.5 g/dL + Hct < 33% + ID) using observational analyses in 6-month old infants from Bogota, Colombia who were EBF for 4 to 5 versus 6 months or older, and examine predictors. METHODS Infant feeding was recorded, anthropometry performed, and blood obtained for Hb and SF at 6 months in healthy term infants (birth weight > 2500 g), all EBF for ≥4 months. RESULTS One hundred eight infants (54% boys) were recruited; 46% EBF for 4 to 5 months, 54% EBF at 6 months. Prevalence of anaemia, ID, and IDA was 20%, 10%, and 5%, with no significant difference between EBF4-5 and EBF6 groups. In multivariate models, anaemia/ID were predicted by greater weight gain from 0 to 6 months, and anaemia also by caesarean delivery; Hb was lower in infants with higher intake of cows' milk; SF was lower in boys and those with greater weight gain. EBF4-5 versus EBF6 was not a significant predictor of any outcome. CONCLUSIONS Anaemia and ID were common at 6 months but were not affected by EBF for 4 to 5 versus 6 months, suggesting 6 months EBF is safe in this population. Further research is, however, required to examine effects on later iron status. The findings highlight the need to emphasise avoidance of cow's milk before 12 months.
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van den Berg M, Kypke K, Kotz A, Tritscher A, Lee SY, Magulova K, Fiedler H, Malisch R. WHO/UNEP global surveys of PCDDs, PCDFs, PCBs and DDTs in human milk and benefit-risk evaluation of breastfeeding. Arch Toxicol 2017; 91:83-96. [PMID: 27438348 PMCID: PMC5225187 DOI: 10.1007/s00204-016-1802-z] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Since 1987, the World Health Organization (WHO) carried out global surveys on polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) in human milk. This study presents a review of the three most recent surveys from 2000 to 2010, including DDT. The objective was to identify global quantitative differences and provide baseline information for 52 countries or provide time-trends for countries with previous data. Individual human milk samples were collected following a WHO-designed procedure and combined to form a national pooled sample. Here, we report global levels for PCDDs, PCDFs, PCBs and the sum of o,p'-DDT, p,p'-DDT, o,p'-DDE, p,p'-DDE, o,p'-DDD and p,p'-DDD (ΣDDTs). A concise risk-benefit evaluation related to human milk contamination with these persistent organic pollutants (POPs) was also done. Large global and regional differences were observed. Levels of PCDDs and PCDFs were highest in India and some European and African countries. PCB levels were highest in East and West Europe. The highest levels of ΣDDTs were found in less industrialized countries. A temporal downward trend for PCDDs, PCDFs and PCBs is indicated. A risk-benefit assessment indicates that human milk levels of PCDDs, PCDFs and PCBs are still significantly above those considered toxicologically safe, while ΣDDTs are below or around those considered safe. With respect to potential adverse health effects, a more dominant role of in utero exposure versus lactational exposure is indicated. If potential adverse effects are balanced against positive health aspects for (breastfed) infants, the advantages of breastfeeding far outweigh the possible disadvantages. Our observations provide a strong argument to plea for further global source-directed measures to reduce human exposure further to dioxin-like compounds.
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Affiliation(s)
- Martin van den Berg
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80177, 3508 TD, Utrecht, The Netherlands.
| | - Karin Kypke
- WHO/UNEP Reference Laboratory, State Institute for Chemical and Veterinary Analysis of Food (CVUA), Bissierstrasse 5, 79114, Freiburg, Germany
| | - Alexander Kotz
- WHO/UNEP Reference Laboratory, State Institute for Chemical and Veterinary Analysis of Food (CVUA), Bissierstrasse 5, 79114, Freiburg, Germany
| | - Angelika Tritscher
- Department of Food Safety and Zoonoses, World Health Organization, Ave Appia 20, 1211, Geneva 27, Switzerland
| | - Seoung Yong Lee
- Department of Food Safety and Zoonoses, World Health Organization, Ave Appia 20, 1211, Geneva 27, Switzerland
| | - Katarina Magulova
- Stockholm Convention Secretariat, United Nations Environment Programme (UNEP), International Environment House, 1219, Châtelaine, Geneva, Switzerland
| | - Heidelore Fiedler
- Division of Technology, Industry and Economics/Chemical Branch, United Nations Environment Programme (UNEP), Chemin des Anémones 11-13, 1219, Châtelaine, Geneva, Switzerland
| | - Rainer Malisch
- WHO/UNEP Reference Laboratory, State Institute for Chemical and Veterinary Analysis of Food (CVUA), Bissierstrasse 5, 79114, Freiburg, Germany
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Payne S, Quigley MA. Breastfeeding and infant hospitalisation: analysis of the UK 2010 Infant Feeding Survey. MATERNAL & CHILD NUTRITION 2017; 13:e12263. [PMID: 27010760 PMCID: PMC6865925 DOI: 10.1111/mcn.12263] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 11/12/2015] [Accepted: 11/17/2015] [Indexed: 11/29/2022]
Abstract
To investigate the contributions of overall breastfeeding duration and exclusive breastfeeding in reducing the risk of hospitalisation for infectious causes, we analysed data from a three-stage survey on infant feeding practices and health outcomes in over 10 000 UK women in 2010-2011. The main outcome measures were risk of overnight hospital admission in the first 8-10 months of infancy. A graded beneficial effect was found between longer duration of any breastfeeding and hospital admission for infectious causes and for respiratory tract infections, with a significantly lower risk in infants breastfed for at least 3 months compared with those never breastfed. The effects were stronger in the subgroup who was also exclusively breastfed. For example, among infants breastfed for 3-6 months, the reduction in risk for infectious causes for those who were also exclusively breastfed for at least 6 weeks was 0.42 (95% CI: 0.22-0.81) and for those not exclusively breastfed for 6 weeks 0.79 (95% CI: 0.49-1.26). Likewise, among infants breastfed for 6 months or more, the odds ratio for those who were also exclusively breastfed for at least 6 weeks was 0.48 (95% CI: 0.32-0.72) and for those not exclusively breastfed for 6 weeks 0.72 (95% CI: 0.48-1.08). The apparent protective effect of any breastfeeding for a long duration may in part be driven by a prolonged period of exclusive breastfeeding. Exclusive breastfeeding in the initial weeks after childbirth and continuing to breastfeed (either exclusively or partially) for at least 3 months, preferably 6 months, may reduce morbidity due to infectious illness in infants.
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Affiliation(s)
- Sarah Payne
- Oxford School of Public HealthUniversity of OxfordOxfordUK
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
| | - Maria A. Quigley
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
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Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017; 64:119-132. [PMID: 28027215 DOI: 10.1097/mpg.0000000000001454] [Citation(s) in RCA: 500] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
UNLABELLED This position paper considers different aspects of complementary feeding (CF), focussing on healthy term infants in Europe. After reviewing current knowledge and practices, we have formulated these recommendations: Timing: Exclusive or full breast-feeding should be promoted for at least 4 months (17 weeks, beginning of the 5th month of life) and exclusive or predominant breast-feeding for approximately 6 months (26 weeks, beginning of the 7th month) is a desirable goal. Complementary foods (solids and liquids other than breast milk or infant formula) should not be introduced before 4 months but should not be delayed beyond 6 months. CONTENT Infants should be offered foods with a variety of flavours and textures including bitter tasting green vegetables. Continued breast-feeding is recommended alongside CF. Whole cows' milk should not be used as the main drink before 12 months of age. Allergenic foods may be introduced when CF is commenced any time after 4 months. Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both) should have peanut introduced between 4 and 11 months, following evaluation by an appropriately trained specialist. Gluten may be introduced between 4 and 12 months, but consumption of large quantities should be avoided during the first weeks after gluten introduction and later during infancy. All infants should receive iron-rich CF including meat products and/or iron-fortified foods. No sugar or salt should be added to CF and fruit juices or sugar-sweetened beverages should be avoided. Vegan diets should only be used under appropriate medical or dietetic supervision and parents should understand the serious consequences of failing to follow advice regarding supplementation of the diet. METHOD Parents should be encouraged to respond to their infant's hunger and satiety queues and to avoid feeding to comfort or as a reward.
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Srivastava NM, Awasthi S. Breastfeeding pattern and the risk of neonatal illnesses among urban poor in Lucknow, Northern India: A prospective follow-up study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Quigley MA, Carson C, Sacker A, Kelly Y. Exclusive breastfeeding duration and infant infection. Eur J Clin Nutr 2016; 70:1420-1427. [PMID: 27460268 PMCID: PMC5153456 DOI: 10.1038/ejcn.2016.135] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND/OBJECTIVES We estimated the risk of infection associated with the duration of exclusive breastfeeding (EBF). SUBJECT/METHODS We analysed the data on 15 809 term, singleton infants from the UK Millennium Cohort Study. Infants were grouped according to months of EBF: never, <2, 2-4, 4-6 and 6 (the latter being World Health Organisation (WHO) policy since 2001: 'post-2001 WHO policy'). Among those EBF for 4-6 months, we separated those who started solids, but not formula, before 6 months, and were still breastfeeding at 6 months (that is, WHO policy before 2001: 'pre-2001 WHO policy'), from other patterns. Outcomes were infection in infancy (chest, diarrhoeal and ear). RESULTS EBF was not associated with the ear infection, but was associated with chest infection and diarrhoea. EBF for <4 months was associated with a significantly increased risk of chest infection (adjusted risk ratios (RR) 1.24-1.28) and diarrhoea (adjusted RRs 1.42-1.66) compared with the pre-2001 WHO policy. There was an excess risk of the chest infection (adjusted RR 1.19, 95% confidence interval (CI): 0.97-1.46) and diarrhoea (adjusted RR 1.66, 95% CI: 1.11, 2.47) among infants EBF for 4-6 months, but who stopped breastfeeding by 6 months, compared with the pre-2001 WHO policy. There was no significant difference in the risk of chest infection or diarrhoea in those fed according to the pre-2001 versus post-2001 WHO policy. CONCLUSIONS There is an increased risk of infection in infants EBF for <4 months or EBF for 4-6 months who stop breastfeeding by 6 months. These results support current guidelines of EBF for either 4-6 or 6 months, with continued breastfeeding thereafter.
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Affiliation(s)
- M A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - C Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Sacker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Y Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
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Berry NJ, Gribble KD. Health and nutrition content claims on websites advertising infant formula available in Australia: A content analysis. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27739216 DOI: 10.1111/mcn.12383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 01/13/2023]
Abstract
The use of health and nutrition content claims in infant formula advertising is restricted by many governments in response to WHO policies and WHA resolutions. The purpose of this study was to determine whether such prohibited claims could be observed in Australian websites that advertise infant formula products. A comprehensive internet search was conducted to identify websites that advertise infant formula available for purchase in Australia. Content analysis was used to identify prohibited claims. The coding frame was closely aligned with the provisions of the Australian and New Zealand Food Standard Code, which prohibits these claims. The outcome measures were the presence of health claims, nutrition content claims, or references to the nutritional content of human milk. Web pages advertising 25 unique infant formula products available for purchase in Australia were identified. Every advertisement (100%) contained at least one health claim. Eighteen (72%) also contained at least one nutrition content claim. Three web pages (12%) advertising brands associated with infant formula products referenced the nutritional content of human milk. All of these claims appear in spite of national regulations prohibiting them indicating a failure of monitoring and/or enforcement. Where countries have enacted instruments to prohibit health and other claims in infant formula advertising, the marketing of infant formula must be actively monitored to be effective.
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Affiliation(s)
- Nina J Berry
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karleen D Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, New South Wales, Australia
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Abstract
BACKGROUND Health organisations recommend exclusive breastfeeding for six months. However, the addition of other fluids or foods before six months is common in many countries. Recently, research has suggested that introducing solid food at around four months of age while the baby continues to breastfeed is more protective against developing food allergies compared to exclusive breastfeeding for six months. Other studies have shown that the risks associated with non-exclusive breastfeeding are dependent on the type of additional food or fluid given. Given this background we felt it was important to update the previous version of this review to incorporate the latest findings from studies examining exclusive compared to non-exclusive breastfeeding. OBJECTIVES To assess the benefits and harms of additional food or fluid for full-term healthy breastfeeding infants and to examine the timing and type of additional food or fluid. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2016) and reference lists of all relevant retrieved papers. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in infants under six months of age comparing exclusive breastfeeding versus breastfeeding with any additional food or fluids. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 11 trials (2542 randomised infants/mothers). Nine trials (2226 analysed) provided data on outcomes of interest to this review. The variation in outcome measures and time points made it difficult to pool results from trials. Data could only be combined in a meta-analysis for one primary (breastfeeding duration) and one secondary (weight change) outcome. None of the trials reported on physiological jaundice. Infant mortality was only reported in one trial.For the majority of older trials, the description of study methods was inadequate to assess the risk of bias. Most studies that we could assess showed a high risk of other biases and over half were at high risk of selection bias.Providing breastfeeding infants with artifical milk, compared to exclusive breastfeeding, did not affect rates of breastfeeding at hospital discharge (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.97 to 1.08; one trial, 100 infants; low-quality evidence). At three months, breastfeeding infants who were provided with artificial milk had higher rates of any breastfeeding compared to exclusively breastfeeding infants (RR 1.21, 95% CI 1.05 to 1.41; two trials, 137 infants; low-quality evidence). Infants who were given artifical milk in the first few days after birth before breastfeeding, had less "obvious or probable symptoms" of allergy compared to exclusively breastfeeding infants (RR 0.56, 95% CI 0.35 to 0.91; one trial, 207 infants; very low-quality evidence). No difference was found in maternal confidence when comparing non-exclusive breastfeeding infants who were provided with artificial milk with exclusive breastfeeding infants (mean difference (MD) 0.10, 95% CI -0.34 to 0.54; one study, 39 infants; low-quality evidence). Rates of breastfeeding were lower in the non-exclusive breastfeeding group compared to the exclusive breastfeeding group at four, eight, 12 (RR 0.68, 95% CI 0.53 to 0.87; one trial, 170 infants; low-quality evidence), 16 and 20 weeks.The addition of glucose water resulted in fewer episodes of hypoglycaemia (below 2.2 mmol/L) compared to the exclusive breastfeeding group, reported at 12 hours (RR 0.07, 95% CI 0.00 to 1.20; one trial, 170 infants; very low-quality evidence), but no significant difference at 24 hours (RR 1.57, 95% CI 0.27 to 9.17; one trial, 170 infants; very low-quality evidence). Weight loss was lower for infants who received additional glucose water (one trial, 170 infants) at six, 12, 24 and 48 hours of life (MD -32.50 g, 95% CI -52.09 to -12.91; low-quality evidence) compared to the exclusively breastfeeding infants but no difference between groups was observed at 72 hours of life (MD 3.00 g, 95% CI -20.83 to 26.83; very low-quality evidence). In another trial with the water and glucose water arms combined (one trial, 47 infants), we found no significant difference in weight loss between the additional fluid group and the exclusively breastfeeding group on either day three or day five (MD -1.03%, 95% CI -2.24 to 0.18; very low-quality evidence) and (MD -0.20%, 95% CI -0.86 to 0.46; very low-quality evidence).Infant mortality was reported in one trial with no deaths occurring in either group (1162 infants). The early introduction of potentially allergenic foods, compared to exclusively breastfeeding, did not reduce the risk of "food allergy" to one or more of these foods between one to three years of age (RR 0.80, 95% CI 0.51 to 1.25; 1162 children), visible eczema at 12 months stratified by visible eczema at enrolment (RR 0.86, 95% CI 0.51 to 1.44; 284 children), or food protein-induced enterocolitis syndrome reactions (RR 2.00, 95% CI 0.18 to 22.04; 1303 children) (all moderate-quality evidence). Breastfeeding infants receiving additional foods from four months showed no difference in infant weight gain (g) from 16 to 26 weeks compared to exclusive breastfeeding to six months (MD -39.48, 95% CI -128.43 to 49.48; two trials, 260 children; low-quality evidence) or weight z-scores (MD -0.01, 95% CI -0.15 to 0.13; one trial, 100 children; moderate-quality evidence). AUTHORS' CONCLUSIONS We found no evidence of benefit to newborn infants on the duration of breastfeeding from the brief use of additional water or glucose water. The quality of the evidence on formula supplementation was insufficient to suggest a change in practice away from exclusive breastfeeding. For infants at four to six months, we found no evidence of benefit from additional foods nor any risks related to morbidity or weight change. The majority of studies showed high risk of other bias and most outcomes were based on low-quality evidence which meant that we were unable to fully assess the benefits or harms of supplementation or to determine the impact from timing and type of supplementation. We found no evidence to disagree with the current international recommendation that healthy infants exclusively breastfeed for the first six months.
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Affiliation(s)
- Hazel A Smith
- Our Lady's Children's HospitalPaediatric Intensive Care UnitCrumlinDublin 12Ireland
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Netzer-Tomkins H, Rubin L, Ephros M. Breastfeeding Is Associated with Decreased Hospitalization for Neonatal Fever. Breastfeed Med 2016; 11:218-21. [PMID: 27070106 DOI: 10.1089/bfm.2016.0007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Breastfeeding is the recommended method for feeding newborns and infants. It confers significant health benefits upon both infant and mother and provides developmental, social, and economic advantages. OBJECTIVE This study explored possible correlations between breastfeeding and neonatal fever (NF). MATERIALS AND METHODS One hundred and forty infants hospitalized for fever during the first month of life (NF) were identified by retrospective chart review. These were matched with healthy infants born on the same day in the study hospital and who were not hospitalized in the first month of life. A structured telephone interview to determine breastfeeding practice was conducted with the parents of all study participants. RESULTS The prevalence of children who were formula fed or only partially breastfed was significantly higher among hospitalized children compared to healthy controls (66% versus 34%, respectively, p < 0.001). This association remained after adjusting for exposure to smoke, gender, and household crowding. Exposure to household smoke was also independently associated with hospitalization for NF. CONCLUSION Increased rates of breastfeeding should result in fewer hospitalizations for NF, fewer laboratory investigations, less intravenous antibiotic therapy and its complications, and lower indirect expenses. This study demonstrates that exclusive or predominant breastfeeding, as opposed to formula or partial breastfeeding, of infants less than 1 month of age reduces the risk of NF-related hospitalization by over two-fold. Our data provide new evidence of the health benefits of breastfeeding. The retrospective nature of the study and possible recall bias are limitations of the study.
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Affiliation(s)
| | - Lisa Rubin
- 2 Department of Maternal and Child Health, Ministry of Health , Jerusalem, Israel .,3 School of Public Health, University of Haifa , Haifa, Israel
| | - Moshe Ephros
- 4 Department of Pediatrics, Carmel Medical Center , Haifa, Israel .,5 Faculty of Medicine, Technion-Israel Institute of Technology , Haifa, Israel
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Lok KYW, Bai DL, Tarrant M. Predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers. BMC Pregnancy Childbirth 2015; 15:286. [PMID: 26531299 PMCID: PMC4632339 DOI: 10.1186/s12884-015-0719-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/23/2015] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In recent years there has been a steady influx of immigrants into Hong Kong from Mainland China, where breastfeeding patterns differ. Studies in other regions have found substantial differences in breastfeeding rates between native-born and immigrant mothers. The purpose of this study was to examine factors associated with breastfeeding initiation in Hong Kong born and Mainland China born mothers living in Hong Kong. METHODS We used a multi-center cross-sectional study design and recruited 2761 new mothers from the postnatal wards of all eight public hospitals in Hong Kong that offer obstetric services. We assessed breastfeeding status as well as various socio-demographic, maternal and birth characteristics. Chi-square tests and multivariable logistic regression were used to identify the predictors of breastfeeding initiation in Hong Kong born and Mainland China born participants. RESULTS 80.3 % of Hong Kong and 81.1 % of Mainland Chinese born women initiated breastfeeding. In the fully adjusted models, multiparity (Odds Ratio [OR] 0.53, 95 % CI 0.43-0.66) and maternal smoking (OR 0.29, 95 % CI 0.18-0.45) were strongly associated with failure to initiate breastfeeding in both Hong Kong and Mainland China born participants. In Hong Kong born mothers, participants with lower maternal education and those who had a cesarean section were significantly less likely to breastfeed. For Mainland China born mothers, paternal smoking (OR 0.70, 95 % CI 0.49-0.99) and having a pregnancy-related health problem (OR 0.60, 95 % CI 0.38-0.94) were both additional risk factors for not breastfeeding. CONCLUSION This study has identified predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers. Given the current high breastfeeding initiation rates among both groups, antenatal breastfeeding education and promotion programmes need to specifically intervene with sub-groups of pregnant women at risk for not breastfeeding so that their efforts are more strategic and cost-effective.
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Affiliation(s)
- Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR.
| | - Dorothy Li Bai
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR.
| | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR.
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Infections and risk of celiac disease in childhood: a prospective nationwide cohort study. Am J Gastroenterol 2015; 110:1475-84. [PMID: 26346866 DOI: 10.1038/ajg.2015.287] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/20/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Studies on early life infections and risk of later celiac disease (CD) are inconsistent but have mostly been limited to retrospective designs, inpatient data, or insufficient statistical power. We aimed to test whether early life infections are associated with increased risk of later CD using prospective population-based data. METHODS This study, based on the Norwegian Mother and Child Cohort Study, includes prospective, repeated assessments of parent-reported infectious disease data up to 18 months of age for 72,921 children born between 2000 and 2009. CD was identified through parental questionnaires and the Norwegian Patient Registry. Logistic regression was used to estimate odds ratios adjusted for child's age and sex (aOR). RESULTS During a median follow-up period of 8.5 years (range, 4.5-14.5), 581 children (0.8%) were diagnosed with CD. Children with ≥10 infections (≥fourth quartile) up to age 18 months had a significantly higher risk of later CD, as compared with children with ≤4 infections (≤first quartile; aOR=1.32; 95% confidence interval (CI)=1.06-1.65; per increase in infectious episodes, aOR=1.03; 95% CI=1.02-1.05). The aORs per increase in specific types of infections were as follows: upper respiratory tract infections: 1.03 (95% CI=1.02-1.05); lower respiratory tract infections: 1.12 (95% CI=1.01-1.23); and gastroenteritis: 1.05 (95% CI=0.99-1.11). Additional adjustments for maternal CD, education level, smoking, birth weight, prematurity, infant feeding practices, birth season, and antibiotic treatment yielded largely unchanged results. CONCLUSIONS This is the first large-scale population-based cohort study of this association. Our results are in line with immunological data suggesting that early life infections may have a role in CD development. However, non-causal explanations for this association due to surveillance bias and reverse causation cannot be excluded.
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Wong KL, Tarrant M, Lok KYW. Group versus Individual Professional Antenatal Breastfeeding Education for Extending Breastfeeding Duration and Exclusivity: A Systematic Review. J Hum Lact 2015; 31:354-66. [PMID: 25908110 DOI: 10.1177/0890334415583294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/26/2015] [Indexed: 11/17/2022]
Abstract
Although breastfeeding initiation rates have increased substantially in many developed countries over the past several decades, breastfeeding duration and exclusivity remain suboptimal. In the antenatal period, both group and individual education interventions have been implemented to improve breastfeeding. The purpose of this review was to compare the effectiveness of group and individual antenatal professional education on breastfeeding exclusivity and duration. A systematic search of the literature was conducted using Medline (1946-June 2014), PubMed (1883-June 2014), the Cumulative Index to Nursing and Allied Health Literature (1947-June 2014), EMBASE (1947-June 2014), British Nursing Index (1994-June 2014), Google Scholar, and the Cochrane Library. Included studies were limited to health care professional-conducted education delivered to pregnant women only. Only studies reporting breastfeeding duration or exclusivity were included. Nineteen studies were included, of which 13 evaluated antenatal group education, 5 evaluated individual antenatal education, and 1 evaluated both a group and an individual antenatal education. When compared with standard care, 4 out of 12 studies supported the effectiveness of antenatal group education on breastfeeding duration or exclusivity, whereas 4 out of 6 studies supported the effectiveness of antenatal individual education. Two studies compared antenatal group education with peer-led education and neither study showed a significant difference in breastfeeding outcomes. The methodological heterogeneity and the small number of high quality studies limited our ability to draw firm conclusions about the effectiveness of either mode of antenatal education.
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Affiliation(s)
- Ka Lun Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Williams LA, Ware RS, Davies PSW. Hospital, infants and feeding: The importance of audit. J Paediatr Child Health 2015; 51:708-12. [PMID: 25622697 DOI: 10.1111/jpc.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/30/2022]
Abstract
AIM Infant feeding can be the reason for presentation and/or admission to hospital. The aim of this study was to identify if infant feeding history was documented in charts of infants presenting and/or admitted to a paediatric hospital. METHODS A systematic random sample of hospital charts of infants who had presented to the emergency department between 1 July 2011 and 30 June 2012 was audited for presence of documentation of feeding. RESULTS In total, 465 charts were audited, representing 12.5% of infants who presented to the emergency department in the year. Frequency of documentation for feeding measures was as follows: feeding mode, 263 (57%); feeding type, 228 (49%); feeding frequency, 119 (26%); and with changes 89 (19%) since birth. Increasing infant age was significantly associated with less frequent recording of feeding mode, type, frequency and changes. CONCLUSION A comprehensive feeding history is not recorded on many occasions of infant presentation and/or admission to hospital. The recording of feeding mode, type, frequency and changes is needed in order to explore the existence, or otherwise, of a relationship between feeding and the reason for presentation and/or admission.
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Affiliation(s)
- Lesley Alison Williams
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Pound CM, Moreau K, Rohde K, Barrowman N, Aglipay M, Farion KJ, Plint AC. Lactation support and breastfeeding duration in jaundiced infants: a randomized controlled trial. PLoS One 2015; 10:e0119624. [PMID: 25747308 PMCID: PMC4351896 DOI: 10.1371/journal.pone.0119624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 01/23/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period. We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants. Study Design We conducted a randomized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants <4 weeks of age. Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge. Both groups received the standard care for jaundice. The primary outcome was exclusive breastfeeding at 3 months. To the exception of research assistants enrolling participants and completing qualitative interviews, all research staff, investigators and statisticians were blinded to group assignment. Qualitative interviews elicited feedback on breastfeeding experiences for both groups. Results 99 participants were recruited, and 86 analyzed for primary outcome. There was no difference in exclusive breastfeeding at 3 months between groups (RR 0.84, 95% CI 0.56–1.24, p = 0.40) or in the secondary outcomes. 31 participants were included in the qualitative analysis. Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding. Participants in the control group reported limited lactation support. Conclusions Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital standard care. Qualitative feedback from the intervention group suggests that mothers’ confidence was increased, which is linked to breastfeeding duration. The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants. Further studies may be needed to fully elucidate the impact of an in-hospital lactation support program on successful breastfeeding for these infants. Trial Registration ClinicalTrials.gov NCT00966719 https://www.clinicaltrials.gov/ct2/show/NCT00966719?term=Lactation+Support+and+Breastfeeding+Duration+in+Jaundiced+Infants%3A+a+Randomized+Controlled+Trial&rank=1
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Affiliation(s)
- Catherine M. Pound
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Katherine Moreau
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kristina Rohde
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Aglipay
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ken J. Farion
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy C. Plint
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Ajetunmobi OM, Whyte B, Chalmers J, Tappin DM, Wolfson L, Fleming M, MacDonald A, Wood R, Stockton DL. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish Birth Cohort (1997-2009). J Pediatr 2015; 166:620-5.e4. [PMID: 25556021 PMCID: PMC4344374 DOI: 10.1016/j.jpeds.2014.11.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/16/2014] [Accepted: 11/05/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the risk of childhood hospitalization associated with infant feeding patterns at 6-8 weeks of age in Scotland. STUDY DESIGN A retrospective population level study based on the linkage of birth, death, maternity, infant health, child health surveillance, and admission records for children born as single births in Scotland between 1997 and 2009 (n = 502 948) followed up to March 2012. Descriptive analyses, Kaplan Meier tests, and Cox regression were used to quantify the association between the mode of infant feeding and risk of childhood hospitalization for respiratory, gastrointestinal, and urinary tract infections, and other common childhood ailments during the study period. RESULTS Within the first 6 months of life, there was a greater hazard ratio (HR) of hospitalization for common childhood illnesses among formula-fed infants (HR 1.40; 95% CI 1.35-1.45) and mixed-fed infants (HR 1.18; 95% CI 1.11-1.25) compared with infants exclusively breastfed after adjustment for parental, maternal, and infant health characteristics. Within the first year of life and beyond, a greater relative risk of hospitalization was observed among formula-fed infants for a range of individual illnesses reported in childhood including gastrointestinal, respiratory, and urinary tract infections, otitis media, fever, asthma, diabetes, and dental caries. CONCLUSIONS Using linked administrative data, we found greater risks of hospitalization in early childhood for a range of common childhood illnesses among Scottish infants who were not exclusively breastfed at 6-8 weeks of age.
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Affiliation(s)
- Omotomilola M Ajetunmobi
- Information Services Division, National Health Service, National Services Scotland, Glasgow, Scotland.
| | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, Scotland
| | - James Chalmers
- Information Services Division, National Health Service, National Services Scotland, Glasgow, Scotland; National Education Scotland, National Health Service, National Services Scotland, Edinburgh, Scotland
| | - David M Tappin
- Pediatric Epidemiology and Community Health (PEACH) Unit, Glasgow University, Glasgow, Scotland
| | - Linda Wolfson
- National Health Service (NHS), Greater Glasgow and Clyde, Glasgow, Scotland
| | - Michael Fleming
- Information Services Division, National Health Service, National Services Scotland, Glasgow, Scotland
| | | | - Rachael Wood
- Information Services Division, National Health Service, National Services Scotland, Glasgow, Scotland
| | - Diane L Stockton
- Information Services Division, National Health Service, National Services Scotland, Glasgow, Scotland
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Abstract
This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women. Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world's poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits? Breastfeeding is a global food production system with unsurpassed capacity to promote children's food security and maternal and child health, but it is side-lined by trade negotiators who seek instead to expand world markets for cow's milk-based formula. Regulators focus on potential risks of feeding donated human milk, rather than on health risks of exposing infants and young children to highly processed bovine milk. Similarly, policymakers aspire to provide universal health care access that may be unaffordable when two thirds of the world's children are not optimally nourished in infancy, resulting in a global double burden of infectious and chronic disease. Universal breastfeeding requires greater commitment of resources, but such investment remains lacking despite the cost effectiveness of breastfeeding protection, support and promotion in and beyond health services. Women invest substantially in breastfeeding but current policy - epitomised by the G20 approach to the 'gender gap' - fails to acknowledge the economic value of this unpaid care work. Economic incentives for mothers to optimally breastfeed are dwarfed by health system and commercial incentives promoting formula feeding and by government fiscal policies which ignore the resulting economic costs. 'The market' fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding.
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Long-Term Effects of Breastfeeding on Children’s Hospitalization for Respiratory Tract Infections and Diarrhea in Early Childhood in Japan. Matern Child Health J 2015; 19:1956-65. [DOI: 10.1007/s10995-015-1703-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lin H, Sun L, Lin J, He J, Deng A, Kang M, Zeng H, Ma W, Zhang Y. Protective effect of exclusive breastfeeding against hand, foot and mouth disease. BMC Infect Dis 2014; 14:645. [PMID: 25471294 PMCID: PMC4273484 DOI: 10.1186/s12879-014-0645-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/20/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Infants who are exclusively breastfed receive natural protection against some infectious agents. This study examined whether there was protective effect of exclusive breastfeeding on the occurrence of hand, foot and mouth disease, which was an emerging infectious disease among children in China. METHODS A community-based case-control study was carried out among children age 4 years or younger in Guangdong Province, China. Cases were newly diagnosed hand, foot and mouth disease. Controls were randomly sampled from healthy children from the nearby village. Unconditional logistic regression model was used to estimate the odds ratio (OR) for exclusive breastfeeding after adjusting for potential confounding factors. RESULTS A total of 316 cases and 566 controls were included in the analysis. Significantly beneficial effect of exclusive breastfeeding during the first 6 months was observed for hand, foot and mouth disease occurrence. The overall OR was 0.63 (95% CI: 0.47-0.85) for exclusive breastfeeding compared with mixed feeding type. The age-specific analyses indicated that the protective effect persisted till the age of 28 months. CONCLUSIONS This study suggests that exclusive breastfeeding might have protective effect against HFMD infection among the children within 28 months of age.
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Affiliation(s)
- Hualiang Lin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
| | - Limei Sun
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
| | - Jinyan Lin
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
| | - Jianfeng He
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
| | - Aiping Deng
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
| | - Min Kang
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
| | - Hanri Zeng
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
| | - Yonghui Zhang
- Guangdong Provincial Center for Disease Control and Prevention, 160, Qunxian Road, Panyu, Guangzhou, 511430, China.
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Abstract
BACKGROUND Widespread recommendations from health organisations encourage exclusive breastfeeding for six months. However, the addition of other fluids or foods before six months is common in many countries and communities. This practice suggests perceived benefits of early supplementation or lack of awareness of the possible risks. OBJECTIVES To assess the benefits and harms of supplementation for full-term healthy breastfed infants and to examine the timing and type of supplementation. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (21 March 2014) and reference lists of all relevant retrieved papers. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in infants under six months of age comparing exclusive breastfeeding versus breastfeeding with any additional food or fluids. DATA COLLECTION AND ANALYSIS Two review authors independently selected the trials, extracted data and assessed risk of bias. MAIN RESULTS We included eight trials (984 randomised infants/mothers). Six trials (n = 613 analysed) provided data on outcomes of interest to this review. The variation in outcome measures and time points made it difficult to pool results from trials. Data could only be combined in a meta-analysis for one secondary outcome (weight change). The trials that provided outcome data compared exclusively breastfed infants with breastfed infants who were allowed additional nutrients in the form of artificial milk, glucose, water or solid foods.In relation to the majority of the older trials, the description of study methods was inadequate to assess the risk of bias. The two more recent trials, were found to be at low risk of bias for selection and detection bias. The overall quality of the evidence for the main comparison was low.In one trial (170 infants) comparing exclusively breastfeeding infants with infants who were allowed additional glucose water, there was a significant difference favouring exclusive breastfeeding up to and including week 20 (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.05 to 1.99), with more infants in the exclusive breastfed group still exclusively breastfeeding. Conversely in one small trial (39 infants) comparing exclusive breastfed infants with non-exclusive breastfed infants who were provided with artificial milk, fewer infants in the exclusive breastfed group were exclusively breastfeeding at one week (RR 0.58, 95% CI 0.37 to 0.92) and at three months (RR 0.44, 95% CI 0.26 to 0.76) and there was no significant difference in the proportion of infants continuing any breastfeeding at three months between groups (RR 0.76, 95% CI 0.56 to 1.03).For infant morbidity (six trials), one newborn trial (170 infants) found a statistically, but not clinically, significant difference in temperature at 72 hours (mean difference (MD) 0.10 degrees, 95% CI 0.01 to 0.19), and that serum glucose levels were higher in glucose supplemented infants in the first 24 hours, though not at 48 hours (MD -0.24 mmol/L, 95% CI -0.51 to 0.03). Weight loss was also higher (grams) in infants at six, 12, 24 and 48 hours of life in the exclusively breastfed infants compared to those who received additional glucose water (MD 7.00 g, 95% CI 0.76 to 13.24; MD 11.50 g, 95% CI 1.71 to 21.29; MD 13.40 g, 95% CI 0.43 to 26.37; MD 32.50 g, 95% CI 12.91 to 52.09), but no difference between groups was observed at 72 hours of life. In another trial (47 infants analysed), we found no significant difference in weight loss between the exclusively breastfeeding group and the group allowed either water or glucose water on either day three or day five (MD 1.03%, 95% CI -0.18 to 2.24) and (MD 0.20%, 95% CI -1.18 to 1.58).Three trials with four- to six-month-old infants provided no evidence to support any benefit from the addition of complementary foods at four months versus exclusive breastfeeding to six months nor any risks related either morbidity or weight change (or both).None of the trials reported on the remaining primary outcomes, infant mortality or physiological jaundice. AUTHORS' CONCLUSIONS We were unable to fully assess the benefits or harms of supplementation or to determine the impact from timing and type of supplementation. We found no evidence of benefit to newborn infants and possible negative effects on the duration of breastfeeding from the brief use of additional water or glucose water, and the quality of the evidence from a small pilot study on formula supplementation was insufficient to suggest a change in practice away from exclusive breastfeeding. For infants at four to six months, we found no evidence of benefit from additional foods nor any risks related to morbidity or weight change. Future studies should examine the longer-term effects on infants and mothers, though randomising infants to receive supplements without medical need may be problematic.We found no evidence for disagreement with the recommendation of international health associations that exclusive breastfeeding should be recommended for healthy infants for the first six months.
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Affiliation(s)
- Genevieve E Becker
- Unit for Health Services Research and International Health, WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Italy, 34137
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Biesbroek G, Bosch AATM, Wang X, Keijser BJF, Veenhoven RH, Sanders EAM, Bogaert D. The impact of breastfeeding on nasopharyngeal microbial communities in infants. Am J Respir Crit Care Med 2014; 190:298-308. [PMID: 24921688 DOI: 10.1164/rccm.201401-0073oc] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Breastfeeding elicits significant protection against respiratory tract infections in infancy. Modulation of respiratory microbiota might be part of the natural mechanisms of protection against respiratory diseases induced by breastfeeding. OBJECTIVES To study the association between breastfeeding and nasopharyngeal microbial communities, including all cultivable and noncultivable bacteria. METHODS In this observational study, we analyzed the microbiota of infants that had received exclusive breastfeeding (n = 101) and exclusive formula feeding (n = 101) at age 6 weeks and 6 months by 16S-based GS-FLX-titanium-pyrosequencing. MEASUREMENTS AND MAIN RESULTS At 6 weeks of age the overall bacterial community composition was significantly different between breastfed and formula-fed children (nonmetric multidimensional scaling, P = 0.001). Breastfed children showed increased presence and abundance of the lactic acid bacterium Dolosigranulum (relative effect size [RES], 2.61; P = 0.005) and Corynebacterium (RES, 1.98; P = 0.039) and decreased abundance of Staphylococcus (RES, 0.48; P 0.03) and anaerobic bacteria, such as Prevotella (RES, 0.25; P < 0.001) and Veillonella (RES, 0.33; P < 0.001). Predominance (>50% of the microbial profile) of Corynebacterium and Dolosigranulum was observed in 45 (44.6%) breastfed infants compared with 19 (18.8%) formula-fed infants (relative risk, 2.37; P = 0.006). Dolosigranulum abundance was inversely associated with consecutive symptoms of wheezing and number of mild respiratory tract infections experienced. At 6 months of age associations between breastfeeding and nasopharyngeal microbiota composition had disappeared. CONCLUSIONS Our data suggest a strong association between breastfeeding and microbial community composition in the upper respiratory tract of 6-week-old infants. Observed differences in microbial community profile may contribute to the protective effect of breastfeeding on respiratory infections and wheezing in early infancy. Clinical trial registered with www.clinicaltrials.gov (NCT 00189020).
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Affiliation(s)
- Giske Biesbroek
- 1 Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Schilithz AOC, Kale PL, Gama SGN, Nobre FF. Risk groups in children under six months of age using self-organizing maps. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 115:1-10. [PMID: 24725333 DOI: 10.1016/j.cmpb.2014.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/22/2014] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
Fetal and infant growth tends to follow irregular patterns and, particularly in developing countries, these patterns are greatly influenced by unfavorable living conditions and interactions with complications during pregnancy. The aim of this study was to identify groups of children with different risk profiles for growth development. The study sample comprised 496 girls and 508 boys under six months of age from 27 pediatric primary health care units in the city of Rio de Janeiro, Brazil. Data were obtained through interviews with the mothers and by reviewing each child's health card. An unsupervised learning, know as a self-organizing map (SOM) and a K-means algorithm were used for cluster analysis to identify groups of children. Four groups of infants were identified. The first (139) consisted of infants born exclusively by cesarean delivery, and their mothers were exclusively multiparous; the highest prevalences of prematurity and low birthweight, a high prevalence of exclusive breastfeeding and a low proportion of hospitalization were observed for this group. The second (247 infants) and the third (298 infants) groups had the best and worst perinatal and infant health indicators, respectively. The infants of the fourth group (318) were born heavier, had a low prevalence of exclusive breastfeeding, and had a higher rate of hospitalization. Using a SOM, it was possible to identify children with common features, although no differences between groups were found with respect to the adequacy of postnatal weight. Pregnant women and children with characteristics similar to those of group 3 require early intervention and more attention in public policy.
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Affiliation(s)
| | - P L Kale
- IESC/UFRJ, Rio de Janeiro, Brazil
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Glasper EA. Editorial: All governments should reinforce their commitment to giving all children a healthy start in life. ACTA ACUST UNITED AC 2014; 37:81-6. [DOI: 10.3109/01460862.2014.905388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Glasper A. Reinforcing the commitment to a healthy start for all children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:336-337. [PMID: 24690932 DOI: 10.12968/bjon.2014.23.6.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Professor Alan Glasper discusses the Departments of Health and Education's plans for promoting optimal child health.
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Williams LA, Davies PSW, Boyd R, David M, Ware RS. A systematic review of infant feeding experience and hospitalisation in developed countries. Acta Paediatr 2014; 103:131-8. [PMID: 24148026 DOI: 10.1111/apa.12477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/28/2013] [Accepted: 10/17/2013] [Indexed: 12/30/2022]
Abstract
UNLABELLED The review examines whether mode of feeding is associated with risk of hospitalisation for illness during infancy in developed countries. Databases were searched for published studies that included the terms 'infant feeding' and 'hospitalisation'. Six studies were included. Breastfeeding was associated with a reduced risk of hospitalisation and adjusted analyses showed mixed results. CONCLUSION There is no clear relationship between mode of feeding and reduction of infant hospitalisation for illness in developed countries.
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Affiliation(s)
- Lesley A Williams
- Children's Nutrition Research Centre; School of Medicine; The University of Queensland; Herston Qld Australia
- Queensland Children's Medical Research Institute; The University of Queensland; Brisbane Qld Australia
| | - Peter SW Davies
- Children's Nutrition Research Centre; School of Medicine; The University of Queensland; Herston Qld Australia
- Queensland Children's Medical Research Institute; The University of Queensland; Brisbane Qld Australia
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre; School of Medicine; The University of Queensland; Herston Qld Australia
| | - Michael David
- Queensland Children's Medical Research Institute; The University of Queensland; Brisbane Qld Australia
- School of Population Health; The University of Queensland; Herston Qld Australia
| | - Robert S Ware
- Queensland Children's Medical Research Institute; The University of Queensland; Brisbane Qld Australia
- School of Population Health; The University of Queensland; Herston Qld Australia
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Factores asociados al abandono precoz de la lactancia materna en una región del este de España. An Pediatr (Barc) 2014; 80:6-15. [DOI: 10.1016/j.anpedi.2013.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/22/2013] [Accepted: 05/15/2013] [Indexed: 11/23/2022] Open
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Wheeler BJ, Dennis CL. Psychometric testing of the modified breastfeeding self-efficacy scale (short form) among mothers of ill or preterm infants. J Obstet Gynecol Neonatal Nurs 2012. [PMID: 23181364 DOI: 10.1111/j.1552-6909.2012.01431.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To psychometrically assess the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among mothers of ill or preterm infants. DESIGN Methodological study. SETTING Three neonatal intensive care units (NICUs) located in two hospitals in a central Canadian city. PARTICIPANTS One hundred forty-four (144) breastfeeding mothers of ill or preterm infants. METHODS Mothers completed the BSES-SF modified for mothers of ill or preterm infants, the Hill and Humenick (H&H) Lactation Scale, and demographic questions. RESULTS The Cronbach's alpha coefficient for internal consistency for the BSES-SF revised for mothers of ill or preterm infants was 0.88. Construct validity was assessed using comparison of contrasted groups (mothers who continued to breastfeed and those who discontinued) and correlation with the construct of maternal perceptions of insufficient milk supply. Support for predictive validity was demonstrated through significant mean differences between mothers who were breastfeeding (M = 83.44, SD = 8.23) and those who discontinued breastfeeding and breast pumping (M = 75.51, SD = 10.08) at 6-weeks post-infant hospital discharge. CONCLUSION Demographic response patterns suggest that the modified BSES-SF is a unique tool to identify breastfeeding mothers of ill or preterm infants at risk of prematurely discontinuing. This study provides evidence that the modified BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among a sample of mothers of ill or preterm infants.
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Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth 2012; 12:36. [PMID: 22621668 PMCID: PMC3449190 DOI: 10.1186/1471-2393-12-36] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/10/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neonatal anxiety and depression and breastfeeding cessation are significant public health problems. There is an association between maternal symptoms of anxiety and depression and early breastfeeding cessation. In earlier studies, the causality of this association was interpreted both ways; symptoms of anxiety and depression prepartum significantly impacts breastfeeding, and breastfeeding cessation significantly impacts symptoms of anxiety and depression.First, we aimed to investigate whether breastfeeding cessation is related to an increase in symptoms of anxiety and depression from pregnancy to six months postpartum. Second, we also investigated whether the proposed symptom increase after breastfeeding cessation was disproportionately high for those women already suffering from high levels of anxiety and depression during pregnancy. METHODS To answer these objectives, we examined data from 42 225 women in the Norwegian Mother and Child Cohort Study (MoBa). Subjects were recruited in relation to a routine ultra-sound examination, and all pregnant women in Norway were eligible. We used data from the Medical Birth Registry of Norway and questionnaires both pre and post partum. Symptoms of anxiety and depression at six months postpartum were predicted in a linear regression analysis by WHO-categories of breastfeeding, symptoms of anxiety and depression prepartum (standardized score), and interaction terms between breastfeeding categories and prepartum symptoms of anxiety and depression. The results were adjusted for cesarean sections, primiparity, plural births, preterm births, and maternal smoking. RESULTS First, prepartum levels of anxiety and depression were related to breastfeeding cessation (β 0.24; 95% CI 0.21-0.28), and breastfeeding cessation was predictive of an increase in postpartum anxiety and depression ( β 0.11; 95%CI 0.09-0.14). Second, prepartum anxiety and depression interacted with the relation between breastfeeding cessation and postpartum anxiety and depression ( β 0.04; 95% CI 0.01-0.06). The associations could not be accounted for by the adjusting variables. CONCLUSIONS Breastfeeding cessation is a risk factor for increased anxiety and depression. Women with high levels of anxiety and depression during pregnancy who stop breastfeeding early are at an additional multiplicative risk for postpartum anxiety and depression.
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Affiliation(s)
- Eivind Ystrom
- Department of Adult Mental Health, Norwegian Institute of Public Health, P.O. box 4404, N-0403, Oslo, Norway.
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Przyrembel H. Timing of Introduction of Complementary Food: Short- and Long-Term Health Consequences. ANNALS OF NUTRITION AND METABOLISM 2012; 60 Suppl 2:8-20. [DOI: 10.1159/000336287] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lepage P, Van de Perre P. The Immune System of Breast Milk: Antimicrobial and Anti-inflammatory Properties. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 743:121-37. [DOI: 10.1007/978-1-4614-2251-8_9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Becker GE, Remmington S, Remmington T. Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database Syst Rev 2011:CD006462. [PMID: 22161404 DOI: 10.1002/14651858.cd006462.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Widespread recommendations from health organisations encourage exclusive breastfeeding for six months. However the addition of other fluids or foods before six months is common practice in many countries and communities. This practice suggests perceived benefits of early supplementation or lack of awareness of the possible risks. OBJECTIVES To assess the benefits and harms of supplementation for full-term healthy breastfed infants and to examine the timing and type of supplementation. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2011) and reference lists of all relevant retrieved papers. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in infants under six months of age comparing exclusive breastfeeding versus breastfeeding with any additional food or fluids. DATA COLLECTION AND ANALYSIS Two authors independently selected the trials; three extracted data and assessed risk of bias. MAIN RESULTS We included six trials (814 infants). Two trials in the early days after birth that reported data did not indicate that giving additional fluids was beneficial. For duration of breastfeeding, there was a significant difference favouring exclusive breastfeeding up to and including week 20 (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.05 to 1.99), indicating that supplements may contribute to reducing the duration.For infant morbidity (three trials), one newborn trial found a statistically, but not clinically, significant difference in temperature at 72 hours (MD 0.10 degrees, 95% CI 0.01 to 0.19), and that serum glucose levels were higher in glucose supplemented infants in the first 24 hours, though not at 48 hours (MD -0.24mmol/l, 95% CI -0.51 to 0.03). Two trials with four- to six-month-old infants did not indicate any benefit to supplemented infants to 26 weeks nor any risks related to morbidity or weight change.None of the trials reported on the remaining primary outcomes, infant mortality or physiological jaundice. AUTHORS' CONCLUSIONS We were unable to fully assess the benefits or harms of supplementation or to determine the impact from timing and type of supplementation .We found no benefit to newborn infants and possible negative effects on the duration of breastfeeding from the brief use of additional water or glucose water. For infants at four to six months, we found no benefit from additional foods nor any risks related to morbidity or weight change. Future studies should examine the longer term effects on infants and mothers, though randomising infants to receive supplements without medical need may be considered unethical.We found no evidence for disagreement with the recommendation of international health associations that exclusive breastfeeding should be recommended for healthy infants for the first six months.
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Cattaneo A, Williams C, Pallás-Alonso CR, Hernández-Aguilar MT, Lasarte-Velillas JJ, Landa-Rivera L, Rouw E, Pina M, Volta A, Oudesluys-Murphy AM. ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence? MATERNAL & CHILD NUTRITION 2011; 7:335-43. [PMID: 21902806 PMCID: PMC6860628 DOI: 10.1111/j.1740-8709.2011.00363.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since 2002, the World Health Organization and many governments and professional associations have recommended exclusive breastfeeding for 6 months followed by complementary feeding (giving solid foods alongside breast milk) as optimal infant feeding practice. Several articles have been published challenging this recommendation. Arguably, the most influential has been the 2008 commentary of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, which recommended that complementary foods should be introduced to all infants between 17 and 26 weeks. We challenge the validity of ESPGHAN's position, questioning the adequacy of the literature search, the interpretation and evidence used to reach their conclusions and the balance of an approach that focuses on disease prevention, with scant consideration of growth and neuromotor development. We contend that ESPGHAN's position should be understood as an expert opinion that may be influenced by conflicts of interest. In our view, the ESPGHAN position paper is not evidence based and does not justify a change of the current public health recommendation for 6 months of exclusive breastfeeding. At an individual level, health professionals should understand that developmental readiness for starting solid foods has an age range like other developmental milestones; that fewer infants will probably be ready to start complementary feeding before, rather than after, 6 months; and that their role is to equip parents with the confidence and skills to recognise the signs of developmental readiness. This empowerment process for infants and parents should be preferred over the prescriptive ESPGHAN approach.
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Affiliation(s)
- Adriano Cattaneo
- Health Services Research, Epidemiology and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
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Exclusive breastfeeding is recommended in the first 6 months of life for healthy term infants. Pediatr Neonatol 2011; 52:57-8. [PMID: 21524623 DOI: 10.1016/j.pedneo.2011.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fisk CM, Crozier SR, Inskip HM, Godfrey KM, Cooper C, Roberts GC, Robinson SM. Breastfeeding and reported morbidity during infancy: findings from the Southampton Women's Survey. MATERNAL AND CHILD NUTRITION 2011; 7:61-70. [PMID: 21143586 DOI: 10.1111/j.1740-8709.2010.00241.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A number of studies in developed countries suggest that breastfeeding protects against infections in infancy. However, the choice to breastfeed is often related to maternal characteristics, and many of these studies are limited in the extent to which they can take account of confounding influences. In a prospective birth cohort study, we assessed the relationship between the duration of breastfeeding and the prevalence of lower respiratory tract infections, ear infections and gastrointestinal morbidity during the first year of life in 1764 infants. We considered the duration of all breastfeeding, including mixed feeding. Eighty-one per cent of the infants were breastfed initially, and 25% were breastfed up to 6 months. There were graded decreases in the prevalence of respiratory and gastrointestinal symptoms between birth and 6 months as breastfeeding duration increased; these were robust to adjustment for a number of confounding factors. The adjusted relative risks (95% confidence interval) for infants breastfed for six or more months compared with infants who were never breastfed were 0.72 (0.58-0.89), 0.43 (0.30-0.61) and 0.60 (0.39-0.92) for general respiratory morbidity, diarrhoea and vomiting, respectively. Duration of breastfeeding in the second half of infancy was less strongly related to diagnosed respiratory tract infections and gastrointestinal morbidity, although important benefits of breastfeeding were still seen. Our data provide strong support for a protective role of breastfeeding against respiratory and gastrointestinal infections in infancy. The graded inverse associations with breastfeeding duration suggest that current efforts to promote breastfeeding and increase duration will have important effects in reducing morbidity in infancy.
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Affiliation(s)
- Catherine M Fisk
- MRC Epidemiology Resource Centre, University of Southampton, Southampton SO16 6YD, UK.
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