Breastfeeding,
why...
Dewey
KG, Cohen RJ, Brown KH, Landa Rivera L. Age of introduction
of complementary foods and growth of term, low-birth-weight,
breast-fed infants: a randomized intervention study in Honduras,
American Journal of Clinical Nutrition, 69: 679-686,
1999.
The optimal age
at which to introduce complementary foods is a topic of
considerable debate. A study on term, low-birth-weight infants
in Honduras is a valuable addition to the scientific data
necessary to resolve this issue. 128 small-for-date (1500-2500
g) infants who had been exclusively breastfed for 4 months
were randomly divided into two groups. The first group continued
to breastfeed exclusively (EBF) until the age of 6 months.
The second group continued to breastfeed and were fed twice
daily complementary food (jarred rice cereal, chicken, fruit,
and vegetables) (SF). At 6 months it was found that 1) time
spent breastfeeding in the SF group declined by 38 min/24
hr, but increased 11 min/ 24 hr in the EBF group, 2) breast
milk intake decreased by 39g/ 24 hr in the SF group, but
increased by 28 g/24 hr in the EBF group, 3) there were
no significant differences in weight, length or head circumference
between the two groups.
The authors concluded
that "...from the perspective of infant growth, exclusive
breast-feeding for about 6 months can be recommended even
among full-term, low-birth-weight babies in a developing
country..."
WHO
Collobrative Study Team on the Role of Breastfeeding on
the Prevention of Infant Mortality. Effect of breastfeeding
on infant and child mortality due to infectious diseases
in less developed countries: a pooled analysis, The
Lancet, 355: 451-455, 2000.
More information
is needed to guide policy makers and community health workers
about the effect of breastfeeding on infant anf child mortality.
This information is especially important in the light of
the HIV/AIDS and infant feeding debate. WHO sponsored researchers
did a pooled analysis of studies which assessed the effect
of not breastfeeding on the risk of death due to infectious
diseases. Data from six studies was available, but because
of universal breastfeeding in Africa an analysis of the
effect of breastfeeding in these countries was not possible.
It was done on three countries, Brazil, the Philippines
and Pakistan. Acute respiratory infections (ARI) and diarrhea
were the leading causes of death from infectious diseases.
The results showed that infants less than 2 months of age
were 5.8 times less likely to die, and infants 2-3 months
of age were 4. 1 times less likely to die if breastfed.
Infants 4-5 months were 1.8 times less likely, and infants
6-8 months were 1.4 times less likely to die if breastfed.
In the first 6 months of life protection from death from
diarrhea was substantially greater than protection from
death from ARI. Protection against death from ARI did not
decrease with age as it did against death from diarrhea.
The authors suggest
that their findings should be used in assessing the impact
of withholding breastfeeding in HIV-positive mothers and
in shaping policy decisions, especially for families of
low socioeconomic status.
Silfverdal
SA, Bodin L, Olcén P. Protective effect of breastfeeding:
an ecologic study of Haemophilus influenzae meningitis and
breastfeeding in a Swedish population, International
Journal of Epidemiology, 28: 152-156, 1999.
Previously researchers
in Sweden had done a case-control study between 1987 and
1992 in which they found that a long duration of breastfeeding
decreased the risk of Haemophilus caused meningitis infection.
In the present study they studied the long term effects
of exclusive breastfeeding on the rate of meningitis infection
over a period of 15 years (1956-1992) at a population level.
They found that breastfeeding strongly reduced the risk
of contracting meningitis for 5-10 years, but not 15 years
and beyond. Over the time span studied the data showed that
low breastfeeding rates were followed by increased menigitis
rates 5-10 years later. The authors concluded that the results
should affect strategies to promote breastfeeding, especially
in countries where Haemophilus vaccination is too costly.
Goodwin
DW, Gabrielli WF, Penick EC, Nickel EJ, Chhibber S, Knopp
J, Jensen P, Schulsinger F. Breast-feeding and alcoholism:
the Trotter hypothesis, American Journal of Psychiatry,
156 (4): 650-652, 1999.
A British physician
during the American Revolutinary War proposed the theory
that early weaning was a factor in alcoholism. 200 hundred
years later Danish investigators tested this hypothesis
using a large database of 9,182 consecutive deliveries to
study the relation between perinatal factors and alcoholism
later in life. 200 sons of alcoholics were matched with
107 controls all from the same database. Results showed
that 48% of the alcohol dependent men were weaned very early
(less than 2 weeks after birth) while only 19% of the non-alcohol
dependent men were weaned very early. When other variables
like mother or father being alcohol dependent were controlled
for, early weaning significantly contributed to the prediction
of alcoholism at age 30.
César
JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact
of breast feeding on admission for pneumonia during postneonatal
period in Brazil: nested case-control study, British
Medical Journal, 318: 1316-1320, 1999.
Pneumonia is
the leading cause of death in children under 5 years old
world-wide. Breastfeeding is known to reduce the risk of
contracting lower respiratory infections. A study carried
out in Brazil was designed to determine to what extent breastfeeding
reduces this risk and whether the protection varies with
age. 152 infants aged 28-364 days who had been admitted
to hospital for pneumonia were matched with 2391 controls.
Results showed that infants who were not breastfed were
17 times more likely to be admitted for pneumonia, while
infants receiving breast milk and other fluids were 3.8
times more likely. According to age, infants less than three
months were 61 times more likely to be admitted, and children
older than 3 months 10 times more likely to be admitted
for pneumonia if they were not breastfed. Infants who were
fed complementary foods were 13.4 times more likely to contract
pneumonia. When analyzed by age results showed that infants
less than 3 months fed complementary foods were 175 times
more likely to be admitted for pneumonia, those 3-6 months
were 9.1 times more likely, while infants older than 6 months
were less likely to contract pneumonia (relative risk, 0.7).
This study provides
more data to support the recommendation that complementary
foods should not be introduced before the age of about 6
months.
von
Kries R, Koletzko, B, Sauerwald T, von Mutius E, Barnert
D, Grunert V, von Voss H. Breast feeding and obesity:
cross sectional study, British
Medical Journal, 319: 147-150, 1999.
Investigators
are increasingly studying the long term effects of breastfeeding.
A study of a large group (13,345) of 5-6 year olds in Southern
Germany found that exclusive breastfeeding reduced the risk
of both obesity and overweight. The obesity rate in children
never breastfed was 4.5% as compared with a rate of 2.8%
in breastfed children. The effect was seen to be dose-dependent.
The prevalence was 3.8% in children breastfed exclusively
for 2 months, 2.3% for 3-5 months, and 1.7% for 6-12 months
of exclusive breastfeeding. After adjusting for other factors
like social class, parental education and current eating
habits, breastfeeding remained a significant protective
factor against obesity. The authors think that breastfeeding
may have a metabolic programming effect in preventing obesity.
Since the risk of adult obesity is increased by child obesity,
breastfeeding could be an important preventive measure in
the effort to reduce cardiovasular and other diseases related
to obesity.
Coutsoudis
A, Pillay K, Spooner E, Kuhn L, Coovadia HM. Influence
of infant-feeding patterns on early mother-to-child transmission
of HIV-1 in Durban, South Africa: a prospective cohort study,
The Lancet, 354: 471-476,
1999.
Studies have
shown that there is a 1 in 7 chance that the HIV virus is
transmitted from mother-to-child through breastfeeding.
However, there is uncertainty regarding the influence infant
feeding patterns have on the mode of transmission. Researchers
in South Africa studied the infant feeding patterns of 549
HIV-infected women and their effect on transmission. Results
showed that at 3 months 18.8% of never-breastfed infants
were estimated to be infected with HIV-1 compared with 21.3%
of breastfed infants. Infants who were exclusively breastfed
showed an infection rate of 14.6% which was significantly
lower than the 24.1% showed by infants receiving mixed feeding.
The transmission rate in the exclusively breastfed infants
was similar to the 18.8% transmission rate in the never-breastfed
infants.
The UNAIDS, UNICEF
and WHO recommendations currently encourage mothers infected
with HIV to breastfeed exclusively if they chose to breastfeed
their infants. Coutsoudis and her colleagues would encourage
women who have no safe alternatives to exclusively breastfeed
to reduce the chance of transmission.
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