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Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial.

ABSTRACT: The duration and exclusivity of breastfeeding in infancy have been inversely associated with future cardiometabolic risk. We investigated the effects of an experimental intervention to promote increased duration of exclusive breastfeeding on cardiometabolic risk factors in childhood.We followed-up children in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. In 1996 to 1997, 17 046 breastfeeding mother-infant pairs were enrolled from 31 Belarusian maternity hospitals and affiliated polyclinics (16 intervention versus 15 control sites); 13 879 (81.4%) children were followed up at 11.5 years, with 13 616 (79.9%) who had fasted and did not have diabetes mellitus. The outcomes were blood pressure; fasting insulin, adiponectin, glucose, and apolipoprotein A1; and the presence of metabolic syndrome. Analysis was by intention to treat, accounting for clustering within hospitals/clinics. The intervention substantially increased breastfeeding duration and exclusivity in comparison with the control arm (43% versus 6% and 7.9% versus 0.6% exclusively breastfed at 3 and 6 months, respectively). Cluster-adjusted mean differences at 11.5 years between experimental versus control groups were as follows: 1.0 mm Hg (95% confidence interval, -1.1 to 3.1) for systolic and 0.8 mm Hg (-0.6 to 2.3) for diastolic blood pressure; -0.1 mmol/L (-0.2 to 0.1) for glucose; 8% (-3% to 34%) for insulin; -0.3 ?g/mL (-1.5 to 0.9) for adiponectin; and 0.0 g/L (-0.1 to 0.1) for apolipoprotein A1. The cluster-adjusted odds ratio for metabolic syndrome, comparing experimental versus control groups, was 1.21 (0.85 to 1.72).An intervention to improve breastfeeding duration and exclusivity among healthy term infants did not influence cardiometabolic risk factors in childhood.Current Controlled Trials: ISRCTN37687716 (http://www.controlled-trials.com/ISRCTN37687716). URL: http://clinicaltrials.gov. Unique identifier: NCT01561612.

SUBMITTER: Martin RM

PROVIDER: S-EPMC3946966 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial.

Martin Richard M RM Patel Rita R Kramer Michael S MS Vilchuck Konstantin K Bogdanovich Natalia N Sergeichick Natalia N Gusina Nina N Foo Ying Y Palmer Tom T Thompson Jennifer J Gillman Matthew W MW Smith George Davey GD Oken Emily E

Circulation 20131203 3

<h4>Background</h4>The duration and exclusivity of breastfeeding in infancy have been inversely associated with future cardiometabolic risk. We investigated the effects of an experimental intervention to promote increased duration of exclusive breastfeeding on cardiometabolic risk factors in childhood.<h4>Methods and results</h4>We followed-up children in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Hea ...[more]

PMID: 24300437

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Project description:Purpose:Breastfeeding may influence early visual development. We examined whether an intervention to promote increased duration and exclusivity of breastfeeding improves visual outcomes at 16 years of age. Methods:Follow-up of a cluster-randomized trial in 31 Belarusian maternity hospitals/polyclinics randomized to receive a breastfeeding promotion intervention, or usual care, where 46% vs. 3% were exclusively breastfed at 3 months respectively. Low vision in either eye was defined as unaided logMAR vision of ?0.3 or worse (equivalent to Snellen 20/40) and was used as the primary outcome. Open-field autorefraction in a subset (n = 963) suggested that 84% of those with low vision were myopic. Primary analysis was based on modified intention-to-treat, accounting for clustering within hospitals/clinics. Observational analyses also examined the effect of breastfeeding duration and exclusivity, as well as other sociodemographic and environmental determinants of low vision. Results:A total of 13,392 of 17,046 (79%) participants were followed up at 16 years. Low vision prevalence was 19.6% (95% confidence interval [CI]: 17.5, 22.0%) in the experimental group versus 21.6% (19.5, 23.8%) in the control group. Cluster-adjusted odds ratio (OR) of low vision associated with the intervention was 0.92 (95% CI: 0.73, 1.16); 0.88 (95% CI: 0.74, 1.05) after adjustment for parental and early life factors. In observational analyses, breastfeeding duration and exclusivity had no significant effect on low vision. However, maternal age at birth (OR: 1.13, 95% CI: 1.07, 1.14/5-year increase) and urban versus rural residence were associated with increased risk of low vision. Lower parental education, number of older siblings was associated with a lower risk of low vision; boys had lower risk compared with girls (0.64, 95% CI: 0.59,0.70). Conclusions:Exclusive breastfeeding promotion had no significant effect on visual outcomes in this study, but other environmental factors showed strong associations. (ClinicalTrials.gov number, NCT01561612.).

Project description:Importance:Evidence that breastfeeding reduces child obesity risk and lowers blood pressure (BP) is based on potentially confounded observational studies. Objective:To investigate the effects of a breastfeeding promotion intervention on adiposity and BP at age 16 years and on longitudinal growth trajectories from birth. Design, Setting, and Participants:Cluster-randomized Promotion of Breastfeeding Intervention Trial. Belarusian maternity hospitals and affiliated polyclinics (the clusters) were allocated into intervention (n?=?16) or control arms (n?=?15) in 1996 and 1997. The trial participants were 17?046 breastfeeding mother-infant pairs; of these, 13?557 children (79.5%) were followed up at 16 years of age between September 2012 and July 2015. Interventions:Breastfeeding promotion, modeled on the Baby-Friendly Hospital Initiative. Main Outcomes and Measures:Body mass index (BMI, calculated as weight in kilograms divided by height in meters squared); fat and fat-free mass indices and percentage of body fat from bioimpedance; waist circumference; overweight and obesity; height; BP; and longitudinal growth trajectories. The primary analysis was modified intention-to-treat (without imputation for losses to follow-up) accounting for within-clinic clustering. Results:We examined 13?557 children at a median age of 16.2 years (48.5% were girls). The intervention substantially increased breastfeeding duration and exclusivity compared with the control arm (exclusively breastfed: 45% vs 6% at 3 months, respectively). Mean differences at 16 years between intervention and control groups were 0.21 (95% CI, 0.06-0.36) for BMI; 0.21 kg/m2 (95% CI, -0.03 to 0.44) for fat mass index; 0.00 kg/m2 (95% CI, -0.21 to 0.22) for fat-free mass index; 0.71% (95% CI, -0.32 to 1.74) for percentage body fat; -0.73 cm (-2.48 to 1.02) for waist circumference; 0.05 cm (95% CI, -0.85 to 0.94) for height; -0.54 mm Hg (95% CI, -2.40 to 1.31) for systolic BP; and 0.71 mm Hg (95% CI, -0.68 to 2.10) for diastolic BP. The odds ratio for overweight/obesity (BMI ?85th percentile vs <85th percentile) was 1.14 (95% CI, 1.02-1.28) and the odds ratio for obesity (BMI ?95th percentile vs <95th percentile) was 1.09 (95% CI, 0.92-1.29). The intervention resulted in a more rapid rate of gain in postinfancy height (1 to 2.8 years), weight (2.8 to 14.5 years), and BMI (2.8 to 8.5 years) compared with the control arm. The intervention had little effect on BMI z score changes after 8.5 years. Conclusions and Relevance:A randomized intervention that increased the duration and exclusivity of breastfeeding was not associated with lowered adolescent obesity risk or BP. On the contrary, the prevalence of overweight/obesity was higher in the intervention arm. All mothers initiated breastfeeding, so findings may not apply to comparisons of the effects of breastfeeding vs formula feeding. Trial Registration:isrctn.org: ISRCTN37687716; and clinicaltrials.gov: NCT01561612.

Dataset Information

Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial.

Publications

Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial.

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