Benefits of Breast Feeding

Breast feeding contributes to both maternal and infant nutrition and health through a number of important mechanisms. It provides a complete source of nutrition for the first 6 months of life for normal, full-term infants and provides one-half and one-third of energy needs for the second half of the first year and the second year of life, respectively. It also contributes significantly to protein and micro-nutrient requirements. Numerous studies have shown that during illness, whereas intake of complementary foods declines significantly, breast milk intake does not decrease. Because of the well-established superiority of breast milk over other infant feeding modes, women cannot ethically be randomized in infant feeding studies and as a result most data on the benefits of breast-feeding and the risks of not breast feeding are observational. However, the dose-response effect observed in such studies, even when donor breast milk is provided through a nasogastric tube to premature newborns, provides evidence of causality.

A large-scale study involving more than 17000 infants in which breast feeding promotion was randomized and morbidity results analyzed on an 'intention to treat' basis, with breast feeding promotion as the treatment, also provides evidence of causality. Infants born in hospitals and provided care in clinics randomized to breast feeding promotion were 40% less likely to have more than one case of gastrointestinal infection and 50% less likely to have atopic eczema than infants not randomized to this intervention (Figure 3). The intervention significantly increased the duration of exclusive breast feeding at 3 months from 6 to 43% and the duration of partial breast-feeding at lyear from 11 to 20%. Therefore, this study proved through a causal design that better breast feeding practices reduce risk of diarrhea and eczema, and that hospital and clinic-based interventions can result in large-scale shifts in behavior.

A pooled analysis of longitudinal data from Brazil, Pakistan, and the Philippines showed that during infancy breast feeding resulted in a 6-fold reduction in mortality during the first month of life, a 4-fold reduction in the second month, and a 2-fold reduction thereafter (Figure 4). In none of the studies was exclusive breast feeding sufficiently prevalent to examine the additional preventive effect of exclusive breast feeding over partial breast feeding. However, case-control studies that have examined breast feeding and mortality show that infants who are exclusively breast fed for the first 2 months of life have a 24-fold reduced risk of diarrhea compared to those exclusively bottle fed (Figure 5).

It is well established that breast-fed infants have a different pattern of growth. The fact that the nutrient composition of breast milk is qualitatively and

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Figure 4 Increased risk of mortality associated with not breast feeding. (From World Health Organization (2000) WHO Collaborative 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. Lancet 355: 451-455.)

1 Exclusive breastfeeding

Mixed-feeding □ Formula fed

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1 Exclusive breastfeeding

Mixed-feeding □ Formula fed

<12 months <2 months

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Figure 5 Exclusive breast feeding and risk of mortality from diarrhea in Brazil. (From Victora CG, Vaughan JP, Lombardi et al. (1987) Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet 2(8554): 319-321.)

<12 months <2 months

Age group

Figure 5 Exclusive breast feeding and risk of mortality from diarrhea in Brazil. (From Victora CG, Vaughan JP, Lombardi et al. (1987) Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet 2(8554): 319-321.)

1 Atopic Eczema □ Diarrhea

1 Atopic Eczema □ Diarrhea

BF promotion No promotion

Group assignment

Figure 3 Breast feeding promotion reduces risk of atopic eczema and diarrhea. (Source: Kramer MS, Chalmers B, Hodnett E et al. (2001) Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the Republic of Belarus. Journal of the American Medical Association 285(4):413-420.)

BF promotion No promotion

Group assignment

Figure 3 Breast feeding promotion reduces risk of atopic eczema and diarrhea. (Source: Kramer MS, Chalmers B, Hodnett E et al. (2001) Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the Republic of Belarus. Journal of the American Medical Association 285(4):413-420.)

quantitatively different than formula, coupled with the epidemic of obesity among children in developed countries, has led a number of investigators to examine its association with infant feeding mode. In one of the largest studies to date of more than 9000 German schoolchildren, a dose-response between the duration of breast feeding and risk of obesity at age 5 or 6 years was reported (Figure 6). However, not all studies have found a relationship. Because most of the research to date has been carried out in developed countries, where breast feeding is more common among the better educated and affluent who are also more likely to practice other healthful behaviors, the possibility of bias persists.

More than 11 studies have documented an association between breast feeding and cognitive development. In the longest follow-up to date, a study cd 4

Months breast fed

Figure 6 Months of breast feeding and prevalence of obesity in German schoolchildren. (From Von Kries R, Koletzko B, Sauerwald T et al. (1999) Breast feeding and obesity: Cross sectional study. British Medical Journal 319: 147.)

also showed that adults who as infants had been breast fed for at least 9 months grew up to be significantly more intelligent than those breast-fed 1 month or less. After adjusting for a variety of factors, a dose-response relationship between the length of breast feeding and a number of different intelligence quotient measures was found in Danish adults who had been breast fed as infants. The total difference for those breast fed between 7 and 9 months versus less than 1 month was 6.6 points.

The longer women breast feed, the more they are protected against breast cancer. A reanalysis of data from 47 studies in 30 countries included more than 50000 women with breast cancer and nearly 97000 without it. Women who developed breast cancer were less likely to have breast fed, or if they had, the length of time they had breast fed was significantly shorter than that of women who were free of breast cancer. The effect of breast feeding on risk of breast cancer did not differ between women in developed and developing countries, and it did not vary significantly by age, menopausal status, ethnic origin, the number of births a woman had, her age when her first child was born, or any of a number of other personal characteristics examined. Based on the size of the effect, it is estimated that the cumulative incidence of breast cancer in developed countries would be reduced by more than half, from 6.3 to 2.7per 100 women by age 70, if women had the average number of births and lifetime duration of breast feeding that has until recently been prevalent in developing countries.

Not surprisingly, not breast feeding results in significantly greater health care expenditures. Among middle-class children from the United States and Scotland, the excess cost of health care services for diarrhea, lower respiratory tract illness, and otitis media during the first year of life was estimated to be between $331 and $475 per never-breast fed infant in 1995. These costs were calculated on the basis of

2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for each 1000 never-breast fed infants compared to 1000 infants breast fed exclusively for at least 3 months.

5 Ways To Get Rid Of The Baby Fat

5 Ways To Get Rid Of The Baby Fat

Many women who have recently given birth are always interested in attempting to lose some of that extra weight that traditionally accompanies having a baby. What many of these women do not entirely realize is the fact that breast-feeding can not only help provide the baby with essential vitamins and nutrients, but can also help in the weight-loss process.

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