Non-breastfed Children Research Articles

Cost-Effectiveness of Early Infant HIV Diagnosis of HIV-Exposed Infants and Immediate Antiretroviral Therapy in HIV-Infected Children under 24 Months in Thailand

BackgroundHIV-infected infants have high risk of death in the first two years of life if untreated. WHO guidelines recommend early infant HIV diagnosis (EID) of all HIV-exposed infants and immediate antiretroviral therapy (ART) in HIV-infected children under 24-months. We assessed the cost-effectiveness of this strategy in HIV-exposed non-breastfed children in Thailand.MethodsA decision analytic model of HIV diagnosis and disease progression compared: EID using DNA PCR with immediate ART (Early-Early); or EID with deferred ART based on immune/clinical criteria (Early-Late); vs. clinical/serology based diagnosis and deferred ART (Reference). The model was populated with survival and cost data from a Thai observational cohort and the literature. Incremental cost-effectiveness ratio per life-year gained (LYG) was compared against the Reference strategy. Costs and outcomes were discounted at 3%.ResultsMean discounted life expectancy of HIV-infected children increased from 13.3 years in the Reference strategy to 14.3 in the Early-Late and 17.8 years in Early-Early strategies. The mean discounted lifetime cost was $17,335, $22,583 and $29,108, respectively. The cost-effectiveness ratio of Early-Late and Early-Early strategies was $5,149 and $2,615 per LYG, respectively as compared to the Reference strategy. The Early-Early strategy was most cost-effective at approximately half the domestic product per capita per LYG ($4,420 in Thailand 2011). The results were robust in deterministic and probabilistic sensitivity analyses including varying perinatal transmission rates.ConclusionIn Thailand, EID and immediate ART would lead to major survival benefits and is cost- effective. These findings strongly support the adoption of WHO recommendations as routine care.

Cobalamin and Folate Status in 6 to 35 Months Old Children Presenting with Acute Diarrhea in Bhaktapur, Nepal

BackgroundCobalamin and folate are essential micronutrients and are important in DNA and RNA synthesis, cell proliferation, growth, hematopoiesis, and cognitive function. However, data on cobalamin and folate status are lacking particularly from young children residing in low and middle income countries.ObjectiveTo measure cobalamin and folate status and identifies their predictors among 6 to 35 months old children presenting with acute diarrhea.DesignThis was a cross-sectional study in 823 children presenting with acute diarrhea. We measured plasma cobalamin, folate, methylmalonic acid and total homocysteine who sought treatment for acute diarrhea between June 1998 and August 2000.ResultsThe mean (SD) plasma concentrations of cobalamin, folate, total homocysteine and methylmalonic acid were 206 (124) pmol/L, 55 (32) nmol/L, 11.4 (5.6) µmol/L and 0.79 (1.2) µmol/L, respectively. The prevalence of low plasma cobalamin (<150 pmol/L) was 41% but less than 2% (15) children had low folate concentration (<10 nmol/L). Plasma homocysteine and methylmalonic acid concentrations were negatively associated with cobalamin concentration but not associated with folate status. The prevalence of cobalamin deficiency was higher in breastfed than non-breastfed children (44% vs 24%; p = <0.001). The prevalence of hyperhomocysteinemia (>10 µmol/L) and elevated methylmalonic acid (>0.28 µmol/L) were 73% and 52%, respectively. In the regression analyses, the plasma cobalamin concentration was positively associated with age, and introduction of animal or formula milk.ConclusionsOur study indicated that poor cobalamin status was common particularly among breastfed children. Folate deficiency was virtually none existent. Possible consequences of cobalamin deficiency in young children need to be explored.

Breastfeeding and trajectories of children's cognitive development

The aim of this study was to examine the association of breastfeeding practices with the growth trajectories of children's cognitive development. We used data from the Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID) with variables on presence and duration of breastfeeding and standardized test scores obtained during three different panel waves (N = 2681). After adjusting for covariates we found that breastfed children had higher test scores but that breastfed and non-breastfed children had similar growth trajectories in test scores over time. The results indicate that breastfeeding has an important association with test scores, and that subsequent schooling and other experiences during adolescence do not eliminate the breastfeeding gap that appears in very early childhood.

Prevalence, severity and risk factors of asthma, rhinitis and eczema in a large group of Chinese schoolchildren

ABSTRACTBackground: There is a lack of information on the prevalence, severity and risk factors of asthma, rhinitis and eczema in Chinese children. Objective: To establish baseline data for a major longitudinal study of factors affecting asthma, rhinitis and eczema in a large group of children from the industrialized city of Shijiazhuang, China. Methods: We used the International Study of Asthma and Allergies in Childhood questionnaire and studied 10 338 children, ages 6–18, from Shijiazhuang. Results: The prevalence of childhood asthma, rhinitis and eczema is 1.2%, 13.5% and 11.8%, respectively. Boys had higher prevalence of these conditions than girls and younger children had higher prevalence of asthma and eczema but lower prevalence of rhinitis than older children. Breastfed children had lower prevalence of asthma and rhinitis, but not eczema, than non-breastfed children. Overweight children had higher prevalence of asthma and rhinitis than those who were not overweight. Children exposed to paternal smoking had higher prevalence of rhinitis and eczema than those not exposed; children exposed to pets had higher prevalence of asthma and rhinitis than those not exposed. Conclusions: The prevalence of asthma in this study group is low, but the prevalence of rhinitis is high, and could be considered a major public health problem. The prevalence of asthma, rhinitis and eczema is generally higher in boys and younger children generally have higher prevalence of asthma and eczema but lower prevalence of rhinitis. Exposure to pets is a risk factor for rhinitis, being overweight is a risk factor for asthma and rhinitis, and exposure to parental smoking is a risk factor for asthma, rhinitis and eczema in these children.

Breastfeeding as a Modifier of the Respiratory Effects of Air Pollution in Children

Breastfeeding and air pollution are both important factors for respiratory symptoms and asthma in children. Few studies have examined possible interaction between them on respiratory outcomes. We studied 31,049 Chinese children, ages 2-14 years old, from 25 elementary schools and 50 kindergartens in the Seven Northeastern Cities during 2008-2009. Parents or guardians completed questionnaires about the children's histories of respiratory conditions, risk factors, and feeding methods. Three-year average concentrations of particles with an aerodynamic diameter ≤ 10 µm, sulfur dioxide, nitrogen dioxides, and ozone were calculated from monitoring stations in 25 study districts. We used two-level logistic regressions to examine the effects of exposure, controlling for covariates. Association of air pollution with childhood respiratory conditions was modified by breastfeeding. Compared with children who had been breastfed, those who were not exhibited consistently stronger effects of air pollution. Among non-breastfed children, odds ratios (ORs) per 10 µg/m increase in nitrogen dioxide were 1.40 (95% confidence interval = 1.19-1.64) for cough, 1.41 (1.16-1.71) for phlegm, 1.17 (1.00-1.36) for current wheeze, and 1.25 (1.07-1.46) for doctor-diagnosed asthma. For breastfed children, the ORs were 1.25 (1.09-1.43) for cough, 1.15 (0.99-1.34) for phlegm, 0.97 (0.87-1.08) for current wheeze, and 1.17 (1.05-1.32) for doctor-diagnosed asthma. Breastfeeding was more protective among younger children. Breastfeeding was also associated with reduced effects of passive smoke exposure in children. Breastfeeding is associated with smaller associations between air pollution and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of pollutants.

Region and harvest season determine child feeding frequency in Ghana

Adequate feeding frequency (FF) helps to ensure young children obtain sufficient energy and nutrients for proper growth and development. In 2008, only 50% of breastfed and 22% of non‐breastfed Ghanaian children 6–23 mo consumed the minimum FF recommendations. No similar information exists for children 2–5 y. The objectives of this study were to determine what factors influence child FF in Ghana. Weighed food intake data of 76 children 2–5 y from 3 regions (2004–2009 ENAM study) were analyzed with ANCOVA to determine predictors of FF. Interviews with 40 caregivers of children &lt; 5 y were conducted in two regions in 2011; grounded theory guided the generation of FF themes. FF was greater in the Central (p&lt;0.05) and Brong Ahafo (p&lt;0.001) regions compared to Upper East, during the post‐harvest compared to pre‐harvest season (p&lt;0.05), and if a caregiver was unmarried compared to married (p=0.01). FF tended to be higher when a caregiver worked as an artisan compared to a farmer (p=0.06). Caregivers identified lack of time and money as main constraints, whereas caregivers with social networks and established working hours felt more confident in providing adequate FF. Strategies to increase child FF must acknowledge a caregiver's environmental context such as region of residence and season, as well as resource constraints, including time and food availability. Funding: Africa Initiative.

Breastfeeding Duration and Cognitive Development at 2 and 3 Years of Age in the EDEN Mother–Child Cohort

To investigate the dose-response relationship between breastfeeding duration and cognitive development in French preschool children. In the French EDEN Mother-Child Cohort Study, we evaluated language ability with the Communicative Development Inventory (CDI) in 1387 2-year-old children and overall development with the Ages and Stages Questionnaire (ASQ) in 1199 3-year-old children. Assessments were compared between breastfed and non-breastfed children and also according to breastfeeding duration in multivariable linear models, controlling for a wide range of potential confounders. We tested departure from linearity. After adjustments, ever-breastfed children scored 3.7 ± 1.8 (P = .038) points higher than never-breastfed children on the CDI and 6.2 ± 1.9 (P = .001) points higher on the ASQ. Among breastfed children, exclusive and any-breastfeeding durations were positively associated with both CDI and ASQ scores. The fine motor domain of ASQ was associated with any-breastfeeding duration, and the problem solving domain with exclusive-breastfeeding duration. We did not observe significant departures from linearity. No interactions were found between the child's sex, parental education or socioeconomic status, and breastfeeding duration. Longer breastfeeding duration was associated with better cognitive and motor development in 2- and 3-year-old children and a dose-response relationship was suggested.

PL02 Breastfeeding and Social Mobility: Neurological Development or Stress Mechanisms?

BackgroundBreastfeeding has been associated with higher cognitive scores, better test results and fewer socio-emotional problems in childhood. These outcomes in turn predict social mobility. This study examines the effect of...

Association of Breastfeeding with Asthma in Young Aboriginal Children in Canada

Few studies have investigated the factors associated with asthma in young Aboriginal children. To characterize the association of demographic, environmental and early life factors with asthma in young Aboriginal children in Canada. The 2006 Aboriginal Children's Survey was conducted among off-reserve Aboriginal children zero to six years of age to obtain information on Aboriginal children's development and well-being. The prevalence of asthma in Aboriginal children was obtained from the parental report of asthma as diagnosed by a health care professional. The prevalence of reported asthma among off-reserve Aboriginal children zero to six years of age (n=14,170) was 9.4%. Asthma prevalence in both exclusively breastfed children (6.8%) and ever but not exclusively breastfed children (9.0%) was significantly lower than that in nonbreastfed children (11.0%). In the multiple logistic regression analysis, exclusive breastfeeding was protective of asthma compared with nonbreastfeeding (OR 0.59 [95% CI 0.44 to 0.78]). Older age groups, male sex, having two or more older siblings, low birth weight, day care attendance and ear infection were significant risk factors for asthma. The prevalence of asthma among young Aboriginal children zero to six years of age living off reserve was slightly lower than that reported for all other Canadian children. Breastfeeding, especially exclusively breastfeeding, was protective of asthma in Aboriginal children, which is consistent with what has been observed in non-Aboriginal children in Canada. Public health interventions intended for reducing asthma incidence in young Aboriginal children should include breastfeeding promotion programs.

Decrease of internal exposure to chlororganic compounds and heavy metals in children in Baden-Württemberg between 1996/1997 and 2008/2009

From 1996/1997 to 2008/2009, blood and urine were sampled from 9- to 11-year-old pupils in the state of Baden-Württemberg, South-West Germany. In blood samples the chlororganics DDE, HCB, PCB-138, PCB-153 and PCB-180 were analysed by gas chromatography and ECD detection. PCDD/PCDF were measured in pooled blood samples using GC/MS. Lead concentrations in blood were quantified by graphite furnace atomic absorption spectrometry (AAS), mercury in urine by using cold vapour AAS. For all chlororganics and heavy metals a distinct decrease of the internal concentration could be shown within the 12-year investigation period. For DDE, the median decreased from 0.32 μg/l to 0.11 μg/l. The median of HCB fell from 0.19 μg/l to 0.07 μg/l. The median of the sum of the three PCB-congeners PCB-138, PCB-153 and PCB-180 decreased from 0.47 μg/l to 0.18 μg/l. The burden of PCDD/PCDF in pooled blood samples resulted in approximately half the concentration after the 12-year period. The internal concentrations of the chlororganics were distinctly higher in breastfed children than in non-breastfed children. In 2008/2009, these differences were strongest for PCB and DDE (2-fold), moderate for PCDD/PCDF (1.6-fold), and slight for HCB (1.2-fold). The median of lead concentrations in blood dropped from 23.6 μg/l to 15.9 μg/l. The median of mercury concentrations in urine decreased from 0.25 μg/l to a value below the limit of quantification of 0.2 μg/l; the 95th percentile was reduced from 3.1 μg/l to less than 0.2 μg/l. The decline of amalgam fillings in children during the investigation period had a strong influence on internal concentrations of mercury. The internal concentration of the persistent xenobiotics investigated here decreased to a low level not likely to be of concern for human health.

Health economic impact of a specific mixture of prebiotics in The Netherlands

To assess the protective role of breast-feeding in infants with CMPA-related AEDS as well as IL-10 utility as marker of disease evolution.64 breast-feeding children with CMPA-related AEDS (31 males and 33 females; mean age 5.56 ± 2.41 months; 21 mild AEDS; 25 moderate AEDS; 18 severe AEDS) and 60 artificial feeding babies (33 males and 27 females; mean age 6.01 ± 2.08 months; 26 mild AEDS; 19 moderate AEDS; 15 severe AEDS) were evaluated. In all patients serum IL-10 levels were detected.Significant Score Atopic Dermatitis (SCORAD) index point differences between breastfed and not breastfed children (p < 0.001) have been detected. The serum IL-10 levels were lower in children with CMPA-related AEDS as compared to the healthy control group (p < 0.001). Moreover, a significant inverse correlation between serum IL-10 levels and SCORAD in both enrolled groups has been also noted. In particular, IL-10 levels, in both groups, were significantly lower in children with severe symptoms. Conversely, serum IL-10 levels were significantly increased in children with mild-severe symptoms in both groups. Furthermore, breastfed children, with lower severe symptoms, had higher serum IL-10 levels. Finally, serum total IgE levels were negatively correlated with serum IL-10 levels in both breastfed and non-breastfed children with CMPA-related AEDS (p < 0.001).We reported that exclusive breast-feeding induces hyposensitization in children with CMPA-related AEDS and it is associated with minor disease severity and higher serum IL-10 levels, resulting as useful disease-monitor marker.

Childhood hodgkin's lymphoma, non‐hodgkin's lymphoma and factors related to the immune system: The escale study (SFCE)

The study investigated the role of factors considered related to the early stimulation of the immune system in the aetiology of childhood lymphoma. The national registry-based case-control study, Escale, was carried out in France over the period 2003-2004. Population controls were frequency matched with the cases on age and gender. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (ORs) were estimated using unconditional regression models adjusted for potential confounders. Data from 128 cases of Hodgkin's lymphoma (HL) aged 5-14 years, 164 cases of non-Hodgkin's lymphoma (NHL) aged 2-14 years and 1,312 controls were analyzed. Negative associations were observed between HL and day care attendance [OR = 0.5 (0.2-1.2)] and between HL and repeated early common infections among non-breastfed children [OR = 0.3 (.2-0.7), p = 0.003] [OR for breastfed children: 1.0 (.5-2.1)], but not for the other factors investigated. Negative associations were observed between NHL and birth order 3 or more [OR = 0.7 (0.4-1.1)], prolonged breastfeeding [OR = 0.5 (0.3-1.0)], regular contact with farm animals [OR = 0.5 (0.3-1.0)], frequent farm visits in early life [OR = 0.6 (0.4-1.1)] and history of asthma [OR = 0.6 (0.3-1.1)]. In conclusion, the results partly support the hypothesis that an abnormal maturation of the immune system may play a role in childhood HL or NHL, and call for further investigations.

Post‐natal growth among HIV‐exposed children: a cross‐study comparison

Infants of HIV-infected mothers are born stunted (low LAZ) but patterns of post-natal growth are not consistent among HIV-exposed infants across studies. We compared anthropometric data from predominantly non-breastfed HIV-exposed children age 0–23 mo in Port-au-Prince, Haiti (2007–09) to published data from predominantly breastfed infants of HIV-infected mothers in Tanzania (1995–97) and Zambia (2001–06). Based on 3366 observations from 458 HIV-negative Haitian children, mean LAZ (SD) was −1.31 (1.64) at birth increasing to −0.53 (1.38) at 6 mo then falling steadily to −1.01 (1.31) by 18 mo (WHO 2006 Std). In contrast, breastfed HIV-negative infants in Dar es Salaam were less stunted at birth but immediately declined in LAZ through 24 mo. Breastfed HIV-negative infants in Zambia were born at similar LAZ to Haitian infants, gained 0.5 LAZ in the first 2 mo then remained at stable LAZ until 10 mo after which they rapidly declined to mean LAZ < −2.0 by 18 mo. Ponderal (WLZ) growth patterns were also qualitatively different between studies. The observed differences in post-natal growth are likely to be associated with differences in short and long term nutrition-related outcomes. The basis for these differences is unknown but likely to stem from both differences in infant feeding and drugs used for HIV prophylaxis. Grant Funding Source: Cornell Einaudi Center, WCMC Center for Global Health

Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition.

ObjectiveNutritional, immunological and psychological benefits of exclusive breastfeeding for the first 6 months of life are unequivocally recognized. However, mothers should also be aware of the importance of breastfeeding for promoting adequate oral development. This study evaluated the association between breastfeeding and non-nutritive sucking patterns and the prevalence of anterior open bite in primary dentition.Material and MethodsInfant feeding and non-nutritive sucking were investigated in a 3-6 year-old sample of 1,377 children, from São Paulo city, Brazil. Children were grouped according to breastfeeding duration: G1 – non-breastfed, G2 – shorter than 6 months, G3 – interruption between 6 and 12 months, and G4 – longer than 12 months. Three calibrated dentists performed clinical examinations and classified overbite into 3 categories: normal, anterior open bite and deep bite. Chi-square tests (p<0.05) with odds ratio (OR) calculation were used for intergroup comparisons. The impact of breastfeeding and non-nutritive sucking on the prevalence of anterior open bite was analyzed using binary logistic regression.ResultsThe prevalence estimates of anterior open bite were: 31.9% (G1), 26.1% (G2), 22.1% (G3), and 6.2% (G4). G1 would have significantly more chances of having anterior open bite compared with G4; in the total sample (OR=7.1) and in the subgroup without history of non-nutritive sucking (OR=9.3). Prolonging breastfeeding for 12 months was associated with a 3.7 times lower chance of having anterior open bite. In each year of persistence with non-nutritive sucking habits, the chance of developing this malocclusion increased in 2.38 times.ConclusionBreastfeeding and non-nutritive sucking durations demonstrated opposite effects on the prediction of anterior open bite. Non-breastfed children presented significantly greater chances of having anterior open bite compared with those who were breastfed for periods longer than 12 months, demonstrating the beneficial influence of breastfeeding on dental occlusion.

Impact of fatty acid status on immune function of children in low-income countries.

In vitro and animal studies point to numerous mechanisms by which fatty acids, especially long-chain polyunsaturated fatty acids (LCPUFA), can modulate the innate and adaptive arms of the immune system. These data strongly suggest that improving the fatty acid supply of young children in low-income countries might have immune benefits. Unfortunately, there have been virtually no studies of fatty acid/immune interactions in such settings. Clinical trial registers list over 150 randomized controlled trials (RCTs) involving PUFAs, only one in a low-income setting (the Gambia). We summarize those results here. There was evidence for improved growth and nutritional status, but the primary end point of chronic environmental enteropathy showed no benefit, possibly because the infants were still substantially breastfed. In high-income settings, there have been RCTs with fatty acids (usually LCPUFAs) in relation to 18 disease end points, for some of which there have been numerous trials (asthma, inflammatory bowel disease and rheumatoid arthritis). For these diseases, the evidence is judged reasonable for risk reduction for childhood asthma (but not in adults), as yielding possible benefit in Crohn's disease (insufficient evidence in ulcerative colitis) and for convincing evidence for rheumatoid arthritis at sufficient dose levels, though formal meta-analyses are not yet available. This analysis suggests that fatty acid interventions could yield immune benefits in children in poor settings, especially in non-breastfed children and in relation to inflammatory conditions such as persistent enteropathy. Benefits might include improved responses to enteric vaccines, which frequently perform poorly in low-income settings, and these questions merit randomized trials.

Spotlight on the November 30 Issue

In this NEAD study, IQs of 42 breastfed children were not different from those of nonbreastfed children. This preliminary analysis failed to demonstrate deleterious effects of breastfeeding during maternal antiepileptic drug (AED) therapy on cognitive outcomes in children previously exposed in utero. Additional research is needed to confirm this observation and extend investigations to other AEDs and polytherapy. See p. 1954 From editorialist Autumn Klein: “There is still a pressing need to gather more data on individual …

Effects of breastfeeding in children of women taking antiepileptic drugs.

Breastfeeding is known to have beneficial effects, but there is concern that breastfeeding during antiepileptic drug (AED) therapy may be harmful to cognitive development. Animal and human studies have demonstrated that some AEDs can adversely affect the immature brain. However, no investigation has examined effects of breastfeeding during AED therapy on subsequent cognitive abilities in children. The Neurodevelopmental Effects of Antiepileptic Drugs Study is an ongoing prospective multicenter observational investigation of long-term effects of in utero AED exposure on cognition. Between 1999 and 2004, we enrolled pregnant women with epilepsy who were taking a single AED (carbamazepine, lamotrigine, phenytoin, or valproate). We recently reported on differential AED effects on age 3 year cognitive outcomes. In this report, we focus on the effects of breastfeeding during AED therapy on age 3 cognitive outcomes in 199 children. A total of 42% of children were breastfed. IQs for breastfed children did not differ from nonbreastfed children for all AEDs combined and for each of the 4 individual AED groups. Mean adjusted IQ scores (95% confidence intervals) across all AEDs were breastfed = 99 (96-103) and nonbreastfed = 98 (95-101). Power was 95% to detect a half SD IQ effect in the combined AED analysis, but was inadequate within groups. This preliminary analysis fails to demonstrate deleterious effects of breastfeeding during AED therapy on cognitive outcomes in children previously exposed in utero. However, caution is advised due to study limitations. Additional research is needed to confirm this observation and extend investigations to other AEDs and polytherapy.

Late postnatal HIV infection in children born to HIV-1-infected mothers in a high-income country

To evaluate the risk of late postnatal HIV-1 infection in nonbreastfed children enrolled in the French ANRS Cohort CO01 (EPF). The EPF cohort has prospectively enrolled HIV-infected mother/child pairs with a low proportion of known breastfeeding (<0.2%). Children were followed until they were 24 months old, with HIV-1 DNA/RNA PCR tests performed at birth, M1, M3 and M6 and a late serology at 18-24 months. This substudy included 4539 children who were uninfected at the age of 6 months in 1984-2005. Five children were late diagnosed with HIV-1 infection despite negative PCR tests until 6 months. In three cases, the infection was diagnosed between 14 and 18 months. The other infections were diagnosed at 10 and 12 years of age because of AIDS-defining symptoms; their last (negative) serologies were performed at 19 and 9 months, respectively. A phylogenetic study performed in the latest case revealed a strong homology between the mother and child strains. No known mode of viral transmission (including breastfeeding or use of premasticated food) could be found. However, we observed previously reported risk factors for intrafamilial HIV-1 transmission: poor socioeconomic backgrounds and sustained HIV-1 viremia in the mothers during the follow-up of their children. Late postnatal HIV-1 infection can rarely be diagnosed in the absence of known breastfeeding in high-income countries. Our results highlight the need for a maintained close follow-up of the noninfected children even after 6 months, especially when there are risk factors for intrafamilial viral transmission.

Breastfeeding is not associated with left cardiac structures and blood pressure during the first two years of life. The Generation R Study

Background Shorter duration of breastfeeding in infancy has been suggested to be associated with an increased risk of cardiovascular disease in adulthood. Early cardiovascular adaptations due to breastfeeding may explain these associations. Aim To investigate whether breastfeeding affects left cardiac structures and blood pressure development in early childhood. Study design Prospective cohort study from fetal life until the age of two years. Subjects Information about the duration and exclusivity of breastfeeding was collected by questionnaires at the ages of 2, 6 and 12 months in 933 children. Outcome measures Left cardiac structures (left atrial diameter, aortic root diameter and left ventricular mass), fractional shortening and blood pressure at the ages of 1.5, 6 and 24 months. Results No differences in cardiac structures, fractional shortening and blood pressure were observed between breastfed and non-breastfed children. Duration and exclusivity of breastfeeding were not consistently associated with any cardiac structure, fractional shortening, or blood pressure until the age of 24 months. Also, there was no association of breastfeeding with cardiac growth between 6 months and 24 months. All analyses were adjusted for child age and sex. Additional adjustment for child anthropometrics, maternal age, anthropometrics, family history, maternal cardiovascular risk factors, pregnancy or delivery complications, parity, socio-economic status, smoking status and alcohol consumption during pregnancy did not materially change the effect estimates. Conclusions Our results do not support the hypothesis that early postnatal cardiovascular adaptations underlie the previously shown associations between breastfeeding and cardiovascular disease in adulthood. Further studies are needed to investigate whether and at what age the associations appear.

Effect of breast- and bottle-feeding duration on the age of pacifier use persistence

This study evaluated the effect of breast- and bottle-feeding duration on the age of pacifier use persistence. Questionnaires (n = 723) with information on nutritive and nonnutritive sucking habits of children aged 3-6 years were assessed. The sample was divided according to breastfeeding duration: G1 - non-breastfed, G2 - up to 3 months, G3 - discontinued between 4 and 6 months, G4 - discontinued between 7 and 12 months, and G5 - longer than 12 months. The children were also assigned to 4 groups by age of pacifier use persistence, as well as by age of bottle-feeding persistence: no habits, up to 2 years, 3-4 years and 5-6 years. Associations between nutritive sucking habits and pacifier use were analyzed using logistic regression. The larger breastfeeding groups were G2 (37.9%) and G4 (19.4%). Many children discontinued pacifier use and bottle-feeding at 3-4 years of age (24.9% and 40.1%, respectively). Chances of non-breastfed children (G1) with prolonged pacifier-sucking habits, in the three age ranges, were progressively higher in comparison with group G4 (OR: 4.0-7.5, p < 0.01). When comparing bottle-fed with non bottle-fed children, the age range at which bottle-feeding had been discontinued was significantly associated with that of pacifier use cessation: up to 2 years (OR = 6.2), 3-4 years (OR = 7.6) and 5-6 years (OR = 27.0), p < 0.01. It may be suggested that breastfeeding duration has an inversely proportional effect on the age of pacifier use persistence. Bottle-fed children who use pacifiers tend to discontinue these habits at the same period.