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Infant feeding

Get advice and support with infant feeding from other users here.

Anyone want some real statistics about breastfeeding?

26 replies

pooter · 30/04/2009 01:28

I found this hereits a pdf file of a meta-analysis of loads of breastfeeding studies - all in developed countries. It makes for interesting reading. I'll just cut and paste a few bits so you get the gist (and no, i wont cherrypick! )

We screened over 9,000 abstracts. Forty-three primary studies on infant health outcomes, 43
primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that
covered approximately 400 individual studies were included in this review.
The association studies of breastfeeding and health outcomes mostly presented results as odds
ratios. To facilitate interpretation of the odds ratio, we chose to present these data as a reduction in
relative risk, estimated as ?(1 ? odds ratio) x 100%,? along with the corresponding 95% confidence
interval (CI).

Full term Infant Outcomes

Acute Otitis Media.
Our meta-analysis of five cohort studies of good and moderate
methodological quality showed that breastfeeding was associated with a significant reduction in the
risk of acute otitis media. Comparing ever breastfeeding with exclusive formula feeding, the risk
reduction of acute otitis media was 23 percent (95% CI 9% to 36%). When comparing exclusive
breastfeeding with exclusive formula feeding, either for more than 3 or 6 months duration, the
reduction was 50 percent (95% CI 30% to 64%). These results were adjusted for potential
confounders.

Atopic Dermatitis.
One good quality meta-analysis of 18 prospective cohort studies on full term
infants reported a reduction in the risk of atopic dermatitis by 42 percent (95% CI 8% to 59%) in
children with a family history of atopy and exclusively breastfed for at least 3 months compared with
those who were breastfed for less than 3 months. The meta-analysis did not distinguish between
atopic dermatitis of infancy (under 2 years of age) and persistent or new atopic dermatitis at older
ages. It has been postulated that the diagnosis of atopic dermatitis in patients younger than 2 years of
age could be attributed to infectious etiologies, which may be prevented by breastfeeding. However,
a stratified analysis by duration of followup found the risk reduction from breastfeeding was similar
in subjects with less than 2 years compared with more than 2 years of followup.

Gastrointestinal Infections.
For non-specific gastroenteritis, one systematic review identified
three primary studies that controlled for potential confounders. These studies reported that there was
a reduction in the risk of non-specific gastrointestinal infections during the first year of life in
breastfed infants from developed countries. But a summary adjusted estimate taking into account
potential confounders could not be determined because the studies did not provide usable quantitative
data. However, a recent case-control study from England that took into account the role of potential
confounders reported that infants who were breastfeeding had a 64 percent (95% CI 26% to 82%)
reduction in the risk of non-specific gastroenteritis compared with infants who were not
breastfeeding.

Lower Respiratory Tract Diseases.
The summary estimate from a good quality meta-analysis
of seven studies reported an overall 72 percent (95% CI 46% to 86%) reduction in the risk of
hospitalization due to lower respiratory tract diseases in infants less than 1 year of age who were
exclusively breastfed for 4 months or more. The results remained consistent after adjustment for
potential confounders.

Asthma.
The studies on asthma were equivocal. A previously published good quality metaanalysis
reported a moderate protective effect and four recent primary studies reaching mixed
conclusions, including two studies finding an increased risk of asthma associated with breastfeeding.
We updated the meta-analysis with the new studies. Our analysis showed that breastfeeding for at
least 3 months was associated with a 27 percent (95% CI 8% to 41%) reduction in the risk of asthma
in those subjects without a family history of asthma compared with those who were not breastfed.
For those with a family history of asthma, there was a 40 percent (95% CI 18% to 57%) reduction in
the risk of asthma in children less than 10 years of age who were breastfed for at least 3 months
compared with those who were not breastfed. However, the relationship between breastfeeding and
the risk of asthma in older children and adolescents remains unclear and will need further
investigation.

Cognitive Development. One well-performed sibling analysis and three prospective cohort
studies of full-term infants, all conducted in developed countries, adjusted their analyses specifically
for maternal intelligence. The studies found little or no evidence for an association between
breastfeeding in infancy and cognitive performance in childhood. Most of the published studies
adjusted their analyses for socioeconomic status and maternal education but not specifically for
maternal intelligence. For those studies that reported a significant effect after specific adjustment for
maternal intelligence, residual confounding from other factors such as different home environments
cannot be ruled out.

Obesity.
Three meta-analyses of good and moderate methodological quality reported an
association of breastfeeding and a reduction in the risk of obesity in adolescence and adult life
compared with those who were not breastfed. One study reported the reduction in the risk of
overweight/obesity in breastfeeders compared with non-breastfeeders was 24 percent (95% CI 14%
to 33%); another study reported 7 percent (95% CI 1% to 12%). Both of these estimates took into
account the role of potential confounders. Furthermore, they also showed that the magnitude of
association decreased when more confounders were entered into the analyses. The third study used
meta-regression and found a 4 percent reduction in the risk of being overweight in adult life for each
additional month of breastfeeding in infancy. Overall, there is an association between a history of
breastfeeding and a reduction in the risk of being overweight or obese in adolescence and adult life.
One should be cautious in interpreting all these associations because of the possibility of residual
confounding.

Risk of Cardiovascular Diseases.
Results from two moderate quality meta-analyses concluded
that there was a small reduction of less than 1.5 mm Hg in systolic blood pressures and no more than
0.5 mm Hg in diastolic blood pressures among adults who were breastfed in their infancy compared
with those who were formula-fed. The association weakened after stratification by study size,
suggesting the possibility of bias in the smaller studies.
One meta-analysis of cohort and case-control studies reported that there was a reduction in total
and LDL cholesterol levels by 7.0 mg/dL and 7.7 mg/dL, respectively, in adults who were breastfed
during infancy compared with those who were not. However, these findings were based on data from
adults with a wide age range. The analysis did not segregate the data according to gender and
potential confounders were not explicitly analyzed. Detailed information (e.g., fasting or non-fasting)
on the collection of specimen for cholesterol testing was not included. Because of these deficiencies,
the correct characterization of a relationship between breastfeeding and adult cholesterol levels
cannot be determined at this time.
One meta-analysis found little or no difference in all-cause and cardiovascular mortality between
adults who were breastfed during infancy and those who were not. There were possible biases and
limitations in the studies reviewed, however. Presence of statistical heterogeneity across studies
suggests that it may not have been appropriate to combine estimates from individual studies into one
summary estimate. Because of these reasons, no definitive conclusion could be drawn regarding the
relationship between a history of breastfeeding and cardiovascular mortality.
In summary, the relationship between breastfeeding in infancy and the risk of cardiovascular
diseases cannot be confidently characterized at this time and will need further investigation.

Type 1 Diabetes.
Two moderate quality meta-analyses suggest that breastfeeding for at least 3
months reduced the risk of childhood type 1 diabetes compared with breastfeeding for less than 3
months. One reported a 19 percent (95% CI 11% to 26%) reduction; the other reported a 27 percent
(95% CI 18% to 35%) reduction. In addition, findings from five of six studies published since the
meta-analyses reported similar results. However, these results must be interpreted with caution
because of the possibility of recall biases and suboptimal adjustments for potential confounders in the
studies.

Type 2 Diabetes.
In one well-performed meta-analysis of seven studies of various designs,
breastfeeding in infancy was associated with a 39 percent (95% CI 15% to 56%) reduced risk of type
2 diabetes in later life compared with those who were not. However, only three of seven studies
adjusted for all the important confounders such as birth weight, parental diabetes, socioeconomic
status, and individual or maternal body size. Though the crude and adjusted estimates did not differ
in these three studies, the lack of adjustments for potential confounders such as birth weight and
maternal factors by all studies could exaggerate the magnitude of an association.

Childhood Leukemia.
The published studies on childhood acute lymphocytic leukemia (ALL)
were equivocal; a good quality meta-analysis reported a moderate protective effect from
breastfeeding and the other good quality systematic review reached the opposite conclusion. We
conducted a meta-analysis including only good and fair quality case-control studies identified in the
systematic review, since the meta-analysis did not provide methodological quality grading of primary
studies. We found breastfeeding of at least 6 months duration was associated with a 19 percent (95%
CI 9% to 29%) reduction in the risk of childhood ALL. The previous meta-analysis also reported an
association between breastfeeding of at least 6 months duration and a 15 percent reduction (95% CI
2% to 27%) in the risk of acute myelogenous leukemia (AML). Overall there is an association
between a history of breastfeeding for at least 6 months duration and a reduction in the risk of both
leukemias (ALL and AML).

Infant Mortality.
One study of moderate methodological quality evaluated the relationship
between breastfeeding and infant mortality. The study reported a protective effect of breastfeeding in
reducing infant mortality after controlling for some of the potential confounders. However, in
subgroup analyses of the study, the only statistically significant association reported was between
?never breastfed? and Sudden Infant Death Syndrome (SIDS) or the risk of injury-related deaths.
Because of the limited data in this area, the relationship between breastfeeding and infant mortality in
developed countries remains unclear. Further investigation is needed.

Sudden Infant Death Syndrome (SIDS).
We conducted a meta-analysis by including only
studies that reported clear definitions of exposure, outcomes, and results adjusted for well-known
confounders or risk factors for SIDS. Our meta-analysis of seven case-control studies found that a
history of breastfeeding was associated with a 36 percent (95% CI 19% to 49%) reduction in the risk
of SIDS compared to those without a history of breastfeeding.

me again There is also a section on preterm infants and the effects of BF on the mother. I didnt want to push my luck with trying to send such a HUMONGOUS post!

oh, and otitis media is ear infection

I am a little surprised actually at some of the supposed benefits (reduced risk of osteoporosis for example) that were not found to be statistically significant, but relieved to find that a lot of the wonders of breastfeeding that i have taken to be fact, without checking properly are actually true.
I always knew breastfeeding was brill etc, but its good to have the figures to back it up - even if some of them aren't as unequivocal as one would hope

OP posts:
ILovePudding · 30/04/2009 06:08

Phew! That was a lot to get through, but interesting reading. Thanks

pooter · 30/04/2009 08:22

and i thought i was bad, posting at half one in the morning - your 6am is unearthly

OP posts:
foxytocin · 30/04/2009 08:43

why are you putting up inconvenient information on MN, pooter? no one is more blind than she who refuses to see.

pooter · 30/04/2009 08:44

what do you mean foxytocin?

OP posts:
ruddynorah · 30/04/2009 08:48

dare i say, well yes i do, that those are not benefits..they just highlight the risks of not breastfeeding

pooter · 30/04/2009 08:52

yes ruddynorah, i know and agree - bf is the norm, so any deviation leading to an increase in disease would be a risk. Sorry - i wasnt watching my language carefully enough. I am chastised

OP posts:
foxytocin · 30/04/2009 08:58

i mean people with no qualifications in analysing the evidence will still discount it as 'not good enough' because they would rather believe that formula is 'good enough' or dare I say it, only make mothers who choose to AF 'feel guilty'.

pooter · 30/04/2009 09:04

well i felt i had to try to find some actual figures on a different thread (the one about the radio 4 interview)and it was so interesting that i thought i would share it a bit more widely. At least if people can see some impartial research they can make a more informed choice. I really dont want to make anyone feel guilty, but you cant ignore the facts and pretend ff is just as good can you.

OP posts:
theyoungvisiter · 30/04/2009 09:04

well I thought it was interesting and was glad to read it.

Just because some people will remain unconvinced, that doesn't mean it's not worth posting.

Thanks Pooter!

pooter · 30/04/2009 09:05

at tyv

OP posts:
foxytocin · 30/04/2009 09:27

maybe I should have said I am only being tongue in cheek. i was being cynical because I noticed a lot of your dissenters on the other thread are the same old same old.

i agree that it is great to put that information out there so that other people who are willing to read impartially can find impartial information.

pooter · 30/04/2009 09:32

ta foxy! i think i was getting a bit paranoid . I will now pay my DS some attention and stop banging my head against a brick wall - for the time being

OP posts:
foxytocin · 30/04/2009 09:35

Have CATted you.

theyoungvisiter · 30/04/2009 09:35

oh sorry! Tongue in cheekness didn't come across well (or maybe it is sleep-deprived me not reading properly).

There is definitely a group of people who will not be convinced of the facts but I think that only makes it more important to post unequivocal scientific findings so that the waverers can compare the science with the anecdotes predictably trotted out.

lal123 · 30/04/2009 09:37

I really don't understand the distinction people are making between the benefits of breastfeeding versus the risk of not breastfeeding. Surely these are just opposite sides of the same coin?

theyoungvisiter · 30/04/2009 09:40

Lal, it is, but the idea is that it should be presented that breastfeeding is the norm rather than an "extra" dose of health on top of the "normal" amount.

If you talk about added benefits of bfing, you imply that formula gives you a "normal" amount of health and breastfeeding just gives you a gold star on top of that, which kind of implies that bfing is just frills on the top.

Whereas if you talk about the risks of ffing, then it drives it home that ffing may be actually compromising your baby's health.

foxytocin · 30/04/2009 09:42

Sorry, it is me. I am feeling cynical these days.

LAL, breastfeeding is the normal physiological way to feed a baby. Hence the argument goes that being normal, it has no benefits. It follows there fore that giving your baby formula has risks.

the other side of that coin is:

If you say breastfeeding has benefits, you are therefore claiming that formula feeding is the normal way to feed a baby.

Bobo23 · 30/04/2009 10:15

oo please post some of the evidence about pre term infants... I'm bfing a 34 weeker who had severe IUGR and was born weighing 2 pounds 12... currently knackered from constant feeding and need some science to cheer me up!!!

goingnowherefast · 30/04/2009 10:36

Thanks for that Pooter. Very interesting.

A couple of those mention specifically exclusive breastfeeding, but some of the others just say "breastfeeding". Does anyone know if that means that a mixed fed infant would be included in those stats?

(dd was mixed fed for a while when we were having difficulties, she was mostly breastfed but for a few weeks she did have some formula daily)

DreamingAboutSleep · 30/04/2009 10:44

Thanks Pooter, it's always good to read the actual evidence for why bf is best.

JulesJules · 30/04/2009 10:45

Thanks for posting that Pooter, very interesting.

foxytocin · 30/04/2009 10:46

Bobo: from the same document linked below: "Necrotizing Enterocolitis (NEC). Our meta-analysis of four randomized controlled trials of
breast milk versus formula in comparing the outcome of NEC demonstrated that there was a
marginally statistically significant association between a history of breast milk feeding and a
reduction in the risk of NEC (P = 0.04). The estimate of the reduction in relative risk ranged from 4
percent to 82 percent. The absolute risk difference between the two groups was 5 percent. Because of
the high case-fatality rate of NEC, this difference is a meaningful clinical outcome. The wide range
of the estimate reflects the relatively small number of total subjects in the studies and the small
number of events. One must also be cognizant of the heterogeneity underlying these trials in
interpreting the findings of the meta-analysis. Examples of which included gestational age that
ranged from 23 to more than 33 weeks; birth weight ranged from less than 1,000 g to more than
1,600 g; and some trials included only ?healthy? infants, while others included both ?healthy? and
?ill? infants."

and the one about SIDS.

pre-term infants are more susceptible to these therefore are at higher risk than healthy term infants if they are also formula fed. (the stats in this study loooked mostly on healthy term) sorry, nursing at keyboard.

CaptainKarvol · 30/04/2009 10:47

I'm off to have a nosey at the link (research head back on), but goingnowhere, IIRC, there is at least some bf research out there that groups anyone who ever breastfed at all (even a lick of colostrum) as 'breastfeeding' and only those who never bf as 'formula'. So mixed feeding is very likely to be part of the 'breastfeeding' stats unless 'exclusive bf' is specified.

CaptainKarvol · 30/04/2009 10:48

oh, here we go
However, many studies did not distinguish between exclusive and partially
breastfed infants; presumably, some of the effects reported from observational studies were from
infants who received both breast milk and formula milk feedings.

So yes to mixed feeding.

goingnowherefast · 30/04/2009 10:56

thank you CaptainKarvol

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