Breastfeeding: long-term effects on society · Breastfeeding: long-term effects on society...
Transcript of Breastfeeding: long-term effects on society · Breastfeeding: long-term effects on society...
Breastfeeding: long-term effects on society
Associate Professor Wendy H Oddy BSc (Nutrition) MPH PhDTelethon Institute for Child Health Research University of Western AustraliaPerth, Western Australia
Global Breastfeeding Partners’ Forum October 17-19th Penang, Malaysia
Goals of this talk
1) Discuss breastfeeding rates globally
2) Determine the evidence for an association between the duration of breastfeeding and illness, disease and development in childhood
3) Targeting key determinants to successful breastfeeding
Universal breastfeeding has been the goal of the World Health Organisation; American Academy of Pediatrics and many other organisations for a quarter of a century.
The Australian National Health and Medical Research Council and the World Health Organisation recommends:
Exclusive breastfeeding for at least the first six months of life and up to two years.
The gradual introduction of nutritious foods for growth and development
To continue breastfeeding for 12 months and beyond
Exclusive breastfeeding: status worldwide
Source: The State of the World’s Children 2001.44129.3World4224.0Least Developed Countries44116.3Developing Countries-9.8Industrialized Countries-6.4CEE/CIS and Baltic States
3711.5Latin America/Caribbean5732.6East Asia/Pacific4635.7South Asia9.39.3Middle East/North Africa3424.0Sub-Saharan Africa
% exclusively breastfed (0-3 mos.)
2000
Births (millions)1999UNICEF Region
Breastfeeding Rates Around the Developed World
Sources: Baby Milk Action, Cambridge, UK; Center for Breastfeeding Information.
Australia (2004) 95 472057United States2163Britain2568Netherlands2480Canada1093Poland5098Norway5398Sweden
% who continue 6 months or longer% of mothers who startCountry
Duration of any, full and exclusive breastfeeding in Perth, Western Australia 2002
0102030405060708090
100
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 39 41 43 45 48 50 52
Duration (w eeks)
Perc
enta
ge BF Any
BF Exclusive
BF Fully
Mammals
MAMMALIAN EVOLUTION
Mammary gland evolves from epidermal glands in reptilian ancestors
Homo Sapiens
Diversification via genetic mutations and natural selection
Continued speciation
Early primates
PrototheriaEutheriaMetatheria
Some of the biochemically active substances in human milk
• Hormones• Growth factors• Cytokines• Colony-stimulating factors• Specific nutrients
MONOCYTE
Cell Content of Human Cell Content of Human BreastmilkBreastmilk
With thanks to Dr M Cregan
MACROPHAGE
Cell Content of Human Cell Content of Human BreastmilkBreastmilk
With thanks to Dr M Cregan
SECRETORY EPITHELIALCELL (LACTOCYTE)
Cell Content of Human Cell Content of Human BreastmilkBreastmilk
With thanks to Dr M Cregan
LYMPHOCYTE
Cell Content of Human Cell Content of Human BreastmilkBreastmilk
With thanks to Dr M Cregan
Some of the specific nutrients in human milk
• Protein• Nucleotides• Glutamine• Lactoferrin• Lipids• Oligosaccharides
IgA Antibodies
Oligosaccharides and glycoconjugates.
The microbiology of breast milk
Breast milk has a large impact on bowel development and gut microflora
Breastfed babies have a more healthy microflora than formula-fed babies’
Formula-fed infants have higher numbers and isolation frequencies of enterococci and clostridia in their faecal biliary than breastfed infants.
Newburg DS. J Pediatr Gastroenterol Nutr 2000; 30:S8-S17.
Epidemiological evidence
Common illnesses Feeding measure Risk Ratio range*
Acute diarrhea Breastfed < 3 mo 6.10 (4.1, 9.0)
Lower respiratory infections Breastfed < 4 mo 3.29 (1.8, 6.0)
Pneumonia No breastfeeding 16.7 (7.7, 36.0)
Ear infections acute Breastfed < 6 mo 1.61 (1.3, 1.8)*
** The risk ratios have been adjusted to reflect a level of risk of formula rather than protection of milk.
Arifeen, S. 2001Yoon PW. 1996César, V. 1999Hanson, LA. 1998
Less common illnesses
Necrotising enterocolitis 39% formula/ 7% breastfed 4.50 (3.00, 6.00)
Urinary tract infections Never breastfed 1.62 (1.35, 1.78)
Insulin dependent diabetes Breastfed < 4 months 1.63 (1.22, 2.17)
Acute lymphobastic leukemia Never breastfed 1.21 (1.09, 1.30)
Sudden infant death syndrome Current formula feeding 1.35 (1.09. 1.54)
Cholera Not breastfeeding 1.70 p<.0001 Nicoll A. 2002
Mårild S. 2004Kimpimäki T. 2001Davis MK. 2001Ford RP. 1993Clemens JD. 1997
Immunologic disease
Coeliac disease Breastfed < 3 months 1.63 (1.36, 1.79)
Crohn's disease Lack of breastfeeding 1.90 (1.50, 3.60)
Ulcerative colitis Lack of breastfeeding 1.50 (1.10, 2.10)
Juvenile rheumatoid arthritis Lack of breastfeeding 1.60 (1.19, 1.80)
Multiple sclerosis Breastfed < 7 months 1.62 (1.26, 1.81)
Ivarsson A.2002.Cashman KD. 2003.Corrao G. 1998. Bond A. et al. 1997.Sadovnick AD. 1996.
Development
Cognitive development in preterm Lack of feeding ↓ mean IQ of 8.3 pts
Cardiovascular disease Lack of feeding ↑ mean Tot Cholesterol
Metabolic development Lack of feeding ↑ ApoB values
Obesity Breastfed < 6 mo 1.25 (1.02, 1.43)
Reynolds A. Pediatr Clin North Am. 2001;48:159-71.Vestergaard M. Acta Paed 1999; 88: 1327-32.Ravellia ACJ. Arch Dis Child 2000;82: 248-52. Dewey KG. J Hum Lact 2003;19: 9-18.
Our results from the Western Australian Pregnancy Cohort
(Raine) Study….
Cumulative incidence of asthma at six years and other milk
*After adjusting for gender, gestational age < 37 weeks, attendance at childcare/playgroup and parental smoking
Doctordiagnosed
asthma
Wheezing 3 ormore times since
the age of 1Introduction of other milkat < 4 monthsORCIp-value
1.24 *(1.02-1.51)
.032
1.41*(1.13-1.76)
.002
Oddy et al. Brit Med J 1999
Prevalence of asthma at six years and other milk
*After adjusting for gender, gestational age of < 37 weeks, attendance at childcare/playgroup and parental smoking
Wheezinglast year
Sleepdisturbance due
to wheezeIntroduction of other milkat < 4 monthsORCIp-value
1.31*(1.05–1.63)
.017
1.42*(1.07–1.90)
.016
Oddy et al. Brit Med J 1999
Prevalence of atopy and other milk
*After adjusting for gender, gestational age < 37 weeks, attendance at childcare/playgroup and parental smoking
Skin Prick Test Positive
Introduction of other milkat < 4 monthsORCIp-value
1.28*(1.03–1.59)
.024
Oddy et al. Brit Med J 1999
0 20 40 60 80
0.5
0.6
0.7
0.8
0.9
1.0
Survival time (months)
% w
ithou
t ast
hma
Age of asthma diagnosis by age of introduction to other milks
Om>4
Om <=4
Oddy et al. Brit Med J 1999
Mental health/ behavioural scores by follow-up & breastfeeding <6 or 6+ mo
40
42
44
46
48
50
52
54
Age 2 Age 5 Age 8 Age 10 Age 14Follow-Up
Men
tal h
ealth
Mea
n Sc
ore
Breastfeeding < 6 monthsBreastfeeding ≥ 6 months
Oddy J Pediatrics 2010
International Diabetes Federation metabolic syndrome at 14 y & breastfeeding duration
0
1
2
3
4
5
6
7
8
1 2 3 4 5 6
B reastfeeding durat io n (mo nths)
MetS
No MetS*p <0 .0 5
Oddy (in prep) 2010
International Diabetes Federation waist criteria at 14 y & breastfeeding duration
0
5
10
15
20
25
30
35
1 2 3 4 5 6Breastfeeding duration (months)
Waist IDFNo Waist IDF
*p <0.05
* **
* * *
Oddy (in prep) 2010
Mean BMI over mean age based on age breastfeeding stopped at ≤ 4 /> 4 months
Chivers P, et al Oddy WH. Int J Obesity 2010
The introduction of milk other than breast milk was a significant risk factor for childhood asthma and allergy at six years of age.
Breastfeeding for less than six months was associated with poorer mental health and behavioural scores throughout childhood
Breastfeeding for less than six months was associated with increased diabetes risk, high waist circumference and BMI in adolescence
ConclusionThe body of research related to breast milk reinforces the benefits of full breastfeeding for at least the first six months of life and up to two years for the health of infants and children.
Targeting key determinants of breastfeeding success
• Need to address the factors that directly influence breastfeeding
• Three levels of factors identified
Hector et al. 2005
Determinants of Breastfeeding
GroupGroup
SocietySociety
IndividualIndividual
Individual-Level Factors
GroupGroup
SocietySociety
IndividualIndividual
SkillsSkills
KnowledgeKnowledge
AttitudesAttitudesConfidenceConfidence
Group-Level Factors
GroupGroupSocietySociety
IndividualIndividual
Hospitals/Health CareHospitals/Health Care
Group-Level Factors
GroupGroupSocietySociety
IndividualIndividual
Hospitals/Health CareHospitals/Health CareHome, Family, andHome, Family, and PeersPeers
Group-Level Factors
GroupGroupSocietySociety
IndividualIndividual
Hospitals/Health CareHospitals/Health CareHome, Family, andHome, Family, and PeersPeers
WorkWork
Group-Level Factors
GroupGroupSocietySociety
IndividualIndividual
Hospitals/Health CareHospitals/Health CareHome, Family, andHome, Family, and PeersPeers
WorkWorkCommunityCommunity
Society-Level Factors
GroupGroup
SocietySociety
IndividualIndividual
Cultural NormsCultural Norms
Gender RolesGender RolesPublic BreastfeedingPublic Breastfeeding Marketing BM SubstitutesMarketing BM Substitutes
Maternity LeaveMaternity Leave
Determinants of Breastfeeding
GroupGroup
SocietySociety
IndividualIndividual
SkillsSkills
KnowledgeKnowledge
AttitudesAttitudesConfidenceConfidence
Hospitals/Health CareHospitals/Health CareHome, Family, andHome, Family, and PeersPeers
WorkWorkCommunityCommunity
Cultural NormsCultural NormsGender RolesGender Roles
Public BreastfeedingPublic Breastfeeding Marketing BM SubstitutesMarketing BM Substitutes
Maternity LeaveMaternity Leave
Advantage of a Multi-Level Approach
• Determinants are often inter-related• Can identify which intervention strategies will
need to be coordinated to have an effect• Can identify those responsible for various
actions and coordinate efforts• Increase the rates, duration, and exclusivity of
breastfeeding
Acknowledgments Study staff, study participants and their families, and our
funders without whom this research would not be possibleThanks to Grant Smith and the CARE team for the level slides
Thank you for inviting me to talk to you today