A critical evaluation of the evidence on the association between type of infant feeding and cognitive development

Association of Breastfeeding Duration with Neurodevelopmental Outcomes in an Enriched Familial Likelihood Cohort for Autism Spectrum Disorder

This study aimed to compare the breastfeeding (BF) duration of the younger siblings of children with ASD in an enriched-likelihood cohort for autism spectrum disorder (ASD), and to determine whether longer BF duration was associated with differences in neurodevelopmental outcomes in this cohort. Information on BF practices was collected via surveys in the MARBLES (Markers of Autism Risk in Babies-Learning Early Signs) study. Developmental evaluations, including the Mullen Scales of Early Learning and the Autism Diagnostic Observation Schedule, were conducted by expert clinicians. Participants' neurodevelopmental outcome was classified by an algorithm into three groups: typical development, ASD, and non-typical development. The median duration of BF was 10.70 months (interquartile range of 12.07 months). There were no significant differences in the distribution of duration of BF among the three neurodevelopmental outcome categories. Children in this enriched-likelihood cohort who were breastfed for > 12 months had significantly higher scores on cognitive testing compared to those who were breastfed for 0-3 months. There was no significant difference in ASD symptomatology or ASD risk based on BF duration.

Characterization of exosomal microRNAs in preterm infants fed with breast milk and infant formula

Breastfeeding not only reduces infection-related morbidity, but also increases growth of preterm infants. Advantages of breast milk (BM) for preterm infants are significant. They continue to be studied. However, because not all preterm infants can receive breastfeeding, bovine-based infant formula (IF) is used as an alternative, which may increase the risk of several preterm complications. Exosomes isolated from biofluids are emerging as biomarkers in research of various diseases. Here, we characterized miRNA contents of exosomes in urine and serum samples of preterm infants who were BM and IF fed and performed transcriptomic analysis of small RNA libraries. We identified significantly up-regulated 6 miRNAs and 10 miRNAs, respectively. Gene Ontology (GO) analysis revealed that target genes of these miRNAs might participate in neuronal development, immunity modulation, detoxification of reactive oxygen species, and transmembrane exchange. Our data suggest that exosome-based systemic screening for preterm infants with breastfeeding might be a screening tool for identifying target molecules involved in therapy for preterm infants in neonatal intensive care unit (NICU) and for future application as nutraceutical formulations or pharmaceuticals.

Exclusive Breastfeeding Measured by Deuterium-Oxide Turnover Method is Associated with Motor Development in Rural Senegalese Infants

BACKGROUND

The findings on the relationship between breastfeeding and children's motor development are very poor, particularly in low and middle income countries, because of the use of inadequate measures of breastfeeding practices.

OBJECTIVES

To assess the relationship between exclusive breastfeeding, measured by the deuterium-oxide turnover method (DTM), and the acquisition of motor development in a cohort of Senegalese children.

METHODS

One hundred forty mother-infant (4-5 mo) pairs were recruited and monitored up to 18 mo. Breast milk intake and breastfeeding practices were measured by DTM. Six stages of motor development were assessed: "sitting without support," "hands-and-knees crawling," "standing with assistance," "walking with assistance," "standing alone," and "walking alone." Acquisition age of motor milestones between exclusively breastfed (EBF) and not exclusively breastfed (non-EBF) infants was compared using Student's and Wilcoxon's tests. Mixed linear regression, adjusted with confounding factors, was used to determine the association between EBF and motor development.

RESULTS

Overall, 32.9% of infants were EBF at the enrollment at 4-5 mo of age. Breast milk intake of EBF infants was significantly higher than that of non-EBF infants (1039 ± 193 g/d compared with 915 ± 211 g/d; P < 0.01). At 4-5 mo of age, only "sitting without support" (67.4% compared with 47.9%, P = 0.02) and "hands-and-knees crawling" (17.4% compared with 4.3%, P = 0.01) were completed significantly in the EBF group. At 18 mo, all children had completed all 6 motor developmental milestones. However, their acquisition age was significantly earlier in the EBF group after adjustment. Non-EBF infants had a delay of 0.4 to 0.5 mo on the acquisition of the first 5 stages compared to EBF infants. For "walking alone," no difference was found after adjustment.

CONCLUSIONS

Motor skill acquisition is earlier in EBF infants compared to non-EBF infants. This finding highlights the need to strengthen the advocacy for EBF up to 6 mo.

Breastfeeding is not a risk factor for clinical severity in Autism spectrum disorder in children from the ELENA cohort

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that results from a complex interaction between genes and environment. Breastfeeding (BF) is thought to promote healthy cognitive development, and a body of research has suggested that it may also protect against ASD. Our objectives were to identify the relationship between the initiation and duration of BF and the severity of clinical presentation in ASD. Data were collected from 243 children with a confirmed diagnosis of ASD followed in the ELENA cohort. Clinical severity was measured according to multiple dimensions using standardised tools. The frequency of the initiation of BF was comparable to that of the general population and the rate of children still being breastfed at six months of age was higher. Our results did not indicate a contribution of initiation or duration of BF to the prevention of clinical severity of ASD. We discuss our results in the light of possible methodological limitations of previous reports of an association between BF and ASD.Clinical Trial Registration: NCT02625116.

Human milk: From complex tailored nutrition to bioactive impact on child cognition and behavior

Human milk is a highly complex liquid food tailor-made to match an infant's needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed 'Lactocrine Programming'. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions.

Breastfeeding in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Italian Observational Study

Objective: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a condition defined by sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioral, or neurological symptoms. Its pathogenesis is unknown but it seems triggered by infections, metabolic disturbances, and other inflammatory reactions. PANS represents a neurodevelopmental problem and infant feeding can play a role. Breast milk is the ideal food for infants and influences children's brain, cognitive, and socio-emotional development. Methods: We enrolled 52 children diagnosed with PANS. We interviewed their parents in order to investigate perinatal history, infant feeding, neurologic development, and confounding factors like socio-economic status and region of origin. We subgrouped PANS patients into three subsets: those who only received human milk (HMO), those who only received infant formula, and those who received mixed feeding. Results: The cohort is composed of 78.9% males, with a median age of 11 years (range 7-17). We found some neurodevelopmental problems (13.5%): walking disorders, ASD, ADHD, oppositional attitude, and delayed psychomotor development. We found scholar performance deficits (25%), including language problems like dysgraphia, dyslexia, and dyscalculia. The achievement of some milestones in the development of the infant is affected in 73.1% of cases. Breastfeeding is not homogeneously practiced in Italy because of social, economic, and cultural phenomena. The richest and the poorest families (100%) in the sample choose breastfeeding, probably with a different approach and for different reasons (awareness or need). In the group of PANS patients fed with HMO, compared to the rest of the patients, we registered fewer cases of growth problems (0 vs. 12.9%; p = 0.14), school performance problems or the need for school support (19.1% vs. 29%; p = 0.42), and a delay in the age of babbling/speaking (range 4-20 vs. 7-36 months; p = 0.066). Conclusion: This is the first study that investigates the role of breastfeeding in the development of PANS. Promoting breastfeeding is important in the general population and also in PANS patients because it has an important social and global health impact, also during adult life. Further studies with a bigger population are needed to investigate the mechanisms underlying PANS and the role that breastfeeding may play in their short- and long-term neurodevelopment.

Gestational weight gain and offspring's cognitive skills: a systematic review and meta-analysis

BACKGROUND

Gestational weight gain has been associated with some adverse perinatal outcomes, but few studies have examined the association between gestational weight gain and offspring's cognition and their conclusions are inconsistent. Our systematic review and meta-analysis aimed to synthesize the evidence regarding the association between gestational weight gain and offspring's cognitive skills.

METHODS

In this systematic review and meta-analysis (PROSPERO number, CRD42017073266), we systematically searched MEDLINE, EMBASE, Web of Science and the Cochrane Library for studies examining association between gestational weight gain and offspring's cognitive skills, without restriction in study design or language. Two reviewers extracted in an independent way the data. The Quality of Reporting of Observational Longitudinal Research scale was used to assess the quality of included studies. Effect size (ES) for adjusted models and their corresponding 95% confidence intervals were calculated for (i) intelligence quotient, (ii) language related skills and (iii) mathematic related skills comparing offspring's cognitive skills when gestational weight gain was within recommendations (as reference) with those from mothers whose gestational weight gain was above or below the recommendations.

RESULTS

Thirteen studies were included. There was a positive trend that associated gestational weight gain above recommendations with better offspring's intelligence quotient, although not statistically significant (ES 0.02, 95% CI -0.00, 0.05; I² = 0.00%).

CONCLUSIONS

There is a not significant positive association between gestational weight gain above recommendations and intelligence quotient and some studies reported associations between gestational weight gain and offspring's cognitive skills. Our analyses confirm a wide variability in the results of studies published so far and highlights the need for conducting studies including specific samples of pregnant women by pre-pregnancy body mass index and trimester of pregnancy.

The Protective Effect of Breastfeeding on Febrile Seizures: A Case-Control Study

Objective: Our study was performed to analyze the interrelationship between breastfeeding for the first 6 months of life and the incidence of febrile seizures (FS). Study Design: A case-control study was conducted in Renmin Hospital of Wuhan University. Three hundred thirty-six patients diagnosed with FS were enrolled as the case group, and 336 febrile children with matched age and gender were enrolled as the control group. Clinical information of all cases was collected from the Electronic Medical Record, including feeding patterns. The primary outcome was the difference of feeding modes between cases and controls, while the secondary outcome included the difference of feeding patterns between simple FS (SFS) and complex FS (CFS). Results: The 336 patients with FS comprised 294 with SFS and 42 with CFS. The difference in feeding methods between the case group and the control group was statistically significant, and children who were breastfed exclusively had a lower risk of suffering from FS compared with formula feeding (odds ratio [OR], 0.504 and 95% confidence interval [CI], 0.303-0.841); although partial breastfeeding exhibited a slight protective effect against FS, the protective role was not statistically significant (OR, 1.016 and 95% CI, 0.560-1.846). In addition, our dates showed that feeding mode was not a risk factor in the occurrence of SFS or CFS (p > 0.05). Conclusion: Our data confirm that exclusive breastfeeding is an independent protective factor that can reduce the occurrence of FS.

The Possible Effects of Breastfeeding on Infant Development at 3 Months: A Case-Control Study

Objective: To examine the influence of exclusive breastfeeding on infant development among 3-month-old infants in a Chinese population. Methods: Mothers and their 3-month-old infants were recruited from four maternal and child health hospitals from April 2018 to March 2019. Based on the infants' feeding patterns, the mother-infant dyads were divided into two groups: exclusive breastfeeding and formula feeding groups. Infant development was evaluated using the Chinese version of the Ages and Stages Questionnaires, 3rd edition (ASQ-C), and maternal depression, parenting confidence, and infant temperament were also assessed using the relevant scales/questionnaires. Multivariate logistic regression analysis was conducted to explore the effects of feeding patterns on infant development at 3 months. Results: The data from 417 mother-infant dyads were analyzed. For the breastfeeding group and formula feeding group, the risk of developmental delay measured by the ASQ-C was 4.1% (10/244) and 9.3% (16/173) respectively for the communication domain; 5.7% (14/244) and 8.1% (14/173) for problem-solving domain and 6.2% (15/244) and 12.1% (21/173) for personal-social domain, respectively. Compared with exclusive breastfeeding, formula feeding was a risk factor for delayed development of communication (adjusted odd ratio [aOR] = 2.60, 95% confidence interval [CI] = 1.42-4.75) problem-solving (aOR = 1.91, 95% CI = 1.06-3.45), and personal-social skills (aOR = 1.96, 95% CI = 1.12-3.42). Conclusions: Exclusive breastfeeding is important for infant communication, problem solving, and social interaction at the age of 3 months. Formula-fed infants may be at a higher risk of developmental delay than exclusively breast-fed infants. It is necessary to encourage mothers to establish and continuous breastfeeding.

Association of breastfeeding status with risk of autism spectrum disorder: A systematic review, dose-response analysis and meta-analysis

Current evidence indicates that nutritional status in newborns, especially the duration of breastfeeding, plays a key role in the pathogenesis of autism spectrum disorder. We aimed to systematically review and meta-analyze relevant studies with findings of an association between autism spectrum disorder and breastfeeding patterns, and undertook an extensive dose-response analysis to interpret the results more accurately. Ten electronic databases and manual search of reference lists were used to identify relevant studies in September 2018. Dose-response and conventional meta-analysis were conducted by the random-effects model. The study protocol was registered in PROSPERO with CRD42016043128. Seven case-control studies were found in which the association between ever breastfeeding and risk of autism spectrum disorder was investigated. We found a 58 % decrease in the risk of autism spectrum disorder with ever breastfeeding and a 76 % decrease in the risk with exclusive breastfeeding. According to our dose-response meta-analysis, breastfeeding for 6 months was associated with a 54 % reduction in the risk. In the conventional meta-analysis, breastfeeding for 12-24 months was associated with the most significant reduction in the risk of autism spectrum disorder. Our results highlight the importance of breastfeeding to decrease the risk of autism spectrum disorder.

Breastfeeding and risk of febrile seizures in infants: The Japan Environment and Children's Study

OBJECTIVE

Our study was conducted to examine the association between breastfeeding and febrile seizures (FS) in the first year of life.

METHODS

We used data from a birth cohort study, the Japan Environment and Children's Study (JECS). In a self-administered questionnaire, we asked participants the duration of breastfeeding and whether their children were diagnosed as having FS during their first 12 months. We estimated the association of duration and exclusiveness of breastfeeding with the FS by using multiple logistic regression analysis.

RESULTS

Of 84,082 children, 995 (1.2%) were diagnosed as having FS by the age of 12 months. The prevalence of FS was higher in children who were breastfed for shorter duration. Multiple logistic regression analysis showed that, compared with children breastfed for less than 1 month, those breastfed for 4-6 months and 7-12 months had lower risks of FS (adjusted odds ratio [aOR], 0.65 [95% confidence interval {CI}, 0.42-0.99]; aOR, 0.66 [95% CI: 0.45-0.96], respectively). Moreover, compared with infants who received both breast milk and formula milk for 6 months, infants who were breastfed exclusively for 6 months had lower risk of FS (aOR: 0.78 [95% CI: 0.64-0.95]).

CONCLUSIONS

Our results suggest that breastfeeding has a protective effect against FS in the first year of life.

Postpartum depression: A multi-disciplinary approach to screening, management and breastfeeding support

Postpartum depression (PPD) is a common condition affecting 11%-20% of all postpartum women. Depression can have significant consequences for both mother and infant. There are many risk factors associated with PPD, all of which contribute to an inflammatory response in the mother. An inverse relationship exists between PPD and breastfeeding; women with PPD are less likely to have a positive breastfeeding experience which can lead to early weaning, while long-term exclusive breastfeeding is associated with decreased rates of PPD. A multi-disciplinary approach to managing PPD, including strong breastfeeding support, will lead to improved mental health outcomes for women and their children.

The Long-Term Effects of Dietary Nutrient Intakes during the First 2 Years of Life in Healthy Infants from Developed Countries: An Umbrella Review

The role of both qualitative and quantitative early nutrient intakes on later health has been suggested for decades and supported by observational studies on humans, mainly preterm and low-birth-weight infants, and animal models. However, to date, no comprehensive review has been conducted to evaluate the full impact of nutritional variables on healthy full-term infants. This umbrella review considers meta-analyses and systematic reviews on the health effects of different nutritional exposures or interventions in the first 2 y of life of healthy full-term infants in developed countries. The systematic reviews and meta-analyses published by March 2018 in MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were included. The following outcomes were considered: growth and obesity, cardiovascular disease, neurodevelopment, allergy and autoimmunity, infections, and malignancy. Breastfeeding and complementary feeding were considered separately and analyzed by means of their differences in delivering heterogeneous food-related variables. The resulting data on the long-term effect of early nutritional differences in healthy full-term infants were found to be inconclusive. Only breastfeeding has a beneficial effect, which is nevertheless slight and limited to just a few outcome measures, whereas the type and duration required to be effective are still unclear. As regards the complementary feeding period, no clear effects of different dietary interventions emerge in terms of health outcomes. Available evidence on the health effects of differences in early nutrition in healthy full-term infants still remains largely inconclusive.

The relationship between exclusive breastfeeding and infant development: A 6- and 12-month follow-up study

BACKGROUND

Breastfeeding offers several advantages for infants with research suggesting that it benefits development, including cognitive and language development. However, limited research has examined the benefits in infants under one year.

AIMS

To investigate the association between breastfeeding duration and infant development.

STUDY DESIGN

A longitudinal study conducted over 12 months.

SUBJECTS

Two hundred fifty-five mothers and their infants living in South Korea were seen at three time-points based on infants' age (4, 6, and 12 months).

OUTCOME MEASURES

Breastfeeding data were collected at 4 and 6 months. The Korea-Developmental Screening Test for Infants & Children was administered at 6 and 12 months to measure developmental milestones. We analyzed the relationship between breastfeeding duration in the first 6 months and infant development at 6 and 12 months using logistic regression analysis.

RESULTS

Compared to infants who did not breastfeed at all, infants who were exclusively breastfed until 4 months of age followed by mixed breastfeeding had a better communication and social interaction at 6 months, and better cognition, communication, and social interaction at 12 months. Exclusive breastfeeding until 6 months of age had no apparent impact on the outcomes at 6 and 12 months.

CONCLUSIONS

Exclusive breastfeeding up to 4 months of age followed by mixed breastfeeding might maximize the effects of infant development in their first year after birth. Breastfeeding programs should effectively communicate that exclusive breastfeeding for at least 4 months benefits infant development.

Infant feeding pattern in the first six months of age in USA: a follow-up study

Background

Infant feeding may consist of direct breastfeeding (DBF), pumping and bottle feeding (P&F), formula feeding (FF), solid food feeding (SFF), and any combination. An accurate evaluation of infant feeding requires descriptions of different patterns, consistency, and transition over time.

Methods

In United States of America, the Infant Feeding Practice Study II collected information on the mode of feeding on nine occasions in 12 months. We focused on the first 6 months with six feeding occasions. To determine the longitudinal patterns of feeding the latent class transition analyses was applied and assessed the transition probabilities between these classes over time.

Results

Over 6 months, 1899 mothers provided feeding information. In month 1 the largest latent class is FF (32.9%) followed by DBF (23.8%). In month 2, a substantial proportion of the FF class included SFF; which increases over time. A not allocated class, due to missing information was identified in months 1-3, transitions to SFF starting in month 4 (8.9%). In month 1, two mixed patterns exist: DBF and P&F combined with FF (13.9%) and DBF combined with P&F (18.7%). The triple combination of DBF, P&F, and FF (13.9%) became FF in month 2 (transition probability: 24.8%), and DBF in combination with P&F (transition probability: 49.1%). The pattern of DBF combined with P&F is relatively stable until month 4, when at least 50% of these infants receive solid food. Only 23-26% of the infants receive direct breastfeeding (DBF) in months 1-4, in month 5-6 SFF is added. Mothers who used FF were less educated and employed fulltime. Mothers who smoke and not residing in the west of the United States were also more likely to practice formula feeding.

Conclusion

Infant feeding is complex. Breastfeeding is not predominant and we additionally considered the mixed patterns of feeding. To facilitate direct breastfeeding, a substantial increase in the duration of maternal leave is necessary in the United States.

Association between breastfeeding duration and cognitive development, autistic traits and ADHD symptoms: a multicenter study in Spain

BACKGROUND

Several studies have related longer breastfeeding duration to better intellectual performance in children. By contrast, few studies have investigated the potential protective effects of breastfeeding against behavioral problems such as attention deficit hyperactivity disorder (ADHD) symptoms, and even fewer on autism spectrum disorders (ASD) traits.

METHODS

We examined the association between breastfeeding duration and cognitive development, attention, ADHD symptoms, and autistic traits using data from the INMA Project, a Spanish multicenter birth-cohort study, and taking into account the intensity of breastfeeding. Duration of any, predominant, and exclusive breastfeeding was documented during infancy through maternal questionnaires. Children (N = 1,346; mean age = 4.9 y) were assessed using the McCarthy Scales of Children's Abilities, Conners' Kiddie Continuous Performance Test, criteria of the DSM-ADHD symptoms form list, and the Childhood Autism Spectrum Test.

RESULTS

After adjustment for several confounders, longer duration of breastfeeding was independently associated with better cognitive development and with fewer autistic traits.

CONCLUSION

This study provides further evidence of a positive association of breastfeeding with cognitive function apart from socio-environmental factors, and also suggests a protective role against autistic traits. Results are in agreement with recommendations for prolonged breastfeeding duration to promote child development.

Human milk intake in preterm infants and neurodevelopment at 18 months corrected age

BACKGROUND

The effect of human milk intake on neurodevelopment in preterm infants is uncertain.

METHODS

We analyzed data from 611 participants in the DHA for Improvement of Neurodevelopmental Outcomes study, enrolled at ≤33 wk gestation from five Australian perinatal centers. The main exposures were (i) average daily human milk intake during the neonatal hospitalization and (ii) total duration of human milk intake before and after discharge. Outcomes were Bayley Scales of Infant Development, 2nd Edition Mental (MDI), and Psychomotor (PDI) Development Indexes.

RESULTS

Adjusting for confounders in linear regression, human milk intake was not associated with higher MDI (0.2 points per 25 ml/kg/d; 95% confidence interval (CI): -0.6, 1.0) or PDI (-0.3 points; 95% CI: -1.1, 0.4). Longer duration of human milk intake was also not associated with MDI (0.1 points per month; 95% CI: -0.2, 0.3) or PDI (-0.2 points per month; 95% CI: -0.5, 0.01) scores, except in infants born 29-33 wk gestation (n = 364, MDI 0.3 points higher per additional month, 95% CI: 0.1, 0.6).

CONCLUSIONS

We found no associations of human milk intake during the neonatal hospitalization with neurodevelopment at 18 mo corrected age.

Developmental risk factors in Vietnamese preschool-age children: Cross-sectional survey

BACKGROUND

Early childhood development (ECD) strongly influences children's basic learning, school success, economic participation, social citizenry and health. Although some risk factors related to childhood development are documented, further exploration is necessary considering various sociodemographic, nutritional, and psychosocial factors. This study investigated factors affecting ECD in Vietnamese preschoolers.

METHODS

We used data from the representative, cross-sectional round of the Vietnam Multiple Indicator Clusters Survey 2011. Early Childhood Development Index questionnaires were administered to mothers of all children aged 36-59 months in the household (n = 1459). Descriptive statistics and multivariate logistic regression were used in the analysis.

RESULTS

In Vietnam, 17.2% of children did not reach their full developmental potential within the first 5 years. Children who had been breast-fed (AOR, 2.78; 95%CI: 1.28-6.02), attended preschool (AOR, 1.75; 95%CI: 1.28-2.39), were of major ethnicity (AOR, 2.41; 95%CI: 1.55-3.74), had a mother with secondary or higher education (AOR, 1.69; 95%CI: 1.19-2.38) and had relatives who engaged with them in four or more activities that promote learning (AOR, 1.55; 95%CI: 1.13-2.14) were more likely to have a normal developmental trajectory. Furthermore, children who experienced physical punishment and stunting were 0.69-fold (95%CI: 0.51-0.95) and 0.71-fold (95%CI: 0.51-0.98) less likely to be on track for ECD, respectively.

CONCLUSIONS

The risk factors associated with delayed ECD were low level of maternal education; family ethnicity; lack of preschool attendance; relatives who did not engage with them in learning; physical punishment; not being breast-fed; and stunting.

Breastfeeding and language outcomes: A review of the literature

Many researchers have investigated the potential impact of breastfeeding in infancy on a child's subsequent development, but only a small subset of these studies considers language development and impairment. This paper reviews that literature, discussing postnatal neurodevelopment, potential mechanisms for dietary influences on communication outcomes, studies of typically developing children, and studies of children with communication concerns. For population based studies of language development, a modest but statistically robust relationship is seen across large samples that account for breastfeeding exclusivity. A similar protective relationship is seen in studies that evaluate the relationship between breastfeeding and language disorders; effect sizes are typically larger in these papers. Implications for researchers and service providers are reviewed.

LEARNING OUTCOMES

Readers will be able to describe possible mechanisms by which early diet might influence neurodevelopment. They will be able to describe the relationships observed between diet in infancy and language outcomes in large population-based studies, as well as the trends observed in studies of the relationship between infant diet and communication impairment.

The Relationship between Nutrition in Infancy and Cognitive Performance during Adolescence

OBJECTIVES

In this study, we aimed to investigate the long-term associations between breastfeeding duration during infancy, diet quality as measured by a diet score at 1 year of age, and cognitive performance during adolescence.

METHODS

Participants (n = 717) were recruited from the West Australian Pregnancy Cohort (Raine) Study, a prospective longitudinal study of 2868 children and their families based in Perth, WA, Australia. Breastfeeding duration and an early diet score at age 1 year were used as the main predictor variables, while a computerized cognitive battery (CogState) was used to assess adolescents' cognitive performance at 17 years. The diet score, which has seven food group components, was based on a 24-h recall questionnaire completed by the mother at 1 year of age. A higher diet score represents a better, more nutritious eating pattern. Associations between breastfeeding duration, diet score, and cognitive performance were assessed in multivariable regression models.

RESULTS

Higher diet scores at 1 year representing better diet quality were significantly associated with faster reaction times in cognitive performance at 17 years [Detection Task (DET): β = -0.004, 95% CI: -0.008; 0.000, p = 0.036; Identification Task (IDN): β = -0.004, 95% CI: -0.008; 0.000, p = 0.027]. Breastfeeding duration (≥4 months) was also significantly associated with a shorter reaction time, but only for males (DET: β = -0.026, 95% CI: -0.046; -0.006, p = 0.010).

CONCLUSION

Nutrition in early childhood may have a long-term association with fundamental cognitive processing speed, which is likely to be related to enhanced brain development in the first year of life.

Infant feeding effects on early neurocognitive development in Asian children

BACKGROUND

Breastfeeding has been shown to enhance global measures of intelligence in children. However, few studies have examined associations between breastfeeding and specific cognitive task performance in the first 2 y of life, particularly in an Asian population.

OBJECTIVE

We assessed associations between early infant feeding and detailed measures of cognitive development in the first 2 y of life in healthy Asian children born at term.

DESIGN

In a prospective cohort study, neurocognitive testing was performed in 408 healthy children (aged 6, 18, and 24 mo) from uncomplicated pregnancies (i.e., birth weight >2500 and <4000 g, gestational age ≥37 wk, and 5-min Apgar score ≥9). Tests included memory (deferred imitation, relational binding, habituation) and attention tasks (visual expectation, auditory oddball) as well as the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Children were stratified into 3 groups (low, intermediate, and high) on the basis of breastfeeding duration and exclusivity.

RESULTS

After potential confounding variables were controlled for, significant associations and dose-response relations were observed for 4 of the 15 tests. Higher breastfeeding exposure was associated with better memory at 6 mo, demonstrated by greater preferential looking toward correctly matched items during early portions of a relational memory task (i.e., relational binding task: P-trend = 0.015 and 0.050 for the first two 1000-ms time bins, respectively). No effects of breastfeeding were observed at 18 mo. At 24 mo, breastfed children were more likely to display sequential memory during a deferred imitation memory task (P-trend = 0.048), and toddlers with more exposure to breastfeeding scored higher in receptive language [+0.93 (0.23, 1.63) and +1.08 (0.10, 2.07) for intermediate- and high-breastfeeding groups, respectively, compared with the low-breastfeeding group], as well as expressive language [+0.58 (-0.06, 1.23) and +1.22 (0.32, 2.12) for intermediate- and high-breastfeeding groups, respectively] assessed via the BSID-III.

CONCLUSIONS

Our findings suggest small but significant benefits of breastfeeding for some aspects of memory and language development in the first 2 y of life, with significant improvements in only 4 of 15 indicators. Whether the implicated processes confer developmental advantages is unknown and represents an important area for future research. This trial was registered at www.clinicaltrials.gov as NCT01174875.

Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials

Interest in the value of omega-3 (n-3) fatty acid supplementation for treatment of ADHD remains high. No prior meta-analysis has examined whether ADHD is associated with alterations in blood lipid levels and meta-analyses of supplementation have reached conflicting conclusions.

METHODS

We report two new meta-analyses. Study 1 examined blood levels of omega-3 fatty acids in relation to ADHD. Study 2 examined a larger sample of randomized intervention trials than previously reported.

RESULTS

Study 1 included 9 studies (n=586) and found lower overall blood levels of n-3 in individuals with ADHD versus controls (g=0.42, 95% CI=0.26-0.59; p<.001). Study 2 included 16 studies (n=1408) and found that n-3 supplementation improved ADHD composite symptoms; using the best available rating and reporter (g=0.26, 95% CI=0.15-0.37; p<.001). Supplementation showed reliable effects on hyperactivity by parent and teacher report, but reliable effects for inattention only by parent report.

CONCLUSIONS

Omega-3 levels are reduced in children with ADHD. Dietary supplementation appears to create modest improvements in symptoms. There is sufficient evidence to consider omega-3 fatty acids as a possible supplement to established therapies. However it remains unclear whether such intervention should be confined to children with below normal blood levels.

A cohort study on full breastfeeding and child neuropsychological development: the role of maternal social, psychological, and nutritional factors

AIM

This study investigated whether duration of full breastfeeding is associated with child neuropsychological development and whether this association is explained by social, psychological, and nutritional factors within families.

METHOD

Participants in this study were a population-based birth cohort in the city of Sabadell (Catalonia, Spain). Females were recruited during the first trimester of pregnancy between July 2004 and July 2006. Information about parental characteristics and breastfeeding was obtained through questionnaires. Full breastfeeding was categorized as never, short term (≤4mo), long term (4-6mo), or very long term (>6mo). A trained psychologist assessed the neuropsychological development of children at 4 years of age (n=434) using the McCarthy Scales of Children's Abilities (MSCA).

RESULTS

Full breastfeeding showed an independent association with child general MSCA scores after adjusting for a range of social, psychological, and nutritional factors (>6mo, coefficient=7.4 [95% confidence interval=2.8-12.0], p=0.011). Maternal social class, education level, and IQ were also associated with child neuropsychological scores, but did not explain breastfeeding associations. Omega-3 (n3) fatty acid levels were not associated with child neuropsychological scores.

INTERPRETATION

Very long-term full breastfeeding was independently associated with neuropsychological functions of children at 4 years of age. Maternal indicators of intelligence, psychopathology, and colostrum n3 fatty acids did not explain this association.

Breastfeeding duration and cognitive, language and motor development at 18 months of age: Rhea mother-child cohort in Crete, Greece

BACKGROUND

Breast feeding duration has been associated with improved cognitive development in children. However, few population-based prospective studies have evaluated dose-response relationships of breastfeeding duration with language and motor development at early ages, and results are discrepant.

METHODS

The study uses data from the prospective mother-child cohort ('Rhea' study) in Crete, Greece. 540 mother-child pairs were included in the present analysis. Information about parental and child characteristics and breastfeeding practices was obtained by interview-administered questionnaires. Trained psychologists assessed cognitive, language and motor development by using the Bayley Scales of Infant Toddler Development (3rd edition) at the age of 18 months.

RESULTS

Duration of breast feeding was linearly positively associated with all the Bayley scales, except of gross motor. The association persisted after adjustment for potential confounders with an increase of 0.28 points in the scale of cognitive development (β=0.28; 95% CI 0.01 to 0.55), 0.29 points in the scale of receptive communication (β=0.29; 95% CI 0.04 to 0.54), 0.30 points in the scale of expressive communication (β=0.30; 95% CI 0.04 to 0.57) and 0.29 points in the scale of fine motor development (β=0.29; 95% CI 0.02 to 0.56) per accumulated month of breast feeding. Children who were breast fed longer than 6 months had a 4.44-point increase in the scale of fine motor development (β=4.44; 95% CI 0.06 to 8.82) compared with those never breast fed.

CONCLUSIONS

Longer duration of breast feeding was associated with increased scores in cognitive, language and motor development at 18 months of age, independently from a wide range of parental and infant characteristics. Additional longitudinal studies and trials are needed to confirm these results.

Does docosahexaenoic acid supplementation in term infants enhance neurocognitive functioning in infancy?

The proposal that dietary docosahexaenoic acid (DHA) enhances neurocognitive functioning in term infants is controversial. Theoretical evidence, laboratory research and human epidemiological studies have convincingly demonstrated that DHA deficiency can negatively impact neurocognitive development. However, the results from randomized controlled trials (RCTs) of DHA supplementation in human term-born infants have been inconsistent. This article will (i) discuss the role of DHA in the human diet, (ii) explore the physiological mechanisms by which DHA plausibly influences neurocognitive capacity, and (iii) seek to characterize the optimal intake of DHA during infancy for neurocognitive functioning, based on existing research that has been undertaken in developed countries (specifically, within Australia). The major observational studies and RCTs that have examined dietary DHA in human infants and animals are presented, and we consider suggestions that DHA requirements vary across individuals according to genetic profile. It is important that the current evidence concerning DHA supplementation is carefully evaluated so that appropriate recommendations can be made and future directions of research can be strategically planned.

WIC participation and breastfeeding in South Carolina: updates from PRAMS 2009-2010

Few studies examined breastfeeding initiation and duration among mothers who were eligible for the Women Infants Children (WIC) program and did not participate. This study is sought to understand the role of WIC participation and poverty level in breastfeeding initiation and duration in South Carolina. The data came from the 2009-2010 South Carolina Pregnancy Risk Assessment Monitoring System (unweighted N = 1,796). All participants were classified as WIC participants, income-eligible non-WIC participants, and income-ineligible non-WIC participants. Logistic regression models were used to analyze the association between breastfeeding initiation and WIC participation. The Kaplan-Meier method and Cox proportional hazards models were used to determine whether the continuation of breastfeeding and hazards of discontinuing breastfeeding differed by WIC participation groups. In South Carolina, two out of three women (67.2%) initiated breastfeeding. The breastfeeding initiation rate was higher among income-ineligible (84.0%) and income-eligible (78.9%) non-WIC participants than among WIC participants (55.5%). Compared to WIC participants, both income-ineligible [odds ratio (OR) = 2.1, 95% confidence interval (CI) 1.2-4.0] and income-eligible (OR = 2.6, 95% CI 1.1-4.3) non-WIC participants were more likely to initiate breastfeeding. Among mothers who already initiated breastfeeding, after adjusting covariates, the hazard ratios for weaning within 34 weeks postpartum were not significantly different by WIC participation groups. This study confirmed WIC participants were less likely to initiate breastfeeding. Once initiated, WIC participation did not significantly impact breastfeeding duration in the early postpartum period. Poverty status may not play an important role in explaining disparities in breastfeeding initiation between WIC and non-WIC participants.

Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity

IMPORTANCE

Breastfeeding may benefit child cognitive development, but few studies have quantified breastfeeding duration or exclusivity, nor has any study to date examined the role of maternal diet during lactation on child cognition.

OBJECTIVES

To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years and to evaluate the extent to which maternal fish intake during lactation modifies associations of infant feeding with later cognition.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study (Project Viva), a US prebirth cohort that enrolled mothers from April 22, 1999, to July 31, 2002, and followed up children to age 7 years, including 1312 Project Viva mothers and children.

MAIN EXPOSURE

Duration of any breastfeeding to age 12 months.

MAIN OUTCOMES AND MEASURES

Child receptive language assessed with the Peabody Picture Vocabulary Test at age 3 years, Wide Range Assessment of Visual Motor Abilities at ages 3 and 7 years, and Kaufman Brief Intelligence Test and Wide Range Assessment of Memory and Learning at age 7 years.

RESULTS

Adjusting for sociodemographics, maternal intelligence, and home environment in linear regression, longer breastfeeding duration was associated with higher Peabody Picture Vocabulary Test score at age 3 years (0.21; 95% CI, 0.03-0.38 points per month breastfed) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years (0.35; 0.16-0.53 verbal points per month breastfed; and 0.29; 0.05-0.54 nonverbal points per month breastfed). Breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores. Beneficial effects of breastfeeding on the Wide Range Assessment of Visual Motor Abilities at age 3 years seemed greater for women who consumed 2 or more servings of fish per week (0.24; 0.00-0.47 points per month breastfed) compared with less than 2 servings of fish per week (−0.01; −0.22 to 0.20 points per month breastfed) (P = .16 for interaction).

CONCLUSIONS AND RELEVANCE

Our results support a causal relationship of breastfeeding duration with receptive language and verbal and nonverbal intelligence later in life.

Neuroimaging, a new tool for investigating the effects of early diet on cognitive and brain development

Nutrition is crucial to the initial development of the central nervous system (CNS), and then to its maintenance, because both depend on dietary intake to supply the elements required to develop and fuel the system. Diet in early life is often seen in the context of "programming" where a stimulus occurring during a vulnerable period can have long-lasting or even lifetime effects on some aspect of the organism's structure or function. Nutrition was first shown to be a programming stimulus for growth, and then for cognitive behavior, in animal studies that were able to employ methods that allowed the demonstration of neural effects of early nutrition. Such research raised the question of whether nutrition could also programme cognition/brain structure in humans. Initial studies of cognitive effects were observational, usually conducted in developing countries where the presence of confounding factors made it difficult to interpret the role of nutrition in the cognitive deficits that were seen. Attributing causality to nutrition required randomized controlled trials (RCTs) and these, often in developed countries, started to appear around 30 years ago. Most demonstrated convincingly that early nutrition could affect subsequent cognition. Until the advent of neuroimaging techniques that allowed in vivo examination of the brain, however, we could determine very little about the neural effects of early diet in humans. The combination of well-designed trials with neuroimaging tools means that we are now able to pose and answer questions that would have seemed impossible only recently. This review discusses various neuroimaging methods that are suitable for use in nutrition studies, while pointing out some of the limitations that they may have. The existing literature is small, but examples of studies that have used these methods are presented. Finally, some considerations that have arisen from previous studies, as well as suggestions for future research, are discussed.

The role of nutrition in children's neurocognitive development, from pregnancy through childhood

This review examines the current evidence for a possible connection between nutritional intake (including micronutrients and whole diet) and neurocognitive development in childhood. Earlier studies which have investigated the association between nutrition and cognitive development have focused on individual micronutrients, including omega-3 fatty acids, vitamin B12, folic acid, choline, iron, iodine, and zinc, and single aspects of diet. The research evidence from observational studies suggests that micronutrients may play an important role in the cognitive development of children. However, the results of intervention trials utilizing single micronutrients are inconclusive. More generally, there is evidence that malnutrition can impair cognitive development, whilst breastfeeding appears to be beneficial for cognition. Eating breakfast is also beneficial for cognition. In contrast, there is currently inconclusive evidence regarding the association between obesity and cognition. Since individuals consume combinations of foods, more recently researchers have become interested in the cognitive impact of diet as a composite measure. Only a few studies to date have investigated the associations between dietary patterns and cognitive development. In future research, more well designed intervention trials are needed, with special consideration given to the interactive effects of nutrients.

Global trends in exclusive breastfeeding

Background

Infant and young child feeding is critical for child health and survival. Proportion of infants 0–5 months who are fed exclusively with breast milk is a common indicator used for monitoring and evaluating infant and young child feeding in a given country and region. Despite progress made since 1990, a previous review in 2006 of global and regional trends found improvement to be modest. The current study provides an update in global and regional trends in exclusive breastfeeding from 1995 to 2010, taking advantage of the wealth of data from recent household surveys.

Methods

Using the global database of infant and young child feeding maintained by the United Nations Children’s Fund, the authors examined estimates from 440 household surveys in 140 countries over the period between 1995 and 2010 and calculated global and regional averages of the rate of exclusive breastfeeding among infants 0–5 months for the two time points to assess the trends.

Results

Trend data suggest the prevalence of exclusive breastfeeding among infants younger than six months in developing countries increased from 33% in 1995 to 39% in 2010. The prevalence increased in almost all regions in the developing world, with the biggest improvement seen in West and Central Africa.

Conclusions

In spite of the well-recognized importance of exclusive breastfeeding, the practice is not widespread in the developing world and increase on the global level is still very modest with much room for improvement. Child nutrition programmes worldwide continue to require investments and commitments to improve infant feeding practices in order to have maximum impact on children’s lives.

Role of breastfeeding in childhood cognitive development: a propensity score matching analysis

AIM

To examine whether the association between breastfeeding and childhood cognitive development is direct or whether the association is spurious owing to confounding variables.

METHOD

The current study conducted a propensity score matching (PSM) analysis using data from the Early Childhood Longitudinal Study, Birth Cohort.

RESULTS

  The results of PSM models revealed that prior to matching, the association between breastfeeding and cognitive functioning was significant (mean difference = 3.20, t-value = 7.86, 95% confidence interval (CI) = 2.40-4.00, P ≤ 0.05). After controlling for a range of confounding factors, the mean difference was reduced by 40% (mean difference = 1.92, t-value = 3.75, 95% CI = 0.92-2.93, P ≤ 0.05); however, significant differences remained between groups.

CONCLUSION

The results produced in the current study provide tentative evidence that breastfeeding may have an influence on the development of cognitive abilities in children. Additional research is necessary, however, in order to further evaluate the causal impact and exact developmental pathway of breastfeeding on childhood cognitive growth.

Breastfeeding and the child cognitive outcomes: a propensity score matching approach

To estimate the effect of breastfeeding initiation and duration on child development outcomes. 3,271 children and their mothers participating in the Child Development Supplement of the Panel Study of Income Dynamics provide data for these analyses. Main outcomes include Woodcock Johnson Psycho-Educational Battery-Revised (WJ-R) test score (letter word, passage comprehension, applied problem, and broad reading), and Wechsler Intelligence Scale for Children-Revised (WISC-R) test score at the 2002 survey. Controlled variables include family, maternal, and child characteristics, many of which can be traced back to the year the child was born. The analytic technique is propensity score matching with multiple imputations. After using propensity scores to adjust for confounding factors, breastfeeding initiation showed statistically significant effects but the practical scale remains small. Breastfeeding duration showed a non-linear effect on those outcomes and most of the effects are not significant. The effects of breastfeeding on child's cognitive outcomes are modest in practical terms. The non-linear effects suggest that selection into breastfeeding may account for the increased score of children who are breastfed.

Effects of diet on early stage cortical perception and discrimination of syllables differing in voice-onset time: a longitudinal ERP study in 3 and 6 month old infants

The influence of diet on cortical processing of syllables was examined at 3 and 6 months in 239 infants who were breastfed or fed milk or soy-based formula. Event-related potentials to syllables differing in voice-onset-time were recorded from placements overlying brain areas specialized for language processing. P1 component amplitude and latency measures indicated that at both ages infants in all groups could extract and discriminate categorical information from syllables. Between-syllable amplitude differences-present across groups-were generally greater for SF infants. Responses peaked earlier over left hemisphere speech-perception than speech-production areas. Encoding was faster in BF than formula-fed infants. The results show that in preverbal infants: (1) discrimination of phonetic information occurs in early stages of cortical processing; (2) areas overlying brain regions of speech perception are activated earlier than those involved in speech production; and (3) these processes are differentially modulated by infant diet and environmental factors.

Breastfeeding, long-chain polyunsaturated fatty acids in colostrum, and infant mental development

BACKGROUND

Breastfeeding has been associated with improved neurodevelopment in children. However, it remains unknown to what extent nutritional advantages of breast milk may explain this relationship.

OBJECTIVE

We assessed the role of parental psychosocial factors and colostrum long-chain polyunsaturated fatty acid (LC-PUFA) levels in the relationship between breastfeeding and children's neurodevelopment.

METHODS

A population-based birth cohort was established in the city of Sabadell (Catalonia, Spain) as part of the INMA-INfancia y Medio Ambiente Project. A total of 657 women were recruited during the first trimester of pregnancy. Information about parental characteristics and breastfeeding was obtained by using a questionnaire, and trained psychologists assessed mental and psychomotor development by using the Bayley Scales of Infant Development in 504 children at 14 months of age.

RESULTS

A high percentage of breastfeeds among all milk feeds accumulated during the first 14 months was positively related with child mental development (0.37 points per month of full breastfeeding [95% confidence interval: 0.06-0.67]). Maternal education, social class, and intelligence quotient only partly explained this association. Children with a longer duration of breastfeeding also exposed to higher ratios between n-3 and n-6 PUFAs in colostrum had significantly higher mental scores than children with low breastfeeding duration exposed to low levels.

CONCLUSIONS

Greater levels of accumulated breastfeeding during the first year of life were related to higher mental development at 14 months, largely independently from a wide range of parental psychosocial factors. LC-PUFA levels seem to play a beneficial role in children's mental development when breastfeeding levels are high.

Breastfeeding and early child development: a prospective cohort study

AIM

Breastfeeding has been associated with multiple developmental advantages for the infant; however, there have also been a number of studies that find no significant benefits to child development. We examined the relationship between breastfeeding for 4 months or longer and child development at age 1, 2 and 3 years.

METHODS

Women were enrolled in the Western Australian Pregnancy Cohort (Raine) Study (N = 2900) and their live born children (N = 2868) were followed to the age of 3 years (N = 2280). Infant feeding data were collected at each age, and the mothers completed the Infant/Child Monitoring Questionnaire (IMQ), which measures progress towards developmental milestones in the domains of gross and fine motor skills, adaptability, sociability and communication. Factors adjusted for in multivariable analyses included maternal sociodemographic characteristics and stressful life events.

RESULTS

Infants breastfed for 4 months or longer had significantly higher mean scores (representing better functioning) for fine motor skills at age 1 and 3, significantly higher adaptability scores up to age two, and higher communication scores at age 1 and 3 years. Infants who were breastfed for <4 months were more likely to have at least one atypical score across the five developmental domains than those who were breastfed for 4 months or longer.

CONCLUSION

Although our effect sizes were small, breastfeeding for 4 months or longer was associated with improved developmental outcomes for children aged one to 3 years after adjustment for multiple confounding factors.

Cortical responses to speech sounds in 3- and 6-month-old infants fed breast milk, milk formula, or soy formula

Controversy exists about the safety of soy formula, with the main concern relating to potential estrogenic effects of soy protein. Since estrogens influence early brain development, we compared behavioral development and cortical responses (event-related potentials; ERPs) to speech sounds in infants fed either breast milk or formula (milk- or soy-based). Across-groups ERP measures were generally similar and behavioral measures were within normal ranges, suggesting no important influences of soy formula on behavioral development and brain function during the study period. Analyses relating ERP and behavioral measures revealed diet- and gender-specific emphases that may reflect differences in developmental trajectories of brain-behavior relationships.

Body mass index and cognitive ability of young children

OBJECTIVE

This study prospectively assessed the association between body mass index (BMI) and cognitive ability of young children, while accounting for confounding factors.

METHODS

The study included 236 children born between 1990 and 1994 participating in a Dutch birth cohort study. Anthropometric data of the children at birth, 4, and 7 years of age were collected from growth records or measured at the Academic Hospital of Maastricht. The Kaufman Assessment Battery for Children (K-ABC) was used to assess cognitive ability at 7 years of age. The association between BMI and cognitive ability was investigated using univariate and multivariate linear regression analyses, including various covariates.

RESULTS

Although the results suggest that cognitive ability at 7 years of age decreased with increasing BMI at 4 years and 7 years of age, this association was not significant in any performed analysis. Multivariate analyses showed that maternal intelligence was strongly associated with all scales of the K-ABC as a significant covariate. Adjusting analyses for physical fitness of the child, maternal education, maternal pre-pregnancy BMI, maternal smoking during pregnancy, and birth weight did not change the results.

CONCLUSION

This study found no evidence for an association between BMI and cognitive ability of school-aged children.

Long-term health outcomes and mechanisms associated with breastfeeding

Breastfeeding is superior to formula feeding because it has factors that have long term consequences for early metabolism and disease later in life. In this paper, the scientific evidence in support of why breast milk is beneficial for infants is summarized and the mechanisms in which breastfeeding impacts on disease are explored. Human milk may show a reduced occurrence of disease because mammalian evolution promotes survival, and because of specific factors in milk that promote active stimulation of the infant's immune system and gastrointestinal mucosal maturation decrease the incidence of infection and alter the gut microflora. Bioactive factors, including: hormones, growth factors, colony-stimulating factors and specific nutrients, may have such far-reaching effects on the infant's immune response that normal development depends heavily on its provision. All mothers should be encouraged and supported to continue breastfeeding for 6 months and beyond in order to promote the good health of their infants.

Natural history of suspected developmental delay between 12 and 24 months of age in the 2004 Pelotas birth cohort

AIMS

To describe the incidence and persistence of suspected developmental delay (SDD) between 12 and 24 months of age and associated factors in the 2004 Pelotas Birth Cohort.

METHODS

A cohort of 4262 newborns, 3907 of whose were monitored from 12 to 24 months of life. SDD was established by Battelle Screening Developmental Inventory. The adjusted analyses were carried out using Poisson regression. Relative risks and 95% confidence intervals were calculated.

RESULTS

Incidence of SDD between 12 and 24 months of age was 1.8% (95% CI: 1.4-2.3). After the adjusted analyses, the following factors increased the risk of the incidence: Apgar 5'<7, preterm delivery, low socio-economic level, intergestational interval<or=24 months, not having been told stories in the previous 2 weeks, lack of children's books at home and male gender. A total of 390 children were positive in the 12 month (prevalence of 10%; 95% CI: 9.0-10.9). From these children, 58 remained positive up to 2 years of age, with a persistence rate of 15.6% (95% CI: 11.9-19.3). The following were factors for persistence in SDD: Apgar 5'<7, low socio-economic level, intergestational interval<or=24 months, breastfeeding duration<6 months and not having been told stories in the previous 2 weeks.

CONCLUSIONS

Easy access to children's literature and telling stories to children are inexpensive measures that may have an impact on the child's development between 12 and 24 months of life.

Assessing exclusive breastfeeding practices, dietary intakes and body mass index (BMI) of nursing mothers in Ekiti State of Nigeria

Breastfeeding is an unequalled way of providing ideal food for the infants. The benefits of breastfeeding practices to infants and mothers are well documented. However, information on breastfeeding practices and its effect on body mass index (BMI) of mothers are scarce, particularly in Ekiti State of Nigeria. Therefore, the present study is designed to assess breastfeeding practices and its association with BMI of mothers. A descriptive and cross-sectional study was conducted among breastfeeding mothers that attended postnatal clinic of the state specialist hospitals and maternity centers in the study location. The specialist hospital and two-third of the nine maternity centers were purposively selected because of their health facilities and personnel. The mother-child pairs (200 respondents) were randomly selected from the study locations. Information on demographic characteristic, socio-economic parameters, nutritional knowledge of breastfeeding and dietary intakes of mothers were collected using questionnaires. BMI of mothers was determined as described by World Health Organization. Age distribution of mothers was between 25-34 years; and almost half of respondents had good educational background and were engaged in different occupations. The respondent monthly income ranged between = N = 3500 - 26000 ($26.92 - $200); and their dietary intakes varied between starchy and protein-based food. The result also showed that the respondent consumed enough nutrients to meet up the recommended daily allowance for protein, carbohydrate, fat, zinc, magnesium, sodium and phosphorous requirements. The BMI classifications showed that over three-fifth of respondents were normal, while the remaining were underweight (6%) and overweight/obese (26.5%). Also, large proportion of respondents engaged in exclusive breastfeeding and with good knowledge of breastfeeding practices. Statistically, exclusive breastfeeding practices had no correlation between the BMI and frequency of breastfeeding. The study, therefore, concluded that mothers had good knowledge of breastfeeding practice; and that there was no association between breastfeeding practices and BMI.

Infant feeding practice and childhood cognitive performance in South India

AIM

Several studies have suggested a beneficial effect of infant breastfeeding on childhood cognitive function. The main objective was to examine whether duration of breastfeeding and age at introduction of complementary foods are related to cognitive performance in 9- to 10-year-old school-aged children in South India.

METHODS

The authors examined 514 children from the Mysore Parthenon birth cohort for whom breastfeeding duration (six categories from <3 to > or = 18 months) and age at introduction of complementary foods (four categories from <4 to > or = 6 months) were collected at the first-, second- and third-year annual follow-up visits. Their cognitive function was assessed at a mean age of 9.7 years using three core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, visuo-spatial and verbal abilities.

RESULTS

All the children were initially breastfed. The mode for duration of breastfeeding was 12-17 months (45.7%) and for age at introduction of complementary foods 4 months (37.1%). There were no associations between longer duration of breastfeeding, or age of introduction of complementary foods, and cognitive function at 9-10 years, either unadjusted or after adjustment for age, sex, gestation, birth size, maternal age, parity, socio-economic status, parents' attained schooling and rural/urban residence.

CONCLUSIONS

Within this cohort, in which prolonged breastfeeding was the norm (90% breastfed > or = 6 months and 65% breastfed for > or = 12 months), there was no evidence suggesting a beneficial effect of longer duration of breastfeeding on later cognitive ability.

Risk factors for suspected developmental delay at age 2 years in a Brazilian birth cohort

Many children are at risk of not achieving their full potential for development. Epidemiological studies have the advantage of being able to identify a number of associated factors potentially amenable to intervention. Our purpose was to identify risk factors for suspected developmental delay (SDD) at age 2 years among all children born in the city of Pelotas, Brazil, in 2004. This study was part of the 2004 Pelotas Birth Cohort. The Battelle Screening Developmental Inventory (BSDI) was administered to cohort children at age 2 years. A hierarchical model of determination for SDD with confounder adjustment was built including maternal sociodemographic, reproductive and gestational characteristics, as well as child and environmental characteristics. Multivariable analysis was carried out using Poisson regression. Prevalence ratios (PR) and 95% confidence intervals [95% CI] were calculated. In the results, 3.3% of the 3869 children studied screened positive for SDD. After confounder control, children more likely to show SDD were: those with positive BSDI at age 12 months (PR = 5.51 [3.59, 8.47]); with 5-min Apgar <7 (PR = 3.52 [1.70, 7.27]); with mothers who had <4 years of schooling (PR = 3.35 [1.98, 5.66]); from social classes D and E (PR = 3.00 [1.45, 6.19]); with a history of gestational diabetes (PR = 2.77 [1.34, 5.75]); born <24 months after the last sibling (PR = 2.46 [1.42, 4.27]); were not told child stories in the preceding week (PR 2.28 [1.43, 3.63]); did not have children's literature at home (PR = 2.08 [1.27, 3.39]); with low birthweight (PR = 1.75 [1.00, 3.07]); were born preterm (PR = 1.74 [1.07, 2.81]); with <6 antenatal care appointments (PR = 1.70 [1.07, 2.68]); with history of hospitalisation (PR = 1.65 [1.09, 2.50]); and of male sex (PR = 1.43 [1.00, 2.04]). These risk factors may constitute potential targets for intervention by public policies and may provide help to paediatricians in preventing developmental delay.

The long-term effects of breastfeeding on child and adolescent mental health: a pregnancy cohort study followed for 14 years

OBJECTIVES

To determine whether there was an independent effect of breastfeeding on child and adolescent mental health.

STUDY DESIGN

The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women and followed the live births for 14 years. Mental health status was assessed by the Child Behaviour Checklist (CBCL) at 2, 6, 8, 10, and 14 years. Maternal pregnancy, postnatal, and infant factors were tested in multivariable random effects models and generalized estimating equations to examine the effects of breastfeeding duration on mental health morbidity.

RESULTS

Breastfeeding for less than 6 months compared with 6 months or longer was an independent predictor of mental health problems through childhood and into adolescence. This relationship was supported by the random effects models (increase in total CBCL score: 1.45; 95% confidence interval 0.59, 2.30) and generalized estimating equation models (odds ratio for CBCL morbidity: 1.33; 95% confidence interval 1.09, 1.62) showing increased behavioral problems with shorter breastfeeding duration.

CONCLUSION

A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.

The risks and benefits of infant feeding practices for women and their children

Infant feeding decisions affect maternal and child health outcomes, worldwide. Even in settings with clean water and good sanitation, infants who are not breast-fed face an increased risk of infectious, as well as non-infectious morbidity and mortality. The decision not to breast-feed can also adversely affect mothers' health by increasing the risk of pre-menopausal breast cancer, ovarian cancer, type II diabetes, hypertension, hyperlipidemia and cardiovascular disease. Clinicians who counsel mothers about the health impact of infant feeding and provide evidence-based care to maximize successful breast-feeding, can improve the short and long-term health of both mothers and infants.

Individual and job-related variation in infant feeding practices among working mothers

OBJECTIVE

To document working mothers' infant feeding practices and delineate factors that may shape infant feeding.

METHODS

Cross-sectional data were obtained from a community sample of working women with 8-month old infants (n=199).

RESULTS

Nearly all working mothers used commercially prepared foods like infant cereals, fruits, and vegetables. Approximately one-fifth fed infants french fries, sweetened beverages, and sweetened desserts. Unhealthy infant feeding was elevated among unmarried mothers, those with less education, and those with a nonstandard work schedule.

CONCLUSIONS

Working mothers use commercially prepared foods for infant feeding. Socially disadvantaged working mothers' infant feeding may pose health and developmental risks.