Association between breastfeeding and breast cancer risk: evidence from a meta-analysis

Breast cancer mortality among ultra-orthodox and non-ultra-orthodox Israeli women: A retrospective cohort study

Background

Breast cancer is the leading cause of cancer death in Israeli women. Previous studies found socioeconomic status and other risk factors impact breast cancer outcomes. The ultra-orthodox community is characterized by a longer life expectancy, lower rates of mammography performance, higher fertility rates and other sociodemographic variables that may be related to breast cancer mortality. This study examined disparities in breast cancer mortality between ultra-Orthodox and non-ultra-Orthodox Israeli women.

Methods

This retrospective cohort study for breast cancer mortality included the all Jewish Israeli citizens women born between 1940 and 1960 and lived in communities with over 20,000 residents (n = 628,617). Data was collected from various sources, monitoring a period of 31 years; for each participants, their sociodemographic characteristics were compiled from the population registry, the tax authority, the education registry, and the Central Bureau of Statistics (CBS). Variables included religiosity, age, marital status, children, origin, education, and income. Multivariable Cox models evaluated predictors of mortality.

Results

Of the 628,617 women in the study, 29,611 were ultra-Orthodox. Ultra-Orthodox women had higher marriage rates, more children, and lower secular education and income. Mortality was 108.8/100,000 overall, lower among ultra-Orthodox (83.4/100,000) than non-ultra-Orthodox women (110.1/100,000) despite their risk factors. Using a multivariate model to evaluate the association between ultra-Orthodoxy and breast cancer mortality, the study found higher breast cancer mortality rate among non-ultra-Orthodox women compared to ultra-Orthodox women (HR = 1.491; 99% CI = 1.232, 1.804). Associations with sociodemographic variables were different for each group.

Conclusions

Although ultra-Orthodox women have socioeconomic risk factors, breast cancer mortality was lower than non-ultra-Orthodox women. Further research on potential cultural and religious factors influencing mortality is warranted. These findings highlight the importance of evaluating predictors within specific populations.

Skin-to-Skin Contact and Breastfeeding After Planned Cesarean Birth Before and During the COVID-19 Pandemic

Background: Benefits of early skin-to-skin contact (SSC) between mother and newborn are widely documented, including improved breastfeeding outcomes. While promoting immediate SSC is standard practice for vaginal birth, it happens less often after cesarean birth. It is not known how changes in hospital practices and staffing shortages during the COVID-19 pandemic have influenced the practice of SSC in the operating room (OR). This study aims to identify the relationship between SSC after cesarean birth and breastfeeding and compare SSC before and during the COVID-19 pandemic at a single institution. Materials and Methods: This was a retrospective cohort study of 244 subjects who had scheduled cesarean births during 2019 and 2020. The primary outcome was newborn feeding at hospital discharge. Secondary outcomes were time to initiate breastfeeding, newborn feeding at 4-8-weeks postpartum, and location of SSC initiation in 2019 versus 2020. Results: SSC within 3 days of birth was significantly associated with feeding type on discharge and/or 4-8 weeks postpartum. More subjects intending to exclusively breastfeed met this intention at discharge with SSC in the OR. Newborns who had SSC in the OR had significantly earlier initiation of breastfeeding. There was an increase in SSC in the OR between 2019 (27%) and 2020 (39%). Conclusion: SSC in the OR was associated with improved short-term breastfeeding outcomes in our study. If immediate SSC is not possible, SSC within 3 days of birth may have breastfeeding benefits. The increase in SSC in the OR during the COVID-19 pandemic indicates that SSC practices can be implemented, despite challenging circumstances.

Impact of Environmental Exposures on Human Breast Milk Lipidome in Future Immune-Mediated Diseases

The composition of human breast milk (HBM) exhibits significant variability both between individuals and within the same individual. While environmental factors are believed to play a role in this variation, their influence on breast milk composition remains inadequately understood. Herein, we investigate the impact of environmental factors on HBM lipid composition in a general population cohort. The study included mothers (All Babies In Southeast Sweden study) whose children later progressed to one or more immune-mediated diseases later in life: type 1 diabetes (n = 9), celiac disease (n = 24), juvenile idiopathic arthritis (n = 9), inflammatory bowel disease (n = 7), hypothyroidism (n = 6), and matched controls (n = 173). Lipidome of HBM was characterized by liquid chromatography combined with high-resolution mass spectrometry. We observed that maternal age, body mass index, diet, and exposure to perfluorinated alkyl substances (PFASs) had a marked impact on breast milk lipidome, with larger changes observed in the milk of those mothers whose children later developed autoimmune diseases. We also observed differences in breast milk lipid composition in those mothers whose offspring later developed autoimmune diseases. Our study suggests that breast milk lipid composition is modified by a complex interaction between genetic and environmental factors, and, importantly, this impact was significantly more pronounced in those mothers whose offspring later developed autoimmune/inflammatory diseases. Our findings also suggest that merely assessing PFAS concentration may not capture the full extent of the impact of chemical exposures; thus, the more comprehensive exposome approach is essential for accurately assessing the impact of PFAS exposure on HBM and, consequently, on the health outcomes of the offspring.

HAMLET in human milk is resistant to digestion and carries essential free long chain polyunsaturated fatty acids and oleic acid

The oleic acid/alpha-lactalbumin complex HAMLET (human alpha-lactalbumin made lethal to tumors) is cytotoxic to various cancerous cell lines and is assembled from alpha-lactalbumin (ALA) and free oleic acid (OA). HAMLET is also cytotoxic to normal immature intestinal cells. It remains unclear if HAMLET, experimentally assembled with OA and heat, can spontaneously assemble in frozen human milk over time. To approach this issue, we used a set of timed proteolytic experiments to evaluate the digestibility of HAMLET and native ALA. The purity of HAMLET in human milk was confirmed by ultra high performance liquid chromatography coupled to tandem mass spectrometry and western blot to resolve the ALA and OA components. Timed proteolytic experiments were used to identify HAMLET in whole milk samples. Structural characterization of HAMLET was performed by Fournier transformed infrared spectroscopy and indicated a transformation of secondary structure with increased alpha-helical character of ALA upon binding to OA.

Autoantibody Diversity Is Augmented in Women with Breast Cancer and Is Related to the Stage of the Disease

Breast cancer (BC) is the most frequent malignant neoplasia and leading cause of cancer mortality for women. A timely diagnosis of BC is crucial to ensure the best chances of survival. Among the various screening tools for BC, antibodies directed towards self-antigens or tumor-associated antigens (autoantibodies) have emerged as an alternative to image-based screening modalities. However, little attention has been paid to the global diversity of autoantibodies. This work aimed to analyze the diversity of autoantibodies reactive to antigens expressed by the BC cell line T47D in the sera of Mexican women with BC, benign breast pathology (BBP), or without breast pathology (WBP). We found that the diversity of antibodies in the sera was higher in the BC and BBP groups than in the WBP group. Likewise, the diversity changed with the progression of BC. Our results show and measure the complexity of the antibody response in breast health and disease.

Breast cancer incidence in Yogyakarta, Indonesia from 2008-2019: A cross-sectional study using trend analysis and geographical information system

BACKGROUND

Breast cancer is a significant public health concern worldwide, including in Indonesia. Little is known about the spatial and temporal patterns of breast cancer incidence in Indonesia. This study aimed to analyze temporal and spatial variations of breast cancer incidence in Yogyakarta Province, Indonesia.

METHODS

The study used breast cancer case data from the Yogyakarta Population-Based Cancer Registry (PBCR) from 2008 to 2019. The catchment areas of the PBCR included the 48 subdistricts of 3 districts (Sleman, Yogyakarta City, and Bantul). Age-standardized incidence rates (ASR) were calculated for each subdistrict. Joinpoint regression was used to detect any significant changes in trends over time. Global Moran's and Local Indicators of Spatial Association (LISA) analyses were performed to identify any spatial clusters or outliers.

RESULTS

The subdistricts had a median ASR of 41.9, with a range of 15.3-70.4. The majority of cases were diagnosed at a late stage, with Yogyakarta City having the highest proportion of diagnoses at stage 4. The study observed a significant increasing trend in breast cancer incidence over the study period the fastest of which is in Yogyakarta City with an average annual percentage change of 18.77%, with Sleman having an 18.21% and Bantul having 8.94% average changes each year (p <0.05). We also found a significant positive spatial autocorrelation of breast cancer incidence rates in the province (I = 0.581, p <0.001). LISA analysis identified 11 subdistricts which were high-high clusters in the central area of Yogyakarta City and six low-low clusters in the southeast region of the catchment area in the Bantul and Sleman Districts. No spatial outliers were identified.

CONCLUSIONS

We found significant spatial clustering of BC ASR in the Yogyakarta Province, and there was a trend of increasing ASR across the region. These findings can inform resource allocation for public health efforts to high-risk areas and develop targeted prevention and early detection strategies. Further res is needed to understand the factors driving the observed temporal and spatial patterns of breast cancer incidence in Yogyakarta Province, Indonesia.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

Risk-Reducing Measures for Cancer Prevention

Cancer, or malignancy, continues to be one of the most serious health problems in the world, leading to death and disability. Unlike in previous years, where new cases of cancer were predominant in developed nations, the number of cases of cancer and the resultant deaths are increasing in low- and middle-income countries. This is partially attributable to the current trend of adopting a Western lifestyle, substantial urbanization, and the rise in infections, such as the human papillomavirus (HPV) and hepatitis B virus (HBV), which together account for over 30% of cancer cases in underdeveloped and developing nations. The deleterious impact of cancer, as cases multiply worldwide, is multi-dimensional. Cancer exerts serious physical, psychological, and monetary burdens, not only on cancer patients but also on their family members, close friends, health care systems, and society at large. Importantly, over half of all cancer types can be prevented globally by mitigating the risk and causative factors as well as prompt adherence to scientifically recommended prevention measures. This review provides various scientifically based and people-centered strategies that every individual could adopt to reduce their risk of developing cancer in the future. It is recommended that, for these cancer prevention strategies to be effective, there should be a strong political will from the governments of individual countries to enact specific laws and implement policies that will significantly reduce sedentary lifestyles and unhealthy eating among the general public. Likewise, HPV and HBV vaccines, as well as cancer screenings, should be made available, affordable, and accessible on a timely basis for those who are eligible to take them. Finally, intensified campaigns and numerous informative and educational programs that promote cancer prevention should be initiated globally.

The Role of Cow's Milk Consumption in Breast Cancer Initiation and Progression

PURPOSE OF REVIEW

This review evaluates cow milk's impact on breast carcinogenesis by linking recent epidemiological evidence and new insights into the molecular signaling of milk and its constituents in breast cancer (BCa) pathogenesis.

RECENT FINDINGS

Recent prospective cohort studies support the association between cow's milk consumption and the risk of estrogen receptor-α-positive (ER⁺) BCa. Milk is a complex biological fluid that increases systemic insulin-like growth factor 1 (IGF-1), insulin and estrogen signaling, and interacting hormonal promoters of BCa. Further potential oncogenic components of commercial milk include exosomal microRNAs (miR-148a-3p, miR-21-5p), bovine meat and milk factors, aflatoxin M1, bisphenol A, pesticides, and micro- and nanoplastics. Individuals with BRCA1 loss-of-function mutations and FTO and IGF1 gain-of-function polymorphisms enhancing IGF-1/mTORC1 signaling may be at increased risk for milk-induced ER⁺ BCa. Recent prospective epidemiological and pathobiochemical studies identify commercial milk consumption as a critical risk factor of ER⁺ BCa. Large meta-analyses gathering individuals of different ethnic origins with milk derived from dairy cows of varying genetic backgrounds and diverse feeding procedures as well as missing data on thermal processing of milk (pasteurization versus ultra-heat treatment) make multi-national meta-analyses unsuitable for BCa risk estimations in susceptible populations. Future studies are required that consider all vulnerable periods of breast carcinogenesis to cow's milk exposure, beginning during the perinatal period and puberty, since these are the most critical periods of mammary gland morphogenesis. Notwithstanding the need for better studies including detailed information on milk processing and vulnerable periods of human breast carcinogenesis, the available evidence suggests that dietary guidelines on milk consumption may have to be reconsidered.

Ketogenic Diet for Neonatal Hypoxic-Ischemic Encephalopathy

The prevalence of neonatal hypoxic-ischemic encephalopathy (HIE), a devastating neurological injury, is increasing; thus, effective treatments and preventions are urgently needed. The underlying pathology of HIE remains unclear; recent research has focused on elucidating key features of the disease. A variety of diseases can be alleviated by consuming a ketogenic diet (KD) despite differences in pathogenesis and features, given the common mechanisms of KD-induced effects. Dietary modification is the most translatable, cost-efficient, and safest approach to treat acute or chronic neurological disorders and reduces reliance on pharmaceutical treatments. Evidence suggests that the KD can exert beneficial effects in animal models and in humans with brain injuries. The efficacy of the KD in preventing neuronal damage, motor alterations, and cognitive decline varies. Moreover, the KD may provide an alternative source of energy, enhance mitochondrial function, and reduce the expression of inflammatory and apoptotic mediators. Thus, this diet has attracted interest as a potential therapy for HIE. This review examined the role of the KD in HIE treatment and described the mechanisms by which ketone bodies (KBs) exert effects under pathological conditions and protect against brain damage; the evidence supports the implementation of dietary interventions as a therapeutic strategy for HIE. Future research should aim to elucidate the underlying mechanisms of the KD in patients with HIE and determine whether the effect of the KD on clinical outcomes can be reproduced in humans.

A Comprehensive Review of Electrospun Fibers, 3D-Printed Scaffolds, and Hydrogels for Cancer Therapies

Anticancer therapies and regenerative medicine are being developed to destroy tumor cells, as well as remodel, replace, and support injured organs and tissues. Nowadays, a suitable three-dimensional structure of the scaffold and the type of cells used are crucial for creating bio-inspired organs and tissues. The materials used in medicine are made of non-degradable and degradable biomaterials and can serve as drug carriers. Developing flexible and properly targeted drug carrier systems is crucial for tissue engineering, regenerative medicine, and novel cancer treatment strategies. This review is focused on presenting innovative biomaterials, i.e., electrospun nanofibers, 3D-printed scaffolds, and hydrogels as a novel approach for anticancer treatments which are still under development and awaiting thorough optimization.

Disparities in Breast Cancer Mortality Rates in Israel among Urban and Rural Women

Breast cancer is a leading cause of death. There are a number of risk factors for breast cancer mortality including parity, age, ethnicity, genetic history, and place of residence. This study examined the disparities in breast cancer-related mortality rates among women from urban areas compared to rural areas in Israel. This was a retrospective, follow-up study on mortality from breast cancer among 894,608 Israeli women born between the years of 1940 and 1960. Data was collected from the Israeli Central Bureau of Statistics, the Population Authority, the Education Ministry, and the Health Ministry. Over 80% of women lived in urban areas. A higher incidence of mortality from breast cancer in Israel was found among urban women compared to rural women (1047.8/100,000 compared to 837/100,000, respectively). Even after adjusting for sociodemographic variables, higher mortality rates were found among women from urban areas in Israel compared to women from rural areas in Israel. It is believed that environmental factors can partially explain the geographic variation of breast cancer incidence, and that breast cancer incidence is likely a complex interaction between genetic, environmental, and health factors.

Lactation mastitis: Promising alternative indicators for early diagnosis

Although lactation mastitis (LM) has been extensively researched, the incidence rate of LM remains a salient clinical problem. To reduce this incidence rate and achieve a better prognosis, early and specific quantitative indicators are particularly important. It has been found that milk electrolyte concentrations (chloride, potassium, and sodium) and electrical conductivity (EC) significantly change in the early stages of LM in an animal model. Several studies have evaluated EC for the detection of subclinical mastitis in cows. EC, chloride, and sodium content of milk were more accurate for predicting infection status than were other variables. In the early stages of LM, lactic sodium, chloride, and EC increase, but potassium decreases. However, these indicators have not been reported in the diagnosis of LM in humans. This review summarizes the pathogenesis and the mechanism of LM in terms of milk electrolyte concentration and EC, and aim to provide new ideas for the detection of sub-clinical mastitis in humans.

Work as an Understudied Driver of Racial Inequities in Breastfeeding

Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to relatively less breastfeeding among Black compared to White mothers, yet little research has addressed these interrelationships. Here, we offer a critical review of the literature and a conceptual framework to guide future research about work and racial inequities in breastfeeding. There is a strong public health case for promoting breastfeeding equity for mothers across race groups and occupation types. Existing theory suggests that employment opportunities and working conditions are a likely pathway that connects structural racism to Black-White breastfeeding inequities, in addition to other known factors. We propose a new conceptual model for studying the interrelationships among work, race, and breastfeeding outcomes.

Comparison of Breast Cancer and Cervical Cancer in Uzbekistan and Korea: The First Report of The Uzbekistan-Korea Oncology Consortium

In general, as a country's economy, education level, and life expectancy increase, the incidence of cancer increases. This is because the peak incidence of cancer occurs in individuals in their 70s and 80s, and the health proportion of non-communicable diseases increases with the development of the living environment. Changes in diet, lifestyle and enhanced methods of detection contribute to an increase in cancer incidence as well. Recently, Uzbekistan has grown rapidly, and its incidence of cancer is also increasing. In the health management of cancer, not only treatment but also the identification and prevention of causes and effective screening should be considered. South Korea has a common ethnicity with Uzbekistan and has successfully performed national screening for seven major cancers over the past 20 years. The 5-year survival rate after cancer diagnosis in Korea was only 42.9% 20 years ago, but recently it has improved to 70.7%. We formed an advisory consortium in which oncologists from Uzbekistan and Korea could cooperate for cancer management in Uzbekistan. This advisory consortium intends to present the necessary considerations and recommendations for cancer management in Uzbekistan by examining the literature and cancer statistics of Uzbekistan and South Korea. In addition to the overall analysis, we identified and reviewed the major cancers with high morbidity in three categories in Uzbekistan: gynecological cancer (breast and cervical cancer), cancer common in men (lung and liver cancer), and gastrointestinal cancer (stomach and colorectal cancer). This review covers the general cancer statistics of Uzbekistan and a detailed review of gynecological cancer between two countries, and relevant recommendations.

Muslim women's attitudes toward infant feeding in Qatar: An exploration using the Iowa infant feeding attitude scale

BACKGROUND

Maternal attitude toward infant feeding is an important determinant of breastfeeding. The Islamic faith encourages breastfeeding, yet many Muslim women do not breastfeed as per the World Health Organization recommendations. In the Middle East, research has not addressed attitudes toward infant feeding among Muslim women. Assessing women's attitudes toward infant feeding choices is crucial to improve breastfeeding rates among Muslim women.

AIM

The aims of this study are to (a) examine postpartum Muslim women's attitudes toward infant feeding, (b) identify the determinants of these attitudes, and (c) determine whether attitudes can predict breastfeeding intention among Muslim women. A secondary aim is to examine the psychometric attributes of the Iowa Infant Feeding Attitude Scale among Muslim women.

METHOD

A convenience sample of postpartum Muslim women (N = 414) were recruited between November 2019 and January 2020 in a large maternity facility in Qatar. A pre-developed questionnaire and the IIFAS were used to collect data. Both Arabic (n = 228) and English (n = 186) versions of the IIFAS were distributed postnatally to measure Muslim women's attitudes towards breastfeeding. A total attitude score was computed with higher scores indicating a more positive attitude toward breastfeeding.

FINDINGS

The mean age of participants was 30.3 ± 5.2 years; 65.2% had a university degree and only 20.5% were employed. The mean attitude score was 61.8 ± 7.8. A significant association was found between the IIFAS attitude score and ethnicity, favouring Non-Qatari Arab women who had significantly higher attitude scores (p < .001). Women with full-time or part-time work had significantly higher scores than those not working (p = .008, p = .023). Older women had significantly lower attitude scores (adjusted slope = -0.230, p = .008). Cronbach's alpha reliability coefficient of the Arabic and English versions of the IIFAS ranged from 0.69 to 0.80.

CONCLUSION

Ethnicity, employment status, and age are determinants of infant feeding attitudes among Muslim women. In Qatar, Muslim women's attitudes related to breastfeeding trend toward positive; however, attitude is not a predictor of antenatal breastfeeding intention. Further research employing a larger sample with a focus on a culturally sensitive approach is recommended. The IIFAS has a moderate reliability level and needs to be culturally adapted to be used among a Muslim population.

Well-Informed and Willing, but Breastfeeding Does Not Work: A Qualitative Study on Perceived Support from Health Professionals among German Mothers with Breastfeeding Problems

Although exclusive breastfeeding is recommended for the first six months of life, a large number of women worldwide do not practice it successfully. Our study aimed to investigate the perceived support from health professionals for women who experienced difficulties in breastfeeding. Furthermore, we examined women’s knowledge about breastfeeding and motivation to breastfeed. We conducted a qualitative exploratory study (June to October 2019) among 15 women who had experienced breastfeeding problems in Germany. Semi-structured interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis following Mayring’s approach. Prior to giving birth, the women’s motivation to breastfeed and theoretical knowledge were high, and breastfeeding problems were not anticipated. Difficulties in breastfeeding after giving birth created a highly demanding situation for the mothers. Health professionals were either perceived as very supportive, for example, by providing helpful technical advice or being emotional assistance, or they could be perceived as nonhelpful, thereby worsening the situation, for example, by pressuring the women to breastfeed or making improper remarks. Adequate support for young mothers in childbed consists of the provision of useful and realistic information concerning breastfeeding and a sensitive treatment when breastfeeding problems occur. Paying attention to this specific group of women who are experiencing difficulties in breastfeeding may improve maternal and child well-being and potentially enable breastfeeding.

Effects of Continuous Care Combined with Evidence-Based Nursing on Mental Status and Quality of Life and Self-Care Ability in Patients with Liver from Breast Cancer: A Single-Center Randomized Controlled Study

Objective

To explore the multidisciplinary collaborative extended care combined with EBN to improve breast cancer liver metastasis patients' psychological status and self-care ability.

Background

In the past ten years, the number of breast cancer patients with liver metastases has increased year by year, becoming a global public health problem. Studies have shown that 30% of breast cancer patients with liver metastases show varying degrees of anxiety and depression, and their quality of life is significantly lower than that of the normal population. Multidisciplinary collaborative continuous care can improve the prognosis of breast cancer treatment to a certain extent and is the key to meeting the needs of cancer patients.

Materials and Methods

The clinical data of 96 patients with liver metastases from breast cancer were selected as the study subjects and divided into a comparison group and an observation group of 48 cases each according to a random number table. Among them, the comparison group implemented evidence-based nursing (EBN) and the observation group implemented multidisciplinary collaborative extended care based on the comparison group. The effects of psychological status, quality of life, self-care ability, and sleep quality were compared between the two groups before and after nursing care.

Results

After nursing, the sleep quality scores, increased awakening scores, sleep quality that shows weakness because important things are not steady or strong scores, and night terrors scores of the two groups of breast cancer patients with liver the spread of diseases through the body were very much improved, and the sleep quality scores of the instance of watching, noticing, or making a statement group were much lower than those of the comparison group (P < 0.05). After nursing, the fear and stress-related score, depression score, tiredness and distress score, and anger score of the two groups of breast cancer patients with liver (the spread of diseases through the body) were very much improved, and the mental state score of the instance of watching, noticing, or making a statement group was much lower than that of the comparison group (P < 0.05). The scores of self-care skills, self-responsibility, health knowledge, and self-idea of patients in the instance of watching, noticing, or making a statement group after nursing were higher than those in the comparison group (P < 0.05). After nursing, the scores of mental energy, social interaction, emotional restriction, and mental status of patients in (instance of watching, noticing, or making a statement) were much higher than those in the comparison group (P < 0.05).

Conclusion

Multidisciplinary collaborative continuous nursing combined with EBN can effectively improve the sleep quality and psychological state of patients with breast cancer and liver metastases and improve self-care ability.

Becoming breastfeeding friendly in Wales: Recommendations for scaling up breastfeeding support

Breastfeeding and the provision of human milk is established as protecting infant and maternal health. However, breastfeeding rates in many countries, including Wales, are low. Given the significant health, economic and environmental impacts of this, the need to strengthen breastfeeding promotion, protection and support is paramount. As part of this, the becoming breastfeeding friendly: a guide to global scale-up (BBF) initiative sets out a methodology to enable countries to assess their readiness to scale up breastfeeding protection, promotion and support by gathering data and scoring progress under eight areas, termed 'gears', shown to be essential for large-scale change. Recently, Wales took part in the BBF initiative. A cross-sector committee, including stakeholders from Universities, Welsh Government, Public Health Wales and Health Boards alongside critical friends scored Wales' support for breastfeeding across the eight gears. The overall score for Wales was 1.1 out of a possible 0-3, representing a moderate scaling up the environment for breastfeeding. Six gears were rated in the moderate gear strength category and two ('Promotion' and 'Advocacy') in the weak gear strength category. Gaps in breastfeeding support were identified and 31 recommendations covering six themes for change were put forward. These included a strategic action plan, consistent and long-term funding, a nuanced, cocreated engagement and promotion framework, strengthened education and training, robust monitoring and evaluation mechanisms and ensuring maternity rights and the International Code of Marketing of Breastmilk Substitute are upheld. Taken together, the analysis and recommendations present a clear vision for protecting and not merely promoting breastfeeding in Wales.

Breastfeeding and Reduced Risk of Breast Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Evidences which prove relation between breastfeeding women and risk of breast cancer have been limited.

OBJECTIVE

A meta-analysis was carried out on the basis of published literature from clinical trials and studies among different parts of the world.

METHODS

Studies were analyzed and extracted using PRISMA flowchart. RevMan 5.4.1 was used for analyzing the extracted data. Included studies were fully cited texts with complete information about studies, trails conducted for risk of breast cancer, and breastfeeding correlations.

RESULTS

Menarche age, family history, lactation duration, and menopausal status have a strong effect on the risks of breast cancer. Family history studies concluded that for 95% CI, the risk ratio was 2.66 (2.00, 3.52).

CONCLUSION

Findings have suggested that family history and lactation duration affect the risks of breast cancer.

There's no formula for a good mother: shame and estranged maternal labour

This article theorises a group of mothers’ experiences of shame as a result of feeding infant formula to their children. Drawing on interviews with formula and breastfeeding mothers, the author brings together insights from scholarship on shame, feminist scholarship on reproductive labour and the Marxist notion of estranged labour to demonstrate that shame causes the formula-feeding mothers in this study, who initially wanted to breastfeed, to be estranged in their labour as mothers. The article addresses a gap in qualitative infant-feeding scholarship, which focuses primarily on breastfeeding. It provides an empathic account framing breastfeeding and formula-feeding mothers as potential allies against ‘controlling images’ of motherhood who face different facets of the same pressure to fulfil idealised roles. Both scholarly work on reproductive labour, and public programmes supporting new mothers, should account more seriously for the experiences of formula feeding mothers.

Place Is Power: Investing in Communities as a Systemic Leverage Point to Reduce Breast Cancer Disparities by Race

Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.

Exclusive breastfeeding promotion policies: whose oxygen mask are we prioritizing?

Provision of human milk is crucial for maternal and infant health. However, exclusive breastfeeding may exacerbate mood disorders in women unable to achieve this goal. A nuanced approach that considers all aspects of maternal and infant health is needed. In this paper, we bring attention to the potentially negative consequences on maternal and infant health that may be associated with exclusive breastfeeding in the setting of significant challenges. We discuss recent literature exploring the relationship between breastfeeding and maternal mental health, and contextualize it with our first-hand experiences as healthcare professionals who aimed to exclusively breastfeed and encountered difficulties. Given existing evidence and our collective anecdotal experience, we advocate for a balanced approach when supporting parents struggling to breastfeed. Timely recommendations are offered for healthcare providers, medical educators and hospital administrators seeking to balance maternal and infant child health considerations while continuing to promote breastfeeding. PRéCIS STATEMENT: Exclusively promotion of breastfeeding impacts maternal mental health and consequently, infant health. We advocate for balanced considerations of maternal and infant child health while promoting breastfeeding. CLINICAL IMPLICATIONS: Singular promotion of exclusive breastfeeding may exacerbate adverse maternal mental health outcomes. A balanced consideration of maternal and infant child health is vital as breastfeeding is encouraged. Clinicians who provide front-line support to breastfeeding parents must be taught and expected to provide nuanced breastfeeding support that anticipates both physical and mental health challenges.

"It Is a Very Emotional Topic for Me"-Managing Breastfeeding Problems among German Mothers: A Qualitative Approach

Breastfeeding is associated with positive health outcomes for both child and mother. Nevertheless, some women experience breastfeeding problems which commonly lead to early cessation, or not starting breastfeeding at all. Our aim was to explore how women that have difficulties in breastfeeding perceive their situation and how they actively manage it. We conducted semi-structured interviews with 15 mothers living in Germany who had experienced breastfeeding problems. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Breastfeeding problems occurred due to different reasons and had a huge impact, as evidenced in the four main themes of the findings: individual situation, managing the situation, perceived consequences for relations, feelings, and potential future pregnancies, and perceived health consequences for the mother. They frequently experienced negative emotions, including psychological distress and mental health problems, with perceived negative consequences for the mother-infant-bonding. Trying to actively manage the situation and availability of social support seemed to have a relieving effect, whereas confrontation and lack of understanding worsened the situation. Breastfeeding problems and the inability to breastfeed can have a great influence on maternal well-being. These can affect different aspects of a mother's life, including the attachment to the child. Providing support for actively managing the situation and supporting the exchange of experience between mothers who perceive breastfeeding problems may help mothers to better deal with their situation. Our findings may help health professionals to understand what these mothers feel and how they can support these women in a sensitive way.

Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits

Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.

Age at last birth and risk of developing breast cancer: a meta-analysis

OBJECTIVES

Results from epidemiologic studies on age at last birth (ALB) and the risk of developing breast cancer were inconsistent. Therefore, we conducted this meta-analysis to evaluate the association between ALB and the risk of developing breast cancer quantitatively.

METHODS

Relevant articles published up to May 2019 were identified by searching systematically in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan Fang Med Online. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Dose-response relationship was assessed by restricted cubic spline model.

RESULTS

Fourteen studies with 132 133 cases and 1 314 005 participants were eligible for this meta-analysis. The pooled RR (95% CI) of breast cancer for the highest vs. the lowest stratification of ALB was 1.22 (1.04-1.42). In the subgroup analysis, significant positive associations were also found in studies conducted in Europe (RR: 1.21, 95% CI: 1.06-1.38), studies with results adjusted for parity (RR: 1.26, 95% CI: 1.04-1.54), and studies with results adjusted for age at first birth (RR: 1.37, 95% CI: 1.08-1.74). The results of the dose-response analysis indicated that the departure from linearity was NS between ALB and the risk of breast cancer (Pnonlinearity = 0.711), but the linear associations were NS.

CONCLUSION

This meta-analysis suggested that ALB was positively associated with the risk of breast cancer. The risk of developing breast cancer increased gradually with the ALB for women. Our findings may have implications for family planning.

Couples talk about breastfeeding: Interviews with parents about decision-making, challenges, and the role of fathers and professional support

Despite health benefits, sustained breastfeeding rates remain low in the United States, and the role of partners in breastfeeding is not well understood. Using a grounded theory approach, the current qualitative study explored how couples communicate regarding breastfeeding decisions and challenges. Mother-father dyads (n = 16) completed individual semi-structured interviews 1 year after the birth of their first child. Following iterative qualitative analysis, three phases of breastfeeding communication emerged: Should we try this? ( Mother's opinion counts) How do we make this work? (adjusting and problem-solving) and How do we settle into a routine? (gaining confidence, resolving issues) Findings underscore the complexity of defining the partner role in breastfeeding.

Effectiveness of educational and supportive intervention for primiparous women on breastfeeding related outcomes and breastfeeding self-efficacy: A systematic review and meta-analysis

BACKGROUND

Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Breastfeeding promotion is an important topic for infant health; and different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches to educational and supportive interventions to improve breastfeeding.

OBJECTIVE

To examine the effects of different approaches to educational and supportive interventions that can help sustain breastfeeding and improve breastfeeding self-efficacy for primiparous postnatal women; and to identify key characteristics of the effective interventions in terms of delivery time, format and mode, main components, use of theoretical framework, and number of sessions.

METHODS

Eleven electronic databases and reference lists of the eligible articles were searched. Randomised controlled trials of educational and supportive interventions published in English and Chinese language over recent 20 years were identified and screened against the review criteria. Risk of bias of the included studies was assessed. Primary outcome measures were exclusive breastfeeding and partial breastfeeding rate. Secondary outcomes included breastfeeding self-efficacy, breastfeeding knowledge and other breastfeeding related outcomes. Meta-analysis was performed in terms of ≤2 months, 3-5 months and ≥6 months postpartum.

RESULTS

Thirteen articles that met the inclusion criteria were included and showed an acceptable risk of bias. Educational and supportive interventions were found effective in increasing exclusive breastfeeding rate at ≤2 months and 6 months, partial breastfeeding rate as well as enhancing breastfeeding self-efficacy at ≤2 months. The optimal delivery time, format and structure of the interventions included: (a) delivering from antenatal to postnatal period; (b) multicomponent involving antenatal group education, postnatal individual breastfeeding coaching and telephone follow-ups; (c) both individual and group basis; (d) being guided by self-efficacy theory; and (e) having ≥3 sessions.

CONCLUSIONS

The findings suggest multicomponent, theory-based intervention with ≥3 sessions delivered via both face-to-face teaching and telephone follow-ups across antenatal and postnatal period can be effective to enhance exclusive breastfeeding over 6-month, partial breastfeeding and breastfeeding self-efficacy over 2-month postpartum.

REGISTRATION NUMBER

CRD42020175473 at the International Prospective Register of Systematic Reviews (PROSPERO).

W. WA, Yunda DK, Pranata R. The Association Between Triglyceride-Glucose Index as a Marker of Insulin Resistance and the Risk of Breast Cancer

BACKGROUND

This study aims to evaluate the association and dose-response between triglyceride-glucose (TyG) index and breast cancer.

METHOD

This is a multicenter case-control study conducted in six public referral hospitals in Indonesia. Cases are individuals aged 19 years or above who were diagnosed with breast cancer within 1 year of diagnosis, based on histopathology and immunohistochemistry. Controls were recruited from corresponding hospitals. TyG index was determined by the formula: ln (fasting TG [mg/dl] × fasting glucose [mg/dl]).

RESULTS

There were 212 participants in the breast cancer group and 212 participants in the control group. TyG index was higher in patients with breast cancer (median 8.65 [7.38, 10.9] vs. 8.30 [7.09, 10.84], p < 0.001). When compared with TyG quartile of Q1, Q4 was associated with an OR of 2.42 (1.77, 3.31), p < 0.001, Q3 was associated with an OR of 1.53 (1.21, 1.93), p < 0.001, Q2 was associated with an OR of 1.39 (1.12, 1.73), p = 0.002 for the risk of breast cancer. The dose-response relationship was nonlinear (p < 0.001). On univariate analysis, smoking (OR 2.15 [1.44, 3.22], p < 0.001), use of contraception (1.73 [1.15, 2.60], p = 0.008), alcohol consumption (OR 2.04 [0.96, 4.35], p = 0.064), and TyG Index >8.87 (OR 3.08 [1.93, 4.93], p < 0.001) were associated with risk of breast cancer. Independently associated with increased risk of breast cancer included smoking (OR 1.93 [1.23, 3.01], p = 0.004), use of contraception (OR 1.59 [1.02, 2.48], p = 0.039), and TyG Index >8.87 (OR 2.93 [1.72, 4.98], p < 0.001).

CONCLUSION

TyG index was associated with breast cancer in a nonlinear dose-response fashion.

Breastfeeding in China: A Review of Changes in the Past Decade

This review summarizes breastfeeding rates in China reported during the decade 2007-2018, a decade on from our previous review published in 2007. Compared with the studies undertaken before 2007 in China, recent studies are more likely to report breastfeeding rates using longer periods of observation, enabling rates to be summarized to six and 12 months postpartum in this review. There appears to have been a modest increase in breastfeeding in China. The mean duration of "any breastfeeding" was 10 months (9 to 11 months in the majority of cities), an increase compared with the previous review in which the mean of "any breastfeeding" duration was 8 months (7 to 9 months in the majority of cities). Using data from cohort studies, the proportion of infants being breastfed at 4 months increased from 78% in the earlier decade to 83% more recently. A second baby is usually breastfed for longer than the first, considering both "any" and "exclusive breastfeeding". China is a huge country and there is considerable diversity in culture, level of economic development, education and breastfeeding rates in different areas of China, but our review suggests that there has been some improvement in the "any breastfeeding" rate in the most recent decade.

Risk factors for inflammatory and non-inflammatory breast cancer in North Africa

PURPOSE

Studies of the etiology of inflammatory breast cancer (IBC), a rare but aggressive breast cancer, have been hampered by limited risk factor information. We extend previous studies by evaluating a broader range of risk factors.

METHODS

Between 2009 and 2015, we conducted a case-control study of IBC at six centers in Egypt, Tunisia, and Morocco; enrolled were 267 IBC cases and for comparison 274 non-IBC cases and 275 controls, both matched on age and geographic area to the IBC cases. We administered questionnaires and collected anthropometric measurements for all study subjects. We used multiple imputation methods to account for missing values and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using polytomous logistic regression comparing each of the two case groups to the controls, with statistical tests for the difference between the coefficients for the two case groups.

RESULTS

After multivariable adjustment, a livebirth within the previous 2 years (OR 4.6; 95% CI 1.8 to 11.7) and diabetes (OR 1.8; 95% CI 1.1 to 3.0) were associated with increased risk of IBC, but not non-IBC (OR 0.9; 95% CI 0.3 to 2.5 and OR 0.9; 95% CI 0.5 to 1.6 for livebirth and diabetes, respectively). A family history of breast cancer, inflammatory-like breast problems, breast trauma, and low socioeconomic status were associated with increased risk of both tumor types.

CONCLUSIONS

We identified novel risk factors for IBC and non-IBC, some of which preferentially increased risk of IBC compared to non-IBC. Upon confirmation, these findings could help illuminate the etiology and aid in prevention of this aggressive cancer.

Breast cancer risk factors in Iran: a systematic review & meta-analysis

OBJECTIVES

Breast cancer is known as one of the deadliest forms of cancer, and it is increasing globally. There are a variety of proven and controversial risk factors for this malignancy. Herein, we aimed to undertake a systematic review and meta-analysis focus on the epidemiology of breast cancer risk factors in Iran.

METHODS

We performed a systematic search via PubMed, Scopus, Web of Science, and Persian databases for identifying studies published on breast cancer risk factors up to March 2019. Meta-analyses were done for risk factors reported in more than one study. We calculated odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using a fixed/random-effects models.

RESULTS

Thirty-nine studies entered into the meta-analysis. Pooling of ORs showed a significant harmful effect for risk factors including family history (OR: 1.80, 95%CI 1.47-2.12), hormonal replacement therapy (HRT) (OR: 5.48, 95%CI 0.84-1.74), passive smokers (OR: 1.68, 95%CI 1.34-2.03), full-term pregnancy at age 30 (OR: 3.41, 95%CI 1.19-5.63), abortion (OR: 1.84, 95%CI 1.35-2.33), sweets consumption (OR: 1.71, 95%CI 1.32-2.11) and genotype Arg/Arg (crude OR: 1.59, 95%CI 1.07-2.10), whereas a significant protective effect for late menarche (OR: 0.58, 95%CI 0.32-0.83), nulliparity (OR: 0.68, 95%CI 0.39-0.96), 13-24 months of breastfeeding (OR: 0.68, 95%CI 0.46-0.90), daily exercise (OR: 0.59, 95%CI 0.44-0.73) and vegetable consumption (crude OR: 0.28, 95%CI 0.10-0.46).

CONCLUSIONS

This study suggests that factors such as family history, HRT, passive smokers, late full-term pregnancy, abortion, sweets consumption and genotype Arg/Arg might increase risk of breast cancer development, whereas late menarche, nulliparity, 13-24 months breastfeeding, daily exercise and vegetable consumption had an inverse association with breast cancer development.

Increased Cancer Risk in Families with Pediatric Cancer Is Associated with Gender, Age, Diagnosis, and Degree of Relation to the Child

BACKGROUND

Studies of cancer risk among relatives of children with cancer beyond parents and siblings are limited. We have investigated the cancer risk up to the third degree of relation in families with pediatric cancer to reveal patterns of inheritance.

METHODS

A single-center cohort of 757 patients with pediatric cancer was linked to the Swedish National Population Register, resulting in 16,137 relatives up to the third degree of relation. All relatives were matched to the Swedish Cancer Register, and standard incidence ratios (SIR) were calculated to define relatives at risk.

RESULTS

Children and adults up to the third degree of relation had increased cancer risk, with SIRs of 1.48 (P = 0.01) and 1.07 (P < 0.01), respectively. The SIRs for first- and third-degree adult relatives were 1.22 and 1.10, respectively, but no increased risk was observed in second-degree relatives. Male relatives had a higher risk than females, especially when related to a girl and when the child had leukemia. The risk was mainly increased for lung, prostate, and gastrointestinal cancer. When excluding 29 families of children with known pathogenic germline variants, the increased risk remained.

CONCLUSIONS

Relatives to children with cancer up to third degree of relation have an increased cancer risk. Known pathogenic germline variants do not explain this increased risk.

IMPACT

The overall increased cancer risk among relatives of children with cancer in this population-based cohort strengthens the importance of surveillance programs for families with pediatric cancer.

Long Noncoding RNAs Involved in the Endocrine Therapy Resistance of Breast Cancer

Long noncoding RNAs (lncRNAs) are defined as RNAs longer than 200 nucleotides that do not encode proteins. Recent studies have demonstrated that numerous lncRNAs are expressed in humans and play key roles in the development of various types of cancers. Intriguingly, some lncRNAs have been demonstrated to be involved in endocrine therapy resistance for breast cancer through their own mechanisms, suggesting that lncRNAs could be promising new biomarkers and therapeutic targets of breast cancer. Here, we summarize the functions and mechanisms of lncRNAs related to the endocrine therapy resistance of breast cancer.

The ketogenic diet for infants: How long can you go?

PURPOSE

Ketogenic diets (KD) are high-fat, low-carbohydrate therapies, established in the treatment for drug-resistant epilepsy in childhood since the 1920ies. This review focuses on the use of ketogenic diet therapies in young childhood with an emphasis on the most recent advances.

FINDINGS

The KD has been used effectively and safely in childhood, and has increasingly been offered in infancy during the last decade. The introduction of a KD is recommended with a fixed fat/ non-fat ratio of 3:1, modified if necessary. In infants the KD is initiated without fasting and fluid restriction and with a shorter treatment duration than in older children. Twenty studies that also included infants below 1 year of age are available. When the KD is used early and in an approach based on syndromes and etiology, seizure freedom is achieved and maintained more often than when used as last ressort. In infants with genetic causes already recognized in early infancy, the KD has shown to be even more effective. Most frequent adverse effects in infancy include emesis, hypoglycemia, food/ liquid refusal and constipation which are mostly transient and resolvable by dietary adjustments. Promising data on the inclusion of expressed breast milk to the KD and maintaining actual breastfeeding while on the KD have shown that complete weaning from breast-feeding is not necessary and inclusion of breast milk as well as breastfeeding should be encouraged.

SUMMARY

The ketogenic diet is a versatile therapy, and effective and safe in its use in infancy. There is growing evidence and guidelines that specify indications where the KD should be used early.

Main Barriers to Optimal Breastfeeding Practices in Armenia: A Qualitative Study

BACKGROUND

In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4-5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices.

RESEARCH AIM

To identify the main barriers to optimal breastfeeding practices in Armenia.

METHODS

We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches.

RESULTS

We identified two main categories of barriers to optimal breastfeeding-systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers-mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers.

CONCLUSION

Optimal breastfeeding is crucial for the best start to an infant's life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.

The Ketogenic Diet Including Breast Milk for Treatment of Infants with Severe Childhood Epilepsy: Feasibility, Safety, and Effectiveness

Objective: The ketogenic diet (KD) is a high-fat and restricted carbohydrate diet for treating severe childhood epilepsy. In infants, breast milk is usually fully replaced by a ketogenic formula. At our center, mothers are encouraged to include breastfeeding into the KD if still breastfeeding. This retrospective study describes achievement and maintenance of ketosis with or without inclusion of breast milk. Methods: Data were retrieved from a prospective longitudinal database of children treated with KD for epilepsy analyzing infants <1 year of age. The time to achieve clinically relevant ketosis (≥2 mmol/L beta-hydroxybutyrate) was compared with and without inclusion of breast milk into standard KD. Ketosis, nutritional intakes, effectiveness, adverse effects, and successful continuation of breastfeeding were evaluated. Results: A total of 79 infants were eligible for analysis. In 20% (16), breast milk was included. Infants with breast milk included into the KD achieved relevant ketosis in 47 hours (interquartile range [IQR] 24-95) compared with 41 hours (IQR 22-70; p = 0.779) in infants with standard KD. Beta-hydroxybutyrate at day 2 was 3.1 mmol/L (IQR 0.5-4.9) and 3.8 mmol/L (IQR 2.2-4.9). Infants with breast milk included received higher amounts of carbohydrates at baseline and calories at 3 months. Seizure freedom and adverse effects showed no relevant differences. No infections occurred in infants receiving breast milk. In two infants, KD was initiated with breast-feds after bottle-feeding KD formula. In 31%, breastfeeding was continued after the KD, and in 25%, inclusion of breast milk and breastfeeding was maintained until complete weaning. Before discharge from hospital, the amount of breast milk included was median 90 mL/day (IQR 53-203) equivalent to median 9% (IQR 6-15). Conclusions: Appropriate ketosis was achieved in most infants and maintained within 48 hours. Incorporation of breast milk into KD is feasible, safe, and effective.

Determinants of Continued Breastfeeding at 12 and 24 Months: Results of an Australian Cohort Study

Breastfeeding to 12 months and beyond offers considerable health benefits to both infants and mothers. Despite these recognized benefits, relatively few women in high income countries breastfeed for 12 months, and rarely breastfeed to 24 months. The aim of this study was to identify the prevalence and determinants of continued breastfeeding to 12 and 24 months amongst a cohort of Australian women participating in the Adelaide-based Study of Mothers' and Infants' Life Events affecting oral health (SMILE). Duration of breastfeeding was known for 1450 participants and was derived from feeding related data collected at birth, 3, 6, 12 and 24 months. Multivariable logistic regression analysis was used to investigate the relationship between explanatory variables and continued breastfeeding to 12 and 24 months. In total, 31.8% of women breastfed to 12 months and 7.5% to 24 months. Women who were multiparous, university educated, had not returned to work by 12 months and whose partners preferred breastfeeding over bottle feeding were more likely to be breastfeeding at 12 months. While women who had introduced complementary foods before 17 weeks and formula at any age were less likely to be breastfeeding at 12 months. Mothers who were born in Asian countries other than India and China, had not returned to work by 12 months and had not introduced formula were more likely to be breastfeeding at 24 months. The majority of the determinants of continued breastfeeding are either modifiable or could be used to identify women who would benefit from additional breastfeeding support and encouragement.

Environmental Exposure to Pesticides and Breast Cancer in a Region of Intensive Agribusiness Activity in Brazil: A Case-Control Study

Background: Breast cancer is a serious public health problem and is the second most prevalent cancer type in the world. The purpose of this article is to evaluate the association between pesticide use and breast cancer in a region of intense agribusiness activity in the state of Mato Grosso, Brazil. Methods: A case-control study was conducted on women living in the city of Rondonópolis, in the south of Mato Grosso state. There were 85 cases of women with confirmed breast cancer and 266 controls who were randomly selected from primary health care users. Bivariate and stratified analyses were performed. Multiple logistic regression was then performed, keeping in the final model the factors with a significance level lower than or equal to 0.05 or considered important according to apriori biological criteria. Results: In the final model, living near cropland with pesticides (OR: 2.37; CI: 95% 1.78–3.16) and women aged over 50 years who experienced early menarche (OR: 2.08; CI: 95% 1.06–4.12) had a higher risk of developing breast cancer compared to control subjects. Conclusion: This study highlights the importance of exposure to pesticides as an environmental risk factor for the development of breast cancer among women.

A Pooled Analysis of Breastfeeding and Breast Cancer Risk by Hormone Receptor Status in Parous Hispanic Women

BACKGROUND

Data on breastfeeding and breast cancer risk are sparse and inconsistent for Hispanic women.

METHODS

Pooling data for nearly 6,000 parous Hispanic women from four population-based studies conducted between 1995 and 2007 in the United States and Mexico, we examined the association of breastfeeding with risk of breast cancer overall and subtypes defined by estrogen receptor (ER) and progesterone receptor (PR) status, and the joint effects of breastfeeding, parity, and age at first birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression.

RESULTS

Among parous Hispanic women, older age at first birth was associated with increased breast cancer risk, whereas parity was associated with reduced risk. These associations were found for hormone receptor positive (HR+) breast cancer only and limited to premenopausal women. Age at first birth and parity were not associated with risk of ER- and PR- breast cancer. Increasing duration of breastfeeding was associated with decreasing breast cancer risk (≥25 vs. 0 months: OR = 0.73; 95% CI = 0.60, 0.89; Ptrend = 0.03), with no heterogeneity by menopausal status or subtype. At each parity level, breastfeeding further reduced HR+ breast cancer risk. Additionally, breastfeeding attenuated the increase in risk of HR+ breast cancer associated with older age at first birth.

CONCLUSIONS

Our findings suggest that breastfeeding is associated with reduced risk of both HR+ and ER- and PR- breast cancer among Hispanic women, as reported for other populations, and may attenuate the increased risk in women with a first pregnancy at older ages.

Breast cancer-linked lncRNA u-Eleanor is upregulated in breast of healthy women with lack or short duration of breastfeeding

Recently, it has been revealed that estrogen-related reproductive factors are linked with some early gene expression lesions associated with malignancy in clinically healthy breasts. Accordingly, the aim of the current study was to evaluate the association of expression levels of estrogen-related long noncoding RNAs (lncRNAs) upstream Eleanor (u-Eleanor) and HOX antisense intergenic RNA (HOTAIR) with the different patterns of reproductive factors in breast tissue of healthy women. The subjects of this study were 98 cancer-free women who had undergone cosmetic mammoplasty. The expression levels of u-Eleanor and HOTAIR were measured using quantitative real-time polymerase chain reaction. The results of the current study showed that the women without a history of breastfeeding had a high-level expression of u-Eleanor compared with the women with a breastfeeding duration greater than 6 to 24 months (P = 0.03) as well as the women with a breastfeeding duration of more than 24 months (P = 0.005). Furthermore, a higher expression of u-Eleanor was found in the women with a short breastfeeding duration for 1 to 6 months than that in the women with a breastfeeding duration of greater than 24 months (P = 0.02). In the same way, the results of correlation test (r = -0.258; P = 0.036) and multivariate regression model (β = -0.321; P = 0.023) are indicative of a significant relationship of elevated expression of u-Eleanor with decreasing breastfeeding duration in the women. These findings could be important to identify the molecular mechanisms behind the relationship between a lack or short duration of the breastfeeding and the risk of breast cancer, which has previously been reported by epidemiological studies.

Metabolic syndrome and cancer risk: The role of xanthine oxidoreductase

Obesity and related pathologies such as diabetes and metabolic syndrome are associated with chronic inflammation and cancer. The serum level of xanthine oxidoreductase (XOR) is correlated to obesity-associated metabolic disorders. XOR can play a role in the pathogenesis of both metabolic syndrome and cancer through the inflammatory response and the oxidative stress elicited by the products of its activity. The reactive oxygen and nitrogen species and the uric acid derived from XOR concur to the development of hypertension, dyslipidemia and insulin resistance and participate in both cell transformation and proliferation, as well as in the progression and metastasis process. Despite the availability of different drugs to inhibit in vivo XOR activity, the complexity of XOR inhibition effects should be carefully considered before clinical application, save in the case of symptomatic hyperuricemia.

•

Metabolic syndrome (MS) increases the risk of cancer development.

•

Xanthine oxidoreductase (XOR) plays a role in both MS and cancer.

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Uric acid, ROS and RNS produced by XOR cause inflammation and oxidative stress.

•

Inflammation and oxidative stress contribute to the pathogenesis of MS and cancer.

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XOR activity can be pharmacologically controlled.

Racial Differences in Breastfeeding Initiation Among Participants in a Midwestern Public Health District

Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial—two or more races—population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-income women.

Methods: Participants for this study (n=1010) were enrolled in the supplemental nutrition program for women, infant, and children and concurrently enrolled in a perinatal depression registry at a public health clinic in the Midwest. Race was obtained from medical records. Breastfeeding initiation was gathered through a clinical interview during the first postpartum visit. Logistic regression was conducted using STATA 14.2.

Results: Sixty-eight percent of study participants reported breastfeeding initiation. The bivariate analysis demonstrated that there were significant differences in rates of breastfeeding initiation by race/ethnicity. The logistic regression models showed that after adjusting for maternal education, age, income, nativity, parity, body mass index, and antenatal smoking, Black (odds ratio [OR] 0.47; confidence interval [95% CI] 0.34–0.66), multiracial (OR 0.21; 95% CI 0.07–0.65), and Latina women (OR 0.48; 95% CI 0.26–0.86) were significantly less likely to initiate breastfeeding compared with White women.

Conclusion: These findings highlight the need for further understanding of the underlying barriers to the initiation of breastfeeding among low-income Black, multiracial, and Latina women. Moreover, breastfeeding should remain a priority for intervention and policy development, particularly among racially and ethnically diverse low-income women.

Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries

Introduction

Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6  months and breastfeeding duration in low-income and middle-income countries (LMICs).

Methods

We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights.

Results

A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95%  CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95%  CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95%  CI 1.1 to 3.4) in breastfeeding duration.

Conclusion

Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.

Risk Reduction of Breast Cancer by Childbirth, Breastfeeding, and Their Interaction in Korean Women: Heterogeneous Effects Across Menopausal Status, Hormone Receptor Status, and Pathological Subtypes

Objectives

The purpose of this study was to examine the associations of childbirth, breastfeeding, and their interaction with breast cancer (BC) risk reduction, and to evaluate the heterogeneity in the BC risk reduction effects of these factors by menopause, hormone receptor (HR) status, and pathological subtype.

Methods

BC patients aged 40+ from the Korean Breast Cancer Registry in 2004-2012 and controls from the Health Examinee cohort participants were included in this study after 1:1 matching (12 889 pairs) by age and enrollment year. BC risk according to childbirth, breastfeeding, and their interaction was calculated in logistic regression models using odds ratios (ORs) and 95% confidence intervals (CIs).

Results

BC risk decreased with childbirth (3+ childbirths relative to 1 childbirth: OR, 0.66; 95% CI, 0.56 to 0.78 and OR, 0.80; 95% CI, 0.68 to 0.95 in postmenopausal and premenopausal women, respectively); and the degree of risk reduction by the number of children was heterogeneous according to menopausal status (p-heterogeneity=0.04), HR status (p-heterogeneity<0.001), and pathological subtype (p-heterogeneity<0.001); whereas breastfeeding for 1-12 months showed a heterogeneous association with BC risk according to menopausal status, with risk reduction only in premenopausal women (p-heterogeneity<0.05). The combination of 2 more childbirths and breastfeeding for ≥13 months had a much stronger BC risk reduction of 49% (OR, 0.51; 95% CI, 0.45 to 0.58).

Conclusions

This study suggests that the combination of longer breastfeeding and more childbirths reduces BC risk more strongly, and that women who experience both 2 or more childbirths and breastfeed for ≥13 months can reduce their BC risk by about 50%.