Longer Breastfeeding Linked to Better Nutritional and Health Outcomes

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Key clinical point: Encourage breastfeeding. The longer mothers breastfeed their children, the less likely the children are to have ear, throat, and sinus infections and the more likely they are to establish some healthful eating habits.

Major finding: At 6 years of age, children who had been breastfed had significantly reduced odds of ear, throat, and sinus infections; were significantly less likely to drink 100% juice or sugar-sweetened beverages; and were significantly more likely to consume fruits, vegetables, and water than those not breastfed or breastfed a shorter duration.

Data source: Two analyses from the prospective Infant Feeding Practices Study II at year-6 follow-up, involving more than 1,200 children, started in 2005-2007.

Disclosures: Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.

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Wealth of data helps assess long-term effects of infant diet

Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.

The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.

Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.

These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.

This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.




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The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.

The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.

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Children breastfed for longer periods of time were less susceptible to numerous health issues later in life, say two new studies.

In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).

Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.

Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.

Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.

These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.

In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.

"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).

At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.

Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.

Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.

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