TY - JOUR

T1 - Effects of promoting increased duration and exclusivity of breastfeeding on adiposity and insulin-like growth factor-I at age 11.5 years

T2 - a randomized trial

AU - Martin, Richard M.

AU - Patel, Rita

AU - Kramer, Michael S.

AU - Guthrie, Lauren

AU - Vilchuck, Konstantin

AU - Bogdanovich, Natalia

AU - Sergeichick, Natalia

AU - Gusina, Nina

AU - Foo, Ying

AU - Palmer, Tom

AU - Rifas-Shiman, Sheryl L.

AU - Gillman, Matthew W.

AU - Davey Smith, George

AU - Oken, Emily

PY - 2013/3/13

Y1 - 2013/3/13

N2 - IMPORTANCE: Evidence that increased duration and exclusivity of breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding. OBJECTIVE: To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I (which regulates growth). DESIGN: Cluster-randomized controlled trial. SETTING: 31 Belarusian maternity hospitals and their affiliated polyclinics, randomized to usual practices (n=15) or a breastfeeding promotion intervention (n=16). PARTICIPANTS: 17,046 breastfeeding mother-infant pairs enrolled in 1996/7, of whom 13,879 (81.4%) were followed-up between January 2008 and December 2010 at a median age of 11.5 years. INTERVENTION: Breastfeeding promotion intervention modeled on the WHO/UNICEF Baby Friendly Hospital Initiative. MAIN OUTCOME MEASURES: Body mass index (BMI), fat and fat-free mass indices (FMI and FFMI), percent body fat, waist circumference, triceps and subscapular skinfold thicknesses, overweight and obesity, and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat (without imputation), accounting for clustering within hospitals/clinics. RESULTS: The experimental intervention substantially increased breastfeeding duration and exclusivity (43% vs. 6% and 7.9% vs. 0.6% exclusively breastfed at 3 and 6 months, respectively) versus the control intervention. Cluster-adjusted mean differences in outcomes at 11.5 years between experimental vs. control groups were: 0.19 kg/m(2) (95% 4 CI: −0.09, 0.46) for BMI; 0.12 kg/m(2) (−0.03, 0.28) for FMI; 0.04 kg/m(2) (−0.11, 0.18) for FFMI; 0.47% (−0.11, 1.05) for % body fat; 0.30 cm (−1.41, 2.01) for waist circumference; −0.07 mm (−1.71, 1.57) for triceps and −0.02 mm (−0.79, 0.75) for subscapular skinfold thicknesses; and −0.02 standard deviations (−0.12, 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight / obesity (BMI ≥85(th) percentile vs

AB - IMPORTANCE: Evidence that increased duration and exclusivity of breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding. OBJECTIVE: To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I (which regulates growth). DESIGN: Cluster-randomized controlled trial. SETTING: 31 Belarusian maternity hospitals and their affiliated polyclinics, randomized to usual practices (n=15) or a breastfeeding promotion intervention (n=16). PARTICIPANTS: 17,046 breastfeeding mother-infant pairs enrolled in 1996/7, of whom 13,879 (81.4%) were followed-up between January 2008 and December 2010 at a median age of 11.5 years. INTERVENTION: Breastfeeding promotion intervention modeled on the WHO/UNICEF Baby Friendly Hospital Initiative. MAIN OUTCOME MEASURES: Body mass index (BMI), fat and fat-free mass indices (FMI and FFMI), percent body fat, waist circumference, triceps and subscapular skinfold thicknesses, overweight and obesity, and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat (without imputation), accounting for clustering within hospitals/clinics. RESULTS: The experimental intervention substantially increased breastfeeding duration and exclusivity (43% vs. 6% and 7.9% vs. 0.6% exclusively breastfed at 3 and 6 months, respectively) versus the control intervention. Cluster-adjusted mean differences in outcomes at 11.5 years between experimental vs. control groups were: 0.19 kg/m(2) (95% 4 CI: −0.09, 0.46) for BMI; 0.12 kg/m(2) (−0.03, 0.28) for FMI; 0.04 kg/m(2) (−0.11, 0.18) for FFMI; 0.47% (−0.11, 1.05) for % body fat; 0.30 cm (−1.41, 2.01) for waist circumference; −0.07 mm (−1.71, 1.57) for triceps and −0.02 mm (−0.79, 0.75) for subscapular skinfold thicknesses; and −0.02 standard deviations (−0.12, 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight / obesity (BMI ≥85(th) percentile vs

U2 - 10.1001/jama.2013.167

DO - 10.1001/jama.2013.167

M3 - Journal article

VL - 309

SP - 1005

EP - 1013

JO - Journal of the American Medical Association

JF - Journal of the American Medical Association

SN - 0098-7484

IS - 10

ER -