Copyright Notice
The contents of this document may be used and reprinted without permission. Endorsements by NESR, NGAD, CNPP, FNS, or USDA of derivative products developed from this work may not be stated or implied.
< PrevNext >
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
< PrevNext >
Never Versus Ever Feeding Human Milk and Cardiovascular Disease Outcomes in Offspring: A Systematic Review
Darcy Güngör, MS, Perrine Nadaud, PhD, Carol Dreibelbis, MPH, Concetta LaPergola, Nancy Terry, MLS, Yat Ping Wong, MLS, MPH, Steve A. Abrams, MD, Leila Beker, PhD, RD, Tova Jacobovits, MS, RD, Kirsi M Järvinen, MD, PhD, Laurie A. Nommsen-Rivers, PhD, RD, IBCLC, Kimberly O. O’Brien, PhD, Emily Oken, MD, MPH, Rafael Pérez-Escamilla, PhD, Ekhard Ziegler, MD, Kellie O. Casavale, PhD, RD, Joanne M. Spahn, MS, RDN, and Eve Stoody, PhD.
Author Information and AffiliationsAlexandria (VA): USDA Nutrition Evidence Systematic Review; 2019 Apr.
TECHNICAL ABSTRACT
Background
- This systematic review was conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
- The goal of this systematic review was to examine the following question: What is the relationship between never versus ever feeding human milk and cardiovascular disease outcomes in offspring?
- This systematic review examines comparisons of infants who were never fed human milk with infants who were ever fed human milk (i.e., any amount of human milk feeding). Human milk feeding was defined as feeding human milk alone or in combination with infant formula and/or complementary foods or beverages such as cow’s milk. Human milk was defined as mother’s own milk provided at the breast (i.e., nursing) or expressed and fed fresh or after refrigeration or freezing. Donor milk (e.g., banked milk) was not examined in this review. Infant formula was defined as commercially-prepared infant formula meeting FDA and/or Codex Alimentarius international food standards.
- This systematic review examines available evidence related to cardiovascular disease outcomes in offspring from childhood through adulthood, including blood lipids, blood pressure, arterial stiffness, metabolic syndrome, cardiovascular disease, and cardiovascular disease-related mortality.
Conclusion statement and grades
- Limited evidence suggests that never versus ever being fed human milk is associated with higher blood pressure, within a normal range, at 6 to 7 years of age.Evidence about the relationship of never versus ever being fed human milk with blood lipids in childhood was inconclusive, and there was insufficient evidence to determine the relationship of never versus ever being fed human milk with endpoint cardiovascular disease outcomes, blood pressure and blood lipids in adolescence or adulthood, metabolic syndrome, and arterial stiffness.Grade: Limited – blood pressure at 6 to 7 years of age; Grade Not Assignable – cardiovascular disease, cardiovascular disease-related mortality, blood lipids, arterial stiffness, metabolic syndrome, blood pressure at ages other than at 6 to 7 years
Methods
- The systematic review was conducted by a team of staff from the Nutrition Evidence Systematic Review in collaboration with a Technical Expert Collaborative.
- A single literature search was conducted to identify literature for several related systematic reviews that examined infant milk-feeding practices and different outcomes. The search was conducted in CINAHL, Cochrane, Embase, and PubMed, and used a search date range of January 1980 to March 2016. A manual search was done to identify articles that may not have been included in the electronic databases searched.
- Articles were screened independently by 2 NESR analysts to determine which articles met predetermined criteria for inclusion.
- Data from each included article were extracted, risks of bias were assessed, and both were checked for accuracy.
- The body of evidence was qualitatively synthesized, a conclusion statement was developed, and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence.
Summary of evidence
- Thirteen articles met the inclusion criteria for this systematic review, including 4 with evidence about blood lipids, 7 with evidence about blood pressure, 2 with evidence about arterial stiffness, and 1 with evidence about metabolic syndrome (1 article presented evidence for both blood pressure and arterial stiffness). None of the included articles presented evidence about cardiovascular disease or cardiovascular disease-related mortality.
- Evidence about the association between never versus ever feeding human milk and higher blood pressure, within a normal range, at 6 to 7 years of age was limited. Across the 5 independent studies (6 articles) that examined blood pressure in children, 3 found statistically significant associations, and all of them showed that never being fed human milk was associated with higher blood pressure within a normal range. The ability to draw stronger conclusions was primarily limited by the small number of studies, the lack of studies from the United States (where cardiovascular disease risk may be higher), and concerns about internal validity such as the potential for confounding.
- Evidence about blood lipids in childhood was inconclusive. Across 3 independent studies, the only significant association was in a subsample of boys, there were no comparable analyses with which to compare the significant finding, and the nonsignificant associations were inconsistent in direction.
- Evidence related to outcomes beyond childhood was scant, and no studies examined endpoint health outcomes (i.e., cardiovascular disease and cardiovascular disease-related mortality).
Contents
Funding source: United States Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA
Suggested citation:
Güngör D, Nadaud P, Dreibelbis C, LaPergola C, Terry N, Wong YP, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O’Brien KO, Oken E, Pérez-Escamilla R, Ziegler, EE, Casavale KO, Spahn JM, Stoody E. Never Versus Ever Feeding Human Milk and Cardiovascular Disease Outcomes in Offspring: A Systematic Review. April 2019. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.PB242018.SR0210
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons using assistive technology should be able to access information in this report. For further assistance please email vog.ADSU@RSEN.NF.MS.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
- (1)
mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410;
- (2)
fax: (202) 690-7442; or
- (3)
email: vog.adsu@ekatni.margorp.
USDA is an equal opportunity provider, employer, and lender.
Related citations:
This systematic review has also been published in the American Journal of Clinical Nutrition: Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O’Brien KO, Oken E, Pérez-Escamilla R, Ziegler, EE, Spahn JM. Infant milk-feeding practices and cardiovascular disease outcomes in offspring: a systematic review. Am J Clin Nutr. 2019;109(7):757S–71S. Available at: https://doi.org/10.1093/ajcn/nqy332 [PMC free article: PMC6500929] [PubMed: 30982871].
Related citations are published in the American Journal of Clinical Nutrition:
- P/B-24 Project overview: Stoody EE, Spahn JM, Casavale KO. The Pregnancy and Birth to 24 Months Project: a series of systematic reviews on diet and health. Am J Clin Nutr. 2019;109(7):685S–97S. Available at: https://doi.org/10.1093/ajcn/nqy372 [PubMed: 30982878].
- P/B-24 Project systematic review methodology: Obbagy JE, Spahn JM, Wong YP, Psota TL, Spill MK, Dreibelbis C, Gungor DE, Nadaud P, Raghavan R, Callahan EH, English LK, Kingshipp BL, LaPergola CC, Shapiro MJ, Stoody EE. Systematic review methodols used in the Pregnancy and Birth to 24 Months Project. Am J Clin Nutr. 2019;109(7):698S–704S. Available at https://doi.org/10.1093/ajcn/nqy226 [PubMed: 30445449].
- NLM CatalogRelated NLM Catalog Entries
- Review Never Versus Ever Feeding Human Milk and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic Review[ 2019]Review Never Versus Ever Feeding Human Milk and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic ReviewGüngör D, Nadaud P, Dreibelbis C, LaPergola C, Terry N, Wong YP, Abrams SA, Beker L, Jacobovits T, Järvinen KM, et al. 2019 Apr
- Review Shorter Versus Longer Durations of Any Human Milk Feeding and Cardiovascular Disease Outcomes in Offspring: A Systematic Review[ 2019]Review Shorter Versus Longer Durations of Any Human Milk Feeding and Cardiovascular Disease Outcomes in Offspring: A Systematic ReviewGüngör D, Nadaud P, Dreibelbis C, LaPergola C, Terry N, Wong YP, Abrams SA, Beker L, Jacobovits T, Järvinen KM, et al. 2019 Apr
- Review The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Overweight and Obesity: A Systematic Review[ 2020]Review The Duration, Frequency, and Volume of Exclusive Human Milk and/or Infant Formula Consumption and Overweight and Obesity: A Systematic ReviewDewey K, Bazzano L, Davis T, Donovan S, Taveras E, Kleinman R, Güngör D, Madan E, Venkatramanan S, Terry N, et al. 2020 Jul
- Review Shorter Versus Longer Durations of Exclusive Human Milk Feeding and Cardiovascular Disease Outcomes in Offspring: A Systematic Review[ 2019]Review Shorter Versus Longer Durations of Exclusive Human Milk Feeding and Cardiovascular Disease Outcomes in Offspring: A Systematic ReviewGüngör D, Nadaud P, Dreibelbis C, LaPergola C, Terry N, Wong YP, Abrams SA, Beker L, Jacobovits T, Järvinen KM, et al. 2019 Apr
- Review Shorter Versus Longer Durations of Any Human Milk Feeding and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic Review[ 2019]Review Shorter Versus Longer Durations of Any Human Milk Feeding and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic ReviewGüngör D, Nadaud P, Dreibelbis C, LaPergola C, Terry N, Wong YP, Abrams SA, Beker L, Jacobovits T, Järvinen KM, et al. 2019 Apr
- Never Versus Ever Feeding Human Milk and Cardiovascular Disease Outcomes in Offs...Never Versus Ever Feeding Human Milk and Cardiovascular Disease Outcomes in Offspring: A Systematic Review
Your browsing activity is empty.
Activity recording is turned off.
See more...