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Shorter Versus Longer Durations of Exclusive Human Milk Feeding and Cardiovascular Disease Outcomes in Offspring: A Systematic Review

, MS, , PhD, , MPH, , , MLS, , MLS, MPH, , MD, , PhD, RD, , MS, RD, , MD, PhD, , PhD, RD, IBCLC, , PhD, , MD, MPH, , PhD, , MD, , PhD, RD, , MS, RDN, and , PhD.

Author Information and Affiliations
Alexandria (VA): USDA Nutrition Evidence Systematic Review; .

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 shorter versus longer durations of exclusive human milk feeding and cardiovascular disease outcomes in offspring?
  • This systematic review examines comparisons of infants who were fed human milk exclusively for shorter durations with infants who were fed human milk exclusively for longer durations. Exclusive human milk feeding was defined as feeding human milk alone and not in combination with infant formula and/or complementary foods or beverages such as cow’s milk. This definition is inclusive of the World Health Organization definitions of exclusive and predominant breastfeeding, which permit limited quantities of (a) drops or syrups containing vitamins, minerals, or medicines, (b) water and water-based drinks such as sweetened water and teas, (c) fruit juice, (d) oral rehydration salts solution, and (e) ritual fluids4. 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.
  • 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 grade

  • Limited evidence suggests that there is no association between the duration of exclusive human milk feeding and blood pressure in childhood or metabolic syndrome at 11.5 years of age. Most of the evidence comes from just one non-US sample assessed using a strong study design.
    There was insufficient evidence to determine the relationship of shorter versus longer durations of exclusive human milk feeding with endpoint cardiovascular disease outcomes, blood pressure in adolescence or adulthood, blood lipids, and metabolic syndrome at ages other than 11.5 years.
    Grade: Limited – blood pressure in childhood, metabolic syndrome at age 11.5 years; Grade Not Assignable – cardiovascular disease, cardiovascular disease-related mortality, blood lipids, blood pressure in adolescence or adulthood, arterial stiffness, metabolic syndrome at ages other than 11.5 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 the included article were extracted, risks of bias were assessed, and both were checked for accuracy.
  • 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

  • Six articles met the inclusion criteria for this systematic review, including 4 with evidence about blood pressure, 2 with evidence about blood lipids, and 1 with evidence about metabolic syndrome (1 article included evidence about both blood pressure and metabolic syndrome).
  • Evidence about the lack of an association between shorter versus longer durations of exclusive human milk feeding and blood pressure in childhood and metabolic syndrome at 11.5 years of age was limited. Most of the evidence came from the Promotion of Breastfeeding Intervention Trial, which used a strong design to examine blood pressure and metabolic syndrome in children in Belarus. One additional study from Brazil provided supporting evidence about childhood blood pressure. The ability to draw stronger conclusions is primarily restricted by the limited number of studies and the lack of evidence from the U.S. where the risk of cardiovascular disease may be higher.
  • Evidence related to other cardiovascular disease outcomes was scant.
4

World Health Organization. Indicators for assessing infant and young child feeding practices: conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C. WHO. 2008.

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. Shorter Versus Longer Durations of Exclusive Human Milk Feeding 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.SR0212

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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].

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.

Bookshelf ID: NBK580888PMID: 35671355DOI: 10.52570/NESR.PB242018.SR0212

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