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Infant Feeding and the Development of Obesity: What Does the Science Tell Us?

A Randomized Breast-feeding Promotion Intervention Did Not Reduce Child Obesity in Belarus^1,2,3

⁴ Departments of Pediatrics, McGill University Faculty of Medicine, Montreal, QC H3G 1Y6, Canada ⁵ Departments of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, QC H3G 1Y6, Canada ⁶ National Research and Applied Medicine Mother and Child Centre, 220053 Minsk, Belarus ⁷ MRC Centre for Causal Analysis in Translational Epidemiology and Department of Social Medicine, University of Bristol, Bristol BS8 1TH, UK ⁸ Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston, MA 02215 ⁹ Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada ¹⁰ Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada

The evidence that breast-feeding protects against obesity is based on observational studies, with potential for confounding and selection bias. This article summarizes a previously published study in which we assessed whether an intervention designed to promote exclusive and prolonged breast-feeding affects children's height, weight, adiposity, and blood pressure (BP) at age 6.5 y. The Promotion of Breastfeeding Intervention Trial (PROBIT) is a cluster-randomized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative. A total of 17,046 healthy breast-fed infants were enrolled from 31 Belarussian maternity hospitals and affiliated clinics, of whom 13,889 (81.5%) were followed up at 6.5 y with duplicate measurements of height, weight, waist circumference, triceps and subscapular skinfold thicknesses, systolic and diastolic BP. Analysis was based on intention to treat, with statistical adjustment for clustering within hospitals/clinics to permit inferences at the individual level. The experimental intervention led to a large increase in exclusive breast-feeding at 3 mo (43.3% vs. 6.4%, P < 0.001) and a significantly higher prevalence of any breast-feeding throughout infancy. No significant intervention effects were observed on height, BMI, adiposity measures, or BP. The breast-feeding promotion intervention resulted in substantial increases in the duration and exclusivity of breast-feeding yet did not reduce measures of adiposity at age 6.5 y. Previous reports of protective effects against obesity may reflect uncontrolled bias caused by confounding and selection.

^* To whom correspondence should be addressed. E-mail: michael.kramer{at}mcgill.ca.