- © 2017 American Society for Nutrition
Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study1,2,3,4
- Kirsten A Bork5,*,
- Cécile Cames5,
- Marie-Louise Newell6,
- Jennifer S Read7,
- Kossiwavi Ayassou8,
- Faith Musyoka9,
- Grace Mbatia10, and
- Amandine Cournil5
- for the Kesho Bora Study Group
- 5Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France;
- 6Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom;
- 7University of California at San Francisco, San Francisco, CA;
- 8Centre Muraz, Bobo-Dioulasso, Burkina Faso;
- 9International Centre for Reproductive Health, Mombasa, Kenya; and
- 10Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya
- ↵*To whom correspondence should be addressed. E-mail: kirsten.bork{at}ird.fr.
Abstract
Background: Early feeding patterns may affect the growth of HIV-exposed children and thus their subsequent health and cognition.
Objective: We assessed the association of infant feeding (IF) mode with length-for-age z score (LAZ) and stunting from age 2 d to 18 mo in HIV-exposed African children within a controlled randomized trial, which evaluated triple antiretrovirals initiated during pregnancy and continued for 6 mo postpartum to prevent HIV transmission.
Methods: HIV-infected pregnant women with CD4+ counts of 200–500 cells/mm3 from Burkina Faso, Kenya, and South Africa were advised to exclusively breastfeed for up to 6 mo or to formula-feed from birth. Factors associated with LAZ were investigated in all uninfected children by using mixed-effects linear models; those associated with stunting (LAZ <−2) at 6 or 12 mo were assessed in multiple logistic regression after exclusion of children stunted at age 2 d. Independent variables were IF mode: formula feeding (FF), exclusive breastfeeding (EBF) <3 mo, or EBF ≥3 mo (reference); sex; trial arm; maternal characteristics; and site.
Results: Among 728 children, FF was associated with a greater increase in LAZ from 2 d to 6 mo (+0.07 z score/mo, P < 0.001). Between 6 and 18 mo, FF and EBF <3 mo were both associated with greater mean LAZ than was EBF ≥3 mo (+0.52 z scores and +0.43 z scores, respectively, P < 0.001). Among children not stunted at 2 d, FF was independently associated with a reduced risk of stunting at 6 mo (OR: 0.24; 95% CI: 0.07, 0.81; P = 0.021), whereas EBF <3 mo was not (OR: 0.49; 95% CI: 0.22, 1.10; P = 0.09).
Conclusions: In this observational study of HIV-exposed uninfected infants, growth in length in the first 6 mo of life was faster in formula-fed infants than in exclusively breastfed infants. The plausibility of residual confounding and reverse causality is discussed. This trial was registered at www.controlled-trials.com as ISRCTN71468401.
Footnotes
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↵1 Supported by the Agence Nationale de Recherche sur le Sida et les hépatites virales, Department for International Development, European and Developing Countries Clinical Trials Partnership, Thrasher Research Fund, Belgian Directorate General for International Cooperation, GlaxoSmithKline Foundation, the CDC, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, United Nations Development Programme/United Nations Population Fund/World Bank/WHO Special Programme of Research, and Development and Research Training in Human Reproduction.
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↵2 Author disclosures: KA Bork, C Cames, M-L Newell, JS Read, K Ayassou, F Musyoka, G Mbatia, and A Cournil, no conflicts of interest.
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↵3 The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funders (WHO, the CDC, European and Developing Countries Clinical Trials Partnership, and the NIH).
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↵4 Supplemental Table 1 is available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.
- Manuscript received: October 7, 2016.
- Initial review completed: November 17, 2016.
- Revision accepted: December 21, 2016.
