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Cited by 168Breastfeeding Practices and InfluencesInfant Nutrition and HealthObesity, Physical Activity, Diet

Effects of Promoting Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like Growth Factor-I at Age 11.5 Years: A Randomized Trial

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Martin, Richard M., Patel, Rita, Kramer, Michael S., Guthrie, Lauren, Vilchuck, Konstantin, Bogdanovich, Natalia, Sergeichick, Natalia, Gusina, Nina +6 more·2013·JAMA
DOI 10.1001/jama.2013.167PMC PMC3752893
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Abstract

IMPORTANCE: Evidence that longer-term and exclusive 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, SETTING, AND PARTICIPANTS: Cluster-randomized controlled trial in 31 Belarusian maternity hospitals and their affiliated clinics, randomized into 1 of 2 groups: breastfeeding promotion intervention (n = 16) or usual practices (n = 15). Participants were 17,046 breastfeeding mother-infant pairs enrolled in 1996 and 1997, 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 (World Health Organization/United Nations Children's Fund). 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 and clinics. RESULTS: The experimental intervention substantially increased breastfeeding duration and exclusivity when compared with the control (43% vs 6% exclusively breastfed at 3 months and 7.9% vs 0.6% at 6 months). Cluster-adjusted mean differences in outcomes at 11.5 years of age between experimental vs control groups were: 0.19 (95% CI, -0.09 to 0.46) for BMI; 0.12 (-0.03 to 0.28) for FMI; 0.04 (-0.11 to 0.18) for FFMI; 0.47% (-0.11% to 1.05%) for percent body fat; 0.30 cm (-1.41 to 2.01) for waist circumference; -0.07 mm (-1.71 to 1.57) for triceps and -0.02 mm (-0.79 to 0.75) for subscapular skinfold thicknesses; and -0.02 standard deviations (-0.12 to 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight/obesity (BMI ≥ 85th vs <85th percentile) was 1.18 (95% CI, 1.01 to 1.39) and for obesity (BMI ≥ 95th vs <85th percentile) was 1.17 (95% CI, 0.97 to 1.41). CONCLUSIONS: AND RELEVANCE Among healthy term infants in Belarus, an intervention that succeeded in improving the duration and exclusivity of breastfeeding did not prevent overweight or obesity, nor did it affect IGF-I levels at age 11.5 years. Breastfeeding has many advantages but population strategies to increase the duration and exclusivity of breastfeeding are unlikely to curb the obesity epidemic. TRIAL REGISTRATION: isrctn.org: ISRCTN37687716; and clinicaltrials.gov: NCT01561612.

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Crossref · 10.1001/jama.2013.167

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  • 17,046 Belarusian women with healthy singleton births were randomized to a breastfeeding promotion intervention or usual care.

    “17 046 Belarusian women with healthy singleton births were randomized to a breastfeeding promotion intervention or usual care.”

    From Triangulation in aetiological epidemiology (2017) · cites this paper as [66]

  • An intention-to-treat analysis was used to assess the impact of these differences on BMI at age 6.5 (n = 13,879) and on BMI and fat mass index (FMI) at age 11.5 (n = 13,866).

    “An intention- to-treat analysis was used to assess the impact of these differences on BMI at age 6.5 (n = 13 879) and on BMI and fat mass index (FMI) at age 11.5 (n = 13 866).”

    From Triangulation in aetiological epidemiology (2017) · cites this paper as [66]

  • The intervention resulted in marked differences in ever breastfeeding, duration of breastfeeding and whether breastfeeding was exclusive.

    “The intervention resulted in marked differences in ever breastfeeding, duration of breastfeeding and whether breastfeeding was exclusive.”

    From Triangulation in aetiological epidemiology (2017) · cites this paper as [66]

  • The large RCT of a breastfeeding intervention that resulted in marked differences in breastfeeding practice showed no effect of randomization on BMI at mean age 6.5 years.

    “The large RCT of a breastfeeding intervention that resulted in marked differences in breastfeeding practice showed no effect of randomization on BMI at mean age 6.5 years”

    From Triangulation in aetiological epidemiology (2017) · cites this paper as [66]

  • The large RCT showed no effect of randomization on BMI or fat mass index at age 11.5 years.

    “or on BMI or fat mass index at age 11.5 years.65,66”

    From Triangulation in aetiological epidemiology (2017) · cites this paper as [66]

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Research works printed but not linked: 2

  1. [22]National Committee for Clinical Laboratory Standards (NCCLS) Blood Collection on Filter Paper for Neonatal Screening Programs, approved standard, National Committee for Clinical Laboratory Standards Document A4A3 1997 3rd edition Wayne, PA National Committee for Clinical Laboratory Standards
  2. [34]Nelson MC Gordon-Larsen P Adair LS Are Adolescents Who Were Breast-fed Less Likely to Be Overweight?: Analyses of Sibling Pairs to Reduce Confounding Epidemiology 2005 16 247 253 15703541

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Authors
Martin, R. M., Patel, R., Kramer, M. S., Guthrie, L., Vilchuck, K., Bogdanovich, N., Sergeichick, N., Gusina, N., Foo, Y., Palmer, T., Rifas-Shiman, S. L., Gillman, M. W., Smith, G. D., & Oken, E.
Affiliations
  • University of Bristol (GB)
  • McGill University (CA)
  • Harvard University (US)
Corresponding author
Martin, Richard M.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2013-03-13
Volume
309
Issue
10
Pages
1005
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2013.167
PMC
PMC3752893
OpenAlex
W1992052312
Cited by
168
References
44
Citations by year
2026: 4 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 11 · 2020: 7 · 2019: 11 · 2018: 12 · 2017: 17 · 2016: 20 · 2015: 21 · 2014: 22 · 2013: 20 · 2012: 1
FWCI
20.16
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Lancaster EPrints (Lancaster University) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
Funders
  • Canadian Institutes of Health Research (MOP_53155)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD069408, R01HD050758)
Topics
  • Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
  • Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
breastfeeding promotion, exclusive breastfeeding, breastfeeding duration, childhood obesity, adiposity, insulin-like growth factor I, Baby-Friendly Hospital Initiative, body mass index, fat mass, fat-free mass, waist circumference, skinfold thickness, childhood overweight, maternity hospital, Belarus, confounding adjustment
MeSH terms
Adult, Breast Feeding, Republic of Belarus, Child, Female, Follow-Up Studies, Health Promotion, Hospitals, Maternity, Humans, Infant, Infant, Newborn, Insulin-Like Growth Factor I, Male, Obesity, Pregnancy, Time Factors, Adiposity, Overweight, Young Adult

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