title: A randomized breast-feeding promotion intervention did not reduce child obesity in Belarus.
abstract: 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.
authors.affiliation: Departments of Pediatrics and of 5Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, QC, Canada. michael.kramer@mcgill.ca
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.forename: Lidia
authors.initials: L
authors.lastname: Matush
authors.forename: Irina
authors.initials: I
authors.lastname: Vanilovich
authors.forename: Robert W
authors.initials: RW
authors.lastname: Platt
authors.forename: Natalia
authors.initials: N
authors.lastname: Bogdanovich
authors.forename: Zinaida
authors.initials: Z
authors.lastname: Sevkovskaya
authors.forename: Irina
authors.initials: I
authors.lastname: Dzikovich
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Shishko
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Collet
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
authors.forename: George Davey
authors.initials: GD
authors.lastname: Smith
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: Beverley
authors.initials: B
authors.lastname: Chalmers
authors.forename: Ellen
authors.initials: E
authors.lastname: Hodnett
authors.forename: Stanley
authors.initials: S
authors.lastname: Shapiro
mesh_terms: D001942:Breast Feeding; D005260:Female; D006801:Humans; D009765:Obesity / Q000517:prevention & control*; D002094:Republic of Belarus / Q000453:epidemiology