title: Infant-feeding patterns and cardiovascular risk factors in young adulthood: data from five cohorts in low- and middle-income countries.
abstract: BACKGROUND
  Infant-feeding patterns may influence lifelong health. This study tested the hypothesis that longer duration of breastfeeding and later introduction of complementary foods in infancy are associated with reduced adult cardiovascular risk.
  
  
  METHODS
  Data were pooled from 10 912 subjects in the age range of 15-41 years from five prospective birth-cohort studies in low-/middle-income countries (Brazil, Guatemala, India, Philippines and South Africa). Associations were examined between infant feeding (duration of breastfeeding and age at introduction of complementary foods) and adult blood pressure (BP), plasma glucose concentration and adiposity (skinfolds, waist circumference, percentage body fat and overweight/obesity). Analyses were adjusted for maternal socio-economic status, education, age, smoking, race and urban/rural residence and infant birth weight.
  
  
  RESULTS
  There were no differences in outcomes between adults who were ever breastfed compared with those who were never breastfed. Duration of breastfeeding was not associated with adult diabetes prevalence or adiposity. There were U-shaped associations between duration of breastfeeding and systolic BP and hypertension; however, these were weak and inconsistent among the cohorts. Later introduction of complementary foods was associated with lower adult adiposity. Body mass index changed by -0.19 kg/m(2) [95% confidence interval (CI) -0.37 to -0.01] and waist circumference by -0.45 cm (95% CI -0.88 to -0.02) per 3-month increase in age at introduction of complementary foods.
  
  
  CONCLUSIONS
  There was no evidence that longer duration of breastfeeding is protective against adult hypertension, diabetes or overweight/adiposity in these low-/middle-income populations. Further research is required to determine whether 'exclusive' breastfeeding may be protective. Delaying complementary foods until 6 months, as recommended by the World Health Organization, may reduce the risk of adult overweight/adiposity, but the effect is likely to be small.
authors.affiliation: MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Caroline Hd
authors.initials: CH
authors.lastname: Fall
authors.forename: Judith B
authors.initials: JB
authors.lastname: Borja
authors.forename: Clive
authors.initials: C
authors.lastname: Osmond
authors.forename: Linda
authors.initials: L
authors.lastname: Richter
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Bhargava
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Martorell
authors.forename: Aryeh D
authors.initials: AD
authors.lastname: Stein
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Barros
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000886:Anthropometry; D001823:Body Composition; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D007223:Infant; D007225:Infant Food; D016014:Linear Models; D008297:Male; D009765:Obesity / Q000453:epidemiology; D010679:Philippines / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors