title: Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial.
abstract: BACKGROUND
  The duration and exclusivity of breastfeeding in infancy have been inversely associated with future cardiometabolic risk. We investigated the effects of an experimental intervention to promote increased duration of exclusive breastfeeding on cardiometabolic risk factors in childhood.
  
  
  RESULTS
  We followed-up children in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. In 1996 to 1997, 17 046 breastfeeding mother-infant pairs were enrolled from 31 Belarusian maternity hospitals and affiliated polyclinics (16 intervention versus 15 control sites); 13 879 (81.4%) children were followed up at 11.5 years, with 13 616 (79.9%) who had fasted and did not have diabetes mellitus. The outcomes were blood pressure; fasting insulin, adiponectin, glucose, and apolipoprotein A1; and the presence of metabolic syndrome. Analysis was by intention to treat, accounting for clustering within hospitals/clinics. The intervention substantially increased breastfeeding duration and exclusivity in comparison with the control arm (43% versus 6% and 7.9% versus 0.6% exclusively breastfed at 3 and 6 months, respectively). Cluster-adjusted mean differences at 11.5 years between experimental versus control groups were as follows: 1.0 mm Hg (95% confidence interval, -1.1 to 3.1) for systolic and 0.8 mm Hg (-0.6 to 2.3) for diastolic blood pressure; -0.1 mmol/L (-0.2 to 0.1) for glucose; 8% (-3% to 34%) for insulin; -0.3 μg/mL (-1.5 to 0.9) for adiponectin; and 0.0 g/L (-0.1 to 0.1) for apolipoprotein A1. The cluster-adjusted odds ratio for metabolic syndrome, comparing experimental versus control groups, was 1.21 (0.85 to 1.72).
  
  
  CONCLUSIONS
  An intervention to improve breastfeeding duration and exclusivity among healthy term infants did not influence cardiometabolic risk factors in childhood.
  
  
  BACKGROUND
  Current Controlled Trials: ISRCTN37687716 (http://www.controlled-trials.com/ISRCTN37687716). URL: http://clinicaltrials.gov. Unique identifier: NCT01561612.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK (R.M.M., R.P., Y.F., G.D.S.); Medical Research Council/University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK (R.M.M., G.D.S.); National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, UK (R.M.M.); Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada (M.S.K.); National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus (K.V., N.B., N.S., N.G.); Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK (T.P.); and Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (J.T., M.W.G., E.O.).
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
authors.forename: Rita
authors.initials: R
authors.lastname: Patel
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.forename: Konstantin
authors.initials: K
authors.lastname: Vilchuck
authors.forename: Natalia
authors.initials: N
authors.lastname: Bogdanovich
authors.forename: Natalia
authors.initials: N
authors.lastname: Sergeichick
authors.forename: Nina
authors.initials: N
authors.lastname: Gusina
authors.forename: Ying
authors.initials: Y
authors.lastname: Foo
authors.forename: Tom
authors.initials: T
authors.lastname: Palmer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thompson
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: George Davey
authors.initials: GD
authors.lastname: Smith
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D002648:Child; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007333:Insulin Resistance; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D002094:Republic of Belarus / Q000453:epidemiology; D012307:Risk Factors; D014944:World Health Organization
keywords: adiponectin; blood pressure; breast feeding; fasting; glucose; insulins; lactation; lipids; randomized controlled trial