Effects of promoting longer-term and exclusive breastfeeding on childhood eating attitudes: a cluster-randomized trial.
BACKGROUND
Observational studies suggest that breastfeeding benefits later maternal child-feeding practices, which in turn may contribute to positive eating attitudes. We investigated the effect of a randomized intervention to increase duration and exclusivity of breastfeeding on pre-adolescent eating attitudes.


METHODS
Long-term follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial in 31 maternity hospitals and affiliated polyclinics in Belarus. Sites were randomly assigned an experimental intervention to promote longer duration and exclusivity of breastfeeding in mothers who initiated breastfeeding (n = 16 sites), or a control intervention of continuing usual care (n = 15 sites); 17 046 healthy infants were enrolled in 1996-7, of whom 13 751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years of age. A ChEAT score ≥ 22.5 (85th percentile) was used as an indicator of problematic eating attitudes. Analysis was based on intention-to-treat, accounting for clustering within hospitals/clinics.


RESULTS
Compared with the control arm, the experimental intervention substantially increased breastfeeding exclusivity (43.3% vs 6.4% exclusively breastfed at 3 months of age) and duration of any breastfeeding throughout infancy. The proportion of children with ChEAT scores ≥ 22.5 was lower in the experimental than control arm (boys 11.4% vs 17.2%; girls 18.5% vs 23.4%) [cluster-adjusted odds ratio (OR), boys: 0.44; 95% confidence interval (CI): 0.21,0.93; girls: 0.51; 95% CI: 0.27,0.99). Results were robust to adjustment for potential confounders and using a ChEAT score ≥ 25.5 (91st percentile) as the outcome (OR: 0.53; 95% CI: 0.28,1.03).


CONCLUSIONS
An intervention to improve the duration and exclusivity of breastfeeding among term infants in Belarus was associated with a reduction in problematic eating attitudes at 11.5 years of age.
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Oleg
O
Skugarevsky
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Kaitlin H
KH
Wade
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Rebecca C
RC
Richmond
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospital
Richard M
RM
Martin
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Kate
K
Tilling
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Rita
R
Patel
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Konstantin
K
Vilchuck
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Natalia
N
Bogdanovich
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Natalia
N
Sergeichick
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
George
G
Davey Smith
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Matthew W
MW
Gillman
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Emily
E
Oken
Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Michael S
MS
Kramer
D001290:Attitude; D001942:Breast Feeding; D002648:Child; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D002094:Republic of Belarus; D016896:Treatment Outcome
Breastfeeding; cluster-randomized trial; problematic eating attitudes