title: Following the World Health Organization's Recommendation of Exclusive Breastfeeding to 6 Months of Age Does Not Impact the Growth of Rural Gambian Infants.
abstract: The WHO recommends exclusive breastfeeding (EBF) for the first 6 mo of life.
  
  
  
  The objective of this study was to assess the benefit of EBF to age 6 mo on growth in a large sample of rural Gambian infants at high risk of undernutrition.
  
  
  
  Infants with growth monitoring from birth to 2 y of age (n = 756) from the ENID (Early Nutrition and Immune Development) trial were categorized as exclusively breastfed if only breast milk and no other liquids or foods were given. EBF status was entered into confounder-adjusted multilevel models to test associations with growth trajectories by using >11,000 weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z score observations.
  
  
  
  Thirty-two percent of infants were exclusively breastfed to age 6 mo. The mean age of discontinuation of EBF was 5.2 mo, and growth faltering started at ∼3.5 mo of age. Some evidence for a difference in WAZ and WHZ was found between infants who were exclusively breastfed to age 6 mo (EBF-6) and those who were not (nEBF-6), at 6 and 12 mo of age, with EBF-6 children having a higher mean z score. The differences in z scores between the 2 groups were small in magnitude (at 6 mo of age: 0.147 WAZ; 95% CI: -0.001, 0.293 WAZ; 0.189 WHZ; 95% CI: 0.038, 0.341 WHZ). No evidence for a difference between EBF-6 and nEBF-6 infants was observed for LAZ at any time point (6, 12, and 24 mo of age). Furthermore, a higher mean WLZ at 3 mo of age was associated with a subsequent higher mean age at discontinuation of EBF, which implied reverse causality in this setting (coefficient: 0.060; 95% CI: 0.008, 0.120).
  
  
  
  This study suggests that EBF to age 6 mo has limited benefit to the growth of rural Gambian infants. This trial was registered at http://www.isrctn.com as ISRCTN49285450.
authors.affiliation: Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom; kamilla.eriksen@mrc-ewl.cam.ac.uk.
authors.forename: Kamilla G
authors.initials: KG
authors.lastname: Eriksen
authors.affiliation: Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Johnson
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: Bakary
authors.initials: B
authors.lastname: Sonko
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Prentice
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: Momodou K
authors.initials: MK
authors.lastname: Darboe
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|Division of Women's Health, King's College London, London, United Kingdom.
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Moore
mesh_terms: D001942:Breast Feeding; D002657:Child Development / Q000502:physiology*; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005714:Gambia; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage; D014944:World Health Organization
chemical_list: D004044:Dietary Proteins; D018977:Micronutrients; D005492:Folic Acid; D007501:Iron
keywords: The Gambia; exclusive breastfeeding; infant feeding practice; multilevel modelling; postnatal growth; reverse causality