title: Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study.
abstract: Background:Early feeding patterns may affect the growth of HIV-exposed children and thus their subsequent health and cognition.Objective:We assessed the association of infant feeding (IF) mode with length-for-agezscore (LAZ) and stunting from age 2 d to 18 mo in HIV-exposed African children within a controlled randomized trial, which evaluated triple antiretrovirals initiated during pregnancy and continued for 6 mo postpartum to prevent HIV transmission.Methods:HIV-infected pregnant women with CD4+counts of 200-500 cells/mm3from Burkina Faso, Kenya, and South Africa were advised to exclusively breastfeed for up to 6 mo or to formula-feed from birth. Factors associated with LAZ were investigated in all uninfected children by using mixed-effects linear models; those associated with stunting (LAZ <-2) at 6 or 12 mo were assessed in multiple logistic regression after exclusion of children stunted at age 2 d. Independent variables were IF mode: formula feeding (FF), exclusive breastfeeding (EBF) <3 mo, or EBF ≥3 mo (reference); sex; trial arm; maternal characteristics; and site.Results:Among 728 children, FF was associated with a greater increase in LAZ from 2 d to 6 mo (+0.07zscore/mo,P< 0.001). Between 6 and 18 mo, FF and EBF <3 mo were both associated with greater mean LAZ than was EBF ≥3 mo (+0.52zscores and +0.43zscores, respectively,P< 0.001). Among children not stunted at 2 d, FF was independently associated with a reduced risk of stunting at 6 mo (OR: 0.24; 95% CI: 0.07, 0.81;P= 0.021), whereas EBF <3 mo was not (OR: 0.49; 95% CI: 0.22, 1.10;P= 0.09).Conclusions:In this observational study of HIV-exposed uninfected infants, growth in length in the first 6 mo of life was faster in formula-fed infants than in exclusively breastfed infants. The plausibility of residual confounding and reverse causality is discussed. This trial was registered at www.controlled-trials.com as ISRCTN71468401.
authors.affiliation: Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France; kirsten.bork@ird.fr.
authors.forename: Kirsten A
authors.identifier: 0000-0002-5909-7332
authors.initials: KA
authors.lastname: Bork
authors.affiliation: Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Cames
authors.affiliation: Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.affiliation: University of California at San Francisco, San Francisco, CA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.affiliation: Centre Muraz, Bobo-Dioulasso, Burkina Faso.
authors.forename: Kossiwavi
authors.initials: K
authors.lastname: Ayassou
authors.affiliation: International Centre for Reproductive Health, Mombasa, Kenya; and.
authors.forename: Faith
authors.initials: F
authors.lastname: Musyoka
authors.affiliation: Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Mbatia
authors.affiliation: Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Cournil
mesh_terms: D001903:Bottle Feeding; D001942:Breast Feeding; D002657:Child Development; D005260:Female; D006130:Growth Disorders / Q000517:prevention & control; D015658:HIV Infections; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D009752:Nutritional Status; D011247:Pregnancy
keywords: Africa; HIV infection; breastfeeding; infant growth; stunting