Applied Evidence

Is the "breast is best" mantra an oversimplification?

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From The Journal of Family Practice | 2018;67(6):E1-E9.

References

A 2015 meta-analysis of 23 high-quality studies with a sample size >1500 children and controlled for important confounders showed a pooled reduction in the prevalence of overweight or obesity of 13% (95% CI, 6-19).57 The protection in this meta-analysis showed a dilution of the effect as the participants aged and an inverse relationship of the effect with sample size.

Breastfeeding is, therefore, unlikely to play a significant, if any, role in combatting the obesity epidemic.

Hypertension. A meta-analysis of high-quality trials demonstrates a <1 mm Hg reduction in systolic blood pressure and no significant difference in diastolic pressure in breastfed infants.57 Similarly, no significant effect of breastfeeding on blood pressure has been demonstrated in trials of preterm infants.51

Type 2 diabetes. Available data are limited and heterogeneous for the association between breastfeeding and later development of type 2 diabetes. Only 2 high-quality trials were identified in the 2013 WHO meta-analysis, and their results conflict.51 A 2015 meta-analysis identified only 3 high-quality studies, without a statistically significant relationship.57

Dyslipidemia. Although earlier data suggested an association between breastfeeding and reduced cholesterol levels later in life, the 2013 WHO meta-analysis and a 2015 meta-analysis concluded that no association exists. The limited data available for preterm infants conflict.51,57

Growth. There is no evidence that feeding method has a short- or long-term effect on weight gain or length gain in preterm or term infants.35,36,58

Death. No clear association has been found between mortality and breastfeeding status in developed countries, except for the association with SIDS.35

Continue to: What issues frame and guide counseling on breastfeeding?

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