BACKGROUND AND OBJECTIVES:Preterm birth relates to long-term alterations in cardiac morphology and function. Understanding whether preterm postnatal life is a tractable period of cardiovascular development that can be positively altered by nutrition is relevant to long-term outcomes. We hypothesized that being fed human breast milk during early postnatal life is beneficial to long-term cardiac structure and function in preterm-born individuals compared with infant formulas.

METHODS:A total of 926 preterm-born infants originally took part in a randomized controlled trial of postnatal milk-feeding regimens between 1982 and 1985 across 5 different UK centers. Preterm-born individuals were randomly assigned to either breast milk donated by unrelated lactating women or nutrient-enriched formulas. We followed 102 individuals from this cohort: 30 of whom had been randomized to being fed exclusively human milk and 16 to being fed exclusively formula. As a comparison group, we recruited an additional 102 individuals born term to uncomplicated pregnancies. Cardiac morphology and function were assessed by MRI.

RESULTS:Preterm-born individuals fed exclusively human milk as infants had increased left and right ventricular end-diastolic volume index (+9.73%, P = .04 and +18.2%, P<.001) and stroke volume index (+9.79%, P = .05 and +22.1%, P = .01) compared with preterm-born individuals who were exclusively formula fed as infants.

CONCLUSIONS:This study provides the first evidence of a beneficial association between breast milk and cardiac morphology and function in adult life in those born preterm and supports promotion of human milk for the care of preterm infants to reduce long-term cardiovascular risk.

BACKGROUND AND OBJECTIVES:Kawasaki disease (KD) is the most common cause of childhood-acquired heart disease in developed countries. However, the etiology of KD is not known. Aberrant immune responses are considered to play key roles in disease initiation and breastfeeding can mature immune system in infants. We thus examined the association between breastfeeding and the development of KD.

METHODS:We used a nationwide population-based longitudinal survey ongoing since 2010 and restricted participants to a total of 37 630 children who had data on their feeding during infancy. Infant feeding practice was queried at 6 to 7 months of age, and responses to questions about hospital admission for KD during the period from 6 to 30 months of age were used as outcome. We conducted logistic regression analyses controlling for child and maternal factors with formula feeding without colostrum as our reference group.

RESULTS:A total of 232 hospital admissions were observed. Children who were breastfed exclusively or partially were less likely to be hospitalized for KD compared with those who were formula fed without colostrum; odds ratios for hospitalization were 0.26 (95% confidence interval: 0.12-0.55) for exclusive breastfeeding and 0.27 (95% confidence interval: 0.13-0.55) for partial breastfeeding. Although the risk reduction was not statistically significant, feeding colostrum only also provided a protective effect.

CONCLUSIONS:We observed protective effects of breastfeeding on the development of KD during the period from 6 to 30 months of age in a nationwide, population-based, longitudinal survey in Japan, the country in which KD is most common.

Abstract Background: A recent study showed that current suboptimal U.S. breastfeeding rates cost the U.S. economy $13 billion per year in 2007 dollars for pediatric health cost and premature death. Cost data of excess maternal disease are not yet published but are thought to be substantial. Little is known about other costs. Methods: The approximate annual costs of many entities that impact breastfeeding or are impacted by breastfeeding were calculated and converted to 2010 dollars. Calculations assumed the United States went from 2007 breastfeeding rates to 90% compliance with medical recommendations. We included pediatric health costs, formula costs, cost of extra food for lactating women, paid leave, and additional factors. Results: If 90% of mothers could comply with current medical recommendations around breastfeeding, our economy could save $3.7 billion in direct and indirect pediatric health costs, with $10.1 billion in premature death from pediatric disease. We would spend $3.9 billion less per year on infant formula. Additional food for nursing mothers would cost up to $1.6-2.1 billion, and more Baby-Friendly(®) (World Health Organization, Geneva, Switzerland/UNICEF, New York, NY) births would cost $0.145 billion. Paid leave would cost $6.2 billion for 12 weeks at 55% pay. Note that current formula company rebates of $2 billion to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are equal to 32% of net WIC expenditures. Conclusions: Even including paid leave, the net cost to our economy of our suboptimal breastfeeding rates would still be at least $8.7 billion. Paid leave would be expected to improve breastfeeding duration and reduce disparities. The WIC budget is dependent on formula company rebates, a conflicting situation.

Breastfeeding has been shown to benefit both maternal and child immune status. The impact of exclusive breastfeeding in the presence of HIV infection on maternal and child health is still unclear. Socio-economic factors make breast-feeding an important source of nutrition for an infant 6 months and under in the developing world. A prospective study was conducted to examine the impact of feeding mode on various maternal indices including anthropometry; body composition indicators (using FTIR); haematology and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease progression. In infants we examined the impact on growth, development and morbidity. AFASS criteria (affordable, feasible, accessible, sustainable and safe) were fulfilled by 38.7% of the formula feeding mothers. No significant differences between the formula feeding and breastfeeding groups in terms of haematological, immunological and body composition changes were seen. Breastfeeding mothers had significantly lower events with high depression scores (P = 0.043). Breastfeeding infants had a significantly lower risk of diarrhoea and hospitalisation at 3 months (P = 0.006 and 0.014 respectively). Breastfeeding was significantly associated with better development scores and growth parameters. Breastfeeding is not harmful to the mother in the presence of HIV infection. Mothers are still choosing formula feeding inappropriately despite counselling about the AFASS criteria. Breastfeeding is beneficial to the infants especially in the first 3 months of life.

The worldwide prevalence of childhood asthma has been increasing considerably, and the protection afforded by breastfeeding in its development has been the subject of controversy for more than 80 years. Previous systematic reviews have generally found a protective effect of breastfeeding on allergic outcomes, although many studies have methodological limitations. Although breastfeeding is protective against lower respiratory tract infection during infancy, such protection has not been demonstrated for asthma in all studies. Breastfeeding has health benefits for the mother and child. Exclusive breastfeeding for the first 6 months of an infant's life, with continued breastfeeding for up to 2 years or longer, is recognized as the"gold"standard for infant feeding because human milk is uniquely suited to the human infant, and its nutritional content and bioactivity promote a healthy development. There is increasing concern that the practice of delaying complementary foods until 6 months may exacerbate the risk of allergic disease. Breast milk contains immunological components that protect against infections and allergic disease in infancy. The composition of human breast milk is complex, containing factors that interact with the infant immune system and intestinal milieu including allergens, cytokines, immunoglobulins, polyunsaturated fatty acids, and chemokines. Transforming growth factorβ is a cytokine in human milk involved in maintaining intestinal homeostasis, inflammation regulation, and oral tolerance development. Modern day society, with increased standards of hygiene, has changed the gut flora of Western infants, potentially impacting the risk of developing immune-mediateddiseases including allergic disease and asthma. Microbial diversity is intrinsic to healthy immune maturation and function. Compared to breastfed infants, formula-fed infants had lower bacterial diversity and an altered intestinal microbiota in the first few weeks of life associated with an increased risk of eczema and asthma. Favorable gut colonization through continued breastfeeding may promote tolerance as well as protection when complementary feeding is initiated.

Background:Premature infants fed formula are more likely to develop necrotizing enterocolitis (NEC) than those who are breastfed, but the mechanisms of intestinal necrosis in NEC and protection by breast milk are unknown. We hypothesized that after lipase digestion, formula, but not fresh breast milk, contains levels of unbound free fatty acids (FFAs) that are cytotoxic to intestinal cells.Methods:We digested multiple term and preterm infant formulas or human milk with pancreatic lipase, proteases (trypsin and chymotrypsin), lipase + proteases, or luminal fluid from a rat small intestine and tested FFA levels and cytotoxicity in vitro on intestinal epithelial cells, endothelial cells, and neutrophils.Results:Lipase digestion of formula, but not milk, caused significant death of neutrophils (ranging from 47 to 99% with formulas vs. 6% with milk) with similar results in endothelial and epithelial cells. FFAs were significantly elevated in digested formula vs. milk and death from formula was significantly decreased with lipase inhibitor pretreatment, or treatments to bind FFAs. Protease digestion significantly increased FFA binding capacity of formula and milk but only enough to decrease cytotoxicity from milk.Conclusion:FFA-induced cytotoxicity may contribute to the pathogenesis of NEC.

OBJECTIVE: Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children.

DESIGN: One month after the earthquake, caregivers of 831 children aged 0-23 months were surveyed regarding receipt of unsolicited donations of BMS, and on recent child-feeding practices and diarrhoeal illness.

SETTING: Community-level survey in an earthquake-affected district.

SUBJECTS: Primary caregivers of surveyed children.

RESULTS: In all, 75 % of households with an infant aged 0-5 months and 80 % of all households surveyed received donated infant formula; 76 % of all households received commercial porridge and 49 % received powdered milk. Only 32 % of 0-5-month-old infants had consumed formula before the earthquake, but 43 % had in the 24 h preceding the survey (P<0·001). Consumption of all types of BMS was significantly higher among those who received donated commodities, regardless of age (P<0·01). One-week diarrhoea incidence among those who received donated infant formula (25·4 %) was higher than among those who did not (11·5 %; relative risk = 2·12, 95 % CI = 1·34, 3·35). The rate of diarrhoea among those aged 12-23 months was around five times the pre-earthquake rate.

CONCLUSIONS: There were strong associations between receipt of BMS and changes in feeding practices, and between receipt of infant formula and diarrhoea. Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies.

The aim of the present study was to determine the influence of serum from formula and breast-fed infants on neutrophil function (as measured by the attachment and phagocytosis of Candida albicans) as well as the chemoattractant activity of the serum. The results indicate that: (a) serum from breast-fed infants induces a greater chemoattractant activity in neutrophils than serum from 3-month-old formula-fed infants; (b) the highest values of the attachment capacity were obtained after incubation of neutrophils with serum from 1-month-old breast-fed infants; and (c) serum from breast-fed infants induces a greater phagocytic capacity against C. albicans in neutrophils than serum from formula-fed infants.

Breast milk provides important maturational stimuli to an infant's developing immune system. However, data concerning the role of breast-feeding in reducing the risk of allergic disease remain contradictory. Previous studies have centred on comparative analyses of breast milk and formula compositions. We chose a slightly different angle, whereby we focused on the effects of the chosen diet on the infant himself, comparing the immune development of formula-fed and breast-fed children. The objective of the present study was to determine how the mode of feeding affects infant immunology. Altogether, eighteen formula-fed infants with limited breast-feeding for< 3 months and twenty-nine infants who were exclusively breast-fed for>3 months were included in the study. Concentrations of interferonγ, TNF-α IL-10, IL-5, IL-4 and IL-2 were measured simultaneously from the same serum sample through use of a multiplexed flow cytometric assay at the ages of 1, 3, 6 and 12 months. Transforming growth factor β2 (TGF-β2) was measured using ELISA at the same time points. Serum TNF-α and IL-2 concentrations were significantly higher in formula-fed than in breast-fed infants during the first year of life (ANOVA, P = 0·002). The serum concentrations of TGF-β were significantly lower in formula-fed than in breast-fed infants throughout the first year of life (ANOVA, P ≤ 0·0001). Exclusive breast-feeding promotes an anti-inflammatory cytokine milieu, which is maintained throughout infancy. Such an immunological environment limits hyper-responsiveness and promotes tolerisation, possibly prohibiting the onset of allergic disease.

Most infants in the UK start solids before the recommended age of 6 months. We assessed the independent effects of solids and breast feeding on the risk of hospitalisation for infection in term, singleton infants in the Millennium Cohort Study (n = 15,980). For both diarrhoea and lower respiratory tract infection (LRTI), the monthly risk of hospitalisation was significantly lower in those receiving breast milk compared with those receiving formula. The monthly risk of hospitalisation was not significantly higher in those who had received solids compared with those not on solids (for diarrhoea, adjusted odds ratio 1.39, 95% CI 0.75 to 2.59; for LRTI, adjusted odds ratio 1.14, 95% CI 0.76 to 1.70), and the risk did not vary significantly according to the age of starting solids.

BACKGROUND:Premature infants have a high risk for dysbiosis of the gut microbiome. Mother's own milk (MOM) has been found to favorably alter gut microbiome composition in infants born at term. Evidence about the influence of feeding type on gut microbial colonization of preterm infants is limited.

OBJECTIVE:The purpose of this study was to explore the effect of feeding types on gut microbial colonization of preterm infants in the neonatal intensive care unit.

METHODS:Thirty-three stable preterm infants were recruited at birth and followed up for the first 30 days of life. Daily feeding information was used to classify infants into six groups (MOM, human donor milk [HDM], Formula, MOM + HDM, MOM + Formula, and HDM + Formula) during postnatal days 0-10, 11-20, and 21-30. Stool samples were collected daily. DNA extracted from stool was used to sequence the 16S rRNA gene. Exploratory data analysis was conducted with a focus on temporal changes of microbial patterns and diversities among infants from different feeding cohorts. Prediction of gut microbial diversity from feeding type was estimated using linear mixed models.

RESULTS:Preterm infants fed MOM (at least 70% of the total diet) had highest abundance of Clostridiales, Lactobacillales, and Bacillales compared to infants in other feeding groups, whereas infants fed primarily HDM or formula had a high abundance of Enterobacteriales compared to infants fed MOM. After controlling for gender, postnatal age, weight, and birth gestational age, the diversity of gut microbiome increased over time and was constantly higher in infants fed MOM relative to infants with other feeding types (p<.01).

DISCUSSION:MOM benefits gut microbiome development of preterm infants, including balanced microbial community pattern and increased microbial diversity in early life.

AIM:A randomized study was conducted to evaluate whether pasteurized milk (Holder pasteurization 62.5 degrees C, 30 min) reduces fat absorption and growth in preterm infants.

METHODS:Preterm infants (825-1325 g) born with gestational age

RESULTS:We found, on an average, 17% higher fat absorption with raw as compared to pasteurized milk. Infants gained more weight and linear growth assessed as knee-heel length was also greater during the week they were fed raw milk as compared to the week they were fed pasteurized milk.

CONCLUSION:Feeding preterm infants pasteurized as compared to raw own mother's milk reduced fat absorption. When the infants were fed raw milk, they gained more in knee-heel length compared to when they were fed pasteurized milk.

In developed communities, the effect of exclusive breastfeeding (EBF) is encouraged since it has been found to be protective against infantile diarrhea. In a newly developing Qatar, modern water supply and sanitation facilities have become available to everyone during the last two decades. The objectives of the current study were to explore the relationships between breastfeeding and diarrhea and to assess the effect of EBF on the risk reduction of diarrhea in children aged 1-5 years. This is a cross-sectional survey conducted in the Well-Baby clinics and pediatric clinics in the 11 Primary Health Care (PHC) Centers and Hamad General Hospital, Hamad Medical Corporation, Qatar. A multistage sampling design was used, and a representative sample of 1500 Qatari infants and pre-school children in the age group of 1-5 years and mothers aged between 18 to 47 years were surveyed during the period from October 2006 to September 2007; 1,278 mothers agreed to participate in this study, with a response rate of 85.2%. The sociodemographic characteristics, feeding modes and diarrhea morbidity were collected from the parents of the children during the interview. Of the 1,278 infants studied, more than half (59.3%) were EBF, followed by those partially breastfed (28.3%), and finally the formula fed (12.4%). The duration of EBF was 11.4 +/- 6.7 months (mean +/- SD) and the duration of partial breastfeeding with bottled milk was 9.2 +/- 4.1 months (mean +/- SD), and the difference was statistically significant (p<0.0010). When compared to the EBF infants, the risk of diarrhea was higher and statistically significant in both the partially breastfed (48.7% vs 32.5%) and in the non-EBF (37.3% vs 32.5%, p<0.001). Upper respiratory tract infection (URTI), short duration of breastfeeding, level of maternal education, and sterilization of bottles were considered as predictors. These results indicate that in Qatar, breastfeeding plays an important role in reducing the incidence and severity of infantile diarrhea. This observation is particularly important given the growing concern that, as an unwanted effect of 'modernization', breastfeeding is on the decline in Qatar and comparable populations elsewhere.

BACKGROUND:The fact that breastfeeding may protect against allergic diseases remains controversial, with hardly any reports from developing countries. Prolonged breastfeeding was shown to reduce the risk of allergic and respiratory diseases.

AIM:The aim of this study was to assess the relationship between breastfeeding and the development of childhood asthma and allergic diseases in Qatari children at age 0-5 years. Additionally, this study investigated the effect of prolonged breastfeeding on the allergic diseases in a developing country.

DESIGN:This is a cross sectional survey.

SETTING:Well baby clinics and Pediatric clinics in the 11 Primary Health Care Centers and Hamad General Hospital, Hamad Medical Corporation, State of Qatar.

SUBJECTS:A multistage sampling design was used and a representative sample of 1500 Qatari infants and pre-school children with age range of 0-5 years and mothers aged between 18 to 47 years were surveyed during the period from October 2006 to September 2007 in Qatar. Out of the 1500 mothers of children, 1278 mothers agreed to participate in this study with the response rate of 85.2%.

METHODS:A confidential, anonymous questionnaire was completed by the selected subjects assessing breastfeeding and allergic diseases. Questionnaires were administered to women who were attending Primary Health Centers for child immunization. Questionnaire included allergic rhinitis, wheezing, eczema, and additional questions included mode and duration of breastfeeding, tobacco smoke exposure, number of siblings, family income, level of maternal education, parental history of allergies. Univariate and multivariate statistical methods were performed for statistical analysis.

RESULTS:More than half of the infants (59.3%) were exclusively breastfed, followed by infants with partial breastfeeding (28.3%) and artificial fed (12.4%). There was a significant difference found across these three categories of infants in terms of their age groups, smoking status of father, socio-economic status and parental consanguinity. Asthma (15.6%), wheezing (12.7%), allergic rhinitis (22.6%), and eczema (19.4%) were less frequent in exclusive breast fed children, compared to infants with partial breast feeding and formula milk. Ear infection (P = 0.0001) and eczema (P = 0.007) were found significant in infants with the history of maternal atopy, while asthma (P = 0.0001) and allergic rhinitis (P = 0.015) were found significant in infants with the history of paternal atopy. The main factors associated with mode of feeding were mothers having first baby, asthmatic mother and parental history of allergic rhinitis. The risk of allergic diseases, eczema, wheeze and ear infection in particular, were lower in children with prolonged breast feeding (>6 months) than in those with short-term breast feeding duration (<6 months).

CONCLUSION:The current study indicates that exclusive breast-feeding prevents development of allergic diseases in children. The main factors associated with breastfeeding for allergic diseases were being the first baby, maternal history of asthma, and parental history of allergic rhinitis. The study findings opens a big avenue for interventional role of breastfeeding. Therefore, we recommend breastfeeding is as one possible way to reduce the risk of onset asthma and allergic diseases in developing countries.

Breastfeeding is the nourishment designed by nature for the newborn and the infant; however its prevalence is nowadays not optimal. The aim of this article is to review the current evidence of the benefits of breastfeeding for children and society, and to elaborate the risks associated with the replacement of lactation with baby formulas. Breastfeeding is a protective factor for several infectious, atopic, and cardiovascular diseases as well as for leukaemia, necrotising enterocolitis, celiac disease, and inflammatory bowel disease. It also has a positive impact on neurodevelopment, improving IQ and reducing the risk of attention deficit disorder, and generalised developmental and behavioural disorders. Lactation can decrease the risk of sudden infant deaths syndrome by 36% and prevent 13% of infant mortality worldwide. Breastfeeding result in direct saving on the use of infant formulas and bottles, and indirectly on associated health costs, premature deaths, and quality-adjusted life years, among others. In addition, breastfeeding is environmentally friendly; it does not leave an ecological footprint in its production and consumption. The use of baby formulas and bottles have inherent risks, because they increase the risk of oral diseases, such as mouth breathing, malocclusion, alteration of bite, and tooth decay. Finally, the intestinal microbiota, oxygenation, and thermoregulation of infants are negatively affected by their use.