Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr

Metabolic Research Group, Veterans Affairs Medical Center.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 11/1999; 70(4):525-35.
Source: PubMed

ABSTRACT Although the results of many clinical studies suggest that breast-fed children score higher on tests of cognitive function than do formula-fed children, some investigators have suggested that these differences are related to confounding covariables such as socioeconomic status or maternal education.
Our objective was to conduct a meta-analysis of observed differences in cognitive development between breast-fed and formula-fed children.
In this meta-analysis we defined the effect estimate as the mean difference in cognitive function between breast-fed and formula-fed groups and calculated average effects using fixed-effects and random-effects models.
Of 20 studies meeting initial inclusion criteria, 11 studies controlled for >/=5 covariates and presented unadjusted and adjusted results. An unadjusted benefit of 5.32 (95% CI: 4.51, 6.14) points in cognitive function was observed for breast-fed compared with formula-fed children. After adjustment for covariates, the increment in cognitive function was 3.16 (95% CI: 2.35, 3.98) points. This adjusted difference was significant and homogeneous. Significantly higher levels of cognitive function were seen in breast-fed than in formula-fed children at 6-23 mo of age and these differences were stable across successive ages. Low-birth-weight infants showed larger differences (5.18 points; 95% CI: 3.59, 6.77) than did normal-birth-weight infants (2.66 points; 95% CI: 2.15, 3.17) suggesting that premature infants derive more benefits in cognitive development from breast milk than do full-term infants. Finally, the cognitive developmental benefits of breast-feeding increased with duration.
This meta-analysis indicated that, after adjustment for appropriate key cofactors, breast-feeding was associated with significantly higher scores for cognitive development than was formula feeding.

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    • "Breastfeeding has been associated with significantly higher scores for cognitive development than formula feeding [4] [5] [6]. Human milk is unique regarding the diversity, quantity and complexity of human milk oligosaccharides (HMOs), with more than 150 structures identified so far [7]. "
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    ABSTRACT: Human milk oligosaccharides (HMOs) are unique with regard to their diversity, quantity, and complexity, particularly in comparison to bovine milk oligosaccharides. HMOs are associated with functional development during early life, mainly related to immunity and intestinal health. Whether HMOs elicit a positive effect on cognitive capabilities of lactating infants remains an open question. This study evaluated the role of the most abundant HMO, 2’-fucosyllactose (2’-FL), in synaptic plasticity and learning capabilities in rodents. Mice and rats were prepared for the chronic recording of field excitatory post-synaptic potentials (fEPSPs) evoked at the hippocampal CA3-CA1 synapse. Following chronic oral administration of 2’-FL, both species showed improvements in input/output curves and in long-term potentiation (LTP) evoked experimentally in alert behaving animals. This effect on LTP was related to better performance of animals in various types of learning behavioral tests. Mice were tested for spatial learning, working memory, and operant conditioning using the IntelliCage system, while rats were submitted to a fixed-ratio schedule in the Skinner box. In both cases, 2’-FL treated animals performed significantly better than controls. In addition, chronic administration of 2’-FL increased the expression of different molecules involved in the storage of newly acquired memories, such as the postsynaptic density protein 95 (PSD-95), phosphorylated calcium/calmodulin-dependent kinase II (pCaMKII), and brain-derived neurotrophic factor (BDNF) in cortical and subcortical structures. Taken together, the data show that dietary 2’-FL affects cognitive domains and improves learning and memory in rodents.
    The Journal of Nutritional Biochemistry 01/2015; 26(5). DOI:10.1016/j.jnutbio.2014.11.016 · 3.79 Impact Factor
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    • "Breastfeeding is important to preterm infants, as it seems to provide even more pronouced health benefits than to infants born at term age [1], [2], [3], [4], [5], [6]. Even though there are significant variations in preterm breastfeeding rates between countries [7], [8], [9], [10], [11], [12], [13], [14] and neonatal intensive care units (NICUs) within coutries [7], [14] preterm infants are not breastfed to the same extent as term infants [7]. "
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    ABSTRACT: Background and Aim Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. Methods The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks. Results Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding. Conclusion Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
    PLoS ONE 09/2014; 9(9):e108208. DOI:10.1371/journal.pone.0108208 · 3.23 Impact Factor
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    • "Aside from intracranial lesions associated with preterm birth, factors shown to impact the neurodevelopmental outcome of VLBW infants include gestational age at birth, sepsis, necrotizing enterocolitis (NEC), chronic lung disease, suboptimal nutrient intake or poor growth [2-8]. Compelling evidence exists to suggest that use of mother’s own breastmilk compared to infant formula during initial hospitalization positively affects the neurodevelopment of VLBW infants during early childhood and beyond [9-15]. Vohr et al. demonstrated a dose dependent relationship between breastmilk intake for extremely low birth weight infants enrolled in the National Institute of Child Health and Human Development Glutamine Trial. "
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    ABSTRACT: Background: Provision of mother's own milk is the optimal way to feed infants, including very low birth weight infants (VLBW, <1500 g). Importantly for VLBW infants, who are at elevated risk of neurologic sequelae, mother's own milk has been shown to enhance neurocognitive development. Unfortunately, the majority of mothers of VLBW infants are unable to provide an adequate supply of milk and thus supplementation with formula or donor milk is necessary. Given the association between mother's own milk and neurodevelopment, it is important to ascertain whether provision of human donor milk as a supplement may yield superior neurodevelopmental outcomes compared to formula.Our primary hypothesis is that VLBW infants fed pasteurized donor milk compared to preterm formula as a supplement to mother's own milk for 90 days or until hospital discharge, whichever comes first, will have an improved cognitive outcome as measured at 18 months corrected age on the Bayley Scales of Infant Development, 3(rd) ed. Secondary hypotheses are that the use of pasteurized donor milk will: (1) reduce a composite of death and serious morbidity; (2) support growth; and (3) improve language and motor development. Exploratory research questions include: Will use of pasteurized donor milk: (1) influence feeding tolerance and nutrient intake (2) have an acceptable cost effectiveness from a comprehensive societal perspective? Methods/design: DoMINO is a multi-centre, intent-to-treat, double blinded, randomized control trial. VLBW infants (n = 363) were randomized within four days of birth to either (1) pasteurized donor milk or (2) preterm formula whenever mother's own milk was unavailable. Study recruitment began in October 2010 and was completed in December 2012. The 90 day feeding intervention is complete and long-term follow-up is underway. Discussion: Preterm birth and its complications are a leading cause long-term morbidity among Canadian children. Strategies to mitigate this risk are urgently required. As mother's own milk has been shown to improve neurodevelopment, it is essential to ascertain whether pasteurized donor milk will confer the same advantage over formula without undue risks and at acceptable costs. Knowledge translation from this trial will be pivotal in setting donor milk policy in Canada and beyond. Trial registration: ISRCTN35317141; Registered 10 August 2010.
    BMC Pediatrics 05/2014; 14(1):123. DOI:10.1186/1471-2431-14-123 · 1.93 Impact Factor
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