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Breastfeeding protects against illness and infection in infants and children: a review of the evidence

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Breastfeeding protects against illness and infection in infants and children: a review of the evidence

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Nutrition is essential to the health and development of infants and children. Breastfeeding is superior to infant formula feeding because in addition to breastmilk's nutritional advantages, it protects against infections through specific and non-specific immune factors and has long-term consequences for metabolism and disease later in life. The objectives of this paper are to summarise the epidemiological and other scientific evidence in support of breastfeeding, to clarify why breastmilk is a better food for infants than infant formula and to demonstrate support for further breastfeeding initiatives in Australia. There is much epidemiological evidence for the benefits of breastfeeding to the human infant against a wide range of illnesses and infections. Other scientific evidence for breastfeeding has demonstrated specific nutritional components that provide immunologic protection and beneficial effects on intestinal flora. Human milk enhances the immature immunologic system of the neonate and strengthens host defence mechanisms against infective and other foreign agents. Mechanisms to explain active stimulation of the infant's immune system by breastfeeding are through bioactive factors in human milk. Following breastfeeding termination there may be prolonged protection against infections due to influences on the infant immune system mediated via human milk. World-wide initiatives have been established to promote breastfeeding and curb the use of infant formula. Primarily the Baby Friendly Hospital Initiative promotes the Ten Steps to Successful Breastfeeding and should be implemented in all maternity services in Australia. There is enough evidence to support further breastfeeding health promotion initiatives in Australia to ensure that all hospitals become 'baby friendly', that all mothers are encouraged and supported to commence breastfeeding and that there is adequate community support for mothers to continue exclusive breastfeeding for at least the first six months of life.
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... The maternal-infant immune nexus is also vital during breastfeeding. The protein fraction of human milk, comprising about 1% of milk volume, contains various immunological proteins focused on protection and tolerance mechanisms (Oddy 2001). Three dominant immunoproteins, immunoglobulin A (IgA), lysozyme, and lactoferrin, provide significant infection protection (Goldman 1993). ...
... Human milk protects the mucosal immune system of the infant in a targeted fashion. Breastfeeding, especially exclusive breastfeeding, has a well-known protective effect against infant diarrhoea, respiratory infections, and ear infections (Hanson 1998;Oddy 2001). For example, a study in Mexico found that mothers with higher anti-Giardia lamblia (eukaryotic) sIgA in their milks had infants with fewer symptoms of Giardia diarrhoea, although the milk sIgA did not protect against infection itself (Walterspiel et al. 1994). ...
... Pengaruh menyusui bagi bayi mencakup pengaruh pisik dan psikologis. Secara pisik, air susu ibu (ASI) merupakan cairan nutrisi yang paling baik untuk dikonsumsi oleh bayi mengalahkan segala keunggulan yang dimiliki oleh susu formula mana pun (Oddy, 2001). Riset menunjukkan bahwa pemberian ASI dapat mendorong berkembangnya kemampuan motorik anak, kemampuan pemecahan masalah, serta keterampilan personal dan sosial -selain keterampilan komunikasi (McCrory and Murray, 2013). ...
... Riset menunjukkan bahwa pemberian ASI dapat mendorong berkembangnya kemampuan motorik anak, kemampuan pemecahan masalah, serta keterampilan personal dan sosial -selain keterampilan komunikasi (McCrory and Murray, 2013). Selain menstimulasi perkembangan otak untuk mengontrol perilaku impulsif, durasi pemberian ASI terbukti mampu meningkatkan kecerdasan kognitif yang pada akhirnya mempengaruhi hasil belajar akademik anak (Horwood and Fergusson, 1998;Oddy et al, 2011A), dan secara pisik ASI mampu menjadi antibody dengan menumbuhkan system imunitas bayi terhadap berbagai jenis penyakit (Oddy, 2001) serta berperan sebagai pengelola energy yang menghindarkan anak dari obesitas (Savino and Liguori, 2008). Secara psikologis, proses pemberian ASI memberikan kenyamanan bagi bayi sehingga ia merasa diterima, dicintai, dan kehadirannya dianggap berharga oleh orang-orang di sekelilingnya. ...
... O leite humano supre a nutrição ideal para a criança lactente, facilita a transição entre a vida intra e extrauterina, fortalece laços afetivos entre mãe e criança e não representa novas despesas para a família. Além disso, protege o lactente de doenças infecciosas e autoimunes, obesidade, diabetes, sendo considerado uma importante medida de Saúde Pública, visto que reduz a morbidade e a mortalidade infantil em curto e longo prazo" (ODDY, 2001). "Com o objetivo de promover o aleitamento materno e evitar o desmame precoce, em 1989 a UNICEF, a Organização Mundial da Saúde (OMS) e outras organizações internacionais desenvolveram um conjunto de práticas e condutas, resumidas nos chamados Dez Passos para o Sucesso do Aleitamento Materno, criação da OMS/UNICEF Iniciativa Hospital Amigo da Criança (IHAC), formalizada em 1990. ...
... Exclusive breastfeeding for the first 6 months of life is recommended for all infants because it is associated with reduced risk of infant wheeze and asthma [7,8], gastrointestinal infection [9], and possibly childhood overweight and obesity [10]. However, the composition of human milk is not uniform among women, and the impact of maternal clinical factors on this variation is now being investigated [11]. ...
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It is unclear whether gestational diabetes mellitus (GDM) alters breast milk composition. We prospectively examined associations of GDM status with concentrations of six potentially bioactive elements (glucose, insulin, C-reactive protein (CRP), interleukin-6 (IL-6), leptin, and adiponectin) in human milk. These were measured at both 1 and 3 months postpartum in 189 fully breastfeeding women. Mixed-effects linear regression assessed GDM status-related differences in these milk bioactives, adjusting for demographics, maternal factors, and diet. At 1 and 3 months postpartum, milk CRP was higher (1.46 ± 0.31 ng/mL; p < 0.001 and 1.69 ± 0.31 ng/mL; p < 0.001) in women with GDM than in women without GDM, whereas milk glucose (−5.23 ± 2.22 mg/dL; p = 0.02 and −5.70 ± 2.22; p = 0.01) and milk insulin (−0.38 ± 0.17 μIU/mL; p = 0.03 and −0.53 ± 0.17; p = 0.003) were lower in women with GDM. These significant associations remained similar after additional adjustment for maternal weight status and its changes. No difference was found for milk IL-6, leptin, and adiponectin. There was no evidence of association between these milk bioactive compounds and 1 h non-fasting oral glucose challenge serum glucose in the women without GDM. This prospective study provides evidence that potentially bioactive elements of human milk composition are altered in women with GDM.
... Several studies also found similar findings [38,39]. Breast milk is the sole natural and primary source of optimum sustenance for newborn babies' physical and neurological growth and cognitive development [40]; it also boosts the child's immune system at an early age [41][42][43]. However, it may be challenging for women to stick to EBF for six months, especially in low and lower-middle income countries like Bangladesh, where maternal malnutrition is frequent, leading to reduce breast milk production [44][45][46][47][48]. ...
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Background Bangladesh is a South Asian developing country trying to achieve the Sustainable Development Goals (SDG)-3 and the objective of the Rural Electrification Board (REB) regarding child mortality. Infectious diseases are leading causes of child mortality, and lack of exclusive breastfeeding (EBF) among infants aged 0–6 months increases child morbidity and mortality from various infectious diseases in developing countries. However, as per existing literature, no study has been conducted yet to determine the lack of EBF practice effect on child mortality in Bangladesh. With this backdrop, the authors intend to measure the likelihood of infectious diseases due to the lack of EBF of infants aged 0–6 months in Bangladesh. Materials and methods This study used Bangladesh Demographic and Health Survey (BDHS) data over 1996–97 to 2017–18. The mothers of infants aged 0–6 months who were willingly participated in the BDHSs were considered to include in our analysis. Initially, there were 9,133 cases in the combined dataset. After filtering, there were 5,724 cases in the final dataset. We have considered diarrhea (D), acute respiratory infection (ARI) separately as well as the presence of either D or ARI or both and named as CoDARI as outcome variables. This study used both graphical and statistical techniques (Chi-square test, Wald test, and logistic regression) to analyze the data. The odds ratio (OR) and 95% confidence interval (CI) were used to quantify the likelihood of infectious diseases due to lack of EBF practice and its elasticity, respectively. Results The EBF practice got a conspicuous increasing trend, but the prevalence of infectious diseases was declined from 0 to 3 months of age of infants, whereas an inverse scenario is observed between 4–6 months. The significance of that inverse relationship was confirmed by p-value corresponding to the chi-square test and the Wald test of the adjusted regression coefficients after adjusting the associated factor’s effect on infectious diseases. The adjusted ORs also concluded that the lack of EBF practice up to six months of age could enhance the risk of D, ARI, and CoDARI by 2.11 [95% CI: 1.56–2.85], 1.43 [95% CI: 1.28–1.60], and 1.48 [95% CI: 1.32–1.66] times higher, respectively. Conclusion Findings of this study emphasize the importance of EBF up to six months of age of infants against diarrhea and ARI specific morbidity and mortality. Our results also agreed to the recommendation of the World Health Organization (WHO), United Nations International Chil- dren’s Emergency Fund (UNICEF), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and National Nutrition Programme of Ethiopia (NNPE) that the EBF practice for the first six months of age could be a best, cost-effective, long-lasting natural preventive way to reduce the child morbidity and mortality due to infectious diseases in developing countries. Therefore, findings would help policymakers ensuring the achievement target of REB and SDG-3 associated with the health sector in Bangladesh.
... One of the most important reasons for breastfeeding is breastmilk's protection against infectious diseases [4]. It is plausible and expected [5] that human milk has a protective effect against COVID-19 due to its content of a-specific immuno-bioactive factors, such as lactoferrin, oligosaccharides, cytokines, and specific antibodies [6]. ...
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The COVID-19 pandemic has carried massive global health and economic burden that is currently counteracted by a challenging anti-COVID-19 vaccination campaign. Indeed, mass vaccination against COVID-19 is expected to be the most efficacious intervention to mitigate the pandemic successfully. The primary objective of the present study is to test the presence of neutralizing anti-SARS-CoV-2 antibodies (IgA and IgG) in the breast milk and sera samples from vaccinated women at least 20 days after the complete vaccine cycle. A secondary aim is to compare the IgG antibodies level in maternal serum and breast milk. The third target is to evaluate the presence of the IgG antibodies in breast milk after several weeks from the vaccination. Finally, we collected information on the health status of infants in the days following maternal vaccination. Forty-two mothers were enrolled in the study. Thirty-six received the Pfizer/BioNTech vaccine, four the Astra Zeneca vaccine, one the Moderna vaccine and another woman Astra Zeneca in the first dose and Pfizer/BioNTech in the second dose. All 42 milk samples confirmed the presence of anti-SARS-CoV-2 IgG, and none showed IgA presence. Regarding the matched 42 sera samples, 41 samples detected IgG presence, with one sample testing negative and only one positive for seric IgA. None of the 42 infants had fever or changes in sleep or appetite in the seven days following the maternal vaccination. The level of IgG antibodies in milk was, on average, lower than that in maternal serum. According to our analysis, the absence of IgA could suggest a rapid decrease after vaccination even if frequent breastfeeding could favour its persistence. IgG were present in breast milk even 4 months after the second vaccine dose. Information on the immunological characteristics of breast milk could change mothers’ choices regarding breastfeeding.
... It was well reported that breast milk protects against infections through specific and nonspecific immune factors. Human milk enhances the immature immunological system among young infants and strengthens host defense mechanisms against infective and other foreign agents [68]. Moreover, anemia also aggravates this immune disturbance, especially in malnourished children [69]. ...
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Invasive fungal infections (IFIs) are opportunistic, especially in immunocompromised and hospitalized patients. Children with IFIs are more vulnerable to a fatal outcome. For early diagnosis and treatment, knowledge of the spectrum and frequency of IFIs among children is prerequisite. In this prospective observational study, we enrolled 168 children of 2–59 months old of either sex from March 2018 to December 2019 admitted to the Dhaka hospital, icddr,b. Study participants with suspected IFIs were with or without severe acute malnutrition (SAM) along with sepsis/pneumonia and fulfilled any of the following criteria: (i) failure to respond to injectable antibiotics, (ii) development of a late-onset hospital-acquired infection, (iii) needed ICU care for >7 days, (iv) took steroids/antibiotics for >2 weeks before hospitalization, and (v) developed thrush after taking injectable antibiotics. The comparison group included non-SAM (weight-for-length Z score ≥ −2) children with diarrhea and fever <3 days in the absence of co-morbidity. We performed real-time PCR, ELISA, and blood culture for the detection of fungal pathogen. Study group children with SAM, positive ELISA and PCR considered to have a IFIs. In the study group, 15/138 (10.87%) children had IFIs. Among IFIs, invasive candidiasis, aspergillosis, histoplasmosis detected in 6 (4.53%), 11 (7.97%), and 1 (0.72%) children, respectively, and (3/15 [2.17%]) children had both candidiasis and aspergillosis. Children with IFIs more often encountered septic shock (26.7% vs. 4.9%; p = 0.013) and had a higher death rate (46.7% vs. 8.9%; p < 0.001) than those without IFIs. IFIs were independently associated with female sex (OR = 3.48; 95% CI = 1.05, 11.55; p = 0.042) after adjusting for potential confounders. Our findings thus implicate that, malnourished children with septic shock require targeted screening for the early diagnosis and prompt management of IFIs that may help to reduce IFIs related deaths.
... Severely malnourished children who were non-breastfed at their neonatal period, were more prone to develop severe sepsis compared to breastfed children which signifies the importance of continuation of breastfeeding in infancy and supports our study findings [35]. In addition to breast milk's nutritional advantages, it reduces frequency of infections, particularly gastrointestinal [38,39] and respiratory tract [39][40][41][42] through specific and non-specific immune factors [43]. A study conducted in Ethiopia showed breastfeeding might reduce mortality by 59% among breastfed under-five SAM children in comparison to those who were non-breastfed [44]. ...
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Background Bacillus Calmette-Guérin (BCG) vaccination has recently been found to have beneficial effects among children infected other than Mycobacterium tuberculosis. Due to the paucity of data on the outcomes of children who had successful BCG vaccination following Expanded Programme on Immunization (EPI) schedule, we aimed to investigate the characteristics of such children and their outcomes who were hospitalized for severe malnutrition.MethodsA prospective observational study was conducted to determine the viral etiology of pneumonia in severely malnourished children those were admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between April 2015 and December 2017, constituted the study population. Using a case-control design for the analysis, children having BCG vaccination prior hospital admission were treated as cases (n = 611) and those without vaccination, constituted as controls (n = 83). Bi-variate analysis was conducted using socio-demographic, clinical, laboratory, and treatment characteristics on admission and outcomes during hospitalization. Finally, log-linear binomial regression analysis was done to identify independent impact of BCG vaccination.ResultsThe cases more often presented with older age, have had lower proportion of maternal illiteracy, higher rate of breastfeeding, severe wasting and lower rate of hypoglycemia, compared to the controls. The cases were also found to have lower risk of severe sepsis and deaths, compared to the controls (for all, p
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Background and objectives: The human immune system has evolved to balance protection against infection with control of immune-mediated damage and tolerance of commensal microbes. Such tradeoffs between protection and harm almost certainly extend to the immune system of milk. Methodology: Among breastfeeding mother-infant dyads in Kilimanjaro, Tanzania, we characterized in vitro proinflammatory milk immune responses to Salmonella enterica (an infectious agent) and Escherichia coli (a benign target) as the increase in interleukin-6 after 24 h of incubation with each bacterium. We characterized incident infectious diseases among infants through passive monitoring. We used Cox proportional hazards models to describe associations between milk immune activity and infant infectious disease. Results: Among infants, risk for respiratory infections declined with increasing milk in vitro proinflammatory response to S. enterica (hazard ratio [HR]: 0.68; 95% confidence interval [CI]: 0.54, 0.86; P: 0.001), while risk for gastrointestinal infections increased with increasing milk in vitro proinflammatory response to E. coli (HR: 1.44; 95% CI: 1.05, 1.99; P: 0.022). Milk proinflammatory responses to S. enterica and E. coli were positively correlated (Spearman's rho: 0.60; P: 0.000). Conclusions and implications: These findings demonstrate a tradeoff in milk immune activity: the benefits of appropriate proinflammatory activity come at the hazard of misdirected proinflammatory activity. This tradeoff is likely to affect infant health in complex ways, depending on prevailing infectious disease conditions. How mother-infant dyads optimize proinflammatory milk immune activity should be a central question in future ecological-evolutionary studies of the immune system of milk.
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PurposeDespite mounting evidence in favour of various perinatal risk factors for occurrence of MIH, verification of these remains doubtful because of lack of documented proof. The present study was aimed at examining the putative risk factors for MIH based on hospital-maintained records assessment.MethodsA total of 3176, 8–12 year-old children were screened for MIH using EAPD criteria (2003). Of these, risk factor analysis was carried out for 104 MIH affected and 211 non-MIH affected children with complete peri-natal medical records maintained up to 3 year post-birth. Chi-square test was used for risk factor comparison, while significance was assessed using logistic regression.ResultsPrevalence of MIH in study population was 11.72% (372/3176). Various pre-natal, natal and post-natal risk factors including intra-uterine growth retardation (6.7 vs. 1.4%); maternal anaemia (10.6 vs. 3.8%) and neonatal jaundice (29.8 vs. 14.2%) were significantly higher in the MIH group. Furthermore, pre-term birth (OR 3.01), low birth weight (OR 2.37), more than three pyrogenic episodes (OR 7.61) and consumption of Amoxicillin Clavulanate (OR 3.01) were significantly associated with higher risk of developing MIH.Conclusions Pre and post-natal risk factors showed a moderate to high association for occurrence of MIH although social and nutritional factors had a lesser association.
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Whether breastfeeding is essential for the human infant has long been debated. Protection against neonatal infection has been demonstrated in industrialized countries as well as in the develop-ing world, where infant nutrition practices often follow ancient traditions. Now there is evidence for a lasting effect of breast-feeding on the immune system, resulting in enhanced protection against infection for many years and appar-ently in a decreased risk for certain inflammatory diseases. Sci & Med 4(6):12-21, 1997.
Conference Paper
To assess the association between infant feeding and childhood cancer, a qualitative review of 9 published case-control studies was undertaken. The results of this synthesis suggest that children who are never breast-fed or are breast-fed short-term have a higher risk than those breast-fed for greater than or equal to 6 months of developing Hodgkin's disease (HD), but not non-Hodgkin's lymphoma or acute lymphoblastic leukemia. HD has features of a complex cellular immune disorder and of chronic infection. Human milk contains an extensive array of anti-microbial activity and appears to stimulate early development of the infant immune system. Artificially fed infants negotiate exposure to infectious agents without the benefits of this immunologic armament and do not do as well as breast-fed infants in resisting infection. Thus, human milk may make the breast-fed infant better able to negotiate future carcinogenic insults by modulating the interaction between infectious agents and the developing infant immune system or by directly affecting the long-term development of the infant immune system. Further research should attempt to confirm the association between infant feeding and HD in large, population-based, case-control studies. Improved measurement of infant feeding must be addressed if future studies are to advance our understanding of this association. In addition, studies of specific measures of immunity, particularly of cellular immune responses, should be conducted in populations of breast-fed and non-breast-fed young children. Published 1998 Wiley-Liss, Inc.
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