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


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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    • "Trials supplementing pregnant or lactating women with fish-oil rich in LC-PUFA have not resulted in more evidence regarding similar outcomes in children (Delgado-Noguera et al., 2010; Gould et al., 2013). Nevertheless, many observational studies have found a positive association between breastfeeding and psychomotor development (Anderson et al., 1999; Brion et al., 2011), few studies highlighting a dose-effect relationship when considering duration and intensity of breastfeeding (Belfort et al., 2013; Bernard et al., 2013a). Whether this link is causal remains controversial because of sociodemographic differences between breastfeeding and non-breastfeeding mothers (Der et al., 2006). "
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    ABSTRACT: Epidemiological studies have reported that breastfed children have improved psychomotor development compared to never breastfed children. Human studies suggest that polyunsaturated fatty acids (PUFA), especially long chain PUFA (LC-PUFA) which are highly contained in breast milk, could explain this link, since they are needed for pre- and postnatal brain development. Our aim was to study the relationships between several measures of pre- and postnatal exposures to PUFA and child’s psychomotor development at 2 and 3 years in the EDEN cohort. We evaluated breastfeeding duration, colostrum PUFA levels and maternal dietary PUFA intake during pregnancy, that we related with three scores of psychomotor development, after taking into account potential confounders. Breastfeeding duration was positively associated with psychomotor development. No relationship was found with both pre- and postnatal exposure to LC-PUFA. However, the maternal dietary omega-6/omega-3 ratio was negatively associated with psychomotor development, mainly driven by intake in linoleic acid (LA). Among breastfed children, linoleic acid levels were negatively associated with psychomotor development. Furthermore, children exposed to the highest colostrum LA levels tended to score closer to never breastfed children than to children exposed to the lowest colostrums LA levels. Taken together, these results do not provide evidence in favour of a positive role of pre- and postnatal exposure to LC-PUFA on later psychomotor development, but highlight a potential negative role of being exposed in early life to high LA levels. From a public health perspective, this work reiterates the need to promote breastfeeding duration, and to monitor the balance of PUFA intake during pregnancy and lactation periods.
    Full-text · Article · Nov 2015
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    • "C. Fotiou et al. Table 1 Content of the informative sessions and interventions provided to parents of hospitalized premature infants (Ackard et al., 2006; Adam and Epel, 2007; Anderson et al., 1999; Armstrong et al., 2005; Baum and Posluszny, 1999; Busse et al., 2013; Callen and Pinelli, 2005; Casper, 2011; Hiscock and Jordan, 2004; Hughes et al., 2002; Kim et al., 2013; Mundy, 2010; Obeidat et al., 2009; Richter and Reck, 2013; Scheier and Carver, 1993; Wolinski, 1993; Wong, 2012). "
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    ABSTRACT: Objective: The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit. Study design: A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group. Data collection: Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels. Results: The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p<0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003). Conclusion: Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.
    Full-text · Article · Nov 2015 · Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses
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    • "The ratio of AA to DHA in human milk is usually 1.5-2/1, but the variability is high, and the ratio is primarily determined by the habitual diet of the region or country[8,9]. The nutritional requirements for LCPUFAs in preterm newborns are not clearly established, because optimal LCPUFA blood levels and accretion rate are not well known[10,11]. It has been reported that newborns fed with DHA-and AA-supplemented formula had higher Bayley mental and psychomotor development scores, with no increase in morbidity or adverse events[12]. "
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    ABSTRACT: Background & aims Nutritional supplementation with polyunsaturated fatty acids is important in preterm infants neurodevelopment, but it is not known if the omega-6/omega-3 ratio affects this process. This study was designed to determine the effects of a balanced contribution of arachidonic acid in very preterm newborns fed with formula milk. This was a randomized trial, in which newborns <1500 g and/or <32 weeks gestational age were assigned to one of two groups, based on the milk formula they would receive during the first year of life. Initially, 60 newborns entered the study, but ultimately, group A was composed of 24 newborns, who were given formula milk with an ω-6/ω-3 ratio of 2/1, and Group B was composed of 21 newborns, given formula milk with an ω-6/ω-3 ratio of 1/1. The infants were followed up for two years: growth, visual-evoked potentials, brainstem auditory-evoked potentials, and plasma fatty acids were periodically measured, and psychomotor development was assessed using the Brunet Lézine scale at 24 months corrected age. A control group, for comparison of Brunet Lézine score, was made up of 25 newborns from the SEN1500 project, who were fed exclusively with breast milk. At 12 months, arachidonic acid values were significantly higher in group A than in group B (6.95 ± 1.55 % vs. 4.55 ± 0.78 %), as were polyunsaturated fatty acids (41.02 ± 2.09 % vs. 38.08 ± 2.32 %) achieved a higher average. Group A achieved a higher average Brunet Lézine score at 24 months than group B (99.9 ± 9 vs. 90.8 ± 11, p =0.028). The Brunet Lézine results from group A were compared with the control group results, with very similar scores registered between the two groups (99.9 ± 9 vs. 100.5 ± 7). There were no significant differences in growth or evoked potentials between the two formula groups. Very preterm infants who received formula with an ω-6/ω-3 ratio of 2/1 had higher blood levels of essential fatty acids during the first year of life, and better psychomotor development, compared with very preterm newborns who consumed formula with an ω-6/ω-3 of 1/1. Therefore, formula milk with an arachidonic acid quantity double that of docosahexaenoic acid should be considered for feeding very preterm infants. Trial registration Identifier NCT02503020.
    Full-text · Article · Sep 2015 · Nutrition Journal
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