Differences in morbidity between breast-fed and formula-fed infants,☆☆,,★★

https://doi.org/10.1016/S0022-3476(95)70395-0Get rights and content

Abstract

To determine whether breast-feeding is protective against infection in relatively affluent populations, morbidity data were collected by weekly monitoring during the first 2 years of life from matched cohorts of infants who were either breast fed (BF) (N = 46) or formula fed (FF) (N = 41) until at least 12 months of age. Cohorts were matched for characteristics such as birth weight and parental socioeconomic status, and we controlled for use of day care in data analysis. Mean maternal educational level was high (16 years) in both groups. In the first year of life the incidence of diarrheal illness among BF infants was half that of FF infants; the percentage with any otitis media was 19% lower and with prolonged episodes (>10 days) was 80% lower in BF compared with FF infants. There were no significant differences in rates of respiratory illness; nearly all cases were mild upper respiratory infections. Morbidity rates did not differ significantly between groups in the second year of life, but the mean duration of episodes of otitis media was longer in FF than BF infants (8.8 ± 5.3 vs 5.9 ± 3.5 days, respectively; p = 0.01). These results indicate that the reduction in morbidity associated with breast-feeding is of sufficient magnitude to be of public health significance. (J P EDIATR 1995;126:696-702)

Section snippets

Study design

The objective of the DARLING study was to compare growth, nutrient intake, morbidity, and activity levels during the first 2 years of life between matched cohorts of infants who were either breast fed (n = 46) or formula fed (n = 41) until at least 12 months of age. Selection criteria and details regarding recruitment and attrition are described elsewhere. 35 Briefly, 92 mothers were recruited into the BF group, of whom 19 dropped out before 3 months (primarily because they were too busy to

Respiratory illness

On average, infants had symptoms of respiratory illness about 11% of the time during the first 6 months and 16% to 20% of the time from 6 to 24 months. Nearly all these illnesses were mild upper respiratory illnesses; in both groups together there were only 10 episodes of physician-diagnosed lower respiratory illnesses during the first two years of life (three BF, seven FF infants). Six infants (three BF, three FF) were hospitalized because of illness during the 2-year period, all for pneumonia.

DISCUSSION

These results indicate that breast-feeding during the first year of life is protective against diarrheal illness and otitis media, even in a relatively affluent, highly educated population. The findings are consistent with those of most previous reports 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 20, 21, 22, 23, 26, 27 but add to the evidence because the groups were carefully matched for many potentially confounding variables. Because mothers who breast-feed generally tend to be of higher income

References (49)

  • Institute of Medicine

    Nutrition during lactation

    (1991)
  • H Bauchner et al.

    Studies of breastfeeding and infections: how good is the evidence?

    JAMA

    (1986)
  • R Paine et al.

    Breastfeeding and infant health in a rural US community

    Am J Dis Child

    (1982)
  • CW. Lo

    Chronic diarrhea

    Pediatrics

    (1983)
  • MR Forman et al.

    The Pima infant feeding study: breastfeeding and respiratory infections during the first year of life

    Int J Epidemiol

    (1984)
  • MG Myers et al.

    Respiratory and gastrointestinal illnesses in breast and formula-fed infants

    Am J Dis Child

    (1984)
  • PI McFarlane et al.

    Human milk in the management of protracted diarrhea of infancy

    Arch Dis Child

    (1984)
  • JS Koopman et al.

    Infant formulas and gastrointestinal illness

    Am J Public Health

    (1985)
  • LC Duffy et al.

    The effects of infant feeding on rotavirus-induced gastroenteritis: a prospective study

    Am J Public Health

    (1986)
  • PW Howie et al.

    Protective effect of breastfeeding against infection

    Br Med J

    (1990)
  • C van den Bogaard et al.

    The relationship between breastfeeding and early childhood morbidity in a general population

    Fam Med

    (1991)
  • T. Ruuska

    Occurrence of acute diarrhea in atopic and nonatopic infants: the role of prolonged breastfeeding

    J Pediatr Gastroenterol Nutr

    (1992)
  • FO. Adebonojo

    Artificial vs breastfeeding: relation to infant health in a middle class American community

    Clin Pediatr

    (1972)
  • AH Cushing et al.

    Diarrhea in breastfed and non-breastfed infants

    Pediatrics

    (1982)
  • Cited by (399)

    View all citing articles on Scopus

    From the Department of Nutrition and Program in International Nutrition, University of California, Davis

    ☆☆

    Supported by U.S. Department of Agriculture grants 86 CRCR 1-1968 and 89-37200-4450, and by a gift from the Mead-Johnson Nutritional Group, Evansville, Ind.

    Reprint requests: Kathryn G. Dewey, PhD, Department of Nutrition, University of California, Davis, CA 95616-8669.

    ★★

    0022-3476/95/$3.00 + 0 9/20/62344

    View full text