Infant milk-feeding practices and cardiovascular disease outcomes in offspring: a systematic review

Abstract

Background: During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations.

Objectives: The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) lower versus higher intensities of human milk fed to mixed-fed infants with intermediate and endpoint cardiovascular disease (CVD) outcomes in offspring.

Methods: The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980-March 2016, dual-screened the results using predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence.

Results: The 4 systematic reviews included 13, 24, 6, and 0 articles, respectively. The evidence was insufficient to draw conclusions about endpoint CVD outcomes across all 4 systematic reviews. Limited evidence suggests that never versus ever being fed human milk is associated with higher blood pressure within a normal range at 6-7 y of age. Moderate evidence suggests there is no association between the duration of any human milk feeding and childhood blood pressure. Limited evidence suggests there is no association between the duration of exclusive human milk feeding and blood pressure or metabolic syndrome in childhood. Additional evidence about intermediate outcomes for the 4 systematic reviews was scant or inconclusive.

Conclusions: There is insufficient evidence to draw conclusions about the relationships between infant milk-feeding practices and endpoint CVD outcomes; however, some evidence suggests that feeding less or no human milk is not associated with childhood hypertension.

Keywords: blood pressure; breastfeeding; cardiovascular disease; cholesterol; human milk; hypertension; infant nutrition; metabolic syndrome; systematic review.

FIGURE 1

The analytic framework for the SRs conducted to examine the relation of infant milk-feeding practices with CVD outcomes in offspring. This framework illustrates the overall scope of the project, including the population, exposures and comparators, and outcomes of interest. It also includes definitions for key terms and identifies key confounders considered in the SR. CVD, cardiovascular disease; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; SES, socioeconomic status; SR, systematic review; TC, total cholesterol; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.