WUNRN
Association
between Breastfeeding & Intelligence, Educational Attainment, & Income
at 30 Years of Age: A Prospective Birth Cohort Study from Brazil
Prof Cesar G Victora
- Dr Bernardo Lessa Horta - Christian Loret de Mola - Luciana Quevedo - Ricardo Tavares
Pinheiro - Denise P Gigante
Helen Gonçalves - Fernando C Barros
Figures
Figure 1
Association of mean IQ with breastfeeding
duration, stratified by family income at birth
Estimates are adjusted for parental
education, household score index, genomic ancestry, maternal smoking during
pregnancy, maternal age, type of delivery, maternal body-mass index before
pregnancy, gestational age, and birthweight.
Figure 2
Direct acyclic graph of the effect of
breastfeeding on monthly income at 30 years
NIE shows that 72% of the total effect of
breastfeeding on income at 30 years (99 [95% CI 6·0–192·0]) is mediated by an
individual's IQ and only 28% through NDE. We adjusted estimates for base
confounders—family income at birth, parental education, household score index,
genomic ancestry, maternal smoking during pregnancy, and birthweight—and
educational attainment as a postconfounder. NIE=natural indirect effect.
NDE=natural direct effect.
Summary
Background
Breastfeeding has clear short-term
benefits, but its long-term consequences on human capital are yet to be
established. We aimed to assess whether breastfeeding duration was associated
with intelligence quotient (IQ), years of schooling, and income at the age of
30 years, in a setting where no strong social patterning of breastfeeding
exists.
Methods
A prospective, population-based birth
cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information
about breastfeeding was recorded in early childhood. At 30 years of age, we
studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational
attainment, and income of the participants. For the analyses, we used multiple
linear regression with adjustment for ten confounding variables and the
G-formula.
Findings
From June 4, 2012, to Feb 28, 2013, of the
5914 neonates enrolled, information about IQ and breastfeeding duration was
available for 3493 participants. In the crude and adjusted analyses, the
durations of total breastfeeding and predominant breastfeeding (breastfeeding
as the main form of nutrition with some other foods) were positively associated
with IQ, educational attainment, and income. We identified dose-response
associations with breastfeeding duration for IQ and educational attainment. In
the confounder-adjusted analysis, participants who were breastfed for 12 months
or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20–5·33),
more years of education (0·91 years, 0·42–1·40), and higher monthly incomes
(341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less
than 1 month. The results of our mediation analysis suggested that IQ was
responsible for 72% of the effect on income.
Interpretation
Breastfeeding is associated with improved
performance in intelligence tests 30 years later, and might have an important
effect in real life, by increasing educational attainment and income in
adulthood.
http://passblue.com/2015/09/01/a-broader-breastfeeding-campaign-emphasizes-mothers-health/
A Broader Breastfeeding Campaign
Emphasizes Mothers’ Health
By Barbara
Crossette on Sep 03, 2015
Breastfeeding
has long been promoted for its health benefits to babies and to mothers, but
only 36 percent of babies are exclusively fed that way worldwide and the
reasons vary by region and demographics.
Every year, the first week of August is
dedicated to promoting the exclusive feeding of newborn infants with natural
breast milk, which evidence shows can ensure numerous health benefits for
mother and child. There are few if any specialists in the field of infant
health who would now dispute that. United Nations agencies, the World Health
Organization, the World Bank and the most influential nongovernment experts
concur.
Earlier this year, the published results of
an innovative 30-year study in Brazil
indicated that infants who were breastfed for 12 months or more had, by age 30,
higher IQ scores, educational attainment and income levels, as reported in the
British medical journal The Lancet. The widely adopted prescription for
breastfeeding is that a newborn infant should be fed for the first time within
an hour of birth, then exclusively on breast milk for six months and up to 24
months or longer with complementary nutritional feeding.
The obvious question is why, after decades of
promoting this schedule, only 36 percent of babies are exclusively breastfed
around the world, contributing to 800,000 infant deaths annually, according to
recent data from the World Health Organization. Individuals, societies and
governments have numerous explanations. Like other issues involving
reproductive health and rights, these often differ in the global North and
South.
Women in richer countries — and the most
affluent mothers in poor nations — may be mostly concerned about problems of
finding time and privacy (and acceptance) in the workplace or in public spaces,
and have ready access to other options in commercial baby formulas or breast
milk banks. In developing nations, where many poor women and their babies take
to breastfeeding naturally and health providers try to fend off the commercial
intrusion of formula makers, other factors are often present. There may be a
lack of clean water and sanitation, no access to professional health care
(especially trained midwives) and scant reliable information about safe
pregnancy. Most important is the poor nutritional state of women.
The world’s poorest women, some with multiple
births behind them and large families to feed with scarce resources, suffer
from anemia in large numbers: 40 to 60 percent of all women of childbearing age
in South Asia and parts of western Africa, compared with less than 20 percent
in all but a few pockets in the Western hemisphere, from pole to pole, WHO data
show. These weakened women may suffer or die in pregnancy or give birth to
children who are born undernourished or are irreversibly stunted physically and
mentally. Both high maternal and infant death rates are common in these
situations.
Stunting, defined physically as a significant
deviation from the median height of children in a given area and age group, was
studied by WHO in 148 developed and developing nations between 1990 and 2010
(with predictions to 2020). In 2010, the study reported that 171 million
children were stunted — 167 million of them in developing countries, including
about half the children in India, soon to be the world’s most populous nation.
Breastfeeding alone is not always the
solution to saving or strengthening low-birth weight babies; making mothers
healthier is. Increasingly, experts argue, the conditions for safe motherhood
should start well before pregnancy. Bangladesh is among the countries committed
to universal breastfeeding standards while also actively involved in improving
the nutrition of mothers.
“Breastfeeding within the first hour of
birth, along with proper nutrition for mothers, is key to ensuring healthy
brain and growth development in children,” said Susan Davis, president of BRAC USA. “For mothers
in low-income countries, breastfeeding is the single most effective way to
prevent child deaths as it wards off infection, diarrhea and respiratory
infections that can be lethal for newborns. Breastfeeding for the first six
months, along with complementary food in the 6-24 month period leads to proper
cognitive and physical development and prevents malnutrition and permanent
stunting.”
BRAC (formerly the Bangladesh Rural
Advancement Committee) was founded in Bangladesh in 1972 by Fazle Hasan Abed, who
has recently been named the winner of the 2015 World Food Prize. BRAC is now
the world’s largest nongovernment development organization, focusing on
increasing food security and ending poverty at local levels mostly in Asia and
Africa. The organization’s projects are led by community health workers, who
offer prenatal care and nutritional information to pregnant women and would-be
mothers. It estimates that its programs have prevented 20,000 neonatal deaths.
BRAC has played an important role in helping
Bangladesh meet numerous targets in the Millennium Development Goals through
its holistic approach to development. The country has reduced poverty, reached
parity between girls and boys in primary and secondary education as well as cut
communicable disease rates, under-five deaths and maternal mortality.
“We are determined to do more,” Davis, a former president of the Women’s Environment and Development Organization (WEDO), said in an email interview with PassBlue. “Bangladesh still has an unacceptably high stunting rate. Working with the government of Bangladesh, BRAC and other groups are committed to improving nutrition. Breastfeeding is an important part of this strategy."