Breastfeeding and association with refractive error in young Singapore Chinese children

Abstract

Purpose The objective of this study was to investigate an association between spherical refractive error and breastfeeding. Methods Strabismus, amblyopia, and refractive errors in Singaporean preschoolers (STARS) is a cross-sectional population-based study of 3009 Chinese children aged 6-72 months conducted between June 2006 and September 2008 in Singapore. Parents were asked about the history of breastfeeding in face-to-face interviews. Children without cycloplegia or without refraction assessment were excluded. The final sample analysed was 2639 children (1375 male, 1264 female). Results Out of those who were breastfed, 842 (41.3%) were breastfed for more than 3 months and 599 (29.4%) were breastfed longer than 6 months. The prevalence of myopia, defined as the spherical equivalent refraction of the right eye of at least À0.5 dioptres (D), was 11.3% (95% CI (10.1, 12.5)). The mean spherical equivalent refraction of breastfed children was 0.12 D higher than that of children who were not breastfed (P-value ¼ 0.03). Breastfeeding, however, was not associated with myopia (adjusted OR ¼ 0.85; 95% CI (0.62, 1.18)). Conclusions The results show that breastfeeding is associated with more hyperopic spherical equivalent refraction in young Chinese children in Singapore.

Risk factors for astigmatic components and internal compensation: the Nanjing Eye Study

“…Some previous studies suggested that infants with breastfeeding will have better vision and be less likely to be myopic in later life than those with formula feeding [38,39]. A study in young Singapore Chinese children showed that breastfeeding was associated with more positive spherical equivalent refraction [40]. However, another two studies did not find any significant relationship between feeding patterns and visual acuity and spherical equivalent refraction [41,42].…”

The Effect of Longer-Term and Exclusive Breastfeeding Promotion on Visual Outcome in Adolescence

“…Several previous observational studies have suggested better visual outcomes in infancy and early childhood among children who were breastfed compared to those formula-fed. 9 , 11 , 28 , 29 However, not all such studies have been as supportive; some suggest no effect 13 or associations that might be partially or wholly explained by residual confounding. 25 Our finding of similar levels of low vision amongst children from maternity hospitals and clinics randomized to breastfeeding promotion or continued standard practice suggests that longer duration and more exclusive breastfeeding has little effect in patterning vision outcomes into late childhood.…”

“…10 Some evidence suggests that breastfeeding promotes visual development, and hence less susceptibility to ametropia (refractive error), 9 , 11 , 12 findings that have been attributed to the long-chain n-3 polyunsaturated fatty acids (LCPUFAs) present in breast milk. However, more recent survey evidence has been less supportive, 13 and although LCPUFAs occur in high concentrations in retinal photoreceptors, trials comparing LCPUFA supplemented with unsupplemented formula have yielded equivocal results. 14 , 15 Inconsistencies may be due to differences in LCPUFA exposure, statistical power or, in observational studies, the degree of adjustment for confounders.…”

Infant Feeding Practices in a Multi-Ethnic Asian Cohort: The GUSTO Study

“…While several local studies have examined breastfeeding [ 16 , 21 , 22 , 23 ], picky eating [ 24 ] and parenting practices [ 14 ], little research has been done on infant feeding practices in Asian populations. To our knowledge, this study is the first to provide data on infant feeding practices in a multi-ethnic cohort.…”