Infant Feeding and School Attainment in Five Cohorts from Low- and Middle-Income Countries

Abstract

BackgroundPerformance in intelligence tests tends to be higher among individuals breastfed as infants, but little is known about the association between breastfeeding and achieved schooling. We assessed the association of infant feeding with school achievement in five cohorts from low- and middle-income countries. Unlike high-income country settings where most previous studies come from, breastfeeding is not positively associated with socioeconomic position in our cohorts, thus reducing the likelihood of a spurious positive association.Methodology and Principal FindingsParticipants included 10,082 young adults from five birth cohorts (Brazil, India, Guatemala, the Philippines, and South Africa). The exposures variables were whether the subject was ever breastfed, total duration of breastfeeding, and age at introduction of complementary foods. We adjusted the estimates for age at follow up, sex, maternal age, smoking during pregnancy, birthweight and socioeconomic position at birth. The key outcome was the highest grade achieved at school. In unadjusted analyses, the association between ever breastfeeding and schooling was positive in Brazil, inverse in the Philippines, and null in South Africa; in adjusted analyses, these associations were attenuated. In Brazil, schooling was highest among individuals breastfed for 3–12 months whereas in the Philippines duration of breastfeeding was inversely associated with schooling; and null associations were observed in South Africa and Guatemala. These associations were attenuated in adjusted models. Late introduction of solid foods was associated with lower schooling achievement in Brazil and South Africa.ConclusionMeasures of breastfeeding are not consistently related to schooling achievement in contemporary cohorts of young adults in lower and middle-income countries.

Factors Associated with Breastfeeding Initiation: A Comparison between France and French-Speaking Canada

“…As described by the WHO in 2003, both clinical and population-based research that focuses on findings pertaining to references for international growth are critical to long-term global goals of increasing breastfeeding engagement [11]. Research in this area has only begun to take an international approach towards meeting this goal [12–13]. …”

“…However, the effects and direction of other determinants such as income, parity, mode of delivery, preterm birth, and ethnicity have been less clear across studies [13,31–34]. These differences may be attributable to interaction effects with determinants particular to specific cultures or regions.…”

Physiological mechanisms, behavioral and psychological factors influencing the transfer of milk from mothers to their young

“…The authors concluded that maternal IQ is a vital confounder, but that the IQ of the mother only partially accounts for the association because even in those studies, which controlled for maternal intelligence, breastfeeding was associated with increased scores on intelligence tests (2.19 IQ points on average) (Horta et al, 2013). Walfisch and co-workers (2013) on the other hand suggested in the most comprehensive meta-analysis to date, that the relationship between breastfeeding and child cognition is mainly due to maternal confounders.…”

“…Two comprehensive meta-analyses with contrasting results have recently been published (Horta et al, 2013;Walfisch et al, 2013). Horta and Victora (2013) suggested that breastfeeding associated with better outcomes in intelligence tests (with an average of 3.5 points) during childhood/adolescence.…”

“…Horta and Victora (2013) suggested that breastfeeding associated with better outcomes in intelligence tests (with an average of 3.5 points) during childhood/adolescence.…”