Breast-feeding Performance Index: a composite index to describe overall breast-feeding performance among infants under 6 months of age

OBJECTIVES: To develop a composite index to describe the overall breast-feeding performance of infants<6 months of age; and, using this index, to identify the factors associated with poor breast-feeding practices and the association between breast-feeding and infant morbidity. DESIGN, SETTING AND SUBJECTS: The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households in Timor-Leste which covered 573 infants aged<6 months. Breast-feeding Performance Index (BPI) was constructed by allocating one point for each of seven infant feeding practices: first suckling within an hour of birth; absence of prelacteals; non-use of feeding bottles; current breast-feeding; not receiving liquids; not receiving formula or other milk; and not receiving solids in the last 24 hours. BPI was treated as the dependent variable in univariate and multivariate analyses to identify the factors associated with poor breast-feeding. RESULTS: Exclusive breast-feeding rate was 29.9%. The BPI (mean 4.4, standard deviation 1.77) was categorised as low, average and high according to tertiles. Multivariate analysis indicated that infants from the richest households were 1.70 (95% confidence interval (CI) 1.04-2.77) times more likely to have 'low BPI' than the poorest. Maternal BMI<18.5 kg m(-2) was predictive of poor breast-feeding (odds ratio=1.79; 95% CI 1.27-2.52). In the 'low' BPI group, the incidence of diarrhoea (13.4%) and acute respiratory infections (20.7%) during the previous two weeks was significantly higher than in 'average' (4.3 and 9.3%) and 'high' BPI groups (4.6 and 5.5%). CONCLUSIONS: Creating a composite index to assess the overall breast-feeding performance among infants<6 months of age is feasible. BPI can be effectively used to identify target groups for breast-feeding promotion interventions.     

Full-term, peri-urban South African infants under 6 months of age are at risk for early-onset anaemia

OBJECTIVE: There is a paucity of data on the micronutrient status of low-income, lactating South African women and their infants under 6 months of age. The aim of this study was to elucidate the level of anaemia and vitamin A deficiency (VAD) in peri-urban breast-feeding women and their young infants. DESIGN: Cross-sectional study including anthropometric, biochemical and infant feeding data.Setting: Peri-urban settlement in Cape Town, South Africa. SUBJECTS: Breast-feeding women (n=113) and their infants (aged 1-6 months) attending a peri-urban clinic. RESULTS: Mean (standard deviation (SD)) haemoglobin (Hb) of the lactating mothers was 12.4 (1.3) g dl(-1), with 32% found to be anaemic (Hb<12 g dl(-1)). Maternal serum retinol was 49.8 (SD 13.3) microg dl(-1), with 4.5% VAD. Using breast milk, mean (SD) retinol concentration was found to be 70.6 (24.6) microg dl(-1) and 15.7 (8.3) microg/g milk fat, with 13% below the cut-off level of <8 microg/g fat. There was no correlation found between breast milk retinol and infant serum retinol. Z-scores (SD) of height-for-age, weight-for-age and weight-for-height were -0.69 (0.81), 0.89 (1.01) and 1.78 (0.83), respectively. Mean (SD) infant Hb was 10.9 (1.1) g dl(-1), with the prevalence of anaemia being 50%, 33% and 12% using Hb cut-offs below 11 g dl(-1), 10.5 g dl(-1) and 9.5 g dl(-1), respectively. Mean (SD) infant serum retinol was 26.9 (7.2) microg dl(-1), with 10% being VAD. None of the infants was exclusively breast-fed, 22% were predominantly breast-fed and 78% received complementary (mixed) breast-feeding. Thirty-two per cent of infants received weaning foods at an exceptionally young age (< or =1 month old). CONCLUSION: A high rate of anaemia is present in lactating women residing in resource-poor settings. Moreover, their seemingly healthy infants under 6 months of age are at an elevated risk of developing early-onset anaemia and at lower risk of VAD.     

Breast-feeding initiation and exclusive duration at 6 months by social class--results from the Millennium Cohort Study

OBJECTIVES: To assess breast-feeding initiation and rates of exclusive breast-feeding for the first 6 months after birth, and to examine social class differences in breast-feeding rates. DESIGN: First sweep of a longitudinal population-based survey, the Millennium Cohort Study. SETTING: Four countries of the UK. SUBJECTS: Subjects were 18 125 singletons born over a 12-month period spanning 2000-01. Data were collected by parental interview on the initiation of breast-feeding and exclusivity at 1, 4 and 6 months after birth. RESULTS: Overall breast-feeding was initiated for 71% of babies, and by 1, 4 and 6 months of age the proportions being exclusively breast-fed were 34%, 3% and 0.3%, respectively. There were clear social class differences and mothers with routine jobs with the least favourable working conditions were more than four times less likely (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.18-0.29) to initiate breast-feeding compared with women in higher managerial and professional occupations. Women in routine jobs were less likely to exclusively breast-feed their infants at 1 month (OR 0.42, 95% CI 0.36-0.50) and 4 months (OR 0.5, 95% CI 0.31-0.77) compared with women in higher managerial and professional occupations. CONCLUSIONS: Clear social class differences in breast-feeding initiation and exclusivity for the first 4 months were apparent in this large UK sample. By 6 months, less than 1% of babies were being exclusively breast-fed. A co-ordinated multi-faceted strategy is required to promote breast-feeding, particularly among lower-income women.     

Excluding infants under 6 months of age from surveys: impact on prevalence of pre-school undernutrition

OBJECTIVE: Infants aged 0-5 months are not systematically included in assessments of child nutritional status and are generally excluded from surveys conducted in emergencies. We estimated the impact of excluding 0-5-month-old infants on the prevalence of stunting, wasting and underweight among children under 5 years (U5) and under 3 years (U3) of age. DESIGN: Comparison of the prevalence of stunting, wasting and underweight in U5 and U3 with or without inclusion of the age group 0-5 months. SETTING: Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 76 developing countries and countries in transition. SUBJECTS: Children under 3 or under 5 years of age included in the surveys.Results Excluding 0-5-month-old infants resulted in an overestimation of the prevalence of stunting, wasting and underweight in U5 of 3.0, 0.3 and 2.6 percentage points, respectively, and of 4.8, 1.0 and 5.2 percentage points, respectively, in U3. The overestimation for wasting was negligible. The regions showing the highest overestimations for stunting and underweight were Asia and sub-Saharan Africa. Overall, countries with high prevalences of stunting and underweight showed especially large overestimations. The prevalence of underweight in infants aged 0-5 months was correlated with the prevalence of low maternal body mass index. CONCLUSION: All surveys, even in situations of nutrition emergency, should include 0-5-month-old infants. Strictly comparable age ranges are essential in nutrition surveys for monitoring trends and evaluating programme impact. Greater awareness of prenatal and early child undernutrition is needed among policy-makers.     

Breast-feeding and maternal mental well-being among Bangladeshi and Pakistani women in north-east England

OBJECTIVES: To explore the relationship between infant feeding and maternal mental well-being among women of Bangladeshi and Pakistani ethnicity; and to explore the sources of advice, information and support available to women before and after childbirth. DESIGN: A cross-sectional survey of infant feeding and maternal well-being via structured interviews conducted in the home. SETTING: Home visits within two inner-city wards of Newcastle upon Tyne. SUBJECTS: Eighty-six women of South Asian ethnicity. RESULTS: Enjoyment of everyday activities was higher among women who breast-fed only (P = 0.028); whereas feeling sad or crying during pregnancy was lower among breast-feeding women (P = 0.005), as was not sleeping well (P = 0.003) and feeling that everything was too much (P = 0.039), compared with women who used formula or mixed feeding. Women who breast-fed only had better mean mood scores than those who formula-fed or those who both breast-fed and formula-fed (P < 0.001). Mean mood responses were also significantly associated with the mother's level of understanding of English and number of years in education (P = 0.005 and P = 0.003, respectively). The association between method of feeding and maternal mood remained strong after controlling for the effects of English language and maternal education. CONCLUSIONS: The study suggests that breast-feeding may be an important mediator of maternal mental well-being after childbirth. Community-based programmes tailored to the needs of Bangladeshi and Pakistani women which support breast-feeding and encourage exclusive breast-feeding may be of benefit.     

Breast-feeding and feeding practices of infants in a developing country: a national survey in Lebanon

OBJECTIVE: Breast-feeding (BF) provides the ideal food for the healthy growth and development of infants. The prevalence of BF in Lebanon shows mixed results. The present study was the first large-scale, extensive survey on BF parameters in Lebanon that aimed to explore demographic, socio-economic and other fundamental issues associated with the initiation and duration of BF by Lebanese mothers.DESIGN: The survey was cross-sectional in design and administered over 10 months.SETTING: Information on all variables was collected from mothers at health centres.SUBJECTS: Two-stage sampling was conducted to select participants. A total of 1,000 participants were randomly selected. A consent form was provided to each participant. Data were collected from 830 of these.RESULTS: Almost all mothers were Lebanese, married and had given birth in a hospital. About a third stated that breast milk was the first food introduced after birth. Although 55.9% started breast-feeding their newborns within a few hours after birth, and 18.3% within half an hour, 21.2% replied that they initiated BF a few days after birth. Only 4.6% of the mothers replied that they never breast-fed their infant. Timing of initiation of BF was associated with the type of delivery (vaginal/Caesarean section) and hospital-related factors (rooming-in, night feedings and frequency of mother-infant interaction). Of the mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a few hours following delivery, while only 13.3% had initiated BF a few days later. Compared with the exceptionally high proportion of BF initiation, exclusivity of BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated with place of residence (urban/rural) and negatively associated with educational level of the mother. Duration of BF was inversely associated with the use of pain killers during delivery and maternal education. Rural mothers and those who practised exclusive BF maintained BF for a longer duration.CONCLUSION: Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low and duration of BF is short. Future research targeting the factors associated with BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers who initiated BF, an ecological perspective on intervention aimed at women and their social support system is required to improve duration and exclusivity.     

Breast-feeding, dietary intakes and their associations with subclinical vitamin A deficiency in children in Anhui Province, China

OBJECTIVE: This study aimed to explore the associations between breast-feeding, dietary intakes and other related factors and subclinical vitamin A deficiency (SVAD) in children aged 0-5 years in an area in China where mild vitamin A deficiency (VAD) is found. METHODS: Data were from a population-based cross-sectional study with 1052 children aged 0-5 years. SVAD cases were identified by the indicator of serum retinol相似文献   

Alcohol and dietary fibre intakes affect circulating sex hormones among premenopausal women

BACKGROUND: The association of alcohol and fibre intake with breast cancer may be mediated by circulating sex hormone levels, which are predictors of breast cancer risk. OBJECTIVE: To evaluate the relationship of alcohol and dietary fibre intake with circulating sex hormone levels among premenopausal women. METHODS: A total of 205 premenopausal women completed a validated food-frequency questionnaire at baseline and after 2 years; blood samples taken at the same time were analysed for circulating sex hormone concentrations, including oestrone (E1), oestradiol (E2), free E2, progesterone, androstenedione and sex hormone-binding globulin, by radioimmunoassay. We used mixed models to estimate least-square means of sex hormone concentrations for alcohol intake categories and quartiles of dietary intake. RESULTS: After adjustment for covariates, alcohol consumption was moderately associated with higher circulating oestrogen levels; those who consumed more than one drink per day had 20% higher E2 (Ptrend=0.07) levels than non-drinkers. In contrast, higher dietary fibre intake was associated with lower serum levels of androstenedione (-8% between the lowest and highest quartiles of intake, Ptrend=0.06), but not oestrogens. Similarly, consumption of fruits (-12%, Ptrend=0.03), vegetables (-9%, Ptrend=0.15) and whole grains (-7%, Ptrend=0.07) showed inverse associations with androstenedione levels. CONCLUSIONS: The consistency of the observed differences in sex hormone levels associated with alcohol and fibre-rich foods indicates that these nutritional factors may affect sex hormone concentrations and play a role in breast cancer aetiology and prevention.     

Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioural factors among African Americans in North Carolina

OBJECTIVE: To examine associations of the frequency of eating at fast-food restaurants with demographic, behavioural and psychosocial factors and dietary intake in African American adults. METHODS: Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20-70 years, in North Carolina. An 11-page questionnaire assessed eating at fast-food restaurants, demographic, behavioural and diet-related psychosocial factors, and dietary intake (fruit, vegetable, total fat and saturated fat intakes, and fat-related dietary behaviours). RESULTS: The participants were aged 43.9+/-11.6 years (mean+/-standard deviation), 41% were male, 37% were college graduates and 75% were overweight or obese. Seventy-six per cent reported eating at fast-food restaurants during the previous 3 months: 4% usually, 22% often and 50% sometimes. Frequency of eating at fast-food restaurants was positively associated with total fat and saturated fat intakes and fat-related dietary behaviours (P<0.0001) and inversely associated with vegetable intake (P<0.05). For example, mean daily fat intake was 39.0 g for usually/often respondents and 28.3 g for those reporting rare/never eating at fast-food restaurants. Participants who reported usual/often eating at fast-food restaurants were younger, never married, obese, physically inactive and multivitamin non-users (all P<0.01). Frequency of eating at fast-food restaurants was positively associated with fair/poor self-rated health, weak belief in a diet-cancer relationship, low self-efficacy for healthy eating, weight dissatisfaction, and perceived difficulties of preparing healthy meals and ordering healthy foods in restaurants (all P<0.05). Frequency of eating at fast-food restaurants did not differ significantly by sex, education, smoking, ability to purchase healthy foods or knowledge of the Food Guide Pyramid. CONCLUSIONS: Eating at fast-food restaurants is associated with higher fat and lower vegetable intakes in African Americans. Interventions to reduce fast-food consumption and obesity in African Americans should consider demographic and behavioural characteristics and address attitudes about diet-disease relationships and convenience barriers to healthy eating.