Full breastfeeding protection against common enteric bacteria and viruses: results from the MAL-ED cohort study
Author:
McCormick Benjamin J J1ORCID, Richard Stephanie A1, Murray-Kolb Laura E2, Kang Gagandeep3ORCID, Lima Aldo A M4, Mduma Estomih5ORCID, Kosek Margaret N6, Rogawski McQuade Elizabeth T6, Houpt Eric R6, Bessong Pascal7, Shrestha Sanjaya8, Bhutta Zulfiqar9ORCID, Ahmed Tahmeed10ORCID, Caulfield Laura E11ORCID, Acosta Angel Mendez12, de Burga Rosa Rios12, Chavez Cesar Banda12, Flores Julian Torres12, Olotegui Maribel Paredes12, Pinedo Silvia Rengifo12, Salas Mery Siguas12, Trigoso Dixner Rengifo12, Vasquez Angel Orbe12, Ahmed Imran9, Alam Didar9, Ali Asad9, Bhutta Zulfiqar A9, Qureshi Shahida9, Rasheed Muneera9, Soofi Sajid9, Turab Ali9, Yousafzai Aisha9, Zaidi Anita K M13, Bodhidatta Ladaporn14, Ammu Geetha3, Babji Sudhir3, Bose Anuradha3, George Ajila T3, Hariraju Dinesh3, Jennifer M Steffi3, John Sushil3, Kaki Shiny3, Kang Gagandeep3, Karunakaran Priyadarshani3, Koshy Beena3, Lazarus Robin P3, Muliyil Jayaprakash3, Ragasudha Preethi3, Raghava Mohan Venkata3, Raju Sophy3, Ramachandran Anup3, Ramadas Rakhi3, Ramanujam Karthikeyan3, Rose Anuradha3, Roshan Reeba3, Sharma Srujan L3, E Shanmuga Sundaram3, Thomas Rahul J3, Pan William K151, Ambikapathi Ramya16, Carreon J Daniel1, Doan Viyada1, Hoest Christel1, Knobler Stacey1, McCormick Benjamin J J1, McGrath Monica17, Miller Mark A1, Psaki Stephanie118, Rasmussen Zeba1, Richard Stephanie A1, Seidman Jessica C1, Gottlieb Michael19, Lang Dennis R19, Tountas Karen H19, Svensen Erling20, Amour Caroline21, Bayyo Eliwaza21, Mduma Estomih R21, Mvungi Regisiana21, Nshama Rosemary21, Pascal John21, Swema Buliga Mujaga21, Yarrot Ladislaus21, Mason Carl J22, Ahmed Tahmeed10, Ahmed A M Shamsir10, Alam Md Ashraful10, Haque Rashidul10, Haque Umma10, Hossain Md Iqbal10, Islam Munirul10, Mahfuz Mustafa10, Mondal Dinesh10, Nahar Baitun10, Tofail Fahmida10, Chandyo Ram Krishna23, Shrestha Prakash Sunder24, Shrestha Rita24, Ulak Manjeswori24, Bauck Aubrey18, Black Robert E17, Caulfield Laura E17, Checkley William17, Kosek Margaret N17, Lee Gwenyth O25, Schulze Kerry17, Yori Pablo Peñataro17, Murray-Kolb Laura E2, Ross A Catharine2, Schaefer Barbara2, Simons Suzanne2, Pendergast Laura26, Abreu Cláudia B27, Costa Hilda27, Moura Alessandra Di27, Filho José Quirino27, Havt Alexandre27, Leite Álvaro M27, Lima Aldo A M27, Lima Noélia L27, Lima Ila F27, Maciel Bruna L L27, Medeiros Pedro H Q S27, Moraes Milena27, Mota Francisco S27, Oriá Reinaldo B27, Quetz Josiane27, Soares Alberto M27, Mota Rosa M S27, Patil Crystal L28, Bessong Pascal7, Mahopo Cloupas7, Maphula Angelina7, Nyathi Emanuel7, Samie Amidou7, Barrett Leah6, Dillingham Rebecca6, Gratz Jean6, Guerrant Richard L6, Houpt Eric6, Petri William A6, Platts-Mills James6, Rogawski Elizabeth6, Scharf Rebecca6, Rogawski Elizabeth T6, Shrestha Binob29, Rayamajhi Bishnu Bahadur29, Shrestha Sanjaya Kumar29, Strand Tor30,
Affiliation:
1. Fogarty International Center/National Institutes of Health, Bethesda, MD, USA 2. The Pennsylvania State University, University Park, PA, USA 3. Christian Medical College, Vellore, India 4. Federal University of Ceara, Fortaleza, Brazil 5. Haydom Lutheran Hospital, Haydom, Manyara, Tanzania 6. University of Virginia, Charlottesville, VA, USA 7. University of Venda, Thohoyandou, South Africa 8. Walter Reed/AFRIMS Research Unit, Nepal, Kathmandu, Nepal 9. Aga Khan University, Karachi, Pakistan 10. icddr,b, Dhaka, Bangladesh 11. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 12. A.B. PRISMA, Iquitos, Peru 13. Bill and Melinda Gates Foundation, Seattle, WA, USA 14. Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 15. Duke University, Durham, NC, USA 16. Purdue University, Department of Nutrition Science, Lafayette, IN, USA 17. Johns Hopkins University, Baltimore, MD, USA 18. Leland Hunger Fellows Program, Congressional Hunger Center, Washington, DC, USA 19. Foundation for the National Institutes of Health, Bethesda, MD, USA 20. Haukeland University Hospital, Bergen, Norway 21. Haydom Lutheran Hospital, Haydom, Tanzania 22. Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA 23. Kathmandu Medical College, Kathmandu, Nepal 24. Institute of Medicine, Tribhuvan University, Kathmandu, Nepal 25. University of Michigan, Department of Epidemiology, Ann Arbor, MI, USA 26. Temple University, Philadelphia, PA, USA 27. Universidade Federal do Ceara, Fortaleza, Brazil 28. University of Illinois at Chicago, Chicago, IL, USA 29. Walter Reed/AFRIMS Research Unit, Kathmandu, Nepal 30. University of Bergen, Bergen, Norway
Abstract
ABSTRACT
Background
Breastfeeding is known to reduce the risk of enteropathogen infections, but protection from specific enteropathogens is not well characterized.
Objective
The aim was to estimate the association between full breastfeeding (days fed breast milk exclusively or with nonnutritive liquids) and enteropathogen detection.
Methods
A total of 2145 newborns were enrolled at 8 sites, of whom 1712 had breastfeeding and key enteropathogen data through 6 mo. We focused on 11 enteropathogens: adenovirus 40/41, norovirus, sapovirus, astrovirus, and rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter spp., and typical enteropathogenic E. coli as well as entero-aggregative E. coli, Shigella and Cryptosporidium. Logistic regression was used to estimate the risk of enteropathogen detection in stools and survival analysis was used to estimate the timing of first detection of an enteropathogen.
Results
Infants with 10% more days of full breastfeeding within the preceding 30 d of a stool sample were less likely to have the 3 E. coli and Campylobacter spp. detected in their stool (mean odds: 0.92–0.99) but equally likely (0.99–1.02) to have the viral pathogens detected in their stool. A 10% longer period of full breastfeeding from birth was associated with later first detection of the 3 E. coli, Campylobacter, adenovirus, astrovirus, and rotavirus (mean HRs of 0.52–0.75). The hazards declined and point estimates were not statistically significant at 3 mo.
Conclusions
In this large multicenter cohort study, full breastfeeding was associated with lower likelihood of detecting 4 important enteric pathogens in the first 6 mo of life. These results also show that full breastfeeding is related to delays in the first detection of some bacterial and viral pathogens in the stool. As several of these pathogens are risk factors for poor growth during childhood, this work underscores the importance of exclusive or full breastfeeding during the first 6 mo of life to optimize early health.
Funder
Bill & Melinda Gates Foundation NIH Fogarty International Center Department of Health and Human Services
Publisher
Oxford University Press (OUP)
Subject
Nutrition and Dietetics,Medicine (miscellaneous)
Cited by
16 articles.
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