Table 4.

Evidence supporting protective effects of breastfeeding on infant health.

Health Outcome	Strongest Evidence	Source	Comparison Groups	ORa	Fold-Riskb
GI tract infection (0–12 mo)	Experimental (hospital BF promotion vs. standard care)	Kramer et al, 2001 1	Intervention v. control (i.e baseline breastfeeding v. increased breastfeeding)	0.6	1.67
GI tract infection (3–6 mo)	Experimental (hospital BF promotion vs. standard care)	Kramer et al, 20032	Exclusively BF at 3 mo and partially BF ≥ 6 mo v. exclusively BF ≥ 6 mo	0.35	2.86
	Meta-analysis of cohorts	Chien et al, 20013	Ever-BF v. never-BF	0.36	2.78
Respiratory infection	Cohort	Duijts et al, 20104	Exclusively BF at 4 mo and partially BF thereafter v. never-BF	URTI: 0.65	URTI: 1.54
				LRTI: 0.50	LRTI: 2.00
			Exclusively BF ≥ 6 mo v. never-BF	URTI: 0.37	URTI: 2.70
				LRTI: 0.33	LRTI: 3.03
Hospitalization for respiratory infection	Meta-analysis	Bachrach et al, 20035	Ever-BF v. never-BF	0.26	3.85
Otitis Media	Meta-analysis of cohorts	Ip et al, 20096	Ever-BF v. never-BF	0.77	1.30
			Exclusively BF ≥ 3 mo v. never-BF	0.5	2.00
Cognitive Development	Experimental (hospital BF promotion vs. standard care)	Kramer et al, 20087	Intervention v. control (i.e. baseline breastfeeding v. increased breastfeeding)	+5.9 points on full-scale IQ	N/A
Sudden Infant Death Syndrome	Meta-analysis	Hauck et al, 20118	Ever-BF v. never-BF	0.55	1.82
			BF ≥ 2 mo v. never-BF	0.38	2.63
			Exclusively BF any duration v. never-BF	0.27	3.70
Acute Lymphoblastic Leukemia	Meta-analysis	Ip et al, 20096	BF > 6 mo v. never-BF	0.81	1.23
Obesity	Meta-analysis	Arenz et al, 20049	Ever-BF v. never-BF	0.79	1.27
	Meta-analysis	Owen at al, 2005 10	Ever-BF v. never-BF	0.87	1.15
			BF duration 1–3 mo v. never-BF	0.81	1.23
	Meta-analysis	Harder et al, 2005 11	BF duration 4–6 mo v. never-BF	0.76	1.32
			BF duration 7–9 mo v. never-BF	0.67	1.49

BF = breastfed, URTI = Upper Respiratory Tract Infection, LRTI = Lower Respiratory Tract Infection.

^aOdds Ratios as reported by original investigators, where the less-ideal behavior—i.e. the second comparison group listed—is used as the referent. The OR thus represents the benefit conferred by breastfeeding.

^bFold-risk as recalculated by the authors, where the more-ideal breastfeeding behavior—i.e. the first comparison group listed—is used as the referent, reflecting the authors’ suggestion that breastfeeding be considered the normative standard. The fold-risk thus represents the increase in morbidity and mortality associated with formula-feeding.

¹Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001;285(4):413–20.

²Kramer MS, Guo T, Platt RW, et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am Journal Clin Nutr. 2003;78(2):291–5.

³Chien P, Howie P. Breast milk and the risk of opportunistic infection in infancy in industrialized and non-industrialized settings. Advances in Nutritional Research. 2001;10:69–104.

⁴Duijts L, Jaddoe VWV, Hofman A, et al. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010;126(1):e18–e25.

⁵Bachrach V, Schwarz E, Bachrach L. Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis. Arch Pediatr Adolesc Med. 2003;157(3):237–43.

⁶Ip S, Chung M, Raman G, et al. A summary of the agency for healthcare research and quality’s evidence report on breastfeeding in developed countries. Breastfeeding Medicine. 2009;4(1):s17–s30.

⁷Kramer MS, Aboud F, Mironova E, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008;65(5) :578–84.

⁸Hauck FR, Thompson JMD, Tanabe KO, et al. Breastfeeding and reduced risk of Sudden Infant Death Syndrome: a meta-analysis. Pediatrics. 2011;128(1):103–10.

⁹Arenz S, Ruckerl R, Koletzko B, et al. Breast-feeding and childhood obesity--a systematic review. International Journal of Obesity and Related Metabolic Disorders. 2004;28(10):1247–56.

¹⁰Harder T, Bergmann R, Kallischnigg G, et al. Duration of breastfeeding and risk of overweight: a meta-analysis. American Journal of Epidemiology. 2005;162(5):397–403.

¹¹Owen CG, Martin RM, Whincup PH, et al. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115(5):1367–77.