Effects of exclusive breastfeeding intervention on child growth and body composition: the MINIMat trial, Bangladesh

Authors

  • Ashraful I Khan,

    Corresponding author
    1. International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
    2. International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
    • Correspondence

      Ashraful Islam Khan, International Centre for Diarrhoeal Diseases Research Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh.

      Tel: +88 02 8860523 32 |

      Fax: +88 02 8823116 |

      Email: ashrafk@icddrb.org

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  • Sophie Hawkesworth,

    1. Medical Research Council – International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
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  • Eva-Charlotte Ekström,

    1. International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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  • Shams Arifeen,

    1. International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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  • Sophie E Moore,

    1. Medical Research Council – International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
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  • Edward A Frongillo,

    1. Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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  • Md Yunus,

    1. International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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  • Lars Å Persson,

    1. International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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  • Iqbal Kabir

    1. International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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  • Trial Registration isrctn.org Identifier: ISRCTN16581394

Abstract

Aim

Exclusive breastfeeding (EBF) for 6 months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition.

Methods

In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54 months and assessment of body composition at 54 months.

Results

The mean duration of EBF in the BFC group was 111 days compared to 76 days in the UHM group (mean difference: 35.0 days, 95% CI 30.6–39.5, p < 0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54 months. Children exposed to prenatal multiple micronutrients (vs 60 mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference −0.17 SD score, p < 0.01).

Conclusion

Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54 months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0–54 months, which raises questions about possible negative effects of MMS.

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