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

• Type of Material: Article
• Authors: Bernardo L. Horta, Universidade Federal de Pelotas; Abet Bas, University of San Carlos; Santosh K. Bhargava, Sunderlal Jain Hospital; Caroline H. D. Fall, University of Southampton; Alan Feranil, University of San Carlos; Julia de Kadt, University of Witwatersrand; Reynaldo Martorell, Emory University; Linda M. Richter, University of Witwatersrand; Aryeh D Stein, Emory University; Cesar G. Victora, Universidade Federal de Pelotas
• Language: English
• Date: 2013-08-20
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Horta et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0071548
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 8
• Issue: 8
• Start Page: e71548
• End Page: e71548
• Grant/Funding Information: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; COHORTS is supported by Wellcome Trust (U.K.) and the Bill and Melinda Gates Foundation. Funding for the individual cohorts was as follows: INTCS (Guatemala) United States National Institutes of Health (NIH) and United States National Science Foundation; Pelotas Birth Cohort (Brazil) Wellcome Trust; New Delhi Birth Cohort Study (India) Indian Council of Medical Research, United States National Center for Health Statistics, Medical Research Council (U.K.), and British Heart Foundation; BTT (South Africa) Wellcome Trust, Human Sciences Research Council, South African Medical Research Council, South-African Netherlands Programme on Alternative Development, Anglo American Chairman's Fund, and University of the Witwatersrand; and CLHNS (the Philippines) NIH.
• Keywords: BIRTH COHORT; CHILD-DEVELOPMENT; RISK-FACTORS; YOUNG ADULTHOOD; OUTCOMES; INTELLIGENCE; PROFILE; COGNITIVE-DEVELOPMENT; LIFE; DURATION; Multidisciplinary Sciences; Science & Technology - Other Topics; Science & Technology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background:Performance 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 Findings:Participants 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.Conclusion:Measures of breastfeeding are not consistently related to schooling achievement in contemporary cohorts of young adults in lower and middle-income countries.