Bottle feeding increases risk of death from heart disease

A prospective randomised study in today's Lancet reports that adolescents have a reduction of 14% in their ratio of LDL to HDL cholesterol if they were fed breastmilk in infancy.

926 infants born preterm in the early 1980s were randomly assigned to receive donated banked breastmilk or preterm formula as their sole diet or as supplements to mother's milk. 216 participants were followed up at age 13-16 years. Measurements were taken of low-density to high-density lipoprotein cholesterol ratio (LDL to HDL), ratio of apolipoprotein B to apolipoprotein A-1 (apoB to apoA-1), and concentration of C-reactive protein (CRP; a measure of the inflammatory process associated with atherosclerosis).

Adolescents who had received banked breastmilk had a lower CRP concentration (p=0·006) and LDL to HDL ratio (mean difference 0·34 [14% lower], 95% CI -0·67 to -0·01; p=0·04) than those given preterm formula. A dose reponse association was found with increased breastmilk intake being linked to improved ratios of LDL to HDL and apoB to apoA-1.

A reference group of infants born at term showed cholesterol concentrations which did not differ significantly from those born preterm.

The authors note that a 10% reduction in the concentration of cholesterol in plasma would reduce the incidence of cardiovascular disease by 25% and mortality by 13-14%. They also report that cholesterol concentrations, and particularly LDL cholesterol, track from adolescence to adult life and, because differences may amplify with age, the beneficial effect of breastfeeding on lipoprotein concentrations could be considerably greater in adulthood.

This latest study reinforces the growing body of evidence for an increased risk of cardiovascular risk factors among adolescents and adults who were artificially fed in infancy.

Singhal A et al (2004). Breastmilk feeding and lipoprotein profile in adolescents born preterm: follow-up of a prospective randomised study . Lancet 363: 1571-78 [Full text]