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Updated: Jun 26, 2026
A Common Marmoset Model of Mother-Infant Intervention for Breastfeeding Disorders in the Presence of Paternal Inhibition and Maternal Neglect
Published on: September 22, 2023
A randomized breast-feeding promotion intervention did not reduce child obesity in Belarus
Michael S Kramer1, Lidia Matush, Irina Vanilovich
1Departments of Pediatrics and of 5Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, QC, Canada. michael.kramer@mcgill.ca
Insights
Promoting exclusive breastfeeding significantly increased its duration but did not reduce childhood obesity or adiposity. Observational studies may overstate breastfeeding
Area of Science:
- Pediatrics
- Public Health
- Nutrition
Background:
- Observational studies suggest breastfeeding protects against obesity, but are prone to bias.
- Confounding and selection bias may influence findings on breastfeeding and child adiposity.
- Need for rigorous trials to confirm breastfeeding's impact on long-term health outcomes.
Purpose of the Study:
- To assess the effect of a breastfeeding promotion intervention on children's adiposity and blood pressure.
- To evaluate the impact of the Promotion of Breastfeeding Intervention Trial (PROBIT) on key health indicators at 6.5 years.
- To determine if increased exclusive and prolonged breastfeeding reduces childhood obesity.
Main Methods:
- Cluster-randomized trial (PROBIT) involving 17,046 infants across 31 Belarussian maternity hospitals.
- Intervention focused on WHO/UNICEF Baby-Friendly Hospital Initiative guidelines.
- Follow-up at 6.5 years included measurements of height, weight, adiposity, and blood pressure (BP) in 13,889 children; intention-to-treat analysis.
Main Results:
- Intervention significantly increased exclusive breastfeeding at 3 months (43.3% vs 6.4%) and any breastfeeding throughout infancy.
- No significant differences observed in height, BMI, adiposity measures (waist circumference, skinfolds), or BP between groups.
- PROBIT intervention successfully enhanced breastfeeding practices but did not impact adiposity at 6.5 years.
Conclusions:
- Intensive breastfeeding promotion increases breastfeeding rates but does not reduce childhood adiposity or affect BP.
- Observed protective effects of breastfeeding against obesity in prior studies may be due to uncontrolled confounding and selection bias.
- Further research needed to understand the complex relationship between breastfeeding and long-term metabolic health.
Abstract:
The evidence that breast-feeding protects against obesity is based on observational studies, with potential for confounding and selection bias. This article summarizes a previously published study in which we assessed whether an intervention designed to promote exclusive and prolonged breast-feeding affects children's height, weight, adiposity, and blood pressure (BP) at age 6.5 y. The Promotion of Breastfeeding Intervention Trial (PROBIT) is a cluster-randomized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative. A total of 17,046 healthy breast-fed infants were enrolled from 31 Belarussian maternity hospitals and affiliated clinics, of whom 13,889 (81.5%) were followed up at 6.5 y with duplicate measurements of height, weight, waist circumference, triceps and subscapular skinfold thicknesses, systolic and diastolic BP. Analysis was based on intention to treat, with statistical adjustment for clustering within hospitals/clinics to permit inferences at the individual level. The experimental intervention led to a large increase in exclusive breast-feeding at 3 mo (43.3% vs. 6.4%, P < 0.001) and a significantly higher prevalence of any breast-feeding throughout infancy. No significant intervention effects were observed on height, BMI, adiposity measures, or BP. The breast-feeding promotion intervention resulted in substantial increases in the duration and exclusivity of breast-feeding yet did not reduce measures of adiposity at age 6.5 y. Previous reports of protective effects against obesity may reflect uncontrolled bias caused by confounding and selection.
