Health and development outcomes in 6.5-y-old children breastfed exclusively for 3 or 6 mo1–3

Background: Despite the current World Health Organization recommendation that infants be exclusively breastfed for 6 mo, this practice remains unusual in both developed and developing countries. Objective: The objective was to compare health and development outcomes at age 6.5 y in children who were exclusively breastfed for 3 mo (EBF3) or for 6 mo (EBF6); in the EBF3 group, the children continued partial breastfeeding for 6 mo. Design: This was a prospective cohort study nested within a large, cluster-randomized trial of a breastfeeding promotion intervention in the Republic of Belarus. Outcomes compared at 6.5 y included anthropometric measurements, systolic and diastolic blood pressure, intelligence quotient, teachers ’ ratings of academic performance, parent- and teacher-rated behavior, atopic symptoms, allergen skin-prick tests, and dental caries. All statistical analyses were ad-justed for cluster- and individual-level covariates and for clustering of outcomes within the clinics at which the children were examined. Results: The 2427 EBF3 and 524 EBF6 children who were fol-lowed up represented 84.7 % and 89.4%, respectively, of those fol-lowed for the first year of life. The only significant differences observed between the 2 groups were in mean body mass index, triceps skinfold thickness, and hip circumference, all of which were higher in the EBF6 group. Conclusions: We observed no demonstrable beneficial or adverse long-term effects on child health of exclusive breastfeeding for 6 mo. Higher adiposity measures in the EBF6 group probably reflect reverse causality rather than a causal effect of prolonged exclusive breastfeeding. Established benefits appear to be limited to the period of exclusive breastfeeding. Am J Clin Nutr 2009;90:1070–4