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29/03/2024

NCDs – a global public health issue

A non-communicable disease (or NCD for short) is a non-infectious disease that cannot be transmitted from person to person. Obesity, diabetes, cancer and cardiovascular disease are NCDs. In 2019, the World Health Assembly extended the WHO Global Action Plan on NCDs 2013-2020 until 2030. See the WHO page on key facts about https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

IBFAN statement on NCDs in 2023

At the World Health Assembly (WHA), IBFAN has supported WHO’s work on NCDs since the start, highlighting the need for Conflicts of Interest safeguards, clear terminology and the protection breastfeeding and sound child feeding – essential in preventing NCDs.  FENSA (Framework of Engagement with Non-State Actors) has led to much confusion about identities and responsibilities.  Corporations have no democratic accountability and health policies should be free of their influence.  In our experience ‘multi-stakeholder’ partnerships with health-harming corporations delay effective legislation, especially on labels and marketing.  WHO must develop a global definition for Ultra Processed products –not food  and covered in claims about added micro-nutrients, yet do so much harm. Deaths from unhealthy food now exceed those of tobacco. We can say this because IBFAN is not a ‘stakeholder’ and has no financial ‘stake’ in this issue. See our page Conflict of interest

One important way of combating NCDs is to focus on reducing the risk factors associated with these diseases. Certain behaviours, such as smoking, physical inactivity unhealthy diet and the harmful use of alcohol, can be modified to reduce the risk of NCDs. Encouraging breastfeeding also helps to reduce this risk, for the health of both the child and the mother. Breastfeeding is associated with normal body weight, normal insulin metabolism, good physical and mental health, long-term physical and mental health. In other words
non-breastfeeding is associated with obesity, diabetes, cancer and cardiovascular disease etc.

Breastfeeding reduces risk factors for NCDs

An important way of combating NCDs is to focus on reducing the risk factors associated with these diseases. Certain behaviours, such as smoking, physical inactivity, poor diet and harmful use of alcohol, can be modified to reduce the risk of NCDs.

Encouraging breastfeeding also helps to reduce this risk, both for the health of the child and for the health of the mother. Breastfeeding is associated with normal body weight, normal insulin metabolism and good long-term physical and mental health. In other words, not breastfeeding is associated with obesity, diabetes, cancer, cardiovascular disease, hypertension, etc.

We need to communicate the benefits of breastfeeding

Breastfeeding is an indisputable fundamental value for the health of both mother and child. It’s also a guiding principle for prevention and health in Switzerland. It is therefore important to communicate in order to

  • inform women, parents, employers and the medical profession about the benefits of breastfeeding,
  • support women who choose to breastfeed, throughout the breastfeeding period,
  • invest in training health professionals about breastfeeding,
  • raise awareness among decision-makers of the need for support and information on breastfeeding,
  • create a breastfeeding-friendly society.

We must bear in mind that breastfeeding is the foundation of public health and at the heart of prevention.

NCDs and Covid-19

Breastfeeding is doubly important to protect against SARS-CoV2 as NCDs because

  • NCDs are risk factors that aggravated a Covid-19 episode,
  • breastmilk transmits many immunoprotective factors to the child. see also Immunology page

Breastfeeding and general health

2023 Wang X et al. Breastfeeding in infancy and mortality in middle and late adulthood: A prospective cohort study and meta-analysis. « During a total of 4732,751 person-years of follow-up, 25,581 deaths were identified. Breastfeeding in infancy was associated with lower risks of mortality in middle and late adulthood, with adjusted HRs (95% CIs) of 0.95 (0.93–0.98) for all-cause mortality; 0.91 (0.87–0.96) for cardiovascular mortality and 0.94 (0.874–0.999) for respiratory mortality. » Breastfeeding in infancy is associated with a lower risk of mortality – even decades later – in middle and late adulthood.

2016 The Lancet Breastfeeding Series states in its executive summary : “With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe. The two papers in this Series will describe past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions.”

Breastfeeding and infant health

Breast-feeding is the optimum nutrition for the child. See also the Immunology page and The Lancet Breastfeeding Series 2016

Infectious and non-infectious diseases

The Swiss Paediatric Society writes in 2017: “Health benefits: Human milk not only has immediate protective effects in the first few months of life (prevention of infections, particularly gastrointestinal and respiratory tract infections, as well as ear infections), but also long-term health benefits that are still observed after several years. Breastfeeding is said to protect against autoimmune diseases such as type 1 diabetes, chronic inflammatory bowel disease, allergies and coeliac disease; it reduces the risk of being overweight and obese, the risk of developing type 2 diabetes, the risk of hypertension, the risk of hypercholesterolaemia, the risk of developing acute lymphoblastic leukaemia, and it also improves the child’s cognitive development, resulting in a higher intelligence quotient. In fact, human milk is a determining factor in an individual’s health, and its effects continue to be felt years and even decades after the breastfeeding period.” Source: https://www.paediatrieschweiz.ch/fr/recommandations-pour-lalimentation-des-nourrissons-2017/

Breastfeeding protects against childhood cancer

2024 Protection against childhood leukemia https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816747 Exclusive Breastfeeding Duration and Risk of Childhood Cancers. Signe Holst Søegaard, P et al. A total of 309 473 children were included (51.3% boys), during 1 679 635 person-years of follow-up. Result : Longer breastfeeding duration may be a potential factor in prevention of childhood B-cell precursor acute lymphoblastic leukemia ALL.t

2021 Su Q et al. Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis. Forty-five articles involving 475,579 individuals were included in the meta-analysis. Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.

2018 Greaves M. A causal mechanism for childhood acute lymphoblastic leukaemia ALL. « Most cases of childhood ALL are potentially preventable. But how? Lifestyle changes including day care attendance or protracted breastfeeding in the first year of life can be advocated but would be difficult to achieve. » – Malgré la conclusion dubitative de l’auteur de cet article, GIFA pense que cette voie de redonner la place et le soutien à l’allaitement comme facteur préventif de l’ALL est une mesure réaliste.

2015 Efrat L et al. Breastfeeding and Childhood Leukemia Incidence Childhood cancer is a leading cause of mortality among children and adolescents in the developed world and the incidence increases by 0.9% each year. Leukemia accounts for about 30% of all childhood cancer but its etiology is still mostly unknown. The meta-analysis of all 17 studies indicated that compared with no or shorter breastfeeding, any breastfeeding for 6 months or longer was associated with a 20% lower risk for childhood leukemia (odds ratio, 0.80; 95% CI, 0.72-0.90). Conclusions and Relevance  Breastfeeding is a highly accessible, low-cost public health measure. This meta-analysis indicates that promoting breastfeeding for 6 months or more may help lower childhood leukemia incidence, in addition to its other health benefits for children and mothers.

Breastfeeding protects against childhood obesity

Obesity (in children and adults) is multifactorial. Breastfeeding helps to protect the child (who is the future adult) in a number of ways.

  • Breastmilk (BM) is a physiological, bio-dynamic liquid that adapts to the child’s needs and retains its nutritional and immuno-protective values throughout the period of breastfeeding (even after 2 years)
  • BM nourishes the baby’s microbiota and good bacteria
  • BM provides hormones that regulate appetite and fat metabolism (ghrelin, leptin, adiponectin, apelin etc.).
  • BM shapes children’s tastes through its variety and prepares them for diversification
  • BM prepares them for the transition to the family table without necessarily using processed industrial foods.

Breastfeeding and women’s health

Breastfeeding is not just about feeding a baby. Important processes take place in the breastfeeding mother’s body that have a positive long-term influence on her health. As a result, breastfeeding also has many benefits for maternal health. It promotes post-partum weight loss, lowers the risk of type 2 diabetes, hypertension, cardiovascular disease, breast and ovarian cancer, helps prevent anaemia and osteoporosis, helps space births (LAM) and promotes attachment by creating a strong mother-child bond.

Breastfeeding protects women against cancer

  • Ligue contre le cancer : https://www.krebsliga.ch/krebs-vorbeugen/praevention-und-frueherkennung/stillen/
  • 2020 : Association between breastfeeding and ovarian cancer risk. Babic A et al. JAMA Oncol 2020. https://pubmed.ncbi.nlm.nih.gov/32239218/
  • 2020 : Breastfeeding and risk of breast cancer: a meta-analysis of published studies. Bernier MO et al. Human Reproduction Update, Volume 6, Issue 4, July 2000, Pages 374–386, https://doi.org/10.1093/humupd/6.4.374
  • 2018 : Impact de la parité et de l’allaitement sur le risque de divers sous-types de cancers ovariens. Histological subtypes of ovarian cancer associated with parity and breastfeeding in the prospective Million Women Study. Gaitskell K et al. Int J Cancer 2018 ; 142(2) : 281-9.
  • 2018 : Reproductive history, breast-feeding and risk of tripple negative breast cancer : the Breast Cancer etiology in Minorities (BEM) study. John EM et al. Int J Cancer 2018 ; 142(11) : 2273-85. Mots-clés : cancer du sein triple négatif, facteurs reproductifs, allaitement.
  • 2017 : Le World Cancer Research Fund et l’American Institute for Cancer Research ont émis une série de 10 grandes recommandations pour prévenir le cancer, dont une portant sur l’allaitement. La protection de l’allaitement face au risque de cancer du sein : « strong evidence ». World Cancer Research Fund/American Institute for Cancer Research. https://www.wcrf.org/int/continuous-update-project/cup-findings-reports/breast-cancer
  • 2017 : Grossesse, allaitement, ménopause et risque de cancer du sein chez des femmes coréennes. Risk reduction of breast cancer by childbirth, breastfeeding, and their interactions in Korean women : heterogeneous effects across menopausal status, hormone receptor status, and pathological subtypes. Jeong SH et al. J Prev Med Public Health 2017 ; 50 : 401-10.
  • 2016 : Allaitement et expression du Ki-67, du p54 et du BCL2 dans les cancers du seinBreastfeeding and immunohistochemical expression of Ki-67, p53 and BCL2 in infiltrating lobular breast carcinoma. Gonzalez-Sistal A et al. PloS ONE 2016 ; 11(3) : e0151093.
  • 2014 : Allaitement et prévention du cancer du sein. Breastfeeding and the prevention of breast cancer : a retrospective review of clinical history. González-Jiménez E et al. J Clin Nurs 2014
  • 2013 : Facteurs reproductifs, récepteurs hormonaux, et risque de cancer du sein. Association between chronological change of reproductive factors and breast cancer risk defined by hormone receptor status : results from the Seoul breast cancer study. Chung S et al. Breast Cancer Res Treat 2013 ; 140(3) : 557-65.
  • 2013 : Lactation et risque de cancer du sein après la ménopause. Investigating the association of lactation history and postmenopausal breast cancer risk in the Women’s Health Initiative. Stendell-Hollis NR et al. Nutr Cancer 2013 ; 65(7) : 969-81.
  • 2012 : Allaitement et réduction du risque de cancer du sein. Breastfeeding and its relationship with reduction of breast cancer : a review. Franca-Bothelho Ado C et al. Asian Pac J Cancer Prec 2012 ; 13(11) : 5327-32.
  • 2002 : Lancet. 2002 Jul 20;360(9328):187-95. L’équipe du Pr Valérie Beral du Centre de recherche sur le cancer d’Oxford a prouvé qu’un allaitement prolongé diminue le risque d’apparition de ce cancer. Les chercheurs ont ainsi réuni les données de 47 études réalisées dans 30 pays différents, et portant au total sur près de 150 000 femmes : Résultat de l’étude Lancet 2002 1) Les femmes présentant un cancer avaient allaité moins souvent, et moins longtemps que les témoins. 2) Le risque de cancer était diminué de 4,3 % pour une année d’allaitement supplémentaire (sachant que le risque était déjà diminué de 7 % pour chaque naissance).

Anemia

Breastfeeding helps delay the return of menstruation and, under certain conditions, acts as a natural contraceptive. It allows rapid involution of the uterus after pregnancy through muscular contractions (the uterus is above all a muscle) under the effect of oxytocin naturally released into the body during breastfeeding.

Hypertension

It has a protective effect on hypertension

Prevention of cardio-vascular diseases

Lower risk of endometriosis

Regaining your normal weight

Exclusive breastfeeding for more than 6 months is associated with a slimmer waistline.

  • Breastfeeding Greater Than 6 Months Is Associated with Smaller Maternal Waist Circumference Up to One Decade After Delivery. GG Snyder et al. Journal of Women’s Health, Vol. 28, No. 4, 22 April 2019. https://pubmed.ncbi.nlm.nih.gov/30481097/

Maternal mental health

To some extent, breastfeeding also has a positive impact on maternal mental health. However, the experience of a mother who wishes to breastfeed and encounters difficulties also represents a significant stress and distress factor. This situation reinforces the idea that all women who wish to breastfeed need appropriate support.

A 2022 study concluded that, overall, breastfeeding was correlated with better maternal mental health. However, this impact was influenced by the course of breastfeeding, the difficulties encountered, the discrepancy between maternal expectations and experience, and the importance attached to breastfeeding by the mother in her role as mother. Further research on this subject is needed.

Maternal obesity

“Rates of prepregnancy obesity are rising in many countries around the globe, and epidemiologic data suggest a direct link between maternal prepregnancy BMI and offspring obesity. Maternal obesity coupled with lack of breastfeeding has been associated with a sixfold increased risk for child obesity. Moreover, population subgroups of women in many countries with the highest burden of obesity also have the lowest rates of initiation and shortest durations of breastfeeding, presenting an alarming possibility of a transgenerational cycle of obesity and associated chronic disease. Evidence is also mounting that lactation may be beneficial to women’s future health including protection against development of cardiovascular and metabolic diseases later in life.”

Breastfeeding – a preventive measure against obesity (children and adults)

Obesity (in children and adults) is multifactorial. Breastfeeding helps to protect the child (who is the future adult) in a number of ways.

It’s important to emphasise the role of breastfeeding from the very start of nutrition, to lay the foundations for healthy metabolic regulation and balanced body weight. Overweight and obesity are often directly linked to the onset of diabetes 2, to the point where we now speak of the ‘diabesity’ epidemic (a contraction of diabetes and obesity). The costs involved are considerable; in Switzerland, 10% of adults and 5% of children are affected: https://www.bag.admin.ch/bag/fr/home/gesund-leben/gesundheitsfoerderung-und-praevention/koerpergewicht/uebergewicht-und-adipositas/kosten-uebergewicht-und-adipositas.html

References for breastfeeding and obesity

  • 2019 Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017 A World Health Organization (WHO) study of 16 countries across Europe has found that breastfeeding can cut the chances of a child becoming obese by up to 25%. In absolute terms, 16.8% of children who were never breastfed were obese, compared with 13.2% who had been breastfed at some time and 9.3% of children breastfed for six months or more.
  • Breastfeeding Reduces Childhood Obesity Risks, 2017, Wang L., Collins C., Ratliff M., Xie B. and Wang Y., Childhood Obesity, 2016, 13 (3), 197-204.
  • Early life nutrition, epigenetics and programming of later life disease. Vickers MH1. Nutrients. 2014 Jun 2;6(6):2165-78. doi: 10.3390/nu6062165.
  • Epigenetic mechanisms linking early nutrition to long term health. Lillycrop, K.A.; Burdge, G.C. Best Pract. Res. Clin. Endocrinol. Metab. 2012, 26, 667–676. https://pubmed.ncbi.nlm.nih.gov/22980048/
  • Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Victora, C.G.; Bahl, R.; Barros, A.J.; França, G.V.; Horton, S.; Krasevec, J.; Murch, S.; Sankar, M.J.; Walker, N.; Rollins, N.C.; Lancet Breastfeeding Series Group. Lancet 2016, 387, 475–490. https://pubmed.ncbi.nlm.nih.gov/26869575/
  • Does breast-feeding protect against childhood obesity?Von Kries R, Koletzko B et al Adv Exp Med Biol. 2000;478:29-39. https://pubmed.ncbi.nlm.nih.gov/11065058/ The preventive effect of breast-feeding on overweight and obesity is an important additional argument for the promotion of breast-feeding in industrialised countries.
  • Arenz, S. , Ruckerl, R. , Koletzko, B. , & von Kries, R. (2004). Breast‐feeding and childhood obesity‐a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28, 1247–1256. https://pubmed.ncbi.nlm.nih.gov/15314625 Nine studies with more than 69,000 participants met the inclusion criteria. The meta-analysis showed that breast-feeding reduced the risk of obesity in childhood significantly. Conclusion: Breast-feeding seems to have a small but consistent protective effect against obesity in children.
  • Moreno et al (2011), Breastfeeding as Obesity Prevention “One important health benefit of breastfeeding is prevention of obesity. Obesity is one of the most serious health problems facing both children and adults today. Childhood obesity often leads to adult obesity, which causes many health problems including heart disease, diabetes, and even early death.” https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107563

Breastfeeding and impact on intellectual performance

2023 Paquette AF et al. The human milk component myo-inositol promotes neuronal connectivity. PNAS 2023 ; 120(30) : e2221413120. https://www.pnas.org/doi/10.1073/pnas.2221413120 The formation and maintenance of brain connectivity are guided by an interplay of genetics, experience, and environment. The impact of these factors can be considered particularly important at two stages of life, when synaptic connections rapidly form in the developing brain and when synapses are gradually lost in aging (1, 2). Diet is one environmental factor, yet the effects of bioactive dietary compounds on the formation and maintenance of neuronal connectivity remain to be defined. In early postnatal development, breast milk is rich in micronutrients and bioactive compounds that could support brain development. Indeed, this complex and dynamic fluid offers short- and long-term health benefits to infants, including increased performance in cognitive tasks (35). Further, observational studies on the other side of the lifespan support that dietary factors can be associated with healthy brain aging (6, 7).

2023 Adams LJ et al Infant feeding method and special educational need in 191,745 Scottish schoolchildren: A national, population cohort study. Infant breastfeeding has been associated with reduced physical and mental health problems in childhood which contribute toward special educational need (SEN). Findings:

  • For women who struggle to breastfeed for the full 6 months recommended by WHO, our study suggests that a shorter duration of nonexclusive breastfeeding could still be beneficial with regard to the development of SEN.
  • Our findings augment the existing evidence base concerning the advantages of breastfeeding and reinforce the importance of breastfeeding education and support.

2022 Pereyra-Elias R et al. To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Data from 7,855 singletons born in 2000–2002 and followed up to age 14 years within the UK Millennium Cohort Study were analysed. Findings show that breastfeeding duration is associated with improved cognitive development in children, but it is unclear whether this is a causal relationship or due to confounding. Conclusion: The associations between breastfeeding duration and cognitive scores persist after adjusting for socioeconomic position SEP and maternal cognitive ability, however the effect was modest.

2022 AlThuneyyan DA et al. The Effect of Breastfeeding on Intelligence Quotient and Social Intelligence Among Seven- to Nine-Year-Old Girls: A Pilot Study (2022) “Exclusively breastfed girls had higher IQ and SI results compared with bottle-fed girls. However, unlike the BMI differences, these results were not statistically significant. This study provides fundamental observational data and can be further modified for use on a larger national-scale level.” This study involved 111 healthy girls, aged 7 to 9 years.

2022 de Weerth C et al. Human milk: From complex tailored nutrition to bioactive impact on child cognition and behavior Several conclusions can be drawn. First, human milk is a tailored nutrition that varies over time, between persons, and with maternal and child factors. Second, there is highly compelling emerging evidence that breast milk is central in nourishing, protecting, and guiding neurological development in human infants. Third, potential effects and mechanisms of lactocrine programming on child cognition and behavior are starting to be uncovered.-

2020 Kim KM et al. Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study “We found that cognitive development was improved in children that were breastfed for > 3 months. Although these results are supported by previous studies, it is important to note that other factors were reported as larger determinants of cognitive development than breastfeeding. Future studies that examine the underlying mechanism for the association between breastfeeding and cognitive development are warranted.”

2016 Boucher O et al. Association between breastfeeding duration and cognitive development. “After adjustment for several confounders, longer duration of breastfeeding was independently associated with better cognitive development and with fewer autistic traits. -This study provides further evidence of a positive association of breastfeeding with cognitive function apart from socio-environmental factors, and also suggests a protective role against autistic traits. Results are in agreement with recommendations for prolonged breastfeeding duration to promote child development.” Data come from Spanish multicenter birth-cohort study including 1,346 children mean age = 4.9 years.

2016 Lee H et al. Effect of Breastfeeding Duration on Cognitive Development in Infants: 3-Year Follow-up Study A total of 697 infants were tested at age 12, 24, and 36 months using the Korean version of the Bayley Scales of Infant Development II (K-BSID-II). After adjusting for covariates, infants who were breastfed for ≥ 9 months had significantly better cognitive development than those who had not been breastfed.

2015 Victora et al. Impact of breastfeeding on intelligence, educational attainment and income at 30 years of age in Brazil Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.

2015 Horta BL et al. Breastfeeding and intelligence: a systematic review and meta-analysis. “Breastfeeding is related to improved performance in intelligence tests. A positive effect of breastfeeding on cognition was also observed in a randomised trial. This suggests that the association is causal.” This review is cited in Victora et al. 2016, in Lancet Breastfeeding Series

2010 Isaacs EB et al. Impact of breast milk on IQ, brain size and white matter development. Although observational findings linking breast milk to higher scores on cognitive tests may be confounded by factors associated with mothers’ choice to breastfeed, it has been suggested that one or more constituents of breast milk facilitate cognitive development, particularly in preterms. Because cognitive scores are related to head size, we hypothesised that breast milk mediates cognitive effects by affecting brain growth. We used detailed data from a randomized feeding trial to calculate percentage of breast milk (%EBM) in the infant diet of 50 adolescents.

1999 Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr. 1999 Oct;70(4):525-35. https://pubmed.ncbi.nlm.nih.gov/19653092/. Meta-analysis of 11 studies. After adjusting for confounding factors such as maternal cognitive performance or paternal education, the authors conclude that breastfed children are three times more likely to have high cognitive function than non-breastfed children.

Read also the blog article by WBTi France https://wbtifrance.jimdofree.com/2018/04/03/intelligence-artificielle-et-allaitement/