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American Journal of Clinical Nutrition. 2003 Aug; 78(2):291-295.Background: Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided, but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding durations in recipient infants. Objective: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding. Design: We conducted an observational cohort study nested within a large randomized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo (with continued mixed breastfeeding through = 6 mo) with 621 infants who were exclusively breastfed for = 6 mo. Regression to the mean, within-cluster correlation, and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses. Results: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent. Conclusions: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life. (author's)
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.