Effects of promoting longer-term and exclusive breastfeeding on childhood eating attitudes: a cluster-randomized trial

Oleg Skugarevsky, Kaitlin H Wade, Rebecca C Richmond, Richard M Martin, Kate Tilling, Rita Patel, Konstantin Vilchuck, Natalia Bogdanovich, Natalia Sergeichick, George Davey Smith, Matthew W Gillman, Emily Oken, Michael S Kramer

Research output: Contribution to journalArticle (Academic Journal)peer-review

14 Citations (Scopus)


BACKGROUND: Observational studies suggest that breastfeeding benefits later maternal child-feeding practices, which in turn may contribute to positive eating attitudes. We investigated the effect of a randomized intervention to increase duration and exclusivity of breastfeeding on pre-adolescent eating attitudes.

METHODS: Long-term follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial in 31 maternity hospitals and affiliated polyclinics in Belarus. Sites were randomly assigned an experimental intervention to promote longer duration and exclusivity of breastfeeding in mothers who initiated breastfeeding (n = 16 sites), or a control intervention of continuing usual care (n = 15 sites); 17 046 healthy infants were enrolled in 1996-7, of whom 13 751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years of age. A ChEAT score ≥22.5 (85th percentile) was used as an indicator of problematic eating attitudes. Analysis was based on intention-to-treat, accounting for clustering within hospitals/clinics.

RESULTS: Compared with the control arm, the experimental intervention substantially increased breastfeeding exclusivity (43.3% vs 6.4% exclusively breastfed at 3 months of age) and duration of any breastfeeding throughout infancy. The proportion of children with ChEAT scores ≥22.5 was lower in the experimental than control arm (boys 11.4% vs 17.2%; girls 18.5% vs 23.4%) [cluster-adjusted odds ratio (OR), boys: 0.44; 95% confidence interval (CI): 0.21,0.93; girls: 0.51; 95% CI: 0.27,0.99). Results were robust to adjustment for potential confounders and using a ChEAT score ≥25.5 (91st percentile) as the outcome (OR: 0.53; 95% CI: 0.28,1.03).

CONCLUSIONS: An intervention to improve the duration and exclusivity of breastfeeding among term infants in Belarus was associated with a reduction in problematic eating attitudes at 11.5 years of age.

Original languageEnglish
Pages (from-to)1263-71
Number of pages9
JournalInternational Journal of Epidemiology
Issue number4
Publication statusPublished - 1 Aug 2014

Bibliographical note

© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.


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  • MRC UoB UNITE Unit - Programme 1

    Davey Smith, G.


    Project: Research

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