Bork Kirsten A, Cames Cécile, Newell Marie-Louise, Read Jennifer S, Ayassou Kossiwavi, Musyoka Faith, Mbatia Grace, Cournil Amandine
Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France;
Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France.
J Nutr. 2017 Mar;147(3):453-461. doi: 10.3945/jn.116.242339. Epub 2017 Jan 25.
Early feeding patterns may affect the growth of HIV-exposed children and thus their subsequent health and cognition. We assessed the association of infant feeding (IF) mode with length-for-age score (LAZ) and stunting from age 2 d to 18 mo in HIV-exposed African children within a controlled randomized trial, which evaluated triple antiretrovirals initiated during pregnancy and continued for 6 mo postpartum to prevent HIV transmission. HIV-infected pregnant women with CD4 counts of 200-500 cells/mm from Burkina Faso, Kenya, and South Africa were advised to exclusively breastfeed for up to 6 mo or to formula-feed from birth. Factors associated with LAZ were investigated in all uninfected children by using mixed-effects linear models; those associated with stunting (LAZ <-2) at 6 or 12 mo were assessed in multiple logistic regression after exclusion of children stunted at age 2 d. Independent variables were IF mode: formula feeding (FF), exclusive breastfeeding (EBF) <3 mo, or EBF ≥3 mo (reference); sex; trial arm; maternal characteristics; and site. Among 728 children, FF was associated with a greater increase in LAZ from 2 d to 6 mo (+0.07 score/mo, < 0.001). Between 6 and 18 mo, FF and EBF <3 mo were both associated with greater mean LAZ than was EBF ≥3 mo (+0.52 scores and +0.43 scores, respectively, < 0.001). Among children not stunted at 2 d, FF was independently associated with a reduced risk of stunting at 6 mo (OR: 0.24; 95% CI: 0.07, 0.81; = 0.021), whereas EBF <3 mo was not (OR: 0.49; 95% CI: 0.22, 1.10; = 0.09). In this observational study of HIV-exposed uninfected infants, growth in length in the first 6 mo of life was faster in formula-fed infants than in exclusively breastfed infants. The plausibility of residual confounding and reverse causality is discussed. This trial was registered at www.controlled-trials.com as ISRCTN71468401.
早期喂养模式可能会影响暴露于艾滋病病毒的儿童的生长发育，进而影响他们后续的健康状况和认知能力。在一项对照随机试验中，我们评估了非洲暴露于艾滋病病毒的儿童从出生2天到18个月时婴儿喂养（IF）方式与年龄别身长评分（LAZ）及发育迟缓之间的关联。该试验评估了孕期开始并在产后持续6个月使用三联抗逆转录病毒药物以预防艾滋病病毒传播的效果。来自布基纳法索、肯尼亚和南非的CD4细胞计数为200 - 500个/立方毫米的感染艾滋病病毒的孕妇，被建议纯母乳喂养至多6个月或从出生就进行配方奶喂养。通过使用混合效应线性模型在所有未感染儿童中研究与LAZ相关的因素；在排除出生2天时就发育迟缓的儿童后，通过多因素逻辑回归评估在6个月或12个月时与发育迟缓（LAZ < -2）相关的因素。自变量包括IF方式：配方奶喂养（FF）、3个月内纯母乳喂养（EBF）或3个月及以上纯母乳喂养（参考）；性别；试验分组；母亲特征；以及地点。在728名儿童中，从出生2天到6个月，FF组的LAZ增长幅度更大（每月增加0.07分，P < 0.001）。在6至18个月期间，FF组和3个月内EBF组的平均LAZ均高于3个月及以上EBF组（分别增加0.52分和0.43分，P < 0.001）。在出生2天时未发育迟缓的儿童中，FF组在6个月时发育迟缓风险独立降低（比值比：0.24；95%置信区间：0.07，0.81；P = 0.021），而3个月内EBF组则没有（比值比：0.49；95%置信区间：0.22，1.10；P = 0.09）。在这项针对暴露于艾滋病病毒但未感染的婴儿的观察性研究中，配方奶喂养的婴儿在出生后前6个月的身长增长比纯母乳喂养的婴儿更快。文中讨论了残余混杂和反向因果关系的合理性。该试验在www.controlled-trials.com上注册，注册号为ISRCTN71468401。
