母乳喂养对儿童行为和情绪发展的影响：中国的前瞻性队列研究。

The Effects of Breastfeeding on Childhood Behavioral and Emotional Development: A Prospective Cohort Study in China.

机构信息

Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China.

Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China.

出版信息

Nutrients. 2024 Jun 2;16(11):1743. doi: 10.3390/nu16111743.

DOI:10.3390/nu16111743

PMID:38892676

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11174704/

Abstract

BACKGROUND

Breastfeeding could improve a child's health early on, but its long-term effects on childhood behavioral and emotional development remain inconclusive. We aimed to estimate the associations of feeding practice with childhood behavioral and emotional development.

METHODS

In this population-based birth cohort study, data on feeding patterns for the first 6 mo of life, the duration of breastfeeding, and children's emotional and behavioral outcomes were prospectively collected from 2489 mother-child dyads. Feeding patterns for the first 6 mo included exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, including mixed feeding or formula feeding), and the duration of breastfeeding (EBF or mixed feeding) was categorized into ≤6 mo, 7-12 mo, 13-18 mo, and >18 mo. Externalizing problems and internalizing problems were assessed with the Child Behavior Checklist (CBCL) and operationalized according to recommended clinical cutoffs, corresponding to scores ≥64. Multivariable linear regression and logistic regression were used to evaluate the association of feeding practice with CBCL outcomes.

RESULTS

The median (interquartile range) age of children at the outcome measurement was 32.0 (17.0) mo. Compared with non-EBF for the first 6 mo, EBF was associated with a lower score of internalizing problems [adjusted mean difference (aMD): -1.31; 95% confidence interval (95% ): -2.53, -0.10], and it was marginally associated with scores of externalizing problems (aMD: -0.88; 95% : -1.92, 0.15). When dichotomized, EBF versus non-EBF was associated with a lower risk of externalizing problems (a: 0.54, 95% : 0.34, 0.87), and it was marginally associated with internalizing problems (a: 0.75, 95% : 0.54, 1.06). Regarding the duration of breastfeeding, breastfeeding for 13-18 mo versus ≤6 mo was associated with lower scores of internalizing problems (aMD: -2.50; 95% : -4.43, -0.56) and externalizing problems (aMD: -2.75; 95% : -4.40, -1.10), and breastfeeding for >18 mo versus ≤6 mo was associated with lower scores of externalizing problems (aMD: -1.88; 95% : -3.68, -0.08). When dichotomized, breastfeeding for periods of 7-12 mo, 13-18 mo, and >18 mo was associated with lower risks of externalizing problems [a (95% ): 0.96 (0.92, 0.99), 0.94 (0.91, 0.98), 0.96 (0.92, 0.99), respectively].

CONCLUSIONS

Exclusive breastfeeding for the first 6 mo and a longer duration of breastfeeding, exclusively or partially, are beneficial for childhood behavioral and emotional development.

摘要

背景

母乳喂养可以在早期改善儿童的健康状况，但它对儿童行为和情绪发展的长期影响仍不确定。我们旨在评估喂养方式与儿童行为和情绪发展之间的关联。

方法

在这项基于人群的出生队列研究中，前瞻性地从 2489 对母婴对子中收集了头 6 个月的喂养模式、母乳喂养持续时间以及儿童情绪和行为结果的数据。头 6 个月的喂养模式包括纯母乳喂养（EBF）和非纯母乳喂养（非 EBF，包括混合喂养或配方奶喂养），母乳喂养的持续时间（EBF 或混合喂养）分为≤6 个月、7-12 个月、13-18 个月和>18 个月。采用儿童行为检查表（CBCL）评估外化问题和内化问题，并根据推荐的临床临界值进行操作，对应于≥64 分的分数。采用多变量线性回归和逻辑回归评估喂养方式与 CBCL 结果的关系。

结果

结局测量时儿童的中位数（四分位距）年龄为 32.0（17.0）个月。与头 6 个月的非 EBF 相比，EBF 与内化问题的 CBCL 评分较低有关[调整均数差（aMD）：-1.31；95%置信区间（95%CI）：-2.53，-0.10]，且与外化问题的 CBCL 评分呈边缘相关（aMD：-0.88；95%CI：-1.92，0.15）。当二分类时，EBF 与非 EBF 相比，外化问题的风险较低（a：0.54，95%CI：0.34，0.87），且与内化问题的风险呈边缘相关（a：0.75，95%CI：0.54，1.06）。关于母乳喂养的持续时间，与≤6 个月相比，13-18 个月母乳喂养与内化问题的 CBCL 评分较低有关（aMD：-2.50；95%CI：-4.43，-0.56）和外化问题的 CBCL 评分较低（aMD：-2.75；95%CI：-4.40，-1.10），与≤6 个月相比，母乳喂养>18 个月与外化问题的 CBCL 评分较低有关（aMD：-1.88；95%CI：-3.68，-0.08）。当二分类时，7-12 个月、13-18 个月和>18 个月的母乳喂养与外化问题的风险较低有关[a（95%CI）：0.96（0.92，0.99）、0.94（0.91，0.98）、0.96（0.92，0.99）]。