Caulfield L E, Bentley M E, Ahmed S
Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Int J Epidemiol. 1996 Aug;25(4):693-703. doi: 10.1093/ije/25.4.693.
A growing body of literature suggests that prolonged breastfeeding (typically defined as beyond the first year of life) may be a risk factor for malnutrition.
To examine the extent to which continued breastfeeding is a risk factor for malnutrition, we used multiple regression techniques to relate current breastfeeding status to weight and stature in children < 36 months old whose mothers participated in one of 19 Demographic and Health Surveys (DHS) conducted between 1987 and 1989.
The data from 9 of 11 countries outside sub-Saharan Africa (SSA) indicated that among older children, those still breastfed are shorter and lighter than those no longer breastfed. These differences, which reached statistical significance in five countries, become apparent at 12-18 months of age. In contrast, in five of eight SSA countries, younger still breastfed children are significantly shorter and lighter than those no longer breastfed, but, the differences are largely diminished among older children. These basic patterns were not altered by adjustment for family sociodemographic characteristics, health care utilization, and recent child illness.
Important differences in nutritional status associated with continued breastfeeding are observed throughout the developing world, and are not likely due to confounding by family sociodemographic characteristics, health care utilization or recent child illness. A unifying interpretation of the observed relationships is that child size is somehow related to the decision to wean, and that whereas in SSA, the biggest children are weaned first, in non-SSA countries, the smallest children are weaned last.
越来越多的文献表明，延长母乳喂养时间（通常定义为超过一岁）可能是营养不良的一个风险因素。
为了研究持续母乳喂养在多大程度上是营养不良的风险因素，我们运用多元回归技术，将1987年至1989年间参与19项人口与健康调查（DHS）之一的母亲所生的36个月以下儿童的当前母乳喂养状况与体重和身高联系起来。
撒哈拉以南非洲（SSA）以外11个国家中9个国家的数据表明，在年龄较大的儿童中，仍在母乳喂养的儿童比不再母乳喂养的儿童更矮、更轻。这些差异在五个国家具有统计学意义，在12至18个月大时变得明显。相比之下，在SSA的八个国家中的五个国家，仍在母乳喂养的较小儿童明显比不再母乳喂养的儿童更矮、更轻，但在年龄较大的儿童中，这些差异在很大程度上减小了。通过对家庭社会人口特征、医疗保健利用情况和近期儿童疾病进行调整，这些基本模式并未改变。
在整个发展中世界都观察到了与持续母乳喂养相关的营养状况的重要差异，而且不太可能是由于家庭社会人口特征、医疗保健利用情况或近期儿童疾病的混杂因素导致的。对观察到的关系的一个统一解释是，儿童的体型在某种程度上与断奶的决定有关，而且在SSA，最大的儿童最先断奶，而在非SSA国家，最小的儿童最后断奶。
