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Dataanalysis

Answer to question1:

The authors conducted a systematic review of published studies from which estimates mean difference (standard error) in blood pressure between breastfed and bottle-fed subjects. Fifteen studies (17 observations) including 17,

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03 subjects were carried out.

Systolic blood pressure was lower in breastfed. A small reduction in diastolic blood pressure was associated with breastfeeding (pooled difference: –0.5 mmHg, 95% CI: –0.9, –0.04), which was independent of study size (Martin et al, 2005).

Effects of infant feeding upon systolic blood pressures:

The results for systolic blood pressure are based on 14 studies with 17 observations. Mean systolic blood pressure was lower in breastfed infants compared with bottle-fed infants according to 10 observations from eight studies (8, 14, 15, 20, 26, 35, 36, and 43). Seven observations (from six studies) showed no or little difference in systolic blood pressure among breastfed versus formula-fed infants (12, 13, 16, 19, 27, and 34).

Two of these seven observations were from the randomized controlled trial in preterm infants with follow-up at ages 7–8 years (16). When the original study was followed up into adolescence (ages 13–16 years), having received breast milk was associated with a 2.7-mmHg reduction in blood pressure (15). A stratified meta-analysis, a smaller effect of breastfeeding on later systolic blood pressure was observed in the larger studies (n≥1,000) (difference: –0.6 mmHg, 95 percent CI:–1.2, 0.02; p= 0.06) compared with the smaller studies (n<1,000) (Martin et al, 2005). In addition the 3 studies that have more calculated weight (influence) in the combined (summary) estimate are Lawlor, 2004 (20), Whincup, 1989 (34) and Martin 2004 (43) and the one that has the least influence is Boulton, 1981 (36.)

The study (34) had a Cl line that crossed the vertical line showing no significant relevance, the combined estimate represented on the plot as dashed vertical line and diamond showed that mean systolic blood pressure was lower among breastfed infant ( – 1.4mmHg, 95%Cl: -2.2, -0.6; p = 0.001). This particular study was part of the 3 studies that relied on retrospective reporting of exclusive or any breastfeeding till 7 years after birth. However retrospective reporting may not be a very accurate way to record breast feeding, mother can forget and get the dates wrong.

Effects of infant feeding upon diastolic blood pressures:

The figure shows results for 13 observations (12 studies) relating to diastolic blood pressure. Mean diastolic blood pressure was lower among breastfed infants according to nine observations from eight studies (8, 12, 15, 16, 19, 20, 25, and 43). In a random-effects model, the pooled mean diastolic blood pressure was lower among breastfed infants (difference: –0.5 mmHg, 95 percent CI: –0.9, –0.04; p= 0.03). There was less evidence of heterogeneity between estimates (χ212= 20.2; p= 0.06) than in the analysis of breast feeding and systolic blood pressure. Difference (–0.4, 95 percent CI: –0.8, –0.01). The effect of breastfeeding on later diastolic blood pressure was similar in the four larger studies (n≥1,000) (difference: –0.4 mmHg, 95 percent CI: –0.9, 0.1; p= 0.10) compared with the seven smaller studies (n< 1,000) (difference: –0.6 mmHg, 95 percent CI: –1.5, 0.2; p= 0.15) (Martin et al, 2005). (Word count 438)

Answer to question 2:

The blood pressure levels in both childhood and young adulthood are influenced by factors operating early in life and are associated with later cardiovascular disease. Specifically, several cohort studies suggest that blood pressure may be determined by early nutritional exposures, including sodium intake in infancy, consumption of formula feed, and breastfeeding. Detection, treatment, and control of hypertension in adulthood do not reduce cardiovascular disease risk to normotensive levels, supporting efforts to identify primary prevention interventions that could be started in early life. Any long-term effect of breastfeeding on blood pressure levels may have implications for policies promoting breastfeeding, particularly among the least affluent families with the lowest breastfeeding rates and the highest risks of premature cardiovascular disease, and it may increase understanding of cardiovascular disease mechanisms operating through early life exposures (Martin et al, 2005). (Word count 131)

Answer to question 3:

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. If this pressure rises and stays high over time, it’s called

high blood pressure

. With high blood pressure, or hypertension, the blood can’t flow easily through blood vessels. This puts pressure on vessels, which damages the vessels and strains the heart. As a result, blood doesn’t flow as well to organs, and can lead to stroke or heart attack, eye problems, or kidney problems. When blood pressure is above the normal range but not is not high enough to have high blood pressure is called pre – hypertension. This means that although the person doesn’t have high blood pressure now but is likely to develop it in the future. Even levels slightly above normal increase heart disease risk and that’s why raised blood pressure is a public health concern. Mothers who breastfeed for the recommended amount of time babies may have a somewhat lower risk of developing high blood pressure later on, new research suggests. However the findings, from a large study of nurses, do not prove that breastfeeding is the reason for the healthier blood pressure. But they do add to evidence that breastfeeding might have benefits not only for babies, but for moms as well as postulated by researchers (Martin et al, 2005). (Word count 219)

Answer to question 4:

An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.

The odds are being classified as overweight or obese for children who were breastfed for variable durations during infancy relative to those who were never breastfed. In unadjusted analysis, with breastfeeding treated as an ordered categorical variable representing varying durations of breastfeeding exposure, breastfeeding for 5 weeks or more was associated with significantly reduced odds of being obese at nine-years of age and a clear dose response relationship was evident in the data. Those who were breastfed for 5-8 weeks were 47 percent less likely to be obese compared with those who were never breastfed (OR = 0.53 CI.95=0.32-0.89), increasing through 58 percent for those breastfed for between 9 and 12 weeks (OR=0.42 CI.95=0.24-0.73), and 13-25 weeks (OR=0.42 CI.95=0.27-0.64), and 62 percent for those breastfeeding excess of 26 weeks (OR=0.38 CI.95=0.24-0.62). There was no statistically significant protective effect of breastfeeding against risk of overweight in the crude model (McCrory & Layte, 2012) (Word count 191)

Answer to question 5:

The pattern of overweight and obesity among occupations differs by gender. Healthy lifestyle behaviours appear to protect females in professional and associate professional occupations from overweight. For high-risk occupations lifestyle modification could be included in workplace health promotion programs.

Author examines that whether being breastfed during infancy was protective against overweight and obesity at nine- years of age using data from a large, nationally representative cohort study in the Republic of Ireland. In agreement with the results of other epidemiologic studies, author’s analyses indicate that being breastfed for a period in excess of 13 weeks during infancy was associated with a significantly reduced risk of being obese at nine-years of age after controlling for a wide range of potential confounding variables including parental overweight status (McCrory & Layte, 2012). (Word count 129)

References

Martin RN, Gunnell D & Davey Smith G (2005) Breastfeeding in Infancy and Blood Pressure in Later Life: Systematic Review and Meta-Analysis. Am J Epidemiol 161(1): 15-26.

McCrory C & Layte R (2012) Breastfeeding and risk of overweight and obesity at nine-years of age. Social Science & Medicine 75: 323-330

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