DRAFT Australian Dietary Guidelines - Eat For Health

5.2.2 Infant growth
For ethical reasons, randomised control trials (RCTs) of breastfeeding are not possible. The best
research alternative is the use of RCTs of health promotion interventions to increase
breastfeeding rates. For this reason, most evidence is based on prospective cohort studies and one
large health promotion RCT, the Promotion of Breastfeeding Intervention Trial (PROBIT) study
[883].
Breastfed infants grow more slowly than formula-fed infants [861]. A systematic review of 19
observational studies in developed countries concluded that the cumulative difference in body
weight at 12 months of age was 600–650g less in infants breastfed for 12 months than formula-fed
infants [884]. Differences in feeding behavior and mother–child interaction between breastfed and
formula-fed infants may account for some of the differences reported. For instance, breastfed
infants showed a different suckling pattern, and appeared to have greater degree of control on
meal sizes and feeding intervals than infants who were formula-fed [885].
5.2.3 Cardiovascular disease, type 2 diabetes and excess
weight
Excess weight: There is convincing evidence that breastfeeding , compared with formula
feeding, is associated with reduced risk of infants becoming obese in childhood, adolescence and
early adulthood (Grade A, Section 17.2 in Evidence Report [14]). The protection offered by
breastfeeding appears to increase with duration of breastfeeding until it plateaus at nine months
[886, 887].
Evidence of an association between the age of introduction of solid foods and excess weight in
children is inconclusive (Section 19.1 in Evidence Report [14]).
Blood pressure: There is probable evidence that infants who are breastfed exclusively in the first
few months of life have a lower adult systolic and diastolic blood pressure (approximately 1.5/0.5
mmHg) compared with those who are formula-fed (Grade B, Section 23.1 in Evidence Report
[14]).
Total and LDL cholesterol: Recent evidence suggests being breastfed initially, and particularly
exclusively breastfed, is associated with lower total and LDL concentrations in adult life when
compared with those who were formula-fed (Grade C, Section 23.1 in Evidence Report [14]).
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