Infant feeding effects on early neurocognitive development in asian children

Shirong Cai, Wei Wei Pang, Yen Ling Low, Wee Sim Lit, Suet Chian Sam, Michaela Bianka Bruntraeger, Eric Qinlong Wong, Doris Fok, Birit F.P. Broekman, Leher Singh, Jenny Richmond, Pratibha Agarwal, Anqi Qiu, Seang Mei Saw, Fabian Yap, Keith M. Godfrey, Peter D. Gluckman, Yap Seng Chong, Michael J. Meaney, Michael S. KramerAnne Rifkin-Graboi*, GUSTO Study Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Breastfeeding has been shown to enhance global measures of intelligence in children. However, few studies have examined associations between breastfeeding and specific cognitive task performance in the first 2 y of life, particularly in an Asian population. Objective: We assessed associations between early infant feeding and detailed measures of cognitive development in the first 2 y of life in healthy Asian children born at term. Design: In a prospective cohort study, neurocognitive testing was performed in 408 healthy children (aged 6, 18, and 24 mo) from uncomplicated pregnancies (i.e., birth weight >2500 and <4000 g, gestational age ≤37 wk, and 5-min Apgar score ≤9). Tests included memory (deferred imitation, relational binding, habituation) and attention tasks (visual expectation, auditory oddball) as well as the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Children were stratified into 3 groups (low, intermediate, and high) on the basis of breastfeeding duration and exclusivity. Results: After potential confounding variables were controlled for, significant associations and dose-response relations were observed for 4 of the 15 tests. Higher breastfeeding exposure was associated with better memory at 6 mo, demonstrated by greater preferential looking toward correctly matched items during early portions of a relational memory task (i.e., relational binding task: P-trend = 0.015 and 0.050 for the first two 1000-ms time bins, respectively). No effects of breastfeeding were observed at 18 mo. At 24 mo, breastfed children were more likely to display sequential memory during a deferred imitation memory task (P-trend = 0.048), and toddlers with more exposure to breastfeeding scored higher in receptive language [+0.93 (0.23, 1.63) and +1.08 (0.10, 2.07) for intermediate- and high-breastfeeding groups, respectively, compared with the low-breastfeeding group], as well as expressive language [+0.58 (20.06, 1.23) and +1.22 (0.32, 2.12) for intermediate- and high-breastfeeding groups, respectively] assessed via the BSID-III. Conclusions: Our findings suggest small but significant benefits of breastfeeding for some aspects of memory and language development in the first 2 y of life, with significant improvements in only 4 of 15 indicators. Whether the implicated processes confer developmental advantages is unknown and represents an important area for future research. This trial was registered at as NCT01174875.

Original languageEnglish
Pages (from-to)326-336
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Issue number2
Publication statusPublished - 1 Feb 2015

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