RANDOMISED CONTROLLED TRIALS Effects of promoting longer-term and exclusive breastfeeding on childhood eating attitudes: a cluster-randomized trial

Background: Observational studies suggest that breastfeeding benefits later maternal child-feeding practices, which in turn may contribute to positive eating attitudes. We investigated the effect of a randomized intervention to increase duration and exclusivity of breastfeeding on pre-adolescent eating attitudes. Methods: Long-term follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial in 31 maternity hospitals and affiliated polyclinics in Belarus. Sites were randomly assigned an experimental intervention to promote longer duration and exclusivity of breastfeeding in mothers who initiated breastfeeding (n1⁄416 sites), or a control intervention of continuing usual care (n1⁄4 15 sites); 17 046 healthy infants were enrolled in 1996–7, of whom 13 751 (80.7%) completed the Children’s Eating Attitude Test (ChEAT) at 11.5 years of age. A ChEAT score 22.5 (85th percentile) was used as an indicator of problematic eating attitudes. Analysis was based on intention-totreat, accounting for clustering within hospitals/clinics. Results: Compared with the control arm, the experimental intervention substantially increased breastfeeding exclusivity (43.3% vs 6.4% exclusively breastfed at 3 months of age) and duration of any breastfeeding throughout infancy. The proportion of children VC The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association 1263 International Journal of Epidemiology, 2014, 1263–1271 doi: 10.1093/ije/dyu072 Advance Access Publication Date: 4 April 2014