Breastfed babies are less likely to have eczema
Babies whose mothers had received support to breastfeed exclusively for a sustained period from birth have a 54% lower risk of eczema at the age of 16, a new study led by researchers from King’s College London, Harvard University, University of Bristol, McGill University and the Research Institute of the McGill University Health Centre (R-MUHC) shows.
"PROBIT, the largest randomized trial ever carried out in the area of human lactation, continues to yield scientifically and clinically important information more than two decades after its inception," says Dr. Michael Kramer, principal investigator on the PROBIT study, who is a senior scientist from the Child Health and Human Development Program at the RI-MUHC and a professor in Pediatrics at McGill University.
The study, which is published today in the Journal of the American Medical Association (JAMA) Pediatrics, examined more than 13,000 Belarussian teenagers enrolled in the PROmotion of Breastfeeding Intervention Trial (PROBIT) and found a 54% reduction in cases of eczema amongst teenagers whose mothers had received support to breastfeed exclusively.
Eczema causes the skin to become itchy, dry, cracked, sore and red. It affects around one in 5 children and one in 10 adults in the developed world.
The paper’s lead author, Dr Carsten Flohr, King’s College London, whose work is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ and King’s College London, said: “The WHO recommends between four and six months of exclusive breastfeeding to aid prevention of allergy and associated illnesses. Our findings add further weight to the importance of campaigns like the Baby-Friendly Hospital Initiative (BFHI), which is tackling low rates of breastfeeding globally.”
The PROBIT study recruited a total of 17,046 mothers and their new-born babies between June 1996 and December 1997. Half of the maternity hospitals and paediatric clinics involved in the study provided additional support modelled on the recommendations of the WHO and United Nations Children's Fund’s BFHI, while the other half continued their usual practices.
"PROBIT, the largest randomized trial ever carried out in the area of human lactation, continues to yield scientifically and clinically important information more than two decades after its inception," says Dr. Michael Kramer, principal investigator on the PROBIT study, who is a senior scientist from the Child Health and Human Development Program at the RI-MUHC and a professor in Pediatrics at McGill University. Dr. Kramer is also the Director of the Centre for Outcomes Research and Evaluation at the RI-MUHC.
The UK has one of the lowest rates of breastfeeding in the world. Only one in three (34%) UK-born babies have received any breast milk, compared with 49% in the United States and 71% in Norway. Only 1% of babies in the UK are exclusively breastfed to six months.
While the study found that the breastfeeding promotion intervention provided protection against eczema there was no reduction in risk of asthma with 1.5% of the intervention group (108/7064) reporting asthma symptoms compared with 1.7% (110/6493) in the control group.
The paper ‘The effect of an intervention to promote breastfeeding on asthma, lung function and atopic eczema at age 16 years’ was published today in JAMA Pediatrics:
The Promotion of Breastfeeding Intervention Trial (PROBIT) is the largest cluster-randomised controlled trial ever conducted in the area of human lactation during infancy. The trial’s directors are: Professor Michael Kramer (McGill University, Research Institute of the McGill University Health Centre), Professor Richard Martin (University of Bristol) and Dr Emily Oken (Harvard University).
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Note to editors:
- Breastfeeding statistics from the WHO National Implementation of the Baby-friendly Hospital Initiative report for 2017.
Funding and support
This study was supported by the European Union, Early Nutrition Programming Long-term Efficacy and Safety, the Canadian Institutes of Health Research, the USA National Institutes of Health (R01 HD050758, K24 HD069408). G.D.S. and R.M.M. work in the Integrative Epidemiology Unit (IEU) supported by the United Kingdom Medical Research Council (MRC) and the University of Bristol (Grant Code: MC_UU_12013/1-9).
The NIHR Bristol Nutrition Biomedical Research Centre is funded by the National Institute for Health Research (NIHR) and is a partnership between the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.
CF is funded through a NIHR Career Development Fellowship (CDF-2014-07-037) and also supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NIH, the EU, the Canadian Institutes of Health Research, the UK National Health Service, the UK NIHR, MRC or the UK Department of Health. The funders had no role in the conduct or reporting of the study.
- The Baby-friendly Hospital Initiative (BFHI) was launched in 1991 as a global programme to incentivize maternity facilities throughout the world to adhere to the Ten Steps to Successful Breastfeeding and comply with the International Code of Marketing of Breast-milk Substitutes.
About the PROBIT study
The Promotion of Breastfeeding Intervention Trial (PROBIT) is the largest cluster-randomised controlled trial ever conducted in the area of human lactation during infancy.
The trial is based on the long-term follow-up of 17,046 healthy mothers and infants who were originally enrolled into the trial in the Republic of Belarus (PROBIT I, Principal Investigator: Professor Michael Kramer, McGill University, Research Institute of the McGill University Health Centre, Canada).
31 maternity hospitals and one each of their affiliated polyclinics (where children are followed for routine health care) were randomised either to the experimental intervention of breastfeeding promotion or the control arm of continuing the prevailing breastfeeding practices at the time of randomisation.
The intervention produced two randomised cohorts with substantially different exposure to breastfeeding, providing a unique opportunity to test, in an intention to treat analysis, the effects of breastfeeding on health outcomes.
For further information, see the project's website: www.bristol.ac.uk/social-community-medicine/projects/probit
Project director(s):
- Professor Michael Kramer (McGill University)
- Professor Richard Martin (University of Bristol)
- Dr Emily Oken (Harvard University)
About the NIHR Biomedical Research Centre at Guy’s and St Thomas’
The National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London works to develop and deliver new medicines and diagnostics to patients, drive research and innovation into the NHS, and provide national systems leadership for maximum impact to patients.
With our research activity organised into nine themes, each holding an individual Athena Swan Silver award highlighting our commitment to equality and diversity, and supported by our interdisciplinary, world leading infrastructure, we are poised to deliver the next step change for the health and wealth of our nation.
About the NIHR
The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health, the NIHR:
- funds high quality research to improve health
- trains and supports health researchers
- provides world-class research facilities
- works with the life sciences industry and charities to benefit all
- involves patients and the public at every step.
About Guy’s and St Thomas’
- Guy's and St Thomas' provides more than 2.4 million patient contacts in acute and specialist hospital services and community services every year. As one of the biggest NHS trusts in the UK, with an annual turnover of almost £1.5 billion, we employ around around 15,300 staff. www.guysandstthomas.nhs.uk
- Guy’s and St Thomas’ is part of King’s Health Partners Academic Health Sciences Centre (AHSC), a collaboration between King’s College London, and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts. www.kingshealthpartners.org
About King’s College London
King's College London is one of the top 25 universities in the world (2017/18 QS World University Rankings), among the oldest in England and has an outstanding reputation for world-class teaching and cutting-edge research.
Since our foundation, King’s students and staff have dedicated themselves in the service of society. King’s will continue to focus on world-leading education, research and service, and will have an increasingly proactive role to play in a more interconnected, complex world. World-changing ideas. Life-changing impact: https://spotlight.kcl.ac.uk/
About the Research Institute of the MUHC
The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and healthcare research centre. The Institute, which is affiliated with the Faculty of Medicine of McGill University, is the research arm of the McGill University Health Centre (MUHC) – an academic health centre located in Montreal, Canada, that has a mandate to focus on complex care within its community. The RI-MUHC supports over 420 researchers and close to 1,200 research trainees devoted to a broad spectrum of fundamental, clinical and health outcomes research at the Glen and the Montreal General Hospital sites of the MUHC. Its research facilities offer a dynamic multidisciplinary environment that fosters collaboration and leverages discovery aimed at improving the health of individual patients across their lifespan. The RI-MUHC is supported in part by the Fonds de recherche du Québec – Santé (FRQS). www.rimuhc.ca