Copyright © 2004 by the European Society of Cardiology.
Clinical research
Breastfeeding and cardiovascular mortality: the Boyd Orr cohort and a systematic review with meta-analysis
a Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, Avon BS8 2PR, UK
b London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Received December 4, 2003;
revised January 28, 2004;
accepted February 5, 2004
* Corresponding author. Tel.: +44-117-928-7321; fax: +44-117-928-7236
E-mail address: richard.martin{at}bristol.ac.uk
Aims To investigate the association of breastfeeding with all-cause, cardiovascular, and ischaemic heart disease mortality.
Methods and results A long-term follow-up of 4999 children originally surveyed from 1937 to 1939 was undertaken (Boyd Orr cohort). Four thousand three hundred and seventy-nine subjects (88%) were traced in adulthood and 3555 (71%) had complete data on all covariates. The results were combined with a meta-analysis of the published literature. In the Boyd Orr study, there was little evidence that breastfeeding was associated with all-cause (hazard ratio: 1.04 [95% CI: 0.90–1.20]), cardiovascular (1.04 [0.83–1.30]), or ischaemic heart disease (1.02 [0.77–1.36]) mortality, compared with bottle-feeding. Meta-analyses of observational studies showed little evidence of an association of breastfeeding with all-cause (pooled rate ratio: 1.01 [95% CI: 0.91–1.13]) or cardiovascular (1.06 [0.94–1.20]) mortality. There was a moderate-to-high degree of between-study heterogeneity for the association between breastfeeding and ischaemic heart disease mortality (
value—indicating the degree of between-study variation attributable to heterogeneity—66%), and estimates were consistent with both an important beneficial or adverse effect of breastfeeding.
Conclusion There is little consistent evidence that breastfeeding influences subsequent all-cause or cardiovascular disease mortality. Results from other well-designed cohorts may clarify residual uncertainty.
Key Words: Breastfeeding • Infant nutrition • Cardiovascular disease • Ischaemic heart disease • Systematic review
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