Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations?
Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations?
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DOI：
10.1093/ajcn/85.2.635s
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发表时间：
2007-02-01
影响因子：
7.1
通讯作者：
Kleinman, Ronald E.
中科院分区：
文献类型：
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作者：
Fewtrell, Mary S.;Morgan, Jane B.;Kleinman, Ronald E.
在2001年之前，世界卫生组织（WHO）建议婴儿在4-6个月内完全母乳喂养，此后引入补充食物（母乳以外的任何液体或食物）。在2001年，经过系统的审查和专家咨询，这一建议被改变，现在建议在生命的前6个月进行纯母乳喂养。WHO委托进行的系统评价比较了纯母乳喂养3-4个月与6个月的婴儿和母亲结局。该综述的结论是，纯母乳喂养6个月的婴儿胃肠道感染的发病率较低，没有表现出生长缺陷，但需要进行大型随机试验，以排除对易感婴儿生长和铁缺乏症发展的微小不良影响。另一些人则表示关切，认为证据不足以有把握地建议发达国家的婴儿在6个月内进行纯母乳喂养，母乳可能无法满足平均6个月婴儿的全部能量需求，并且无法估计纯母乳喂养的婴儿有特定营养缺乏风险的比例。此外，几乎没有数据可用于形成在配方奶粉喂养的婴儿中引入固体的循证建议。鉴于越来越多的证据表明，早期营养和生长对短期和长期健康都有影响，因此在高质量的随机研究中调查这一问题至关重要。同时，应在不同环境中监测世卫组织建议的后果，以评估遵守情况，并记录和处理不良事件。然后，应根据新数据审查该政策，以制定循证建议。
Before 2001, the World Health Organization (WHO) recommended that infants be exclusively breastfed for 4-6 mo with the introduction of complementary foods (any fluid or food other than breast milk) thereafter. In 200 1, after a systematic review and expert consultation, this advice was changed, and exclusive breastfeeding is now recommended for the first 6 mo of life. The systematic review commissioned by the WHO compared infant and maternal outcomes for exclusive breastfeeding for 3-4 mo versus 6 mo. That review concluded that infants exclusively breastfed for 6 mo experienced less morbidity from gastrointestinal infection and showed no deficits in growth but that large randomized trials are required to rule out small adverse effects on growth and the development of iron deficiency in susceptible infants. Others have raised concerns that the evidence is insufficient to confidently recommend exclusive breastfeeding for 6 mo for infants in developed countries, that breast milk may not meet the full energy requirements of the average infant at 6 mo of age, and that estimates of the proportion of exclusively breastfed infants at risk of specific nutritional deficiencies are not available. Additionally, virtually no data are available to form evidence-based recommendations for the introduction of solids in formula-fed infants. Given increasing evidence that early nutrition and growth have effects on both short- and longer-term health, it is vital that this issue be investigated in high-quality randomized studies. Meanwhile, the consequences of the WHO recommendation should be monitored in different settings to assess compliance and record and act on adverse events. The policy should then be reviewed in the context of new data to formulate evidence-based recommendations.