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Formula-feeding of HIV-exposed uninfected African children is associated with faster growth in length during the first six months of life in the Kesho Bora study

Formula-feeding of HIV-exposed uninfected African children is associated with faster growth in length during the first six months of life in the Kesho Bora study
Formula-feeding of HIV-exposed uninfected African children is associated with faster growth in length during the first six months of life in the Kesho Bora study
Background: Early feeding patterns may affect growth of HIV-exposed children and thus their subsequent health and cognition.

Objective: An observational cohort study assessed the association of infant feeding mode (IF) with length-for-age z-score (LAZ) and stunting from age 2 days to 18 months in HIV-exposed African children within the Kesho Bora controlled randomized trial which evaluated triple antiretrovirals initiated during pregnancy and continued for six months postpartum to prevent HIV transmission.

Methods: HIV-infected pregnant women with CD4+ counts 200-500 cells/mm3 from five sites in Burkina Faso, Kenya and South Africa were advised to exclusively breastfeed (EBF) for up to six months or formula-feed (FF) from birth. Factors associated with mean LAZ and change in LAZ with increasing age were investigated in all uninfected children using mixed-effects linear models; those associated with stunting (LAZ<-2) at 6 or 12 months were assessed in multiple logistic regression after exclusion of children stunted at age 2 days. Independent variables were IF: FF, EBF<3 months or EBF ?3 months (reference), sex, trial arm, maternal characteristics, and site.

Results: Among 728 children, FF was associated with a greater increase in LAZ from 2 days to 6 months (+0.07 z-score/month, P<0.001). Between 6 and 18 months, FF and EBF <3 months were both associated with greater mean LAZ than EBF ?3 months (+0.52 z-scores and +0.43 z-z-scores, respectively, P<0.001). Among children not stunted at 2 days, FF was independently associated with reduced risk of stunting at 6 months (OR: 0.24; 95% CI: 0.07, 0.81; P: 0.021), while EBF<3 months was not (OR: 0.49; 0.22, 1.10; P: 0.09).

Conclusion: In this observational study of HIV-exposed uninfected infants, growth in length in the first six months of life was faster in FF infants than in EBF infants. The plausibility of residual confounding and reverse causality is discussed.

This trial was registered at Current Controlled Trials as ISRCTN71468401.
0022-3166
1-37
Bork, K.
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Cames, C.
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Newell, M-L.
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Read, J.
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Ayassou, K.
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Musyoka, F.
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Mbatia, G.
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Cournil, A.
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Bora, K.
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Bork, K.
cd9ad6bb-b433-4c55-a9be-0e7f6de6e56e
Cames, C.
7b12f275-420f-483f-a764-d5cdb5cfd42c
Newell, M-L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Read, J.
af3e718d-c323-4b51-9b91-fb4dba2a79e4
Ayassou, K.
d8c6cb00-0d93-413e-900a-1359de4e6115
Musyoka, F.
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Mbatia, G.
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Cournil, A.
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Bora, K.
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Bork, K., Cames, C., Newell, M-L., Read, J., Ayassou, K., Musyoka, F., Mbatia, G., Cournil, A. and Bora, K. (2017) Formula-feeding of HIV-exposed uninfected African children is associated with faster growth in length during the first six months of life in the Kesho Bora study. Journal of Nutrition, 1-37. (doi:10.3945/?jn.116.242339).

Record type: Article

Abstract

Background: Early feeding patterns may affect growth of HIV-exposed children and thus their subsequent health and cognition.

Objective: An observational cohort study assessed the association of infant feeding mode (IF) with length-for-age z-score (LAZ) and stunting from age 2 days to 18 months in HIV-exposed African children within the Kesho Bora controlled randomized trial which evaluated triple antiretrovirals initiated during pregnancy and continued for six months postpartum to prevent HIV transmission.

Methods: HIV-infected pregnant women with CD4+ counts 200-500 cells/mm3 from five sites in Burkina Faso, Kenya and South Africa were advised to exclusively breastfeed (EBF) for up to six months or formula-feed (FF) from birth. Factors associated with mean LAZ and change in LAZ with increasing age were investigated in all uninfected children using mixed-effects linear models; those associated with stunting (LAZ<-2) at 6 or 12 months were assessed in multiple logistic regression after exclusion of children stunted at age 2 days. Independent variables were IF: FF, EBF<3 months or EBF ?3 months (reference), sex, trial arm, maternal characteristics, and site.

Results: Among 728 children, FF was associated with a greater increase in LAZ from 2 days to 6 months (+0.07 z-score/month, P<0.001). Between 6 and 18 months, FF and EBF <3 months were both associated with greater mean LAZ than EBF ?3 months (+0.52 z-scores and +0.43 z-z-scores, respectively, P<0.001). Among children not stunted at 2 days, FF was independently associated with reduced risk of stunting at 6 months (OR: 0.24; 95% CI: 0.07, 0.81; P: 0.021), while EBF<3 months was not (OR: 0.49; 0.22, 1.10; P: 0.09).

Conclusion: In this observational study of HIV-exposed uninfected infants, growth in length in the first six months of life was faster in FF infants than in EBF infants. The plausibility of residual confounding and reverse causality is discussed.

This trial was registered at Current Controlled Trials as ISRCTN71468401.

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Accepted/In Press date: 21 December 2016
e-pub ahead of print date: 25 January 2017
Published date: March 2017
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 404449
URI: http://eprints.soton.ac.uk/id/eprint/404449
ISSN: 0022-3166
PURE UUID: 43848db7-93d2-4a86-acee-39a68e2a8b20
ORCID for M-L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

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Date deposited: 09 Jan 2017 16:08
Last modified: 17 Dec 2019 06:28

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Contributors

Author: K. Bork
Author: C. Cames
Author: M-L. Newell ORCID iD
Author: J. Read
Author: K. Ayassou
Author: F. Musyoka
Author: G. Mbatia
Author: A. Cournil
Author: K. Bora

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