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Early Hum Dev. 1997 Oct 29;49 Suppl:S83-103.

Gastroenteritis, diarrhoea and breast feeding.

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Unit of Paediatric and Perinatal Epidemiology, University of Bristol, UK.


In this paper we review the literature in regard to possible relationships between breast feeding and diarrhoea or gastroenteritis. We show that in the developed as well as the developing world, there is consistent evidence of a protective effect of exclusive breast feeding in the first 4-6 months of life. The odds ratios were generally in excess of 3.0 for non-breast milk feeds. The relationship was not consistent for rotavirus infections but was consistently strong for non-viral pathogens. There are a number of indicators that suggest biological plausibility, in both the developing and developed world. The triple indicators of consistency and strength of the epidemiological associations, together with biological plausibility are major arguments for believing that there is a causal sequence involved.


The precise impact of breast feeding practices on the prevention of gastroenteritis remains under debate. However, a review of the available research literature confirms the existence of a protective effect of exclusive breast feeding on nonviral diarrhea risk in the first 4-6 months of life. For non-breast-fed infants, odds ratios of diarrhea are generally in the range of 3.0-6.0. Moreover, infants who are breast fed during diarrhea experience a milder episode, especially if breast feeding is continued. Although this protective effect is clear for bacterial pathogens such as Giardia, Escherichia coli, Salmonella, and possibly Campylobacter, the situation is more uncertain for rotavirus diarrhea. After 6 months of age, protection associated with breast feeding has been demonstrated only for cholera and shigellosis. The triple indicators of consistency and strength of the epidemiologic associations, together with biological plausibility, are major arguments for the existence of a causal sequence between infant feeding and diarrhea. There are two likely mechanisms: 1) supplementary feeding carries increased risk of introducing pathogens to the infant's gut and 2) breast milk contains immunoglobulins that increase an infant's resistance to infection.

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