What is the question?

• The question is: What is the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and cardiovascular disease outcomes in offspring?

What is the answer to the question?

• There is no evidence to determine whether or not there is a relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and cardiovascular disease outcomes in offspring. 

Why was this question asked? 

• This important public health question was identified and prioritized as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.

How was this question answered? 

• A team of Nutrition Evidence Systematic Review staff conducted a systematic review in collaboration with a group of experts called a Technical Expert Collaborative.

What is the population of interest? 

• The population of interest was generally healthy infants and toddlers (ages 0-24 months) who were in studies examining cardiovascular disease outcomes from childhood through adulthood (ages 2 years and up).

What evidence was found? 

• No evidence was found to answer this systematic review question.

How up-to-date is this systematic review? 

• This review includes literature from 01/1980 to 03/2016.

Background

• This systematic review was conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
• The goal of this systematic review was to examine the following question: What is the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and cardiovascular disease outcomes in offspring?
• This systematic review examines comparisons of mixed-fed infants fed different intensities, proportions, or amounts of human milk. Mixed feeding was defined as feeding human milk and infant formula but not complementary foods or beverages such as cow’s milk. Human milk was defined as mother’s own milk provided at the breast (i.e., nursing) or expressed and fed fresh or after refrigeration or freezing.  Donor milk (e.g., banked milk) was not examined in this review. Infant formula was defined as commercially-prepared infant formula meeting FDA  and/or Codex Alimentarius  international food standards. Complementary foods and beverages was defined as foods and beverages other than human milk or infant formula provided to an infant or young child to provide nutrients and energy. 
• This systematic review examines available evidence related to cardiovascular disease outcomes in offspring from childhood through adulthood, including blood lipids, blood pressure, arterial stiffness, metabolic syndrome, cardiovascular disease, and cardiovascular disease-related mortality.

Conclusion Statement and Grade

• There is no evidence to determine whether or not there is a relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and cardiovascular disease outcomes in offspring. 
  
  Grade: Grade Not Assignable

Methods 

• The systematic review was conducted by a team of staff from the Nutrition Evidence Systematic Review in collaboration with a Technical Expert Collaborative.
• A single literature search was conducted to identify literature for several related systematic reviews that examined infant milk-feeding practices and different outcomes. The search was conducted in CINAHL, Cochrane, Embase, and PubMed, and used a search date range of January 1980 to March 2016. A manual search was done to identify articles that may not have been included in the electronic databases searched. 
• Articles were screened independently by 2 NESR analysts to determine which articles met predetermined criteria for inclusion.
• Because no articles were identified that met the inclusion criteria, the conclusion statement and grade reflect the absence of evidence and that no grade was assignable to the strength of the evidence.

Summary of Evidence 

• No articles met the inclusion criteria for this systematic review.