

Conclusion Statement
Moderate evidence suggests that there is no association between the duration of any human milk feeding and blood pressure in childhood.
Evidence about the relationship of shorter versus longer durations of any human milk feeding with blood lipids in childhood and adulthood and with metabolic syndrome was inconclusive, and there was insufficient evidence to determine the relationship of shorter versus longer durations of any human milk feeding with endpoint cardiovascular disease outcomes, blood pressure in adolescence or adulthood, blood lipids in adolescence, and arterial stiffness.
Grade: Moderate – blood pressure in childhood; Grade Not Assignable – cardiovascular disease, cardiovascular disease-related mortality, blood lipids, blood pressure in adolescence or adulthood, arterial stiffness, metabolic syndrome
Plain Language Summary
What is the question?
- The question is: What is the relationship between shorter versus longer durations of any human milk feeding and cardiovascular disease outcomes in offspring?
What is the answer to the question?
- Moderate evidence suggests that there is no association between the duration of any human milk feeding and blood pressure in childhood.
Evidence about the relationship of shorter versus longer durations of any human milk feeding with blood lipids in childhood and adulthood and with metabolic syndrome was inconclusive, and there was insufficient evidence to determine the relationship of shorter versus longer durations of any human milk feeding with endpoint cardiovascular disease outcomes, blood pressure in adolescence or adulthood, blood lipids in adolescence, and arterial stiffness.
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?
- This review includes 24 articles.
- These articles compared infants fed human milk for shorter durations with infants fed human milk for longer durations. The infants could be fed any amount of human milk.
- These articles examined 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.
- Most of the evidence examined blood pressure in childhood, blood lipids in childhood and adulthood, and metabolic syndrome in childhood.
- Children who were fed human milk for shorter durations and children who were fed human milk for longer durations do not seem to have differences in blood pressure.
- With the evidence that is available, it is not possible to conclude whether children and adults who were fed human milk for shorter durations have different levels of blood lipids from children and adults fed human milk for longer durations, and it is not possible to conclude whether children fed human milk for shorter durations have different risk of metabolic syndrome from children fed human milk for longer durations.
- There are limitations in the evidence as follows:
- There was not a lot of evidence about outcomes beyond childhood; therefore, there was not a lot of evidence about cardiovascular disease or cardiovascular disease-related mortality.
- There was not of evidence, or evidence was inconclusive, for outcomes other than blood pressure in childhood.
- Some studies did not use strong methods to collect infant feeding data.
- It is possible for factors other than infant feeding to impact the observed outcomes, and these factors were addressed differently by different studies.
- There was no evidence from the U.S., and the risk of cardiovascular disease in the U.S. may be higher than it is in the populations with available evidence.
How up-to-date is this systematic review?
- This review includes literature from 01/1980 to 03/2016.
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Technical Abstract
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 shorter versus longer durations of any human milk feeding and cardiovascular disease outcomes in offspring?
- This systematic review examines comparisons of infants who were fed human milk for shorter durations with infants who were fed human milk for longer durations. Human milk feeding was defined as feeding human milk alone or in combination with infant formula and/or 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.
- 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
- Moderate evidence suggests that there is no association between the duration of any human milk feeding and blood pressure in childhood.
Evidence about the relationship of shorter versus longer durations of any human milk feeding with blood lipids in childhood and adulthood and with metabolic syndrome was inconclusive, and there was insufficient evidence to determine the relationship of shorter versus longer durations of any human milk feeding with endpoint cardiovascular disease outcomes, blood pressure in adolescence or adulthood, blood lipids in adolescence, and arterial stiffness.
Grade: Moderate – blood pressure in childhood; Grade Not Assignable – cardiovascular disease, cardiovascular disease-related mortality, blood lipids, blood pressure in adolescence or adulthood, arterial stiffness, metabolic syndrome
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.
- Data from each included article were extracted, risks of bias were assessed, and both were checked for accuracy.
- The body of evidence was qualitatively synthesized, a conclusion statement was developed, and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence.
Summary of Evidence
- Twenty-four articles met the inclusion criteria for this systematic review, including 13 with evidence about blood pressure, 10 with evidence about blood lipids, 3 with evidence about metabolic syndrome, 3 with evidence about arterial stiffness, and 2 with evidence about cardiovascular disease-related mortality (some articles included evidence for more than one outcome).
- Evidence about the lack of an association between shorter versus longer durations of any human milk feeding and blood pressure in childhood was moderate. Compelling evidence from the Promotion of Breastfeeding Intervention Trial showed no significant relationship between the duration of any human milk feeding and blood pressure at 6.5 or 11.5 years of age, and inconsistent evidence across 6 independent prospective cohort studies did not suggest any discernable relationship between the duration of any human milk feeding and blood pressure in childhood. The ability to draw stronger conclusions was primarily limited by the small number of studies and concern about generalizability of the evidence, because none of the evidence was from the U.S. and U.S. populations may be at higher risk for CVD than the populations examined by the studies included in the systematic review.
- Evidence about blood lipids in childhood and adulthood and about metabolic syndrome was inconclusive, primarily due to inconsistencies in the direction and statistical significance of the findings.
- Evidence related to outcomes beyond childhood was scant, and only 2 articles, with evidence from the same retrospective cohort study, examined endpoint cardiovascular disease outcomes (cardiovascular disease-related mortality in both articles).
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Full Systematic Review

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Suggested citation: Güngör D, Nadaud P, Dreibelbis C, LaPergola C, Terry N, Wong YP, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O’Brien KO, Oken E, Pérez-Escamilla R, Ziegler, EE, Casavale KO, Spahn JM, Stoody E. Shorter Versus Longer Durations of Any Human Milk Feeding and Cardiovascular Disease Outcomes in Offspring: A Systematic Review. April 2019. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.PB242018.SR0211.
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