Early Breastfeeding Initiation, Prelacteal Feeding, and Infant Feeding Are Associated with Biomarkers of Environmental Enteric Dysfunction
Authors: Smith Emily R. , Manji Karim , McDonald Christine M , Gosselin Kerri , Kisenge Rodrick , Fawzi Wafaie , Gewirtz Andrew T , Duggan Christopher 
Published: June 2021

ObjectiveTo identify the relationship between infant feeding and biomarkers of environmental enteric dysfunction (EED).MethodsThis prospective cohort study consists of a subset of children (n=590) who were enrolled in a micronutrient supplementation trial in Tanzania. Study nurses collected information about infant feeding every month from age six weeks to one year. We assessed early breastfeeding initiation (<1 hour after birth), prelacteal feeding, colostrum consumption at birth, and breastfeeding type (exclusive, predominant or partial, or no breastfeeding) at 6 weeks, 6 months, and 12 months of age. Samples were tested for biomarkers of gastrointestinal function (antibodies to lipopolysaccharide (LPS) and flagellin). We created a binary variable to indicate whether or not the infant had a biomarker measurement in the top quartile of all measurements at that time point. We assessed the association between each infant feeding characteristic and the risk of being in the top quartile for each biomarker at 6 weeks, 6 months, and 12 months using log binomial regression models. We adjusted for potential confounders including maternal age, maternal education, household wealth, birthweight, infant sex, delivery by cesarean section, and place of birth.ResultsWe found that prelacteal feeding was associated with higher levels of EED biomarkers at six months. Infants fed prelacteals has 2.64 times the risk of being in the upper quartile of flagellin IgG (95% CI 1.13–6.15; p value 0.02) and were 3.25 times more likely to be in the upper quartile of LPS IgA (95% CI 1.98–5.33; p value <0.0001) at six months. Delayed breastfeeding initiation (>1 hour) was also associated with about 2 times greater risk of being in the upper quartile of both LPS IgG and LPS IgA at six months. Colostrum consumption was not associated with any EED biomarker at any time point. Not breastfeeding at six weeks was associated with 2.32 times the risk of being in the upper quartile of flagellin IgG compared to those exclusively breastfeeding (95% CI 1.07–5.06; p value 0.03) at that age. Similarly, not breastfeeding at six weeks was associated with an increased risk of being in the highest quartile of flagellin IgA, LPS IgG, and LPS IgA at six weeks.ConclusionWe found that both delayed breastfeeding initiation and prelacteal feeding were associated with elevated biomarkers of EED. Large cohort studies have found that delayed breastfeeding initiation is associated with an increased risk of neonatal and infant mortality through six months. While early breastfeeding initiation has been hypothesized to decrease the risk of microbial translocation and accelerate intestinal maturation, this is one of the first studies to show that early feeding behavior is also associated with biomarkers of EED.Support or Funding InformationSupport for this effort was provided by the Feed the Future Food Innovation Lab for Nutrition which is funded by the United States Agency for International Development (USAID).