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Protective effect of exclusive breastfeeding against infections during infancy: a prospective study
  1. Fani Ladomenou1,
  2. Joanna Moschandreas2,
  3. Anthony Kafatos2,
  4. Yiannis Tselentis3,
  5. Emmanouil Galanakis1
  1. 1Department of Paediatrics, University of Crete, Heraklion, Greece
  2. 2Department of Social Medicine, University of Crete, Heraklion, Greece
  3. 3Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University of Crete, Heraklion, Greece
  1. Correspondence to Professor Emmanouil Galanakis, Department of Paediatrics, University of Crete, POB 2208, Heraklion 710 03, Greece; emmgalan{at}


Objective To prospectively investigate the effects of breastfeeding on the frequency and severity of infections in a well-defined infant population with adequate vaccination coverage and healthcare standards.

Study design In a representative sample of 926 infants, successfully followed up for 12 months, feeding mode and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis and thrush, were recorded at 1, 3, 6, 9 and 12 months of life.

Results Infants exclusively breastfed for 6 months, as per WHO recommendations, presented with fewer infectious episodes than their partially breastfed or non-breastfed peers and this protective effect persisted after adjustment for potential confounders for ARI (OR 0.58, 95% CI 0.36 to 0.92), AOM (OR 0.37, 95% CI 0.13 to 1.05) and thrush (OR 0.14, 95% CI 0.02 to 1.02). Prolonged exclusive breastfeeding was associated with fewer infectious episodes (rs=−0.07, p=0.019) and fewer admissions to hospital for infection (rs=−0.06, p=0.037) in the first year of life. Partial breastfeeding was not related to protective effect. Several confounding factors, including parental age and education, ethnicity, presence of other siblings, environmental tobacco smoke exposure and season of birth were demonstrated to have an effect on frequency of infections during infancy.

Conclusions Findings from this large-scale prospective study in a well-defined infant population with adequate healthcare standards suggest that exclusive breastfeeding contributes to protection against common infections during infancy regarding and lessens the frequency and severity of infectious episodes. Partial breastfeeding did not seem to provide this protective effect.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Research Committee, Medical Faculty, University of Crete, Greece.

  • Provenance and peer review Not commissioned; externally peer reviewed.