Practice of Exclusive Breastfeeding: A Narrative Review of Its Relevance and Added Value as a Public Health Strategy to Reduce the Double Burden of Malnutrition — Oak Academic Publishing
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Practice of Exclusive Breastfeeding: A Narrative Review of Its Relevance and Added Value as a Public Health Strategy to Reduce the Double Burden of Malnutrition
Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
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Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
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Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
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Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Laboratoire de Biochimie, Biotechnologie, Technologie Alimentaire et Nutrition, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
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Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
1 Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
2 Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
3 Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
4 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
5 Laboratoire de Biochimie, Biotechnologie, Technologie Alimentaire et Nutrition, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
6 Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
7 Laboratoire des Sciences Agronomiques et Biologiques Appliquées, Université de Kara, Kara, Togo
Among public health guidelines and strategies for optimal children’s growth, exclusive breastfeeding in the first six months occupies a pivotal place. The present review provides an overview of the composition of human breast milk and the relevance of exclusive breastfeeding as a public health tool that can improve children’s health as well as mother’s wellbeing. Analyses encompass nutrients supply to children, children’s immune system setting and maturation, cognitive and psychomotor development, epigenetic regulation, and microbiome establishment. The relevance of exclusive breastfeeding as a public health strategy is discussed before reviewing the level of application of this strategy worldwide. Furthermore, breastfeeding evaluation methods are presented alongside factors associated with exclusive breastfeeding practice.
KeywordsExclusive BreastfeedingHuman Breast MilkChildren under 6 MonthsBreast Milk Composition
Clark, H., Coll-Seck, A.M., Banerjee, A., Peterson, S., Dalglish, S.L., Ameratunga, S., et al . (2020) A Future for the World’s Children? A WHO-UNICEF-Lancet Commission. The Lancet , 395, 605-658. https://doi.org/10.1016/s0140-6736(19)32540-1
Lu, C., Black, M.M. and Richter, L.M. (2016) Risk of Poor Development in Young Children in Low-Income and Middle-Income Countries: An Estimation and Analysis at the Global, Regional, and Country Level. The Lancet Global Health , 4, e916-e922. https://doi.org/10.1016/s2214-109x(16)30266-2
Stein, A.D., Adair, L.S., Donati, G., Wray, C., Richter, L.M., Norris, S.A., et al . (2023) Early-Life Stature, Preschool Cognitive Development, Schooling Attainment, and Cognitive Functioning in Adulthood: A Prospective Study in Four Birth Cohorts. The Lancet Global Health , 11, e95-e104. https://doi.org/10.1016/s2214-109x(22)00448-x
WHO (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. World Health Organization.
Pérez-Escamilla, R., Tomori, C., Hernández-Cordero, S., Baker, P., Barros, A.J.D., Bégin, F., et al . (2023) Breastfeeding: Crucially Important, but Increasingly Challenged in a Market-Driven World. The Lancet , 401, 472-485. https://doi.org/10.1016/s0140-6736(22)01932-8
Victora, C.G., Bahl, R., Barros, A.J.D., França, G.V.A., Horton, S., Krasevec, J., et al . (2016) Breastfeeding in the 21st Century: Epidemiology, Mechanisms, and Lifelong Effect. The Lancet , 387, 475-490. https://doi.org/10.1016/s0140-6736(15)01024-7
WHO (2022) Infant and Young Child Feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
UNICEF (2011) Programming Guide. Infant and Young Child Feeding. https://dev.nutritioncluster.net/sites/nutritioncluster.com/files/2020-01/Final_IYCF_prog_guide_May_26_2011.pdf
Lee, H., Padhi, E., Hasegawa, Y., Larke, J., Parenti, M., Wang, A., et al . (2018) Compositional Dynamics of the Milk Fat Globule and Its Role in Infant Development. Frontiers in Pediatrics , 6, Article 313. https://doi.org/10.3389/fped.2018.00313
Sala-Vila, A., Castellote, A.I., Rodriguez-Palmero, M., Campoy, C. and López-Sabater, M.C. (2005) Lipid Composition in Human Breast Milk from Granada (Spain): Changes during Lactation. Nutrition , 21, 467-473. https://doi.org/10.1016/j.nut.2004.08.020
Bardanzellu, F., Peroni, D.G. and Fanos, V. (2020) Human Breast Milk: Bioactive Components, from Stem Cells to Health Outcomes. Current Nutrition Reports , 9, 1-13. https://doi.org/10.1007/s13668-020-00303-7
Lönnerdal, B. (2004) Human Milk Proteins: Key Components for the Biological Activity of Human Milk. In: Advances in Experimental Medicine and Biology , Springer, 11-25. https://doi.org/10.1007/978-1-4757-4242-8_4
Molinari, C.E., Casadio, Y.S., Hartmann, B.T., Livk, A., Bringans, S., Arthur, P.G., et al . (2012) Proteome Mapping of Human Skim Milk Proteins in Term and Preterm Milk. Journal of Proteome Research , 11, 1696-1714. https://doi.org/10.1021/pr2008797
Meng, F., Uniacke-Lowe, T., Ryan, A.C. and Kelly, A.L. (2021) The Composition and Physico-Chemical Properties of Human Milk: A Review. Trends in Food Science & Technology , 112, 608-621. https://doi.org/10.1016/j.tifs.2021.03.040
Li, X., Zhang, X., Zhang, M., Liu, X., Gao, Z., Zhao, J., et al . (2025) Human Milk Whey Proteins: Constituents, Influencing Factors, Detection Methods, and Comparative Analysis with Other Sources. Food Chemistry : X , 25, Article 102082. https://doi.org/10.1016/j.fochx.2024.102082
Donovan, S.M. (2019) Human Milk Proteins: Composition and Physiological Significance. In: Nestlé Nutrition Institute Workshop Series , S. Karger AG, 93-101. https://doi.org/10.1159/000490298
Lönnerdal, B. (2016) Bioactive Proteins in Human Milk: Health, Nutrition, and Implications for Infant Formulas. The Journal of Pediatrics , 173, S4-S9. https://doi.org/10.1016/j.jpeds.2016.02.070
Witkowska-Zimny, M. and Kaminska-El-Hassan, E. (2017) Cells of Human Breast Milk. Cellular & Molecular Biology Letters , 22, 1-11. https://doi.org/10.1186/s11658-017-0042-4
Plaza-Díaz, J., Fontana, L. and Gil, A. (2018) Human Milk Oligosaccharides and Immune System Development. Nutrients , 10, Article 1038. https://doi.org/10.3390/nu10081038
Kunz, C., Rudloff, S., Baier, W., Klein, N. and Strobel, S. (2000) Oligosaccharides in Human Milk: Structural, Functional, and Metabolic Aspects. Annual Review of Nutrition , 20, 699-722. https://doi.org/10.1146/annurev.nutr.20.1.699
Cheng, L., Akkerman, R., Kong, C., Walvoort, M.T.C. and de Vos, P. (2021) More than Sugar in the Milk: Human Milk Oligosaccharides as Essential Bioactive Molecules in Breast Milk and Current Insight in Beneficial Effects. Critical Reviews in Food Science and Nutrition , 61, 1184-1200. https://doi.org/10.1080/10408398.2020.1754756
Schwertmann, A., Schroten, H., Hacker, J. and Kunz, C. (1999) S-Fimbriae from Escherichia Coli Bind to Soluble Glycoproteins from Human Milk. Journal of Pediatric Gastroenterology & Nutrition , 28, 257-263. https://doi.org/10.1097/00005176-199903000-00009
Varki, A. (1993) Biological Roles of Oligosaccharides: All of the Theories Are Correct. Glycobiology , 3, 97-130. https://doi.org/10.1093/glycob/3.2.97
Dinleyici, M., Barbieur, J., Dinleyici, E.C. and Vandenplas, Y. (2023) Functional Effects of Human Milk Oligosaccharides (HMOs). Gut Microbes , 15, Article 2186115. https://doi.org/10.1080/19490976.2023.2186115
Koletzko, B., Rodriguez-Palmero, M., Demmelmair, H., Fidler, N., Jensen, R. and Sauerwald, T. (2001) Physiological Aspects of Human Milk Lipids. Early Human Development , 65, S3-S18. https://doi.org/10.1016/s0378-3782(01)00204-3
Andreas, N.J., Kampmann, B. and Mehring Le-Doare, K. (2015) Human Breast Milk: A Review on Its Composition and Bioactivity. Early Human Development , 91, 629-635. https://doi.org/10.1016/j.earlhumdev.2015.08.013
Garwolińska, D., Namieśnik, J., Kot-Wasik, A. and Hewelt-Belka, W. (2018) Chemistry of Human Breast Milk—A Comprehensive Review of the Composition and Role of Milk Metabolites in Child Development. Journal of Agricultural and Food Chemistry , 66, 11881-11896. https://doi.org/10.1021/acs.jafc.8b04031
Vaysse, C., Billeaud, C., Guesnet, P., Couëdelo, L., Alessandri, J.M., Putet, G., et al . (2011) Teneurs en acides gras polyinsaturés essentiels du lait maternel en France: Évolution des teneurs en acides linoléique et alpha-linolénique. Médecine & Nutrition , 47, 5-9. https://doi.org/10.1051/mnut/201120003
Ballard, O. and Morrow, A.L. (2013) Human Milk Composition: Nutrients and Bioactive Factors. Pediatric Clinics , 60, 49-74.
Tanaka, K., Hosozawa, M., Kudo, N., Yoshikawa, N., Hisata, K., Shoji, H., et al . (2013) The Pilot Study: Sphingomyelin-Fortified Milk Has a Positive Association with the Neurobehavioural Development of Very Low Birth Weight Infants during Infancy, Randomized Control Trial. Brain and Development , 35, 45-52. https://doi.org/10.1016/j.braindev.2012.03.004
Hamdan, I.J.A., Sanchez-Siles, L.M., Matencio, E., Garcia-Llatas, G. and Lagarda, M.J. (2018) Cholesterol Content in Human Milk during Lactation: A Comparative Study of Enzymatic and Chromatographic Methods. Journal of Agricultural and Food Chemistry , 66, 6373-6381. https://doi.org/10.1021/acs.jafc.8b02205
Ni, X., Zhang, Z., Deng, Z., Duan, S., Szeto, I.M., He, J., et al . (2025) Global Levels and Variations of Cholesterol and Polar Lipids of Human Milk: A Systematic Review and Meta-Analysis. Journal of Agricultural and Food Chemistry , 73, 7046-7064. https://doi.org/10.1021/acs.jafc.4c11942
Li, C., Solomons, N.W., Scott, M.E. and Koski, K.G. (2016) Minerals and Trace Elements in Human Breast Milk Are Associated with Guatemalan Infant Anthropometric Outcomes within the First 6 Months. The Journal of Nutrition , 146, 2067-2074. https://doi.org/10.3945/jn.116.232223
FAO (1998) Human Vitamin and Mineral Requirements: Report of a Joint FAO/WHO Expert Consultation (FAO Food and Nutrition Series No. 77). FAO. https://www.fao.org/3/y2809e/y2809e00.htm
Kim, S.Y. and Yi, D.Y. (2020) Components of Human Breast Milk: From Macronutrient to Microbiome and MicroRNA. Clinical and Experimental Pediatrics , 63, 301-309. https://doi.org/10.3345/cep.2020.00059
Khayat, S., Fanaei, H. and Ghanbarzehi, A. (2017) Minerals in Pregnancy and Lactation: A Review Article. Journal of Clinical and Diagnostic Research , 11, QE01.
Zhang, H., Ren, X., Yang, Z. and Lai, J. (2022) Vitamin a Concentration in Human Milk: A Meta-Analysis. Nutrients , 14, Article 4844. https://doi.org/10.3390/nu14224844
Xi, Y., Wang, X., Liu, K., Zhang, H., Ren, X., Zhao, A., et al . (2022) Vitamin E Concentration in Breast Milk in Different Periods of Lactation: Meta-Analysis. Frontiers in Nutrition , 9, Article 1050011. https://doi.org/10.3389/fnut.2022.1050011
Kratzsch, J., Bae, Y.J. and Kiess, W. (2018) Adipokines in Human Breast Milk. Best Practice & Research Clinical Endocrinology & Metabolism , 32, 27-38. https://doi.org/10.1016/j.beem.2018.02.001
Mazzocchi, A., Giannì, M.L., Morniroli, D., Leone, L., Roggero, P., Agostoni, C., et al . (2019) Hormones in Breast Milk and Effect on Infants’ Growth: A Systematic Review. Nutrients , 11, Article 1845. https://doi.org/10.3390/nu11081845
Savino, F., Liguori, S.A., Fissore, M.F. and Oggero, R. (2009) Breast Milk Hormones and Their Protective Effect on Obesity. International Journal of Pediatric Endocrinology , 2009, 1-8. https://doi.org/10.1155/2009/327505
Suwaydi, M.A., Gridneva, Z., Perrella, S.L., Wlodek, M.E., Lai, C.T. and Geddes, D.T. (2021) Human Milk Metabolic Hormones: Analytical Methods and Current Understanding. International Journal of Molecular Sciences , 22, Article 8708. https://doi.org/10.3390/ijms22168708
Ilcol, Y.O., Hizli, Z.B. and Ozkan, T. (2006) Leptin Concentration in Breast Milk and Its Relationship to Duration of Lactation and Hormonal Status. International Breastfeeding Journal , 1, 1-9.
Savino, F., Costamagna, M., Prino, A., Oggero, R. and Silvestro, L. (2002) Leptin Levels in Breast-Fed and Formula-Fed Infants. Acta Paediatrica , 91, 897-902. https://doi.org/10.1111/j.1651-2227.2002.tb02874.x
Palou, M., Picó, C. and Palou, A. (2018) Leptin as a Breast Milk Component for the Prevention of Obesity. Nutrition Reviews , 76, 875-892. https://doi.org/10.1093/nutrit/nuy046
Picó, C. and Palou, M. (2021) Leptin and Metabolic Programming. Nutrients , 14, Article 114. https://doi.org/10.3390/nu14010114
Scherer, P.E., Williams, S., Fogliano, M., Baldini, G. and Lodish, H.F. (1995) A Novel Serum Protein Similar to C1q, Produced Exclusively in Adipocytes. Journal of Biological Chemistry , 270, 26746-26749. https://doi.org/10.1074/jbc.270.45.26746
Aydin, S., Aydin, S., Ozkan, Y. and Kumru, S. (2006) Ghrelin Is Present in Human Colostrum, Transitional and Mature Milk. Peptides , 27, 878-882. https://doi.org/10.1016/j.peptides.2005.08.006
Wren, A.M. (2001) Ghrelin Enhances Appetite and Increases Food Intake in Humans. Journal of Clinical Endocrinology & Metabolism , 86, 5992-5992. https://doi.org/10.1210/jc.86.12.5992
Steppan, C.M., Bailey, S.T., Bhat, S., Brown, E.J., Banerjee, R.R., Wright, C.M., et al . (2001) The Hormone Resistin Links Obesity to Diabetes. Nature , 409, 307-312. https://doi.org/10.1038/35053000
Cho, G.J., Yoo, S.W., Hong, S.C., Oh, M., Kim, T., Kim, H.J., et al . (2006) Correlations between Umbilical and Maternal Serum Resistin Levels and Neonatal Birth Weight. Acta Obstetricia et Gynecologica Scandinavica , 85, 1051-1056. https://doi.org/10.1080/00016340500470150
Klagsbrun, M. (1978) Human Milk Stimulates DNA Synthesis and Cellular Proliferation in Cultured Fibroblasts. Proceedings of the National Academy of Sciences , 75, 5057-5061. https://doi.org/10.1073/pnas.75.10.5057
Elmlinger, M.W., Hochhaus, F., Loui, A., Frommer, K.W., Obladen, M. and Ranke, M.B. (2007) Insulin-Like Growth Factors and Binding Proteins in Early Milk from Mothers of Preterm and Term Infants. Hormone Research in Paediatrics , 68, 124-131. https://doi.org/10.1159/000100488
Froń, A. and Orczyk-Pawiłowicz, M. (2023) Understanding the Immunological Quality of Breast Milk in Maternal Overweight and Obesity. Nutrients , 15, Article 5016. https://doi.org/10.3390/nu15245016
Notarbartolo, V., Giuffrè, M., Montante, C., Corsello, G. and Carta, M. (2022) Composition of Human Breast Milk Microbiota and Its Role in Children’s Health. Pediatric Gastroenterology , Hepatology & Nutrition , 25, 194-210. https://doi.org/10.5223/pghn.2022.25.3.194
Dombrowska-Pali, A., Wiktorczyk-Kapischke, N., Chrustek, A., Olszewska-Słonina, D., Gospodarek-Komkowska, E. and Socha, M.W. (2024) Human Milk Microbiome—A Review of Scientific Reports. Nutrients , 16, Article 1420. https://doi.org/10.3390/nu16101420
Demmelmair, H., Jiménez, E., Collado, M.C., Salminen, S. and McGuire, M.K. (2020) Maternal and Perinatal Factors Associated with the Human Milk Microbiome. Current Developments in Nutrition , 4, nzaa027. https://doi.org/10.1093/cdn/nzaa027
Stagno, S. and Cloud, G.A. (1994) Working Parents: The Impact of Day Care and Breast-Feeding on Cytomegalovirus Infections in Offspring. Proceedings of the National Academy of Sciences , 91, 2384-2389. https://doi.org/10.1073/pnas.91.7.2384
Glenn, W.K., Whitaker, N.J. and Lawson, J.S. (2012) High Risk Human Papillomavirus and Epstein Barr Virus in Human Breast Milk. BMC Research Notes , 5, Article No. 477. https://doi.org/10.1186/1756-0500-5-477
Sissoko, D., Keïta, M., Diallo, B., Aliabadi, N., Fitter, D.L., Dahl, B.A., et al . (2017) Ebola Virus Persistence in Breast Milk after No Reported Illness: A Likely Source of Virus Transmission from Mother to Child. Clinical Infectious Diseases , 64, 513-516. https://doi.org/10.1093/cid/ciw793
WHO (2016) Guideline: Updates on HIV and Infant Feeding. World Health Organization. https://iris.who.int/server/api/core/bitstreams/3ade44b1-647c-462d-9ac2-3f4e3dd874a8/content
WHO (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. WHO Library Cataloguingin Publication Data. https://pubmed.ncbi.nlm.nih.gov/23905206/
la Torre, A., Lo Vecchio, F. and Greco, A. (2023) Epigenetic Mechanisms of Aging and Aging-Associated Diseases. Cells , 12, Article 1163. https://doi.org/10.3390/cells12081163
Hatmal, M.M., Al-Hatamleh, M.A.I., Olaimat, A.N., Alshaer, W., Hasan, H., Albakri, K.A., et al . (2022) Immunomodulatory Properties of Human Breast Milk: MicroRNA Contents and Potential Epigenetic Effects. Biomedicines , 10, Article 1219. https://doi.org/10.3390/biomedicines10061219
Arefimehr, R. and Ahmad, A. (2026) Exosomal MicroRNAs: From Cellular Communication to Disease Biomarkers. International Immunopharmacology , 173, Article 116328. https://doi.org/10.1016/j.intimp.2026.116328
Słyk-Gulewska, P., Kondracka, A. and Kwaśniewska, A. (2023) Microrna as a New Bioactive Component in Breast Milk. Non - Coding RNA Research , 8, 520-526. https://doi.org/10.1016/j.ncrna.2023.06.003
Hicks, S.D., Confair, A., Warren, K. and Chandran, D. (2022) Levels of Breast Milk MicroRNAs and Other Non-Coding RNAs Are Impacted by Milk Maturity and Maternal Diet. Frontiers in Immunology , 12, Article 785217. https://doi.org/10.3389/fimmu.2021.785217
Kosaka, N., Izumi, H., Sekine, K. and Ochiya, T. (2010) MicroRNA as a New Immune-Regulatory Agent in Breast Milk. Silence , 1, Article No. 7. https://doi.org/10.1186/1758-907x-1-7
Brockway, M., Daniel, A.I., Reyes, S.M., Gauglitz, J.M., Granger, M., McDermid, J.M., et al . (2024) Human Milk Bioactive Components and Child Growth and Body Composition in the First 2 Years: A Systematic Review. Advances in Nutrition , 15, Article 100127. https://doi.org/10.1016/j.advnut.2023.09.015
Alsaweed, M., Hartmann, P., Geddes, D. and Kakulas, F. (2015) MicroRNAs in Breastmilk and the Lactating Breast: Potential Immunoprotectors and Developmental Regulators for the Infant and the Mother. International Journal of Environmental Research and Public Health , 12, 13981-14020. https://doi.org/10.3390/ijerph121113981
Carrillo-Lozano, E., Sebastián-Valles, F. and Knott-Torcal, C. (2020) Circulating MicroRNAs in Breast Milk and Their Potential Impact on the Infant. Nutrients , 12, Article 3066. https://doi.org/10.3390/nu12103066
de Vries, J., Pundir, S., Mckenzie, E., Keijer, J. and Kussmann, M. (2018) Maternal Circulating Vitamin Status and Colostrum Vitamin Composition in Healthy Lactating Women—A Systematic Approach. Nutrients , 10, Article 687. https://doi.org/10.3390/nu10060687
de Siqueira, C.D., Borges, L., Dal Mora, T., Saleh, N.A., Alves, E.S., Wopereis, S., et al . (2025) Early Postnatal Effects of Maternal Obesity on Breast Milk Composition and Breastfeeding Outcomes. Clinical Nutrition ESPEN , 65, 365-374. https://doi.org/10.1016/j.clnesp.2024.11.036
Dugas, C. (2021) Rôle de l’alimentation dans la prévention des complications associées à une exposition intra-utérine au diabète gestationnel. Université Laval.
Chellala, S. and Kechout, R. (2022) Étude comparative de la qualité nutritionnelle du lait maternel et du lait maternisé (infantile). Université Mouloud Mammeri.
Wu, J., Domellöf, M., Zivkovic, A.M., Larsson, G., Öhman, A. and Nording, M.L. (2016) NMR-Based Metabolite Profiling of Human Milk: A Pilot Study of Methods for Investigating Compositional Changes during Lactation. Biochemical and Biophysical Research Communications , 469, 626-632. https://doi.org/10.1016/j.bbrc.2015.11.114
WHO and UNICEF (2003) Global Strategy for Infant and Young Child Feeding. World Health Organization. https://iris.who.int/handle/10665/42590
Albernaz, E., Victora, C.G., Haisma, H., Wright, A. and Coward, W.A. (2003) Lactation Counseling Increases Breast-Feeding Duration but Not Breast Milk Intake as Measured by Isotopic Methods. The Journal of Nutrition , 133, 205-210. https://doi.org/10.1093/jn/133.1.205
Walters, D.D., Phan, L.T.H. and Mathisen, R. (2019) The Cost of Not Breastfeeding: Global Results from a New Tool. Health Policy and Planning , 34, 407-417. https://doi.org/10.1093/heapol/czz050
Delli Carpini, G., Morini, S., Papiccio, M., Serri, M., Damiani, V., Grelloni, C., et al . (2019) The Association between Childbirth, Breastfeeding, and Uterine Fibroids: An Observational Study. Scientific Reports , 9, Article No. 10117. https://doi.org/10.1038/s41598-019-46513-0
Abedi, P., Jahanfar, S., Namvar, F. and Lee, J. (2016) Breastfeeding or Nipple Stimulation for Reducing Postpartum Haemorrhage in the Third Stage of Labour. Cochrane Database of Systematic Reviews , 2016, CD010845. https://doi.org/10.1002/14651858.cd010845.pub2
Figueiredo, B., Dias, C.C., Brandão, S., Canário, C. and Nunes-Costa, R. (2013) Breastfeeding and Postpartum Depression: State of the Art Review. Jornal de Pediatria , 89, 332-338. https://doi.org/10.1016/j.jped.2012.12.002
Ahn, S. and Corwin, E.J. (2015) The Association between Breastfeeding, the Stress Response, Inflammation, and Postpartum Depression during the Postpartum Period: Prospective Cohort Study. International Journal of Nursing Studies , 52, 1582-1590. https://doi.org/10.1016/j.ijnurstu.2015.05.017
Rosenblatt, K.A. and Thomas, D.B. (1993) Lactation and the Risk of Epithelial Ovarian Cancer. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives. The International Journal of Epidemiology , 22, 192-197.
Collaborative Group on Hormonal Factors in Breast Cancer (2002) Breast Cancer and Breastfeeding: Collaborative Reanalysis of Individual Data from 47 Epidemiological Studies in 30 Countries, Including 50 302 Women with Breast Cancer and 96 973 Women without the Disease. The Lancet , 360, 187-195.
Chowdhury, R., Sinha, B., Sankar, M.J., Taneja, S., Bhandari, N., Rollins, N., et al . (2015) Breastfeeding and Maternal Health Outcomes: A Systematic Review and Meta-Analysis. Acta Paediatrica , 104, 96-113. https://doi.org/10.1111/apa.13102
Temples, H.S. (2019) Breastfeeding Reduces Risk of Type 2 Diabetes in the (PETS). Nursing Outlook , 67, 115. https://doi.org/10.1016/j.outlook.2018.12.026
Wells, J.C., Sawaya, A.L., Wibaek, R., Mwangome, M., Poullas, M.S., Yajnik, C.S., et al . (2020) The Double Burden of Malnutrition: Aetiological Pathways and Consequences for Health. The Lancet , 395, 75-88. https://doi.org/10.1016/s0140-6736(19)32472-9
Hamer, D.H., Solomon, H., Das, G., Knabe, T., Beard, J., Simon, J., et al . (2022) Importance of Breastfeeding and Complementary Feeding for Management and Prevention of Childhood Diarrhoea in Low-and Middle-Income Countries. Journal of Global Health , 12, Article 10011. https://doi.org/10.7189/jogh.12.10011
Qiao, J., Dai, L., Zhang, Q. and Ouyang, Y. (2020) A Meta-Analysis of the Association between Breastfeeding and Early Childhood Obesity. Journal of Pediatric Nursing , 53, 57-66. https://doi.org/10.1016/j.pedn.2020.04.024
Yan, J., Liu, L., Zhu, Y., Huang, G. and Wang, P.P. (2014) The Association between Breastfeeding and Childhood Obesity: A Meta-Analysis. BMC Public Health , 14, Article No. 1267. https://doi.org/10.1186/1471-2458-14-1267
Tambalis, K.D., Mourtakos, S., Panagiotakos, D.B. and Sidossis, L.S. (2018) Association of Exclusive Breastfeeding with Risk of Obesity in Childhood and Early Adulthood. Breastfeeding Medicine , 13, 687-693. https://doi.org/10.1089/bfm.2018.0117
Li, W., Yuan, J., Wang, L., Qiao, Y., Liu, E., Wang, S., et al . (2022) The Association between Breastfeeding and Childhood Obesity/Underweight: A Population-Based Birth Cohort Study with Repeated Measured Data. International Breastfeeding Journal , 17, Article No. 82. https://doi.org/10.1186/s13006-022-00522-4
UNICEF (2023) Global Breastfeeding Scorecard 2023. https://www.unicef.org/documents/global-breastfeeding-scorecard-2023
UNICEF (2025) Analysis, Planning and Monitoring. Global UNICEF Global Databases: Infant and Young Child Feeding: Exclusive Breastfeeding. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/
Diop, R.A. and Boye, S. (n.d.) Allaitement en Afrique de l’Ouest et du Centre. UNICEF–IRD. https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers18-01/010071735.pdf#page=3
Amir, L.H. (2014) Breastfeeding in Public: “You Can Do It?” International Breastfeeding Journal , 9, Article No. 187. https://doi.org/10.1186/s13006-014-0026-1
Nzame, Y., Gahouma, D., Koko, J., et al . (2020) Place of Breastfeeding in Infant Feeding in Libreville: Survey of 501 Mothers. Health Sciences and Disease , 21, 35-40.
Rollins, N.C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C.K., Martines, J.C., et al . (2016) Why Invest, and What It Will Take to Improve Breastfeeding Practices? The Lancet , 387, 491-504. https://doi.org/10.1016/s0140-6736(15)01044-2
Huet, F., Maigret, P., Elias-Billon, I. and Allaert, F.A. (2016) Identification des déterminants cliniques, sociologiques et économiques de la durée de l’allaitement maternel exclusif. Journal de Pédiatrie et de Puériculture , 29, 177-187. https://doi.org/10.1016/j.jpp.2016.04.010
Savenije, O.E.M. and Brand, P.L.P. (2006) Accuracy and Precision of Test Weighing to Assess Milk Intake in Newborn Infants. Archives of Disease in Childhood — Fetal and Neonatal Edition , 91, F330-F332. https://doi.org/10.1136/adc.2005.091876
Coward, W.A., Whitehead, R.G., Sawyer, M.B., Prentice, A.M. and Evans, J. (1979) New Method for Measuring Milk Intakes in Breast-Fed Babies. The Lancet , 314, 13-14. https://doi.org/10.1016/s0140-6736(79)90177-6
Lucas, A., Ewing, G., Roberts, S.B. and Coward, W.A. (1987) Measurement of Milk Intake by Deuterium Dilution. Archives of Disease in Childhood , 62, 796-800. https://doi.org/10.1136/adc.62.8.796
Fjeld, C., Brown, K. and Schoeller, D. (1988) Validation of the Deuterium Oxide Method for Measuring Average Daily Milk Intake in Infants. The American Journal of Clinical Nutrition , 48, 671-679. https://doi.org/10.1093/ajcn/48.3.671
Limon-Miro, A.T., Aldana-Madrid, M.L., Alvarez-Hernandez, G., Antunez-Roman, L.E., Rodriguez-Olibarria, G. and Valencia Juillerat, M.E. (2017) Breast Milk Intake and Mother to Infant Pesticide Transfer Measured by Deuterium Oxide Dilution in Agricultural and Urban Areas of Mexico. Chemosphere , 181, 682-689. https://doi.org/10.1016/j.chemosphere.2017.04.110
Ojo, J. (2018) Determination of Babies’ Intake of Trace Elements through Breastmilk and Mothers’ Nutritional Status in Ile-Ife, Nigeria. International Symposium on Understanding the Double Burden of Malnutrition for Effective Interventions. Book of Abstracts. https://inis.iaea.org/records/wj0w8-z1k07
Davidsson, L. (2010) Stable Isotope Technique to Assess Intake of Human Milk in Breastfed Infants. International Atomic Energy Agency.
Sinha, S. and Loechl, C.U. (2023) Atoms for Nutrition: IAEA’s Contribution to Tackling Malnutrition. The Journal of Nutrition , 153, 10-16. https://doi.org/10.1016/j.tjnut.2022.11.019
Cissé, A.S., Bluck, L., Diaham, B., Dossou, N., Guiro, A.T. and Wade, S. (2002) Use of Fourier Transformed Infrared Spectrophotometer (FTIR) for Determination of Breastmilk Output by the Deuterium Dilution Method among Senegalese Women. Food and Nutrition Bulletin , 23, 138-141. https://doi.org/10.1177/15648265020233s127
UNICEF and WHO (2007) Indicators for Assessing Infant and Young Child Feeding Practices. WHO and UNICEF. https://iris.who.int/handle/10665/4389
WHO (2021) Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods. https://iris.who.int/handle/10665/340706
Owino, V.O., Slater, C. and Loechl, C.U. (2017) Using Stable Isotope Techniques in Nutrition Assessments and Tracking of Global Targets Post-2015. Proceedings of the Nutrition Society , 76, 495-503. https://doi.org/10.1017/s0029665117000295
Fenta, E.H., Yirgu, R., Shikur, B. and Gebreyesus, S.H. (2017) A Single 24 H Recall Overestimates Exclusive Breastfeeding Practices among Infants Aged Less than Six Months in Rural Ethiopia. International Breastfeeding Journal , 12, Article No. 36. https://doi.org/10.1186/s13006-017-0126-9
Liu, Z., Diana, A., Slater, C., Preston, T., Gibson, R.S., Houghton, L., et al . (2019) Development of a Nonlinear Hierarchical Model to Describe the Disposition of Deuterium in Mother-Infant Pairs to Assess Exclusive Breastfeeding Practice. Journal of Pharmacokinetics and Pharmacodynamics , 46, 1-13. https://doi.org/10.1007/s10928-018-9613-x
Slater, C., Kaestel, P. and Houghton, L. (2019) Assessing Breastfeeding Practices Objectively Using Stable Isotope Techniques. Annals of Nutrition and Metabolism , 75, 109-113. https://doi.org/10.1159/000503667
IAEA (2011) Introduction to Body Composition Assessment Using the Deuterium Dilution Technique with Analysis of Saliva Samples by Fourier Transform Infrared Spectrometry. International Atomic Energy Agency. https://www-pub.iaea.org/MTCD/Publications/PDF/Pub1450_web.pdf