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Exclusive Breastfeeding, Complementary Feeding, and Food Choices in UK Infants Julie Armstrong, Elizheeba Christie Abraham, Mhairi Squair, Yvonne Brogan and Anne Merewood J Hum Lact 2014 30: 201 originally published online 20 December 2013 DOI: 10.1177/0890334413516383 The online version of this article can be found at: http://jhl.sagepub.com/content/30/2/201

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JHLXXX10.1177/0890334413516383Journal of Human LactationArmstrong et al

Original Research

Exclusive Breastfeeding, Complementary Feeding, and Food Choices in UK Infants

Journal of Human Lactation 2014, Vol. 30(2) 201­–208 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0890334413516383 jhl.sagepub.com

Julie Armstrong, PhD, MPH, RNutr1, Elizheeba Christie Abraham, PhD1, Mhairi Squair, MSc, PgDip1, Yvonne Brogan, PhD, RNutr1, and Anne Merewood, PhD, MPH, IBCLC2

Abstract Background: Limited data exist that explore the association between exclusive breastfeeding and dietary behaviors related to key food choices in later infancy. Objective: This study aimed to examine the relationship between exclusive breastfeeding at 3 months with age of starting complementary feeding and key complementary feeding data collected at 8 to 10 months. Methods: Secondary data analysis was performed on the UK Infant Feeding Survey 2005. Results: After adjusting for maternal characteristics, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was positively associated with giving homemade infant foods (adjusted odds ratio [AOR] = 1.41; 95% confidence interval [CI], 1.19–1.66), vegetables (AOR = 1.46; 95% CI, 1.25–1.72), fruits (AOR = 1.73; 95% CI, 1.42–2.11), and fresh foods frequently (AOR = 2.24; 95% CI, 1.41–3.56) at 8 to 10 months of age. Conversely, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was negatively associated with very early complementary feeding (AOR = 0.35; 95% CI, 0.30–0.42) and giving the following foods at 8 to 10 months of age: baby food from jar (AOR = 0.78; 95% CI, 0.66–0.92), powdered baby food (AOR = 0.73; 95% CI, 0.57–0.94), canned baby food (AOR = 0.48; 95% CI, 0.32–0.71), and ready-made bought meals (AOR = 0.67; 95% CI, 0.57–0.78). Conclusion: Exclusively breastfeeding for 3 months compared to mixed or formula feeding was positively associated with the introduction of complementary feeding after 4 months and giving infants fruits, vegetables, and homemade infant foods frequently at 8 to 10 months. Keywords breastfeeding, exclusive breastfeeding, infant complementary feeding, infant feeding, maternal characteristics, United Kingdom

Well Established Bioactive and nutritional components of breast milk provide benefits to infants. Breastfeeding may be associated with healthier dietary behavior in infancy and childhood.

Newly Expressed Exclusive breastfeeding for 3 months was positively associated with fruit and vegetable intake and negatively associated with giving processed infant foods at 8 to 10 months. There was no significant association between exclusive breastfeeding and giving cow’s milk at 8 to 10 months.

current US2 and UK3 guidelines. Certain outcomes, such as prevention of obesity1,4,5 and type 2 diabetes,1 have been associated with bioactive and nutritional factors present in breast milk. Evidence also suggests that the positive effects of breastfeeding are dose related.6,7 However, since exposure to breast milk bioactive and nutritional factors only partially explains the positive health benefits,1 hypotheses have been

1

School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK 2 Division of General Pediatrics, Boston University, Boston, MA, USA Date submitted: July 10, 2013; Date accepted: November 13, 2013.

Background Numerous theories exist for the beneficial short- and longterm infant health outcomes associated with exclusive breastfeeding for 6 months of life,1,2 as recommended by

Corresponding Author: Dr. Julie Armstrong, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK. Email: [email protected]

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proposed for positive behaviors associated with breastfeeding that may influence nutrition and health in later life.8-13 A study by Noble and Emmett found distinct differences in food and nutrient intake between breastfed and formulafed infants at 4 months, with breastfed infants more likely to have consumed fruit and vegetables than formula-fed infants.14 Previous studies have linked breastfeeding with age-appropriate feeding practices, such as timely complementary feeding,15 and healthier food choices in the first year of infancy16 and in preschool children.13,17 In addition, exclusive breastfeeding and timely complementary feeding have been strongly linked to maternal characteristics such as socioeconomic status, educational attainment, and age.15,18-21 It has also been reported that early complementary feeding is associated with higher energy intakes in infancy,22 higher growth trajectories in infancy,9 being overweight later in childhood,13,23,24 and early introduction of cow’s milk.18 Previous studies, however, are based on small samples,14,25,26 with varying definitions of breastfeeding,13,27 and there is limited evidence on how exclusive breastfeeding at 3 months is associated with being given unmodified cow’s milk early. Therefore, the goals of this study were to determine the relationship between exclusive breastfeeding for 3 months and (1) timing of complementary feeding, (2) food choices at 8 to 10 months, and (3) being given cow’s milk at 8 to 10 months, using the UK Infant Feeding Survey data.28

Methods Study Cohort The quinquennial UK Infant Feeding Survey (IFS) is carried out to monitor trends in exclusive breastfeeding and other infant feeding practices. In 2005, the IFS recruited 19 848 mother and infant pairs from a nationally representative sample of mother/infant pairs living in England, Scotland, Wales, and Northern Ireland.20 Maternal characteristics and infant feeding information were collected from self-completed postal questionnaires during the first year of infancy from October 2005 to August 2006 in 3 stages (stage 1: infants’ age 4–10 weeks; stage 2: infants’ age 4–6 months; and stage 3: infants’ age 8–10 months).

Variables and Definitions At each stage of the survey, mothers were asked a series of questions about breastfeeding, including what type of milk was given, at what age breastfeeding started and stopped, if formula milk had been given and at what age, and if foods other than milk had been given and at what age. From these variables, the duration of exclusive breastfeeding was derived and reported, using the World Health Organization criteria.29 Prevalence data relating to the duration of exclusive breastfeeding were reported in the database at birth, 6 weeks, 2 months, 3 months, 4 months, and 6 months.20 These

questions were also used to derive the age of starting complementary feeding.20 In 2005 and currently, the UK recommendation on the timing of complementary feeding was to begin at 6 months.3 Therefore, in this study, very early complementary feeding was defined as introduction of food and/ or drinks in addition to breast milk or formula milk by 4 months (≤ 4 months).

Infant Foods Given at 8 to 10 Months At stage 3, when the infants were 8 to 10 months of age, mothers were asked 24-hour dietary recall questions relating to the sort of solid foods the baby ate. In this study, we were able to examine the intake of the following food items: (a) fruits, (b) vegetables, (c) canned baby food, (d) powdered baby food, (e) baby food from a jar, and (f) homemade foods made for the baby. The frequency of complementary foods given to their infants was collected using the following 7-day recall questions: “How often do you give your baby fresh foods (such as fruit, vegetables, homemade foods)?” and “How often do you give your baby ready-made bought foods (such as canned or powdered products)?” using the following 6-point Likert-type scale categories: 1 (more than once a day), 2 (once a day), 3 (3 or more times a week), 4 (once or twice a week), 5 (less than once a week), and 6 (never). These categories were subsequently collapsed into 2-point Likerttype scale categories defined as 0 (nonfrequent) by combining groups 4 to 6, and 1 (frequent) by combining groups 1 to 3. Mothers were asked if cow’s milk was given as a drink to the infant using the following recall question: “Excluding breast milk, which one of the following kinds of milk has your baby been given most often over the last 7 days?”28

Maternal Characteristics Data relating to maternal characteristics used in this study were collected during stage 1, when the infants were 4 to 10 weeks of age. Maternal socioeconomic status was defined by National Statistics Socio-Economic Classification (NS-SEC) with women classified into the following occupational groups: managerial and professional, intermediate, routine and manual, never worked, and unclassified. Maternal education was defined by 3 age bands (≤ 16, 17 or 18, and > 18) at which the mother left full-time education. These social variables, along with maternal age, defined as 5 age bands (< 20, 20–24, 25–29, 30–34, and 35+) and parity (first birth and second or later birth), were significantly associated with exclusive breastfeeding at 3 months and were entered as covariates into the multivariable model.

Statistical Analysis Statistical analyses were carried out using SPSS Statistics for Windows version 19. An SPSS complex sample plan file was generated using the “stage 3 weight for UK” sample weight

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Armstrong et al variable, provided in the UK IFS dataset, to account for (1) oversampling of Scottish, Northern Irish, and Welsh infants, (2) low response rates and nonresponse of younger mothers and mothers from areas of higher deprivation, and (3) nonresponse introduced through attrition over the course of the survey. The SPSS complex sample file was used to produce the weighted descriptive and inferential statistics for the entire UK infant population. These are reported in Table 1. Full details of the study sampling process and the complex survey design are available from the IFS user guide.20 Women with missing data in 1 or more variables within a particular statistical model described below were excluded from that analysis. First, the complex sample Pearson chi-square (χ2) test, within the IBM SPSS Complex Sample module, was used to explore associations between exclusively breastfeeding for 3 months and each of the variables relating to timing of complementary feeding, food choices at 8 to 10 months, cow’s milk consumption at 8 to 10 months, and maternal characteristics. Using the results from the chi-square tests and previous evidence for the use of cow’s milk in infancy,18 10 separate univariable logistic regression models were created to explore the strength of association between exclusive breastfeeding, defined as the exposure variable, and each of the outcome variables relating to timing of complementary foods and food choices at 8 to 10 months. A further 4 separate univariable logistic regression models were created to determine the magnitude of association between each variable relating to maternal characteristics, defined as the exposure variable, and exclusive breastfeeding at 3 months. See Table 1 for the odds ratio (OR) and respective 95% confidence intervals (CIs). Finally, 10 multivariable logistic regression models were generated to analyze the association of exclusive breastfeeding at 3 months, after adjusting for maternal characteristics, on timing of complementary foods and mothers’ food choice for their infant at age 8 to 10 months. The results were reported as adjusted odds ratio (AOR) with their respective 95% CIs (see Table 2).

Ethical Approval This study was exempt from ethical approval because it was a secondary analysis of a publicly available dataset.

Results Survey participation at stage 1 of data collection was 62% (n = 12 290/19 848), at stage 2 it was 54% (n = 10 814/19 848), and at stage 3 it was 47% (n = 9 416/19 848) compared to those initially sampled. A total of 9 416 mothers completed all 3 stages of data collection and answered questions relevant to the current study relating to milk feeding and complementary feeding. During the univariable logistic regression statistical analysis, cases with missing data were identified within the variables relating to food choices at 8 to 10 months (n = 27),

maternal education (n = 81), maternal age (n = 30), and cow’s milk consumption at 8 to 10 months (n = 345).

Prevalence of Infant Feeding The prevalence of exclusive breastfeeding decreased as time progressed from birth (65%, n = 6091/9416), 6 weeks (21%, n = 1970/9416), 2 months (18%, n = 1670/9416), 3 months (13%, n = 1264/9416), 4 months (7%, n = 705/9416), to 6 months (< 1%, n = 30/9416). The proportion of all infants who were introduced to complementary feeding by 3 months was 10% (n = 925/9416), by 4 months it was 51% (n = 4835/9416), and by 6 months it was 98% (n = 9209/9416). Data collected from mothers at stage 3 of the survey revealed that 44% (n = 4169/9389) gave vegetables, 48% (n = 4553/9389) prepared homemade foods, and 68% (n = 6405/9389) gave fruits to their 8- to 10-month-old infant in the previous 24 hours. A smaller percentage of all mothers gave their 8- to 10-monthold infant baby food from a jar (37%, n = 3465/9389), powdered baby food (13%, n = 1198/9389), and canned baby food (9%, n = 806/9389) the day before completing the survey. Only 7% (n = 609/9071) of all mothers had reported giving cow’s milk during the last 7 days when surveyed at stage 3.

Association of Exclusive Breastfeeding with Very Early Introduction to Complementary Feeding To ensure adequate numbers of exclusive breastfeeders in our analyses, we used 3 months of exclusive breastfeeding as the exposure variable. Of the mothers who breastfed exclusively for 3 months, 26% (n = 329/1264) had introduced complementary foods very early compared to 55% (n = 4506/8152) of those who had mixed and formula fed (Table 1). A significant negative association between all durations of exclusive breastfeeding and very early introduction to complementary feeding was observed after adjusting for maternal characteristics: exclusively breastfed (EBF) at birth AOR = 0.64 (95% CI, 0.57–0.72); EBF for 1 month AOR = 0.58 (95% CI, 0.52–0.66); EBF for 2 months AOR = 0.44 (95% CI, 0.38–0.51); and EBF for 3 months AOR = 0.35 (95% CI, 0.30–0.42).

Association of Exclusive Breastfeeding for 3 Months with Infant Feeding Mothers who had exclusively breastfed their infant for 3 months were significantly more likely to give fruit, χ2(1) = 110.6, P < .001; vegetables, χ2(1) = 82.2, P < .001; and homemade foods, χ2(1) = 85.7, P < .001; as well as frequently give fresh foods such as fruit, vegetables, and homemade foods, χ2(1) = 39.1, P < .001, to their 8- to 10-month-old infants over the previous week compared to mothers who had mixed or formula fed (Table 1). After adjusting for

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Table 1.  Chi-square Analysis to Test for the Association between Exclusive Breastfeeding for 3 Months and Very Early Introduction to Complementary Feeding and Infant Foods Given at 8 to 10 Months.a Exposure Variable  

EBF for 3 Months Outcome Variable

Timing of complementary feeding   Very early, introduced ≤ 4 months   Introduced after 4 months Infant foods given at 8–10 months  Fruits   Yes   No  Vegetables   Yes   No   Homemade infant food   Yes   No   Canned food   Yes   No   Baby food from jar   Yes   No   Powdered baby food   Yes   No   Ready-made bought meals frequency   Frequently   Nonfrequently   Fresh food frequency   Frequently   Nonfrequently   Cow’s milk   Yes   No



Not EBF for 3 Months



Total (n)

n

%

n

%

χ2 Value, P

9416 4835 4581

1264 329 935

100 26 74

8152 4506 3646

100 55 45

9389 6405 2984 9389 4169 5220 9389 4553 4836 9389 907 8481 9389 3465 5924 9389 1198 8191 9389 5464 3925 9389 8780 609 9071 609 8462

1260 1021 239 1260 708 552 1260 764 496 1260 51 1209 1260 399 861 1260 118 1142 1260 593 667 1260 1229 31 989 61 928

100 81 19 100 56 44 100 61 39 100 4 96 100 32 68 100 9 91 100 47 53 100 98 2 100 6 94

8129 5384 2745 8129 3461 4668 8129 3789 4340 8129 857 7272 8129 3066 5063 8129 1080 7049 8129 4871 3258 8129 7551 578 8082 548 7534

100 66 34 100 43 57 100 47 53 100 9 91 100 38 62 100 13 87 100 60 40 100 93 7 100 7 93

χ2(1) = 375.1, < .001     χ2(1) = 110.6, < .001   χ2(1) = 82.2, < .001   χ2(1) = 85.7, < .001   χ2(1) = 53.0, < .001   χ2(1) = 17.3, .001   χ2(1) = 14.8, .002   χ2(1) = 74.6, < .001   χ2(1) = 39.1, < .001   χ2(1) = 0.5, .582  

Abbreviation: EBF, exclusive breastfeeding. a All results generated using the IBM SPSS complex sample plan. All outcome variables (except complementary feeding by 4 months) reflect whether the infant received that particular food, based on 24-hour recalls at stage 3 of the Infant Feeding Survey, when the infants were 8 to 10 months old. Frequently means ≥ once per day and 3 or more times per week; nonfrequently means ≤ twice per week and never.

maternal characteristics, exclusive breastfeeding for 3 months was significantly positively associated with being given fruits (AOR = 1.73; 95% CI, 1.42–2.11), vegetables (AOR = 1.46; 95% CI, 1.25–1.72), and homemade infant foods (AOR = 1.41; 95% CI, 1.19–1.66) at 8 to 10 months, compared to infants mixed or formula fed at 3 months (Table 2). There was also a significant positive association between exclusive breastfeeding at 3 months (vs mixed or formula feeding) and frequently giving fresh foods (AOR = 2.24; 95% CI, 1.41–3.56) to infants at 8 to 10 months (Table 2). Conversely, exclusive breastfeeding for 3 months was negatively associated with giving commercial infant foods such as powdered baby food (AOR = 0.73; 95% CI, 0.57–0.94),

canned baby food (AOR = 0.48; 95% CI, 0.32–0.71), and baby food from a jar (AOR = 0.78; 95% CI, 0.66–0.92) and the frequent use of ready-made bought meals (AOR = 0.67; 95% CI, 0.57–0.78) at 8 to 10 months (Table 2). Exclusive breastfeeding for 3 months (vs mixed or formula feeding) was not significantly associated with infants being given cow’s milk at 8 to 10 months (AOR = 1.17; 95% CI, 0.82– 1.68) (Table 2).

Discussion We found that in a large cohort of British infants, exclusive breastfeeding for 3 months was positively associated with

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Table 2.  Logistic Regression Analysis to Determine the Magnitude of the Association between Exclusive Breastfeeding for 3 Months and Very Early Introduction to Complementary Feeding and Infant Foods Given at 8 to 10 Months.a

  Timing of complementary feeding   Very early, introduced ≤ 4 months   Introduced after 4 months Infant foods given at 8–10 months  Fruits   Yes   No  Vegetables   Yes   No   Homemade infant food   Yes   No   Canned food   Yes   No   Baby food from jar   Yes   No   Powdered baby food   Yes   No   Ready-made bought meals frequency   Yes   No   Fresh food frequency   Yes   No   Cow’s milk   Yes   No

Univariable

Multivariable

OR (95% CI)

AOR (95% CI)

0.28 (0.24–0.34) 1.00

2.18 (1.80–2.64) 1.00 1.73 (1.49–2.02) 1.00 1.76 (1.51–2.06) 1.00 0.36 (0.24–0.52) 1.00 0.77 (0.65–0.90) 1.00 0.68 (0.53–0.87) 1.00 0.59 (0.51–0.69) 1.00 3.05 (1.93–4.82) 1.00 0.91 (0.64–1.28) 1.00

  0.35 (0.30–0.42) 1.00     1.73 (1.42–2.11) 1.00   1.46 (1.25–1.72) 1.00   1.41 (1.19–1.66) 1.00   0.48 (0.32–0.71) 1.00   0.78 (0.66–0.92) 1.00   0.73 (0.56–0.94) 1.00   0.67 (0.57–0.78) 1.00   2.24 (1.41–3.56) 1.00   1.17 (0.82–1.68) 1.00

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; EBF, exclusive breastfeeding; OR, odds ratio. a Magnitude of association reported as OR and AOR. Adjusted odds ratio estimates the magnitude of the association when confounding variables (maternal education, National Statistics Socio-Economic Classification, parity status, and maternal age) have been adjusted for within the multivariable logistic regression models. The reference group for the exposure variable is “not EBF for 3 months.”

higher prevalence of introduction to complementary feeding after 4 months, giving their infants fruits, vegetables, and homemade foods, and frequent provision of fresh foods at 8 to 10 months. The magnitude of these associations increased as the duration of exclusive breastfeeding increased from birth to 3 months. Conversely, exclusive breastfeeding was negatively associated with the introduction of processed and ready-made infant foods at 8 to 10 months. It is 1 of a few large surveys that have been able to adjust for maternal characteristics in the exploration of exclusive breastfeeding, timing of complementary feeding, fruit and vegetable intake, and use of cow’s milk in the first year. The data collected, also, allow exclusive breastfeeding and timing of complementary feeding to be defined

without reliance on long periods of recall, which has been shown to be problematic when recording infant feeding practice. Our findings concur with previous studies that have reported that absence or short duration of breastfeeding was a behavioral determinant of early introduction to complementary feeding.13,18 Although the UK IFS does not collect infant anthropometric data, both early introduction to complementary feeding and early cow’s milk consumption have been linked to increased risk of being overweight in childhood and beyond.9,13,24,26,30 Conversely, infants introduced to complementary feeding after 4 months have been shown to have slower weight gain between the ages of 2 and 14 months.30

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In addition, consistent with our findings, longitudinal studies have shown that breastfed infants consumed greater amounts of vegetables and fruits compared to non-breastfed infants,14 which tracked onto preschool years17 and childhood.31 Vegetables and fruits are considered to be less energy-dense foods that will provide essential vitamins, minerals, and fiber. Therefore, the higher prevalence of vegetable and fruit intake observed in infants exclusively breastfed for 3 months in this study provides a simple indicator of positive complementary feeding practices during the first 8 to 10 months that may set a healthy foundation for future dietary practices beyond 10 months of age. This theory, however, does not take into account other influences such as peer, media, and nursery related exposures that might not only broaden their taste/texture palates but also widen the food choices available for intake. Likewise, the survey does not provide data on quantity or how the vegetables and fruits consumed were prepared; for example, if fruits and vegetables were composite elements within ready-made bought infant meals or homemade infant food, there is potential for misinterpretation of the questions, which could easily affect the overall accuracy of the fruit or vegetable intake data. The lower prevalence of commercial ready-made food intake observed in infants exclusively breastfed for 3 months is not necessarily an indicator of healthier dietary infant practices, because ready-made infant foods have been found to be positively associated with key micronutrients such as iron and calcium and negatively associated with sodium intake. However, commercial convenience infant foods are likely to be enriched with sugar and preservatives to extend product shelf lives, and some of these food products may be relatively more energy-dense; therefore, frequent consumption of these together with formula milk feeding may have an unhealthy cumulative effect on infant weight if linked with a predominately sedentary lifestyle. Therefore, using tools to monitor age-specific infant weight, concurrently improving infant feeding practices in the UK, and encouraging exclusive breastfeeding beyond 3 months could help to tackle the growing prevalence of obesity and obesity-associated diseases in later life. Several underlying mechanisms have been proposed for the positive behavioral effects that exclusive breastfeeding has on infant health and dietary patterns. As shown in this study, maternal characteristics are significant predictors of exclusive breastfeeding at 3 months. It is thought that mothers who exclusively breastfeed may be more attentive to the quality of foods offered at complementary feeding and have a more responsive parenting style that may encourage consumption of a variety of healthy foods in the infant.32,33 Singhal and Lanigan8 postulated that because breastfeeding is more common in families who adopt healthy dietary and lifestyle habits, breastfed infants may be more likely to learn healthier eating behaviors and continue to adopt these throughout life due to the enabling environment in which they grow up. Another hypothesis posits that breastfeeding mothers who eat

vegetables and fruits frequently as part of their own diet will encourage intake of these foods by their infants.34 Galloway et al33 reported that exclusive breastfeeding resulted in a less fussy response to the introduction of new foods during infancy and postulated that this could be a result of early exposure to a diversity of flavors via the breast milk. In addition to the significant effects of parental modeling on healthy eating behaviors in childhood, exposure to healthy foods such as fruits and vegetables during early infancy can influence food preference in childhood.34 In addition, it is suggested that frequent exposure to home-cooked foods, which exposes the infant’s palate to a greater range of flavors and textures, may improve acceptance and intake of healthy foods in later life.35,36

Strengths and Limitations The UK IFS is a large longitudinal population survey that collects extensive information on infant feeding practices and maternal characteristics from early to late infancy. The data are collected from mother and infant pairs at 3 time points during their infancy, allowing patterns to be explored over the first year. However, the data are observational and can be used to explore associations but not to imply causation. Using the IFS, it was not possible to assess the full infant diet or nutrient intake, as the survey did not provide an exhaustive list of complementary foods given to infants at 8 to 10 months. Nevertheless, key foods such as fruits and vegetables, which are strong indicators of a healthy childhood diet, were surveyed.

Conclusion In 2010, only 17% of UK infants were exclusively breastfed at 3 months. This is considerably lower than most other European and Australasian countries and the US.37 The observations from the present study have strong practical implications as they highlight the importance of sustained education and public health campaigns that encourage exclusive breastfeeding up to 6 months, leading to appropriate complementary feeding. In the UK, this is of greater public health importance because of the low prevalence and short duration of exclusive breastfeeding. Acknowledgments We would like to acknowledge the sponsors for enabling the collection of the UK 2005 Infant Feeding Survey data and the UK Data Archive, University of Essex, Colchester, for giving us permission to carry out secondary data analysis of the anonymized data.

Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Armstrong et al Funding The authors received no financial support for the research, authorship, and/or publication of this article.

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Exclusive breastfeeding, complementary feeding, and food choices in UK infants.

Limited data exist that explore the association between exclusive breastfeeding and dietary behaviors related to key food choices in later infancy...
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