Lack of Breastfeeding Linked to Increased Risk of Atherosclerosis

Featured on the Web page of The Lancet

A healthy start

Breastfeeding in infancy is likely to reduce the risk of atherosclerosis--and therefore cardiovascular disease--in adult life, according to the authors of a UK study. Atul Singhal and colleagues suggest that infant nutrition permanently affects the lipoprotein profile later in life, and specifically that breastmilk feeding has a beneficial effect. In an accompanying Viewpoint article, two of the authors discuss their findings along with other relevant evidence, and propose a synthesis with major implications for public-health practice and future research.

Breastmilk feeding and lipoprotein profile in adolescents born preterm: follow-up of a prospective randomised study

Atul Singhal, Tim J Cole, Mary Fewtrell, Alan Lucas

MRC Childhood Nutrition Research Centre

(A Singhal MD, M Fewtrell MD, A Lucas FRCP)

and Centre for Paediatric Epidemiology and Biostatistics

(T J Cole ScD),

Institute of Child Health, London, UK

Correspondence to:

Dr A Singhal, 
MRC Childhood Nutrition Research Centre, 
Institute of Child Health, 
30 Guilford Street, 
London WC1N 1EH, UK

(e-mail:This email address is being protected from spambots. You need JavaScript enabled to view it.)



Breastfeeding is associated with reduced cholesterol concentration later in life, but previous studies have not used random assignment of infant diet with prospective follow-up. We tested the hypothesis that breastmilk feeding benefits the lipoprotein profile in adolescents born preterm, in whom randomisation to different diets at birth is feasible.


926 infants born preterm were randomly assigned in two parallel trials to receive (trial 1) donated banked breastmilk or preterm formula, or (trial 2) standard term formula or preterm formula, as sole diet or as supplements to mother’s milk in both trials. We followed up 216 participants at age 13-16 years and measured ratio of low-density to high-density lipoprotein cholesterol (LDL to HDL), ratio of apolipoprotein B to apolipoprotein A-1 (apoB to apoA-1), and concentration of C-reactive protein (CRP; a measure of the inflammatory process associated with atherosclerosis).


Adolescents who had been randomised to banked breastmilk had a lower CRP concentration (p=0.006) and LDL to HDL ratio (mean difference 0.34 [14% lower], 95% CI -0.67 to -0.01; p=0.04) than those given preterm formula. A greater proportion of human milk intake in infancy was associated with lower ratios of LDL to HDL (p=0.03) and apoB to apoA-1 (p=0.004)--independent of gestation and potential confounding factors--and with lower CRP concentration (p=0.03). CRP concentration correlated with the two lipoprotein ratios (p=0.0001 and p=0.003, respectively).


Our data provide experimental evidence for the long-term benefits of breastmilk feeding on the risk of atherosclerosis.

Lancet 2004; 363: 1571-78

Media Coverage of the Study:

Canada: Breast milk may prevent later heart disease

The Globe and Mail Newspaper 
Friday, May 14, 2004 - Page A17

Mother’s milk may well be the best "drug" available for preventing heart disease.

New research suggests that babies who are breastfed are less likely to develop atherosclerosis (clogged arteries) as adults, and the lower risk may be due to breast milk permanently altering the way cholesterol is stored by the body.

"The findings suggest that infant nutrition permanently affects the lipoprotein profile later in life, and specifically that breast-milk feeding has a beneficial effect," said Atul Singhal from the Institute of Child Health in London.

The research, published in today’s edition of the medical journal The Lancet, was conducted on 926 premature babies who, at birth, were assigned to get breast milk or formula.

Researchers tracked down 216 of the children when they had reached age 14 to 16 and tested their blood for several markers of heart disease: high-density lipoprotein (HDL, or good cholesterol), LDL (low-density lipoprotein, or bad cholesterol), apolipoprotein B and A-1 (apoB and apoA-1), and C-reactive protein (CRP).

They found the breastfed children had markedly lower ratios of HDL to LDL and of apoB to apoA-1, both of which are measures of atherosclerosis risk. The children fed on mother’s milk also had lower concentrations of CRP, another marker of atherosclerosis.

Dr. Singhal said the study is important because it is the first to prospectively look at the benefits of breastfeeding, with two groups of children assigned randomly to get breast milk or formula. All other research on the link between cardiovascular disease and breastfeeding was retrospective, asking people with heart disease whether they had been breastfed.

The researcher said the findings also bolster the growing body of evidence that the way infants are fed, and consequently the way they grow in the early stages of life, can have lasting impacts on their health.

Dr. Singhal said breastfeeding has been shown to reduce a person’s risk of developing high blood pressure, obesity, insulin resistance (a precursor to diabetes) and cardiovascular disease.

The biological mechanism is not entirely clear, but all these conditions are linked to a person’s metabolism and, more specifically, to the body’s inflammatory response.

One belief is that colostrum is the key. Colostrum is produced in the early days of breastfeeding, before true milk; it is low in fat, but rich in protein and in antibodies that protect a child from infection. Infections, because they cause an inflammatory response, seem to play a role in the development of a number of chronic conditions, such as asthma, heart disease and Alzheimer’s disease.

Another school of thought is related to the fact that breastfed children tend to grow more slowly and steadily in the early months of life, while formula-fed babies often have growth spurts. That is because mother’s milk contains far fewer calories than formula.

Dr. Singhal said it appears that the "relative overnutrition" provided by formula feeding can alter the body’s metabolism and lead to significant health risks in adult life.

About 70 per cent of women breastfeed their newborns, but that falls to less than 15 per cent by the baby’s first birthday.

According to the World Health Organization, babies should breastfeed exclusively until the age of six months, and continue to be breastfed for at least two years for optimal health.

Media Coverage of the Study:UK:

This study was in several UK newspapers today. Headlines and coverage varied.

Interestingly, in the Telegraph, we are told that 'breastfeeding protects etc etc etc': Breastfeeding 'cuts heart risks in adult life'.

The Guardian, however, reflects what the study actually says, that formula has risks.

And the article here: Bottle-fed babies 'face higher risk of heart death'

Thanks to Heather Welford Neil for media monitoring in the UK

Media Coverage of the Study: United States:

From USA Today website Posted 5/13/2004 7:01 PM

Study: Breast-feeding linked to better cholesterol later in life