Full breastfeeding protection against common enteric bacteria and viruses: results from the MAL-ED cohort study

Benjamin J J McCormick, Stephanie A Richard, Laura E Murray-Kolb, Gagandeep Kang, Aldo A M Lima, Estomih R. Mduma, Margaret N Kosek, Elizabeth T Rogawski McQuade, Eric R Houpt, Pascal Bessong, Sanjaya Shrestha, Zulfiqar Bhutta, Tahmeed Ahmed, Laura E Caulfield* (Corresponding Author), MAL-ED Network Investigators

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Breastfeeding is known to reduce the risk of enteropathogen infections, but protection from specific enteropathogens is not well characterized.The aim was to estimate the association between full breastfeeding (days fed breast milk exclusively or with nonnutritive liquids) and enteropathogen detection.A total of 2145 newborns were enrolled at 8 sites, of whom 1712 had breastfeeding and key enteropathogen data through 6 mo. We focused on 11 enteropathogens: adenovirus 40/41, norovirus, sapovirus, astrovirus, and rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter spp., and typical enteropathogenic E. coli as well as entero-aggregative E. coli, Shigella and Cryptosporidium. Logistic regression was used to estimate the risk of enteropathogen detection in stools and survival analysis was used to estimate the timing of first detection of an enteropathogen.Infants with 10\0 d of a stool sample were less likely to have the 3 E. coli and Campylobacter spp. detected in their stool (mean odds: 0.92–0.99) but equally likely (0.99–1.02) to have the viral pathogens detected in their stool. A 10\ E. coli, Campylobacter, adenovirus, astrovirus, and rotavirus (mean HRs of 0.52–0.75). The hazards declined and point estimates were not statistically significant at 3 mo.In this large multicenter cohort study, full breastfeeding was associated with lower likelihood of detecting 4 important enteric pathogens in the first 6 mo of life. These results also show that full breastfeeding is related to delays in the first detection of some bacterial and viral pathogens in the stool. As several of these pathogens are risk factors for poor growth during childhood, this work underscores the importance of exclusive or full breastfeeding during the first 6 mo of life to optimize early health.
Original languageEnglish
Pages (from-to)759-769
Number of pages11
JournalThe American Journal of Clinical Nutrition
Issue number3
Early online date26 Nov 2021
Publication statusPublished - Mar 2022

Data Availability Statement

Data described in the manuscript will be made available upon request pending application and approval at http://clinepidb.org.


  • breastfeeding
  • enteropathogens
  • infant feeding
  • enteropathy
  • MAL-ED


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