Benjamin O. Yarnoff

Feeding patterns during the first 2 years and health outcome.

Low-birth-weight infants, in particular those with birth weights <1,500 g, benefit from fortified breast milk. Low protein intake is critical, because it is limiting growth. Long-term health outcomes in small-for-gestational-age infants from developing countries in relation to their early nutrition still need to be evaluated in controlled trials. Term infants both in developing and developed countries also benefit from exclusive breastfeeding: an analysis of a large dataset of surveys from 20 developing countries (168,000 infants and small children from the Demographic Health Survey, United States Agency for International Development) indicates that exclusive breastfeeding until 6 months is associated with significantly higher weight, length, and lower probability of stunting, wasting, and infections. Nine out of 10 infants still receive breast milk between 6 and 12 months and probability of infections tends to be lower if breastfeeding is continued during that age range. Between 12 and 24 months, when stunting and wasting rates are already high, 7 out of 10 infants still receive breast milk. No associations of feeding patterns with disease outcome can be found. Effectiveness trials of complementary feeding strategies in food-insecure countries are urgently needed. Follow-up until 10 years in a developed country now indicates that an infant population at risk for allergic diseases benefits both from breastfeeding and the use of hypoallergenic formula during the first 4 months of life, when compared to cows milk-based formula: both the cumulative incidences of atopic disease and all allergic diseases are significantly lower.

Associations between infant feeding practices and length, weight, and disease in developing countries

The health benefits of exclusive breastfeeding are well-known, but the relative detrimental impacts of other foods on infant health are unknown. Because infants in developing countries are fed a wide range of food, quantifying the burden of these diverse feeding practices on infant health is essential for public health policy. We used data from the Demographic Health Survey from 20 developing countries over multiple years to examine the independent association of six different types of food (exclusive breastfeeding, non-exclusive breastfeeding, infant formula, milk liquids, non-milk liquids, and solid foods) with five measures of infant health (length, weight, diarrhea, fever, and cough). We estimated associations with regression analysis, controlling for confounding factors with infant, mother, and household factors and community-year fixed effects. We used these estimates in a simulation model to quantify the burden of different combinations of food on infant health. We show that for an infant younger than 6 months old, following current guidelines and exclusively breastfeeding instead of giving the infant solid foods may increase length by 0.75 cm and weight by 0.25 kg and decrease diarrhea, fever, and cough prevalence by 8, 12, and 11%, respectively. We found that the burden on infant health of some feeding practices is less than others. Although all other feeding practices are associated with worse health outcomes than exclusive breastfeeding, breastfeeding supplemented with liquids has a lower burden on infant health than solid foods and infant formula has a lower burden than milk or non-milk liquids as measured by four of five health metrics. Providing specific quantified burden estimates of these practices can help inform public health policy related to infant feeding practices.

Mother, Infant, and Household Factors Associated with the Type of Food Infants Receive in Developing Countries

Objectives: We explore the complex factors associated with infant feeding by analyzing what mother, infant, and household factors are associated with the types of food given to infants. We seek to quantify associations in order to inform public health policy about the importance of target populations for infant feeding programs. Methods: We used data from the Demographic Health Survey in 20 developing countries for multiple years to examine mother, infant, and household factors associated with six types of food given to infants (exclusive breastfeeding, non-exclusive breastfeeding, infant formula, milk liquids, non-milk liquids, and solid foods). We performed a seemingly unrelated regressions analysis with community-year fixed effects to account for correlation between food types and control for confounding factors associated with community resources, culture, time period, and geography in the pooled analysis. Results: We found that several mother, infant, and household characteristics were associated with each of the feeding types. Most notably, mother’s education, working status, and weight are significantly associated with the type of food given to infants. We provide quantified estimates of the association of each of these variables with six types of food given to infants. Conclusion: By identifying maternal characteristics associated with infant feeding and quantifying those associations, we help public health policymakers generate priorities for targeting infant feeding programs to specific populations that are at greatest risk. Higher educated, working mothers are best to target with exclusive breastfeeding programs for young infants. Mothers with lower education are best to target with complementary feeding programs in infants older than 1 year. Finally, while maternal weight is associated with higher levels of exclusive breastfeeding the association is too weak to merit targeting of breastfeeding programs to low-weight mothers.

The cost-effectiveness of using chronic kidney disease risk scores to screen for early-stage chronic kidney disease

BackgroundBetter treatment during early stages of chronic kidney disease (CKD) may slow progression to end-stage renal disease and decrease associated complications and medical costs. Achieving early treatment of CKD is challenging, however, because a large fraction of persons with CKD are unaware of having this disease. Screening for CKD is one important method for increasing awareness. We examined the cost-effectiveness of identifying persons for early-stage CKD screening (i.e., screening for moderate albuminuria) using published CKD risk scores.MethodsWe used the CKD Health Policy Model, a micro-simulation model, to simulate the cost-effectiveness of using CKD two published risk scores by Bang et al. and Kshirsagar et al. to identify persons in the US for CKD screening with testing for albuminuria. Alternative risk score thresholds were tested (0.20, 0.15, 0.10, 0.05, and 0.02) above which persons were assigned to receive screening at alternative intervals (1-, 2-, and 5-year) for follow-up screening if the first screening was negative. We examined incremental cost-effectiveness ratios (ICERs), incremental lifetime costs divided by incremental lifetime QALYs, relative to the next higher screening threshold to assess cost-effectiveness. Cost-effective scenarios were determined as those with ICERs less than

The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease

50,000 per QALY. Among the cost-effective scenarios, the optimal scenario was determined as the one that resulted in the highest lifetime QALYs.ResultsICERs ranged from

Predicting the health effects of switching infant feeding practices for use in decision-making.

8,823 per QALY to

Costs of community-based interventions from the Community Transformation Grants

124,626 per QALY for the Bang et al. risk score and

Modeling the impact of obesity on the lifetime risk of chronic kidney disease in the United States using updated estimates of GFR progression from the CRIC study

6,342 per QALY to

The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative.

405,861 per QALY for the Kshirsagar et al. risk score. The Bang et al. risk score with a threshold of 0.02 and 2-year follow-up screening was found to be optimal because it had an ICER less than

Title Page / Table of Contents / Policy Statement

50,000 per QALY and resulted in the highest lifetime QALYs.ConclusionsThis study indicates that using these CKD risk scores may allow clinicians to cost-effectively identify a broader population for CKD screening with testing for albuminuria and potentially detect people with CKD at earlier stages of the disease than current approaches of screening only persons with diabetes or hypertension.