The title of this article is worth noting. "Effects of **PROMOTING**
Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like
Growth Factor-I at Age 11.5 Years".  It is not an article about
breastfeeding, but about breastfeeding promotion.

The authors set out to examine whether there was a relationship
between *an initiative to PROMOTE breastfeeding in maternity units*,
and the prevalences of adiposity and insulin-like growth factor-I
among the 11 year old children born in the areas where this promotion
took place. Nearly one in five of the children in the original data
set had been lost to follow-up in the intervening years, so the
conclusions are based on the roughly 80% the researchers were able to
contact.

When the breastfeeding promotional campaign at the outset only
succeeded in raising rates and duration of exclusive breastfeeding
from 'dismal' to 'less dismal', it is no surprise that they did not
find an effect in the population years later based on which group the
child's mother's hospital had been randomized to.

In such a study, it would be interesting, though not conclusive
statistically, to know the individual breastfeeding histories of all
the children, and see whether there were detectible differences in the
outcome variables based on actual duration of any, and exclusive,
breastfeeding.  Many retrospective, observational studies are done
precisely this way, and are frought with various sources of bias of
their own.

The authors make apparent in their choice of title for the article
that they are not examining whether breastfeeding per se has an effect
on the outcome variables - they are examining whether PROMOTING
breastfeeding in maternity units affects adiposity etc in the
offspring more than a decade later. That distinction is too
complicated for mass media to notice, and certainly not in the
interest of the kind of spin agencies commissioned by the food
industry to get the story out there for as much mileage as they dare.

Rachel Myr
Kristiansand, Norway

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