Background

Previous analyses of trends in feeding indicators of children younger than 2 years have been limited to low-income and middle-income countries. We aimed to assess time trends in the consumption of different types of milk (breastmilk, formula, and animal milk) by children younger than 2 years from 2000 to 2019 at a global level.

Methods

In this time-series analysis, we combined cross-sectional data from 487 nationally representative surveys from low-income and middle-income countries and information from high-income countries to estimate seven infant and young child feeding indicators in up to 113 countries. Multilevel linear models were used in pooled analyses to estimate annual changes in feeding practices from 2000 to 2019 for country income groups and world regions.

Findings

For the absolute average annual changes, we found significant gains in any breastfeeding at age 6 months in high-income countries (1·29 percentage points [PPs] per year [95% CI 1·12 to 1·45]; p<0·0001) and at age 1 year in high-income countries (1·14 PPs per year [0·99 to 1·28]; p<0·0001) and upper-middle-income countries (0·53 PPs per year [0·23 to 0·82]; p<0·0001). We also found a small reduction in low-income countries for any breastfeeding at age 6 months (−0·07 PPs per year [–0·11 to −0·03]; p<0·0001) and age 1 year (−0·13 PPs per year [–0·18 to −0·09]; p<0·0001). Data on exclusive breastfeeding and consumption of formula and animal milk were only available for low-income and middle-income countries, where exclusive breastfeeding in the first 6 months of life increased by 0·70 PPs per year (0·51–0·88; p<0·0001) to reach 48·6% (41·9–55·2) in 2019. Exclusive breastfeeding increased in all world regions except for the Middle East and north Africa. Formula consumption in the first 6 months of life increased in upper-middle-income countries and in east Asia and the Pacific, Latin America and the Caribbean, the Middle East and north Africa, and eastern Europe and central Asia, whereas the rates remained below 8% in sub-Saharan Africa and south Asia. Animal milk consumption by children younger than 6 months decreased significantly (−0·41 PPs per year [–0·51 to −0·31]; p<0·0001) in low-income and middle-income countries.

Interpretation

We found some increases in exclusive and any breastfeeding at age 6 months in various regions and income groups, while formula consumption increased in upper-middle-income countries. To achieve the global target of 70% exclusive breastfeeding by 2030, however, rates of improvement will need to be accelerated.

Funding

Bill & Melinda Gates Foundation, through WHO.

中文翻译：

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2000-2019年2岁以下儿童母乳、配方奶和动物奶消费率和时间趋势：113个国家分析

背景

此前对 2 岁以下儿童喂养指标趋势的分析仅限于低收入和中等收入国家。我们旨在评估 2000 年至 2019 年全球范围内 2 岁以下儿童不同类型牛奶（母乳、配方奶和动物奶）消费的时间趋势。

方法

在这个时间序列分析中，我们结合了来自低收入和中等收入国家的 487 项具有全国代表性的调查的横断面数据和来自高收入国家的信息，估计了多达 113 个国家的七项婴幼儿喂养指标。在汇总分析中使用了多级线性模型来估计 2000 年至 2019 年国家收入组和世界区域的喂养做法的年度变化。

发现

对于绝对平均年度变化，我们发现在高收入国家 6 个月大的任何母乳喂养都有显着提高（每年 1·29 个百分点 [PPs] [95% CI 1·12 至 1·45]；p<0 ·0001) 和 1 岁时在高收入国家（每年 1·14 PPs [0·99 至 1·28]；p<0·0001）和中上收入国家（每年 0·53 PPs [0·23 到 0·82]；p<0·0001)。我们还发现低收入国家在 6 个月大（-0·07 PPs 每年 [-0·11 至 -0·03]；p<0·0001）和 1 岁（-每年 0·13 PPs [–0·18 至 -0·09]；p<0·0001)。纯母乳喂养以及配方奶和动物奶消费的数据仅适用于低收入和中等收入国家，这些国家出生前 6 个月的纯母乳喂养每年增加 0·70 PPs (0·51–0·88 ; p< 0·0001) 到 2019 年达到 48·6% (41·9–55·2)。除中东和北非以外，世界所有地区的纯母乳喂养均有所增加。在中高收入国家、东亚和太平洋、拉丁美洲和加勒比、中东和北非、东欧和中亚，婴儿出生前 6 个月的配方奶粉消费量有所增加，而这一比例仍然低于8% 在撒哈拉以南非洲和南亚。在低收入和中等收入国家，6 个月以下儿童的动物奶消费量显着下降（每年 -0·41 PPs [-0·51 至 -0·31]；p<0·0001）。在中高收入国家、东亚和太平洋、拉丁美洲和加勒比、中东和北非、东欧和中亚，婴儿出生前 6 个月的配方奶粉消费量有所增加，而这一比例仍然低于8% 在撒哈拉以南非洲和南亚。在低收入和中等收入国家，6 个月以下儿童的动物奶消费量显着下降（每年 -0·41 PPs [-0·51 至 -0·31]；p<0·0001）。在中高收入国家、东亚和太平洋、拉丁美洲和加勒比、中东和北非、东欧和中亚，婴儿出生前 6 个月的配方奶粉消费量有所增加，而这一比例仍然低于8% 在撒哈拉以南非洲和南亚。在低收入和中等收入国家，6 个月以下儿童的动物奶消费量显着下降（每年 -0·41 PPs [-0·51 至 -0·31]；p<0·0001）。

解释

我们发现，不同地区和收入群体在 6 个月大时纯母乳喂养和任何母乳喂养的比例有所增加，而中高收入国家的配方奶粉消费量有所增加。然而，为了到 2030 年实现 70% 纯母乳喂养的全球目标，需要加快改善速度。

资金

比尔和梅琳达盖茨基金会，通过世卫组织。