Impact of scaling up breastfeeding on reducing the global burden of non-communicable diseases in mothers and children: a population-based modelling analysis for 132 low-income and middle-income countries.

BACKGROUND Growing evidence suggests breastfeeding offers long-term protective effects against non-communicable diseases (NCDs) later in life in mothers and their offspring. These benefits could be substantial at the population level but have not yet been rigorously quantified. We aimed to estimate the population-level effect of scaling up exclusive breastfeeding on long-term NCD burden in mothers and their offspring in 132 low-income and middle-income countries (LMICs). METHODS In this population-based modelling analysis, we developed mathematical simulation models based on the population impact fraction estimator and leveraging available effect estimates and global input data. We conducted umbrella reviews to obtain pooled effect estimates from high-quality meta-analyses, with quality assessed using AMSTAR-2. Input data included cause-specific mortality (Global Burden of Diseases, Injuries, and Risk Factors Study), diabetes and hypertension prevalence (NCD Risk Factor Collaboration), baseline exclusive breastfeeding coverage (WHO-UNICEF), and demographics (UN Population Division). We quantified delayed cause-specific NCD deaths, averted diabetes and hypertension cases, and years of life gained (YLG) across four exclusive breastfeeding coverage scenarios. All future benefits were discounted (3% rate). FINDINGS Scaling up exclusive breastfeeding coverage to 90% in 132 LMICs could delay 0·17% of NCD deaths across the two generations, equivalent to 72 300 delayed NCD deaths annually, yielding 1·04 million YLG. It substantially reduced type 2 diabetes prevalence by 1·29% (10 million cases averted across the lifespan of the cohort) and moderately reduced hypertension prevalence by 0·17% (3·8 million averted cases). The maternal generation constituted 42% of delayed deaths, 23% of averted diabetes cases, and approximately half of the total YLG. Regionally, southeast Asia, east Asia, and Oceania followed by south Asia had the largest absolute benefits due to population size; however, after adjusting for cohort and population size, sub-Saharan Africa and north Africa and the Middle East showed the largest benefits per million intervened mothers. Most delayed deaths were from ischaemic heart disease (43%) and stroke (33%), with cancer accounting for 18%. INTERPRETATION Scaling up exclusive breastfeeding coverage could lead to benefits in reducing NCDs, complementing its established benefits for child mortality and early childhood development. FUNDING Nutrition International.