الفهرس 
acknowledgementOnly 14 pages are availabe for public view
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Abstract
Cardiovascular disease is one of the leading causes of death globally. Low-density lipoprotein cholesterol (LDL-C) is a key contributor to cardiovascular disease. Breastfeeding is part of the World Health Organization’s (WHO) “Global Action Plan for the prevention and control of non-communicable diseases 2013–2020”. Breastfeeding has long-term benefits on lipid metabolism in adulthood, it also, has important implications for combating this epidemic. Breast milk contains more cholesterol than infant formula, and infants who are breastfed have higher blood cholesterol. Higher neonatal dietary cholesterol is associated with different cholesterol metabolism and less endogenous cholesterol synthesis in infants who are breastfed. It has been hypothesized that such early changes in cholesterol metabolism may program subsequent cholesterol homeostasis and lipid profile in adulthood in a right way. Both breastfeeding duration and exclusivity have been suggested as potential modifiers of the risk of later CVD. Infant formulas are designed to be a substitute for breast milk. Since they are sole source of nutrition for growing and developing infants, they are highly regulated by the government. All ingredients in infant formulas must be considered generally recognized as safe. And all manufacturers are continually modifying their products to make them more like breast milk. Functional ingredients added to infant formula include long chain polyunsaturated fatty acids, nucleotides, prebiotics, and probiotics. The most common breast milk substitutes are standard cow’s milk–based term infant formulas, which include subcategories of organic and breast milk supplementation, and come in standard dilutions of 19 or 20 calories per ounce. Breastfeeding could affect blood pressure through a variety of mechanisms, including 1) reducing sodium intake in infancy; 2) Increasing intake of long-chain polyunsaturated fatty acids, important structural components of tissue membrane systems, including the vascular endothelium; and 3) protecting against hyperinsulinemia in infancy and insulin resistance in early life, adolescence, and adulthood, 4) regulating processes that may raise blood pressure via several mechanisms. Dietary habits, from prenatal nutrition, breastfeeding, complementary feeding to childhood and adolescence nutrition play a basic role in metabolic processes along life. The metabolic and neuroendocrine environment of the fetus is fundamental in the body’s metabolic programming. Further several studies have demonstrated the beneficial effects of breastfeeding on cardiovascular risk factors reduction. Moreover the introduction of complementary foods represents another important step, with particular regard to protein intake. An adequate distribution between macronutrients (lipids, proteins, and carbohydrates) is required for correct growth development from infancy throughout adolescence and for prevention of several cardiovascular disease risk determinants in adulthood. The study was included 50 infants classified into two groups, 25 infants in breast fed group and 25 infants in formula fed group aged 10-14 months attending the outpatient nutrition clinic of the Assiut University Children Hospital, Assiut, Egypt, during the study period and fulfilling the inclusion criteria were included in this study. All cases were subjected to full history included; Age, sex, perinatal history, type of feeding in first 4 months ”breast-feeding or formula-feeding”, causes of non-breast feeding and the need for formula, family size, causes of neonatal intensive care unit (NICU) admission, age of start of complementary food, junk food intake and its frequency, dairy food products intake and its frequency, vaccination history, developmental milestones, associated co-morbidity as congenital heart disease, maternal dyslipidemia or family history of congenital hyperlipidemia and socioeconomic status. Examination included all vital signs blood pressure, heart rate, respiratory rate and body temperature. Chest, cardiac, abdominal, and neurological examination. Anthropometric measurements including weight, head circumference, chest circumference, mid upper arm circumference (MUAC) and height. The investigations included: serum blood glucose and serum Lipid profileThis study aimed to assess lipid profile, nontraditional lipid indices and blood pressure in breast fed versus formula fed infants. The current study results showed, were non-significant differences as regard sociodemographic data. also, both groups had insignificant differences as regard diastolic blood pressure (DBP), systolic blood pressure (SBP), and blood glucose. Regarding the laboratory investigations, in this presenting study, we found that infant with breast feeding had significantly higher total cholesterol and LDL-c. The higher cholesterol and LDL-c levels in breastfed infants in our study might be explained by increased lipase activity or an increased concentration of cofactor apo E II in human milk that might enhance exogenous and endogenous TG lipolysis and thus increasing serum lipid levels. Regarding non-traditional lipid profile, the current study also, revealed that both groups had insignificant differences with exception of significantly higher non-HDL among breast fed group. In conclusion, prolonged breastfeeding in early infancy may be associated with a better lipid profile suggesting its potential long-term benefits for cardiovascular health, which should be supported. Further studies used to unravel the biological mechanism through which breastfeeding programs lipid metabolism. Breast milk is an optimal feed for infant, both for full term and preterm, as suggested in international and national guidelines. Breast milk not only provides all the nutrients in proper amount to the infant, but it has other beneficial effects to both infant and mother. Long term benefits associated with breast feeding are better cognitive development in childhood and lower risk of obesity, diabetes mellitus, high blood pressure, better lipid metabolism in both infancy and adulthood, and atherosclerotic cardiovascular disease. Finally, there are risks inherent in the use of formulas and bottles in replacement of BF, so it is important to encourage breastfeeding beginning in pregnancy, at childbirth and during puerperium in an empathetic, respectful and welcoming way as part of achieving whole health. Projects for promotion of breast feeding in addition to maternal and doctors education about importance of breast feeding in prevention of long term sequels of cardiovascular disease. Further studies used to unravel the biological mechanism through which breastfeeding programs lipid metabolism and the health impact of prolonged breastfeeding are warranted. Future large prospective studies designed specifically to address this topic are needed to fully assess and understand the association of breastfeeding and CVD risks factors at various life stages. Further research is required in low- and middle-income countries to define healthy nutritional practices and patterns of growth, particularly using studies with an experimental design to establish causal links between early nutrition and long-term health. Finally this relevant body of knowledge should be considered in the clinical practice, since prenatal life, in order to develop preventive and intervention strategies to promote health across life course, aimed to CVD prevention. Encourage breastfeeding programes, as part of achieving whole health.