Breastfeeding and the first 1000 days: an overlooked frontier for disease prevention and health promotion in Europe

Guest article by :

Angela Giusti, Francesca Zambri, Vincenza Di Stefano, Annachiara Di Nolfi, Flavia Splendore (Italian National Institute of Health, Italy), Anne Bærug, Ann-Magrit Lona, Hanne Christine Mosand Bliksås, Gry Hay (Norwegian Directorate of Health, Norway)

JACARDI is proud to feature this guest article from the JA PreventNCD team on Baby Friendly Communities and Health Services. The piece shows how breastfeeding and the first 1000 days are a crucial, yet often overlooked, opportunity to prevent noncommunicable diseases in Europe.

JACARDI represents one of the most ambitious and comprehensive efforts Europe has undertaken to reduce the burden of cardiovascular disease (CVD) and type 2 diabetes. Its life-course approach, its commitment to equity, and its attention to the social and commercial determinants of health create a uniquely fertile ground for expanding the reach of prevention upstream. In this special guest article, the JA PreventNCD team shares their perspective on one such upstream dimension: the first 1000 days of life, from pregnancy to a child’s second birthday. The evidence linking breastfeeding to reduced long-term risk of CVD and type 2 diabetes, in both children and mothers, is now robust, consistent, and biologically grounded.

A Consistent Body of Evidence

Over three decades of research have produced a compelling and converging picture: protecting, promoting, and supporting breastfeeding are among the most effective interventions available for reducing the lifetime risk of the two conditions at the heart of JACARDI’s mandate. The effect sizes are clinically meaningful, dose-related, and supported by plausible biological mechanisms making a strong public health case for action.

Dr. Nigel Rollins, professor at Queen’s University Belfast and one of the lead authors of the Lancet Breastfeeding Series, recently participated in a webinar organized by JA PreventNCD, presenting data on the lifelong effects of human milk. As that landmark series established, and as subsequent systematic reviews have consistently confirmed, having been breastfed as a child is associated with a 26% reduction in the probability of childhood overweight and obesity, falling to a still significant 13% when restricted to high-quality studies adjusting for confounders. Obesity, in turn, is one of the strongest modifiable risk factors for both diabetes and cardiovascular disease. 

The Maternal Dimension: Prevention Starts at the Source

The protective effects of breastfeeding are not confined to the child. Mothers who breastfeed also accumulate significant cardiometabolic protection and given that CVD is the leading cause of death in women across Europe, this dimension deserves greater prominence in prevention policy.

A systematic review and meta-analysis drawing on data from over 1,19 million parous women (i.e., women who have given birth) across 8 studies, found that women who had ever breastfed had an 11% reduction in all-cause cardiovascular disease, a 14% reduction in coronary heart disease, a 12% reduction in stroke, and, most strikingly, a 17% reduction in fatal cardiovascular events. A complementary prospective study of nearly 300 000 women replicated these findings across a different population context, confirming a dose-related effect: longer breastfeeding duration consistently lowered risk. 

For diabetes specifically, a systematic review found breastfeeding associated with a 27% lower risk of type 2 diabetes in mothers, rising to a 34% risk reduction among women with a history of gestational diabetes, precisely the group at highest risk of progression to overt type 2 disease. A 2025 meta-analysis confirmed a 36% reduced risk of type 2 diabetes mellitus in women with gestational diabetes who breastfed, while non-exclusive breastfeeding in this group was associated with a 76% increased risk, a stark illustration of what suboptimal support costs. 

Beyond statistics: biological plausibility

A legitimate scientific question is whether an intervention as simple and as early as infant feeding could plausibly exert effects on cardiometabolic health decades later. The evolving science of human milk composition provides a compelling answer. Breastmilk is not a fixed nutritional formula: it contains maternal gut bacteria, immune cells primed in the mother’s intestine, human milk oligosaccharides that actively shape the infant’s microbiome, small RNAs that regulate gene expression in the baby, and exosomes that carry epigenetic signals. It is, as researchers in the field put it, a complex biological dyadic system, much more than a combination of synthetic ingredients.

The infant gut microbiome established in the first year of life differs markedly between breastfed and formula-fed babies, and these differences persist into childhood and beyond, with downstream effects on immune regulation, metabolic programming, and inflammatory tone. These are precisely the mechanisms through which early-life exposures translate into adult disease trajectories. Breastfeeding does not merely nourish; it calibrates systems.

Enabling informed choice

Understanding the biological depth of breastfeeding does not translate into an obligation. Women, families, have the right to make informed decisions about how they feed their babies,  and that right is only meaningful when it rests on genuine access to accurate information, skilled support, and environments that make healthy choices feasible. As the WHO European Strategy for the Prevention and Control of Noncommunicable Diseases “Gaining Health” established nearly two decades ago, the goal of public health is not to tell people what to do, but to make the healthy choice the easy choice. This principle applies with particular force in the first 1000 days, a period in which families are navigating major biological, psychological, and social transitions, often with limited support.

The evidence reviewed here and presented at the JA PreventNCD webinar underscores why that support matters at a systemic level. Breastfeeding rates across Europe remain well below WHO recommendations, and the barriers are rarely individual: they include inadequate parental leave policies, lack of workplace accommodation, aggressive commercial marketing of breastmilk substitutes, and insufficient access to skilled lactation support. These are structural determinants, not personal failures. Collective responsibility, of health systems, employers, policymakers, and communities, means addressing those structures, so that women and families who wish to breastfeed are genuinely able to do so, and those who cannot or choose not to are supported without stigma or judgment.

European Joint Actions and the first 1000 days: a shared foundation

The evidence presented here is not only of academic relevance, it is already informing coordinated action across Europe. Within JA PreventNCD, the Joint Action on Prevention of Non-Communicable Diseases and Cancer, Work Package 6 is dedicated to promoting healthy living environments, and Task 6.5 focuses on implementing the Baby-Friendly Community and Health Services (BFCHS), evaluated as a Best Practice for NCD prevention by the EU Commission in 2022.

Coordinated by the Italian National Institute of Health in partnership with the Norwegian Directorate of Health, this task is implementing the BFCHS model across seven European countries (Greece, Italy, Lithuania, Norway, Slovenia, Spain, and Ukraine) with a specific aim of increasing breastfeeding rates as a contribution to reducing NCDs incidence, starting from the first 1000 days of life, with a focus on social and health inequalities. 

The convergence between JA PreventNCD and JACARDI’s mandate is both natural and consequential. Both actions are grounded in a life-course and equity-oriented approach, addressing the social and commercial determinants that shape health trajectories. The science of the first 1000 days, and of breastfeeding, offers a shared evidence base that connects upstream prevention with the downstream outcomes that JACARDI is working to reduce. What begins in the first weeks of life can still be measured, in cardiovascular risk registers and diabetes incidence data, decades later.

Future European Joint Actions and NCD strategies may find in the first 1000 days not a parallel track, but an integral part of the life-course continuum that prevention policy is already committed to addressing.