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(2025) conducted a systematic review and meta-analysis on predictors of exclusive breastfeeding, offering valuable insights but facing methodological challenges. Despite a robust search strategy, PROSPERO registration, and use of the Newcastle–Ottawa Scale, heterogeneity remained high (I² >85%), with limited exploration through prediction intervals. Combining diverse designs and minimal subgroup justification reduced interpretability. Future reviews should incorporate prediction intervals, sensitivity analyses, and clearer subgroup rationale to enhance methodological transparency and reproducibility.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/commentary-on-methodological-rigor-in-predictors-of-exclusive-breastfeeding-a-systematic-review-and-meta-analysis/406920/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/commentary-on-methodological-rigor-in-predictors-of-exclusive-breastfeeding-a-systematic-review-and-meta-analysis/406920.png","ImageObject",300,407,{"name":92,"@type":93},"awa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What methodological strengths does the commentary highlight in Kalhor et al. (2025)?","Question",{"text":112,"@type":113},"The commentary praises the robust search across multiple databases, PROSPERO registration, adherence to PRISMA, and the use of the Newcastle–Ottawa Scale for quality assessment.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why does the commentary criticize the heterogeneity results?",{"text":117,"@type":113},"It notes that heterogeneity was often very high (I² >85%) and argues that limited investigation—especially through prediction intervals—reduces interpretability.",{"name":119,"@type":110,"acceptedAnswer":120},"What improvements does the commentary recommend for future reviews?",{"text":121,"@type":113},"It recommends adding prediction intervals, conducting sensitivity analyses (e.g., comparing REML with alternatives), and providing clearer subgroup rationales and more nuanced quality appraisal.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406920,1791185878,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},3985747858093,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Kumar et al. International Breastfeeding Journal (2025) 20:96  \n[https://doi.org/10.1186/s13006-025-00787-5](https://doi.org/10.1186/s13006-025-00787-5)  \nInternational Breastfeeding Journal  \nCOMMENT Open Access  \nCommentary on methodological rigor in“Predictors of exclusive breastfeeding: a systematic review and meta-analysis”  \nArun Kumar 1,2, Ankur Sharma3, Saumya Das4, Preeti Dnyandeo Sonje5 and Dhanya Dedeepya6*  \nAbstract  \nKal hor et al. (2025) conducted a systematic review and meta-analysis on predictors of exclusive breastfeeding, offering valuable insights but facing methodological challenges. Despite a robust search strategy, PROSPERO registration, and use of the Newcastle–Ottawa Scale, heterogeneity remained high (I² >85%), with limited exploration through prediction intervals. Combining diverse designs and minimal subgroup justification reduced interpretability. Future reviews should incorporate prediction intervals, sensitivity analyses, and clearer subgroup rationale to enhance methodological transparency and reproducibility.  \nDear editor,  \nWe read with interest the article by Kalhor et al. (2025) entitled “Predictors of Exclusive Breastfeeding: A Systematic Review and Meta-Analysis” [1]. The study provides valuable insight into the multifactorial determinants of exclusive breastfeeding (EBF) by synthesizing evidence across diverse populations. While the review offers an extensive synthesis and follows PRISMA guidelines,  \n*Correspondence:  \nDhanya Dedeepya  \n[111701033.smc@saveetha.com](111701033.smc@saveetha.com)  \n1Faculty of Pharmaceutical Sciences, Graphic Era Hill University, Dehradun, India  \n2Centre for Promotion of Research, Graphic Era Deemed University, Dehradun, India  \n3Department of Anatomy, School of Medical Sciences and Research, Sharda University, Greater, Noida, India  \n4Department of Pharmacology, Noida Institute of Engineering & Technology (Pharmacy Institute), Plot No. 19, Knowledge Park-II, Greater, Noida, India  \n5Department of Anatomy, Hospital and Research Centre, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune, Maharashtra 411018, India  \n6Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India  \nseveral methodological aspects warrant further consideration to enhance interpretability and reproducibility.  \nThe authors’ comprehensive search strategy across nine major databases and inclusion of both English and Persian literature are commendable steps toward reducing selection bias. Registering the protocol in PROSPERO strengthens transparency and prospective planning. Moreover, the application of the Newcastle–Ottawa Scale (NOS) for assessing study quality demonstrates methodological diligence. However, the adaptation of NOS for cross-sectional studies remains debated for its limited discrimination power between moderate and highquality studies; thus, complementary quality appraisal tools such as the JBI checklist may have provided more nuanced evaluation [2].  \nA critical point relates to the handling and interpretation of heterogeneity. The authors quantified heterogeneity using the I² statistic, but the reported values were exceedingly high (often >85%), suggesting substantial between-study variability. As highlighted by Borenstein (2020), I² reflects the proportion of total variance attributable to heterogeneity rather than the magnitude of effect size dispersion, and thus should not be interpreted  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under","cbCaifXJNiENLuLP","https://ap.wps.com/l/cbCaifXJNiENLuLP","pdf",539887,"English","# Commentary\n## Authors' overall assessment and strengths\n## Heterogeneity handling and prediction intervals\n## Quality appraisal, model choice, and sensitivity analyses\n## Subgroup and publication bias considerations","[{\"question\":\"What methodological strengths does the commentary highlight in Kalhor et al. (2025)?\",\"answer\":\"The commentary praises the robust search across multiple databases, PROSPERO registration, adherence to PRISMA, and the use of the Newcastle–Ottawa Scale for quality assessment.\"},{\"question\":\"Why does the commentary criticize the heterogeneity results?\",\"answer\":\"It notes that heterogeneity was often very high (I² \\u003e85%) and argues that limited investigation—especially through prediction intervals—reduces interpretability.\"},{\"question\":\"What improvements does the commentary recommend for future reviews?\",\"answer\":\"It recommends adding prediction intervals, conducting sensitivity analyses (e.g., comparing REML with alternatives), and providing clearer subgroup rationales and more nuanced quality appraisal.\"}]","Commentary on methodological rigor in Predictors of exclusive breastfeeding: a systematic review and meta-analysis | PDF",1790568938]