PHA-Exchange> Extended breastfeding

[Claudio]

From: <helmant at info.curtin.edu.au>
Subject: Arbor Clinical Nutrition Update #167
____________________________________________________
NUTRITION RESEARCH REVIEW

> Study 1: Exclusive breastfeeding in developing country

> Exclusive breast feeding for 6 rather than 3 months does not produce
> significant adverse effects on growth, and protects against
> gastrointestinal infection, according to a study from  the former Soviet
republic of Belarus.
> Results: The 6 month exclusive breastfed group had slightly slower weight
> and height gain in the second three months of life, compared with the 3
> month exclusive breastfed group (differences of 29gm/month and 1.1mm
> respectively).
>
> However, the 6 month group had greater length gain in the period from 6-12
> months than did the 3 month group (0.9 mm/month) and a greater head
> circumference at 12 months (0.19 cm).
>
> There was also a significantly lower level of gastrointestinal infection
> between 3 and 6 months of age  in the 6 month compared with 3 month
> breastfed group.
>
> Reference: Am J Clin Nutr. 2003 Aug;78(2):291-5.
>
> Study 2: Growth similar in a Western country
> Infants who are exclusively breastfed until 6 months of age do not grow
> differently to those  who are only partially breastfed, according to a new
> Swedish study.
>
> Results: There were no statistically significant differences between the
> exclusively breastfed children and those who had been regularly receiving
> formula by 16 weeks of age.
> Reference: Acta Paediatr. 2003;92(2):145-51.
>
> COMMENTS
> Breastfeeding well into the first year of life has undoubted health
> advantages for the infant.
>
> However, one question that has been raised is whether infants exclusively
> breastfed beyond 3 months and particularly after 6 months of age might
have
> lesser average energy intake and lower growth, compared to infants
> receiving formula at that time (whether alongside breast milk or instead
of
> it). And if this is so, is it a physiological effect of breastfeeding or a
> confounding effect of other variables that influence breastfeeding choice,
> particularly in less well nourished populations.
> In a Danish study, for example, infants breastfed for at least 7 months
> gained nearly 200 gm less weight and 7 mm less length from 5 to 10 months
> of age than infants who were not breastfed. On the other hand, in a
> sample of Kenyan children, those breastfed for longer were found to grow
> more than those breastfed for shorter periods, right up to 2 years of age.
>
> By no means is it the case that such differences in growth, if they exist,
> are necessarily a problem. But many experts believe that there is at least
> a need to revise the current growth chart standards to properly account
for
> children breastfed for extended periods. The current standards have tended
> to be established using infant populations where many children were
formula fed.
>
> In interpreting any research looking at breastfed infants, it is essential
> to be certain about exactly what is being studied and compared. Are we
> talking about exclusive breastfeeding, how much breastfeeding is taking
> place in the `control' group, what effort has been made to control for the
> various factors (such as education, illness and poverty) that can
influence
> both the mother's breastfeeding choice and health outcomes in the child?
> All these factors have to be looked at.
>
> In the Swedish study (Study 2 above), for example, there was a fairly high
> level of partial breastfeeding in the `control' group and the mothers as a
> whole would be expected to be a fairly well nourished group, thus making
it
> less likely that differences in growth associated with breastfeeding would
> be found.
>
> In the study from Belarus, on the other hand, the children exclusively
> breastfed for the longer period did grow a little less during the second 3
> months of life than those children exclusively breastfed for a shorter
> period. However, this growth difference was largely made up during the
> following 6 months, and moreover the children breastfed for longer had
less  GIT infection.
>
> The fact that the Belarus observational study was conducted within a
> community based, controlled intervention trial adds to its strength,
> because there was likely to be less influence of the confounding
> socioeconomic, educational and health influences that are  so strong in
> relation to breastfeeding choice.
>
> It is also interesting that the results from this Belarus study were in
> accord with another trial from India that has just been published. In the
> Indian study (randomised at the community level) an intervention designed
> to promote extended, exclusive breastfeeding resulted not only in greater
> breastfeeding but also normal growth and less diarrhoea.
>
> Overall, these new studies are very reassuring about prolonging exclusive
> breastfeeding beyond 3 months of age. At the same time, there seems to be
> merit in efforts to revise growth standards to better align with breastfed
> babies.