Nutrition During Lactation (1991) / Chapter Skim
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7 Infant Outcomes
7 Infant Outcomes
Pages 153-196
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From page 153... ...
Since infant nutrition, growth, development, and health are interrelated, the effects of breastfeeding and maternal nutrition on each of these outcomes were reviewed. The health-related outcomes include resistance to infectious diseases, allergic disorders, and chronic diseases with an immunologic basis that develop later in childhood; the passage of infectious or toxic agents in milk to the recipient; and infant mortality.
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From page 154... ...
Thus, the lower risks of morbidity reported for breastfed infants may be in part due to factors other than breastfeeding. Other potential sources of bias are reviewed by Kramer (19871.
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From page 155... ...
Ala-Houhala (1985) reported that in the winter months, 10 of 18 unsupplemented breastfed infants had plasma levels of less than 5 ng/ml, which may lead to rickets (Nutrition Foundation, 19841.
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From page 156... ...
In a study by Greer and colleagues (1982) , which included randomization of breastfed infants to a placebo or to a daily supplement of 10 ,ug of vitamin D, the bone mineral content of the placebo group was significantly lower in the first few months after birth but slightly higher than that of the supplemented group by the end of the first year.
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From page 157... ...
Breastfed infants born to women who eat little or no animal foods are at risk for developing vitamin BE deficiency. In a study of six vitamin B~2deficient, exclusively breastfed infants in India, vitamin BE concentrations in their mother's milk ranged from 0.03 to 0.07 ~g/liter (Jadhav et al., 1962~.
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From page 158... ...
Serum and red cell folate levels are adequate in breastfed infants; indeed, they are several-fold greater than adult reference levels (Ek and Magnus, 1979; Salmenpera et al., 1986b; Smith et al., 1985~. This is reported for infants exclusively breastfed for up to 1 year (Salmenpera et al., 1986b)
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From page 159... ...
Body stores of iron and ferritin levels increase during the first 3 months of postnatal life and then drop during the fourth to sixth months (Duncan et al., 1985; Garry et al., 1981; Saarinen et al., 19771. Despite those changes, iron deficiency is uncommon in breastfed infants during their first 6 months (Duncan et al., 1985; Garry et al., 1981; Owen et al., 1981; Picciano and Deering, 1980; Saarinen and Siimes, 1979a; Saarinen et al., 1977~.
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From page 160... ...
could find case reports of copper deficiency of exclusively breastfed infants. Thus, the evidence suggests that the bioavailability of copper in human mink is high and that the copper status of breastfed infants is adequate during the first year of life.
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From page 161... ...
In industrialized countries, the rate of weight gain of breastfed infants is similar to that of formula-fed infants and to National Center for Health Statistics (NCHS) reference data for infants up to age 2 to 3 months; however, it is less rapid over the subsequent 9 months (Chandra, 1982; Czajka-Narins and Jung, 1986; Dewey et al., 1990a; Duncan et al., 1984; Forsum and Sadurskis, 1986; Garza et al., 1987; Hitchcock et al., 1985; Saarinen and Slimes, 1979b; Salmenpera et al., 1985; Whitehead and Paul, 19841.
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From page 162... ...
As discussed in Chapter 5, these lower intakes by breastfed infants are governed primarily by infant demand, not by insufficient milk volume. Assessment of Growth of Breastfed Infants Growth charts used to assess infant growth are based on data derived primarily from formula-fed infants (Hamill et al., 19771.
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From page 163... ...
One shortcoming of the study was that the breastfed infants were allowed up to 240 ml of formula per day, and before 1979, all infants were allowed solid foods beginning at 1 month of age. Therefore, additional data are necessary to construct appropriate growth charts for infants exclusively breastfed for the first 4 to 6 months and extensively breastfed throughout the remainder of the first year.
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From page 164... ...
The links among maternal nutrition, the composition of human milk, and growth rates of breastfed infants are problematic for several reasons. First, infant growth is not a very good indicator of mink or energy intake because the amount of energy required for growth is a relatively small fraction of total energy needs.
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From page 165... ...
However, no reports have been published concerning the influence of maternal nutrition on any of these indices within a group of breastfed infants. Gastrointestinal and Metabolic Responses Compared with formula-fed infants, breastfed infants have slower rates of gastric filling (Lucas et al., 1981a)
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From page 166... ...
, most of which are absent from infant formula, or are present only in limited quantities, and are produced by the young infant only in limited amounts. The frequency of gastrointestinal infections appears to be much lower in breastfed infants than in formula-fed infants in many industrialized countries (Cunningham, 1981; Cushing and Anderson, 1982; Patti et al., 1984)
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From page 167... ...
For example, respiratory syncytial virus infections are less severe among breastfed infants than among formula-fed babies, although the attack rate is the same (Chiba et al., 1987; Downham et al., 1976; Pullan et al., 1980~. In addition, serum interferon-o~ levels are higher in breastfed infants following respiratory syncytial virus infection (Chiba et al., 1987)
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From page 168... ...
suggest that the passage of food allergens, especially from cow's milk, through human milk accounts for 30% of the cases of colic in breastfed infants. It is difficult to generalize from that report, however, since the subjects may not have been representative of the overall population of infants with colic.
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From page 169... ...
However, symptomatic infections with those enteropathogens are unusual in the recipient infant, seemingly because of the activity of the host defense system in human milk. Of more concern are the reports that human milk contains viral pathogens including cytomegalovirus, hepatitis B virus, rubella virus, human T lymphocytotropic virus type 1 (HTLV-1)
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From page 170... ...
Since the annual incidence of adult T-cell leukemia in that population is estimated to be 0.1 to 0.2%, the demonstration of HTLV-1 in human mink is of great concern there. In a small sample investigated in Hino's study, 30% of breastfed, 10% of mixed-fed, and none of the totally formulafed infants became positive carriers for the virus.
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From page 171... ...
Nevertheless, no association between breastfeeding and obesity in the adult has been established. In general, early studies indicated that breastfed infants were much leaner than formula-fed ones (Taitz, 1977; Well, 1977)
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From page 172... ...
The trends are striking and straightforward: there were markedly lower mortality rates among breastfed than among bottle-fed infants throughout. Although mortality rates, and thus absolute differences in mortality rates between the two groups, fell dramatically during the period, the relative advantage of breastfed infants persisted throughout, such that the postneonatal death rates of breastfed infants continued to remain at least half those of bottle-fed infants.
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From page 173... ...
. During the neonatal period, the incidence of infectious disease appears to be lower among exclusively breastfed infants.
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From page 174... ...
Recently there has been renewed focus on the effect of child spacing among breastfed infants (see Chapter 8) on child survival (Hobcraft, 1987; Thapa et al., 19881.
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From page 175... ...
What are the relative impacts on infant mortality of improvements in nutritional status, immunologic competence, or protection from a contaminated food supply?
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From page 176... ...
Maternal consumption of one or two caffeine-containing beverages per day is not associated with unacceptable levels of caffeine in human milk (Committee on Drugs, 1989; Wilson, 1981; Wilson et al., 19851. There is evidence from a study in Costa Rica that maternal consumption of three or more cups of coffee per day during pregnancy and lactation can affect iron concentrations in mink and infant iron status at 1 month of age (Munoz et al., 19881.
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From page 177... ...
nor the subcommittee found reports of associations between nicotine levels present in the milk of heavy smokers and symptoms in their nursing infants. Studies to compare nicotine and cotinine levels of breastfed and formulafed infants are most appropriate if conducted after the infants are 8 days old to eliminate the effect of transplacental exposure.
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From page 178... ...
Based on a single case study, llyu and colleagues (1978) state that loss of lead from the body can be expected in breastfed infants exposed to lead in utero if their lead intake is less than 5 ,ug/kg of body weight per day.
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From page 179... ...
After the third month, exclusively breastfed infants tend to follow lower weight-for-age and length-for-age percentiles. In general, those patterns are not altered by the introduction of solid foods.
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From page 180... ...
The subcommittee concluded that to reduce the chance of allergy or colic in their breastfed infants, mothers should not avoid important food sources of nutrients such as cow's mink in the absence of objective evidence provided by oral elimination-challenge trials (see later section "Maternal Diet"~. Although there are some reports of untoward reactions in breastfed infants linked to extrinsic food allergens in human milk, the use of food allergen-restricted diets in pregnancy, lactation, or both should be limited to those cases for which the sensitization has been proven.
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From page 181... ...
The subcommittee recommends that health care providers be informed about the differences in growth between healthy breastfed and formula-fed infants. On average, breastfed infants gain weight more slowly than do those fed formula.
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From page 182... ...
1985. Cytomegalovirus in breast milk of Swedish milk donors.
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From page 183... ...
Human Lactation 4: Breastfeeding, Nutrition, Infection and Infant Growth in Developed and Emerging Countries. ARTS Biomedical Publishers and Distributors.
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From page 184... ...
1987. Effect of breast feeding on responses of systemic interferon and virus-specific lymphocyte transformation in infants with respiratory syncytial virus infection.
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From page 185... ...
Maternal vs. infant factors related to breast miLk intake and residual milk volume: the DARLING study.
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From page 186... ...
1979. Plasma and red blood cell folate in breastfed infants.
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From page 187... ...
1983. Protection against cholera in breast-fed children by antibodies in breast milk.
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From page 188... ...
1979. Infant feeding practices and obesity.
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From page 189... ...
1984. The passage of maternal dietary proteins into human breast milk.
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From page 190... ...
1983. Vitamin D nutritional status of premature infants supplemented with 500 IU vitamin D2 per day.
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From page 191... ...
1980. The effect of thiamin and riboflavin supplementation on the level of those vitamins in human breast miLk and urine.
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From page 192... ...
1973. Infant feeding and infant mortality in rural Chile.
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From page 193... ...
1979a. Iron absorption from breast milk, cow's milk, and iron-supplemented formula: an opportunistic use of changes in total body iron determined by hemoglobin, ferritin, and body weight in 132 infants.
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From page 194... ...
1988. Longitudinal study of the body composition of weight gain in exclusively breastfed and intake-measured whey-based formula-fed infants to age 3 months.
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From page 195... ...
1987. Breast-feeding/breast milk and human immunodeficiency virus (HIV)
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From page 196... ...
1989. Breast milk fatty acids in mothers of children with atopic eczema.
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