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Health concerns over global baby formula boom

By Chukwuma Muanya, Assistant Editor (Head Insight Team, Science & Technology)
04 July 2016   |   3:23 am
A new study from The Australian National University (ANU) has found a global boom in the sale of infant and baby formula, especially in China and Southeast Asia, raising concerns about the health of millions of mothers and their babies.

Breastfeeding-in-Nigeria

Infants fed directly from breast have reduced risk of ear infections, diarrhoea
Researchers have raised fresh alert about the health of millions of mothers and their babies following global boom in the sale of infant and baby formula even as they said that feeding at the breast may be healthier than feeding pumped milk from a bottle for reducing the risk of ear infection. They also said feeding breast milk compared with formula may reduce the risk of diarrhoea.

A new study from The Australian National University (ANU) has found a global boom in the sale of infant and baby formula, especially in China and Southeast Asia, raising concerns about the health of millions of mothers and their babies.

Lead researcher Dr. Phillip Baker said the study suggested governments around the world needed to do more to control marketing of baby formula and to ensure work policies gave women a choice to breastfeed their children.

The research has been published in the Public Health Nutrition journal.Growth in formula sales was most rapid in East Asia, particularly China, Indonesia and Vietnam, where millions of mothers are entering the workforce as the countries industrialise.

“What we are talking about is potentially the largest shift in infant and young child nutrition on record,” said Baker, from the RegNet School of Regulation and Global Governance at ANU.

The World Health Organization recommends infants are exclusively breastfed up to six months of age, with ongoing breastfeeding for up to two years of age and beyond, to ensure they get the best start in life.

Meanwhile, feeding at the breast may be healthier than feeding pumped milk from a bottle for reducing the risk of ear infection, and feeding breast milk compared with formula may reduce the risk of diarrhoea, according to a recent study by researchers at The Research Institute at Nationwide Children’s Hospital.

“We certainly don’t want women to stop pumping because there are not adequate data or guidelines about whether pumped breast milk is an equivalent substitute for feeding at the breast, so more research needs to be done,” said Sarah Keim, senior author of the study and principal investigator in the Center for Biobehavioral Health in The Research Institute at Nationwide Children’s.

A total of 491 mothers completed surveys as part of the study, published last week in the Journal of Pediatrics. Mothers who stated their intent to bottle-feed exclusively were not included in the study. In the remaining surveys, three out of four women used some combination of feeding from the breast, pumped milk and formula in the first 12 months of their children’s lives.

After accounting for demographic and other related factors, researchers found that one month of feeding at the breast was associated with a four percent reduction in the odds of ear infection, and they found a 17 percent reduction in the odds for infants fed at the breast for six months of infancy Among infants who were fed only breast milk, either at the breast and/or pumped breast milk from a bottle, for the first six months, the odds of experiencing an ear infection increased by approximately 14 percent for infants fed pumped milk for one month and by 115 percent for infants fed with pumped milk for six months.

Baker said: “Paid employment is a very good thing for families, especially those living on the bread line. The problem is that without paid parental leave or family friendly workplaces breastfeeding can be very difficult or even impossible.” “Without supportive workplace policies and regulations in place, formula feeding is often the only choice available to parents in many countries.

“Competition among companies selling formula is also reaching fever pitch. We estimate that the industry’s global marketing spend exceeded $US4.48 billion in 2014, a figure comparable with the World Health Organization’s annual budget.

“The decision to breast feed or formula feed should be an informed choice made in dialogue with a health professional, not by the marketing of a formula company.”

The research examined the growth in formula sales worldwide. It found sales grew by 41 per cent from 5.5 kilograms to 7.8 kilograms per infant/child between 2008 and 2013, a figure predicted to increase to 10.8 kilograms by 2018.

This global sales boom applies not only to infant formula for infants aged up zero to six months but also to follow-up formulas for children aged seven to 12 months and toddlers aged 13 to 36 months, which can displace ongoing breastfeeding.

Baker said formula-fed children experience poorer health and developmental outcomes than breastfed children, with increased risks of pneumonia, diarrhoea, obesity and type-2 diabetes, ear infections and asthma.

“Marketing by these companies powerfully shapes what parents consider best for their babies by portraying formula as a symbol of modernity, as comparable or superior to breast-milk and formula feeding,” Baker said.Baker said he hoped that this study would encourage debate and discussion about the need for stronger regulation of the marketing of these products.”“Ultimately the health of mums and kids is at risk and governments need to do more,” he said.

Keim explained: “While it is not completely clear why ear infections may be related to bottle feeding, it could be because bottles can create a negative pressure during feeding. This negative pressure is then transferred from the bottle to the middle ear of the infant during feedings, which may precipitate ear infections.”

Infants fed with breast milk by either mode for six months had an approximately 30 percent reduced risk of diarrhea. Diarrhea risk was reduced by 25 percent for infants fed any breast milk for six months, and by 26 percent for infants fed at the breast for 6 months, while infants fed formula for six months had a 34 per cent increased risk of experiencing diarrhea.

According to the researchers, this finding suggests that the substance fed, rather than the mode of feeding, may underlie differences in risk of diarrhea.
“This research begins to identify unique and separate associations of substance fed and mode of breast milk delivery, and demonstrates the importance of exploring these distinctive exposures in infant feeding research,” said Kelly McNamara Boone, co-author on the study.

In addition to identifying the distinct contributions of both the substance fed and the mode of breast milk delivery to infant health, the study demonstrated large socioeconomic differences in feeding patterns. Mothers who fed their infants breast milk only were of greater socioeconomic status than those who fed their infants formula. Women who only used bottles (containing breast milk and/or formula) to feed their infants were of lower socioeconomic status than those who fed their infants at the breast.

“This finding is consistent with previous research that shows positive associations between socioeconomic status and breastfeeding. Initiation and duration of breastfeeding may be explained by health care and information resources available to and accessed by mothers of greater socioeconomic status,” said Keim.

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