Dear all
I'm coming out of lurkdom to request your help
and professional opinion about the health
benefits claimed for a fortified formula
apparently published in the British Medical
Journal in 2006, and now discussed in a newspaper
article published yesterday in the Philippines,
see Manila Bulletin Online
http://www.mb.com.ph/issues/2007/01/30/MOMS2007013085886.html
The text is pasted below with my own insertions
of the words 'Interviewer' and 'general text' for
clarity. You'll also see that the copyright info
says 2001-2005, so it's possible that this may be
a reprint of a previous article.
You may know that a concerted effort is being
made in the Philippines to counteract efforts to
implement the Code. The article touches on many
issues including poor breastfeeding management,
claims about continued breastmilk production, and
better health outcomes for children/babies fed
fortified formula, micronutrient and fat
requirements etc. Please send your thoughts,
opinions and responses, including journal
references/citations wherever possible, to me at
(my new email address!)
<[log in to unmask]> so that I can
forward them on to our friends who are attempting
to compile a suitable response. All replies will be very gratefully received.
Pamela Morrison, IBCLC
Co-coordinator, WABA Task Force on HIV and Infant Feeding
Email: [log in to unmask]
--------------
Your kid and fortified milk
WORDS KAYE MAGSANOC
ALL MOMS DREAM of breastfeeding their kids. Who
doesn’t? That moment of latching, of linkage, of
looking into the eyes of your baby … it’s a
peaceful moment full of faith and love,
symbolizing the strongest bond of all --- the
bond between mother and child. Many consider
breastfeeding a phenomenal human practice, since
it not only strengthens the bond between mother
and child, it is also said to be the perfect
source of the perfect food, the perfect medicine
and the perfect source of height and IQ-boosters: breastmilk.
But not all moms are lucky enough to be given
this chance. I wasn’t. Basti was left in the NICU
for two weeks after being born with pneumonia. Even though I
did my best, I wasn’t there every moment of each
day that he stayed there. When I wasn’t there
breastfeeding him, he would be given my expressed milk
in feeding bottles. This happened more often than
our breastfeeding-and-bonding time. By the time I
took him home, he simply refused to latch on, no
matter how hungry he was.I felt bad. I felt like
a bad mom, a mom who didn’t breastfeed her child.
How else can I give him excellent nutrition if I didn’t breastfeed him?
Good thing there was formula milk to turn to.
Although made from cow’s milk, it is fortified to
suit human needs, and to perform the same functions of human
milk as much as possible. Based on experience,
I’ve learned that, more than any other effect
fortified milk may have on our babies, the immune-boosting
effect is the most important of all.
A few weeks ago, I had the chance to meet
Professor Sunil Sazawal, an Associate Professor
at the Department of International Health, Bloomberg
School of Public Health in John Hopkins
University. With him was Rebecca Cannan, a
nutritionist whose key interest surrounds the central role of nutrition
in promoting the healthy growth and development of children.
Over lunch, Professor Sazawal enlightened me
about a study he conducted in India that proves
that fortified milk powder prevents childhood diseases. This
study was published by the British Medical Journal last November 2006.
Interviewer: Prof. Sazawal, tell us about the study you conducted.
Dr. Sazawal: First of all, let me stress that,
for the first six months of life, breastmilk
should be the only food all children must have.
It is only after six months that supplementary
feeding may be introduced. I conducted my study
in Delhi. We call it a double-blind controlled
trial, a very stringent method of evaluating an
intervention. The 633 children aged between 12 to
36 months who were involved in the trial, did not
know which child was getting which intervention. That was the essence of it.
Interviewer: What was the objective of the study?
Dr. Sazawal: We wanted to evaluate the effect of
fortifying milk or adding micronutrients like
zinc, iron and selenium. Zinc and iron are the
most common micronutrients that children lack
globally, but are important in preventing
childhood diseases like diarrhea and pneumonia.
These two diseases cause the highest morbidity in
this age group. I was told that pneumonia is the
number one cause of death among Filipino
children, and diarrhea is number three.
Interviewer: It is said that mother’s milk
adjusts miraculously to the nutritional needs of
her child. If so, won’t she be producing these
same micronutrients if her child needs them?
Dr. Sazawal: Mothers can breastfeed their
children for as long as possible, but
introduction of other sources of nutrition after
six months is a must. Breastmilk will no longer
be sufficient at this point. The amount of
breastmilk goes down as the lactation period
increases, no matter what the mother takes.
Breastmilk production is driven by hormones from
the pregnancy, so if you are no longer pregnant,
the production starts to slow down. But the
volume of milk that the child needs is still
increasing. A mother’s breastmilk production may
not be able to keep up with the increase in the
amount of her child’s breastmilk consumption.
Interviewer: There are moms who have problems
with making their child latch on to their breast.
Is this an excuse to give the child formula milk earlier than six months?
Dr. Sazawal: It is more advisable for the mom to
extract her milk and feed her milk to her baby
through a feeding bottle. She should do this for as long as
she can. But it is understood that, sometimes, in
very rare situations, even this is not possible.
This is why instant formulas are out there. But
it is very important to note that, for the first
six months of life, breastmilk is the best for
baby. It is not affected by the fact that the
mother or the baby is sick. Continue
breastfeeding nonetheless. Only if everything
else fails can the mother turn to formula milk.
Interviewer: Do the iron and zinc in fortified milk come from natural sources?
Dr. Sazawal: There is no such thing as synthetic
iron or zinc because these are minerals. There
are no synthetic ways of producing them. Thus, iron and
zinc are natural. Even if they are metals, they
are very important in the body. Zinc is a
complement of 200 enzymes in the body, starting with the DNA
application. If you have no zinc in your body,
your cells won’t grow or multiply. And remember
that your body can’t make zinc. You need sources for it. Iron is
the most important component of hemoglobin. It
helps bring oxygen to the heart. Without this, a human can’t live.
Rebecca: Children’s bodies absorb iron and zinc
and these two help their bodies fight diseases
and infection. There’s no need for mothers to worry.
Interviewer: Can obese babies still take
fortified milk? Or should they resort to drinking non-fat milk?
Dr. Sazawal: Fortified is different from non-fat.
A fortified milk formula can be non-fat. Fat and
micronutrients are not synonymous. At the moment,
there is not scientific evidence that if you give
non-fat milk to your children, they will not be
obese when they grow up. Fat plays an important
role in soluble vitamin-absorption.
Rebecca: The fat in fortified milk is so low.
It’s only three percent. It’s better to give an
obese child regular fortified milk, and increase his physical activity.
This will stimulate your child’s metabolism.
(General text?) Things you don't know about your formula milk
Among children aged 1 to 3 years, the clinical
study of Sazawal found that consumption of fortified milk was associated with:
• 18% lower incidence of diarrhea
• 26% lower incidence of acute lower respiratory infections (like pneumonia)
• 15% fewer days sick with severe illnesses
• 4% lower use of antibiotics
Among children aged 1 to 2 years, the study found
that consumption of fortified milk was associated with:
• 16% lower incidence of diarrhea
• 47% lower incidence of acute lower respiratory infections (e.g. pneumonia)
• 36% fewer days sick with severe illness
Among children aged 2-3 years the study found that consumption of
fortified milk was associated with:
• 20% lower incidence of diarrhea
Copyright © 2001-2005, Manila Bulletin. All Rights Reserved.
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