Hi Sarah,
Unfortunately the study that you referred to didn't measure exclusive breastfeeding. It only looked at whether babies were being fed infant formula or breastmilk- solid foods were not considered. So it doesn't say anything about low level supplementation of formula in previously exclusive breastfed infants. 
Allergy studies are notoriously poorly done and are such a mixed bag. Of the ones you cite De Jong had no exclusively breastfed infants in the study. Lindfors had really high rates of exclusive breastfeeding (even for Sweden) and doesn't give a definition of what they mean by exclusive breastfeeding I suspect that they did not account for solid foods (it is very common for young infants in Sweden even these days to be given porridge early). It's usually in the definition of exclusive breastfeeding and in recall that allergy studies have real problems- my fav is an Australian study that found 30% of children were exclusively breastfed for 6 months at a time when the recommendation for duration of exclusive breastfeeding was 4 months and the national health survey found 0% of babies EBF to 6 months. When the definitions are rubbish the results are rubbish and in allergy research and infant feeding it's almost all rubbish. 
TRIGR may not give us what we want to know anyway because unfortunately it's not designed to look at the impact of EBF of risk of diabetes but rather it's a formula trial and has no EBF control group. A huge shame because it would have been very useful if it had had an EBF control. Hopefully though the studies may have enough subjects to inadvertently have useful info. I sure hope so. 
If you really want to look at the impact of EBF on protection against infection and the facilitation of infection via introduction of foreign foods like early solids or infant formula then you have to look at the HIV research because that is where it was truly discovered how important tightly defining how a baby is fed can be to susceptibility to infection. True, they don't have exposure measured in mls. But in some research I believe that a single exposure to other milks was enough to kick a dyad from the EBF group into the mixed fed one. That is where I suggest you go looking. 
However, I don't think that you're ever going to get the research that you're looking for. The "lets expose a baby to formula in the first few days of life and then ensure EBF for the next 6 months" treatment group and the "lets ensure EBF for 6 months) control and look at outcomes in infection and autoimmune disease will not ever happen. What we have are much rougher observational studies that do show that mixed feeding results in greater rates of infection in babies as compared to EBF. What we also have is observational research on stuff like what the addition of infant formula does to the intestinal microbiota and a very quickly growing body of evidence that this intestinal microbiota affects health in the short and long term....I won't go into that sort of thing further because there's been enough about that from others already I reckon! And the theoretical with some observational work about early exposure to foreign proteins and development of autoimmune conditions like diabetes. As discussed no link has been proven but that does not mean that there is not evidence that supports the proposition that there is a link- and in this case, if there is a link then it is very likely that even a small exposure could result in a big problem. 
But now I'd like to put the shoe on the other foot. What evidence is there of safety of giving a newborn small amounts of formula? We've discussed the observational research and theory suggesting that it is a problem. What work is there (observational and theoretical) indicating that it is not?
Karleen Gribble
Australia
On 31/05/2013, at 9:16 PM, Sarah Vaughan wrote:

> Karleen Gribble wrote:
> <Did you see my post some days ago? There is a lot of research looking at infection rates in exclusively vs predominantly vs partly breastfed infants.>
> 
> Certainly did, thanks - been meaning to reply to it but kept getting sidetracked!
> 
> Yes, I've seen some research looking at infection rates in mixed-fed babies, but there seems to be very little breaking it down according to amount of formula in the diet. The Scariati study from Pediatrics (http://pediatrics.aappublications.org/content/99/6/e5.full) is the best one I know of, and of course that one *doesn't* support the hypothesis that low-level supplementation increases infection rates. I haven't seen any studies looking specifically at infection rates associated with small amounts of supplementation in the early days (for that matter, I haven't seen much research even on effects on the gut flora).
> 
> We don't have the TRIGR results on the diabetes study yet, and won't for a few years. We've got some research pointing to an association with allergy risk, but, as you pointed out, the research there is retrospective and thus not brilliant quality, and against that we've got the RCT from De Jong et al that didn't find a difference and from Lindfors et al which actually showed a *reduced* risk in exposure in infants with atopic heredity (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717657/pdf/v079p00126.pdf, http://www.ncbi.nlm.nih.gov/pubmed/3344931, http://www.ncbi.nlm.nih.gov/pubmed/1510232).
> 
> So what I'm wondering is - what evidence do we really have, at this point, to support the hypothesis that even small amounts of formula are harmful? There seems to be a major disconnect between the emphasis with which people are stating this as an inarguably proved fact, and the amount/quality of evidence actually available for it. This is why I keep asking. Are there actually studies demonstrating harmful effects of even small amounts of formula supplementation? If such studies exist, I'm more than happy to look at them.
> 
> 
> Best wishes,
> 
> Dr Sarah Vaughan (already using up the post allotment for the day - bah)
> MBChB MRCGP
> 
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