Dear all:

I will post on this again.  Two of the important researchers:  Kathryn Dewey and Ken 
Brown have conducted very solid research on infant nutrition for DECADES. Kathryn 
Dewey did an EXCELLENT presentation at the Academy of Breastfeeding Medcine about 
three or four years ago that made the case for iron and zinc as well as focusing on the 
NUMBER of meals rather than whether food or breast is offered first at a particular meal.

I want to make it very clear that infants everywhere are the same. Race is actually a 
social construct, not a biologic one.  There is very little difference in growth patterns on a 
population basis among infants and young children to age five.  Almost all differences are 
INDIVIDUAL genetic variation and nutritional, not ethnic or cultural or racial.

So, well designed studies ANYWHERE apply to infants and young children.  The research 
suggests that infants typically start needing more iron and zinc in very high quantities 
around six months of age. At six months of age, most healthy full term infants have used 
up much of their iron stores that they acquired in the last trimester of pregnancy.  Iron 
deficiency (even BEFORE ANEMIA) has been implicated in cognitive delays.  Hematocrit 
and hemoglobin tests are LATE-TERM indicators because you have already been in iron 
deficiency for a while before you get to ANEMIA.  Some of the cognitive delays have bene 
shown to be irreversible.  AND having tested the HemoCue device that is commonly used 
in pediatrician's offices in large-scale evaluations in developing countries, I would pit any 
one of my former survey workers against the practices I have seen in pediatricians 
offices in Manhattan.  It is very easy to skew the results of these tests by squeezing the 
child's finger, not filling the cuvette, or not waiting for the alcohol to dry on the finger.  
The International Nutritional Anemia Consultative Group actually deemed this device so 
inaccurate (which I believe was going way too far from the evidence I looked at) that 
they wouldn't want it used in survey work.  Statistically, you need a far GREATER degree 
of accuracy for diagnostic purposes for an intervention in an individual than for deciding 
whether to implement a large scale program.

Moreover, after having just presented my talk to the Cornell medical students I find that 
there are the same flaws in logic being applied to solids as being applied to breast milk.  
What the formula industry used to do was criticize the research that showed higher 
mortality rates for infants that were not bresatfed and these mortality rates were much 
much higher in developing countries.  One criticism was that the research in developing 
countries were flawed and therefore, the mortality rates were not that high.  This was 
completely debunked by a very well designed study in Malaysia that showed that it lack 
of latrines coupled with not breastfeeding that dramatically increased the risk of death.  
Another analogy is smoking and asbestos.  Both are deadly --- together they actually 
have a multiplicative effect dramatically increasing the risk of death to very high levels.  
This also blows the argument that babies in "developing" areas are different genetically 
or nutritionally different out of the water as well.  It is a flawed argument that I am 
increasingly finding leads to an "us" and "them" mentality.  "They" have problems 
because "they" don't have enough food, "they" have too many babies, "they" aren't using 
modern agricultural techniques--- take your pick of the sometimes patronizing 
conclusions we reach when thinking about "those less fortunate". Pamela Morrison really 
got me started thinking about this issue when she posted long ago about how women in 
developing areas are physiologically no different than women in developed areas and 
they have problems breastfeeding too.

As with any population based conclusion, there are individual variations that are 
EXTREMELY important on an individual case basis.  As lactation consultants, most of us 
work with individual clients.  So we all know the children that are on the ends of the 
population curve that need something sooner and those for whom delaying something 
(e.g. solids) is entirely warranted.  Food allergies and esophageal reflux disease 
immediately come to mind.  And I think we are a long long way from figuring out how to 
appropriately handle these conditions.  

I will strongly suggest that those who are not familiar with nutrition research spend some 
time with the peer-reviewed journals first.  Both the cognitive and the six months issue 
can be found.  My former field actually did have many dedicated researchers who 
received funding from sources that did not have conflicts of interest with the food 
industry.


Best,

Susan E. Burger, MHS, PhD, IBCLC

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