Mary The statement you quote, "The WHO reports that the longterm effects breastfeeding has on BP, Obesity Diabetes, Cholesterol and Intelligence are minimal if they exist at all" from Evidence on the Long-term Effects of Breastfeeding Systematic Reviews and Meta-Analyses from the World Health Organization, is indeed really unexpected, isn't it? But it's less surprising when you read the fine print further on in the document. While we might suppose, as the title suggests, that WHO are reporting on the long-term effects of breastfeeding - actually, WHO are reporting on the effects of _any_ breastfeeding over the long-term. Semantics, perhaps, but the difference is crucial. Further excerpts from the document help to clarify: "The present review was aimed at assessing the long-term consequences of breastfeeding on five different outcomes. The type of comparison group used (e.g. never breastfed or breastfed for less than x months) did not constitute a selection criterion.....Subjects were classified as either breastfed or non-breastfed.... "Among the reviewed studies, most compared ever-breastfed subjects to those who were never breastfed. Other studies compared subjects breastfed for less than a given number of months, often 2-3 months (including those who were never breastfed), to those breastfed for longer periods. Few studies treated breastfeeding duration as a continuous or ordinal variable with several categories, thus allowing dose-response analyses. Furthermore, breastfeeding patterns (exclusive, predominant, or partial) have rarely been assessed. Studies comparing ever versus never breastfed subjects may be subject to misclassification ....The comparison of ever versus never breastfed makes sense if the early weeks of life are regarded as a critical period for the programming effect of breastfeeding on adult diseases ... On the other hand, if there is no critical window and breastfeeding has a cumulative effect, comparisons of ever versus never breastfed infants will lead to substantial underestimation of the effect of breastfeeding. ...... "Nearly all studies on the long-term consequences of breastfeeding have been conducted in high income countries and in predominantly Caucasian populations. The findings from these studies may not hold for other populations exposed to different environmental and nutritional conditions, such as ethnic minorities in high-income countries ... or populations from less developed countries....." Ever vs never breastfed, often a breastfeeding duration of 2-3 months, nearly all studies conducted in high income countries (where any breastfeeding is usually of short duration), no distinction at all between partial, predominant, exclusive breastfeeding etc ....... It becomes fairly clear now, doesn't it, why the effects of any breastfeeding over the long-term appear to be almost negligible?! Actually, Mary, I'm glad you brought this up. There are other statements in other WHO documents, which are grudging, to say the least, eg: "The Expert Consultation observed that, on a population basis, there is no adverse effect of exclusive breastfeeding for six months on infant growth", in PAHO-WHO 2003, Guiding principles for complementary feeding of the breastfed child, see <http://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf>http://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf Or, "Neither controlled clinical trials nor the observational studies (predominantly cohort studies) from either developing or developed countries suggest that infants who continue to be exclusively breastfed for 6 months show deficits in weight or length gain from 3 to 7 months or thereafter. WHO 2002, (Kramer & Kakuma) Optimal duration of exclusive breastfeeding". When a paper seems "off", I find that it's instructive to look either at the definitions, the methodology, or the funding. Why WHO appears to be taking this stance lately is a mystery to me. See this Press Release from WHO on 28 August, "Inequities are killing people on a "grand scale" reports WHO's Commission", which can be found at <http://www.who.int/mediacentre/news/releases/2008/pr29/en/index.html>http://www.who.int/mediacentre/news/releases/2008/pr29/en/index.html Not a single word about breastfeeding! Pamela Morrison IBCLC Rustington, England ------------------------------------------------ Date: Wed, 3 Sep 2008 15:00:57 -0700 From: Mary Herrington <[log in to unmask]> Subject: WHO meta-analyses from 2007 This meta-anaylsis from 2007 has just been brought to my attention: Evidence on the Long-term Effects of Breastfeeding Systematic Reviews and Meta-Analyses from the World Health Organization. http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf Does anyone know of any arguments based on scientific data to counter the statement: "The WHO reports that the longterm effects breastfeeding has on BP, Obesity , Diabetes, Cholesterol and Intelligence are minimal if they exist at all" Thank you, Mary Herrington, RN, IBCLC, mommy to three *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. 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