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

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