Documente Academic
Documente Profesional
Documente Cultură
Juliet Sio Aguilar, M.D., M.Sc.(Birm) Professor of Pediatrics University of the Philippines Manila Wellstart Associate
Presented at the XXIII International Congress of the Fetus as a Patient International Society 16 March 2007, EDSA Shangri-LA Manila
WHO and UNICEF: Global Strategy for Infant and Young Child Feeding (2002)
To revitalize focus on impact of feeding practices on nutritional status, growth and development and health, and ultimately the survival of infants and young children .health and other relevant sectors protect, promote and support exclusive breastfeeding for six months and continued breastfeeding up to two years or beyond
Impact of Breastfeeding
Fetal Origins of Adult Diseases Obesity Diabetes Allergic Disorders
Development of disproportionately high fat mass in a setting of low muscle mass Overgrowth of limited cell mass during period of catch-up growth Persistence of secretion of hormones (insulin, insulin-like growth factor 1, growth hormone) established in utero
Eriksson JG, Forsn T, Tuomilehto J, Winter PD, Osmond C, Barker DJP. BMJ 1999; 318: 427.
DARLING Study
Breastfed
infants
Leaner with mean weight-for-length at 12 mos = 0.2-0.6 SD below NCHS median infants Larger skinfold thicknesses in later infancy (9-15 mos)
Dewey KG et al. AJCN 1992; 56: 1012.
Formula-fed
feeding mode
Result
Breastfeeding
reduced risk of obesity in childhood significantly AOR = 0.78 [95% CI: 0.71, 0.85]
Arenz S, Rckerl R, Koletzko B, von Kries R. Int J Obes 2004; 28: 1247.
Duration of BF inversely associated with risk of overweight [r=0.94, 95% CI: 0.89, 0.98]
1.0
0.65, 1.55 5
0.81
0.74, 0.88 14
0.76
0.67, 0.86 15
0.67
0.55, 0.82 11
0.68
0.50, 0.91 7
Exclusivity of Breastfeeding and Risk of Obesity Across the Life Course: Subgroup Analysis
Hediger ML et al. JAMA 2001; 285: 2453. Armstrong J, Reilly JJ. Lancet 2002; 359: 2003. Liese AD et al. Int J Obes Relat Metab Disord. 2001; 25: 1644. Neyzi G et al. Human Growth and Development. New York: Plenum; 1984: 603.
higher protein intake stimulate higher insulin secretion higher plasma insulin in formula-fed infants stimulate fat deposition and early development of adipocytes
bioactive factors which modulate EGF and TNF inhibit adipocyte differentiation
Dewey KG. J Hum Lact 2003; 19:9. Von Kries R et al. BMJ 1999; 319:147.
2,949 Finnish infants with increased genetic risk of IDDM (HLA typing)
monitored 3-6-mo intervals for four islet cell antibodies 65 infants seropositive before 4 yr-old compared to 390 controls seronegative Exclusive BF >4mos lowers risk of seroconversion OR = 0.17 [95% CI: 0.03, 0.86] Introduction of cow milk <4mos increases risk of seroconversion <2m: OR = 5.02 [95% CI: 1.27, 19.89] 2-3.9m: OR = 6.19 [95% CI: 1.10, 34.84]
Kimpimaki T et al. Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity. Diabetologia 2001; 44: 63.
Bovine -casein targets humoral and cellular immune responses of IDDM pts
Ab to bovine -casein elevated in IDDM and babies fed with cow milk but not in babies exclusively breastfed for 4 mos
Monetini L et al. Diabetes Metab Res Rev 2001; 17: 51.
Allergic Diseases
Increased prevalence in last decades Its development depends on complex interaction between genetic and environmental factors
Environmental
factors: food and inhalant allergens; non-specific adjuvant factors (e.g., tobacco smoke, air pollution, infections) Genetics: account for ~50% of allergic diseases
Allergic Rhinitis
0.74 0.54, 1.01 0.87
Asthma
0.70 0.60, 0.81 0.52
0.42, 9.92
0.48, 1.58
Partial BF (>6m)
reduced risk of asthma AOR = 0.69 [95% CI: 0.52, 0.91] up to age 2 yrs reduced risk of multiple allergic disease AOR = 0.69 [95% CI: 0.50, 0.95] up to age 2 yrs
Exclusive BF (>4m)
reduced risk of multiple allergic disease AOR = 0.66 [95% CI: 0.48, 0.90] up to age 2 yrs
Kull I, Wickman M et al. Arch Dis Child 2002; 87: 478.
Results
BF assoc with lower total serum IgE at 6 yrs old vs never BF (24.2 vs 44.3 IU/ml) BF > 4m with higher IgE vs no BF or BF < 4m vs 38.9 IU/ml) (97.0
immunological components of breast milk (i.e., sIgA) alter susceptibility to infection growth factors in breast milk facilitate maturation of organs (including lung)
predictive of asthma later in childhood Increases risk of having disease over many decades
Kull I, Wickman M et al. Arch Dis Child 2002; 87: 478.
Exclusive breastfeeding for at least 4 mos Breastfeed for at least 6 mos Caution in severe maternal asthma Exclusive breastfeeding for at least 4 mos Delay introduction of cows milk until 4 mos