Breast Feeding (maternity, newborn, diabete, average)

[irishmom]

Originally Posted by ADVentive

Do you discount the studies which show formula fed babies have greater incidence of chronic illnesses including some cancers as adults (as I described above)? To my knowledge there is no definitive studies that show breastfed babies get less cancers as adults, but please show me where to find them, I would love to see that.

I think that with respect to allergies, that moms of BF babies may be more likely to delay introduction of solid foods and that may contribute to a decrease in food allergies among these babies. I am often shocked at how early some people are starting solids these days despite all the recommendations for waiting until 6 months. As early as 3 months in some cases they are sticking cereal in the bottles even earlier...some things the earlier generations have done just get carried forward even when there is a better way


Yes, if the baby is actually being held during their feedings. Yet bottle feeding babies are much more likely to be taught to hold their own bottle and self-feed at a pretty early age. They are also fed by anyone who is available, so don't spend as much time bonding with mom. Also, nursing babies will often comfort nurse and spend even more time being held and nursed when they are not actually eating. In addition, sleeping close to the baby is common with breastfeeding moms due to the ease of nursing during sleep without having to fully wake either mom or baby, and that also contributes to the increased attachment. So yes, while it is possible, and some bottle feeding parents do make the specific effort, I do not think it is common for this to happen. The point is if bottle feeding is done with love and attention there is no greater bond in a breast fed infant...bonding has many facets and babies can easily bond with out breast feeding. To assume that bottle feeding parents are not making a special effort to bond with their child is the type of stereotyping that drives me nuts, its simply not the norm.
It's exactly statements like these from health professionals though that are what I am talking about. A statement like this makes it sound like you are saying, "yah, breastfeeding is great, but it's no big deal if you don't do it". I think that's really the wrong message to send to patients. It's what my doctor said too - she said "Breastfeeding is best and I will support you if that is your choice. But if you use formula, just know that a whole generation grew up on formula and we seem to be doing okay too." That is pretty much saying, without actually saying it, that formula feeding is as good as, or nearly as good as, breastfeeding. And I really hate to hear that message from a healthcare professional, especially one who deals with pregnant moms or babies! If a woman can not breastfeed she is probably feeling bad enough already about it, so why do you think it would be more responsible to cause her greater anxiety and guilt? So the fact of the matter is yes breastfeeding is great and preferred, if you can do it, but if you can't it really isn't a big deal. Parenting is hard enough with out worrying about the things you can't control.
Here is another such comment. Antibodies are not passed through the air via good parenting skills. It's just not true. They are passed through breast milk. Period. You're not breastfeeding? Well, your kid isn't getting them, no matter how good of a parent you are.
Again if you take a mother that breastfeeds but she has bad parenting the skills that child will not do well...no matter how many antibodies the child receives. So again although it's preferred, it's not necessary to produce healthy, well adjusted and happy children. It just isn't.


But what brand of diapers or other baby care items you use does not have a health impact on your baby, whereas whether or not you use formula does! Big difference! Giving out free formula to new mothers is just sending the message that it's endorsed by the doctor, which sends the message that breastfeeding really isn't that important. Giving out free diapers or other items does not send any kind of parallel message. I do not think that doctors should be giving out free formula at all. Are you going to send your diabetic patients home with free candy bars too if Nestle provides them along with the formula?

No but they do send the diabetic patients home with free blood glucose monitors so those patients will buy their brand of testing strips...that's where the profit is. Hospitals give the choice of receiving the bottle feeding samples or the breast feeding samples. Patients are advised to breast feed if they are able, but it's a personal choice and handing out formula samples doesn't make someone suddenly want to bottle feed instead of breast feed.

Now I understand you are passionate about breastfeeding, that's fine and admirable. But it's the attitude that not only is the method superior but so are the breastfeeding moms I will not participate in. This just isn't true. So again yes there are feeding, immune advantages and digestive advantages to breastfeeding, but you can bottle feed and still do fine. I for one refuse to beat up a patient''s feelings and insecurities by not supporting whatever feeding decision they make. Parenting will always be the most important part of raising a child, no matter how you feed them.

[deerislesmile]

I tried BFing my son (he's 8 now) and it didn't work out. You don't need to know WHY I stopped bfing because it's really none of your business. He is pretty darn healthy, except for a little autism, and that's not really a bf/bottle issue. I really can't believe the audacity of the people who attack (vocally or not) mothers who make a choice (for what ever reason) not to breastfeed. Some people feel completely justified in asking "Why aren't you breastfeeding?", where I see that as akin to asking "Why don't you use tampons?"- it's a personal decision that doesn't effect you in any way whatsoever, so why are you asking? The mother makes her choice depending on her life factors and values, and then, if she has chosen to bottle feed, must defend it repeatedly to strangers? I just don't agree with that. I'm quite sure that she is likely doing what is right for her particular situation.

I work with young limited income families, and have worked with at least 3 young mothers who had babies as a result of a sexual assault. They are made to apologize repeatedly for choosing to bottlefeed, and explain that they had been raped and did not feel comfortable enough not only with their own bodies, but with the level of intimacy that bfing can bring. My heart broke a little every time I saw these young women struggle with the guilt that other people had put on them for not bfing, and the shame of telling every stranger about an incredibly personal thing.

[Inthesierras]

Originally Posted by deerislesmile

I work with young limited income families, and have worked with at least 3 young mothers who had babies as a result of a sexual assault. They are made to apologize repeatedly for choosing to bottlefeed, and explain that they had been raped and did not feel comfortable enough not only with their own bodies, but with the level of intimacy that bfing can bring. My heart broke a little every time I saw these young women struggle with the guilt that other people had put on them for not bfing, and the shame of telling every stranger about an incredibly personal thing.

That is really sad. It always amazes me at what people feel is ok to say to complete strangers.

[Sonnenwende]

Originally Posted by ADVentive

I think that may relate to other aspects of BF benefits, like increased attachment and whatnot. And certainly kids in daycare are more likely to get sick than kids who are not. But when they do these studies, they take those factors into account, and formula feeding and daycare are independent predictors for increased illness, regardless of your individual experiences with it.

I never thought my daughter was less attached for formula feeding. I know I felt more attached to her when she wasn't the object of my resentment when I was struggling with breastfeeding. Formula feeding made me a better mother in my situation.

Breastfeeding and formula feeding = YMMV

[ADVentive]

Originally Posted by irishmom

To my knowledge there is no definitive studies that show breastfed babies get less cancers as adults, but please show me where to find them, I would love to see that.

I will be happy to look up these studies for you and post later. It will take me some time.

The point is if bottle feeding is done with love and attention there is no greater bond in a breast fed infant...bonding has many facets and babies can easily bond with out breast feeding. To assume that bottle feeding parents are not making a special effort to bond with their child is the type of stereotyping that drives me nuts, its simply not the norm.

I'm not saying that they can't or don't have a bond. I'm specifically talking about whether they hold their child during feedings. A baby holding his own bottle is considered a milestone in our culture - it's even in my baby book along with first smiled, first crawled, etc. Are you saying that most bottle feeding parents continue to hold their babies for feedings once their baby can hold their own bottle and sit unassisted? Even so, it's not the main point that I want to argue, which is the medical, not social benefits of BF.

If a woman can not breastfeed she is probably feeling bad enough already about it, so why do you think it would be more responsible to cause her greater anxiety and guilt? So the fact of the matter is yes breastfeeding is great and preferred, if you can do it, but if you can't it really isn't a big deal. Parenting is hard enough with out worrying about the things you can't control.

If a woman can't breastfeed, she is not the patient I am talking about. I'm talking about the ones who make the choice not to, not the ones who have no choice. And specifically, those who make that choice because they have been led to believe that "it really isn't a big deal". And since the overwhelming majority of women and babies CAN breastfeed, this does apply to most of them. Are you trying to argue that most women who don't breastfeed, CAN'T breastfeed? I do not believe that. I have met way to many women who didn't breastfeed because they thought it was just icky, or they thought they couldn't do it if they went back to work so why bother starting, or they thought it was going to hurt forever, etc etc. I've even heard moms say that they thought formula was better because it is made by scientists or that their own milk wouldn't be enough to feed their babies. What these moms needed was education, not just a pat on the back. Of the people I've known that truly couldn't breastfeed, I haven't met them in real life - only on the internet, like yourself. I truly do not think that it describes the majority of women who don't breastfeed.

Again if you take a mother that breastfeeds but she has bad parenting the skills that child will not do well...no matter how many antibodies the child receives. So again although it's preferred, it's not necessary to produce healthy, well adjusted and happy children. It just isn't.

I didn't say that breastfeeding was the most critical decision in your child's life. You don't need to make it out that way. But antibodies are actually really important for your health, and I don't want you to discount that.

No but they do send the diabetic patients home with free blood glucose monitors so those patients will buy their brand of testing strips...that's where the profit is.

The difference being that these are testing supplies that the patient needs either way for a positive health benefit. Formula has a negative health impact, not a positive one. Doctors should not be giving it out on a routine basis.

Patients are advised to breast feed if they are able, but it's a personal choice

First, I am trying to make the point that it's more than just a personal choice. It's a choice with a medical impact, and should be treated more seriously than other "personal" choices. By saying it's a personal choice so flippantly, I think it makes people think they are equal and it doesn't really matter which they choose. I wish that people were more educated about the ramifications of their choice, and I think that health care professionals have a large role in this education.

Not everything we do as parents is a simple personal choice, and not all choices need to be supported as equal. What will you say to someone who makes the personal choice not to use a car seat? Will you try to educate them on the safety benefits of using one? Will you try to help them get one if they feel they can't afford it? Help them install it correctly? Not all choices that relate to our children are simple personal decisions, like what theme to use in the nursery or what brand of diapers to use. Should I dress the baby in red or green today? I think green is nicer, but eh, it doesn't really matter. Some decisions have serious health and safety implications, and I don't want professionals to tell people it doesn't make a difference when it does. Sure, one decision does not need to define your entire parenting style, but that's not what we're talking about here. We're talking about one particular parenting decision.

and handing out formula samples doesn't make someone suddenly want to bottle feed instead of breast feed.

And handing out formula samples by hospitals HAS been shown to be detrimental to breastfeeding rates. I can find the evidence on this for you too and get back to you. I'm surprised you aren't aware of this if you are an IBCLC as there has been a lot of talk about it for the last few years.

Now I understand you are passionate about breastfeeding, that's fine and admirable. But it's the attitude that not only is the method superior but so are the breastfeeding moms I will not participate in. This just isn't true.

My attitude is not geared toward the moms in this debate, but toward the lack of education about the issue provided to them by health care providers which makes them think that it really doesn't matter. I think that most people make the best choice they can based on the information that they have. I want to increase the amount of information they have, and I think that health care professionals are a key component to this.

So again yes there are feeding, immune advantages and digestive advantages to breastfeeding, but you can bottle feed and still do fine. I for one refuse to beat up a patient''s feelings and insecurities by not supporting whatever feeding decision they make. Parenting will always be the most important part of raising a child, no matter how you feed them.

I don't think it is out of line for a health care professional to strongly endorse BF for medical reasons. I'm not talking about the parenting or attachment aspect here, just the medical reasons. I don't need my doctor to give me parenting advice - that is my personal choice. But not BF has a medical impact on the child, and I want doctors to make that clear to their patients and not just pat them on the back and say formula is good too so as to not hurt their feelings. I'm not trying to say that BF is the most important part of raising a child, just that it is medically superior by far and I want medical professionals to be better advocates for it.

PS- I have never approached anyone to ask them if they were BF or FF and why or why not.

[deerislesmile]

I am kind of lumped in with health care professionals- I teach budgeting, cooking, and nutrition skills to families. Most of my clients are young families or pregnant moms. We teach them about prenatal nutrition, as well as a lesson on breastfeeding and another on bottle feeding. We also offer education about breastfeeding support groups and make referrals to lactation consultants and maternal health care nurses, as well as parenting support groups. Most, if not all, of my mothers are also recieving WIC, so they also get educated there about the choices that they have. In addition, many are educated about their choices by their OB/GYN or midwife or nurse on their usual prenatal visits. I would say that the information about breastfeeding is adequately made available to most new mothers in one form of delivery or another.

I'm interested in what your definition of "strongly endorse" is, ADVentive. I'm thinking of my own interaction with my clients. If I have given them all of the information about their choices, and they choose to bottle feed, what then? If they looked at the healthcare professional and stated "We have looked at all of the information and decided that we are going to bottle feed.", what should be the response at that point? What if they come in for the 2 or 3 week postpartum checkup and have already gone to a bottle? Is there anything to say at that point?

[ADVentive]

I said: Meanwhile, other medical benefits of breastfeeding last into adulthood: adults who were breastfed have less incidence of certain chronic diseases, such as Crohn's and colitis, diabetes, allergies, asthma, rheumatoid arthritis, and certain cancers.

Irishmom said: Now after the child is weaned the is no evidence of the health protection lasting beyond that time.

I said: Do you discount the studies which show formula fed babies have greater incidence of chronic illnesses including some cancers as adults (as I described above)?

Irishmom said: To my knowledge there is no definitive studies that show breastfed babies get less cancers as adults, but please show me where to find them, I would love to see that.

I said: I will be happy to look up these studies for you and post later. It will take me some time.

--------------------

So here ya go! Enjoy! This was the product of about 2 hours of research, so I hope you appreciate it! J If you would like more, please let me know. J These are just the ones I pulled out.

First, the cancer studies:

Breast Cancer

Freudenheim JL, Marshall JR, Graham S, Laughlin R, Vena JE, Bandera E, Muti P, Swanson M, Nemoto T. Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology. 1994 May;5(3):324-31.

Early childhood nutrition may affect the subsequent risk of breast cancer in adulthood. We examined the association of having been breastfed with risk of breast cancer in a case-control study of women age 40-85 years in western New York. Cases (N = 528) had newly diagnosed primary, pathologically confirmed breast cancer; controls (N = 602) were randomly selected from the same community and were frequency matched on age. Having been breastfed was associated with decreased risk. The multivariate adjusted odds ratio was 0.74, and the 95% confidence interval was 0.56-0.99. We found little difference in the association for pre- and postmenopausal women despite a much higher frequency of breastfeeding among the older women. These findings indicate that early nutriture in general and bottle feeding in particular may relate to breast cancer development in adulthood.

Barba M, McCann SE, Nie J, Vito D, Stranges S, Fuhrman B, Trevisan M, Muti P, Freudenheim JL. Perinatal exposures and breast cancer risk in the Western New York Exposures and Breast Cancer (WEB) Study. Cancer Causes Control. 2006 May;17(4):395-401.

BACKGROUND: There is increasing evidence that early life exposures, such as birth weight, infant feeding practices, birth rank and maternal age at delivery may play a role in breast carcinogenesis. METHODS: We conducted a case-control study of women aged 35-80 in Western New York (Western New York Exposure and Breast Cancer Study, the WEB Study, 1996-2001). The study included 845 women diagnosed with primary, incident, histologically confirmed breast cancer, and 1538 controls frequency-matched to cases on age, race, and county of residence. We conducted extensive in-person interviews including self-reported birth weight, history of having been breastfed, birth rank, and maternal age at delivery. RESULTS: Birth weight was significantly associated with pre- but not post-menopausal breast cancer risk. Compared to women whose birth weight was 5.5-7 pounds, we found an increased risk associated with a birth weight greater than 8.5 pounds (OR 1.84, 95%CI: 1.12-3.02). Risk was also increased for pre- but not post-menopausal women who had not been breastfed (OR 1.78, 95%CI: 1.21-2.60). Birth order and maternal age at delivery were not significantly associated with breast cancer risk. CONCLUSIONS: Our findings are consistent with other studies showing breast cancer risk associated with birth weight for pre- but not post-menopausal breast cancer. As we found in an earlier study, having been breastfed was associated with decreased risk. These findings add to the accumulating evidence that early life events impact women's subsequent breast cancer risk.

ALL and AML

Kwan ML, Buffler PA, Abrams B, Kiley VA. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Rep. 2004 Nov-Dec;119(6):521-35

OBJECTIVE: The authors used a meta-analytic technique to (1) quantify the evidence of an association between duration of breastfeeding and risk of childhood acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML), (2) assess the influence of socioeconomic status (SES) on any such associations, and (3) discuss the implications of these findings for the evaluation of whether breastfeeding reduces the risk of childhood leukemia. METHODS: A fixed effects model was employed to systematically combine the results of 14 case-control studies addressing the effect of short-term (< or = 6 months) and long-term (>6 months) breastfeeding on the risk of childhood ALL and/or AML. Subgroup analyses of studies that did and did not adjust for SES were also performed. RESULTS: A significant, negative association was observed between long-term breastfeeding and both ALL risk (odds ratio [OR]=0.76; 95% confidence interval [CI] 0.68, 0.84) and AML risk (OR=0.85; 95% CI 0.73, 0.98). Short-term breastfeeding was similarly protective for ALL and AML. Results for studies that adjusted and did not adjust for SES were not significantly different from the results for the 14 studies combined. CONCLUSIONS: This meta-analysis showed that both short-term and long-term breastfeeding reduced the risk of childhood ALL and AML, suggesting that the protective effect of breastfeeding might not be limited to ALL as earlier hypothesized. Potential bias introduced by different participation rates for case and control samples that differed in SES can be minimized by implementing larger case-control studies with SES-matched, population-based controls.


Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD, Reaman H, Robison LL. Breast-feeding and risk of childhood acute leukemia. J Natl Cancer Inst. 1999 Oct 20;91(20):1765-72.

BACKGROUND: Breast-feeding is well known to have a protective effect against infection in infants. Although the long-term effects of breast-feeding on childhood cancer have not been studied extensively, a protective effect against childhood Hodgkin's disease and lymphoma has been suggested previously from small investigations. In this study, we tested the hypothesis that breast-feeding decreases the risk of childhood acute leukemia. METHODS: A total of 1744 children with acute lymphoblastic leukemia (ALL) and 1879 matched control subjects, aged 1-14 years, and 456 children with acute myeloid leukemia (AML) and 539 matched control subjects, aged 1-17 years, were included in the analysis. Information regarding breast-feeding was obtained through telephone interviews with mothers. All leukemias combined, histologic type of leukemia (ALL versus AML), immunophenotype of ALL (early pre-B cell, pre-B cell, or T cell), and morphology of AML were assessed separately in the data analysis. RESULTS: Ever having breast-fed was found to be associated with a 21% reduction in risk of childhood acute leukemias (odds ratio [OR] for all types combined = 0.79; 95% confidence interval [CI] = 0.70-0.91). A reduction in risk was seen separately for AML (OR = 0.77; 95% CI = 0.57-1.03) and ALL (OR = 0.80; 95% CI = 0.69-0.93). The inverse associations were stronger with longer duration of breast-feeding for total ALL and AML; for M0, M1, and M2 morphologic subtypes of AML; and for early pre-B-cell ALL. CONCLUSION: In this study, breast-feeding was associated with a reduced risk of childhood acute leukemia. If confirmed in additional epidemiologic studies, our findings suggest that future epidemiologic and experimental efforts should be directed at investigating the anti-infective and/or immune-stimulatory or immune-modulating effects of breast-feeding on leukemogenesis in children.

ALL, Hodgkin's disease, and neuroblastoma

Martin RM, Gunnell D, Owen CG, Smith GD. Breast-feeding and childhood cancer: A systematic review with metaanalysis. Int J Cancer. 2005 Dec 20;117(6):1020-31

It has been suggested that breast milk may play a role in the prevention of certain childhood cancers. We undertook a systematic review of published studies investigating the association between breast-feeding and childhood cancers using Medline (1966 to June 2004), supplemented with auto alerts and manual searches. Analyses are based on odds ratios for specific cancers among those ever breast-fed compared with those never breast-fed, pooled using random-effects models. Forty-nine publications were potentially relevant; of these, 26 provided odds ratio estimates for at least one childhood cancer outcome and were included in metaanalyses. Overall, 92% of the studies were case-control studies, 85% relied on long-term recall of feeding history, only 8% examined breast-feeding exclusivity and control response rates were under 80% in over half. Metaanalyses suggested lower risks associated with having been breast-fed of 9% (95% CI = 2-16%) for acute lymphoblastic leukemia, 24% (3-40%) for Hodgkin's disease and 41% (22-56%) for neuroblastoma, with little between-study heterogeneity. The estimates for Hodgkin's disease and neuroblastoma, however, were driven by single studies. There was little evidence that breast-feeding was associated with acute nonlymphoblastic leukemia, non-Hodgkin's lymphoma, central nervous system cancers, malignant germ cell tumors, juvenile bone tumors, or other solid cancers. In conclusion, ever having been breast-fed is inversely associated with acute lymphoblastic leukemia, Hodgkin's disease and neuroblastoma in childhood, but noncausal explanations are possible. Even if causal, the public health importance of these associations may be small. Our estimates suggest that increasing breast-feeding from 50% to 100% would prevent at most 5% of cases of childhood acute leukemia or lymphoma.

ALL, Hodgkin's, and Non-Hodgkin's

Bener A, Denic S, Galadari S. Longer breast-feeding and protection against childhood leukaemia and lymphomas. Eur J Cancer. 2001 Jan;37(2):234-8.

The role of breast-feeding in protecting against childhood acute leukaemia and lymphomas is uncertain. We investigated this issue in a case-control study comprising 117 patients, aged 2-14 years, with acute lymphocytic leukaemia (ALL), Hodgkin's (HL) and non-Hodgkin's lymphoma (NHL), as well as 117 controls matched for age, sex and ethnicity. Information was collected via a telephone interview of the mothers. The median duration of breast-feeding among patients was significantly shorter than among controls, 7 (range 0-23) and 10 (range 0-20) months, respectively (P<0.0001). Breast-feeding of 0-6 months' duration, when compared with feeding of longer than 6 months, was associated with increased odds ratios (OR) for ALL (OR=2.47, 95% confidence interval (CI) 1.17-5.25), HL (OR=3.75, 95% CI 0.80-18.69), NHL (OR=4.06, 95% CI 0.82-22.59), and overall (OR=2.79, 95% CI 1.54-5.05). In the patient group, there were a significantly higher number of children and people per family, and patients were of a higher birth order than controls. In multivariate analysis, breast-feeding duration continues to be an independent predictor of lymphoid malignancies (P=0.015). In conclusion, breast-feeding lasting longer than 6 months may protect against childhood acute leukaemia and lymphomas.


Next post - Non-cancer, chronic diseases

[ADVentive]

Allergies

Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995 Oct 21;346(8982):1065-9.

Atopic diseases constitute a common health problem. For infants at hereditary risk, prophylaxis of atopy has been sought in elimination diets and other preventive measures. We followed up healthy infants during their first year, and then at ages 1, 3, 5, 10, and 17 years to determine the effect on atopic disease of breastfeeding. Of the initial 236 infants, 150 completed the follow-up, which included history taking, physical examination, and laboratory tests for allergy. The subjects were divided into three groups: prolonged (> 6 months), intermediate (1-6 months), and short or no (< 1 month) breastfeeding. The prevalence of manifest atopy throughout follow-up was highest in the group who had little or no breastfeeding (p < 0.05, analysis of variance and covariance with repeated measures [ANOVA]). Prevalence of eczema at ages 1 and 3 years was lowest (p = 0.03, ANOVA) in the prolonged breastfeeding group, prevalence of food allergy was highest in the little or no groups (p = 0.02, ANOVA) at 1-3 years, and respiratory allergy was also most prevalent in the latter group (p = 0.01, ANOVA) having risen to 65% at 17 years of age. Prevalences in the prolonged, intermediate, and little or no groups at age 17 were 42 (95% CI 31-52)%, 36 (28-44)%, and 65 (56-74)% (p = 0.02, trend test) for atopy, respectively, and 8 (6-10)%, 23 (21-25)%, and 54 (52-56)% (p = 0.0001, trend test) for substantial atopy. We conclude that breastfeeding is prophylactic against atopic disease--including atopic eczema, food allergy, and respiratory allergy--throughout childhood and adolescence.

Asthma

Oddy WH. A review of the effects of breastfeeding on respiratory infections, atopy, and childhood asthma. J Asthma. 2004 Sep;41(6):605-21.

The etiology of childhood asthma is not fully understood. Early exposure to certain respiratory infections may be protective for atopy and/or asthma whereas some infections have been suggested to exert the opposite effects. Wheezing lower respiratory illness (LRI) in the first year of life and atopy are independently associated with increased risk for current asthma in childhood and their effects are mediated via different causal pathways. These risk factors are multiplicative when they operate concommitantly within individual children. Exclusive breastfeeding protects against asthma via effects on both these pathways, as well as through other as yet undefined mechanisms. Furthermore, exclusive breastfeeding may protect against asthma and may reduce the incidence of lower respiratory illness, especially respiratory syncytial virus (RSV). We have previously demonstrated a protective effect of exclusive breastfeeding on asthmatic traits in children. The aim of this review was to clarify this protective association from intermediate associations with respiratory infections, atopy, or through other facets of breastfeeding. The bioactivity of breast milk and subsequent pathways that may act upon the development of asthma in children are explored.


IBD: Crohn's and Colitis

Klement E, Cohen RV, Boxman J, Joseph A, Reif S. Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis. Am J Clin Nutr. 2004 Nov;80(5):1342-52.Click here to read Links

BACKGROUND: It has long been believed that breastfeeding provides protection against ulcerative colitis and Crohn disease. Studies designated to test this hypothesis were conducted without reaching conclusive results. OBJECTIVE: The aim of this meta-analysis was to examine the role of breastfeeding in preventing inflammatory bowel disease and to summarize the evidence gathered about this subject. DESIGN: A meta-analysis was performed on 17 relevant articles that were found by using MEDLINE, EMBASE, the Internet, and articles' references. The publications were fully reviewed and divided, on the basis of their quality, into 3 groups. RESULTS: Studies showed heterogeneous results. The pooled odds ratios of all the 17 reviewed studies, calculated according to the random-effects model, were 0.67 (95% CI: 0.52, 0.86) for Crohn disease and 0.77 (0.61, 0.96) for ulcerative colitis. However, only 4 studies for Crohn disease and 4 for ulcerative colitis were eventually included in the highest quality group. In this group, the pooled odds ratio was 0.45 (0.26, 0.79) for Crohn disease and 0.56 (0.38, 0.81) for ulcerative colitis. CONCLUSIONS: The results of this meta-analysis support the hypothesis that breastfeeding is associated with lower risks of Crohn disease and ulcerative colitis. However, because only a few studies were graded to be of high quality, we suggest that further research, conducted with good methodology and large sample sizes, should be carried out to strengthen the validity of these observations.

Diabetes: Type 2

Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. Am J Clin Nutr. 2006 Nov;84(5):1043-54.

BACKGROUND: Observational evidence suggests that having been breastfed in infancy may reduce the prevalence of type 2 diabetes in later life. OBJECTIVE: The objective was to examine the influence of initial breastfeeding on type 2 diabetes and blood glucose and insulin concentrations. DESIGN: A systematic review of published studies identified 1010 reports; 23 examined the relation between infant feeding and type 2 diabetes in later life or risk factors for diabetes. Risk factors in infants were examined separately from those in children and adults. All estimates were pooled by using fixed-effect models; differences <0 and ratios <1 imply a beneficial effect of breastfeeding. RESULTS: Subjects who were breastfed had a lower risk of type 2 diabetes in later life than did those who were formula fed (7 studies; 76 744 subjects; odds ratio: 0.61; 95% CI: 0.44, 0.85; P = 0.003). Children and adults without diabetes who had been breastfed had marginally lower fasting insulin concentrations than did those who were formula fed (6 studies; 4800 subjects; percentage difference: -3%; 95% CI: -8%, 1%; P = 0.13); no significant difference in fasting glucose concentrations was observed. Breastfed infants had lower mean preprandial blood glucose (12 studies; 560 subjects; mean difference: -0.17 mmol/L; 95% CI: -0.28, -0.05 mmol/L; P = 0.005) and insulin (7 studies; 291 subjects; mean difference: -2.86 pmol/L; 95% CI: -5.76, 0.04 pmol/L; P = 0.054) concentrations than did those who were formula fed. CONCLUSION: Breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations in later life, and with lower blood glucose and serum insulin concentrations in infancy.

Diabetes: Type 1

Holmberg H, Wahlberg J, Vaarala O, Ludvigsson J; ABIS Study Group. Short duration of breast-feeding as a risk-factor for beta-cell autoantibodies in 5-year-old children from the general population. Br J Nutr. 2007 Jan;97(1):111-6

Breast-feeding has been suggested to have a protective effect against the development of type 1 diabetes. In the present study, we investigated the relation between duration of breast-feeding and beta-cell autoantibodies in 5-year-old non-diabetic children who participated in a prospective population-based follow-up study (the All Babies in Southeast Sweden study). Autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and the protein tryosine phosphatase-like IA-2 (IA-2A) were measured by radiobinding assays. A short duration of total breast-feeding was associated with an increased risk of GADA and/or IAA above the ninety-fifth percentile at 5 years of age (OR 2.09, 95% CI 1.45, 3.02; P<0.000) as well as with an increased risk of IAA above the ninety-fifth percentile at this age (OR 2.89, 95% CI 1.81, 4.62, P<0.000). A short duration of exclusive breast-feeding was associated with an increased risk of GADA, IAA and/or IA-2A above the ninety-ninth percentile (OR 2.01, 95% CI 1.08, 3.73; P=0.028) as well as with an increased risk of IA-2A above the ninety-ninth percentile (OR 3.50, 95% CI 1.38, 8.92, P=0.009) at 5 years of age. An early introduction of formula was associated with an increased risk of GADA, IAA and/or IA-2A above the ninety-ninth percentile (OR 1.84, 95% CI 1.01, 3.37; P=0.047) at 5 years of age. The positive association between a short duration of both total and exclusive breast-feeding, as well as an early introduction of formula, and positivity for beta-cell autoantibodies in children from the general population suggest that breast-feeding modifies the risk of beta-cell autoimmunity, even years after finishing breast-feeding.


Coeliac Disease

Ivarsson A, Persson LA, Hernell O. Does breast-feeding affect the risk for coeliac disease? Adv Exp Med Biol. 2000;478:139-49.

Coeliac disease, or permanent gluten sensitive enteropathy, has emerged as a widespread health problem. It is considered an immunological disease, possibly of autoimmune type, albeit strictly dependent on the presence in the diet of wheat gluten and similar proteins from rye and barley. There are reasons to believe that the aetiology of coeliac disease is multifactorial, i.e. that other environmental exposures than the mere presence in the diet of gluten affect the disease process. Our studies have shown that prolonged breast-feeding, or perhaps even more important, ongoing breast-feeding during the period when gluten-containing foods are introduced into the diet, reduce the risk for coeliac disease. The amount of gluten consumed is also of importance in as much as larger amounts of gluten-containing foods increase the risk for coeliac disease, while it still is uncertain if the age for introducing gluten into the diet of infants is important. Thus, a challenging possibility, that need to be further explored, is if the coeliac enteropathy can be postponed, or possibly even prevented for the entire life span, by favourable dietary habits early in life.


Cholesterol

Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG. Infant feeding and blood cholesterol: a study in adolescents and a systematic review. Pediatrics. 2002 Sep;110(3):597-608.

OBJECTIVE: To examine the influence of infant feeding method on serum total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol. METHODS: A cross-sectional study of 13- to 16-year-olds and a systematic review of studies (all observational) on the effects of infant feeding on cholesterol in infancy (<1 year), childhood or adolescence (1-16 years), and adulthood (> or =17 years) were conducted using random effects models. Differences are presented as breastfed-bottle-fed. A total of 1532 individuals (92% white; 55% male; mean age: 15.1 years) in 10 British towns were studied, and 37 studies with 52 observations on TC (26 in infancy, 17 in childhood or adolescence, and 9 in adulthood; corresponding figures for LDL were 7, 4, and 6) were reviewed. RESULTS: Mean TC in childhood or adolescence (including the new study) was not related to infant feeding pattern (mean TC difference = 0.00; 95% confidence interval [CI]: -0.07 to 0.07 mmol/L). However, in infancy, mean TC was higher among those breastfed (mean TC difference = 0.64; 95% CI: 0.50-0.79 mmol/L), whereas in adults, mean TC was lower among those breastfed (mean TC difference = -0.18; 95% CI: -0.30 to -0.06 mmol/L). Patterns for LDL were similar to those for TC throughout. CONCLUSIONS: Breastfeeding is associated with increased mean TC and LDL levels in infancy but lower levels in adulthood/adult life. These results suggest that breastfeeding may have long-term benefits for cardiovascular health and may have implications for the content of formula feed milks.


Cardiovascular disease


Martin RM, Ebrahim S, Griffin M, Davey Smith G, Nicolaides AN, Georgiou N, Watson S, Frankel S, Holly JM, Gunnell D. Breastfeeding and atherosclerosis: intima-media thickness and plaques at 65-year follow-up of the Boyd Orr cohort. Arterioscler Thromb Vasc Biol. 2005 Jul;25(7):1482-8.

OBJECTIVES: The impact of breastfeeding in infancy on cardiovascular disease risk is uncertain. We related breastfeeding in infancy to atherosclerosis in adulthood. METHODS AND RESULTS: A historic cohort study based on a 65-year follow-up of the Carnegie (Boyd Orr) survey of diet and health in prewar Britain, 1937 to 1939. A total of 732 eligible cohort members living in or around Aberdeen, Bristol, Dundee, Wisbech, and London were invited for follow-up examinations in 2002, and 405 (55%) participated. In models controlling for age and sex, breastfeeding was inversely associated with common carotid intima-media thickness (IMT; difference -0.03 mm; 95% CI, -0.07 to 0.01), bifurcation IMT (difference -0.19 mm; 95% CI, -0.37 to -0.01), carotid plaque (odds ratio [OR], 0.52; 95% CI, 0.29 to 0.92), and femoral plaque (OR, 0.54; 95% CI, 0.26 to 1.12), compared with bottle-feeding. Controlling for socioeconomic variables in childhood and adulthood, smoking and alcohol made little difference to effect estimates. Controlling for factors potentially on the causal pathway (blood pressure, adiposity, cholesterol, insulin resistance, and C-reactive protein) made little difference to observed associations. CONCLUSIONS: Breastfeeding may be associated with a reduced risk of atherosclerosis in later life. Measurement error and power considerations limit the extent to which conclusions about the mechanisms underlying this relationship can be made.


Blood pressure

Martin RM, Gunnell D, Smith GD. Breastfeeding in infancy and blood pressure in later life: systematic review and meta-analysis. Am J Epidemiol. 2005 Jan 1;161(1):15-26.

The influence of breastfeeding on blood pressure in later life is uncertain. The authors conducted a systematic review of published studies from which estimates of a mean difference (standard error) in blood pressure between breastfed and bottle-fed subjects could be derived. They searched MEDLINE and Excerpta Medica (EMBASE) bibliographic databases, which was supplemented by manual searches of reference lists. Fifteen studies (17 observations) including 17,503 subjects were summarized. Systolic blood pressure was lower in breastfed compared with bottle-fed infants (pooled difference: -1.4 mmHg, 95% confidence interval (CI): -2.2, -0.6), but evidence of heterogeneity between study estimates was evident (chi(2)(16) = 42.0, p < 0.001). A lesser effect of breastfeeding on systolic blood pressure was observed in larger (n > or = 1,000) studies (-0.6 mmHg, 95% CI: -1.2, 0.02) compared with smaller (n < 1,000) studies (-2.3 mmHg, 95% CI: -3.7, -0.9) (p for difference in pooled estimates = 0.02). A small reduction in diastolic blood pressure was associated with breastfeeding (pooled difference: -0.5 mmHg, 95% CI: -0.9, -0.04), which was independent of study size. If causal, the small reduction in blood pressure associated with breastfeeding could confer important benefits on cardiovascular health at a population level. Understanding the mechanism underlying this association may provide insights into pathways linking early life exposures with health in adulthood.


General

Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin North Am. 2001 Feb;48(1):125-41

A growing body of research suggests that infant feeding practices influence the risk for several chronic diseases of childhood and adolescence. Increased risks for type 1 diabetes, celiac disease, some childhood cancers, and inflammatory bowel disease have been associated with artificial infant feeding and short-term breastfeeding. As genetic susceptibility is understood more completely and gene-environment interactions are elucidated, evidence to either confirm or refute these findings will be forthcoming.

[deerislesmile]

The difference being that these are testing supplies that the patient needs either way for a positive health benefit. Formula has a negative health impact, not a positive one. Doctors should not be giving it out on a routine basis.

Are you actually saying that formula is to a baby as chocolate is to a diabetic? That formula is actually harmful to a baby? I'll give you second best to breastfeeding, but I disagree strongly with you that it is harmful to a baby. If so, we should be reporting all non-bfers to the child welfare department for abuse/neglect. That would teach them, huh?

What will you say to someone who makes the personal choice not to use a car seat? Some decisions have serious health and safety implications, and I don't want professionals to tell people it doesn't make a difference when it does.

Again, I strongly disagree with your argument that formula is as potentially harmful to babies as not being securely harnessed in a safety seat or as harmful as a disease like diabetes. Show me some studies, facts, or reliable research that prove that formula actually harms an infant, which is what I hear you saying repeatedly. Formula might be less than optimal, but hardly detrimental.

And handing out formula samples by hospitals HAS been shown to be detrimental to breastfeeding rates. I can find the evidence on this for you too and get back to you. I'm surprised you aren't aware of this if you are an IBCLC as there has been a lot of talk about it for the last few years.

Detrimental to breastfeeding rates, not actual detrimental to babies, right?

I don't really approve of the "freebies" given at the hsopital because they seem to endorse one brand over another, but I know my clients have found them helpful. Some have recieved a formula bag with free formula samples and bottle samples, and others have recieved a bfing pack with pads, lotion, and a water bottle. Both bags have brochures and informational publications from area parenting agencies, including WIC and LLL, in addition to the corporate stuff. And of course, they all have the option to not take the bag at all.

[milliebfit]

I bottle feed both my kids, they were never sick. I would only take them to the doctor for there once a year visits, very rarely in between. My pediatrician was shocked that I had such healthy kids!!?? My next door neighbor breast fed her son and he was always sick, green stuff always coming from his nose. I never wanted her son around my healthy kids. I do not think it had anything to do with breast feeding. Her son was in day care from 8 weeks old. My kids stayed home with me because I worked at night. I really believe it is a personal choice. If you decide to bottle feed you should not be made to feel like you are giving your baby posion. Today I have 2 very happy healthy smart kids.