 |  | Risks of Formula Feeding
for Infants and Mothers
The World Health Organization recommends exclusive breastfeeding
for six months and introducing nutritious complementary foods at six
months and continued breastfeeding for two years and beyond.
Hundreds of studies (a few listed below) have concluded that
breastfeeding is imperative for the health of the child and mother.
The International Code of Marketing of Breast milk Substitutes
requires that parents be informed about the health hazards
of unnecessary or improper use of infant formula.
This brief annotated bibliography from INFACT Canada gives
some examples from the extensive body of research documenting
the importance of breastfeeding and in turn the associated risks of formula feeding.
LEARN MORE ABOUT BREASTFEEDING
Some of the risks associated with formula feeding:
For Infant and Mothers
1. Increased risk of asthma
2. Increased risk of allergy
3. Reduced cognitive development
4. Increased risk of acute respiratory disease
5. Increased altered occlusion
6. Increased risk for infection from contaminated formula
7. Increased risk of nutrient deficiencies
8. Increased risk of childhood cancers
9. Increased risk of chronic diseases
10. Increased risk of diabetes
11. Increased risk of cardiovascular disease
12. Increased risk of obesity
13. Increased risk of gastrointestinal infections
14. Increased risk of mortality
15. Increased risk of otitis media and ear infections
16. Increased risk of side effects of environmental contaminants
For mothers
1. Increased risk of breast cancer
2. Increased risk of overweight
3. Increased risk of ovarian cancer and endometrial cancer
4. Increased risk of osteoporosis
5. Reduced natural child spacing
6. Increased risk of rheumatoid arthritis
7. Increased risk of stress and anxiety
8. Increased risk of maternal diabetes
A study of 2184 children done by the Hospital for Sick Children
in Toronto determined that the risk of asthma and wheeze was
approximately 50 per cent higher when infants were formula-
fed compared to infants who were breastfed for nine months
or longer.
Dell S, To T. Breastfeeding and Asthma in Young Children. Arch Pediatr Adolesc Med 155:
1261-1265, 2001
Researchers in West Australia studied 2602 children to
determine the development of asthma and wheeze at six
years of age. Not breastfeeding increased the risk of asthma
and wheeze by 40 per cent compared to infants who were
exclusively breastfed for four months. The authors recommend
exclusive breastfeeding for at least four months to reduce the
risk of asthma.
Oddy WH, Peat JK, de Klerk NH. Maternal asthma, infant feeding, and the risk for asthma in
childhood. J. Allergy Clin Immunol. 110: 65-67, 2002
The reviewers looked at 29 studies to evaluate the protective
effect of breastfeeding on asthma and atopy. After applying strict
criteria for assessment, 15 studies remained in the review. All
15 showed a protective effect of breastfeeding. They concluded
that the evidence is clear and consistent that not breastfeeding
puts infants at risk for asthma and atopy.
Oddy WH, Peat JK. Breastfeeding, Asthma and Atopic Disease: An Epidemiological Review
of Literature. J Hum Lact 19: 250-261, 2003
A longitudinal prospective study of 1246 healthy infants in
Arizona, USA, aimed to determine the relationship between
breastfeeding and recurrent wheeze. The results showed
that non-atopic children at the age of six years, who had not
been breastfed, were three times more likely to have recurrent
wheezing.
Wright AL, Holberg CJ, Taussig LM, Martinez FD. Relationship of infant feeding to recurrent
wheezing at age 6 years. Arch Pediatr Adolesc Med 149: 758-763, 1995
InCreased rIsk oF allergy
Children in Finland who had been breastfed the longest had the
lowest incidence of atopy, eczema, food allergy and respiratory
allergy. At 17 years of age, the incidence of respiratory allergy
for those who had little breastfeeding was 65 per cent and for
those who were breastfed the longest 42 per cent.
Saarinen UM, Kajosarri M. Breastfeeding as a prophylactic against atopic disease:
Prospective follow-up study until 17 years old. Lancet 346: 1065-1069, 1995
Infant with a maternal history of respiratory allergy or asthma
were assessed for atopic dermatitis during the first year of life.
Seventy-six Dutch children and 228 children without atopic
dermatitis were examined. Exclusive breastfeeding for the
first three months of life was found to have a protective effect
against dermatitis.
Kerkhof M, Koopman LP, van Strien RT, et al. Risk factors for atopic dermatitis in infants at
high risk of allergy: The PIAMA study. Clin Exp Allergy 33: 1336-1341, 2003
The effects of maternal dietary vitamins C and E on breastmilk
antioxidant composition to protect against the
development of atopy in infants were assessed.
Mothers with atopic disease kept four-day
food records and breastmilk samples were
collected at the infants’ age of 1 mo.
Results showed that maternal
intake of vitamin C in her diet but
not as a supplement determined the
concentration of vitamin C in breastmilk.
A higher concentration of vitamin C in
concluded that breastfeeding even for a short period (three
months) would significantly reduce the episodes of otitis
media during infancy.
Duffy LC, Faden H, Wasielewski R, Wolf J, Krystofik D. Exclusive breastfeeding protects
against bacterial colonization and day care exposure to otitis media. Pediatrics 100: E7,
1997
InCreased rIsk oF sIde eFFeCts oF
envIronmental ContamInants
A Dutch study showed that at six years of age, cognitive
development is affected by prenatal exposure to polychlorinated
biphenyls (PCBs) and dioxins. An adverse effect of prenatal
exposure on neurological outcome was also demonstrated in
the formula-fed group but not in the breastfed group. Despite
higher PCB exposures from breast milk, the study found at 18
months, 42 months of age, and at six years of age a beneficial
effect of breastfeeding on the quality of movements, in terms
of fluency, and in cognitive development tests.
The data gives evidence that prenatal exposure to PCBs
does have subtle negative effects on neurological and cognitive
development of the child up to school age. The study also
gives evidence that breastfeeding counteracts the adverse
developmental effects of PCBs and dioxins.
Boersma ER, Lanting CI. Environmental exposure to polychlorinated biphenyls (PCBs) and
dioxins. Consequences for longterm neurological and cognitive development of the child.
Adv Exp Med Biol 478:271-87, 2000
Another Dutch study to determine the perinatal effects of
exposure to polychlorinated biphenyls (PCBs), assessed
breastfed and formula-fed infants at nine years of age. By
measuring auditory P300 latencies (the reaction time to
incoming stimuli, which are known to be negatively impacted
by PCBs) they found that those who were formula-fed or
breastfed for less than 6 to 16 weeks, experienced greater
latency and delayed mechanisms in the central nervous
system that evaluate and process relevant stimuli. On the
other hand breastfeeding accelerates these mechanisms.
Vreugedenhill HJI, Van Zanten GA, Brocaar MP, Mulder PGH, Weisglas-
Kuperus, N. Prenatal exposure to polychlorinated biphenols and
breastfeeding: opposing effects on auditory P300 latencies in 9-year old
Dutch children.
Develop Med & Child Neurol 46: 398-405, 2004
Risks of Formula Feeding
For mothers
InCreased rIsk oF breast CanCer
Researchers from England evaluated a possible association
between cancer incidence and breastfeeding during infancy.
This study included nearly 4,000 adults who were originally
surveyed from 1937-1939. The data included on meta-
analysis showed that rates of breast cancer diagnosed in
premenopausal women were approximately 12% lower among
women who had been breast-fed as infants.
Martin R, Middleton N, Gunnell D, Owen C, Smith G. Breast-Feeding and Cancer: The Boyd
Orr Cohort and a Systematic Review With Meta-Analysis. Journal of the National Cancer
Institute. 97: 1446-1457, 2005
Breast-feeding decreases the risk of breast cancer in mothers
and infection, allergy, and autoimmunity in infants. The
presence of mediators of the innate immune system in human
milk, including defensins, cathelicidins, and toll-like receptors
(TLRs), were extracted and analysed from the whey fractions
of colostrum and transitional and mature milk (n = 40) from
normal mothers (n = 18) and from mothers with autoimmune
or allergic diseases.
The authors suggest that the innate immune system
in breastmilk is complex and likely provides protection for
maternal breast tissue and the developing digestive tract of
newborns.
Armogida, Sheila A.; Yannaras, Niki M.; Melton, Alton L.; Srivastava, Maya D. Identification
and quantification of innate immune system mediators in human breast milk. Allergy and
Asthma Proc 25: 297-304, 2004
InCreased rIsk oF overweIght
A Brazilian cohort of 405 women were followed at 6 and 9
months postpartum to determine the association between
weight retention and breastfeeding practices. When women
who had 22% body fat and breastfed for 180 days were
compared with those who had breastfed for only 30 days, each
month of breastfeeding brought an average reduction of 0.44
kg in weight. In conclusion the authors confirm the association
between breastfeeding and postpartum weight and that the
promotion of longer duration can contribute to decreases in
postpartum weight retention.
Kac G, Benício MHDA, Velásquez-Meléndez G, Valente JG, Struchiner CJ. Breastfeeding
and postpartum weight retention in a cohort of Brazilian women. Am J Clin Nutr 79: 487-493,
2004
InCreased rIsk oF ovarIan CanCer
and endometrIal CanCer
Not breastfeeding has been associated with increased risk
of ovarian cancer. A large case-control Italian study of 1031
women with epithelial ovarian cancer were compared to 2411
women admitted to the same network of hospitals for a wide
spectrum of acute non-neoplastic conditions, unrelated to
known risk factors for ovarian cancer. Results showed inverse
trends in risk with increasing duration of breastfeeding and
number of children breastfed. Additional analyses by histologic
subtypes suggested that the protective role of breastfeeding
would be larger for serious neoplasms.
Chiaffarino F, Pelucchi C, Negri E, Parazzini F, Franceschi S, Talamini R, Montella M,
Ramazzotti V, La Vecchia C. Breastfeeding and the risk of epithelial ovarian cancer in an
Italian population. Gynecol Oncol. 98: 304-308, 2005
To determine the link between breastfeeding and endometrial
cancer, this Japanese hospital-based case-control study
compared cases of women with endometrial cancer (155) with
controls (96) selected from women attending the outpatient
clinic for cervical cancer screening. The women were
interviewed to determine breastfeeding practices, contraceptive
usage, as well as potential risk factors for endometrial cancer.
The authors observed a greater risk of endometrial cancer
for parous women who had never breastfed, and concluded
that breastfeeding reduces the risk of endometrial cancer in
Japanese women.
Okamura C, Tsubono Y, Ito K, Niikura H, Takano T, Nagase S, Yoshinaga K, Terada Y,
Murakami T, Sato S, Aoki D, Jobo T, Okamura K, Yaegashi N. Tohoku J Exp Med. Lactation
and risk of endometrial cancer in Japan: a case-control study. 208: 109-15, 2006
InCreased rIsk oF osteoporosIs
Longitudinal studies have suggested that both pregnancy and
lactation are associated with a bone mineral density loss of
up to 5%, and that the loss recovers after weaning. Cross-
sectional studies have indicated that women with many children
and a long total period of lactation have similar or higher bone
mineral density and similar or lower fracture risk than their
peers who have not given birth and breastfed. This trend has
been observational and found in cross-sectional case-control
studies. The causal relationships have yet to be determined.
Karlsson MK, Ahlborg HG, Karlsson C, Maternity and mineral density.
Acta Orthopaedica 76:
2-13, 2005
reduCed natural ChIld spaCIng
A questionnaire was used to obtain data from Nigerian
breastfeeding mothers to determine the impact of breastfeeding
practices on lactational amenorrheoa. Exclusive breastfeeding
was practised by 100% of the mothers on discharge. This went
down to 3.9% at six months. Feeding on cue was practised by
98.9% of the mothers. By 6 weeks 33.8% of mothers resumed
mensus and this rose to 70.2% at six months. The duration
of lactational amenorrheoa was longer in exclusively breast-
feeding mothers than in those who were not. None of the 178
mothers who participated in the survey became pregnant.
Egbuonu I, Ezechukwu CC, Chukwuka JO, Ikechebelu JI. Breast-feeding, return of menses,
sexual activity and contraceptive practices among mothers in the first six months of lactation in
Onitsha, South Eastern Nigeria. J Obstet Gynaecol. 25: 500-503, 2005
InCreased rIsk oF rheumatoId
arthrItIs
Female reproductive and hormonal risks factors were studied
in a cohort of 121,700 women enrolled in the Nurses’ Health
Study. Breastfeeding for more than 12 months was inversely
related to the development of rheumatoid arthritis. The effect
was found to be dose related. Those who breastfed shorter had
a higher risk.
Karlson E W et al. Do breast-feeding and other reproductive factors
influence future risk of rheumatoid arthritis?: Results from the Nurses
Health Study. Arthiritis & Rheumatism 50: 3458-3467, 2004
InCreased stress and anxIety
To find out if there is a relationship between feeding practices,
stress, and mood and levels of serum cortisol, prolactin
and ACTH (adrenocorticotrophic hormone) in mothers, the
author compared the emotional responses of 84 exclusively
breastfeeding, 99 exclusively formula-feeding and 33 non post-
partum healthy control women. The mothers’ responses were
studied at 4 to 6 weeks post-partum.
Overall the breastfeeding mothers had more positive moods,
reported more positive events, and perceived less stress than
formula-feeders. Breastfeeders had less depression and anger
than formula feeders and serum prolactin levels were inversely
related to stress and mood in formula-feeders.
World Alliance for breastfeeding
Action (WAbA)
P O Box 1200, 10850 Penang, Malaysia
Tel: 604-658 4816
Fax: 604-657 2655
e-mail: waba@streamyx.com
WebsiTe: www.waba.org.my
www.breastfeedingweek.org
Prepared by Elisabeth Sterken, BSc MSc nutritionist,
INFACT Canada/IBFAN North America, revised May 2006
infACt Canada
6 Trinity Square, Toronto ON MSC 1B1
Tel: (416) 595 9819
Fax: (416) 591 9355
e-mail: info@infactcanada.ca
WebsiTe: www.infactcanada.ca
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