Группа авторов

Human Milk: Composition, Clinical Benefits and Future Opportunities


Скачать книгу

the infant. I shall look carefully at these areas to help pave the way to a more solid basis for modern breastfeeding medicine. Firstly, I shall look at evolutionary theory for human breastfeeding and consider in general terms the implications for optimal nutritional care of breastfed infants. Secondly, I shall show how HM composition has been incorrectly translated into dietary intake in a large body of past flawed work that resulted in misleading data. Implementing such data as a model for infant formula appears to have increased the risk of obesity and cardiovascular disease (CVD) in formula-fed infants. Finally, most studies that examine the benefits of HM are observational and potentially confounded. So, this body of data needs to be backed by experimental evidence. Here, I shall use preterm infants as a model, since numerous RCTs and physiological studies over 40 years have compared exclusive HM feeding versus cow’s milk exposure. Unexpectedly diverse immediate beneficial effects span the field of neonatology, and long-term programmed effects have been shown for cognition, brain structure, risk factors for CVD, structural development of the heart and lungs, bone health, and atopy. These data add much weight to the evidence, obtained in full-term infants using observational study designs, that HM feeding in early life may fundamentally and permanently change the biology of the organism. Breastfeeding is emerging as a major evidence-based field of medical and public health practice.

      © 2019 Nestlé Nutrition Institute, Switzerland/S. Karger AG, Basel

      Introduction

      Given 7 billion people on the planet and 134 million births/year, the recommendation that all babies should be breastfed constitutes a colossal public health intervention. All public health interventions should be rooted in sound scientific evidence and I shall consider some modern advances in the science and understanding of this important field.

      I shall focus on 3 important pillars in breastfeeding medicine: (1) that human milk (HM) is the product of 200 million years of mammalian evolution; (2) that HM composition is the gold standard for infant nutritional requirements; and (3) that HM has numerous clinical benefits for the infant.

      Finally, I shall emphasize the great importance of breastfeeding as an evidence-based clinical and public health intervention.

      Breastfeeding and Mammalian Evolution

      In summary, current evidence (see later) shows that breastfeeding is superior to its substitutes on numerous health grounds. Nevertheless, given the evolutionary aspects considered, it is in the interests of population health to identify areas in which nutritional care of breastfeeding mothers or their babies could further improve outcome – a principle already in practice in relation to the use of prophylactic vitamin K and vitamin D in infancy.

      Breast Milk Composition as the Gold Standard for Infant Nutritional Needs

      HM composition has generally been regarded as a gold standard for deriving infant nutritional requirements – for instance in situations where artificial feeding is required. This has certainly been a most helpful concept.

      However, for breast milk to be a valid gold standard, it is critical that accurate data are obtained using appropriate methodology. This latter aspect is the one that is discussed in this section since it will be argued that despite intensive work on the composition of breast milk, misleading data have been derived in the past that have misdirected nutrition practice in ways that have had adverse impact on babies and their long-term health.