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Human Milk: Composition, Clinical Benefits and Future Opportunities


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href="#ulink_e7923609-f32b-5e01-b2cd-9a182f905ac7">18] comparing EHM feeding versus CM-based products (used either alone or in combination with HM). In these trials, the HM arm received no CM since this was the era before the development (in the later 1980s) of CM-based breast milk fortifiers. The largest of such trials was by Lucas et al. on over 500 infants but at least 5 other smaller RCTs of this nature were done by other investigators.

      Necrotizing Enterocolitis and Systemic Sepsis

      Thus, at least 12 RCTs and 8 quasi-experimental studies show that HM has a major protective effect against infective/inflammatory conditions that provide support for a causal role of breastfeeding in protecting against infection in term infants.

      Mortality

      The US trials (combined) of lacto-engineered products show that death rate was 4 times higher in those exposed to CM versus an EHM diet comprising modern lacto-engineered products [25].

      Retinopathy of Prematurity

      Cardiorespiratory Impact

      Cognitive Development

      In preterm infants, numerous observational studies have shown that use of HM in neonatal care is associated with higher IQ or DQ but, like the studies in full-term infants, such data do not prove causation. However, the opportunity to study this using an experimental design arose with our own RCTs in neonates whose mothers had elected not to provide their own breast milk (thus eliminating the potential confounding relating to mother’ choice to provide breast milk). These two trials compared as sole diets: (i) DBM versus preterm formula (PTF), and (ii) term formula (TF) versus PTF. The first of these trials, DBM versus PTF, compared HM with CM, but the CM arm (PTF) provided much higher protein and energy intakes. Nevertheless, the HM (DBM) group was not disadvantaged in later cognitive scores, suggesting that breast milk had factors that ameliorated the poor nutrient intake. In order to remove the major nutritional difference between these groups, we elected to compare DBM from trial (i) with TF from trial (ii) since these were diets both suitable for term infants. This cross comparison of RCTs was justified since both trials used the same PTF, thus constituting an “internal standard.” The HM (DBM) group had a significant 7-point advantage in the Bayley psychomotor index compared to the TF, providing compelling experimental evidence that HM promoted better cognitive development than seen in the CM (TF) group.