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Friday, January 14, 2011

INFACT: WHO Breastfeeding Recommendations under attack

INFACT Canada Release: January 14, 2011

WHO breastfeeding recommendations under attack from industry-funded scientists.

Are the infant formula and baby foods industries attempting to undermine the World Health Organization and globally accepted recommendations that infants be exclusively breastfed for the first six months of life?
The BBC, the Guardian and other media are carrying stories about a new review which is published in the British Medical Journal:
The authors, of the article entitled, Six months of exclusive breastfeeding: how good is the evidence?, led by Dr Mary Fewtrell, a consultant paediatrician at the UCL Institute of Child Health in London, have reviewed the evidence behind the current guidance and say the time is right to reappraise this recommendation.
Three of the four authors of this study, Mary Fewtrell, Alan Lucas and David Wilson, receive funding from the baby food industry.
Prof Lucas in particular plays a key role in advising the UK baby food industry, and has opposed the WHO recommendation for many years. In 2003 he went so far as to appear for the defence when one of the largest baby food companies, SMA Wyeth, which was successfully prosecuted for illegal advertising by the UK Trading Standards.
INFACT Canada is concerned that this review, of which three out of the four authors receive funding from the infant formula and baby foods industries, and the media coverage it is generating is being used by the infant formula and baby foods industries in their attempt to weaken national policies and legislation recommending exclusive breastfeeding for the first six months of life.
Exclusive breastfeeding for the first six months of life has been demonstrated to reduce respiratory and gastro infectious diseases, childhood obesity, optimize brain and neurological development, and reduce the risk of chronic diseases such diabetes, breast cancer and heart disease in later life.
In Canada, complementary foods are already labeled to imply that these foods be used before the age of six months. This is in contradiction to Health Canada’s infant feeding policy of exclusive breastfeeding for the first six months of life.
In response to the article in the British Medical Journal, the World Health Organization’s Head of Nutrition, Francesco Branca stated:
“WHO’s global public health recommendation is for infants to be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health. Thereafter, infants should be given nutritious complementary foods and continue breastfeeding up to the age of 2 years or beyond.
WHO closely follows new research findings in this area and has a process for periodically re-examining recommendations. Systematic reviews accompanied by an assessment of the quality of evidence are used to review guidelines in a process that is designed to ensure that the recommendations are based on the best available evidence and free from conflicts of interest.
The paper in this week’s BMJ is not the result of a systematic review. The latest systematic review on this issue available in the Cochrane Library was published in 2009 (“Optimal duration of exclusive breastfeeding (Review)”, Kramer MS, Kakuma R. The Cochrane Library 2009, Issue 4). It included studies in developed and developing countries and its findings are supportive of the current WHO recommendations.
It found that the results of two controlled trials and 18 other studies suggest that exclusive breastfeeding (which means that the infant should have only breast milk, and no other foods or liquids) for 6 months has several advantages over exclusive breastfeeding for 3-4 months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection for the baby, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections or of allergic diseases have been demonstrated. No adverse effects on growth have been documented with exclusive breastfeeding for 6 months, but a reduced level of iron has been observed in developing-country settings.


When assessing the BMJ - Fewtrell data the following points should be borne in mind:
  • this is not a report on new data - it is observational only.
  • WHO’s policy arose from a review of 3,000 studies on infant feeding.
  • Keeping recommendations under review and randomised controlled trials in progress is good practice; this paper is pre-empting the results of these.
  • The study implies that delayed introduction of solid foods may be linked to increased obesity - this is total conflict with the studies which show that early introduction - particularly of sugary foods is an important factor behind the obesity epidemic. Breastfeeding may actually help in the development of taste receptors.
  • The argument to introduce solids at 4 months to prevent coeliac disease and allergies was summarised by ESPGHAN in late 2009 and was considered by many to be flawed. see press release:
  • the UK Scientific Committee on Nutrition (SACN) and the Committee on Toxicity (COT) are reviewing the evidence on solid foods and coeliac disease. The draft opinion is NOT FINAL BUT is on the SACN website with the Agenda papers for next week’s SACN meeting. See paper SMCN/11/01 downloadable from
  • SACN use international growth charts to describe the optimal pattern of infant growth in the UK (UK-WHO charts). These are based on studies of babies in 7 countries around the world and no significant difference was found between their growth profiles. The proposal from the four scientists that babies are treated differently depending on where they live conflicts with the findings of this research. The mean age at introduction of solids to this cohort of breastfed infants in the WHO studies was 5.4 months (or “..about 6-months”).
  • The UK policy is to introduce complementary foods at around 6-months and progress responsively, in line with individual babies’ progress and acceptance. Not all babies need solids at the same time: in every aspect of infant development there is a wide range of normal. Very importantly the introduction of the new policy in 2003 has been associated with a marked reduction in the numbers of mothers giving solids very early (i.e. before 4-months). Since it is widely accepted that very early introduction carries greater risk (particularly of coeliac disease), the UK policy could be considered from this perspective a success.
  • The practice of ‘baby-led weaning’ is becoming more widespread, where babies are allowed to experiment with appropriately prepared family foods and decide for themselves when to eat. Experience in this area suggests that babies naturally start to ingest complementary foods at around 6 months of age, when various developmental factors (hand-eye coordination, mastication ability etc) come together. This may be an evolved natural behaviour that has been lost through the practice of spoon feeding prepared cereal paps. Further research is required in this area.
  • Marianne Monie, Chair of the UK Breastfeeding Network, made an important point about the risk of swine flu: The evidence supports introducing food when a baby is developmentally ready at around 6 months. Introducing food or infant formula before that time increases the risk of infections. Questioning the wisdom of the six-month guideline at a time when babies are at risk of catching swine flu is unfortunate, because exclusive breastfeeding reduces the risk of secondary infections that can be serious enough to need hospital admission. Parents should not feel pressured into rushing their baby onto solid food. Waiting until around six months gives another two valuable months of additional protection against chest and stomach infection.”
For more information contact:
Elisabeth Sterken, MSc, RD
Director INFACT Canada