Human Milk: Composition, Clinical Benefits and Future Opportunities. Группа авторов

Чтение книги онлайн.

      90th Nestlé Nutrition Institute Workshop Lausanne Oct. 30–Nov 1, 2017

State of Breastfeeding in the World

      Donovan SM, German JB, Lönnerdal B, Lucas A (eds): Human Milk: Composition, Clinical Benefits and Future Opportunities. Nestlé Nutr Inst Workshop Ser, vol 90, pp 1–12, (DOI: 10.1159/000490290)

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

      ______________________

Scientific Evidence for Breastfeeding

      Alan Lucas

      Institute of Child Health, University College, London, UK

      ______________________

      Abstract

      The global drive to promote breastfeeding targeted at all 134 million infants born/year on the planet is one of the most pervasive public health interventions. It is, therefore, critical that the breastfeeding field is rooted in sound evidence. Three important scientific pillars of breastfeeding have been: (1) that human milk (HM) is the product of 200 million years of mammalian evolution; (2) that HM composition should be seen as the gold standard for infant nutritional requirements; and (3) that HM has numerous clinical benefits for 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

With 200 million years of mammalian evolution, breast milk has evolved major diversity – for instance a 2% concentration of fat in mare’s milk contrasts with over 40% fat in the milk of the harp seal, where the offspring must survive extreme cold. Nevertheless, the application of evolutionary biology to human breastfeeding requires some special considerations with potential implications for practice [1].

Until relatively recently, humans lived in hunter-gatherer societies, but, in a short period, as intelligent primates, humans changed their environment dramatically, whereas our genes are still ancient. The consequent mismatch between our genes and environment is known as “evolutionary discordance.” As Cordain et al. [2] noted for adult humans, the principal phenotypic manifestation of evolutionary discordance is disease. Thus, it is proposed that the high incidence of obesity and cardiovascular disease (CVD) in modern humans is due to the mismatch between genetic adaptation and our modern diet – an example of evolutionary discordance.

The question of relevance here is whether human breastfed СКАЧАТЬ