Literature review for - Flourish Paediatrics

EFFECTS OF FEEDING UNMODIFIED COW’S MILK TO INFANTS LESS THAN
12 MONTHS
What are the risks associated with feeding unmodified cow’s milk to infants less than 12
months of age?
Draft Evidence Statement Feeding infants with whole cow’s milk before 12
months of age is associated with an increased
incidence of iron deficiency
Draft Grade
Component Rating Notes
D
Evidence Base Satisfactory 7 studies [4 cohort study, 3 cross sectional study (2 P,
5 O)]
Consistency
Clinical impact Poor Slight
Generalisability
Applicability
Satisfactory 6 studies reported a negative association between
cow’s milk intake between 6-12 months of age and
iron status
Satisfactory Populations studied were UK, Denmark, Canada, NZ,
Iceland, Brazil and Australia
Satisfactory Results are applicable to Australian women
(Lehmann, Gray-Donald et al. 1992; Michaelsen, Milman et al. 1995; Wharf, Fox et al. 1997;
Oti-Boateng, Seshadri et al. 1998; Heath, Tuttle et al. 2002; Thorsdottir and Gunnarsson
2006; Fernandes, de Morais et al. 2008)
The studies included in the body of evidence statement are shown in the Table below
Notes on the introduction of unmodified cow’s milk in infancy
Cow’s milk feeding is the most consistent risk factor negatively influencing iron status in the
first year of life (Faldella, Corvaglia et al. 2003). Cow’s milk is a poor source of iron owing
to a low iron content and a low iron bioavailability. Consumption of cow’s milk also reduces
the bioavailability of non-haem iron provided by other foods and may be associated with
occult loss of blood from the gastrointestinal tract. A controlled trial by Ziegler and
colleagues suggested that cow’s milk can provoke microscopic intestinal bleeding if
consumed early in infancy, but this effect does not continue beyond 12 months of age.
Ziegler and colleagues compared the effects of cow’s milk feeding on stool Hb concentration
in 7.5 month old infants and 12 month old infants (Ziegler, Jiang et al. 1999). In the trial all
371