Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceThe case for breastfeedingAll current guidelines, including those from the Department of Health (DH), recommend exclusivebreastfeeding for newborns and for the first six months of infancy. Breast milk provides all thenutrients required at this age in a form that is hygienic and easy to digest. The protein,carbohydrate and fat profiles are unique to breast milk and differ in many ways from other animalmilks. 126 Breast milk also contains a range of bioactive components, including anti-microbial andanti-inflammatory factors, digestive enzymes, hormones and growth factors. 126, 127 Anti-microbialagents include leucocytes, secretory immunoglobulin (Ig)A, IgM and IgG antibodies, oligosaccharides,lysozyme, lactoferrin, lipids, fatty acids and mucins. Growth factors are thought to be importantfor gut maturation. Lactoferrin is one of several specific binders in human milk that greatly increasethe bioavailability of micronutrients.Key messageAll current guidelines, including those from DH, recommend exclusive breastfeeding for thefirst six months after birth.The volume and composition of breast milk vary with the stage of lactation, within each individualfeed, and with maternal nutritional status. 126 Recent research in animals has shown that reducedfetal growth caused by placental insufficiency can impair the quality and quantity of breast milk. 128Colostrum, produced during the first few days is low in volume and nutrient content but high inanti-microbial factors. Volume and nutrient content reach a peak, in mature breast milk, severalweeks after birth. The mother’s macronutrient intakes do not have much influence on milkcomposition, but her diet does affect the long-chain fatty acid and vitamin content of her milk.Breastfed infants have more control over the flow of milk than bottle-fed infants. Breastfeeding istherefore often described as an ideal ‘supply and demand’ regulation system. The feedingbehaviour of the baby and the quality of the breast milk change with time in a way that mayprevent overfeeding, teach the infant how to recognise satiety signals, and regulate energy intakedifferently from formula-fed infants.The role of leptin in breast milk may be of particular importance in the early development of bothadipose tissue and appetite regulatory systems in the infant, and ultimately on propensity toobesity in later life. A recent study showed that administration of physiological levels of leptin tosuckling rats caused a significantly lower body weight in adulthood. 129 Observational studies haveshown that breastfeeding is associated with lower rates of childhood obesity. 130 Bearing in mindthe absence of leptin in formula milk, this may have important implications for the prevention ofobesity in children and in adults.26Early life nutrition and lifelong health