Laktation_und_Stillen_2016-3 EN Web p1-10

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COVER STORY
› es if the child is breastfed for less than six
months. [23, 24] And not breastfeeding for at
least this long increases the risk of middle
ear infections. [25]
Diabetes
Not breastfeeding increases the risk of diabetes
type 2 (IDDM). This correlation is
dose-dependent both for children and for
[26, 27, 28, 29]
their mothers.
Obesity
The less time a baby is breastfed, the higher
the risk of obesity in childhood. [30]
Childhood Cancer
Breastfeeding for six months reduces the
risk of leukemia in childhood by 19 %. [31]
The high amount of TNF-related apoptosis-inducing
ligands (TRAIL) in colostrum
and mature mother’s milk also act against
other kinds of cancer in childhood. [32]
Malocclusion
The connection between breastfeeding and
normal oral development is not yet completely
clear – partially due to the small
number of subjects and partially due to
confounding factors, such as partial breastfeeding
and the use of pacifiers. Nevertheless,
a recent study [33] has shown that
children who were exclusively breastfed
between 3 and 5.9 months had 41 % less
malocclusion than children who were never
breastfed. Those children who were exclusively
breastfed for six months had 72 %
less malocclusion.
Multiple Sclerosis
There are still very few studies which explore
the effect of breastfeeding on the
development of multiple sclerosis in the
child’s later life. According to one study
from the 1990s [34] there is a two- to threefold
increased risk for multiple sclerosis if
a baby is breastfed for fewer than seven
months (or not at all). Newer research indicates
that breastfeeding for at least four
months halves the risk of MS in later life. [35]
Long-term Breastfeeding is also good
for mothers
For young women and those of middle age,
a shorter breastfeeding duration increases
the risk of developing diabetes 2. For
women who have given birth within the
previous 15 years, every year of breastfeeding
reduces the risk by another 15 %. [36]
A study in China indicates that a mother
who breastfeeds less than six months
compared to a woman who breastfeeds
a child for two years, doubles her risk
of breast cancer. [37] A meta-analysis of
30 countries also confirms that increased
risk. [38] The relative risk of breast cancer
is reduced by 4.3 % for every 12 months a
mother breastfeeds. This study also shows
that the advantages for mothers who have
breastfed for more than two years over
their lifetime were doubled by comparison
to mothers who breastfed for one year.
The risks for ovarian [39] and uterine [40]
cancer for women under 55 who have had
a shorter period of breastfeeding are also
increased.
Breastfeeding in the Second Year of
Life and Beyond
What arguments are there for continuing
breastfeeding after the first birthday? Surprisingly,
there are quite a lot of them. Nutrition,
for example.
Mother’s milk has 70 [41] -75 [42] kilocalories
per 100 ml. These calories can make a
great difference to the toddler’s nutritional
status – especially, but not only, in developing
countries. A classic but still relevant
work in this area [43] cites research to the
effect that, in some areas, children over
18 months who are still breastfeeding in
addition to eating complementary foods,
may have a 17 % higher energy intake than
those who are weaned from the breast. Between
the 6 th and the 24 th month of life, the
amount of breastmilk is about 500 ml per
day and, thus, contains a large proportion
of the calories that a child needs in these
months. Should it be necessary, the milk
production can be increased and a child
who normally eats solids can again, for a
short period, be exclusively nourished by
breastmilk.
Between 12 and 23 months, 448 ml of
mother’s milk covers: [44]
29 % of the energy requirement
43 % of the protein requirement
36 % of the calcium requirement
75 % of the Vitamin A requirement
76 % of the folic acid requirement
94 % of the Vitamin B12 requirement
60 % of the Vitamin C requirement
Bioavailability, Vitamins and Minerals
The calories in mother’s milk are not empty
calories. Mother’s milk remains an important
source of protein, vitamins and other
nutrients – high quality and bioavailable.
How much of a nutrient is in the milk is
not the most interesting question. Rather,
we should be asking: “Is it bioavailable?” It’s
no use if it is only there and the baby cannot
make use of it.
Protein in mother’s milk, for instance
is particularly well-absorbed. In the second
year of life, mother’s milk covers about
29 % of the child’s protein needs. And the
story with vitamins and minerals is even
more gratifying. In the second year of life,
mother’s milk covers three-quarters of the
child’s vitamin A requirements. In developing
countries this can be particularly important.
In Africa, for instance, non-breastfed
children have a six-to-eight fold increased
risk of being afflicted with xerophthalmia
(“dry eyes”), caused by a lack of vitamin
A, compared to breastfed children. [45] This
protection continues throughout the entire
breastfeeding period.
About 43 % of the iron requirement
between one and two years can be met
through the mother’s milk. The iron level
is, indeed, lower in mother’s milk than in
cow’s milk but up to 50 % is absorbed [46]
(4 % of the iron in cow’s milk is absorbed)
so a breastfed child is better supplied with
iron than is a non-breastfed child.
Immune Factors
Immune factors remain important in
the second and third years of life and beyond.
Today it is known that the amount
of immunoglobulin rises after the sixth
month of life, apparently as a reaction to
the declining amount of milk. In a new
article [47] the authors write “Human milk
in the second year postpartum contained
significantly higher concentrations of total
protein, lactoferrin, lysozyme and immunoglobulin
A, than milk bank samples…”
The milk in the second year postpartum
was compared to pooled, unpasteurized
milk samples from 51 approved donors less
than one year postpartum.
When we consider this, it is also quite
logical that some protective factors increase
at this time because children become
quite mobile from about six months. They
go everywhere and put everything in their
mouths. They need as much protection as
we can offer them!
This protection comes about through
various immune factors, among them:
Lysozyme, an unspecific antimicrobial
factor which is concentrated in mother’s
milk reaches its highest level after six
months. [48] 1 ml of mother’s milk contains
around 4000 living cells (predominantly
lymphocytes and macrophages) which hinder
the growth of bacteria, virus, fungi and
parasites.
The bifidus factor in mother’s milk
continues to promote the growth of lactobacillus
bifidus in the child’s intestine
www.elacta.eu Lactation & Breastfeeding 3 • 2016