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What are the Risks Associated with Formula Feeding? A Re-Analysis and Review

Authors

  • Melinda E. McNiel MPH,

    1. Melinda E. McNiel is an MD candidate at the University of North Carolina School of Medicine, Charlotte; Miriam H. Labbok is Professor and Director and Sheryl W. Abrahams is Research and Development Consultant at the Carolina Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
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  • Miriam H. Labbok MD, MPH, FACPM,

    1. Melinda E. McNiel is an MD candidate at the University of North Carolina School of Medicine, Charlotte; Miriam H. Labbok is Professor and Director and Sheryl W. Abrahams is Research and Development Consultant at the Carolina Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
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  • Sheryl W. Abrahams MPH

    1. Melinda E. McNiel is an MD candidate at the University of North Carolina School of Medicine, Charlotte; Miriam H. Labbok is Professor and Director and Sheryl W. Abrahams is Research and Development Consultant at the Carolina Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
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  • This work was supported by the Carolina Global Breastfeeding Institute (CBI) at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. All data calculations were performed with the guidance and support of the Odum Institute for Research and Social Science at the University of North Carolina at Chapel Hill, North Carolina, USA.

Address correspondence to Melinda E. McNiel, MPH, MD candidate, The University of North Carolina School of Medicine, 2632-A Park Road, Charlotte, NC 28209, USA.

Abstract

Abstract:  Background:  Most infant feeding studies present infant formula use as “standard” practice, supporting perceptions of formula feeding as normative and hindering translation of current research into counseling messages supportive of exclusive breastfeeding. To promote optimal counseling, and to challenge researchers to use exclusive breastfeeding as the standard, we have reviewed the scientific literature on exclusive breastfeeding and converted reported odds ratios to allow discussion of the “risks” of any formula use.

Methods:  Studies indexed in PubMed that investigated the association between exclusive breastfeeding and otitis media, asthma, types 1 and 2 diabetes, atopic dermatitis, and infant hospitalization secondary to lower respiratory tract diseases were reviewed. Findings were reconstructed with exclusive breastfeeding as the standard, and levels of significance calculated.

Results:  When exclusive breastfeeding is set as the normative standard, the re-calculated odds ratios communicate the risks of any formula use. For example, any formula use in the first  6 months is significantly associated with increased incidence of otitis media (OR: 1.78, 95% CI: 1.19, 2.70 and OR: 4.55, 95% CI: 1.64, 12.50 in the available studies; pooled OR for any formula in the first 3 mo: 2.00, 95% CI: 1.40, 2.78). Only shorter durations of exclusive breastfeeding are available to use as standards for calculating the effect of “any formula use” for type 1 diabetes, asthma, atopic dermatitis, and hospitalization secondary to lower respiratory tract infections.

Conclusions:  Exclusive breastfeeding is an optimal practice, compared with which other infant feeding practices carry risks. Further studies on the influence of presenting exclusive breastfeeding as the standard in research studies and counseling messages are recommended. (BIRTH 37:1 March 2010)

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