Should the recommendations be amended to increase breastfeeding duration?
here on an excellent review of the midwife Sylvia Höfer current Fachdiskusson the start of complementary feeding, is from the wonderful page
http://www.hebamme4u.net/baby/stillen/aeltere-babys/stillenbeikost-1.html
first Breastfeeding and celiac disease
products by Sylvia Höfer
is hardly the EU directive on labeling of baby food with the WHO and NSK recommendation, at least six months exclusive breastfeeding, implemented, shake again, the first of the six-month Recommendation - led by the DGE, and (what a surprise?) the infant formula manufacturers. Their argument:
Early Beikosteinführung to reduce the risk of developing celiac disease. But the evidence on Data are inconsistent and not prove an advantage of a shorter duration of breastfeeding.
Strange that this uncertainty occurs at a time when the federal government has implemented an EU directive on labeling of infant formula and follow-on formula: with a transitional arrangement until January 2010, infant formula labeled for up to finished sixth Month of life babies breast milk only, alternatively a milk marked pre or 1 is to be fed.
The uncertainty is understandable: Competent authorities recommend looking for a departure from the writer of the World Health Organisation (WHO), the German National Breastfeeding Committee (NSC) and the German Midwives Association (DHV). And are now - allegedly scientific reasons - the rules of the European Union (EU) for the identification of infant formula feeding from 6 months to qualify.
But what the data are really like?
A worldwide breastfeeding recommendation
The current recommendations still go back to work by the WHO, published in 2002 as a results of a detailed expert advice. Since then the world based midwives, lactation consultants and other professionals on the following principle: In general, the aim should be that infants exclusively in the first 6 months through breast milk to be fed, after a special complementary foods should be introduced. Recently, the WHO has also published new recommendations for medical reasons for breast milk substitute diets. The NSK supports the WHO recommendations, "Mother's milk is the best food for most infants. Exclusive breastfeeding in the first six months for the majority of infants adequate diet. " The DHV adopted these recommendations and added them with practical recommendations to support breastfeeding.
critics say the WHO recommendation, the 6-month full breastfeeding recommendation was not a good evidence base. This is wrong! The WHO published simultaneously with the recommendation, a comprehensive study, which over the years continued and the last time was after a revision in 2006 and just re-released.
is also often stated, the focus of the WHO recommendations stood children and mothers in poor, marked by hunger, is in development countries.
That's not true. The WHO and this updated data into account all situations, from those in highly industrialized countries to those in poor countries. In addition, from 2005 to 2007 on behalf of the U.S. health authorities 9000 scientific publications on the situation in developed countries (EU, Australia, USA evaluated) (AHRQ 2007): each of 40 studies on the health of children and of women and 29 review articles, which evaluates a total of 400 individual studies. The 400-page thick report forms the basis of the official U.S. recommendations. They are not in conflict with those of WHO.
studies repeatedly show that exclusive breastfeeding through at least six months including the risk and lowering of obesity, diabetes type 1 and 2, asthma in young children, serious infections of the upper respiratory tract, childhood leukemia, sudden infant death (SIDS), nekrotisierendeEnterokolitis and non-specific gastroenteritis. For the mothers, the risks reduction for type 2 diabetes, depression, breast and ovarian cancer. This also applies to rich countries (AHRQ 2007).
second Breastfeeding and celiac disease
In celiac disease, known as celiac disease in adulthood, it is an intolerance to gluten, a protein in many cereals. An immunological response to the breakdown product of gliadin leads to inflammation of the small intestine to the destruction of the villi.
With the start of feeding of complementary foods to connect chronic recurrent diarrhea, weight loss and malnutrition. In Germany, most publications do this, 0.3 to 0.9 cases per 1000 live births from (0.03 to 0.09 per cent). These figures should be viewed with caution because only a few systematic surveys exist good about the frequency of celiac disease / sprue.
A research group in Milan was probably the first to recognize that breastfed children suffer less from celiac disease. The conclusions were formulated but still very cautious and even five years later, still restrained, although a protective effect of breast milk was apparent. The debate was sparked when celiac disease in Sweden, where infants were given relatively early Vollkornbrei increased, significantly. Since this also little gruel was fed (Oats contain little gluten), Swedish babies were about 40 times more gluten than, say Danish infants. Fälth-Magnusson et al. showed that celiac children had received most Vollkornbrei earlier and had been breast-fed less often in the introduction of this food was.
This is often referred to as "Swedish celiac disease epidemic," increase in disease by 3.5 fold in the 80s in some images returned (for example, DGE 2008) to a modified Still recommendation in 1982, although Swedish studies not changed could detect breast feeding. However
was in Sweden 1983, the composition of the first Follow-on formula changed. It contained no gluten until then, as from 4 Month should be fed. Were published for gluten-containing foods, in particular, a whole grain-based diet high Glutenghalt, the 8th from the Month should be fed. Ill infants appeared to have received these past food not as ill. Ivarsson et al. have shown that increased the risk of disease, when large quantities of gluten were suddenly introduced in the new infant formula and if not satisfied during and after the introduction of gluten.
Recently published data from 1560 children with a genetic predisposition in Colorado confirmed celiac disease in Sweden Observations: infants who received the first three months of gluten ill, 5 times more common in celiac disease. The average age of the children for a first biochemical evidence of celiac disease was 4.7 years. Although there was evidence that introducing gluten between 4 and 6 months might be associated with a lower incidence rate.
The influence of breast-feeding is difficult to evaluate: a few children were in the first few months were exclusively breastfed in the 2nd Month, already 50 percent receive cow's milk, in the 6th Months percent of 80th In the 5th Month was only half of the children were ever breastfed. A research group from Manchester in 2005 evaluated all previous Studies on the relationship of celiac disease, breastfeeding and infant formulas. Apart from a small study all showed that longer breast-fed children suffer less from celiac disease. celiac disease occurred less frequently when was breast-fed during and after the introduction of gluten. Was not clarified, however, whether breast milk the disease time only postponed or prevented the disease.
It is not clear yet what the protective effect of breast milk is based. Akobeng et al. see a possible cause in the lower rate gastroenteraler infection and inflammation in breast-fed children.
second, it could also be a correlation between IgA antibodies and immune cells der Muttermilch bestehen, die eine immunmodulatorische Wirkung auf das Immunsystem des Säuglings haben und so die Häufigkeit allergischer Reaktionen (auch gegen Gliadin) reduzieren.
Im Juli 2008 veröffentlichte die Deutsche Gesellschaft für Ernährung (DGE) eine Empfehlung, mit der sie die weltweite Stillempfehlung von WHO, NSK und DHV infrage stellte. Sie führte aus, „dass sich bei Säuglingen mit genetischer Disposition für Zöliakie die Einführung von Gluten während der Stillphase als günstig erweist, und zwar im Zeitfenster zwischen dem 4. und 6. Lebensmonat“.
Da vielen Eltern die genetische Disposition ihres Kindes nicht bekannt ist und 25 Prozent der Kinder eine Zöliakie-Disposition have (of which, however ill not 98 percent), results from a general perspective of the DGE hereby Still new recommendation: Exclusive breast-feeding without complementary feeding only until 4 Month.
The most important point raised by the DGE that in Sweden after the amendment of national breastfeeding recommendation 1996 for the introduction of small amounts of gluten from 4 Months "to" the mid-nineties showed a reduction of celiac disease. " A statistical correlation is still no evidence of a causal link.
Meanwhile, the group Ivarsson the impact of early gluten introduction in Sweden of children before and after the change compared. Although found in the second group of rare celiac disease (1.3 vs. 0.7 percent.), But the children were in the second group to the time of investigation, on average only 2.9 years old - actually too young for a reliable diagnosis.
Last year the group published by Ivarsson now the presumption that the "Swedish epidemic" is not so unique, though clearly noticeable, as was already observed again an increase in the frequency of celiac disease. was the adequacy of the surveys remains umstritten.Inzwischen Ivarsson show that half of the "Swedish epidemic" can be attributed to the fact that Swedish Children after the weaning of large amounts of gluten were given.
Another cause was the high gluten content of the Swedish baby food. The fact that children who were born in summer were more affected by the epidemic, Ivarsson leads to higher caloric food supply winter returned with a high gluten value at a time with increased infections.
Another epidemiological follow-up of affected cohorts are planned. The population study in Sweden to become the core of a European study on infant feeding and celiac disease: PREVENTCD.Ein The study aims to examine the influence of diet in their first year on the development of celiac disease zu untersuchen. PREVENTCD wird jedoch nicht nur von Universitäten,Forschungseinrichtungen und der Europäischen Kommission gefördert, sondern unter anderem auch vom Konzern Numico, deren Tochterfirma Danone Milupa vertreibt.
In der Studienleitung ist eine der Firmen vertreten, die die Screening-Diagnostik für Zöliakie anbieten. Welch ein Schelm, der dabei an wirtschaftliche Interessen denkt. Auch hier wird die Beikosteinführung ab dem 4. Monat empfohlen – wenn auch unter Vorbehalt, da die Gründe erst mit der Studie belegt werden sollen.
Zurückhaltung erwünscht
Nach Prüfung der vorliegenden Untersuchungen, Veröffentlichungen und laufenden Forschungsprojekte Clearly, the questioning of the current recommendation is still barely on scientifically backed arguments. And even if an earlier Beikosteinführung in terms of celiac disease should be beneficial (for which there is no evidence!) would still be a balance between that advantage and the proven positive effects of exclusive breastfeeding for at least 6 months to weigh.
All those who have initiated the widespread uncertainty in pregnant women and nursing mothers and the recommendations of NSK and WHO provide reasons as inadequate question is to do at least more restraint. Such profound uncertainty in the diet von Säuglingen sollte nicht ohne vorherige Fachdiskussion in die Öffentlichkeit gebracht werden.
Ich rate: Hände weg von einer leichtfertigen Infragestellung der Stillempfehlungen! Wir sollten lieber dafür eintreten, dass mehr Frauen entsprechend der weltweiten Empfehlung stillen.
Berlin, den 1.3.2009
Autorin: Silvia Höfer, Hebamme
Kontakt: silvia.hoefer@online.de
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