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Role of breast-feeding in managing malnutrition and infectious disease

Published online by Cambridge University Press:  28 February 2007

Suzanne M. Filteau
Suzanne M. Filteau*
Affiliation:
Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
*
Corresponding author:Dr Suzanne Filteau, fax +44 (0)20 7404 2062, email sfilteau@ich.ucl.ac.uk
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Abstract

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Breast-feeding policy tends to be an emotive issue. International agencies recommend exclusive breast-feeding for 4–6 months followed by continued partial breast-feeding into the second year of life in order to promote infant and child health and minimize the damage caused by the malnutrition–infection cycle. To what extent are these recommendations supported by the experimental evidence? Are they a simplification for emotional reasons or public health purposes? Breast-feeding is believed to benefit infants because breast milk contains the ideal mix of nutrients for infants, because it contains factors which promote development of the infant’s gut and immune system and which prevent pathogen invasion, and because exclusive breast-feeding prevents intake of pathogens in food or water. However, some apparently contradictory evidence exists. First, in environments which are not highly contaminated breast-fed infants tend to growth falter relative to those fed formula. Second, in such environments partial breast-feeding is not associated with significantly increased gut damage relative to exclusive breast-feeding, suggesting that active promotion of gut development by breast-feeding is more important than simple avoidance of pathogens from other foods. Third, many immune factors in breast milk are probably present primarily to protect the mother, not the infant. Finally, breast milk itself may contain bacteria or viruses. This problem has come to the fore with the human immunodeficiency virus epidemic, since it is clear breast-feeding is an important mode of mother-to-child transmission. The present review will examine these challenges to the basis of the international infant feeding recommendations and will suggest that the science does actually support the policy.

Keywords

Breast-feedingInfantsMaternal healthImmunityHuman immunodeficiency virus
Type
Symposium on ‘Nutrition and immunity’
Information
Proceedings of the Nutrition Society , Volume 59 , Issue 4 , November 2000 , pp. 565 - 572
Copyright
Copyright © The Nutrition Society 2000

References

Anderson, JW, Johnstone, BM & Remley, DT (1999) Breast-feeding and cognitive development: a meta-analysis. American Journal of Clinical Nutrition 70, 525–535.CrossRefGoogle ScholarPubMed
Barber, MR & Yang, TJ (1998) Chemotactic activities in nonmastitic and mastitic mammary secretions: presence of interleukin-8 in mastitic but not nonmastitic secretions. Clinical and Diagnostic Laboratory Immunology 5, 82–86.CrossRefGoogle Scholar
Brakohiapa, LA, Bille, A, Quansah, E, Kishi, K, Yartey, J, Harrison, E, Armar, MA & Yamamoto, S (1988) Does prolonged breastfeeding adversely affect a child's nutritional status? Lancet ii, 416–418.CrossRefGoogle Scholar
Briend, A & Bari, A (1989) Breastfeeding improves survival, but not nutritional status, of 12–35 month old children in rural Bangladesh. European Journal of Clinical Nutrition 43, 603–608.Google Scholar
Brown, K, Dewey, K & Allen, L (1998) Complementary Feeding of Young Children in Developing Countries. Geneva: WHO.Google Scholar
Brown, KH, Black, RE, de Romana, GL & de Kanashiro, HC (1989) Infant-feeding practices and their relationship with diarrheal and other diseases in Huascar (Lima), Peru. Pediatrics 83, 31–40.CrossRefGoogle ScholarPubMed
Brown, KH & Perez, F (1992) Determinants of dietary intake during childhood diarrhea and implications for appropriate nutritional therapy. Acta Paediatrica Suppl. 381, 127–132.CrossRefGoogle ScholarPubMed
Buescher, ES & McIlheran, SM (1988) Antioxidant properties of human colostrum. Pediatric Research 24, 14–19.CrossRefGoogle ScholarPubMed
Buescher, ES & McIlheran, SM (1993) Polymorphonuclear leukocytes and human colostrum: effects of in vivo and in vitro exposure. Journal of Pediatric Gastroenterology and Nutrition 17, 424–433.CrossRefGoogle ScholarPubMed
Calhoun, DA, Lunoe, M, Du, Y, Staba, SL & Christensen, RD (1999) Concentrations of granulocyte colony-stimulating factor in human milk after in vitro simulations of digestion. Pediatric Research 46, 767–771.CrossRefGoogle ScholarPubMed
Chang, S-J (1990) Antimicrobial proteins of maternal and cord sera and human milk in relation to maternal nutritional status. American Journal of Clinical Nutrition 51, 183–187.CrossRefGoogle ScholarPubMed
Chen, DC, Nommsen-Rivers, L, Dewey, KG & Lonnerdal, B (1998) Stress during labour and delivery and early lactation performance. American Journal of Clinical Nutrition 68, 335–344.CrossRefGoogle ScholarPubMed
Connor, AE (1979) Elevated levels of sodium and chloride in milk from mastitic breast. Pediatrics 63, 910–911.CrossRefGoogle Scholar
Coutsoudis, A, Pillay, K, Spooner, E, Kuhn, L & Coovadia, HM (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet 354, 471–476.CrossRefGoogle ScholarPubMed
Crago, SS, Prince, SJ, Pretlow, TG, McGhee, JR & Mestecky, J (1979) Human colostral cells. I. Separation and characterization. Clinical and Experimental Immunology 38, 585–597.Google ScholarPubMed
Defrance, T, Vanbervliet, B, Briere, F, Durand, I, Rousset, F & Banchereau, J (1992) Interleukin 10 and transforming growth factor-β cooperate to induce anti-CD40-activated naive human B cells to secrete immunoglobulin A. Journal of Experimental Medicine 175, 671–682.CrossRefGoogle Scholar
Dignass, AU & Podolsky, DK (1993) Cytokine modulation of intestinal epithelial cell restitution: central role of transforming growth factor-β. Gastroenterology 105, 1323–1332.CrossRefGoogle ScholarPubMed
Donovan, SM & Odle, J (1994) Growth factors in milk as mediators of infant development. Annual Review of Nutrition 14, 147–167.CrossRefGoogle ScholarPubMed
Dunn, DT, Newell, M-L, Ades, AE & Peckham, CS (1992) Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 340, 585–588.Google ScholarPubMed
Filteau, SM (2000) Milk components with immunomodulatory potential. Advances in Nutritional Research (In the Press).Google Scholar
Filteau, S & Tomkins, A (1994) Infant feeding and infectious disease. In Infant Nutrition: Issues in Nutrition and Toxicology, pp. 143–162 [Walker, AF and Rolls, BA, editors]. London: Chapman and Hall.CrossRefGoogle Scholar
Filteau, SM, Leitz, G, Mulokozi, G, Bilotta, S, Henry, CJK & Tomkins, AM (1999 a) Milk cytokines and subclinical breast inflammation in Tanzanian women: effects of dietary red palm oil and sunflower oil supplementation. Immunology 97, 595–600.CrossRefGoogle ScholarPubMed
Filteau, SM, Rice, AL, Ball, JJ, Chakraborty, J, Stoltzfus, R, de Francisco, A & Willumsen, JF (1999 b) Breast milk immune factors in Bangladeshi women supplemented postpartum with retinol or β-carotene. American Journal of Clinical Nutrition 69, 953–958.CrossRefGoogle ScholarPubMed
Garofalo, R, Chheda, S, Mei, F, Palkowetz, KH, Rudloff, HE, Schmalstieg, FC, Rassin, DK & Goldman, AS (1995) Interleukin-10 in human milk. Pediatric Research 37, 444–449.CrossRefGoogle ScholarPubMed
Goldblum, RM, Schanler, RJ, Garza, C & Goldman, AS (1989) Human milk feeding enhances the urinary excretion of immunologic factors in low birth weight infants. Pediatric Research 25, 184–188.CrossRefGoogle ScholarPubMed
Goldman, AS (1993) The immune system of human milk: antimicrobial, antiinflammatory and immunomodulatory properties. Pediatric Infectious Disease Journal 12, 664–671.CrossRefGoogle Scholar
Gonzalez-Cossio, T, Habicht, J-P, Rasmussen, KM & Delgado, HL (1998) Impact of food supplementation during lactation on infant breast-milk intake and on the proportion of infants exclusively breast-fed. Journal of Nutrition 128, 1692–1702.CrossRefGoogle ScholarPubMed
Goto, K, Chew, F, Torun, B, Peerson, JM & Brown, KH (1999) Epidemiology of altered intestinal permeability to lactulose and mannitol in Guatemalan infants. Journal of Pediatric Gastroenterology and Nutrition 28, 282–290.Google ScholarPubMed
Grazioso, CF & Buescher, ES (1996) Inhibition of neutrophil function by human milk. Cellular Immunology 168, 125–132.CrossRefGoogle ScholarPubMed
Hahn-Zoric, M, Fulconis, F, Minoli, I, Moro, G, Carlsson, B, Bottiger, M, Raiha, N & Hanson, LA (1990) Antibody responses to parenteral and oral vaccines are impaired by conventional and low protein formulas as compared to breast-feeding. Acta Paediatrica Scandinavica 79, 1137–1142.CrossRefGoogle ScholarPubMed
Hamosh, M (1998) Protective function of proteins and lipids in human milk. Biology of the Neonate 74, 163–176.CrossRefGoogle ScholarPubMed
Harmsen, MC, Swart, PJ, de Bethune, M-P, Pauwels, R, De Clercq, E, The, TH & Maijer, DKF (1995) Antiviral effects of plasma and milk proteins: lactoferrin shows potent activity against both human immunodeficiency virus and human cytomegalovirus replication in vitro. Journal of Infectious Diseases 172, 380–388.CrossRefGoogle ScholarPubMed
Hasselbalch, H, Engelmann, MDM, Ersboll, AK, Jeppesen, DL & Fleischer-Michaelsen, K (1999) Breast-feeding influences thymic size in late infancy. European Journal of Pediatrics 158, 964–967.CrossRefGoogle ScholarPubMed
Hasselbalch, H, Jeppesen, DL, Engelmann, MDM, Michaelsen, KF & Nielsen, MB (1996) Decreased thymus size in formula-fed infants compared with breastfed infants. Acta Paediatrica 85, 1029–1032.CrossRefGoogle ScholarPubMed
Hawkes, JS, Neumann, MA & Gibson, RA (1999) The effect of breast feeding on lymphocyte subpopulations in healthy term infants at 6 months of age. Pediatric Research 45, 648–651.CrossRefGoogle Scholar
Herias, MV, Cruz, JR, Gonzalez-Cossio, T, Nave, F, Carlsson, B & Hanson, LA (1993) The effect of caloric supplementation on selected milk protective factors in undernourished Guatemalan mothers. Pediatric Research 34, 217–221.CrossRefGoogle ScholarPubMed
Howie, PW, Forsyth, JS, Ogston, SA, Clark, A & Florey, CV (1990) Protective effect of breast feeding against infection. British Medical Journal 300, 11–16.CrossRefGoogle ScholarPubMed
Ishizaka, S, Kimoto, M, Tsujii, T & Saito, S (1994) Antibody production system modulated by oral administration of human milk and TGF-β. Cellular Immunology 159, 77–84.CrossRefGoogle ScholarPubMed
Keeney, SE, Schmalstieg, FC, Palkowetz, KH, Rudloff, HE, Le, B-M, & Goldman, AS (1993) Activated neutrophils and neutrophil activators in human milk: increased expression of CD11b and decreased expression of L-selectin. Journal of Leukocyte Biology 54, 97–104.CrossRefGoogle ScholarPubMed
Khin-Maung-U, , Nyunt-Nyunt-Wai, , Myo-Khin, , Mu-Mu-Khin, , Tin-U, & Thane-Toe, (1985) Effect on clinical outcome of breast feeding during acute diarrhea. British Medical Journal 290, 587–589.CrossRefGoogle Scholar
Kling, PJ, Sullivan, TM, Roberts, RA, Phillips, AF & Koldovsky, O (1998) Human milk as a potential enteral source of erythropoietin. Pediatric Research 43, 216–221.CrossRefGoogle ScholarPubMed
Kumar, RM & Shahul, S (1998) Role of breast-feeding in transmission of hepatitis C virus to infants of HCV-infected mothers. Journal of Hepatology 29, 191–197.CrossRefGoogle ScholarPubMed
Leroy, V, Newell, M-L, Dabis, F, Peckham, C, Van de Perre, P, Bulterys, M, Kind, C, Simonds, RJ, Wiktor, S & Msellati, P (1998) International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Lancet 352, 597–600.CrossRefGoogle ScholarPubMed
Letterio, JJ, Geiser, AG, Kulkarni, AB, Roche, NS, Sporn, MB & Roberts, AB (1994) Maternal rescue of transforming growth factor-β1 null mice. Science 264, 1936–1938.CrossRefGoogle Scholar
Lonnerdal, B, Forsum, E, Gebre-Medhin, M & Hambraeus, L (1976) Breast milk composition in Ethiopian and Swedish mothers. II. Lactose, nitrogen and protein contents. American Journal of Clinical Nutrition 29, 1134–1141.CrossRefGoogle ScholarPubMed
Lonnerdal, B, Zavaleta, N, Kusunoki, L, Lanata, CF, Peerson, JM & Brown, KH (1996) Effect of postpartum maternal infection on proteins and trace elements in colostrum and early milk. Acta Pediatrica 85, 537–542.CrossRefGoogle ScholarPubMed
Lundin, BS, Karlsson, MR, Svensson, LA, Hanson, LA, Dahlgren, UIH & Telemo, E (1999) Active suppression in orally tolerized rats coincides with in situ transforming growth factor-beta expression in the draining lymph nodes. Clinical and Experimental Immunology 116, 181–187.CrossRefGoogle ScholarPubMed
Lunn, PG, Northrop-Clewes, CA & Downes, RM (1991) Intestinal permeability, mucosal injury, and growth faltering in Gambian infants. Lancet 338, 907–910.CrossRefGoogle ScholarPubMed
Miotti, PG, Taha, TET, Kumwenda, NI, Broadhead, R, Mtimavalye, LAR, Van der Hoeven, L, Chiphangwi, JD, Liomba, G & Biggar, RJ (1999) HIV transmission through breastfeeding: a study in Malawi. Journal of the American Medical Association 282, 744–749.CrossRefGoogle ScholarPubMed
Miranda, R, Saravia, NG, Ackerman, R, Murphy, N, Berman, S & McMurray, DN (1983) Effect of maternal nutritional status on immunological substances in human colostrum and milk. American Journal of Clinical Nutrition 37, 632–640.CrossRefGoogle ScholarPubMed
Morton, JA (1994) The clinical usefulness of breast milk sodium in the assessment of lactogenesis. Pediatrics 93, 802–806.CrossRefGoogle ScholarPubMed
Narayanan, I, Murthy, NS, Prakash, K & Gujral, VV (1984) Randomised controlled trial of effect of raw and holder pasteurised human milk and of formula supplements on incidence of neonatal infection. Lancet ii, 1111–1113.CrossRefGoogle Scholar
Newburg, DS (1997) Do the binding properties of oligosaccharides in milk protect human infants from gastrointestinal bacteria? Journal of Nutrition 127, 980S–984S.CrossRefGoogle ScholarPubMed
Newburg, DS, Linhardt, RJ, Ampofo, SA & Yolken, RH (1995) Human milk glycosaminoglycans inhibit HIV glycoprotein gp120 binding to its host cell CD4 receptor. Journal of Nutrition 125, 419–424.Google ScholarPubMed
Nicoll, A, Newell, M-L, Van Praag, E, Van de Perre, P & Peckham, C (1995) Infant feeding policy and practice in the presence of HIV-1 infection. AIDS 9, 107–119.CrossRefGoogle ScholarPubMed
Northrop-Clewes, CA, Lunn, PG & Downes, RM (1997) Lactose maldigestion in breast-feeding Gambian infants. Journal of Pediatric Gastroenterology and Nutrition 24, 257–263.Google ScholarPubMed
Nube, M & Asenso-Okyere, WK (1996) Large nutritional differences in nutritional status between fully weaned and partially breast fed children beyond the age of 12 months. European Journal of Clinical Nutrition 50, 171–177.Google ScholarPubMed
Pabst, HF & Spady, DW (1990) Effect of breast-feeding on antibody response to conjugate vaccine. Lancet 336, 269–270.CrossRefGoogle ScholarPubMed
Peaker, M (1974) Recent advances in the study of monovalent ion movements across the mammary epithelium: relation to onset of lactation. Journal of Dairy Science 58, 1042–1047.CrossRefGoogle Scholar
Perez-Escamilla, R, Cohen, RJ, Brown, KH, Rivera, LL, Canahuati, J & Dewey, KG (1995) Maternal anthropometric status and lactation performance in a low-income Honduran population: evidence for the role of infants. American Journal of Clinical Nutrition 61, 528–534.CrossRefGoogle Scholar
Peterson, JA, Patton, S & Hamosh, M (1998) Glycoproteins of the human milk fat globule in the protection of the breast-fed infant against infections. Biology of the Neonate 74, 143–162.CrossRefGoogle ScholarPubMed
Pickering, LK, Granoff, DM, Erickson, JR, Masor, ML, Cordle, CT, Schaller, JP, Winship, TR, Paule, CL & Hilty, MD (1998) Modulation of the immune system by human milk and infant formula containing nucleotides. Pediatrics 101, 242–249.CrossRefGoogle ScholarPubMed
Planchon, SM, Martins, CAP, Guerrant, RL & Roche, JK (1994) Regulation of intestinal epithelial barrier function by TGF-β1. Journal of Immunology 153, 5730–5739.CrossRefGoogle Scholar
Prentice, A (1987) Breast feeding increases concentrations of IgA in infants' urine. Archives of Disease in Childhood 62, 792–795.CrossRefGoogle ScholarPubMed
Prentice, A, Prentice, AM, Cole, TJ & Whitehead, RG (1983) Determinants of variations in breast milk protective factor concentrations of rural Gambian mothers. Archives of Disease in Childhood 58, 518–522.CrossRefGoogle ScholarPubMed
Prentice, A, Prentice, AM & Lamb, WH (1985) Mastitis in rural Gambian mothers and the protection of the breast by milk antimicrobial factors. Transactions of the Royal Society of Tropical Medicine and Hygiene 79, 90–95.CrossRefGoogle ScholarPubMed
Rasmussen, KM (1992) The influence of maternal nutrition on lactation. Annual Review of Nutrition 12, 103–117.CrossRefGoogle ScholarPubMed
Sazawal, S, Bhan, MK & Bhandari, N (1992) Type of milk feeding during acute diarrhea and the risk of persistent diarrhea: a case control study. Acta Paediatrics Suppl. 381, 93–97.CrossRefGoogle ScholarPubMed
Schroten, H, Bosch, M, Nobis-Bosch, R, Kohler, H, Hanisch, F-G, & Plogmann, R (1999) Secretory immunoglobulin A is a component of the human milk fat globule membrane. Pediatric Research 45, 82–86.CrossRefGoogle ScholarPubMed
Semba, RD, Kumwenda, N, Hoover, DR, Taha, TE, Quinn, TC, Mtimavalye, L, Biggar, RJ, Broadhead, R, Miotti, PG, Sokoll, LJ, van der Hoeven, L & Chiphangwi, JD (1999 a) Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. Journal of Infectious Diseases 180, 93–98.CrossRefGoogle ScholarPubMed
Semba, RD, Kumwenda, N, Taha, TE, Hoover, DR, Lan, Y, Eisinger, W, Mtimavalye, L, Broadhead, R, Miotti, PG, van der Hoeven, L & Chiphangwi, JD (1999 b) Mastitis and immunological factors in breast milk of lactating women in Malawi. Clinical and Diagnostic Laboratory Immunology 6, 671–674.CrossRefGoogle ScholarPubMed
Shuster, DE, Kehrli, ME & Baumrucker, CR (1995) Relationship of inflammatory cytokines, growth hormone, and insulin-like growth factor-1 to reduced performance during infectious disease. Proceedings of the Society for Experimental Biology and Medicine 210, 140–149.CrossRefGoogle ScholarPubMed
Shuster, DE, Kehrli, ME & Stevens, MG (1993) Cytokine production during endotoxin-induced mastitis in lactating dairy cows. American Journal of Veterinary Research 54, 80–85.CrossRefGoogle ScholarPubMed
Shuster, DE, Lee, EK & Kehrli, ME (1996) Bacterial growth, inflammatory cytokine production, and neutrophil recruitment during coliform mastitis in cows within ten days after calving, compared with cows in mid-lactation. American Journal of Veterinary Research 57, 1569–1575.CrossRefGoogle Scholar
Silfverdal, SA, Bodin, L, Hugosson, S, Garpenholt, O, Werner, B, Esbjorner, E, Lindquist, B & Olcen, P (1997) Protective effect of breastfeeding on invasive. Haemophilus influenzae infection: a case-control study in Swedish preschool children. International Journal of Epidemiology 26, 443–450.CrossRefGoogle ScholarPubMed
Thomsen, AC, Espersen, T & Maigaard, S (1984) Course and treatment of milk stasis, noninfectious inflammation of the breast, and infectious mastitis in nursing women. American Journal of Obstetrics and Gynecology 149, 492–495.CrossRefGoogle ScholarPubMed
Uauy, R, Stringel, G, Thomas, R & Quan, R (1990) Effect of dietary nucleosides on growth and maturation of the developing gut in the rat. Journal of Pediatric Gastroenterology and Nutrition 10, 497–503.Google ScholarPubMed
Van de Perre, P (1995) Postnatal transmission of human immunodeficiency virus type 1: the breast-feeding dilemma. American Journal of Obstetrics and Gynecology 173, 483–487.CrossRefGoogle ScholarPubMed
Victora, CG, Vaughan, JP, Martines, JC & Barcelos, LB (1984) Is prolonged breast-feeding associated with malnutrition? American Journal of Clinical Nutrition 39, 307–314.Google ScholarPubMed
Vochem, M, Hamprecht, K, Jahn, G & Speer, CP (1998) Transmission of cytomegalovirus to preterm infants through breast milk. Pediatric Infectious Disease Journal 17, 53–58.CrossRefGoogle ScholarPubMed
Waller, KP, Colditz, IG, Flapper, P & Seow, H-F (1997) Leukocyte and cytokine accumulation in the ovine teat and udder during endotoxin-induced inflammation. Veterinary Research Communications 21, 101–115.CrossRefGoogle ScholarPubMed
Warden, RA, Noltorp, RS, Francis, JL, Dunkley, PR & O'Loughlin, EV (1997) Vitamin A deficiency exacerbates methotrexate-induced jejunal injury in rats. Journal of Nutrition 127, 770–776.CrossRefGoogle ScholarPubMed
Willumsen, JF, Filteau, SM, Coutsoudis, A, Uebel, KE, Newell, M-L, & Tomkins, AM (2000) Subclinical mastitis as a risk factor for mother-infant HIV transmission. In Short and Long Term Effects of Breast Feeding on Child Health [Koletzko, B, editor\. London and New York: Kluwer Academic/Plenum Publishing.Google Scholar
World Health Organization (1993). Breast-feeding: The Technical Basis and Recommendations for Action. Geneva: WHO.Google Scholar
World Health Organization Working Group on Infant Growth (1994). An Evaluation of Infant Growth. Geneva: WHO.Google Scholar
Wright, AL, Bauer, M, Naylor, A, Sutcliffe, E & Clark, L (1998) Increasing breastfeeding rates to reduce infant illness at the community level. Pediatrics 101, 837–844.CrossRefGoogle ScholarPubMed
Zavaleta, N, Lanata, C, Butron, B, Peerson, JM, Brown, KH & Lonnerdal, B (1995) Effect of acute maternal infection on quantity and composition of breast milk. American Journal of Clinical Nutrition 62, 559–563.CrossRefGoogle ScholarPubMed