Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-27T23:04:08.627Z Has data issue: false hasContentIssue false

Duration of exclusive breast-feeding: introduction of complementary feeding may be necessary before 6 months of age

Published online by Cambridge University Press:  08 March 2007

John J. Reilly*
Affiliation:
Division of Developmental Medicine, University of Glasgow, Yorkhill Hospitals, Glasgow G3 8SJ, UK
Jonathan C. K. Wells
Affiliation:
MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
*
*Corresponding author: Dr John J. Reilly, fax +44 141 201 9275, email jjr2y@clinmed.gla.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The WHO recommends exclusive breast-feeding for the first 6 months of life. At present, <2 % of mothers who breast-feed in the UK do so exclusively for 6 months. We propose the testable hypothesis that this is because many mothers do not provide sufficient breast milk to feed a 6-month-old baby adequately. We review recent evidence on energy requirements during infancy, and energy transfer from mother to baby, and consider the adequacy of exclusive breast-feeding to age 6 months for mothers and babies in the developed world. Evidence from our recent systematic review suggests that mean metabolisable energy intake in exclusively breast-fed infants at 6 months is 2·2–2·4 MJ/d (525–574 kcal/d), and mean energy requirement approximately 2·6–2·7 MJ/d (632–649 kcal/d), leading to a gap between the energy provided by milk and energy needs by 6 months for many babies. Our hypothesis is consistent with other evidence, and with evolutionary considerations, and we briefly review this other evidence. The hypothesis would be testable in a longitudinal study of infant energy balance using stable-isotope techniques, which are both practical and valid.

Type
Horizons in Nutritional Science
Copyright
Copyright © The Nutrition Society 2005

References

Aiello, L & Key, K (2002) The energetic consequences of being a Homo erectus female. Am J Hum Biol 14, 551565.CrossRefGoogle ScholarPubMed
Butte, NF, Wong, WW & Hopkinson, JM (2001) Energy requirements of lactating women derived from doubly-labelled water and milk energy output. J Nutr 131, 5358.CrossRefGoogle Scholar
Department of Health (2002) Infant Feeding 2000: A Survey Conducted on Behalf of the Department of Heatlh, The Scottish Executive, The National Assembly for Wales and the Department of Health, Social Services and Public Safety in Northern Ireland. London: The Stationery Office.Google Scholar
Department of Health (2003) Infant Feeding Recommendations, May 2003. www.dh.gov.uk/assetRoot/04/09/69/99/04096999.pdf (accessed 20 June 2005). London: Department of Health.Google Scholar
Fewtrell, MF, Lucas, A & Morgan, JB (2003) Factors associated with weaning in full-term and pre-term infants. Arch Dis Child 88, F296F301.CrossRefGoogle Scholar
Freeman, JV, Cole, TJ, Chinn, TJ, Jones, PR, White, EM & Preece, MA (1995) Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 73, 1724.CrossRefGoogle ScholarPubMed
Goldberg, GR, Prentice, AM, Coward, WA, Davies, HL, Murgatroyd, PR, Sawyer, MB, Ashford, JB & Black, AE (1991) Longitudinal assessment of the components of energy balance in well nourished lactating women. Am J Clin Nutr 54, 788798.CrossRefGoogle ScholarPubMed
Kramer, MS & Kakuma, R (2002) Optimal duration of exclusive breastfeeding (Cochrane Review). In The Cochrane Library Issue 1, 2002. Oxford: Update Software.Google Scholar
Lanigan, JA, Bishop, JA, Kimber, AC & Morgan, J (2001) Systematic review concerning the age of introduction of complementary foods to the healthy full-term infant. Eur J Clin Nutr 55, 309320.CrossRefGoogle Scholar
Lovelady, CA, Meredith, CN, McCrory, MA, Nommsen, LA, Joseph, LJ & Dewey, KG (1993) Energy expenditure in lactating women: a comparison of doubly-labelled water and heart-rate monitoring methods. Am J Clin Nutr 57, 512518.CrossRefGoogle Scholar
Lucas, A, Ewing, G, Roberts, SB & Coward, WA (1987) How much energy does the breast-fed infant consume and expend? BMJ 295, 7577.CrossRefGoogle ScholarPubMed
Michaelsen, KF, Weaver, LT, Branca, F & Robertson, A (2000) Feeding and Nutrition of Infants and Young Children. WHO Regional Publications Series, no. 87. WHO: Copenhagen.Google Scholar
O'Keefe, M (1994) The first six months: so easy to miss. Aust J Fam Phys 23, 18851889.Google ScholarPubMed
Reilly, JJ, Ashworth, S & Wells, JC (2005) Energy intake in the exclusively breast-fed infant age 3–6 months from developed countries: a systematic review. Br J Nutr 94, 5663.CrossRefGoogle ScholarPubMed
Savage, SAH, Reilly, JJ, Edwards, CA & Durnin, JVGA (1998) Weaning practice and factors influencing it in the Glasgow Longitudinal Infant Growth Study. Arch Dis Child 70, 153156.CrossRefGoogle Scholar
Singhal, A, Fewtrell, M, Cole, TJ & Lucas, A (2003) Low nutrient intake and early growth for later insulin resistance in adolescents born pre-term. Lancet 361, 10891097.CrossRefGoogle Scholar
Stettler, N, Kumanyika, S, Katz, SH, Zemel, BS & Stallings, VA (2003) Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans. Am J Clin Nutr 77, 13741378.CrossRefGoogle Scholar
Stettler, N, Zemel, BS, Kumanyika, S & Stallings, VA (2002) Infant weight gain and childhood overweight status in a multicenter cohort study. Pediatrics 109, 194199.CrossRefGoogle Scholar
Trivers, RL (1974) Parent–offspring conflict. Am Zool 14, 249264.CrossRefGoogle Scholar
Wells, JCK (2003) Parent-offspring conflict theory, costly begging behaviour, signalling of nutritional need, and differential weight gain in early life. Q Rev Biol 78, 169202.CrossRefGoogle Scholar
Wells, JCK & Davies, PSW (1998) Estimation of the energy cost of physical activity in infancy. Arch Dis Child 78, 131136.CrossRefGoogle ScholarPubMed
Wilson, AC, Forsyth, JS, Greene, SA, Irvine, L, Hau, C & Howie, PW (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316, 2125.CrossRefGoogle ScholarPubMed
World Health Organization (2002 a ) Infant and Young Child Nutrition. Global strategy on Infant and Young Child Feeding. WHO Fifty-fifth World Health Assembly 16 April 2002. www.who.int/gb/ebwha/PDF_files/WHA55/ea55715.pdf (Accessed 14 April 2005). Geneva: WHO.Google Scholar
World Health Organization (2002 b) Human Energy Requirements. Report of a Joint FAO/WHO/UNU Expert Consultation. Rome: Food and Agriculture Organisation.Google Scholar
Wright, CM (2005) Growth charts for babies. BMJ 330, 13991400.CrossRefGoogle ScholarPubMed