On December 12, 2013, the Norwegian Scientific Committee for Food Safety, VKM, presented its Report on the Benefit and Risk Assessment of Breastmilk for Infant Health in Norway. The media release summarises the main findings:
The Report concludes:
“Following a comprehensive assessment of scientific literature on the positive health effects of breastmilk and concentrations in breastmilk of compounds representing possible health hazards, and given current knowledge about concentrations of contaminants in Norwegian breastmilk and breastfeeding duration in Norway, VKM concludes that the benefits associated with breastmilk clearly outweigh the risk presented by current levels of contaminants in breastmilk.”
As a Norwegian breastfeeding advocate explains: “The chair of the working group, Helle Margrethe Meltzer, gave an excellent presentation concluding with a strong recommendation for breastfeeding. Contaminants in breastmilk have been an issue of concern for many years and the issue has been frequently raised in media. For us in Norway this report represents the “state of the art” which we now can refer to.”
The full report is at: http://www.english.vkm.no/dav/af230e02c9.pdf
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Benefit and risk assessment of breastmilk with focus on the infant’s health
It is important to note that Norwegian breastfeeding rates are among the highest in the world; many infants are exclusively and partially breastfed up to the age of 6 months and partially breastfed up to 12 months of age. The Report on the Benefit and Risk Assessment of Breastmilk for Infant Health in Norway concludes that “the benefits associated with breastmilk clearly outweigh the risk presented by current levels of contaminants in breastmilk. This conclusion is not affected by whether a child is exclusively or partially breastfed up to the age of 6 months and partially breastfed up to 12 months of age”.
IBFAN hopes that the publication of the Report will confirm Norway’s continued support for exclusive and continued breastfeeding, even in a contaminated world. IBFAN notes that the Report confirms the conclusions of the 2013 IBFAN Statement on Chemical Residues and Infant and Young child Feeding. http://ibfan.org/ips/IBFAN-Statement-on-Infant-and-Young-Child-Feeding-and-Chemical-Residues.pdf.
Both the Norwegian Report and the IBFAN Statement underscore the need to continue to campaign for elimination of environmental contaminants.
Although this “state of the art” risk assessment provides conclusive evidence of the benefits of breastmilk, IBFAN groups and environmentalists still need to continue campaigning to eliminate all toxic chemicals from our environment, including the food we eat, the water we drink, the cosmetics we use, as well as a reduction in all the packaging used for consumer products.
The Extensive Summary includes key conclusions and specific findings
“VKM concludes that the benefits of breastmilk clearly outweigh the possible risk of impaired neurodevelopment from contaminants in breastmilk.
VKM concludes that the benefits of breastmilk in terms of defence against infections clearly outweigh the possible risk of reduced resistance to infections from contaminants in breastmilk, at least as long as the child is breastfed.
VKM concludes that the reduced risk of overweight and obesity associated with breastfeeding clearly outweighs the possible risk presented by contaminants in breastmilk.”
The Report explains the protective effect of breastmilk
“Breastmilk also contains a number of specialised components, including growth
factors, factors with anti-microbial and anti-inflammatory properties and selected
immunological components which boost the maturation of the infant’s immune system. Infant formula fulfils the infant’s established nutritional needs, but does not provide the specific protective factors which are present only in breastmilk.”
“Breastmilk has protective properties. It contains a number of specialised components, including factors with anti-microbial and anti-inflammatory properties as well as constituents boosting the maturation of the infant’s immune system. This benefits health in childhood and most likely also later in life. The milk antibodies are targeted against potential pathogens and other antigens to which the mother has been exposed. Moreover, maturation of the infant’s immune system is influenced by contact with the immune-modulating factors in breastmilk as well as dietary and microbial constituents in the infant’s gut. Different components in breastmilk facilitate the establishment of a beneficial intestinal microbiota, which is important for induction of a balanced mucosal immune system. Through all these mechanisms, breastfeeding represents an ingenious immunologic integration of mother and child.”
Limited data on prenatal exposures
The Report affirms “It was set as an absolute inclusion criterion that the studies should provide good breastfeeding data and be able to differentiate effects of postnatal exposure from prenatal exposure”. The Report notes that “A number of the papers evaluated for risk of negative health effects found associations with prenatal exposure to contaminants which were not observed postnatally (Tables 7.5-7.13)”, and explains the reasons why: “The rapid growth of the foetus implicates high activity in cellular processes which needs to be tightly regulated. At this stage there is also immature capacity to handle and detoxify xenobiotics and limited capacity of homeostatic regulation. Hence, the unborn foetus is generally recognised as the most vulnerable being in the population regarding adverse effects from exposure to environmental contaminants or other xenobiotics such as drugs.”
Cursory review of contaminants in infant formula
The Report of the risk assessment emphasises that “The present benefit and risk assessment of breastmilk and contaminants in breastmilk does not provide an extensive review of infant formula.“ Although this is not a risk assessment of contaminants in infant formula, the report provides some information on concentrations of metals in infant formula, for example:
“Metal concentrations in both breastmilk and infant formula (e.g. mercury and lead) are generally low and not at levels associated with concern”. The Report provides more detail on lead, arsenic and aluminium:
“Thus, infant formula might contain up to three times the lead concentration of breastmilk.”
“The arsenic concentration was higher in some hypoallergenic formulas for special medical purposes than in breastmilk and in infant formula based on cow’s milk.”
“Also aluminum has been shown to be present at higher concentrations in infant formula than in breastmilk, and particularly in soy-based formula.”
Further information on concentrations is available in the studies published by Blundell and Coxley in 2010 on aluminium in infant formulas:
and in the Swedish Karolinska Institute 2010 study on High concentrations of essential and toxic elements in infant formula: http://www.ibfan.org/art/foodchem11ljungmanganeseinformula.pdf
Endocrine Disrupting Chemicals, EDCs
The report mentions EDCs such as Bisphenol A and phthalates and notes: “Data on phthalates in breastmilk or infant formula from Norway has not been found.”
However, the Report does not cover the presence of these and other EDCs in liquid and powdered formula, feeding products and packaging. It is to be hoped that a subsequent risk analysis will cover chemical and microbiological contamination of infant and follow-on formulas, in an ‘extensive review of the contaminants in infant formula’.