Consumption of breast milk, formula and other non-human milk by children aged under 2 years: analysis of eighty-six low- and middle-income countries.

OBJECTIVE: To investigate the prevalence and socio-economic inequalities in breast milk, breast milk substitutes (BMS) and other non-human milk consumption, by children under 2 years in low- and middle-income countries (LMIC). DESIGN: We analysed the prevalence of continued breast-feeding at 1 and 2 years and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-h dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socio-economic inequalities. SETTING: Nationally representative surveys from 2010 onwards from eighty-six LMIC. PARTICIPANTS: 394 977 children aged under 2 years. RESULTS: Breast-feeding declined sharply as children became older in all LMIC, especially in upper-middle-income countries. BMS consumption peaked at 6 months of age in low/lower-middle-income countries and at around 12 months in upper-middle-income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breast-feeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breast-feeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breast-feeding. CONCLUSIONS: Breast-feeding falls sharply as children become older, especially in wealthier families in upper-middle-income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences.

Infant Formula Consumption Is Positively Correlated with Wealth, Within and Between Countries: A Multi-Country Study.

BACKGROUND: In contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs. METHODS: We examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0-5 mo, and for continued breastfeeding at ages 12-15 mo through graphical presentation of coverage wealth quintiles. RESULTS: Between-country analyses showed that log GDP was inversely correlated with exclusive (r = -0.37, P < 0.001) and continued breastfeeding (r = -0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r = -0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = -0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries. CONCLUSIONS: BMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

Por que investir e o que será necessário para melhorar as práticas de amamentação? / Why invest, and what it will take to improve breastfeeding practices?

Apesar de seus benefícios estabelecidos, a amamentação não é mais uma norma em muitas comunidades. Os determinantes multifatoriais da amamentação necessitam de medidas de suporte em diversos níveis, de legislações e políticas a atitudes e valores sociais, condições de trabalho e emprego para mulheres, e serviços de saúde para possibilitar que as mulheres amamentem. Quando intervenções relevantes são oferecidas adequadamente, as práticas de amamentação são responsivas e podem melhorar rapidamente. Os melhores resultados são obtidos quando intervenções são implementadas concomitantemente por diversos canais. A propaganda de substitutos ao leite materno afeta negativamente a amamentação: as vendas em todo o mundo em 2014 de 44,8 bilhões de dólares demonstram a grande ambição competitiva da indústria com a alimentação infantil. Não amamentar está associado com menor inteligência e perdas econômicas de aproximadamente 302 bilhões de dólares anualmente ou 0,49% do produto nacional bruto mundial. A amamentação fornece, em curto e longo prazos, vantagens para a saúde, econômicas e ambientais para as crianças, mulheres e para a sociedade. Para alcançar estes ganhos, suporte político e investimento financeiro são necessários para proteger, promover e dar suporte à amamentação.

Practicas de alimentación infantil: Informe final de la investigación formativa / Practices of infantile feeding: Closing report of formativa investigation

Presenta el informe y evaluaci¢n de una investigaci¢n formativa en materia de nutrici¢n infantil y prácticas alimentarias más eficientes para su desarrollo...

Practicas de alimentación infantil: Revision de Literatura / Practices of infantile feeding: Revision of Literature

Presenta una visi¢n general sobre las consideraciones fundamentales en nutrici¢n infantil. Expone las bases para una educaci¢n nutricional de calidad, la metodolog¡a de la investigaci¢n formativa y las nuevas estrategias para alimentaci¢n infantil...