Early Life Nutrition and Lifelong Health - Lactation Science and Barriers

Question 1

Is there a biological difference between breast milk and formula?

Answer 1

Yes, they are totally different
But 67% of people said no
72% of people do not think being formula fed has long-term consequences for health

Question 2

What are the WHO guidelines for the length of breast feeding?

Answer 2

Exclusive for 6 months

But up to 2 years and beyond with complimentary food

Question 3

What is the full duration of breastfeeding per child?

Answer 3

From primate studies and tribal humans

Between 4 and 7 years

Question 4

How does breastfeeding differ in Western cultures?

Answer 4

Many mothers do not breastfeed
Most mothers stop breastfeeding by the time their child is 1 years old
1 in 200 mothers in the Western World continue to breastfeed their child after 1 year

Question 5

How do milk teeth correlate with breastfeeding?

Answer 5

Children start to lose their milk teeth at 6 y/o

Corresponds with children weaning away from breastfeeding at this age, as their jaw and teeth structure changing

Question 6

What is formula milk made up of?

Answer 6

Usually cow’s milk

Question 7

What is a unifying factor of mammals?

Answer 7

All mammals have the capacity to lactate

Even if they are egg laying or placental mammals

Question 8

What is the difference between cows and human milk?

Answer 8

Cows milk have more protein
As they are bred to have a lot of muscle mass
Infants on formula grow faster
But human breastmilk has more fatty acids - humans are better at extracting the fat from their maternal diets for their breastmilk than other mammals

Question 9

How does human breast milk vary over 24 hours? How does this affect the baby?

Answer 9

There is a diurnal rhythm to milk
Contains typtophan, an amino acid that is found in larger quantities in the evening
Tryptophan helps the infant set a diurnal rhythm too

Question 10

What else is found in human milk? How does this affect the baby?

Answer 10

Pluripotent stem cells - taken up and absorbed in the gut of the infants, found in all organ systems
Unknown the benefits of this

Question 11

What are the benefits of human milk?

Answer 11

Developmental tool
Epigenetic regulator
Innate immunity
Antimicrobial factors
High fatty acid composition
Pluripotent stem cells

Question 12

What is a proposed theory for why human brains are different?

Answer 12

Infant brain growth is incredibly fast

Could be as a result of the breast being good at extracting fats

Question 13

What are the broad classes of molecules in milk that have antiviral properties?

Answer 13

SigA
Gangliosides
Glycosaminoglycans
Oligosaccharides
Mucins
Lactadherin
Lewis X
Lysozyme
Tenascin C
Cytokines
Bacteriophages
Extracellular vesicles
Monolaurin
Lactoferrin
Vitamin A
Oxysterols

Question 14

Why do babies put things in their mouth?

Answer 14

Fumbling their environment - for the development of their innate immune system and gut microbiome

Question 15

How does breastfeeding affect the gut microbiome?

Answer 15

Exposure to breast milk feeding up to 14 months that principally was responsible for patterning the immune system and gut microbiome

Question 16

How does breastmilk shape the infant’s gut microbiome?

Answer 16

Complex oligosaccharides found in human breast milk - over 200 oligosaccharides identified
20 of these cannot be metabolised by the infants - therefore there to preferentially select the bacteria bifidobacteria and lactobacillus bacilli to grow and reproduce

Question 17

What influences the components of a mother’s breast milk?

Answer 17

Each mother has unique fingerprint for their breast milk dependent on:

• Genetics
• Environment influences
• Local environment pathogens
• Season

Question 18

What does the gut epithelium look like in infants? Why is the structure important / relevant to milk feeding?

Answer 18

Single cell layer
2 way process in infant’s gut - gaps between cells allows big molecules e.g. immunoglobulins (Igs), stem cells etc. to be taken up from the milk
BUT also enables dendritic cells to poke tendrils out into the lumen to sample the gut bacteria and proteins - which are then chopped and presented to the T and B cells in the gut
Allows infant’s immune system to differentiate between friend and foe

Question 19

When do the gaps in the junctions close up? Why is it important?

Answer 19

When infant starts eating solid food - i.e. as soon as non-human protein is identified by the gut epithelium, a range of genetic signalling pathways activate to close the gaps between the cells / activate tight junctions
To stop slid food from getting through the gut walls
Also blunts the immune programming mechanism - may be a reason for friving infants towards having increased auto-immune disease risk later in life

Question 20

What is a modulator of diathesis stress model?

Answer 20

Gut microbiome
Although genetic susceptibility and environmental stressor lead to disease outcome, aberrant microbiome is the mediator between these two

Question 21

What is a primary modulator of the gut microbiome?

Answer 21

Infant feeding

Question 22

What diseases are being implicated by poor of infant feeding?

Answer 22

Asthma
Obesity
T1DM (type 1 diabetes mellitus) - although not previously associated with any lifestyle factor, T1DM cases have risen by 20 fold since 40 years ago
Acute lymphoblastic leukemia
Neurological disease - dementia, parkinsons, alzheimers

Question 23

Why is breast feeding very important?

Answer 23

Setting infants on a trajectory of health from the beginning

Question 24

How is infant temperature control influenced by human milk?

Answer 24

Unique fatty acids (alkylglycerols) found in only human milk (And in small amounts in donkey milk) that act to keep Basch Thermogenic Adipocytes
Basch Thermogenic Adipocytes - produce a heat drive of 300x the utilisation of ATP to produce heat
Helps infants regulate their body temperature

Question 25

Why do infants that are formula fed by the age of one have a significantly higher risk of being overweight?

Answer 25

If those unique alkylglycerols are not present, then those Basch fat cells convert into white fat cells (storage fat cells)
If infants are fed until a year and beyond, the Basch adipocytes perisst until child and adolescence - probably longer

Question 26

Why has previous research into the differences in children who have and have not breast fed not been appreciated in modern research?

Answer 26

Methodology of all studies have been flawed - they would have two categories, ‘ever fed’ and ‘never fed’
Ever fed = large variations in infants who have been fed human milk, some may have tried it, some may have maintained it for several years etc.

Question 27

What is the association between breast feeding and cancer?

Answer 27

Breast, ovarian, endometrial and oesophageal cancer risk is reduced by breast feeding
Triple negative breast cancers that have worse prognosis and affect younger women - breastfeeding reduced this by 20%

Question 28

How much does breastfeeding reduce the risk of breast cancer in those with high risk genetic mutations e.g. BRCA1?

Answer 28

1yr of breastfeeding = 35-40% reduction

2yrs of breastfeeding = 55-60% reduction

Question 29

What is the link between breast feeding and postnatal depression?

Answer 29

Reduces risk of post natal depression

Question 30

How does breastfeeding affect child mortality?

Answer 30

Over the last few years, child mortality has halved in Brazil - largely been put down to breastfeeding

Question 31

What is normal lactation?

Answer 31

Prolactin helps lactocytes to produce milk
Oxytocin acts on the myeopithelial cells to squeeze and eject milk into the baby’s mouth - aids with milk secretion
Baby’s only need to suckle, the milk is ejected into their mouths
Supply meets demand
The more the baby feeds the more milk is produced

Question 32

What is important about breastfeeding within the first hour of birth?

Answer 32

Amniotic fluid on baby’s hand should not be dried as it has a similar scent to mother’s nipple - helps baby find nipple, latch on and suckle
For the same reason, mother’s nipple should not be washed before their baby breast feeds

Question 33

How often do babies breastfeed in 24 hours?

Answer 33

8-12 times
Long feed every 3 hours
Other times, short feed for hydration

Question 34

What is cluster feeding?

Answer 34

Feeding solidly for 6-8 hours
Ramps up the mothers supply
Establishes the mothers ability to produce a full supply

Question 35

What are factors that can decrease mothers milk supply?

Answer 35

Supplementing with formula milk
Using a dummy in the early weeks
Separating mother and baby
Trying to follow a routine
Sleep training

Question 36

What are newborn sleep patterns?

Answer 36

No clear circadian rhythm for sleep
Half their sleep is active (AKA REM sleep)
They active sleep for 30 mins, then quiet sleep for 50 mins

Question 37

How can newborns be aroused from active sleep?

Answer 37

Hunger
Cold
Discomfort
Startle reflex
Unfamiliar conditions

Question 38

What is responsive feeding?

Answer 38

Interaction between mother and child

Mother can pick up on babies signals

Question 39

What is responsive feeding associated with?

Answer 39

Higher prolactin levels
Longer duration of breastfeeding
Fewer breastfeeding difficulties
Increased milk supply
Lower risk of overweight
Later satiety responsiveness