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TAS Nutrition > Evaluation of Infant Feeding > Flashcards

Evaluation of Infant Feeding Flashcards

1
Q

What is the natural biological food for a human infant?

A

Breast milk

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2
Q

When is the use of cows milk as the main drink not recommended?

A

Before 12 months

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3
Q

What is the composition of breast milk used as the basis of?

A
  • Determining infant nutrient requirements during the first 6 months of life
  • The regulations on permitted compositions of breast milk substitutes (infant formula)
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4
Q

What issues should be considered when using breast milk composition as the basis for recommended nutrient intake/composition of breast milk substitutes?

A
  • Breast milk composition varies between and within mothers
  • Method used to obtain breast milk samples may affect results
  • Composition of EBM may differ from that of energy suckled from infant direct from breast
  • Breast milk contains many bioactive substances
  • Milk from different mammals varies considerably
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5
Q

Over what time frames does the composition of breast milk change within the same mother?

A
  • Over the course of lactation
  • During a day
  • During a feed
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6
Q

In what respects might the methods for obtaining breast milk samples vary?

A
  • Fore vs hindmilk
  • Hand vs pump expressed
  • Single vs pooled samples
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7
Q

What is the consequence of breast milk composition varying depending on the mother, time, and method of obtaining sample?

A

It is difficult to define a single reference concentration for many nutrients

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8
Q

What is the consequence of the composition of EBM potentially differing from breast milk suckled straight from the breast?

A

It has probably resulted in an overestimation of human milk, which was then applied to human formulas

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9
Q

Give 2 bioactive substances that breast milk contains?

A
  • Hormones

- Growth factors

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10
Q

What is the limitation of breast milk containing bioactive substances when using it as a reference for infant formula?

A

These are difficult or impossible to mimic in infant formula

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11
Q

In what respect does milk from different mammals vary?

A
  • Composition

- Configuration or quality of fat or protein

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12
Q

What is the consequence of milk from different mammals varying in terms of configuration or quality of fat/protein?

A

Infant formulas may contain the same total fat or protein concentration as human milk, but may still be significant different in type of nutrients

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13
Q

Give 2 examples of differences in the type of nutrients in formula milk compared to breastmilk?

A
  • Stereo-isomeric differences in triglycerides influence fat and calcium absorption
  • Different protein composition, e.g. alpha-lactalbumin, beta-lactoglobulin, can affect growth
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14
Q

What is the result of the problems with trying to make formula milk resemble breast milk as closely as possible?

A

Recently there has been a greater focus on trying to achieve the performance (health and developmental outcomes) of breastfed infants, rather than simply trying to mimic the composition of breast milk

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15
Q

How can data on the effectiveness and safety of interventions regarding infant feeding be obtained?

A
  • Observational studies

- RCTs

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16
Q

What are RCTs considered the ‘gold standard’ for?

A

Demonstrating causal relationships between an intervention and outcome

17
Q

What is the advantage of observational studies for evaluating infant feeding?

A
  • Large sample size

- Can obtain results rapidly

18
Q

What is the limitation of observational studies for evaluating infant feeding?

A

Because the type of infant feeding is not randomly assigned, they can show ‘associations’ between infant feeding and health outcomes, but they cannot demonstrate causation

19
Q

What is the main problem with RCTs when evaluating infant feeding?

A

Healthy term infants cannot ethically or feasibly be randomised to breast-fed or formula fed, which prevents use of RCT for assessing the effect of any intervention against the ‘gold standard’ for infant feeding

20
Q

What is problem with RCTs when evaluating breastfeeding?

A

Difficult to randomise breastfeeding mothers to different breast-feeding practices

21
Q

What is the result of the problems with using RCTs to evaluate infant feeding?

A

Most data on the subject comes from observational studies

22
Q

What are the methodological problems with observational studies into infant nutrition?

A
  • Determination of feeding behaviour
  • Definition of breastfeeding
  • Outcomes
  • Control for confounders
  • Reverse causality
23
Q

What are the problems with the determination of feeding behaviour in observational studies into infant feeding?

A
  • Often retrospective

- Different sources of data, e.g. mother, HCP

24
Q

What are the problems with the definition of breastfeeding in observational studies into infant feeding?

A
  • Definitions are very variable, especially for exclusivity

- Range from ‘ever/never’ to detailed prospective records

25
Q

What are the problems with outcomes in observational studies into infant feeding?

A
  • Assessment not always blind

- Lack of consistent definitions or measurement methods

26
Q

What are the problems with control for cofounders in observational studies into infant feeding?

A
  • Variable definition and collection of data on confounders

- Direction of confounding differs in different populations and with time

27
Q

Give an example of a confounding factor when comparing breastfeeding to formula feeding?

A

The choice of feeding mode is strongly related to social and demographic factors such as educational achievement and socio-economic status, which are in turn related to many of the health outcomes of interest

28
Q

What is the problem with reverse causality in observational studies into infant feeding?

A

Alteration to feeding behaviour may be response to outcome, rather than cause

29
Q

Give an example of where reverse causality may be a factor when comparing breastfeeding to formula feeding?

A

Mothers with a family history of atopy may breastfeed for longer to prevent the infant from developing atopy, but if the infant then develops atopy, it may be attributed to breastfeeding

30
Q

What are the problems with the determination of feeding behaviour in observational studies into infant feeding?

A
  • Often retrospective

- Different sources of data, e.g. mother, HCP

31
Q

What are the problems with the definition of breastfeeding in observational studies into infant feeding?

A
  • Definitions are very variable, especially for exclusivity

- Range from ‘ever/never’ to detailed prospective records

32
Q

What are the problems with outcomes in observational studies into infant feeding?

A
  • Assessment not always blind

- Lack of consistent definitions or measurement methods

33
Q

What are the problems with control for cofounders in observational studies into infant feeding?

A
  • Variable definition and collection of data on confounders

- Direction of confounding differs in different populations and with time

34
Q

Give an example of a confounding factor when comparing breastfeeding to formula feeding?

A

The choice of feeding mode is strongly related to social and demographic factors such as educational achievement and socio-economic status, which are in turn related to many of the health outcomes of interest

35
Q

What is the problem with reverse causality in observational studies into infant feeding?

A

Alteration to feeding behaviour may be response to outcome, rather than cause

36
Q

Give an example of where reverse causality may be a factor when comparing breastfeeding to formula feeding?

A

Mothers with a family history of atopy may breastfeed for longer to prevent the infant from developing atopy, but if the infant then develops atopy, it may be attributed to breastfeeding

37
Q

What are the current UK recommendations regarding breastfeeding and solid foods?

A

Infants should be exclusively breastfed for around 6 months before introducing solid foods alongside breastfeeding, which should continue ideally for up to 2 years

38
Q

When are mothers who formula feed advised to introduce solid foods?

A

Around 6 months

TAS Nutrition (11 decks)

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