L10 Nutrition and Lactation

Question 1

What conditions are associated with lack of breastfeeding (for the child):

Answer 1

• Acute otitis media (ear infection)
• Non-specific gastroenteritis
• Severe lower respiratory tract infections
• Dental malocclusion
• Obesity
• T1, 2DM
• SIDS
• Necrotising entercolitis

Question 2

What conditions are associated with lack of breastfeeding (for the mother):

Answer 2

• T2DM
• Breast cancer
• Ovarian cancer
• Postnatal depression

Question 3

What would be the potential benefits of increasing breastfeeding rates in the UK?

Answer 3

• Lower incidence of serious disease (e.g. breast cancer)
• Lower incidence of health burdens like diabetes and diabetes (less severe but big financial drain)
• Cost savings (projected 21 million savings if half of those that do not breastfeed took it up for 18 months)
• Improved quality of life for mothers

Question 4

How many mothers breastfeed in the UK?

Answer 4

• 2010 to 2015: consistently at around 30% at the 6 to 8 week point
• Further 13 - 15% mixed feeding

Question 5

What is colostrum?

Answer 5

• Initial presentation of breastmilk (day 1 - 3)
• Thick, concentrated and yellow (fatty)
• Small volume (allowing baby to get rid of excess tissue fluid without overloading kidneys)
• High Ab concentration
• Rich in growth factors and vitamins (particularly A and K; lipophilic)
• Mild laxative effect
• Will become progressively less fatty over time (transitions to mature milk by 14 days)

Question 6

What antibodies are found in breastmilk?

Answer 6

• IgA: only type present in breastmilk -> produced specifically by maternal lymphocytes which migrate to the breast -> secreted in breast milk in response to specific microbes in maternal environment
• IgG is able to pass into placenta so will be issued in utero

Question 7

What antibacterial properties does breastmilk have?

Answer 7

• Lactoferrin: iron binding -> less bacterial nutrition in gut
• Lysosyme -> bacteriocidal and antiinflammatory -> contributes to destruction of E.coli and some salmonellas
• Production increases with age of infant
• Enabling the baby to develop a healthy gut population but kept in check to avoid dysbiosis
• Early breastmilk is acidic, less conducive to bacterial growth

Question 8

How can formula-feeding contribute to gastroenteritis?

Answer 8

• Free iron in gut -> bacterial nutrition (and no lactoferrin to mop it up)
• No bifidus factor -> increased pH
• No oligosaccharides (pathogens not prevented from attaching)
• No secretory IgA (binds pathogens and prevents them from crossing gut wall)
• No entero/broncho-mammary pathway (for Ab production)
• No WBCs, lysosymes (protecting against pathogens)
• No epidermal growth factor for gut maturation
• No viral fragments to train up neonatal immune system
• Key: Formula itself is a contamination risk

Question 9

Outline the prolactin response:

Answer 9

• Baby suckles -> sensory impulses from nipple to mum’s brain
• PL secreted by anterior pituitary gland -> reaches breast through bloodstream
• Production of milk in lactocytes
• In this way, PL levels peak after the feed stimulating milk production ready for the next feed (levels remain high for 90mins)

Question 10

How does prolactin influence fertility during breastfeeding?

Answer 10

• Supresses release of gonadotrophins -> inhibits ovulation
• Lactational amenorrhea
• Not particularly reliable, must be very consistently breastfeeding for the duration (every 4 hrs)

Question 11

Outline the prolactin receptor theory:

Answer 11

• Frequent PL release maximises long-term milk supply by increasing expression of PLRs

Question 12

Outline the oxytocin reflex:

Answer 12

• Suckling -> impulses to brain
• Secretion of oxytocin from PP
• -> Myo-epithelial cells contract and expel milk
• Becomes conditioned over time, and aided by other sensory inputs (sights, sounds and smell of baby)

Question 13

What is the role of FIL?

Answer 13

• Feedback inhibitor of lactation
• Breast milk contains FIL, causes lactocytes to ignore signals from PL when breast is full
• As a result, if not sufficiently emptied, milk production will slow down

Question 14

Why is correct positioning and attachment important during breastfeeding?

Answer 14

• Ensures efficient milk transfer and thus adequate nutrition to baby
• Prevents mother from becoming sore (ineffective attachment -> engorgement, abrasion, can lead to mastitis

Question 15

What was the NOSH trial?

Answer 15

• NOSH: Nourishing start for health
• Controversial trial involving financial incentives for breastfeeding
• Didn’t follow up on how money was actually being fed so hard to trace impact on diet and nutrition
• Did manage to improve breastfeeding levels

Question 16

When would breastfeeding be discouraged?

Answer 16

• Certain illnesses such as HIV (where viral load is high)
• Mums taking certain medications
• Mastitis where abscess has developed