Breast-feeding policy tends to be an emotive issue. International agencies recommend exclusive breast-feeding for 4-6 months followed by continued partial breast-feeding into the second year of life in order to promote infant and child health and minimize the damage caused by the malnutrition-infection cycle. To what extent are these recommendations supported by the experimental evidence? Are they a simplification for emotional reasons or public health purposes? Breast-feeding is believed to benefit infants because breast milk contains the ideal mix of nutrients for infants, because it contains factors which promote development of the infant's gut and immune system and which prevent pathogen invasion, and because exclusive breast-feeding prevents intake of pathogens in food or water. However, some apparently contradictory evidence exists. First, in environments which are not highly contaminated breast-fed infants tend to growth falter relative to those fed formula. Second, in such environments partial breast-feeding is not associated with significantly increased gut damage relative to exclusive breast-feeding, suggesting that active promotion of gut development by breast-feeding is more important than simple avoidance of pathogens from other foods. Third, many immune factors in breast milk are probably present primarily to protect the mother, not the infant. Finally, breast milk itself may contain bacteria or viruses. This problem has come to the fore with the human immunodeficiency virus epidemic, since it is clear breast-feeding is an important mode of mother-to-child transmission. The present review will examine these challenges to the basis of the international infant feeding recommendations and will suggest that the science does actually support the policy.

译文

母乳喂养政策往往是一个情绪化的问题。国际机构建议完全母乳喂养4-6个月,然后继续部分母乳喂养到生命的第二年,以促进婴儿和儿童健康,并最大程度地减少营养不良感染周期造成的损害。这些建议在多大程度上得到实验证据的支持?它们是出于情感原因还是出于公共卫生目的的简化?母乳喂养被认为对婴儿有益,因为母乳中含有婴儿理想的营养成分,因为它含有促进婴儿肠道和免疫系统发育并防止病原体入侵的因素,并且因为纯母乳喂养可以防止摄入食物或水中的病原体。但是,存在一些明显矛盾的证据。首先,在没有受到高度污染的环境中,母乳喂养的婴儿相对于那些喂养的配方奶的婴儿往往会生长迟缓。其次,在这种环境中,相对于纯母乳喂养,部分母乳喂养与肠道损伤的显着增加无关,这表明通过母乳喂养积极促进肠道发育比简单地避免其他食物中的病原体更为重要。第三,母乳中的许多免疫因子可能主要是为了保护母亲而不是婴儿。最后,母乳本身可能含有细菌或病毒。随着人类免疫缺陷病病毒的流行,这个问题已经凸显出来,因为很明显,母乳喂养是母婴传播的重要方式。本次审查将在国际婴儿喂养建议的基础上研究这些挑战,并建议科学确实支持该政策。

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