Monday, February 26, 2024

WHO and Europe’s formula industry at odds on cow’s milk

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Industry body – and Fonterra in NZ – challenge new guidelines on infant feeding.
China’s total imports of dairy are 20.3% lower at the end of September, compared to the same period the year prior.
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The European specialised nutrition industry says new guidelines by the World Health Organisation stating that cow’s milk can be fed to infants under 12 months of age are not backed by sound scientific evidence.

The industry also says WHO’s new take that infant formula contributes to child mortality is false.

Previous evidence shows cow’s milk does not contain enough iron for a healthy infant diet and that cow’s milk could lead to intestinal bleeding in infants.

WHO’s new guidelines conclude that for infants 6-11 months of age who are fed milks other than breast milk, either milk formula or animal milk can be fed.  

WHO said it conducted a systematic review of studies that compared health outcomes in infants 6-11 months of age fed infant formula vs animal milk.

“Evidence showed no statistical difference in the risk of gastrointestinal blood loss. An earlier review had shown that occult blood losses in infants 6-11 months of age are very minor and not likely to affect iron status,” WHO said.

The use of infant formula is associated with increased risks of child mortality, gastrointestinal infections, lower respiratory diseases, type 2 diabetes, obesity and leukemia, WHO said.  

The adverse outcomes could be caused by contaminated water, dirty bottles, bacterial growth during storage, differences in nutritional components, cow’s milk protein in formula, overdilution of formula or the means of feeding, WHO said.

The guidelines say infant formula can only be given if it supports normal growth, if safe water and sanitation are assured during preparation, and if it carries a low risk of diarrhoea and malnutrition.

 “Cow’s milk does contain lower amounts of iron and evidence does show that infants consuming cow’s milk are at greater risk of iron deficiency compared to those consuming formula.  However, there are many other ways to provide iron besides infant formula. 

“Iron from meat sources is more readily absorbed in the intestines than the iron in formula.   Given the variety of alternative sources of iron, along with the health risks and costs associated with use of infant formula, WHO concluded that there is no clear benefit to infant formula over animal milks.” 

A spokesperson for Specialised Nutrition Europe (SNE) said breast milk is the best source of nutrition for babies, but when mothers are unable to breast-feed, infant formula is the only safe breastmilk substitute. 

SNE is an industry organisation that represents special nutrition manufacturers.

Europe’s specialised nutrition industry disagrees with WHO that milk formulas are associated with child mortality, the spokesperson said

The claim does not appear to be supported by any scientific evidence, the spokesperson said.

“It is widely accepted in scientific literature that formula is the only safe alternative to breastfeeding. For young children 12-23 months of age, the guideline recognises that ‘milk formula provides supplemental sources of iron and other nutrients’ but still doesn’t recommend its use.”

The spokesperson said SNE is not against cow’s milk, but for infants of 6-11 months, cow’s milk is not ideal. 

“The [WHO] guideline recommends the use of either formula or animal milk for infants 6-11 months who are not breastfed. Recommending animal milk before one year clearly goes against the generally accepted medical recommendation that cows’ milk should not be introduced as breast-milk substitute before one year of age.”

“The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition, for example, considers that cows’ milk ‘is ‘a poor iron source and provides excess protein, fat and energy when used in large amounts’.  

“Contrary to cows’ milk, follow-up formula, which will soon be covered at international level by an updated Codex Standard4, is specifically adapted to the nutritional needs of older infants.” 

The SNE submitted its position statement to WHO, including a request to revise its guideline using robust scientific methodology, the spokesperson said. 

The head of innovation for powders and ingredients at Fonterra, Angela Rowan, said the recommendation in New Zealand is also that cow’s milk should be offered to infants as a drink only from 12 months of age.

Fonterra agrees with the SNE’s concerns, Rowan said.

“SNE’s main concern is with the recommendation that for infants 6-11 months who are not breastfed, that infant formula or full fat animal milk can be used.

“While the WHO scientific literature review shows ‘the use of cow’s milk in infants aged 6-11 months who are non-breastfed/mixed breastfed may increase the risk of anemia but is unlikely to affect growth outcomes’, adapting this into a global guidance is a strong recommendation and should be supported by a review of the impact this may have on nutritional deficiencies for infants.” 

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