Studies

With twins on the way I've been giving a lot of thought to FF vs BF and the pros and cons of both.

In my reasonably rudimentary view of these matters, I find it curious that statements are frequently made to the effect of "we all know breastfeeding is best". It suggests that this is an irrefutable truth, such that the sun is hot and the ocean is made of water.

What I am genuinely interested to see (because I don't know where to look) is a listing of scientific studies using proper methodology which proves this point. I expect that such studies would need to compare a number of FF and BF babies from the same socio-economic background, over a period of say 5 years, for the purposes of evaluating present and post-BF/FF outcomes. The control would need to be a sample of both FF/BF infants whose health and immune characteristics can be quantified. How this is done I don't know but I'm not a scientist.

I am not interested in links to blanket statements made by the ABA, or a blog or whatever, or sources which mention studies and evidence as "proof" but don't actually cite the source. An example of a dinky di study (unrelated to BF) is here: MJA: Blyth, et al., Hospitalisation for congestive heart failure: burden and outcomes

If you haven't got a source in a format similar to the above (ie. a formal scientific study) I am not going to look at it - I'm not trying to be nasty, I'm just telling you what I am after and am wondering if anyone can help.

This isn't a wind up or an excuse to start a debate, I actually want to know for myself and for DW. I am asking because I am assuming that some of you who are very pro_BF will have knowledge of what I am after.

This .pdf file might be a good starting point for you.
At the end of each section there is a list of references so you can research anything that you need to know more about in more depth.
It is a model chapter for medical texts developed by the W.H.O.

Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals

Getting hold of peer reviewed studies online can be a bit tiresome. You might want to go to you closest tertiary institution and use their databases. They are a much better source than the interwebz.

Is something like this what you are after?

Prospective studies of the effect of breast feedin... [Acta Paediatr Scand. 1979] - PubMed result

Thanks Onyx, lots of info there for me to hunt down soon.

Leasha, it's a bit brief to meet my exacting requirements, but it's a good start ;) Thank you.

As BF sentiment is so strong on BB (not a criticism), there must be more of you that actually base your choices on empirical evidence that you've actually read yourself?

I thought i would be, being that its an abstract haha. Should be able to have a decent look tomorrow arvo. I have uni access, so might be able to find the full article to the one I linked.

That's the problem with these studies - so many list the abstract but unless you have access to edu facilities or want to pay for it, it's pretty hard to get the full monty. Cheers.

Slyder, if you are able to get in to a library of a university that has medicine they would have all the journals there, all you would need to do is search their databases (pubmed was the main one I used at uni - studying biology related subjects) and then find the volume (s) that the journals articles would be in. I think you can also search pubmed online and that way you don't have to spend as long in the library.

ETA - you don't have to be a memeber to search and view the articles, and you can photocopy them in there so you don't have to borrow them....

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As BF sentiment is so strong on BB (not a criticism), there must be more of you that actually base your choices on empirical evidence that you've actually read yourself?

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I know you don't want a debate and that is fine but as a breastfeeding mother I find this comment offensive. I may not have researched my decision to breastfeed over formulae feed because for me formulae feeding wasn't even something I wanted to consider. To me breastfeeding is free and natural and therefore my first option and I have been lucky that I am able to feed for as long as I have. I understand in the case of twins where the physical and mental toll is greater why you would want to look into the pro's and con's further but I am offended at your implication that I decided to breastfeed wasn't based on empirical evidence and therefore I am somehow uneducated or doing the wrong thing or uninformed?!

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To me breastfeeding is free and natural and therefore my first option and I have been lucky that I am able to feed for as long as I have.

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Yep, the free was a big factor for me. That and the no washing up bottles. I breastfed because I'm a lazy cheapskate :p

Have you actually checked out the ABA website, specifically the Lactation Resource Centre page. All the sciency stuff is on there. It would give you a place to start with what studies you want to look further into.

Slyder, I'm subscribing here and going to follow those sources! As far as I could find, there are NO real studies. No double-blind random trials. Nothing about the parents, the background, the other nature AND nurture factors or anything I would require. Of course I wanted evidence that I was doing the best thing! And yet all I found at the time were dated sociopolitical "studies" and propaganda from both sides. I decided to go with breast as it's human milk designed for MY child - not a group of children, my child, made by my body. Seems better than a boring homogenous formula. Plus breastmilk changes "weight" during the day so that the child gets sleepy hormones and more full at night. Have to find that study for you. But you can get "sleepy baby" formulae these days anyway.

Having said that, I'm going to be more "militant" about BFing #2+. Because Liebs was intolerant of cow milk, as was I as a child as was my father as a child... breastmilk is free, easy and adaptable. Bottles require work and money. And a gym membership because my stomach thanked breastfeeding a lot.

I don't have access to the full studies but the following may be of interest to you:\

Breast feeding and respiratory morbidity in infanc... [Arch Dis Child. 2003] - PubMed result Breast feeding and respiratory morbidity in infancy: a birth cohort study.
Effect of breastfeeding duration on lung function ... [Thorax. 2009] - PubMed result
Effect of breastfeeding duration on lung function at age 10 years: a prospective birth cohort study. Ogbuanu IU et al
Breast feeding and obesity: cross sectional study -- von Kries et al. 319 (7203): 147 -- BMJ Breast feeding and obesity: cross sectional study Von Kries et al

I'm assuming as you linked in a study from the Medical Journal Australia that you have searched that website for breastfeeding and formula feeding?
I haven't read any of them but did see some interesting titles for studies there.

I don't want to start a debate either and I NEVER have got into a b/f vs f/f debate and I am not now but to me the ultimate in "empirical" evidence is that the human race managed to sustain its young for thousands of years prior to formula being invented. I am not talking about individuals here, as I believe not all mums and bubs have successful breastfeeding, I am talking about the human race. But at the same time, as you now have a choice, you have every right to research that choice.
(Oh, and like Onyx, I am also a lazy cheapskate.)

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I breastfed because I'm a lazy cheapskate :p

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Me too! Couldn't be bothered getting out of bed to make bottles, (unless i had to).

There was an article sent through via my email yesterday looking at BF and the effect on fevers post immunisation. I will hunt it down and get back to you as a starting point. There are a few but many are significantly flawed on both sides of the discussion due the variability of factors that make up a *good*, replicable study.

Hey slyder, interesting question. I've wondered about this too but am too lazy (and my uni days are too far behind me) to properly assess the quality of studies these days. If you find some good articles that you don't need to have uni access to read, do you mind posting them here?
Good luck to you and the missus, whatever you decide to do.

You are probably hamstringing yourself with your criteria.

The kind of study you describe is almost impossible to conduct, due to ethical considerations and the difficulty of eliminating confounding factors. A more useful and valid way to look at breastfeeding is to try and examine very specific outcomes, which is why you'll see most of the studies are geared that way. But just because they're not randomised, double-blind trials shouldn't automatically exclude them from consideration.

It's not a study of BM v formula per se but "Immunobiology of Human Milk" is a great book about how breastfeeding protects babies. It's essentially a research paper but has all the scientific fact and figures you could possibly want. I got my copy from the ABA shop.

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I know you don't want a debate and that is fine but as a breastfeeding mother I find this comment offensive. I may not have researched my decision to breastfeed over formulae feed because for me formulae feeding wasn't even something I wanted to consider. To me breastfeeding is free and natural and therefore my first option and I have been lucky that I am able to feed for as long as I have. I understand in the case of twins where the physical and mental toll is greater why you would want to look into the pro's and con's further but I am offended at your implication that I decided to breastfeed wasn't based on empirical evidence and therefore I am somehow uneducated or doing the wrong thing or uninformed?!

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My thoughts exactly. As a midwife we are educated about the benefits of BF, but are also supportive of FF. I as an educated informed person chose to BF without specificlly researching topic.

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Yep, the free was a big factor for me. That and the no washing up bottles. I breastfed because I'm a lazy cheapskate :p

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Haha me 2.

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You are probably hamstringing yourself with your criteria.

The kind of study you describe is almost impossible to conduct, due to ethical considerations and the difficulty of eliminating confounding factors. A more useful and valid way to look at breastfeeding is to try and examine very specific outcomes, which is why you'll see most of the studies are geared that way. But just because they're not randomised, double-blind trials shouldn't automatically exclude them from consideration.

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You're absolutely right, and I'll definitely continue looking at the type of material you're suggesting. But what I am generally getting at is that some of the very substantial claims made about BF'ing must be backed by some stringent long ranging studies, surely?

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I know you don't want a debate and that is fine but as a breastfeeding mother I find this comment offensive. I may not have researched my decision to breastfeed over formulae feed because for me formulae feeding wasn't even something I wanted to consider. To me breastfeeding is free and natural and therefore my first option and I have been lucky that I am able to feed for as long as I have. I understand in the case of twins where the physical and mental toll is greater why you would want to look into the pro's and con's further but I am offended at your implication that I decided to breastfeed wasn't based on empirical evidence and therefore I am somehow uneducated or doing the wrong thing or uninformed?!

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That is absolutely not what I said or implied. I asked a direct question without making any inference or comment about anyones personal choices, and specifically avoided getting into all this touchy feely sensitive hoohaa, so I have no intention of derailing my thread with your problem.

Thanks to everyone else for your suggestions and guidance. I appreciate it and will be using your material for expanding my knowledge.

LZ - you're thinking along exactly the same lines as me. I'm not doubting the great benefits of BF'ing, I just want to see some studies for my own understanding, knowledge and interest.

Rosie - will do. Cheers.

Dear Slyder,

Congratulations on the birth of your twins. What an exciting time for your family.
Given that breastfeeding is the norm for feeding human infants, it is interesting that in most cases it is breastfeeding advocates who are asked to "provide the evidence". I wonder if you had considered putting a similar request on the formula feeding forums?
I'm sure that you would understand (as Michael points out) it would be unethical to conduct the type of studies you are requesting, when the risks of formula feeding and the associated poorer health outcomes are so well understood to randomly allocate babies to a "control group" (breastfeeding) or an intervention group (bottle feeding)
I'm not sure it is the role of myself or others on this forum to be your unpaid research assistants on this matter. There is an enormous amount of information available on the internet. For more specialised studies you may need to pay for access. With your knowledge I am sure you are able to sort out the evidence.
I think when you research this thoroughly you will see that organisations such as the Australian breastfeeding Association are extremely rigorous in accessing the most up todate research on the subject and are not at all prone to make "blanket statements" without evidence.
Importantly, though, I wonder how your partner feels about breastfeeding your children? Science is one thing, but the decision of how to feed your children is a whole lot more personal and more emotional. It's something each family must consider.
To get you started I offer the abstract below. If you PM me I can send you the full article
What are the Risks Associated with Formula
Feeding? A Re-Analysis and Review
Melinda E. McNiel, MPH, Miriam H. Labbok, MD, MPH, FACPM, and
Sheryl W. Abrahams, MPH
ABSTRACT: Background: Most infant feeding studies present infant formula use as ‘‘standard’’
practice, supporting perceptions of formula feeding as normative and hindering translation
of current research into counseling messages supportive of exclusive breastfeeding. To
promote optimal counseling, and to challenge researchers to use exclusive breastfeeding as the
standard, we have reviewed the scientific literature on exclusive breastfeeding and converted
reported odds ratios to allow discussion of the ‘‘risks’’ of any formula use. Methods: Studies
indexed in PubMed that investigated the association between exclusive breastfeeding and otitis
media, asthma, types 1 and 2 diabetes, atopic dermatitis, and infant hospitalization secondary
to lower respiratory tract diseases were reviewed. Findings were reconstructed with exclusive
breastfeeding as the standard, and levels of significance calculated. Results: When exclusive
breastfeeding is set as the normative standard, the re-calculated odds ratios communicate the
risks of any formula use. For example, any formula use in the first 6 months is significantly
associated with increased incidence of otitis media (OR: 1.78, 95% CI: 1.19, 2.70 and OR:
4.55, 95% CI: 1.64, 12.50 in the available studies; pooled OR for any formula in the
first 3 mo: 2.00, 95% CI: 1.40, 2.78). Only shorter durations of exclusive breastfeeding are
available to use as standards for calculating the effect of ‘‘any formula use’’ for type 1 diabetes,
asthma, atopic dermatitis, and hospitalization secondary to lower respiratory tract infections.
Conclusions: Exclusive breastfeeding is an optimal practice, compared with which
other infant feeding practices carry risks. Further studies on the influence of presenting exclusive
breastfeeding as the standard in research studies and counseling messages are recommended.
(BIRTH 37:1 March 2010)
Key words: any formula use, breastfeeding,

Slyder we have been involved in a study on the effects of DHA in pregnancy and breastfeeding, and their effects through the preschool years. The study is not yet complete but whether the child is BF or FF is part of it. I dont know if anything has been published yet so I will have a look and see what I can find.

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Dear Slyder,

Congratulations on the birth of your twins. What an exciting time for your family.
Given that breastfeeding is the norm for feeding human infants, it is interesting that in most cases it is breastfeeding advocates who are asked to "provide the evidence". I wonder if you had considered putting a similar request on the formula feeding forums?
I'm sure that you would understand (as Michael points out) it would be unethical to conduct the type of studies you are requesting, when the risks of formula feeding and the associated poorer health outcomes are so well understood to randomly allocate babies to a "control group" (breastfeeding) or an intervention group (bottle feeding)
I'm not sure it is the role of myself or others on this forum to be your unpaid research assistants on this matter. There is an enormous amount of information available on the internet. For more specialised studies you may need to pay for access. With your knowledge I am sure you are able to sort out the evidence.
I think when you research this thoroughly you will see that organisations such as the Australian breastfeeding Association are extremely rigorous in accessing the most up todate research on the subject and are not at all prone to make "blanket statements" without evidence.
Importantly, though, I wonder how your partner feels about breastfeeding your children? Science is one thing, but the decision of how to feed your children is a whole lot more personal and more emotional. It's something each family must consider.
To get you started I offer the abstract below. If you PM me I can send you the full article

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Barb, I am simply looking for evidence of the claims made about BF vs FF. I agree that BF'ing is the natural and normal way of doing things and don't dispute that it is the ideal option in many cases. This isn't a veiled anti-BF or BF sceptic thread.

As these poorer FF outcomes are apparently so well understood, I want to read the evidence for myself. It's what I do, I'm Mr Analytical.

My ABA comment was poorly worded - I'm not saying they aren't a good source of info, I just didn't want a heap of blanket quotes lifted from their site as I thought may be the case.

Your comment about me expecting members to be my unpaid research assistants is unneccessarily snarky as that was never my intention as is quite clear. What I asked for was links to studies which I believed that some members may already have knowledge of. I never asked anyone to do my leg work for me.

My wife and I feel the same regarding feeding. Ideally, if all things are well, she'd like to BF both for a number of reasons, both health related and emotional. However, we are also preparing ourselves if this is not possible, and trying to make some very informed decisions for ourselves.

PS. I would still be interested to view (if possible) the types of scientific studies with which you base your comments on BB on. I repeat - this is not some veiled attack on BF, but I assume a strong advocate of BF such as yourself would have an interest in, and knowledge of a range of in depth scientific studies that you base your professional knowledge around.

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Slyder we have been involved in a study on the effects of DHA in pregnancy and breastfeeding, and their effects through the preschool years. The study is not yet complete but whether the child is BF or FF is part of it. I dont know if anything has been published yet so I will have a look and see what I can find.

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That sounds awesome and very interesting. Cheers.

Slyder, can I congratulate you on your efforts to find out more about this. The ABA also has a Lactation Resource Centre that examines scientific studies from around the world on bfing. Every issue of their magazine covers one of these studies. You might argue the LRC is not 'independent' in that it's part of the ABA, but the studies they examine are in no way connected and I have seen them look at both the pros and cons from studies. You can access it from their website.

One other 'study' to put to you is that a mother is many, many more times more likely to be successful in bfing her baby/ies if her partner is supportive. So I think examining this for yourself will have a very big impact on your wife's ability to bf your children successfully.

I have just had a look and as yet there are no publications because the followups aren't finished But this is what I have found

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Trial Title A Randomised Trial of DHA in pregnancy to prevent postnatal depressive symptoms and enhance neurodevelopment in children
Acronym DOMINO
ANZCTR ACTRN012605000569606
NHMRC NHMRC349301
Status Complete. Follow-up continuing
Type Maternal
Trial Contact karen.best@cywhs.sa.gov.au

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So if any of those numbers mean anything you might be able to find some preliminary info

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Your comment about me expecting members to be my unpaid research assistants is unneccessarily snarky as that was never my intention as is quite clear. What I asked for was links to studies which I believed that some members may already have knowledge of. I never asked anyone to do my leg work for me.

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It may not be your intention, but it is what naturally happens. You ask, people want to help, so they will go off and look things up for you.

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It may not be your intention, but it is what naturally happens. You ask, people want to help, so they will go off and look things up for you.

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Well good on them. Doesn't mean I expect them to be my unpaid research assistants.

Thanks Alioops.

Thanks too Jennifer. I'm looking at this now, appreciate your help. I'm also very supportive of BF'ing and will be 100% behind DW if that is the route we can take.

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You're absolutely right, and I'll definitely continue looking at the type of material you're suggesting. But what I am generally getting at is that some of the very substantial claims made about BF'ing must be backed by some stringent long ranging studies, surely?

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Or alternatively, by the lack of any real scientific evidence as to the benefits of formula feeding over breastfeeding. ;)

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As BF sentiment is so strong on BB (not a criticism), there must be more of you that actually base your choices on empirical evidence that you've actually read yourself?

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pmsl, that just sounds funny to me. Ahh....no, I didn't research if BF was the best thing. It's what my body naturally does, it's how babies are fed. Of course something man made will be an inferior product. Not to mention the other non-nutritional benefits. So anyway, I can't help I guess. I mostly look at the ABA anyway. They do have a lot of articles where they mention things and they are actually referenced though. i.e. Australian Breastfeeding Association - Sustained Breastfeeding There's a long reference list at the end of that if it helps.

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PS. I would still be interested to view (if possible) the types of scientific studies with which you base your comments on BB on. I repeat - this is not some veiled attack on BF, but I assume a strong advocate of BF such as yourself would have an interest in, and knowledge of a range of in depth scientific studies that you base your professional knowledge around.

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Again, maybe Barb does base her knowledge around scientific research, but I don't think it's a prerequisite for those in her field!! I would much rather the help of a very experienced LC than one that's up on all the latest research. BF is a natural part of life and feeding babies, it doesn't need scientific studies to validate it. Though I'm sure they are out there! Good luck with your search!

I'm trying to determine as much as possible, the health based differences between BF and FF (ie. to what extent FF'ing trails BF'ing). I am not saying that BF'ers need to justify what comes naturally. Hopefully that again explains my intention.

Slyder, what you are asking makes a huge amount of sense to me. I always knew breast was best, but as formula was a safe alternative I was happy to switch to it when things became tough. It was only when I started reading research (and I apologise I have no access to the studies as I was shown the information at conferences, and have been referred to it through friends) that I decided with my twins I would not use any formula at all if I could possibly help it due to the health risks of formula. The research helped me understand the importance of exclusive breastfeeding and I think to make an informed decision you need to have access to all the information. I hope you find what you are looking for, I only wish I had kept the references of the studies I looked at when in the same situation as you.

T
xx

PS congratulations on your twins, they really are double the joy

This is the current document which informs Australian and State government policy regarding infant feeding: Australian National Breastfeeding Strategy 2010 - 2015

On page 50 you will find the references, which include documents on breastfeeding rates, promoting breastfeeding, but also a number of studies regarding the health benefits of breastfeeding. Many of them contain links to further documents, including this one: Evidence on the long-term effects of breastfeeding : systematic review and meta-analyses (WHO) which intelligently and scientifically asks the sorts of questions that you are about the whole body of study that has been conducted.

Hopefully by mining down some of these layers, you will understand that the 'blanket statements' that are promulgated by bodies like the ABA and WHO are actually founded on many layers of evidence, studies which read individually only provide a small piece of the picture but collectively provide a large body of evidence-based information.

Slyder - I know you're after empirical evidence, but you might find it interesting to read some anecdotal stories here too. https://www.bellybelly.com.au/forums...g-twins-2.html

I haven't read any replies here because I don't have the time but couldn't not leave my humble little opinion ;) Apologies if anyone has said the same.

I don't have an scientific studies but:

My body was able to grow and nurture a baby (well OK 4 of them). To sustain and develop this new life my body gave it nutrients from my own.

My breasts create milk. This milk is also filled with nutrients from my body. THE same body which was able to make and nurture this perfectly formed human being is also able to nurture it through it's infancy outside my body using my milk.

Therfore the milk my body creates from my breast, which is made from the same body that made the baby, is better than anything made by a factory.

Why do you need a scientific study to tell you what is better? Trust in the ability of the womans body to grow a perfectly formed human being as well as create the milk to nurture the infant once it's born!

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I'm trying to determine as much as possible, the health based differences between BF and FF (ie. to what extent FF'ing trails BF'ing). I am not saying that BF'ers need to justify what comes naturally. Hopefully that again explains my intention.

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Slyder's made his requests pretty clear. Let's keep it on topic. If you'd like to discuss the more unquantifiable or intangible benefits of breastfeeding, then please start a new thread. Thank you.