Pediatric Nutrition in Practice

Breastfeeding 93

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tities, typically one third to half of the content
found in cow’s milk ( table 1 ). This is a reflection
of the much slower growth velocity in infants
than in calves, and thereby a lower requirement
for growth nutrients. The fat content is at the
same level as in cow’s milk, while the content of
lactose is considerably higher. Human milk also
contains many other substances apart from nutri-
ents with specific important functions. These in-
clude hormones, growth factors, oligosaccha-
rides, and immune-related compounds such as
antibodies (sIgA), leukocytes (B and T lympho-
cytes, neutrophils and macrophages), nucleotides
and cytokines. These nonnutritional substances
are involved in many of the short- and long-term
effects breastfeeding has on the infant.

Positive Effects on the Infant and Mother

Breastfeeding has significant positive effects on
health and development during infancy, with some
effects reaching into childhood and adulthood [1,
2, 6]. Most studies, however, are observational, and
confounding can therefore be difficult to rule out;
mothers who choose to breastfeed in industrial-
ized countries, for example, are typically better ed-
ucated and their children also have a lower risk of
developing some diseases. Nevertheless, for many
of the effects there is convincing evidence.

The most evident effect of breastfeeding is pro-

tection against infectious diseases, especially di-

arrhea and respiratory tract infections [1]. This is

the main reason that mortality in low-income

countries is several times higher among those not

being breastfed. In high-income countries, the

risk of diarrhea in breastfed infants is only about

one third of the risk in infants not breastfed [2].

These differences could be explained by passive

protection of mucous membranes provided by the

antibodies and other immune components in hu-

man milk, but there is also evidence that the

child’s own immune system is positively inf lu-

enced by breastfeeding. There is also convincing

evidence that breastfeeding has positive effects on

long-term health and development [1, 2 , 6]. The

inf luence of breastfeeding on the development of

the immune system could be the reason for the

fact that some immune-related diseases, e.g. asth-

ma, type 1 diabetes, inf lammatory bowel diseases

and some childhood cancers, are less common

among children who have been breastfed than

among children who are predominantly formula

fed. A consistent finding throughout many stud-

ies from both industrial and low-income coun-

tries is a small but significant advantage of breast-

feeding to later cognitive function [6]. This effect

is likely to be related to an optimal ratio between

n–3 and n–6 fatty acids and the content of the

long-chain polyunsaturated fatty acid docosa-

Ta b l e 1. Mean macronutrient and energy contents in mature human milk and in cow’s milk

Component Mature human

milk (≥14 days)

% of

energy

Cow’s milk % of

energy

Protein 1.0 g/100 g 6 3.4 g/100g 21

Of which caseins 0.4 g/100 g

(40% of protein)

2.4 2.8 g/100 g

(80% of protein)

17

Fat 3.8 g/100 g 52 3.7 g/100 g 51

Lactose 7.0 g/100 g 42 4.6 g/100 g 28

Minerals 0.2 g/100 g – 0.8 g/100 g –

Energy 66 kcal/100 g 100 65 kcal/100 g 100

Adapted from Koletzko [13].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 92–96
DOI: 10.1159/000360323