NUTN 507: Seminar

Graduate Programs in Human Nutrition

19 May 2014
4:00-6:00 PM
Presented by Amanda Rosenberg

Extended Breast Feeding: Breast Feeding In the Second Year of Life and Beyond

Objectives:
1. Outline current breast feeding recommendations.
2. Explain changes in macronutrients in breast milk after 12 months of lactation.
3. Describe the potential relationship between malnutrition and extended breast feeding.
The American Academy of Pediatrics (AAP) recommends exclusive breast feeding for
the first six months of life, followed by continued breast feeding as complementary foods are
introduced, with the continuation of breast feeding for one year or longer, as mutually desired by
mother and infant (1,2). The World Health Organization (WHO) recommends exclusive breast
feeding for six months of life and after six months receive complementary foods with continued
breast feeding until age two or beyond (3,5). This recommendation is based on the increased
intake of family foods and decrease risk of disease (3). This is a controversial topic due to the
changes in nutrient composition and the association of malnutrition with extended breast
feeding (6,7,8,9).
Most of the literature has shown the most drastic changes in macronutrient composition
of breast milk occur in its protein content (4). At three months of lactation, the protein content is
0.4 g/oz, which decreases to 0.3 g/oz at six months of lactation (4). Protein content increases
again at 12 months of lactation to 0.4 g/oz. Regardless of length of breast feeding, protein
content is 0.6 mg/oz during weaning, when breast milk volume is less than 10 oz/day (4).
Although protein content of breast milk is consistent in research, fat content has mixed results.
One study found that fat content of breast milk between 2-6 months of lactation was 4.7-10%
and lactation longer than one year had fat content of 5.6-15.7% (4). Other studies report no
change in fat composition at three months of lactation compared to the milk of mothers lactating
for longer than one year (4). The wide variability of fat content in breast milk is due to the
variations of the methods of sample collections as well as the wide variation in milk composition
between lactating mothers (4). Carbohydrate, specifically lactose, composition stayed constant
at 2.7 g/oz regardless of lactation duration (4).
The literature on breast feeding in the second year of life allude to a relationship
between extended breast feeding and risk of malnutrition. Breast feeding beyond 12 months is
associated with a decreased height for age, weight for age, and weight for height (6,7,8). This
decrease is dependent on what growth charts are used. For example, the use of the older
National Center for Health Statistics growth chart is associated with lower weight for age in
infants breastfed past one year due to the charts accommodation for a high number of formula
fed infants (9). Confounding factors of malnutrition in extended breast feeding include
inadequate complementary foods and the inability to establish a direct cause and effect of
breast feeding on malnutrition (10). Other evidence suggests that extended breast feeding is
beneficial for children with low dietary intake of complementary foods, high incidence of
diarrhea, not thriving, poor hygiene and those in poor living conditions (11). In summary
extended breast feeding by itself is insufficient to meet the calorie and nutrient needs for the
growing toddler but does offer a valuable supplementary source of protein, fat and
micronutrients (7).
References
1. Policy Statement: Breastfeeding and the Use of Human Milk. American Academy of
Pediatrics. 2012; 129 (3): 827-841.
2. Weinstein, M.; Oleske, J.; Bogden, J. A Selected Review of Breast-Feeding
Recommendations. Nutrition Research. 2006; 26: 379-384.
3. Infant and Young Child Feeding Fact Sheet. World Health Organization. 2014.
http://www.who.int/mediacentre/factsheets/fs342/en/
4. Tigchelaar-Perrin, M.; Fogleman, A.; Allen, J. The Nutritive and Immunoprotective
Quality of Human Milk beyond 1 Year Postpartum: Are Lactation-Duration-Based Donor
Exclusions Justified? Journal of Human Lactation. 2013; 29(3): 341-349.
5. Haschke, F.; Haiden, N.; Detzel, P.; Yarnoff, B.; Allaire, B.; Haschke-Becher, E. Feeding
Patterns During the First 2 Years and Health Outcomes. Annals of Nutrition &
Metabolism. 2013; 62(3): 16-25.
6. Victora, C.; Vaughan, J.; Martines, J.; Barcelos, L. Is Prolonged Breast-feeding
Associated with Malnutrition? American Journal of Clinical Nutrition. February 1983; 39:
307-341.
7. Taren, D.; Chen, J. A Positive Association Between Extended Breast-Feeding and
Nutritional Status in Rural Hubei Province, Peoples Republic of China. American
Journal of Clinical Nutrition. 1993; 58: 862-867.
8. Buckley, K. Long-Term Breastfeeding: Nourishment or Nurturance? Journal of Human
Lactation. 2001; 17(4): 304-312.
9. Grummer-Strawn, L. Does Breast-feeding Impair Child Growth? A Critical Review.
Pediatrics. Apr 1993; 91(4):766-71.
10. Piovanetti, Y. Breastfeeding Beyond 12 Months: An Historical Perspective. Pediatric
Clinics of North America. February 2001; 48(1): 199-205.
11. Karra, M.; Udipi, S.; Kirksey, A.; Roepke, J. Changes in Specific Nutrients in Breast Milk
During Extended Lactation. American Journal of Clinical Nutrition. 1986; 43: 495-503.