Effects of Replacing Cow's Milk with Plant-Based Beverages on Potential Nutrient Intake in Sustainable Healthy Dietary Patterns: A Case Study.

More consumers are replacing cow's milk (CM) with plant-based drinks (PBD), but data indicating the nutritional impact are limited. This theoretical study aims to assess the effect of substituting CM with PBD sold in Italy on nutrient intake within two dietary patterns: one aligned with the EAT-Lancet Commission reference diet adapted to Italian food habits (EAT-IT) and another one in line with the Italian Dietary Guidelines (IDG). Nutrition information from 368 PBD were collected and categorized according to their descriptive name and their fortification or not with calcium (Ca- and nCa-fortified). The substitution of CM with each PBD category in both dietary patterns was conducted, and an analysis of nutrient content and adequacy was performed. Substituting CM with all PBD resulted in reduced protein intake, except for nCa-fortified soy drinks, decreased saturated fat and vitamins B2 and B12, and increased fiber intake. Replacing CM with nCa-fortified PBD within both diets decreased Ca intake. Following the substitution of CM with Ca-fortified PBD, variations in vitamin D intake depended on the PBD category. The main risk of nutritional inadequacy was observed in Ca and vitamin D levels, which may even be amplified considering the different bioavailability based on the source of nutrients. This study highlighted the important role of CM in meeting calcium requirements and the potential unintended consequences of substituting CM with PBD without considering their nutritional differences.

Substitutive Effects of Milk vs. Vegetable Milk on the Human Gut Microbiota and Implications for Human Health.

Background: In the last two decades, the consumption of plant-based dairy substitutes in place of animal-based milk has increased in different geographic regions of the world. Dairy substitutes of vegetable origin have a quantitative composition of macronutrients such as animal milk, although the composition of carbohydrates, proteins and fats, as well as bioactive components, is completely different from that of animal milk. Many milk components have been shown to have relevant effects on the intestinal microbiota. Methods: Therefore, the aim of this review is to compare the effects obtained by previous works on the composition of the gut microbiota after the ingestion of animal milk and/or vegetable beverages. Results: In general, the results obtained in the included studies were very positive for animal milk intake. Thus, we found an increase in gut microbiota richness and diversity, increase in the production of short-chain fatty acids, and beneficial microbes such as Bifidobacterium, lactobacilli, Akkermansia, Lachnospiraceae or Blautia. In other cases, we found a significant decrease in potential harmful bacteria such as Proteobacteria, Erysipelotrichaceae, Desulfovibrionaceae or Clostridium perfingens after animal-origin milk intake. Vegetable beverages have also generally produced positive results in the gut microbiota such as the increase in the relative presence of lactobacilli, Bifidobacterium or Blautia. However, we also found some potential negative results, such as increases in the presence of potential pathogens such as Enterobacteriaceae, Salmonella and Fusobacterium. Conclusions: From the perspective of their effects on the intestinal microbiota, milks of animal origin appear to be more beneficial for human health than their vegetable substitutes. These different effects on the intestinal microbiota should be considered in those cases where the replacement of animal milks by vegetable substitutes is recommended.

Is it possible to obtain substitutes for human milk oligosaccharides from bovine milk, goat milk, or other mammal milks?

Considering the current level of chemical and biological synthesis technology, it was a sensible selection to obtain milk oligosaccharides (MOs) from other mammals as the potential substitute for human MOs (HMOs) that possessed various structural features in the infant formula. Through a comprehensive analysis of the content, structure, and function of MOs in six distinct varieties of mammal milk, it has been shown that goat milk was the most suitable material for the preparation as a human milk substitute. Goat MOs (GMOs) had a relatively high content and diverse structural features compared to those found in other mammalian milks. The concentration of GMOs in colostrum ranged from 60 to 350 mg/L, whereas in mature milk, it ranged from 200 to 24,00 mg/L. The acidic oligosaccharides in goat milk have attracted considerable attention due to their closeness in acidic content and structural diversity with HMOs. Simultaneously, it was discovered that some structures, like N-glycolylneuraminic acid, were found to have a certain content in GMOs and served essential functional properties. Moreover, studies focused on the extraction of MOs from goat milk indicated that the production of GMOs on an industrial scale was viable. Furthermore, it is imperative to do further study on GMOs to enhance the preparation process, discover of new MOs structures and bioactivity evaluation, which will contribute to the development of both the commercial production of MOs and the goat milk industry.

Outcomes of implementing the International Code of Marketing of Breast-milk Substitutes as national laws: a systematic review.

BACKGROUND: The International Code of Marketing of Breast-milk Substitutes, or 'the Code,' sets standards to regulate marketing of commercial milk formula (CMF) to protect breastfeeding. World Health Organization member states are advised to legislate the Code into national law, but understanding of its implementation outcomes is limited. This systematic review aimed to examine implementation outcomes in countries implementing the Code as national law. METHODS: We systematically searched five academic databases in September 2022 for articles published in English from 1982 to 2022. We double-screened titles/abstracts and then full texts for eligible articles reporting implementation outcomes of the Code in 144 eligible countries. We used the Mixed Methods Appraisal Tool for quality assessment and synthesized data thematically. We applied the Proctor et al. framework to guide synthesis of implementation outcomes, organizing our findings according to its taxonomy. RESULTS: We included 60 eligible articles of the 12,075 screened, spanning 28 countries. Fifty-seven articles focused on legal compliance, 5 on acceptability, and 1 on feasibility. Compliance was assessed across multiple sources, including mothers, health workers, media, points of sale, and product labels. Maternal exposure to CMF promotion remained widespread, with reports of mothers receiving free samples and coupons, and encountering media advertisements. Compliance of health workers varied across countries, with many reporting contact with CMF companies despite legal prohibitions. Public hospitals generally showed better adherence to the national law than private ones. While implementing the Code as national law effectively regulated the promotion of CMF for infants aged 0-12 months in public settings and in the media, it remains insufficient in addressing the promotion of unregulated products like growing-up milk, which are often marketed through emerging strategies such as cross-promotion and digital advertising. Point-of-sales compliance was inconsistent, with many countries reporting non-compliant price-related promotions. CONCLUSION: To enhance legal compliance, robust monitoring and reporting systems are necessary. Utilizing technology-assisted solutions for monitoring compliance can be an option for countries with limited human resources. Adequate training for health workers and communication strategies targeting shop managers about national law are also essential in enhancing their acceptability and compliance.

The effect of the implementation of the international code of marketing of breast-milk substitutes on child mortality in Ghana and Tanzania.

OBJECTIVE: The International Code of Marketing of Breast-Milk Substitutes is an important instrument to protect and promote appropriate infant and young child feeding and the safe use of commercial milk formulas. Ghana and Tanzania implemented the Code into national legislation in 2000 and 1994, respectively. We aimed to estimate the effects of the Code implementation on child mortality (CM) in both countries. SETTING: The countries analysed were Ghana and Tanzania. PARTICIPANTS: For CM and HIV rates, data from the Institute for Health Metrics and Evaluation from up to 2019 were used. Data for income and skilled birth rates were retrieved from the World Bank, for fertility from the World Population Prospects, for vaccination from the Global Health Observatory and for employment from the International Labour Organization. DESIGN: We used the synthetic control group method and performed placebo tests to assess statistical inference. The primary outcomes were CM by lower respiratory infections, mainly pneumonia, and diarrhoea and the secondary outcome was overall CM. RESULTS: One-sided inference tests showed statistically significant treatment effects for child deaths by lower respiratory infections in Ghana (P = 0·0476) and Tanzania (P = 0·0476) and for diarrhoea in Tanzania (P = 0·0476). More restrictive two-sided inference tests showed a statistically significant treatment effect for child deaths by lower respiratory infections in Ghana (P = 0·0476). No statistically significant results were found for overall CM. CONCLUSION: The results suggest that the implementation of the Code in both countries had a potentially beneficial effect on CM due to infectious diseases; however, further research is needed to corroborate these findings.

Bioactive (Poly)phenol Concentrations in Plant-Based Milk Alternatives in the US Market.

Plant-based milk alternatives (PBMAs) are increasingly consumed as a dairy alternative [Olson, S. Milk and Non-Dairy Milk - US - 2021, 2021.]. Plant foods are rich sources of (poly)phenols, but concentrations of these bioactive phytochemicals in processed PBMAs are not well documented. We procured twenty-seven PBMA products of 6 types (almond, coconut, oat, pea, rice, and soy) for (poly)phenol analysis. Samples were analyzed via ultra high-performance liquid chromatography-diode array with mass spectrometry. The (poly)phenol content of PBMAs varies and is dependent on plant source, brand, and added flavorings. Soy milk had the highest concentration and rice milk had the lowest (91.9 ± 2.7 and 0.9 ± 0.2 mean mg ± SD/cup serving, respectively). Almond milk, the most widely consumed PBMA, averaged 12.1 ± 8.2 mg/cup serving, but the majority of (poly)phenols are derived from added flavorings. PBMAs contain a wide range of potentially bioactive (poly)phenols and may contribute significantly to overall dietary (poly)phenol intake with the potential to impact health outcomes.

Lipid Profile of Plant-Based Milk Alternatives (PBMAs) and Cow's Milk: A Comparison.

Some consumers are replacing cow's milk with plant-based milk alternatives (PBMAs). The present study aimed to characterize the lipid profiles of cow's milk (n = 60) and PBMA types (soya, oat, rice, almond, coconut, and hazelnut; n = 10 per type). Significant differences were found in the fatty acid (FA) profiles of PBMAs and milk, particularly in FA diversity (15 FAs in PBMAs vs 54 FAs in milk) and the proportion of prime FA groups. The FA profile of coconut was dominated by saturated FAs (SFA), whereas monounsaturated FAs (MUFA) or polyunsaturated FAs (PUFA) were dominant in the remaining PBMA types. Cholesterol was not detected in any PBMA type. The FA profile of milk FAs was dominated by SFA; however, different individual SFA have varying health outcomes. Additionally, milk contains some FA groups with health-promoting properties, such as methyl-branched-chain FAs (BCFA) and conjugated linoleic acid (CLA), both of which are absent in PBMAs.

The effect of pH shifting on the calcium-fortified milk analogue with chickpea protein.

Milk alternative attracts more attention due to nutrition benefits, but the low solubility and the calcium deficiency of plant protein hinder the development of milk alternatives. Therefore, pH shifting was optimized to improve chickpea protein solubility and calcium fortification while ensuring good digestibility. The results showed that pH shifting reduced the particle size from 2197.67 ± 178.2 nm to 80.2 ± 2 nm, and increased the net ζ potential from -0.48 ± 0.24 to -21.27 ± 0.65 due to the unfolding of secondary protein structure, by which chickpea protein bring better solution stability. Additionally, the whiteness of the solution with chickpea protein increased. The calcium addition kept the solution stable with small particle size despite a slight increase. The microstructure of chickpea protein during digestion was well disrupted even with fortifying calcium. This study provides proof of the positive effect of pH shifting on chickpea protein stability and calcium fortification.

Investigating factors influencing decision-making around use of breastmilk substitutes by health care professionals: a qualitative study.

BACKGROUND: Breastfeeding is recognized as the gold standard of infant feeding and nutrition. The World Health Organization recommends exclusive breastfeeding (EBF) of infants for the first 6 months of life. A variety of factors may impact breastfeeding practices in-hospital which may continue after hospital discharge, such as the use of breastmilk substitutes (BMS). The Baby-Friendly Initiative (BFI), which aims to promote and support breastfeeding practices, established a target rate of 75% for EBF from birth to hospital discharge. Currently, this target is not being met at The Ottawa Hospital (TOH), indicating there is room for improvement in EBF rates. The purpose of this study is to explore health care professionals (HCP) decision-making around use of BMS and identify factors that drive the use of BMS with and without medical indications. METHODS: In this qualitative study, semi-structured interviews were conducted with HCPs within TOH from January to June 2022. All participants had experience in maternity or postpartum care and were probed on factors influencing use of BMS at this institution. Interview transcripts were coded using an inductive approach. RESULTS: A total of 18 HCPs were interviewed including physicians, midwives, lactation consultants, and registered nurses. Multilevel barriers influencing the use of BMS were categorized into patient, HCP, and institution-level factors. Subthemes that emerged ranged from parental preferences, training differences amongst HCPs, to budget and staffing issues. Over half of HCPs were prepared to answer questions on EBF and were familiar with the BFI. Although most were supportive of this institution receiving BFI designation, a few providers raised concerns of its impact on parents who would like to supplement. CONCLUSIONS: Several modifiable factors influencing decision-making for use of BMS were identified. These findings will be used to inform unit leads, help identify effective strategies to address modifiable barriers, and develop tailored breastfeeding supports to improve EBF rates.

The contribution of milk substitutes to the nutritional status of children with cow's milk allergy.

BACKGROUND: The impact of alternative milk substitutes on the nutritional status of children with cow's milk allergy (CMA), the prevailing cause of food allergies, is unresolved. METHODS: A cross-sectional study was performed in children older than 2 years with IgE-mediated CMA. Patients' clinical characteristics, anthropometric measurements, dietary intake (by 3-day food diary), and biochemical markers of nutritional status were assessed. RESULTS: One hundred two children with CMA (68.6% boys; median age, 3.7 years; 51% multiple food allergies) were evaluated. 44.1% of the children consumed plant-based beverages (PBB), 19.6% therapeutic formula and 36.3% did not consume any milk substitutes. In all age groups, dietary calcium, riboflavin, and vitamin D intake of those who did not use milk substitutes were lower than those who consumed formula or PBB (p < .01). Also in the 2-3 years old age group, dietary zinc (p = .011) and iron intake (p = .004) of the formula-fed group was higher. Formula-fed patients had higher levels of 25-OH vitamin D (µg/L) and serum vitamin B12 (ng/L) than PBB-fed patients (respectively; p < .001, p = .005) and those who did not consume any milk substitute (p < .001). Patients of all ages who did not utilize a milk substitute failed to obtain an adequate amount of dietary calcium. CONCLUSION: The use of milk substitutes positively affects dietary calcium, riboflavin, and vitamin D intake in CMA, but their contribution is variable. Those who do not use milk substitutes are at greater risk inadequate of dietary calcium intake. Personalized nutritional advice, given the clinical diversity and the impact of individual differences, is required.

Transition milk or milk replacer powder as waste milk supplements to cold-stressed neonatal Holstein dairy calves: Effects on performance, feeding behavior, and health.

Young calves are more susceptible to cold than older animals due to their limited ability to regulate body temperature and lack of fat reserves and may have difficulty consuming the energy needed to cope with the cold by maintaining body temperature and meeting their metabolic needs, especially when fed constant levels of waste milk (WM) with less solids, which can be detrimental to health and future performance. An alternative to overcome this problem is increasing the milk's solids content to the existing volume by using different sources [milk replacer powder (MR) or transition milk (TM)]. Thus, we aimed to evaluate the effects of increasing the total solids of WM via MR (WM+MR) or TM (WM+TM) on the performance, feeding behavior, and health-related variables of cold-stressed dairy calves during pre- and post-weaning. We hypothesized that feeding WM supplemented with MR or TM as potential liquid feed enhancers would improve milk dry matter and energy intake of the calves with a positive impact on body development and have no negative impact on feeding behavior and health. Additionally, we hypothesized that MR would not differ from TM. As a sample size calculation at 80% power using power analysis (PROC POWER) in SAS 9.4, a total of 51 Holstein-Friesian vigorous male calves [vigor score 21-27; 17 per treatment; 4-d old; body weight (BW) = 40.0 ± 0.63 kg (mean ± SD)] were selected, assigned randomly to treatments, and housed in individual pens in an outdoor barn. Irrespective of the type of treatment, all calves were fed 6 kg/d liquid feed from d 1 to d 53 of the experiment. In a step-down weaning program, calves received 0.5 kg liquid feed from d 54 to d 60. All calves were weaned on d 61 and remained in the study until d 101 as post-weaning evaluation. The calves had ad libitum access to starter feed and fresh drinking water across the experiment. Intake, growth, and behavior data were analyzed using a general linear mixed model and health data were analyzed using mixed logistic regression, mixed linear regression, and survival analysis models in SAS. We found that supplementation was responsible for a greater dry matter intake (DMI; P = 0.004), superior average BW (P = 0.037), and increased crude protein (CP; P = 0.001) and crude fat (CF; P = 0.001) intakes, with the most favorable outcomes observed for the WM+TM group when compared with WM+MR. Animals fed WM (control group; CON) showed a smaller average daily gain during the first 40-d of life (P = 0.026), showing slight changes during the whole period of evaluation when compared with the supplemented groups (SUP; WM+MR and WM+TM). No difference between MR- and TM-SUP groups, probability of having abnormal appearance (P = 0.032) and pneumonia occurrence (P = 0.022) was reduced in the SUP than in CON animals, with no effect on diarrhea among treatment groups (P = 0.461). Using milk supplements added to WM is an alternative to improve the intake, performance, and health of young calves under cold stress. Our findings showed that SUP animals outperformed the CON group in terms of DMI, average BW, and intake of CP and CF, with the TM-SUP group displaying the most favorable outcomes. Moreover, the SUP groups demonstrated reduced odds of experiencing abnormal appearance and pneumonia, highlighting the positive impact of supplementation on calf health.

Analysis of physicochemical properties of nut-based milk and sweetened condensed milk alternatives.

This study analyzed the physicochemical properties of nut-based milk and sweetened condensed milk (SCM) alternatives. Four types of nuts (almonds, cashews, hazelnuts, and walnuts) were roasted at 140 °C for 15 min, followed by the preparation and analysis of milk and SCM alternatives. During the production of SCM by heating with adding sugar, the pH, moisture, and L* decreased, while the carbohydrates, viscosity, and browning index increased significantly (p < 0.05). Oleic acid, linoleic acid, and linolenic acid contents were comparable among all samples (p > 0.05). Volatile compounds were analyzed using HS-SPME-GC-MS to determine changes due to roasting and heating, and a total of 54 volatile compounds were identified. These findings to show the importance of the physicochemical characteristics of milk and SCM alternatives, provide practical information for the development of improved-quality dairy alternatives.

Working with companies that manufacture breastmilk substitutes: An EAACI position paper.

Breastmilk is the optimal source of nutrition for infants and should ideally be provided exclusively for the first 6 months of life, and alongside complementary food until 2 years of life. However, there are circumstances where a breastmilk substitute (BMS) may be required. This includes maternal and/or child conditions or personal preference. Whilst these circumstances should never be used as an opportunity to promote BMS, healthcare professionals (HCPs) need to have the knowledge of suitable alternatives and should always be guided by scientific and health motives when recommending a BMS. The Task Force 'Milk Formula Industry Sponsorship' from the European Academy of Allergy and Clinical Immunology (EAACI), provides with this publication recommendations for EAACI interactions with the BMS manufacturers and how this will be supervised.

Sensory characteristics of plant-based milk alternatives: Product characterisation by consumers and drivers of liking.

Like other plant-based (PB) product categories, PB milk alternatives (PBMA) are in ascendency as part of the green consumer transition and a greater focus on personal health. However, consumption remains far below that for cow's milk, and among multiple barriers to uptake, inferior sensory properties is one problem, nutritional inadequacies another. While exceptions exist in both instances, a general need for improved products remains. The present research is situated in this nexus, and its primary aim was to contribute new consumer-centric insight regarding the sensory drivers of liking/disliking in the PBMA category. This was achieved through a central location study with adult New Zealanders (n = 143, not regular PBMA consumers) who tasted 18 different PBMA samples spanning a broad range of PB ingredients (soy, oat, coconut, almond, rice, cashew, peanut, macadamia, lentil, hemp, sesame) in different product types (single PB source, blends, barista style) with varying nutritional profiles. The most liked sample (6.5/9), which was made from soy, had the nutritional profile that most approximated cow's milk (3 g/100 mL protein), as well as a milky appearance and taste. Its mouthfeel was smooth, and this sensory characteristic was also paramount for barista-style PBMAs being well-liked (>5.9/9) regardless of their constituent PB ingredient (oat, almond, coconut). Opportunities for product innovation within this type of PBMA was identified including for using barista-style beyond hot beverages, as these samples received positive liking scores on average. The same applied to blends as multiple-source PBMAs can facilitate improved nutritional composition, and significant scope seemed to exist to identify more liked vs less liked PB ingredient combinations (e.g., almond/rice vs coconut/sesame). By identifying, through penalty/lift analysis that positive sensory drivers of PBMA liking span all sensory modalities (appearance, taste, flavour, texture and mouthfeel), it becomes easier to appreciate that products in this category are complex and challenging to optimise. A second minor research aim was focused on the modulating influence of PBMA consumption frequency on product liking and the sensory drivers of liking. The key result was a positive association between liking and higher consumption frequency, and greater appreciation of sweet, coconut, nutty and cereal/oaty characteristics of PBMAs.

Postprandial metabolism and gut permeability in calves fed milk replacer with different macronutrient profiles or a whole milk powder.

Significant differences exist in the composition of current milk replacers (MR) and bovine whole milk. This study investigated how the macronutrient profile of 3 different MR formulations containing varying amounts of fat, lactose, and protein, and a whole milk powder (WP), affect postprandial metabolism and gut permeability in male Holstein calves. Sixty-four calves (45.4 ± 4.19 kg [mean ± SD] and 1.8 ± 0.62 d of age) were blocked in order of arrival to the facility and within each block, calves were randomly assigned to 1 of 4 treatments. Treatments included a high-fat MR (HF: 25.0% dry matter [DM] fat, 22.5% protein, 38.6% lactose; n = 14), a high-lactose MR (HL: 44.6% lactose, 22.5% protein, 18.0% fat; n = 17), a high-protein MR (HP: 26.0% protein, 18.0% fat, 41.5% lactose; n = 17), and WP (26.0% fat, 24.5% protein, 38.0% lactose; n = 16). Calves were fed 3.0 L (135 g/L) 3 times daily at 0600, 1200, and 1800 h with a teat bucket. Milk intake was recorded daily for the first 28 d after arrival, and blood sampling and body weight measurements were performed at arrival and on d 7, 14, 21, and 27. Gut permeability was estimated from fractional urinary excretion of indigestible markers (Cr-EDTA, lactulose, and d-mannitol) administered as a single dose on d 21 instead of the morning milk meal. Digestibility was determined simultaneously from a total collection of feces over 24 h. Postprandial dynamics were measured on d 28 by sequential blood sampling over 7.5 h. Dry matter intake of MR over 28 d was slightly greater in calves fed HL and HP than in WP. Recovery of Cr-EDTA and d-mannitol over a 24-h urine collection was greater in calves fed WP and HP than HL calves. Apparent total-tract digestibility of crude ash, protein, and fat did not differ among treatments; however, DM digestibility was lower in calves fed WP than in other treatment groups. In addition, abomasal emptying, as indicated by the area under the curve (AUC) for acetaminophen, was slower in calves fed WP than in calves fed HF and HL. The AUC for postprandial plasma glucose was lower in calves fed HL than WP and HF and lower in calves fed HP than WP. The AUC for postprandial serum insulin was greater in calves fed HP than WP and HF, whereas calves fed HL did not differ from the other treatments. Postprandial triglycerides were greater in calves fed WP, and postprandial adiponectin was higher in calves fed HL than other treatments. The high content of lactose and protein in MR had a major effect on postprandial metabolism. This raises the possibility of optimizing MR formulations to maintain metabolic homeostasis and influence development.

Introduction of Breast Milk Substitutes During the First 3 Days of Life: Results of the Mexican National Survey of Demographic Dynamics, 2018.

Background: The introduction of foods or fluids other than breast milk in the first few days after birth interferes with the establishment of breastfeeding. This study aimed to investigate the association of formula introduction during the first 3 days of life with maternal sociodemographic characteristics, hospital practices, and breastfeeding duration. Materials and Methods: Information from the National Survey of Demographic Dynamics, 2018, which includes 17,686 mother-baby pairs was analyzed. Mother-baby pairs were classified into categories according to breastfeeding duration: <5 months and ≥5 months. Statistical methods and a machine learning algorithm (Bayesian network, BN) were used to analyze the data. Results: In general, 3,720 (21%) mothers reported introducing formula during the first 3 days of life. A lower education level, lower sociodemographic stratum, living in a rural area, and considering oneself indigenous were factors associated with not introducing formula during the first 3 days of life. A total of 5,168 (29.2%) mother-baby pairs practiced breastfeeding for <5 months, and 12,518 (70.8%) for ≥5 months. Almost twice as many mothers who practiced breastfeeding for <5 months introduced formula during the first 3 days of life (31.7%) compared with those who practiced breastfeeding for ≥5 months (16.6%). The BN model can sufficiently predict cases with a breastfeeding duration ≥5 months (precision-recall curve area = 0.792). Discussion: Introducing formula during the first 3 days of life was associated with a shorter breastfeeding duration. BN analysis showed a probabilistic dependency between the type of delivery and variables associated with the establishment of breastfeeding.

Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project.

OBJECTIVES: The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code). INTRODUCTION: The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support. METHODS: We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022. RESULTS: Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%). CONCLUSIONS: Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.

A comparison of total cost estimates between exclusive breast-feeding and breast milk substitute usage in humanitarian contexts.

OBJECTIVE: Using a model-based analysis, we calculated the total costs associated with the exclusive breast-feeding (EBF) and breast milk substitute (BMS) usage for one infant for six months within select humanitarian contexts to (a) determine if there is a notable difference in costs and (b) use these results to inform future creation of data-informed humanitarian response standard operating procedures. DESIGN: The inputs and costing data were drawn from a mixture of local e-commerce vendors, peer-reviewed literature and personal communications with field-based humanitarian responders. To account for cost fluctuations, each input's costs along with low and high parameters are presented. All costs are presented in 2021 United States Dollars. SETTING: Humanitarian responses within Indonesia and Jordan. PARTICIPANTS: Not applicable. RESULTS: There was a notable difference in the total cost of care in both selected locations across the study arms (Indonesia: $542; Jordan: $892). CONCLUSIONS: Given the reality of limited funding for comprehensive humanitarian response around the world and the necessity of prioritising certain interventions, humanitarian response organisations should consider the notable cost difference between EBF and BMS usage (along with the proven health benefits of EBF). This difference should play a role in informing the future creation of standard operating procedures while also ensuring that all infants within a humanitarian crisis receive appropriate feeding.

Micro problems with macro consequences: accumulation of persistent organic pollutants and microplastics in human breast milk and in human milk substitutes.

Industrial activities provide a modern human lifestyle with advances and comforts in every field. However, such scenario has brought several negative issues. Persistent organic pollutants (POPs) and a growing plastic usage together with the degradation byproducts, namely microplastics (MPs), are current environmental problems present in every ecosystem, disturbing all forms of life. POPs and MPs are also found in human consumption products including animal and vegetal derivatives, human milk substitutes, and in human breast milk. To date, it is currently unknown what are the effects of MPs and POPs when ingested during the first and most important stage for health programming of the offspring, the first 1000 days of life. Here, we add epidemiological and clinical evidence supporting major sources of POPs and MPs in the ecosystem; and we will precisely describe the effect of POP and MP accumulation in animal- or plant-based infant formulas and human breast milk, modulating health outcomes in the newborn. This review provides a rational to incentive the POP and MP identification in human breast milk and human milk substitutes for avoiding susceptibility to negative health outcomes for the newborn.