Abstract
Many infants do not receive breastmilk for the recommended 2-year duration. Instead, alternative milk beverages are often used, including infant formula and raw animal milk products. The purpose of this systematic review was to summarize the effect of animal milk consumption, compared to infant formula, on health outcomes in non-breastfed or mixed-fed infants aged 6–11 months. We searched multiple databases and followed Cochrane guidelines for conducting the review. The primary outcomes were anemia, gastrointestinal blood loss, weight-for-age, length-for-age, and weight-for-length. Nine studies were included: four randomized controlled trials (RCT) and five cohort studies. All studies, except one, were conducted in high income countries. There was a low certainty of evidence that cow’s milk increased the risk of anemia compared to formula milk (Cohort studies RR: 2.26, 95% CI: 1.15, 4.43, RCTs: RR: 4.03, 95% CI: 1.68, 9.65) and gastrointestinal blood loss (Cohort study RR: 1.52, 95% CI: 0.73, 3.16, RCTs: RR: 3.14, 95% CI: 0.98, 10.04). Additionally, there was low certainty evidence that animal milk consumption may not have a differential effect on weight and length-for-age compared to formula milk. Overall, the evidence was of low certainty and no solid conclusions can be drawn from this data. Further studies are needed from low- and middle-income countries to assess optimal milk type in non-breastfed infants aged 6–11 months.
Highlights
Introduction published maps and institutional affilThe World Health Organization (WHO) and United Nations Children’s Fund (UNICEF)recommend exclusive breastfeeding for the first six months of life with the continuation of breastfeeding for up to 2 years or beyond with complementary feeding beginning at 6 months of age [1,2]
The results showed, with a low certainty of evidence, that cow’s milk as the main milk drink leads to an increase in anemia when compared to formula feeding in infants 6–11 months of age (Cohort studies relative risk (RR): 2.26, 95% Confidence interval (CI): 1.15, 4.43, No of studies: 2; p = 0.02, I2 = 0%, Grade certainty: Low; Randomized controlled trials: RR: 4.03, 95% CI: 1.68, 9.65, No of studies: 2; p = 0.002, I2 = 0%; Grade certainty: Low: Figure 2)
The results showed a very low to low certainty of evidence that cow’s milk leads to increased gastrointestinal blood loss (Cohort study RR: 1.52, 95% CI: 0.73, 3.16, No of studies: 1; p = 0.27; Grade certainty: very Low: Randomized controlled trial: RR: 3.14, 95% CI: 0.98, 10.04, No of studies: 1; p = 0.05; Grade certainty: Low: Figure 3)
Summary
Recommend exclusive breastfeeding for the first six months of life with the continuation of breastfeeding for up to 2 years or beyond with complementary feeding beginning at 6 months of age [1,2]. Many infants do not receive breastmilk exclusively through. 6 months of age, or breastfeeding might be stopped before the recommended duration of 2 years [3]. According to the Lancet Breastfeeding series, 37% of children aged 6–24 months do not receive breast milk, with variation in rates of 18% in the lower-income countries, 34%. Cow’s milk contains higher levels of protein (0.9–1.2 g/100 mL in human milk vs 1.8–2.0 in cow’s milk) and lower lactose levels (7.0 g/100 mL in human milk vs 4.1 g/100 mL in cow’s milk) [6]. Human milk has higher iron than cow’s iations
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