Infant Formula Companies Research Articles

Infant formula donations and code violations during earthquake relief efforts in Türkiye in 2023: an observational study

BackgroundOn 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies.MethodsData was collected from 6 February to 10 March 2023 through Internet sources. Social media, news websites, and the Emergency Nutrition Network forum were used for data collection. Turkish content was translated into English for analysis, with a focus on donation-related information and Code violations related to baby food and infant feeding.ResultsA total of 40 reports on CMF, complementary food, and feeding equipment donations were collected. Three main types of violations of the OG-IFE and the Code were identified, with the majority of them being incidences of individuals, humanitarian organizations, and government agencies seeking or accepting donations. Infant formula companies continued to violate the Code by donating large quantities of CMF and feeding equipment to the Turkish Red Crescent, government agencies, and disaster relief infant and young child feeding (IYCF) coordination authorities.ConclusionsThese incidents reflected a systematic violation of the Code and non-compliance with the OG-IFE. Globally accepted IYCF standards and recommendations were not consistently followed due to fragmented early responses. There is a critical need to step up efforts to ensure appropriate and safe IYCF practice protecting and supporting breastfed and non-breastfed infants in emergencies.

THE EXTENT OF THE IMPACT OF TOTAL QUALITY MANAGEMENT ON ACHIEVING THE COMPETITIVE ADVANTAGE OF INFANT MILK COMPANIES IN BAGHDAD/DIYALA PROVINCE

Companies in the infant formula industry are currently facing multiple challenges and difficulties due to advancing technological trends, increased global competition, and changing consumer behaviors. However, these companies can achieve excellence and maximize their profits by adopting new methods and mechanisms, establishing internal rules within the company, and applying them professionally and distinctly. Among these crucial methods is the adoption of Total Quality Management (TQM) to achieve a competitive advantage for infant formula companies in local and global markets Total Quality Management is a fundamental element for improving a company's competitiveness and ensuring its continuity and success. TQM effectively contributes to enhancing organizational performance and achieving operational and production objectives by focusing on employee efficiency and achieving organizational unity in performance. The implementation of Total Quality Management requires companies to adhere to recognized quality standards and practices, continuously improve processes, and work towards achieving customer satisfaction. Total Quality Management is an ongoing process and not time-bound; it does not end when a company meets a quality standard. Therefore, quality management is built on performing tasks correctly from the beginning to prevent the repetition of mistakes. It serves as a proactive and strategic approach that replaces the need for rework. Achieving a competitive advantage in infant formula companies heavily depends on Total Quality Management to obtain superior and excellent outputs for competitive markets. These companies are interrelated and depend on each other, so linking quality management to achieving outstanding performance can build numerous sustainable competitive advantages for companies

Company commitments and practices on nutrition and environmental sustainability in Belgium

Abstract Introduction INFORMAS developed a Business Impact Assessment for benchmarking and monitoring company commitments and practices on nutrition and environmental sustainability (BIA-Obesity & BIA-Sustainability). The aim of this study is to assess the transparency, comprehensiveness and specificity of company commitments in Belgium, as well as their related practices. Methods We selected 38 companies across supermarkets, quick service restaurants, catering companies, and packaged food, infant formula and non-alcoholic beverage companies, according to market share data in Belgium. For BIA-sustainability, company commitments were assessed for a series of indicators in 10 domains (corporate sustainability strategy, packaging, emission, energy use, water and discharge, biodiversity, food waste, environmental compliance, animal-based products and sustainable products). For BIA-Obesity, company commitments were assessed for a range of indicators across 6 domains (corporate nutrition strategy, product reformulation, product labeling, product and brand promotion, product accessibility and relationships with other organizations). Performance metrics to evaluate the size of efforts undertaken by food companies to improve their practices, alongside their commitments are under development. Results There is a wide variation in scores for transparency, comprehensiveness and specificity of commitments related to environmental sustainability across companies within sectors. Most companies have some overarching commitments for reducing environmental impacts but increasing sustainable or plant-based products within portfolios were hardly addressed in the commitments. In general, scores for BIA-Obesity are lower than those for BIA-Sustainability in Belgium. Conclusions During the workshop detailed results of these assessments in Belgium will be presented, as well as linkages between BIA-Obesity and BIA-Sustainability and commitments in relation to practices.

The Idealization of Infant Formula: A Longitudinal Analysis of Labels in Uruguay.

Labels are a key element of the marketing strategies of infant formula companies, and often include text or images that idealize their use, undermining efforts to promote breastfeeding. To evaluate the prevalence of marketing cues that idealize infant formula on labels of products commercialized in Uruguay and to assess changes after a periodic monitoring of compliance with the International Code of Marketing of Breast-Milk Substitutes (IC). This study is a descriptive, observational, and longitudinal assessment of the information included on infant formula labels. The first data collection was in 2019, as part of a periodic assessment to monitor the marketing of human-milk substitutes. In 2021, the same products were purchased to evaluate changes in their labels. Thirty-eight products were identified in 2019, of which 33 were still available in 2021. All information available on the labels was analyzed through content analysis. Most products included at least one textual or visual marketing cue idealizing infant formula in both 2019 (n = 30, 91%) and 2021 (n = 29, 88%). This represents a violation of both the IC and national regulations. References to nutritional composition were the most frequent marketing cue, followed by references to child growth and development. No relevant changes were observed after the periodic assessment conducted by the Uruguayan government. Monitoring compliance with the IC per se cannot be expected to trigger changes in the marketing strategies of infant formula companies. More explicit regulations and strong enforcement mechanisms are needed to end the inappropriate marketing practices on infant formula labels.

Pediatricians' Reports of Interaction with Infant Formula Companies.

Introduction: Seventy percent of countries follow the World Health Organization International Code of Marketing Breast Milk Substitutes that prohibits infant formula companies (IFC) from providing free products to health care facilities, providing gifts to health care staff, or sponsoring meetings. The United States rejects this code, which may impact breastfeeding rates in certain areas. Objective: We aimed at gathering exploratory data about interactions between IFC and pediatricians. Methods: We distributed an electronic survey to U.S. pediatricians asking about practice demographics, interactions with IFC, and breastfeeding practices. Using the zip code of the practice, we obtained additional information from the 2018 American Communities Survey, including median income, percent of mothers who had graduated college, percent of mothers working, and racial and ethnic identity. We compared demographic data for those pediatricians who had a formula company representative visit versus not and those who had a sponsored meal versus not. Results: Of 200 participants, the majority reported a formula company representative visit to their clinic (85.5%) and receiving free formula samples (90%). Representatives were more likely to visit areas with higher-income patients (median = $100K versus $60K, p < 0.001). They tended to visit and sponsor meals for pediatricians at private practices and in suburban areas. Most of the reported conferences attended (64%) were formula company-sponsored. Conclusion: Interactions between IFC and pediatricians are prevalent and occur in many forms. Future studies may reveal whether these interactions influence the advice of pediatricians or the behavior of mothers who had planned to exclusively breastfeed.

Is the legal framework by itself enough for successful WHO code implementation? A case study from Ethiopia.

Since 2016, Ethiopia has passed several proclamations and directives to regulate the promotion of commercial breastmilk substitute (BMS). Ethiopia's market potential will undoubtedly be the gravitating point for international infant formula companies due to growing urbanization, purchasing power, population, and the relatively low use of BMS to‐date. The aim of this review is to assess the strengths and weaknesses of the existing laws, standards, and monitoring documents used to regulate the marketing of BMSs in Ethiopia and make future recommendations. The study findings highlighted that the regulation on marketing are comprehensive and strong to limit the promotion of infant formula. On the other hand, the regulation on marketing of follow‐up formulas, complementary foods, and growing‐up milk by manufacturers and distributors, media houses, and communication and advertisement agencies are underregulated, especially with regards to the international 69.9 regulation. The monitoring and enforcement of the existing marketing regulations remain limited in the absence of a formal coordination mechanism. Several violations of the national BMS regulations were observed. Forty‐one percent of mothers reported observing the BMS advertising and logos were detected in 36% of health facilities assessed. In 100% of cases, the infant formula labels contained violations. As the lead national authority mandated to regulate food safety, the Ethiopian Food and Drug Authority needs to update its regulations related to the marketing of BMS to fill the loopholes and revise the national law in line with the international code of marketing of BMSs to protect breastfeeding.

A qualitative examination of barriers against effective medical education and practices related to breastfeeding promotion and support in Lebanon

ABSTRACT Background: Insufficient breastfeeding promotion and support by physicians contribute to suboptimal breastfeeding rates globally. Understanding setting-specific barriers against breastfeeding promotion and support from the perspective of medical students and addressing those that can be modified through undergraduate medical education may help improve learning outcomes, medical practice, and ultimately health outcomes associated with breastfeeding. Objectives: We selected the underserved and under-supported public medical school in Lebanon to explore psychosocial, institutional, and societal barriers hindering effective preventative medicine practices using breastfeeding promotion and support as an exemplar case. Methods: One-on-one semi-structured interviews, each lasting around 60 min, were conducted with medical interns (in Med III and Med IV) at their training hospitals. Interviews were voice-recorded, transcribed verbatim, coded, and analyzed thematically based on Theory of Planned Behavior. Results: Interns (n= 49; 96% response rate) completed the study. Five major themes emerged addressing barriers at various levels. At the health care system level at large, interns identified the predominant focus on pathophysiology and treatment rather than on disease prevention and health promotion as a barrier. At the level of trainees and their education experiences, interns reported limited and optional clerkship training in obstetrics/gynecology and in neonatology which contributes to their insufficient knowledge and low self-efficacy. Competing financial interests from infant formula companies and social pressures to promote infant formula were identified as two main barriers at the level of physicians and clinical practice. Conclusions: Our work using breastfeeding as an exemplary case highlights how undergraduate medical education and its learning outcomes and how medical practices and patient behavior are highly intertwined with psychosocial, institutional, and social drivers and constraints. Re-evaluating the success of undergraduate medical curricula in light of overcoming these constraints and not only based on meeting national accreditation and certification guidelines might prove helpful in improving medical education and ultimately clinical practice.

Breastfeeding in the 21st century: How we can make it work

There is abundant knowledge on the major health and social benefits of breastfeeding, and on how to protect, promote, and support breastfeeding. Hence, it is surprising that recommended breastfeeding behaviors continue to be suboptimal in the 21st Century among large segments of the population, globally. Moving forward, it is crucial to enable the breastfeeding environments for women through family friendly employment policies and to enforce the WHO Code for Marketing of Breastmilk Substitutes. It is also key to invest more in training the workforce for successful large-scale implementation and sustainability of the Baby Friendly Hospital Initiative, community-based breastfeeding counseling, and to prevent conflicts of interests with infant formula companies. Behavior change social marketing interventions that include social media need to be designed following social network science and behavioral economics principles. Evidence-informed policy tools are now available to help policy makers invest in and guide the scaling-up of cost-effective breastfeeding programs.

Exploring parental perceptions and knowledge regarding breastfeeding practices in Rajanpur, Punjab Province, Pakistan

BackgroundExclusive breastfeeding is significantly associated with strong infant immunity and optimal development. The importance of breastfeeding is underestimated. Parental lack of knowledge and unhealthy practices regarding breastfeeding deprive infants of their basic right to mother’s milk. In developing countries, including Pakistan, with high child mortality and malnutrition, healthy breastfeeding practices can bring positive changes in child health status. From this perspective, the present study aims to understand parents’ knowledge, attitudes and practical encounters with breastfeeding practices and the factors that prevent them from adopting such practices.MethodsA qualitative study was carried out in both rural and urban settings in Rajanpur District of Punjab Province, Pakistan. We conducted 12 focus-group discussions (FGDs) that involved 38 mothers and 40 fathers with children aged under two years who were being breastfed. A thematic content analysis of data collected through FGDs was performed manually. The themes were both inductive and deductive in nature.ResultsThe study found that a majority of participants believed that the first thing given to an infant after birth should not be breast milk but honey, rose flower, or goat’s milk from the hands of an elder in the family or a religious person. No cleanliness measures were practised in this regard. The participants had misconceptions about the benefits of colostrum, which frequently prevented it being given to newborns. Participants reported many factors, such as: insufficient milk syndrome (slow growth of infants due to insufficient daily breast milk intake), a mother’s high workload, lack of social support, the influence of culturally designated advisors, and the promotion and marketing strategies of infant formula companies, that undermined exclusive breastfeeding efforts and encouraged mothers to switch to infant formula.ConclusionsCulturally acceptable and integrated public health interventions are needed to improve the breastfeeding-related health literacy and practices of parents, grandparents and communities. This will ultimately reduce the high infant mortality and malnutrition rates in Pakistan.

Changes in the policy environment for infant and young child feeding in Vietnam, Bangladesh, and Ethiopia, and the role of targeted advocacy

BackgroundThere is limited literature examining shifts in policy environments for nutrition and infant and young child feeding (IYCF) over time, and on the potential contribution of targeted advocacy to improved policy environments in low- and middle-income countries. This study tracked changes in the policy environment over a four-year period in three countries, and examined the role of targeted nutrition and IYCF advocacy strategies by a global initiative.MethodsQualitative methods, including key informant interviews, social network mapping, document and literature review, and event tracking, were used to gather data on nutrition and IYCF policies and programs, actor networks, and perceptions and salience of nutrition as an issue in 2010 and 2014 in Bangladesh, Ethiopia, and Vietnam. Theoretical frameworks from the policy sciences were used to analyze policy change over time, and drivers of change, across countries.ResultsThe written policy environment improved to differing extents in each country. By 2014, the discourse in all three countries mirrored international priorities of stunting reduction and exclusive breastfeeding. Yet competing nutrition priorities such as acute malnutrition, food insecurity, and nutrition transitions remained in each context. Key actor groups in each country were government, civil society, development partners and the private sector. Infant formula companies, in particular, emerged as key players against enforcement of IYCF legislation. The role of a targeted IYCF advocacy and policy support initiative was well-recognized in supporting multiple facets of the policy environment in each country, ranging from alliances to legislation and implementation support. Despite progress, however, government commitment to funding, implementation, and enforcement is still emerging in each country, thus challenging the potential impact of new and improved policies.ConclusionTargeted policy advocacy can catalyze change in national nutrition and IYCF policy environments, especially actor commitment, policy guidance, and legislation. Implementation constraints – financing, capacity and commitment of systems, and competing priorities and actors – are essential to address to sustain further progress. The lack of pressing political urgency for nutrition and IYCF, and the uncertain role of international networks in national policy spaces, has implications for the potential for change.

Relationship Between the American Academy of Pediatrics and Infant Formula Companies

Relationship Between the American Academy of Pediatrics and Infant Formula Companies

Analisis Implementasi Sosialisasi Pemberian Asi Eksklusif Oleh Bidan Praktek Swasta (BPS) Di Kabupaten Bengkulu Selatan

Profile of South Bengkulu district health office 2008 – 2009 did not include data on exclusive breastfeeding coverage. Private practice midwives (BPS) did not have standard operating procedure (SOP) in providing obstetric service. One of midwives duties was to provide exclusive breastfeeding socialization to pregnant women, childbearing mothers and community. The objective of this study was to analyze the implementation of exclusive breastfeeding socialization by BPS in South Bengkulu district. This study applied qualitative method and using in-depth interview as data collection technique. The main informant was 3 private practice midwives in the city area and 2 private practice midwives in the rural area. Triangulation was done to 5 head of puskesmas, chief of nutritional unit and head of Indonesian Midwifery Association (IBI). Focus group discussion was conducted to 3 mothers and 3 people in the community (family member of the patient) in each selected BPS. Results of the study showed that implementation of exclusive breastfeeding socialization variable was still limited to individual education and no education materials were provided. There was no communication among head of puskesmas, head of district health office and head of IBI towards BPS. BPS facilities were still insufficient to support the success of exclusive breastfeeding. Disposition had not supported exclusive breastfeeding coverage improvement. In the bureaucracy structure variable, there was no reporting format from BPS to puskesmas on exclusive breastfeeding socialization implementation in South Bengkulu district. It was suggested to district health office to formulate regulation policy in the form of decree regarding exclusive breastfeeding and to forbid collaboration between BPS and infant formula companies. Head of puskesmas had to do supervision and monitoring to BPS. Private practice midwives were expected to improve the frequency of exclusive breastfeeding socialization and to avoid collaboration with infant formula companies.

Effects of high hydrostatic pressure on the conformational structure and the functional properties of bovine serum albumin

Abstract Non-thermal technologies, such as High Hydrostatic Pressure (HHP), are able to induce extensive changes in the structure of biological macromolecules, namely proteins. HHP treatments disrupt the electrostatic interactions, which stabilize the quaternary and the tertiary structure of the proteins, and activate the reactions of sulfhydryl-disulfide bond exchange. These structural changes result in the dissociation and refolding of proteins during HHP treatments, and consequently in the modification of protein functional properties, namely physicochemical properties (solubility, binding and surfactant properties, water and oil absorption capacity, emulsifying and foaming properties). The technological behavior of the proteins in food preparation, processing, storage, as well as their contribution to determine quality perception of foods mainly depends on these functional properties. This work aims at investigating the effects of HHP treatments on the conformational (quaternary, tertiary and secondary) structure and the functional properties of a globular water soluble protein, the Bovine Serum Albumin (BSA). BSA (50–100 mg/mL) solutions in Sodium Phosphate Buffer were processed at different pressure levels (100–500 MPa) and treatment times (15, 25 min). BSA unfolding and refolding were analyzed in terms of free sulfhydryl (SH) groups, changes of secondary structure, foaming and emulsifying properties. Analyzing the experimental data it can be concluded that the unfolding of BSA samples with a concentration of 50 mg/mL occurred in the pressure range between 100 and 400 MPa. In fact an increased number of the free SH groups as well as an improved foaming and emulsifying ability were detected in the treated samples. Pressure levels above 400 MPa promoted the interactions between adjacent polypeptide chains and the formation of soluble high molecular mass aggregates. The concentration of the protein in the samples, also, controlled the occurrence of unfolding and aggregation. Extensive changes in BSA secondary structure were observed at pressure level above 300 MPa, for longer processing times and higher protein concentrations. In these processing conditions β-sheet aggregates were likely to replace the initial α-helixes. Industrial relevance The paper consists in the study of the Effects of High Hydrostatic Pressure processing (HHP) on the conformational structure and the functional properties of Bovine Serum Albumin. he work proposes an innovative technology for Food Industries that can be widely used for food conservation and to induce protein modifications in the same time. For this reason the technology represents a good tool for the production of hypoallergenic compounds especially in the field of dairy products and infant formula companies.

Oligosaccharides in infant formula: more evidence to validate the role of prebiotics.

The gastrointestinal (GI) microbiota differs between breast-fed and classic infant formula-fed infants. Breast milk is rich in prebiotic oligosaccharides (OS) and may also contain some probiotics, but scientific societies do not recommend the addition of prebiotic OS or probiotics to standard infant formula. Nevertheless, many infant formula companies often add one or the other or both. Different types of prebiotic OS are used in infant formula, including galacto-oligosaccharide, fructo-oligosaccharide, polydextrose and mixtures of these OS, but none adds human milk OS. There is evidence that the addition of prebiotics to infant formula brings the GI microbiota of formula-fed infants closer to that of breast-fed infants. Prebiotics change gut metabolic activity (by decreasing stool pH and increasing SCFA), have a bifidogenic effect and bring stool consistency and defecation frequency closer to those of breast-fed infants. Although there is only limited evidence that these changes in GI microbiota induce a significant clinical benefit for the immune system, interesting positive trends have been observed in some markers. Additionally, adverse effects are extremely seldom. Prebiotics are added to infant formula because breast milk contains human milk OS. Because most studies suggest a trend of beneficial effects and because these ingredients are very safe, prebiotics bring infant formula one step closer to the golden standard of breast milk.

Probiotics and prebiotics in infant formula

The gastrointestinal flora of breast-fed infants and those on classic standard infant formula differs. While mother’s milk is rich in prebiotic oligosaccharides and also contains some probiotics, a standard infant formula contains none of both. There is evidence that addition of pro- and prebiotics bring the gastrointestinal (GI) flora composition of formula-fed infants closer to that of breastfed infants. However, there is only limited evidence that these changes in GI flora induce a health benefit. Almost no adverse effects have been shown. Pre- and probiotics are added to infant formula because they are present in mother’s milk, and since the risk for adverse events seems minimal to non-existent. The evidence of a relevant clinical benefit is limited. However, since most studies suggest a trend for beneficial effects (which differs from study to study and which is most of the time insignificant) and since these ingredients are very safe, most infant formula companies do add prebiotics or probiotics, or both, to infant formula.

Dietary Long-Chain PUFA Enhance Acute Repair of Ischemia-Injured Intestine of Suckling Pigs1–3

Infant formula companies have been fortifying formulas with long-chain PUFA for 10 y. Long-chain PUFA are precursors of prostanoids, which stimulate recovery of intestinal barrier function. Supplementation of milk with PUFA increases the content of arachidonic acid (ARA) in enterocyte membranes; however, the effect of this enrichment on intestinal repair is not known. The objective of these experiments was to investigate the effect of supplemental ARA on intestinal barrier repair in ischemia-injured porcine ileum. One-day-old pigs (n= 24) were fed a milk-based formula for 10 d. Diets contained no PUFA (0% ARA), 0.5% ARA, 5% ARA, or 5% EPA of total fatty acids. Following dietary enrichment, ilea were subjected to in vivo ischemic injury by clamping the local mesenteric blood supply for 45 min. Following the ischemic period, control (nonischemic) and ischemic loops were mounted on Ussing chambers. Transepithelial electrical resistance (TER) was measured over a 240-min recovery period. Ischemia-injured ileum from piglets fed 5% ARA (61.0 ± 14%) exhibited enhanced recovery compared with 0% ARA (16 ± 14) and 0.5% ARA (22.1 ± 14)-fed pigs. Additionally, ischemia-injured ileum from 5% EPA (51.3 ± 14)-fed pigs had enhanced recovery compared with 0% ARA-fed pigs (P< 0.05). The enhanced TER recovery response observed with ischemia-injured 5% ARA supplementation was supported by a significant reduction in mucosal-to-serosal flux of3H-mannitol and14C-inulin compared with all other ischemia-injured dietary groups (P< 0.05). A histological evaluation of ischemic ilea from piglets fed the 5% ARA showed reduced histological lesions after ischemia compared with the other dietary groups (P< 0.05). These data demonstrate that feeding elevated levels of long-chain PUFA enhances acute recovery of ischemia-injured porcine ileum.

Enrichment of Intestinal Mucosal Phospholipids with Arachidonic and Eicosapentaenoic Acids Fed to Suckling Piglets Is Dose and Time Dependent

Infant formula companies began fortifying formulas with long-chain PUFA in 2002, including arachidonic acid (ARA) at ∼0.5% of total fatty acids. The primary objective of this study was to determine the time-specific effects of feeding formula enriched with supra-physiologic ARA on fatty acid composition of intestinal mucosal phospholipids. One-day-old pigs (n = 96) were fed a milk-based formula for 4, 8, or 16 d. Diets contained either no PUFA (0% ARA, negative control), 0.5% ARA, 2.5% ARA, 5% ARA, or 5% eicosapentaenoic acid (EPA) of total fatty acids (wt:wt). Growth (299 ± 21 g/d) and clinical hematology were unaffected by treatment (P > 0.6). Although minimal on d 4, concentrations of ARA in jejunal mucosa were enriched 47, 272 and 428% by d 8 and 144, 356, and 415% by d 16 in pigs fed the 0.5% ARA, 2.5% ARA, and 5% ARA diets, respectively, compared with the 0% ARA control pigs (P < 0.01). On d 16, ARA enrichment increased progressively with increasing dietary ARA supplementation from 0 to 2.5% but plateaued as dietary ARA rose to 5%. A similar pattern of ARA enrichment was observed in ileal mucosal phospholipids, but maximal enrichment in the ileum exceed that in the jejunum by >50%. As ARA increased, linoleic acid content decreased reciprocally. Although maximal enterocyte enrichment with EPA approached 20-fold by d 8, concentrations were only ∼50% of those attained for ARA. Negligible effects on gross villus/crypt morphology were observed. These data demonstrate a dose-dependent response of intestinal mucosal phospholipid ARA concentration to dietary ARA with nearly full enrichment attained within 8 d of feeding formula containing ARA at 2.5% of total fatty acids and that supra-physiologic supplementation of ARA is not detrimental to growth.

Awareness and reported violations of the WHO International Code and Pakistan's national breastfeeding legislation; a descriptive cross-sectional survey.

BackgroundNational legislation in Pakistan adopted the International Code of Marketing of Breastmilk Substitutes in 2002 to restrict the promotion of infant formula feeding. Our objectives were to assess health professionals' awareness of this law in urban government hospitals and describe their reports of violations, including receiving free samples, gifts and sponsorship.MethodsStructured interviews were conducted with health staff between July and August 2006 at 12 urban government hospitals in Islamabad, Rawalpindi and Peshawar including paediatricians, obstetricians, nurses, resident doctors, midwives and lady health visitors (LHVs).ResultsOf the 427 health workers interviewed, the majority were not aware of the national breastfeeding law (70.5%; n = 301) or the International Code (79.6%; n = 340). Paediatricians, and staff who had been working for 10 years or more, were more likely to be aware of the law [OR = 7.00, 95% CI 3.12, 15.7 (paediatricians); OR = 2.48, 95% CI 1.45, 4.24 (10 years working)].More than one third (38.4%, n = 164) had received small gifts such as pens, pencils and calendars; 12.4% (n = 53) had received sponsorship for training or conferences; and 15.9% (n = 68) had received free samples of infant formula from the Companies. Staff who were aware of the law were also more likely to report receiving gifts (OR = 1.64, 95% CI 1.08, 2.51) and free samples (OR = 1.86, 95% CI 1.09, 3.19).ConclusionMost hospital health professionals were unaware of national breastfeeding legislation in Pakistan, and infant formula companies were continuing to flout the ban on gifts, free samples and sponsorship for health staff.

Probiotics: `good bacteria'?: While the research is promising, additional data needed to prove benefits for children

Yogurt companies have been touting it for years — “the good bacteria found in yogurt helps the digestive system.” Now, infant formula companies are joining the marketing campaign, and many pediatricians and parents are wondering whether there is research to back the claims about this good

Differences in perception of the WHO International Code of Marketing of Breast Milk Substitutes between pediatricians and obstetricians in Japan

BackgroundThe World Health Organization International Code of Marketing of Breast-Milk Substitutes (WHO Code) aims to protect and promote breastfeeding. Japan ratified the WHO Code in 1994, but most hospitals in Japan continue to receive free supplies of infant formula and distribute discharge packs to new mothers provided by infant formula companies. The aim of this study was to explore the knowledge and attitudes of pediatricians and obstetricians in Japan to the WHO Code.MethodsA self-completion questionnaire was sent to 132 pediatricians in the 131 NICUs which belonged to the Neonatal Network of Japan, and to 96 chief obstetricians in the general hospitals in the Kanto area of Japan, in 2004.ResultsResponses were received from 68% of pediatricians and 64% of obstetricians. Sixty-six percent of pediatricians agreed that "Breastmilk is the best", compared to only 13% of obstetricians. Likewise, pediatricians were more likely to be familiar with the WHO Code (51%) than obstetricians (18%).ConclusionIn Japan, pediatricians and obstetricians, in general, have low levels of support for breastfeeding and low levels of familiarity with the WHO Code. To increase the breastfeeding rates in Japan, both pediatricians and obstetricians need increased knowledge about current infant feeding practices and increased awareness of international policies to promote breastfeeding.