Use Of Infant Formula Research Articles

Implementing the world health organization code: Improved information for mothers

Beginning in 1977 in the United States and in 1979 internationally, Nestle S.A., a multinational corporation, became the target of a major boycott. Criticism of the company's activities focused on its attempts to influence health professionals in Third World countries to recommend the company's infant formula to mothers, and on the allegedly biased nature of the company's educational materials and product information on infant feeding. In 1981, the company accepted the International Code of Marketing of Breast-milk Substitutes, which was passed by the World Health Assembly that same year ,(1). However, the international committee that organized the boycott contended that the company was not complying with four specific areas of the code, and insisted that the boycott would not be lifted until the company complied fully with the recommendations made by the World Health Organization (WHO). Among other stipulations, the committee called for the company to change its product labels and educational materials regarding the benefits, use, and preparation of infant formula. In the Joint Statement of Understanding signed in January 1984 by the company and the boycott committee, the company agreed to seek advice from health communication c.onsultants to revise its labels and educational materials, and to consult with representatives of the boycott committee, WHO, and the United Nations Children's Fund (UNICEF) on its progress in the four areas of contention. To fulfill its pledge to seek advice from health communication consultants, the company contracted with our organization, a U.S.-based, international private nonprofit organization (Note 1), to assist it in revising its infant-formula labels and educational materials on breastfeeding. This case study outlines a successful approach to implementing parts of the international code (Note 2). It also is an example of cooperation between private industry and the international development community to foster socially responsible marketing of infant formula. Other companies may find that this approach can help make their information conform to the code.

Allergenicity of Whey Protein

Enzymatic in vitro hydrolysis was evaluated as a possible treatment to abolish the allergenicity of whey proteins in view of their use in infant formulas. Guinea pigs without prior immunological contact (including fetal life) with cow's milk were fed various preparations of cow's milk proteins. Oral exposure to milk or untreated whey protein led to anaphylactic sensitization of the animals. In contrast, trypsin-hydrolyzed whey protein and a peptide preparation produced from the tryptic hydrolysate by ultrafiltration were devoid of sensitizing capacity by the oral route. The hydrolysate (crude or purified) was also ineffective in triggering local or systemic anaphylaxis in previously sensitized animals.

Allergenicity of Whey Protein

Enzymatic in vitro hydrolysis was evaluated as a possible treatment to abolish the allergenicity of whey proteins in view of their use in infant formulas. Guinea pigs without prior immunological contact (including fetal life) with cow'S milk were fed various preparations of cow'S milk proteins. Oral exposure to milk or untreated whey protein led to anaphylactic sensitization of the animals. In contrast, trypsin‐hydrolyzed whey protein and a peptide preparation produced from the tryptic hydrolysate by ultrafiltration were devoid of sensitizing capacity by the oral route. The hydrolysate (crude or purified) was also ineffective in triggering local or systemic anaphylaxis in previously sensitized animals.

Incidence of aspiration with endotracheal tubes in children

tion in one; it probably was not significantly contributory to the fat malabsorption. Bile acid loss persisted despite dietary and pancreatic extract therapy and the resulting correction of steatorrhea, indicating that the unhydrolysed triglycerides were not the main reason for impaired ileal bile acid absorption. The spontaneous recovery in both children toward the end of the first year of life indicated to us that a transient delay in maturation of exocrine pancreatic function was probably responsible for the malabsorption. Absent lipolytic and amylolytic activity and blunted response to hormonal stimulation have been described in premature and newborn infants. 2,a2 These functions were found to be normal and comparable to those of adults by 2 years of age. The exact timing of maturation is unknown. The malabsorption syndrome caused by pancreatic insufficiency may easily be missed if it is transient or masked by the liberal use of infant formulas containing simple sugars, hydrolyzed protein, and medium-chain triglycerides.

RESPONSE BY NESTLE TO THE WHO CODE ON BREAST-MILK SUBSTITUTES

The Nestle Group has prepared written instructions (dated February, 1982) for its employees on the implementation of the W.H.O. International Code of Marketing of Breast-milk Substitutes. . . . The instructions appear in parallel with the relevant sections of the code, and the comparisons thus offered raise some doubts about the purity of Nestle's intentions. Article 2 of the international code, for instance, states that it covers all breast-milk substitutes, including complementary foods. Nestle has limited its applicability to infant formula alone, exempting its weaning cereals and canned milks, which are often marketed as early supplements to breast milk. Concerning the circulation of informational and educational material to pregnant women and mothers of young children, Nestle says: "Information intended for mothers. . . may bear corporate and product brand (packshot permitted)." Is this really within the terms of the code? Another requirement of the code disregarded by Nestle, is the inclusion in any such material of a warning of the health hazards of the improper use of infant formula. Article 5 of the W.H.O. code states that "There should be no advertising or other forms of promotion to the general public of products within the scope of this Code." Nestle has written: "Information relating to specific brands of infant formula must not be communicated directly to mothers or to the general public." Conceivably, such a statement could permit generic infant formula advertising in the mass media. Analysis of Nestle's guidelines discloses ways in which they might be used to circumvent various parts of the international code, such as the code's stipulations on free samples to health workers and free supplies to institutions.

Infant Formula Controversy-Reply

In Reply. —I fully agree with Dr Simms' assertion that inappropriate infant formula promotion and use are not the largest contributors to excessive infant and child mortality in developing countries; I would further agree that contaminated and diluted infant formula is not even the number one cause of diarrhea and malnutrition. However, the linkages between mass marketing of infant formula to poverty populations and consequent declines in breast-feeding with associated diarrhea and malnutrition are significant and major contributors to Third World morbidity and mortality patterns. Moreover, they are factors that we can do something about now, with promotive, preventive, and curative health efforts. Probably only around 15 million infants in developing countries are currently exposed to infant formula; that leaves some 85 million infants per year, most of them born into desperately poor and environmentally unhygienic settings, whose health can be promoted by vigorous support of breast-feeding, and many of

The recent trend in milk feeding among WIC infants.

The type of milk fed infants from birth to six months of age was ascertained by quarterly surveys of a national sample of births. WIC (Women, Infants and Children Program) participants were identified from this sample, and trend data indicate that an increased percentage of WIC mothers ae choosing to breastfeed their infants. Infant formula use has declined in the early months of life, but increased at the expense of cow's milk toward the middle of the first year.

A method for the removal of nitrates from waterprior to use in infant formula

Summary Experimental work was conducted and data presented showing it practicaland possible to reduce the nitrate content of well water to a safe level by the use of a rapid anion exchange resin either in a batch or column operation.