The deadly influence of formula in America

[Guest guest]

http://www.naturalfamilyonline.com/BF/200312-formula-report2.htm

 

A Natural Family Online Special Report:

The deadly influence of formula in America

By Dr. Linda Folden Palmer

 

Editor’s Note: This groundbreaking analysis from noted author, health educator

and advocate Dr. Linda Folden Palmer is the first time a health expert has

published an examination of the available scientific research comparing the

death rates of formula-fed and breastfed babies. While the results hold no

surprises for breastfeeding educators and advocates, the study may prove to be a

rude awakening for the millions of Americans who have bought into the myth that

infant formula is a perfectly safe breast milk substitute.

Read the follow-up article on optimizing the health of formula-fed babies.

 

Infant formula was designed to be a medical nutritional tool for babies who are

unable to breastfeed. Formula does not fully meet the nutritional and immunity

needs of infants, leaving their immune systems flailing. An infant’s immune

system has three aspects: her own immature, developing immune system; the small

component of immunities that passes through the placenta during natural

childbirth (and to a lesser degree with premature births and cesarean sections);

and the most valuable, living portion that is passed on through mother’s milk on

an ongoing basis. Remove any of these components and you take away a vital

support structure.

This brings us face to face with the safety and effectiveness of infant formula

as a breast milk substitute. Is formula actually as safe as we have been led to

believe? In fact, the answer is a resounding “no.” In fact, the use of infant

formula doubles the risk of infant death for American babies.

While the dangers of formula feeding aren’t something you’re likely to hear in

your doctor’s office, the conclusions can be derived through an examination of

the available scientific research on infant mortality in the United States and

across the world. There are studies showing artificial feeding’s impact on

overall infant death rates in both developing and undeveloped countries. While

studies offering comparative death rates are not available for industrialized

regions, there are numerous studies providing comparative occurrence rates for

many illnesses and disorders in the United States and other industrialized

nations. Many more reports are available extolling superior survival rates and

decreased illness rates among breastfed infants, but only those with solid

numbers are useful here. We can assemble the statistics from these studies to

build a firm picture of the ratio of infant deaths for U.S. formula-fed babies

against those who are breastfed.

The relative risks of formula

It is clear that feeding infants artificial formula instead of breastfeeding

increases their relative risk of death. A number of studies point to this fact.

Table 1 shows figures from two studies measuring infant mortality risks during

certain age ranges. A risk number of 3 in the chart represents three times the

risk of infant death for infants who are artificially fed.

While the numbers in the charts reflect any amount of breastfeeding during the

study period (and not necessarily exclusive breastfeeding), nearly all studies

mention that during the first six months, exclusive breastfeeding produces much

higher survival rates than partial breastfeeding. No studies refute this

assertion. Figures for each age range listed here do not include children who

died prior to reaching that age group. Figures reflect infants who received no

breast milk or had weaned prior to reaching the reported age group versus those

who received any breastfeeding through that age.

Table 1 clearly demonstrates that the disadvantages of formula are most

devastating in the earliest months. Significant disadvantages for formula

continue throughout the year-long study period.

Suggested Relative Risks for Infant Deaths

No Breastfeeding or Any Breastfeeding Ending Before Designated Age Ranges vs.

Breastfeeding Through Designated Age Ranges1,2

CountryAuthor0 to 2 Months3 to 5 Months6 to 11 Months

MexicoPalloni1363

Brazil, Pakistan and Philippines (pooled)World Health

Organization 0 to 2 Months 2-3 Months4-5 Months6-8 Months9-11 Months

6 42.5 2 1.5

 

A relative risk of 13 here means that a child who was not breastfed through the

time period has thirteen times the risk of dying during his first year as a

child who had received any breast milk through that period.

 

The studies cited in the next table compare no breastfeeding with 12 months of

breastfeeding, each deriving a relative risk of death over the full first year.

Suggested Relative Risks for Infant Deaths

No Breastfeeding vs. Any Breastfeeding for 12 Months3-7

CountryAuthorCurrent Infant Mortality Rate (IMR)IMR During Period Study was

PerformedRelative Risk To Formula-Fed Infants

 

United States 7 Number we wish to find

MalaysiaHabicht 19 30> 2 *

Mexico (from Table 1)Palloni 24 38 10 *

 

Philippines

Guilkey2831 > 5.5

China Tu 27 36 > 3.0

PeruPalloni38 1002.5

Brazil, Pakistan, and Philippines, pooled (from Table 1)WHO48 average 4.5 *

IndiaSrivastava61106 > 1.5

 

Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live

births, from 0 to 12 months of age.

A relative risk of 5 here means that an infant who receives formula

statistically faces five times the risk of dying as an infant who is partially

or completely breastfed.

* These values are calculated from numbers provided in the studies, with

averages weighted by percentages of total deaths occurring in each age range.

More than two-thirds of deaths occur during the first month.

While the United States has a current infant mortality rate of 6.75 per

thousand, many countries have rates approaching 100, with 16 of 225 reporting

nations suffering well over 100 infant deaths for every 1,000 children born.8

The nations in the above table with lower infant mortality rates can thus be

seen as somewhat comparable to the U.S.

Factors influencing high infant death rates include malnourished mothers, high

numbers of births per mother with short spacing between births, poor weaning

foods, the early use of cow’s milk, inadequate medical attention and supplies,

poor sanitation leading to high infection rates and a rapid spread of infectious

disease, and limited education about methods of limiting infection and the

spread of disease.

Why do U.S. babies die?

Below are the percentages and total numbers of U.S. infants who die from various

leading causes, according to the 1999 National Vital Statistics Reports.9,10

Total U.S. births in 1999:4,000,000

Total U.S. infant deaths in 1999:28,000

 

 

 

20%Congenital abnormalities (birth defects)5,500

16%Low birth weight and premature birth 4,500

10%Sudden Infant Death Syndrome (SIDS) 2,700

8.5%Complications during pregnancy and birth 2,400

6% Respiratory distress: lung collapse, influenza, pneumonia1,750

3%Accidents (unintentional injuries) 850

2.5%Bacterial sepsis (infections)700

2.4%Circulatory system diseases650

1.4%Necrotizing enterocolitis400

1%Intestinal inflammations (diarrhea)300

0.3%Meningitis100

0.3% Cancer 100

 

 

 

 

 

 

 

Numbers account for 70% of total infant deaths

So how does formula play into these deaths? Let’s look at some of the common

causes of infant death and see what current research has to say on the

involvement of infant formula.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) accounts for a full 10% of U.S. infant

deaths. Several studies performed in the United States and other industrialized

nations reveal increased risks of SIDS among babies who receive formula instead

of breast milk. In the table below, the 2002 Scandinavian study takes into

account variables thought to have affected the 2000 U.S. study, finding even

stronger risks associated with formula.

The most recent U.S. study (2003) takes advantage of the lessons from these

earlier studies to raise confidence in its final results. Its finding of five

times the risk of infant death from SIDS for formula-fed infants seems to be the

most powerful statistic yet.

Studies Demonstrating Relative Risks of Infant Death from SIDS

Formula-Fed vs. Breastfed11-17

CountryAuthorYear of study publicationRelative risk for SIDS, formula-fed

infants

United StatesHauck20035

ScandinaviaAlm20021.6 to 5.1

United StatesMcVea20002

GermanySchellscheidt19977.7

EnglandGilbert19953.1

United StatesKlonoff-Cohen19952.7

New ZealandFord19932

 

 

 

 

 

 

 

 

A relative risk of 5 here means that an infant who receives formula

statistically faces five times the risk of dying from SIDS as an infant who is

breastfed.

 

Heart, Circulatory and Respiratory Failure

Premature infants and those with circulatory abnormalities often display one or

more warning signs of potential death, including inadequate oxygenation of the

blood, apnea (episodes where breathing stops) and high blood pressure. Studies

illustrate the dangers of formula for these infants. One study observed better

body temperature and superior oxygenation in pre-term infants receiving breast

milk. Formula-fed infants demonstrated many episodes of inadequate oxygenation

and some apnea, both of which were not seen among the breastfed infants. A

Scottish study found significantly better blood pressure among naturally fed

infants.

Three U.S. studies are available examining feeding methods for infants with

early circulatory problems. One study reported that more than half of infants

with congenital heart disease lost oxygenation during bottle feedings, while

none did so while breastfeeding. Another study also dealing with heart disease

found infants’ growth to be significantly inferior and their hospitalizations to

be longer when they were fed formula. A third study of very low birth-weight

infants found twice as many episodes of inadequate oxygenation among formula-fed

infants as in those who received breast milk.

Heart and Circulatory Disease in Formula-Fed vs. Breastfed18-22

CountryAuthorYearFindings for formula-fed infants

Scotland Wilson1998Higher blood pressure

TaiwanChen2000Apnea and many episodes of oxygen desaturation (none among

breastfed infants)

Inferior body temperature regulation

USA Bier1993 Double the episodes of oxygen desaturation

USACombs1993 Less growth; longer hospital stays

USAMarino1995Oxygen desaturation during more than half of bottle feedings (none

during breastfeeding)

 

 

 

 

 

 

 

 

 

Necrotizing Enterocolitis

Necrotizing enterocolitis is a severe intestinal inflammatory disorder that

affects around 4% of low birth-weight babies and 1% of full-term infants. About

one-third of low birth-weight infants and 20% of full-term infants who contract

this disorder die. While necrotizing enterocolitis is reported to be responsible

for 1.4% of infant deaths, many more unconfirmed cases are likely to be

responsible for some portion of infant deaths reported as caused by prematurity.

In the United Kingdom, it was discovered that confirmed cases of necrotizing

enterocolitis occurred in three times as many infants who received no breast

milk as in those who received both breast milk and formula. For infants who

exclusively received breast milk, necrotizing enterocolitis occurred six to 10

times less often than among wholly formula-fed infants.

Necrotizing Enterocolitis23

CountryAuthor Year Relative risk of necrotizing enterocolitis, formula-fed

infants

United Kingdom Lucas19906-10 times more often

 

 

 

 

Diarrhea

A World Health Organization (WHO) study revealed a risk of diarrhea for

formula-fed babies in developing nations averaging more than six times that of

breastfed babies. A summary article for industrialized nations demonstrated an

average of triple the risk of diarrhea for formula-fed babies. The risk in China

and Israel is reported as slightly less than triple (2.8); in Scotland, the risk

is five-fold; and a doubled risk is measured in Canada.

While one study noted nearly twice the risk of developing diarrhea for

artificially fed infants in Brazil, other studies have demonstrated that the

risk of actually dying from diarrhea was an astounding 14 to 15 times greater.

The latter studies demonstrated not only that the artificially fed infants

suffer higher rates of illness, but also that the severity and duration of their

illnesses are even greater when they do occur and result in proportionately more

deaths. This same assertion is demonstrated in a study from India, where

formula-fed infants suffer six times the death rate, once diarrhea occurs, as

breastfed infants with diarrhea.

Four separate studies in the United States all deduce a doubled risk of diarrhea

for formula-fed babies. The U.S. studies also reiterate the well-established

factor of greater severity and extent of illness once diarrhea does occur among

formula-fed babies. Death rates for formula-fed U.S. infants who get diarrhea

may be three times higher or more than their breastfed contemporaries.

The table below collates the reported risks of diarrhea for formula-fed infants

from many studies.

Diarrhea Risks for Formula-Fed vs. Breastfed24-40

CountryAuthor Year

Relative risk of diarrheal illness (or death), formula-fed infants

IsraelPalti19842.7 (during the first 5 months)

Brazil

Victora 1989 14 times the death rate

ScotlandHowie1990 5 (compared with infants with 3 months of breastfeeding)

IndiaSachdev1991 6 times the death rate with diarrhea during the first 6 months

CanadaBeaudry1995 1.9

PhilippinesYoon 1996 9 times the death rate

Mexico Lopez-Alarcon 1997 4 to 6.3

Industrialized nations, pooledGolding19973 (gastroenteritis and diarrhea)

China Fu2000 2.8 (during the first 4 months)

 

6 developing nationsWHO 2000 6 (during the first 6 months)

ItalyGianino2002 3 (rotavirus, including increased severity)

BrazilEscuder 200315 times the death rate (during the first 6 months)

2.2 times the death rate (from 4 to 11 months)

BrazilVieira20031.8

USADewey 19952

USAScariati 1997 1.8

USAWright1998

2

USARaisler19992 (during the first 6 months)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Respiratory Illnesses

Numerous studies document higher numbers of respiratory infections among

formula-fed infants than among those who are breastfed. It is clear that

respiratory infections are at least triple in the United States for formula-fed

infants. The death rate is likely to be even higher, since some of these studies

note that both the severity and extent of respiratory illnesses are considerably

higher once they occur.

Respiratory Illness Risks for Formula-Fed vs. Breastfed41-50

Country AuthorYear Relative risk of respiratory illness (or death), formula-fed

infants

IsraelPalti 1984 3.7 (during the first 5 months)

Brazil Victora 19873.6 times death

Italy Pisacane 1994 4.5

Mexico Lopez 19972 to 8.5 (during the first 4 months)

1.5 to 3 times as many days for each occurrence

Scotland Wilson1998 1.9 (during the first 4 months)

Brazil Cesar 1999 17 times hospitalization for pneumonia

USA Wright 1998 2 (bronchitis)

4 (pneumonia)

USALevine1999 3.7 (pneumococcal disease, 2 to 11 months)

USABlaymore- Bier2002 6 times as many days of upper respiratory infection

(during the first month)

USA Bachrach 20033.5 (severe respiratory tract illnesses)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cancer

A joint study between the United States and Canada on neuroblastoma, a common

childhood cancer, revealed a doubled risk for children who did not receive

breast milk for more than one year. This study is consistent with several other

childhood cancer studies in other nations, with results ranging from 1.45 to 4

times the risk for developing various common childhood cancers for formula-fed

babies.

Childhood Cancer Risks for Formula-fed vs. Breastfed51-56

CountryAuthorYearFindings for formula feeding and cancer risks

ChinaShu 1995 1.5 (leukemia and lymphoma)

UAEBener 2001 2.8 (leukemia and lymphomas for no or less than 6 months breastfed

versus longer breastfeeding)

FrancePerrillat 20022 (leukemia for breastfeeding over 6 months)

U.S. & CanadaDaniels2002 2 (neuroblastoma)

 

 

 

 

 

 

 

Low Birth-Weight and Pre-term Birth

Representing 16% of U.S. infant mortality totals, premature birth and low

birth-weight are the second leading diagnoses on death certificates of U.S.

infants. While prematurity may lay the foundation for difficulties in tiny

infants, the factors that actually take their lives include infection,

respiratory distress, unconfirmed necrotizing enterocolitis, circulatory

deficiency and diarrhea. These diagnoses are often detectable only with a

biopsy, so the listed cause in these cases is often simply prematurity. One

study that performed autopsies on a group of extremely low birth-weight infants

who had not survived found that infection was the actual primary cause of death

for half of the infants. Prematurity was the cause of death predominantly for

infants who weighed less than one pound.

Preemies in India who received only preemie formula were found to develop more

than twice as many infections as those who received some human milk. Another

Indian study on high-risk newborns found that those receiving human milk plus

formula suffered twice the infection rate of those receiving only pasteurized

human milk and triple the rate of those receiving only raw human milk. A

Columbian study found a nearly doubled death rate for low birth-weight infants

who were partially or completely formula fed. And a Malaysian study found a huge

difference in total infant survival among extremely low birth-weight babies who

received expressed breast milk as opposed to those who did not.

A U.S. study performed at George Washington University Hospital found 2.5 times

the number of infections among formula-fed infants in the intensive care unit

than among those receiving human milk. Another study at Georgetown University

Medical Center also found more than double the number of infections in very low

birth-weight infants not receiving human milk. A San Diego study found twice as

many infections in pre-term, formula-fed infants compared with infants who

received human milk.

As shown in many other studies, the extent and severity of infection among

pre-term and low birth-weight infants are generally greater in formula-fed

infants as well. One study gives a solid example for preemies, finding

respiratory infections among U.S. formula-fed preemies to run six times as many

days as those in their breastfed counterparts.

Pre-term Infant Illness and Death Rates57-64

 

Country Author Year Relative risk for illness or death, formula-fed pre-term and

low birth-weight infants

IndiaNarayanan 1980 2.25 times the infections for no breast milk as opposed to

some

IndiaNarayanan19842 times the infections for formula plus pasteurized breast

milk as pasteurized breast milk alone3 times the infections as raw breast milk

alone

Malaysia Boo2000 Many times the death rate for no breast milk

ColumbiaCharpak2001

2 times the death rate for any amount of formula as for exclusive breastfeeding

USAel-Mohandes 19972.5 times the infections

USA Hylander 19982 times the infections

USA Schanler2001 2 times the infections

USABlaymore-Bier20026 times the duration of upper respiratory infections

 

 

 

 

 

 

 

 

 

 

 

 

 

Exclusive feeding of raw breast milk is not always an option for premature

infants, although it is common in some hospitals with excellent support.

Sometimes, less-effective pasteurized breast milk is used and often fortifiers

are added. Several studies show decreased survival for infants fed milk with

added fortifiers as opposed to those fed unfortified milk,65-68 but the picture

is complex and the choices of fortifiers vary greatly.

And finally, it is worth noting that the eye damage that can occur in very low

birth-weight infants, retinopathy of prematurity, occurs only half as often in

infants who receive some breast milk.69 Even a disorder as apparently unrelated

to feeding methods as inguinal hernia has been discovered to occur twice as

often in artificially fed infants and even more frequently when compared with

infants who are exclusively breastfed.70

Congenital Abnormalities

Twenty percent of U.S. infant deaths are attributed to birth defects. The most

common potentially lethal birth defects include heart disorders, various

chromosomal or genetic defects and underdeveloped lungs. In terms of infant

formula’s impact, we have the least amount of statistical information in this

category. However, many factors suggest that formula-fed infants with congenital

abnormalities have smaller chances of survival than their breastfed

counterparts.

While death certificates often list the initial abnormality as the cause of

death, infection is actually the final factor in many of these deaths. We have

already seen how drastically infection rates and deaths are reduced by

breastfeeding. It is clear that the youngest and weakest infants are the ones

who are most strongly endangered by infant formula’s inadequacies.

Studies suggest that formula-fed infants suffer inferior blood oxygenation and

higher blood pressure as well as more episodes of apnea (cessation of breathing

for a short time) than their breastfed counterparts. While no studies compare

the actual survival of such infants in the United States, it is obvious that

some proportion of babies with congenital heart abnormalities is being seriously

disadvantaged by formula feedings. Artificially fed infants with heart defects

requiring surgery are less likely to live until their surgery and less likely to

recover from surgery’s challenges.

A wide variety of common birth defects has been shown to have better survival

rates among breastfed infants, although the actual figures are not available.

Most birth defects have not been specifically studied in this regard. The

background information, nonetheless, is striking.

For example, infants born with phenylketonuria (PKU), a defect in handling a

certain protein in the diet, need specialized supplementation to breast milk in

order to prevent mental retardation and other difficulties. Yet a study

demonstrated that infants who had been breastfed before being diagnosed with PKU

fared far better than those who had been fed on formula.71 The greatest

complications for infants with cystic fibrosis are lung infection, decreased

oxygenation and malnutrition – all of which are recognized to be complicated by

formula feeding.72 The negative impact of formula on neurological development

has been demonstrated in healthy infants.73-76 One study that quantified the

effect reported double the amount of neurological “non-normality” in formula-fed

infants.77 It is reasonable to assume that neurological damage or problems

stemming from birth disorders can be exacerbated by artificial feeding.

Clearly, feeding choice may have a significant impact on the survival of infants

born with various defects, although there is not enough information available to

render an actual ratio of survival.

Complications of Pregnancy and Birth

Complications of pregnancy and birth produce a wide range of injuries and

problems for babies. Some certainly pose no hope of survival. Infection,

insufficient neurological recovery and inadequate oxygenation lead to many

infant deaths. Artificial feeding certainly has some degree of impact on

mortality in these cases. Based on a lack of further detailed evidence, we will

apply a very modest number to figures for increased risk of death for

formula-fed infants in this category.

Accidents

It seems logical that accidents happen equally among artificially and naturally

fed infants. Figures bear this out. One paper actually measured accidental

injuries between breast- and formula-fed infants, finding an equal number in

both.78

Examining the numbers

So now we are left to examine artificial feeding’s actual impact on all American

babies. First, we note that there should be a relationship dictating that if

rates for a certain disease are doubled by formula feeding, for instance, then

death rates for that disease may also be somewhere in the neighborhood of

doubled when compared with rates for breastfed infants. In fact, the evidence

suggests that the death rates would be even higher. While formula feeding may

result in twice as many episodes of a certain illness, a great number of studies

demonstrate that each of these episodes are also longer and more severe. This

would suggest that the rate of death among artificially fed infants from various

causes would actually be higher than the rates that the various illnesses occur.

The reported percentages of U.S. infants dying from each cause include a certain

number of infants who were breastfed and a portion who were formula-fed. Because

formula feeding’s impact is much more or less influential in some disorders than

others, we need to weigh each category accordingly. (This exercise will account

for the assumption that a lower proportion of infants who died from congenital

abnormalities, for instance, were formula-fed infants than the proportion who

died from SIDS.) Because two-thirds of all infants die in the first month, and

because exclusive breastfeeding runs about 50% during the first month, this

number can be used in the calculations to help weigh the greater or lesser

impact of breastfeeding for each cause.

2001 U.S. Breastfeeding Rates79,80

Study Hospital Initiation 4 Months 6 Months12 Months

Any BFExclusiveAny BFExclusiveAny BFExclusiveAny

Ross/Abbott Labs69.5%46.2% 32.5%17.2%

National Immunization Survey 65.1%59%35%24%27%7.9% 12.3%

 

 

 

 

An overall risk rate of infant death for formula-fed infants has been selected

conservatively based on the available information presented in this paper for

each cause of death in the table below. Assuming that 50% of the total infants

born were breastfed, we can calculate formula-fed and breastfed infant death

rates and totals for each cause.

Because one-third of the deaths actually occurred as the percentage of infants

breastfeeding was dropping to a much smaller number, the use of 50% throughout

the calculations keeps the resultant finding very conservative. Although the

literature reiterates time and again how the extent, severity and frequency of

disease is greater in formula-fed infants, I have only taken this factor into

account in an extremely conservative manner in instances where the literature

provides solid numerical examples. In other instances where this aspect is not

clearly demonstrated, I have not used this factor at all. Again, this effort

keeps the final quotient conservative. Finally, the ratios from many studies

used are for full formula feeding versus any amount of breastfeeding. Some of

these ratios would be much higher if formula feeding were compared to exclusive

breastfeeding. This factor again keeps our final conclusion conservative.

Here’s the math

There are 4,000,000 births annual births in the United States. Using 50% as the

number of infants who have actually been breastfed, the number of infants

breastfed (B) equals 2,000,000. The number of formula-fed (F) infants also

equals 2,000,000.

B = F = 2,000,000

R = Infant Mortality Rate (IMR) for each cause

RB = IMR for breastfed

 

RF = IMR for formula fed

Rel = Estimated Relative Risk for formula feeding versus breastfeeding, for each

cause

 

RFF + RBB = Total Number of Deaths for that cause = TND

 

RF = Rel x RB

 

RF x 2,000,000 + RB x 2,000,000 = TND

 

Rel x RB x 2,000,000 + RB x 2,000,000 = TND

 

RB = __________TND___________

Rel x 2,000,000 + 2,000,000

 

RB x 4,000,000 = Number Deaths if all B

 

 

 

 

 

 

 

 

 

 

 

 

 

Let’s apply this formula to congenital abnormalities. Clearly, feeding’s impact

in this category could be significant, but there is not enough solid statistical

evidence to say for sure. If we modestly assume a 50% higher death rate for the

50% of formula-fed infants, the number of breastfed infants who died would be

2,200. The number of formula-fed who died would be 3,300. If all of the infants

had actually been breastfed, then the total number of deaths would be 4,400 -- a

savings of 1,100 lives.

The relative risk for formula feeding in other categories was much more clearly

defined by the studies. Conservative but appropriate rates were selected, as

seen in the table below.

Calculating Formula’s Final Impact

Cause of death Actual U.S. infant deaths (1999)Relative risk for formula-fed

infantsEstimated

IMR for breastfed babiesDeaths if all were breastfedDeaths if all were

formula-fedLives saved if all were breastfed

Congenital abnormality 5500 1.5 1.1 4400 6600 1100

Prematurity 4500 2.5 .643 2570 6430 1930

SIDS 2700 4 .27 1080 4320 1620

Complications of pregnancy & birth 2400 1.25 .5332135 2670 270

Respiratory distress & infections1750 4 .17570028001050

Accidents850 1 .213850 850 0

Bacterial infection700 3.0873501050350

Circulatory problems650 1.5 .13520780 130

Necrotizing enterocolitis 4008.022 90 710 310

Diarrhea 300 2.5 .043 170430 130

Meningitis 1003.014 55 170 45

Cancer 100 2 .028016020

 

SUBTOTALS 19950 2.075 3.25 13000 26970 6955

All other80502 1.6644012880 1610

TOTALS28000 2 4.718665 37335

IMR 9.49335

 

Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live

births, from 0 to 12 months of age.

Based on the current U.S. infant death rate of 6.75 and an average breastfeeding

rate of 50%, the American infant mortality rate would climb to 9.4 if all

infants were formula-fed and would drop to 4.7 if all were breastfed. Twenty-two

nations with high rates of breastfeeding have infant mortality rates below 5,

while the U.S. ranks higher in infant death than 41 other nations.81 Clearly,

lower rates for the United States are a possibility.

The ugly truth about formula

From the above statistics, we see that formula feeding costs American babies

more than four additional lives per thousand. The final relative risk for

formula feeding comes out to 2 – that’s double the risk of death for American

infants who are fed with formula, compared with babies who are fed naturally.

A multitude of studies demonstrate that when breastfeeding is accompanied by

formula supplementation, illness and death rates are much closer to those of

babies who are fully formula-fed. Studies also reveal conclusively that the

longer breastfeeding lasts, the greater the measurable difference in illness and

death rates.

Answering the detractors

Criticisms are often spread about studies that find increased illness and death

rates associated with formula feeding. For just this reason, each later study

aggressively attempts to take into account any factors that have been purported

as distorting previous study outcomes. These research papers address as many

aspects as possible, from maternal education, to smoking, to income level, to

day care usage and many more possibilities. The results continue to reveal the

risks of formula feeding.

It’s commonly said that formula feeding does not risk lives in industrialized

nations where education and medical advances prevent increased deaths. The

evidence is quite to the contrary. Some insist that the blame for the United

States’ relatively high infant death rate lies with underprivileged communities.

Again, it has been shown that elevated death rates among U.S. blacks cannot be

attributed to poverty. Hispanic Americans rank similarly to African-American

populations for socio-economic factors, but they match non-Hispanic whites in

their lower infant mortality rates. The difference is not socio-economic;

rather, it’s in rates of formula use versus breastfeeding.82-84

A New York study sought to establish the connection between education, income

and infant survival. It concluded strongly that the number of illnesses is

increased by two to three times in formula-fed babies regardless of

socioeconomic status or level of parental education.85 A later study in Israel

confirmed the effects of formula feeding across all classes and education

levels.86 The most recent analysis of this issue, again performed in the United

States, reiterated that higher illness rates among formula-fed or

formula-supplemented infants “did not differ among income groups.”87

And beyond the first year

While the extent of breast milk’s health protection declines with age, a great

number of studies demonstrate the continued survival advantage of breastfeeding

through the second year and beyond. A World Health Organization study of

less-developed countries found a doubled risk of death in the second year of

life for those weaned prematurely or never receiving breast milk.88 A study in

The Netherlands found a strong correlation between the extent of breastfeeding

and the number of illnesses in children. Significant protection from

breastfeeding was noted during the first three years of life.89 Other studies

show a sizeable increase in illnesses throughout all of childhood for those who

were never breastfed or prematurely weaned.90-92 In fact, an increased risk of

death throughout life has been well documented for people who were formula-fed.

Higher blood pressure, more heart disease, obesity, diabetes and artery disease,

a nearly doubled rate of Crohn’s disease and tripled rates of celiac disease

have all been associated with early formula feeding.93-105

What your doctor doesn’t tell you

Pediatricians spend much time frightening parents with 1 in 100,000 risks from

vaccine-preventable diseases when parents question the utility and safety of

vaccines. “Would you want to risk the life of your child?” they demand. Yet

these very same professionals offer formula samples with the other hand – when

the magnitude of health risks associated with the use of formula is 500 times

greater.

Parenting is all about making choices and weighing risks and benefits. Many

parents need to make the riskier choice of formula feeding in order to balance

other factors that benefit the family. Yet some parents who have lost their

children, possibly based on pediatric advice condoning or encouraging

formula-feeding, would surely wish that they had been informed of the very real

risks related to using formula.

 

Dr. Linda Folden Palmer consults and lectures on natural infant health, optimal

child nutrition and attachment parenting. After running a successful

chiropractic practice focused on nutrition and women’s health for more than a

decade, Linda’s life became transformed eight years ago by the birth of her son.

Her research into his particular health challenges led her to write Baby

Matters: What Your Doctor May Not Tell You About Caring for Your Baby.

Extensively documented, this healthy parenting book presents the scientific

evidence behind attachment parenting practices, supporting baby's immune system,

preventing colic and sparing drug usage. You can visit Linda’s web site at

www.babyreference.com.

 

1. Palloni et al., ?The effects of breast-feeding and the pace of childbearing

on early childhood mortality in Mexico,? Bulletin of the Pan American Health

Organization (Mexico) 28, no.2 (Jun 1994): 93-111.

2. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention

of Infant Mortality, ?Effect of breastfeeding on infant and child mortality due

to infectious diseases in less developed countries: a pooled analysis,? Lancet

355, no. 9202 (Feb 2000): 451-5.

3. J.P. Habicht et al., ?Does breastfeeding really save lives, or are apparent

benefits due to biases?? American Journal of Epidemiolofy 123, no. 2 (Feb 1986):

279?90.

4. D.K. Guilkey and R.T. Riphahn, ?The determinants of child mortality in the

Phillipines: estimation of a structural model,? Journal of Development Economics

(US and Germany) 56, no. 2 (Aug 1998): 281-305.

5. P. Tu, ?The effects of breastfeeding and birth spacing on child survival in

China,? Studies in Family Planning (China) 20, no. 6 (Nov.-Dec. 1989): 332-342.

6. Palloni and M. Tienda, ?The effects of breastfeeding and pace of childbearing

on mortality at early ages,? Demography (US) 23, no. 1 (Feb 1986): 31-52.

7. S.P. Srivastava et al., ?Mortality patterns in breast versus artificially fed

term babies in early infancy: a longitudinal study,? Indian Peadrics (India) 31,

no. 11 (Nov 1994): 1393-6.

8. The World Fact Book,

http://www.odci.gov/cia/publications/factbook/rankorder/2091rank.html

9. National Vital Statistics Report, 49, no. 11 (Oct 12, 2001): 1-12.

10. National Vital Statistics Report, 50, no. 16 (Sep 16, 2002): 1-12.

11. F.R. Hauck et al., ?Sleep environment and the risk of Sudden Infant Death

Syndrome in an urban population: the Chicago infant mortality study,? Pediatrics

(US) 111, no. 5 (May 2003): 1207-1214.

12. B. Alm et al., ?Breastfeeding and the sudden infant death syndrome in

Scandinavia, 1992-1995,? Archives of Disease in Childhood (Sweden) 86

(2002:400-402.

13. K.L. McVea et al., ?The role of breastfeeding in sudden infant death

syndrome,? Journal of Human Lactation (US) 16, no. 1 (Feb 2000): 13-20.

14. J. Schellscheidt et al., ?Epidemiological features of sudden infant death

after a German intervention campaign in 1992,? Eur J Pediatr (Germany) 156, no.

8 (Aug 1997): 655?60.

15. R.E. Gilbert, ?Bottle feeding and the sudden infant death syndrome,? British

Medical Journal (England) 310, no. 6972 (Jan 14, 1995): 88-90.

16. H.S. Klonoff-Cohen et al., ?The effect of passive smoking and tobacco

exposure through breast milk on sudden infant death syndrome,? JAMA (US) 273,

no. 10 (Mar 1995): 795?8.

17. R.P. Ford et al., ?Breastfeeding and the risk of sudden infant death

syndrome,? International Journal of Epidemiology (New Zealand) 22, no. 5 (Oct.

1993): 885-90.

18. A.C. Wilson et al., ?Relation of infant diet to childhood health: seven year

follow up of cohort of children in Dundee infant feeding study,? BMJ (Scotland)

316, no. 7124 (Jan 1998): 21?5.

19. C.H. Chen et al., ?The effect of breast- and bottle-feeding on oxygen

saturation and body temperature in preterm infants,? Journal of Human Lactation

(Taiwan) 16, no. 1 (Feb 2000): 21-7.

20. J.B. Bier et al., ?Breast-feeding of very low birth weight infants,? Journal

of Pediatrics (Rhode Island, USA) 123, no. 5 (Nov 1993): 773-8.

 

21. V.L. Combs and B.L. Marina, ?A comparison of growth patterns in breast and

bottle-fed infants with congenital heart disease,? Pediatric Nursing (USA) 19,

no. 2 (Mar-Apr 1993):175-9.

22. B.L. Marino et al., ?Oxygen saturations during breast and bottle feedings in

infants with congenital heart disease,? Journal of Pediatric Nursing (USA) 10,

no. 6 (Dec 1995): 360-4.

23. A. Lucas and T.J. Cole, ?Breast milk and neonatal necrotising

enterocolitis,? Lancet (UK) 336, no. 8730 (Dec 22-29, 1990): 1519-23.

24. H. Palti et al., ?Episodes of illness in breast-fed and bottle-fed infants

in Jerusalem,? Israel Journal of Medical Science (Israel) 20, no. 5 (May 1984):

395-9.

25. C.G. Victora et al., ?Infant feeding and deaths due to diarrhea. A

case-control study,? American Journal of Epidemiology (Brazil) 129, no. 5 (May

1989): 1032-41

26. P.W. Howie et al., ?Protective effect of breast feeding against infection,?

British Medical Journal (Scotland) 300, no. 6716 (Jan 6, 1990): 11-6.

27. H.P. Sachdev et al., ?Does breastfeeding influence mortality in children

hospitalized with diarrhoea?? Journal of Tropical Pediatrics (India) 37, no. 6

(Dec 1991): 275-9.

28. M. Beaudry et al., ?Relation between infant feeding and infections during

the first six months of life,? Journal of Pediatrics (Canada) 126, no. 2 (Feb

1995): 191-7.

29. P.W. Yoon, ?Effect of not breastfeeding on the risk of diarrheal and

respiratory mortality in children under 2 years of age in Metro Cebu, The

Philippines,? American Journal of Epidemiology (Philippines) 143, no. 11 (Jun

1996): 1142-8.

30. M. Lopez-Alarcon et al., ?Breast-feeding lowers the frequency and duration

of acute respiratory infection and diarrhea in infants under six months of age,?

J Nutr (Mexico) 127, no. 3 (Mar 1997): 436?43.

31. J. Golding et al, ?Gastroenteritis, diarrhoea and breast feeding,? Early

Human Development (England) 49, suppl. (Oct 29, 1997): S83-103

32. Z. Fu et al., ?Exclusive breastfeeding and growth of infants under 4 months

in China,? Wei Sheng Yan Jiu (Center for Public Health Information, Chinese

Academy of Preventive Medicine) 29, no. 5 (Sep 2000): 275-8.

33. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention

of Infant Mortality, ?Effect of breastfeeding on infant and child mortality due

to infectious diseases in less developed countries: a pooled analysis,? Lancet

355, no. 9202 (Feb 2000): 451-5.

34. P. Gianino et al., ?Incidence of nosocomial rotavirus infections,

symptomatic and asymptomatic, in breast-fed and non-breast-fed infants,? Journal

Of Hospital Infection (Italy) 50, no. 1 (Jan 2002): 13-7.

35. M.M. Escuder et al., ?Impace estimates of breastfeeding over infant

mortality,? Rev Saude Publica (Brazil) 37, no. 3 (Jun 2003): 319-25.

36. G.O. Vieira et al., ?Child feeding and diarrhea morbidity,? Journal of

Pediatrics (Brazil) 79, no. 5 (Sep-Oct 2003): 449-54.

37. K.G. Dewey et al., ?Differences in morbidity between breast-fed and

formula-fed infants,? Journal of Pediatrics (Davis, USA) 126, no. 5, pt. 1 (May

1995): 696-702.

38. P.D. Scariati et al., ?A longitudinal analysis of infant morbidity and the

extent of breastfeeding in the United States,? Pediatrics (USA) 99, no. 6 (Jun

1997): E5.

39. A.L. Wright et al., ?Increasing breastfeeding rates to reduce infant illness

at the community level,? Pediatrics (Tucson, USA) 101, no. 5 (May 1998): 837-44.

40. J. Raisler et al., ?Breast-feeding and infant illness: a dose-response

relationship?? Am J Public Health (Ann Arbor, USA) 89, no. 1 (Jan 1999): 25?30.

41. H. Palti et al., ?Episodes of illness in breast-fed and bottle-fed infants

in Jerusalem,? Israel Journal of Medical Science (Israel) 20, no. 5 (May 1984):

395-9.

42. C.G. Victora et al., ?Evidence for protection by breast-feeding against

infant deaths from infectious diseases in Brazil,? Lancet (Brazil) 2, no. 8554

(Aug 1987): 319-22.

43. Pisacane et al., ?Breastfeeding and acute lower respiratory infection,? Acta

Paediatr (Italy) 83, no. 7 (Jul 1994): 714-8.

44. M. Lopez-Alarcon et al., ?Breast-feeding lowers the frequency and duration

of acute respiratory infection and diarrhea in infants under six months of age,?

J Nutr (Mexico) 127, no. 3 (Mar 1997): 436?43.

45. A.C. Wilson et al., ?Relation of infant diet to childhood health: seven year

follow up of cohort of children in Dundee infant feeding study,? BMJ (Scotland)

316, no. 7124 (Jan 1998): 21?5.

46. J.A. Cesar et al., ?Impact of breast feeding on admission for pneumonia

during postneonatal period in Brazil: nested case-control study,? British

Medical Journal (Brazil) 318, no. 7194 (May 1999): 1316-20.

47. A.L. Wright et al., ?Increasing breastfeeding rates to reduce infant illness

at the community level,? Pediatrics (USA) 101, no. 5 (May 1998): 837-44.

48. O.S. Levine et al., ?Risk factors for invasive pneumococcal disease in

children: a population-based case-control study in North America,? Pediatrics

(USA) 103, no. 3 (Mar 1999): E28.

49. M.D. Blaymore Bier et al., ?Human milk reduced outpatient upper respiratory

symptoms in premature infants during their first year of life,? Journal of

Perinatology (Providence, USA) 22, no. 5 (Jul/Aug 2002): 354-359.

50. V.R. Bachrach et al., ?Breastfeeding and the risk of hospitalization for

respiratory disease in infancy: a meta-analysis,? Archives of Pediatric

Adolescent Medicine (USA) 157, no. 3 (Mar 157): 237-43.

51. X.O.Shu et al., ?Infant breastfeeding and the risk of childhood lymphoma and

leukaemia,? International Journal of Epidemiology (China) 24, no. 1 (Feb 1995):

27-32.

52. Bener et al., ?Longer breast-feeding and protection against childhood

leukaemia and lymphomas,? European Journal of Cancer (UAE) 37, no. 2 (Jan 2001):

234-8.

53. F. Perrillat et al., ?Day-care, early common infections and childhood acute

leukaemia: a multicentre French case-control study,? British Journal of Cancer

(France) 86, no. 7 (Apr 8, 2002): 1064-9.

54. J.L. Daniels et al., ?Breastfeeding and neuroblastoma, USA and Canada,?

Cancer Causes and Control (USA, Canada) 13, no. 5 (Jun 2002): 401-5.

55. G.P. Mathur et al., ?Breastfeeding and childhood cancer,? Indian Pediatrics

(India) 30, no. 5 (May 1993): 651-7.

56. M.K. Davis, ?Review of the evidence for an association between infant

feeding and childhood cancer,? International Journal of Cancer (USA) 11, supp.

(1998): 29?33.

57. I Narayanan et al., ?Partial supplementation with expressed breast milk for

prevention of infection in low birth weight infants,? Lancet (India) 2 (1980):

561?3.

58. Narayanan et al., ?Randomised controlled trial of effect of raw and holder

pasteurized human milk and of formula supplements on incidence of neonatal

infection,? Lancet (India) 2, no. 8412 (Nov 17, 1984): 1111-3.

59. N.Y. Boo et al., ?The role of expressed breastmilk and continuous positive

airway pressure as predictors of survival in extremely low birthweight infants,?

Journal of Tropical Pediatrics (Malaysia) 46, no. 1 (Feb 2000): 15-20.

60. N. Charpak et al., ?A randomized, controlled trial of kangaroo mother care:

results of follow-up at 1 year of corrected age,? Pediatrics (Columbia) 108, no.

5 (Nov 2001): 1072-9.

61. A.E. el-Mohandes et al., ?Use of human milk in the intensive care nursery

decreases the incidence of nosocomial sepsis,? Journal of Perinatology

(Washington, DC) 17, no. 2 (Mar-Apr 1997): 130-4.

62. M.A. Hylander et al., ?Human milk feedings and infection among very low

birth weight infants,? Pediatrics (Washington, DC) 102, no. 3 (Sep 1998): E38.

63. J. Schanler et al., ?Feeding strategies for premature infants: Beneficial

outcomes of feeding fortified human milk versus preterm formula,? Pediatrics

(USA) 103, no. 6 (June 1999): 1150-1157.

64. M.D. Blaymore Bier et al., ?Human milk reduced outpatient upper respiratory

symptoms in premature infants during their first year of life,? Journal of

Perinatology (Providence, USA) 22, no. 5 (Jul/Aug 2002): 354-359.

65. S. Awasthi et al., ?Is high protein milk beneficial for SGA-terms?? Indian

Pediatr 26, no. 1 (Jan 1989): 45?51.

 

66. G. Boehm et al., ?[Protein utilization by premature infants with a birth

weight less than 1,500 g during nutrition with MANSAN or breast milk protein],?

Kinderarztl Prax (German) 59, no. 1?2 (Jan?Feb 1991): 26?30.

 

67. R. Quan et al., ?The effect of nutritional additives on anti-infective

factors in human milk,? Clin Pediatr (Phila) 33, no. 6 (Jun 1994): 325?8.

 

68. A. Lucas et al., ?Randomized outcome trial of human milk fortification and

developmental outcome in preterm infants,? Am J Clin Nutr (England) 64, no. 2

(Aug 1996): 142?51.

 

69. M.A. Hylander et al., ?Association of human milk feedings with a reduction

in retinopathy of prematurity among very low birthweight infants,? Journal of

Perinatology 21, no. 6 (Sep 2001): 356-62.

 

70. A. Pisacane et al., ?Breast-feeding and inguinal hernia,? Journal of

Pediatrics (Italy) 127, no. 1 (Jul 1995): 109-11.

 

71. E. Riva et al., ?Early breastfeeding is linked to higher intelligence

quotient scores in dietary treated phenylketonuric children,? Acta Paediatrica

(Italy) 85, no. 1 (Jan 1996): 56-8.

72. Borowitz et al., ?Consensus report on nutrition for pediatric patients with

cystic fibrosis,? Pediatric Gastroenterology and Nutrition (USA) 35, no. 3 (Sep

2002): 246-59.

73. E. Riva et al., ?Early breastfeeding is linked to higher intelligence

quotient scores in dietary treated phenylketonuric children,? Acta Paediatrica

(Italy) 85, no. 1 (Jan 1996): 56-8.

74. J.W. Anderson et al., ?Breast-feeding and cognitive development: a

meta-analysis,? American Journal of Clinical Nutrition (USA) 70, no. 4 (Oct

1999): 525-35.

75. W.H. Oddy et al., ?Breast feeding and cognitive development in childhood: a

prospective birth cohort study,? Paediatric Perinatal Epidemiology (Australia)

17, no. 1 (Jan 2003): 81-90.

76. M.R. Rao et al., ?Effect of breastfeeding on cognitive development of

infants born small for gestational age,? Acta Paediatrica (USA) 91, no. 3

(2002):267-74.

77. C.I. Lanting et al., ?Neurological differences between 9-year-old children

fed breast-milk or formula-milk as babies,? Lancet (Netherlands) 344, no. 8933

(Nov 12, 1994): 1319-22.

78. A.L. Wright et al., ?Increasing breastfeeding rates to reduce infant illness

at the community level,? Pediatrics (Tucson, USA) 101, no. 5 (May 1998): 837-44.

79. A.S. Ryan et al., ?Breastfeeding continues to increase into the new

millennium,? Ross Products Division of Abbott Laboratories (US) 110, no. 6 (Dec

2002): 1103-9.

80. L.R. Zhao et al., ?Prevalence of breastfeeding in the United States: the

2001 National Immunization Survey,? Pediatrics (US) 111, no. 5, part 2 (May

2003): 1198-201.

81. The World Fact Book,

http://www.cia.gov/cia/publications/factbook/rankorder/2091rank.html

R. Li et al., ?Prevalence of breastfeeding in the United States: the 2001

National Immunization Survey? Pediatrics (USA) 111, no 5., part 2 (May 2003):

1198-201.

82. R. Li and L. Grummer-Strawn, ?Racial and ethnic disparities in breastfeeding

among United States infants: Third National Health and Nutrition Examination

Survey, 1988-1994,? Birth (USA) 29, no. 4 (Dec 2002): 251-7.

83. R. Li et al., ?Prevalence of breastfeeding in the United States: the 2001

National Immunization Survey? Pediatrics (USA) 111, no 5., part 2 (May 2003):

1198-201.

84. R. Forst et al., ?The decision to breastfeed in the United States: does race

matter?? Pediatrics (USA) 108, no. 2 (Aug 2001): 291-6.

85. A.S. Cunningham, ?Morbidity in breast-fed and artificially fed infants,?

Journal of Pediatrics (New York) 90, no. 5 (May 1977): 726-9.

86. H. Palti et al., ?Episodes of illness in breast-fed and bottle-fed infants

in Jerusalem,? Israel Journal of Medical Science (Israel) 20, no. 5 (May 1984):

395-9.

87. J. Raisler et al., ?Breast-feeding and infant illness: a dose-response

relationship?? Am J Public Health (Ann Arbor) 89, no. 1 (Jan 1999): 25?30.

88. ?Effect of breastfeeding on infant and child mortality due to infectious

diseases in less developed countries: a pooled analysis. WHO Collaborative Study

Team on the Role of Breastfeeding on the Prevention of Infant Mortality? Lancet

355, no. 9202 (Feb 2000): 451-5.

89. C. van den Bogaard et al., ?The relationship between breast-feeding and

early childhood morbidity in a general population,? Fam Med (Netherlands) 23,

no. 7 (Oct?Sep 1991): 510?5.

90. A.C. Wilson et al., ?Relation of infant diet to childhood health: seven year

follow up of cohort of children in Dundee infant feeding study,? BMJ (Scotland)

316, no. 7124 (Jan 1998): 21?5.

91. S.A. Silfverdal et al., ?Protective effect of breastfeeding: an ecologic

study of Haemophilus influenzae meningitis and breastfeeding in a Swedish

population,? Int J Epidemiol (Sweden) 28, no. 1 (Feb 1999): 152?6.

92. L.A. Hanson, ?Human milk and host defence: immediate and long-term effects,?

Acta Paediatrica (Sweden) 88, no. 430 suppl. (Aug 1999): 42-6.

93. A.C. Wilson et al., ?Relation of infant diet to childhood health: seven year

follow up of cohort of children in Dundee infant feeding study,? BMJ (Scotland)

316, no. 7124 (Jan 1998): 21?5.

94. A.C. Ravelli et al., ?Infant feeding and adult glucose tolerance, lipid

profile, blood pressure, and obesity,? Archives of Disease in Childhood (UK) 82

(March 2000): 248-52.

95. S.B. Roberts, ?Prevention of hypertension in adulthood by breastfeeding??

Lancet (USA) 357, no. 9254 (Feb 10, 2001): 413-9.

 

96. C.H. Fall et al., ?Relation of infant feeding to adult serum cholesterol

concentrations and death from ischaemic heart disease,? British Medical Journal

(UK) 304, no. 6830 (March 28, 1992): 801-5.

 

97. von Kries et al., ?Breast feeding and obesity: cross sectional study,?

British Medical Journal (Germany) 319, no. 7203 (July 17, 1999): 147-50.

 

98. R.B. Elliott et al., ?Type I (insulin-dependent) diabetes mellitus and cow

milk: casein variant consumption,? Diabetologia (New Zealand) 42, no. 3 (Mar

1999): 292?6.

99. S.G. Gimeno and J.M. deSouza, ?IDDM and milk consumption: A case-control

study in Sao Paulo, Brazil,? Diabetes Care (Brazil) 20, no. 8 (Aug 1997):

1256?60.

100. J. Karjalainen et al., ?A bovine albumin peptide as a possible trigger of

insulin-dependent diabetes mellitus,? N Engl J Med (Canada) 327, no. 5 (Jul 30,

1992): 302?7.

101. T. Saukkonen et al., ?Significance of cow?s milk protein antibodies as risk

factor for childhood IDDM: interactions with dietary cow?s milk intake and

HLA-DQB1 genotype. Childhood Diabetes in Finland Study Group,? Diabetologia

(Finland) 41, no. 1 (Jan 1998): 72?8.

102. S.M. Virtanen et al., ?Diet, cow?s milk protein antibodies and the risk of

IDDM in Finnish children. Childhood Diabetes in Finland Study Group,?

Diabetologia (Finland) 37, no. 4 (Apr 1994): 381?7.

103. P. Vähäsalo et al., ?Relation between antibodies to islet cell antigens,

other autoantigens, and cow?s milk proteins in diabetic children and unaffected

siblings as the clinical manifestation of IDDM,? Autoimmunity (Finland) 23, no.

3 (1996): 165?74.

104. G. Corrao et al., ?Risk of inflammatory bowel disease attributable to

smoking, oral contraception and breastfeeding in Italy: a nationwide

case-control study,? International Journal of Epidemiology (Italy) 27, no. 3

(Jun 1998): 397-404.

105. Rigas et al., ?Breast-feeding and maternal smoking in the etiology of

Crohn's disease and ulcerative colitis in childhood,? Annals of Epidemiology

(New York) 3, no. 4 (Jul 1993): 387-92.

 

Return to NFO