Breastfeeding and Breast Milk – from Biochemistry to Impact A Multidisciplinary Introduction About the Foundation Published by The Family Larsson-Rosenquist Foundation is one of the first foundations in the Family Larsson-Rosenquist Foundation world with a prime focus on promoting and supporting breast milk and bre- astfeeding. Based in Zug, Switzerland, it was founded in 2013 with the aim of promoting the scientific and public recognition of breastfeeding and breast milk as – given the current state of science – the best nutrition for newborns and infants. It considers itself as an instigator and promoter of new knowledge. The Book Foundation invests globally in projects and scientific research in breastfeeding and breast milk. It places high value on multidisciplinary collaboration and sup- ports projects with a sustainable impact on the well-being of mother and child. Preview With compliments An Evidence-Based Reference Book: a Key Resource for Decision Makers and Practitioners Available at the end of September 2018 Authors from around the globe, each of all the benefits that breastfed infants a specialist within their field have readily enjoy. Based on sound science but written contributed to provide readers with a in popular science style, ensuring an easy Also available as an e-book comprehensive overview of breastfeeding read, the book provides a comprehensive and human milk to encourage and empower and solid foundation including sources and interested parties to move breastfeeding references. It also features a unique in-depth higher up on the public health agenda. scientific glossary of lactation that provides There are many books available looking definitions for a plethora of important at “how to” breastfeed or focusing on a terms of breastfeeding and human milk single topic within the field, others look at that are science based and reviewed by the biomedical aspects of milk, however acknowledged experts in the field. none address a wide range of research The book aims to provide a holistic overview, disciplines to provide a truly multidisciplinary and is divided into four parts with individual Breastfeeding and Breast Milk – from Biochemistry to Impact comprehensive overview: covering introductions. As each chapter covers a topic A Multidisciplinary Introduction topics from physiology and psychology, in depth, it can be also be read independently. Published by Family Larsson-Rosenquist Foundation culture, politics and economics to HIV and Furthermore, the book can be used as a Dip- Georg Thieme Verlag, Stuttgart, 2018 medications, NICU and human milk banking. In-and-Out book as each chapter provides Edition: 1 The topics are varied, yet all relevant and a summary of the topics covered at the Pages: 416 important elements in the quest to increasing beginning as well as a list of key findings Illustrations: 73 ISBN 978-3-13-220401-0 (Print) breastfeeding rates. and messages at the end of the chapter. This eISBN 978-3-13-220421-8 (e-book) eISBN 978-3-13-220411-9 (PDF) Multidisciplinary Introduction to Breast- allows the reader to quickly identify topics feeding and Breast Milk – from Biochemistry and peruse key findings to identify areas of to Impact is written for a wide and varied specific interest and to read the book in a For further information please visit Thieme Webshop: audience, ranging from nursing staff and more targeted manner. www.thieme.de/shop/p/000000000311610101 lactation experts who have daily contact Overall this book provides a unique insight or the Family Larsson-Rosenquist Foundation: with mothers and babies, to health ministers into a wide range of aspects of breastfeeding, who want to learn about how scaling up of humanmilk and lactation, empowering www.larsson-rosenquist.org/en/projects/ReferenceBook.html breastfeeding can contribute to reducing individuals with the knowledge to increase their health care expenditure. It is also a key public interest and towork towards the goal for doctors and researchers who have an of making breastfeeding the norm again. interest in the topic yet are not fully aware Contents 8 9 Contents 4.4 Physiology ................................................ 56 4.4.1 Origin of Milk ............................................... 56 4.4.2 Secretory Differentiation ........................................ 58 4.4.3 Secretory Activation ........................................... 59 Foreword ................................................ 5 4.4.4 Milk Ejection ............................................... 64 Preface .................................................. 7 4.4.5 Infant Suck, Swallow, and Breathe ................................... 66 4.4.6 Established Lactation .......................................... 67 4.4.7 Reference Ranges ............................................ 70 Part 1 4.5 Changes to Physiology in Mother and Infant ............................ 72 Setting the Scene 4.5.1 Menstrual Cycle ............................................. 74 4.5.2 Weaning and Involution ......................................... 74 1 Introduction .............................................. 18 4.6 Conclusion ................................................ 75 Peter E. Hartmann 5 Why Breastfeeding? ......................................... 78 2 Breast Milk, Global Health and Sustainable Development ................ 20 Berthold Koletzko Leith Greenslade 5.1 Introduction ............................................... 78 2.1 The Importance of Empowered Mothers .............................. 20 5.2 The Evolution of Lactation ....................................... 78 2.2 The Benefits of Breast Milk ...................................... 20 5.3 Assessing Health Effects of Breastfeeding .............................. 81 2.3 Breastfeeding as an Equity Strategy................................. 21 5.4 Breastfeeding and Maternal Health ................................. 82 2.4 The Cost-Effectiveness of Breastfeeding .............................. 23 5.5 Breastfeeding and Infant Health ................................... 82 2.5 Breastfeeding’s Poor Performance ................................. 23 5.6 Conclusion ................................................ 86 2.6 Barriers to Breastfeeding ....................................... 24 2.7 A Collective Failure to Respond ................................... 25 2.8 Investments in Breastfeeding Innovations ............................. 26 2.9 Breaking Breastfeeding Barriers: a Call to Action ......................... 27 Part 2 2.10 Breastfeeding and the Sustainable Development Goals ..................... 28 Different Perspectives 3 Data Collection on Infant Feeding ................................ 32 6 Introduction............................................... 92 Maria Quigley Rafael Pérez-Escamilla 3.1 Data Collection on Infant Feeding .................................. 32 3.1.1 What Data Need to be Collected ................................... 32 7 Human Milk: Bioactive Components and Their Effects on the Infant and Beyond .. 93 3.1.2 Who Collects Data and How ...................................... 32 Donna Geddes, Foteini Kakulas 3.2 Problems with Data Collection .................................... 36 7.1 What Science Tells Us about Human Milk .............................. 93 3.2.1 How Exclusive is Exclusive Breastfeeding? .............................. 37 7.2 Key Properties of Human Milk and their Functions ........................ 93 3.2.2 Does Breastfeeding Include Breast Milk Feeding?.......................... 37 7.2.1 Fat ..................................................... 95 3.2.3 How to Collect Complex Feeding Data: Preterm Infants, Multiples ............... 37 7.2.2 Protein ................................................... 96 3.3 Conclusion ................................................ 37 7.3 Carbohydrate: Lactose ......................................... 99 7.3.1 Human milk oligosaccharides (HMOs) ................................ 99 4 How Breastfeeding Works: Anatomy and Physiology of Human Lactation ..... 39 7.4 Vitamins and Minerals ......................................... 100 Melinda Boss, Peter E. Hartmann 7.5 Human Milk Microbiome........................................ 101 4.1 Introduction ............................................... 39 7.6 Appetite Factors ............................................. 101 4.2 Background ............................................... 39 7.7 Metabolites................................................ 102 4.3 Gross Anatomy ............................................. 44 7.8 New Discoveries ............................................. 103 4.3.1 History .................................................. 44 7.8.1 Cells .................................................... 103 4.3.2 Foetal and Pubertal Development .................................. 45 7.8.2 MicroRNA ................................................. 105 4.3.3 Non-Lactating Adult Breast ...................................... 46 7.9 What Does the Future Hold? ..................................... 107 4.3.4 Pregnancy ................................................ 48 4.3.5 Lactating Breast ............................................. 54 Contents Contents 10 11 8 The Psychological Effects of Breastfeeding .......................... 119 11 Human Milk in Economics Context ................................ 176 Jennifer Hahn-Holbrook Subhash Pokhrel 8.1 Introduction ............................................... 119 11.1 Economics of Lactation ......................................... 176 8.2 Psychological