1
|
Rusi HC, Grummer-Strawn L, Perrin MT, Risling T, Brockway ML. Conceptualizing the Commercialization of Human Milk: A Concept Analysis. J Hum Lact 2024:8903344241254345. [PMID: 38855823 DOI: 10.1177/08903344241254345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
BACKGROUND Donor human milk is recommended when infants are unable to be fed their mother's own milk or require supplementation. For-profit companies use technologies to create human milk products for infants in the neonatal intensive care setting without consistent guidelines and regulatory frameworks in place. This commercialization of human milk is inadequately conceptualized and ill-defined. RESEARCH AIMS The aim of this study is to conceptualize and define the commercialization of human milk and discuss the need for policy guidelines and regulations. METHOD Using a concept analysis framework, we reviewed the literature on the commercialization of human milk, analyzed the antecedents and potential consequences of the industry, and developed a conceptual definition. The literature review resulted in 13 relevant articles. RESULTS There has been a surge in the development and availability of human milk products for vulnerable infants developed by for-profit companies. Commercialized human milk can be defined as the packaging and sale of human milk and human milk components for financial gain. Factors contributing to the commercialization of human milk include an increased demand for human milk, and consequences include potential undermining of breastfeeding. The lack of guidelines and regulations raises concerns of equity, ethics, and safety. CONCLUSION The industry is rapidly growing, resulting in an urgent need for consistent guidelines and regulatory frameworks. If left unaddressed, there could be potential risks for donor milk banking, the future of breastfeeding, and infant and maternal health.
Collapse
Affiliation(s)
- Heather Christine Rusi
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | | | | | - Tracie Risling
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Meredith Lee Brockway
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| |
Collapse
|
2
|
Sergius-Ronot M, Suwal S, Pitino MA, Shama S, Unger S, O'Connor DL, Pouliot Y, Doyen A. Development of a human milk protein concentrate from donor milk: Impact of the pasteurization method on static in vitro digestion in a preterm newborn model. Food Res Int 2023; 164:112385. [PMID: 36737969 DOI: 10.1016/j.foodres.2022.112385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
The impact of high temperature short time (HTST, 72 °C, 15 s), Holder pasteurization- (63 °C, 30 min) and high hydrostatic pressure (HHP, 600 MPa-10 min) was evaluated on the digestibility of human milk protein concentrate (HMPC) by using a static in vitro gastrointestinal digestion system. The results showed that the processing steps used to produce the HMPC induced a decrease in readily available nitrogen (non-protein nitrogen and peptides). Overall, digestibility was similar between pasteurized and raw HMPC (degree of hydrolysis ranged from 26 to 34 %). Lactoferrin was more susceptible to gastric and intestinal digestion after thermal pasteurization. Additionally, the resistance of β-casein to digestion increased after HHP and Holder pasteurization due to aggregation and changes in protein structure. During intestinal digestion, Holder pasteurization induced a higher release of arginine, phenylalanine and tyrosine from HMPC compared to raw and HHP-treated HMPC. Overall, protein structural changes induced by human milk (HM) processing (freeze-thawing and filtration) and pasteurization treatments affected HMPC proteolysis during in vitro digestion. However, protein digestion behaviors were quite similar for raw and HHP-treated HMPC compared to the thermal-treated HMPC, with no effect on lactoferrin digestion. Consequently, pasteurization of HMPC by HHP represents an interesting non-thermal process that preserves the HM bioactive proteins during digestion.
Collapse
Affiliation(s)
- Mélanie Sergius-Ronot
- Departement of Food Science, Institute for Nutrition and Functional Foods (INAF) and Dairy Research Centre (STELA), Laval University, Quebec, Canada
| | - Shyam Suwal
- Arla Foods Amba, Agro Food Park 19, Aarhus 8200, Denmark
| | - Michael A Pitino
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada
| | - Sara Shama
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada; Department of Neonatology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, Toronto, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, Toronto, Canada
| | - Yves Pouliot
- Departement of Food Science, Institute for Nutrition and Functional Foods (INAF) and Dairy Research Centre (STELA), Laval University, Quebec, Canada
| | - Alain Doyen
- Departement of Food Science, Institute for Nutrition and Functional Foods (INAF) and Dairy Research Centre (STELA), Laval University, Quebec, Canada.
| |
Collapse
|
3
|
Tomori C, Palmquist AEL. Racial capitalism and the US formula shortage: A policy analysis of the formula industry as a neocolonial system. FRONTIERS IN SOCIOLOGY 2022; 7:961200. [PMID: 36386859 PMCID: PMC9644151 DOI: 10.3389/fsoc.2022.961200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The U.S. is currently experiencing a formula shortage and an infant feeding crisis that began with a formula recall and the hospitalization of 4 infants, 2 of whom died. Since 1981, governments around the world have been calling for an end to blatant human rights violations made by the commercial milk formula (CMF) industry. These practices not only involve targeting nutritionally vulnerable populations of mothers and newborns to turn a profit, but also actively undermining the implementation of policies, legislation, and regulatory oversight that might compromise their accumulation of wealth. In this paper we analyze the 2022 formula-shortage-as-infant-feeding-crisis through the lens of the history of colonialism and critical theory in the anthropology of reproduction. First, we provide an overview of the colonial roots of the formula industry from a global perspective. We then focus on how the mechanisms of racial exploitation remain entrenched in the U.S. approach to infant feeding policies, regulation and investment, setting the stage for the current infant feeding crisis. Through our analysis of the 2022 infant feeding crisis we demonstrate how the multinational CMF industry perpetuates racial capitalism and racialized health inequities and disparities through its operations as a neocolonial enterprise. Finally, we offer policy interventions and potential solutions that are grounded in structural interventions for more equitable, anticolonial, antiracist infant feeding systems.
Collapse
Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing and the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Aunchalee E. L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
4
|
Romero-Maldonado S, Soriano-Becerril DM, García-May PK, Reyes-Muñoz E, Muñoz-Ortíz EG, Carrera-Muiños S, Granados-Cepeda ML, Cardona-Pérez JA, Castro-Millán E, Segura-Cervantes E, Ceballos G, Montoya-Estrada A. Effect of Oropharyngeal Administration of Colostrum in Premature Newborns ≤32 Weeks of Gestation on the Immune Response and Neonatal Morbidity: A Double-Blind Randomized Clinical Trial. Front Pediatr 2022; 10:891491. [PMID: 35874579 PMCID: PMC9304973 DOI: 10.3389/fped.2022.891491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The mother's colostrum carries immunological components, such as cytokines and immunoglobulins (Igs), derived from the maternal circulation with bacteriostatic properties. OBJECTIVE The objective of this study was to evaluate the effect of oropharyngeal administration of colostrum (OPAC) vs. placebo in the first 4 days of life in premature newborns ≤32 weeks of gestation on serum Ig concentration, neonatal morbidity, and total days of hospitalization. HYPOTHESIS The OPAC increases serum Igs and decreases morbidity and total days of hospitalization. MATERIALS AND METHODS A double-blind randomized controlled trial was carried out. Participants were randomly assigned to one of the two groups, namely, group 1: placebo (P) (n = 50) and group 2: colostrum (C) (n = 46). A blood sample was obtained at baseline and 7 and 28 days of life to quantify immunoglobulin G (IgG), immunoglobulin A (IgA), and IgM. Results: The C group showed an increase in serum IgA on day 28 expressed as median and [interquartile range]; C: 25 [12-35] vs. P: 11 [8-18], p < 0.001. There were no significant differences in neonatal morbidity. Newborns in the colostrum group showed the completed enteral feeding earlier (days), C: 13.9 ± 7 vs. P: 17.4 ± 8.4, p < 0.04; they reached the birth weight earlier, C: 10.9 ± 2.8 vs. P: 12.9 ± 4, p < 0.01, and had less days of hospitalization, C: 60.2 ± 33.8 vs. P: 77.2 ± 47.3, p < 0.04. Neonatal mortality was lower in the colostrum group than the placebo group 0% vs. 12%, respectively, without a statistical difference (p = 0.06). CONCLUSION In premature newborns ≤32 weeks of gestation, the OPAC within 4 days after birth increases serum IgA concentration at day 28 compared to placebo. Similarly, OPAC decreased the days to complete enteral feeding and reach the birth weight and total days of hospitalization. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT03578341], identifier: [NCT03578341].
Collapse
Affiliation(s)
- Silvia Romero-Maldonado
- Coordination of the Human Milk Bank, National Institute of Perinatology, Mexico City, Mexico
| | | | - Perla Karina García-May
- Neonatal Intensive Care Unit, Hospital Adolfo López Mateos of the ISSSTE, Mexico City, Mexico
| | - Enrique Reyes-Muñoz
- Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Mexico City, Mexico
| | | | | | | | | | - Elsa Castro-Millán
- Coordination of the Human Milk Bank, National Institute of Perinatology, Mexico City, Mexico
| | - Enrique Segura-Cervantes
- Infectious Diseases and Epidemiology Unit, National Institute of Perinatology, Mexico City, Mexico
| | - Guillermo Ceballos
- Postgraduate and Research Section, Higher School of Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Mexico City, Mexico
| |
Collapse
|
5
|
McLeod G, Farrent S, Gilroy M, Page D, Oliver CJ, Richmond F, Cormack BE. Variation in Neonatal Nutrition Practice and Implications: A Survey of Australia and New Zealand Neonatal Units. Front Nutr 2021; 8:642474. [PMID: 34409058 PMCID: PMC8365759 DOI: 10.3389/fnut.2021.642474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Significant global variation exists in neonatal nutrition practice, including in assigned milk composition values, donor milk usage, fortification regimens, probiotic choice and in methods used to calculate and report nutrition and growth outcomes, making it difficult to synthesize data to inform evidence-based, standardized nutritional care that has potential to improve neonatal outcomes. The Australasian Neonatal Dietitians' Network (ANDiN) conducted a survey to determine the degree to which neonatal nutritional care varies across Australia and New Zealand (A&NZ) and to highlight potential implications. Materials and Methods: A two-part electronic neonatal nutritional survey was emailed to each ANDiN member (n = 50). Part-One was designed to examine individual dietetic practice; Part-Two examined site-specific nutrition policies and practices. Descriptive statistics were used to examine the distribution of responses. Results: Survey response rate: 88%. Across 24 NICU sites, maximum fluid targets varied (150–180 mL.kg.d−1); macronutrient composition estimates for mothers' own(MOM) and donor (DM) milk varied (Energy (kcal.dL−1) MOM: 65–72; DM 69–72: Protein (g.dL−1): MOM: 1.0–1.5; DM: 0.8–1.3); pasteurized DM or unpasteurized peer-to-peer DM was not available in all units; milk fortification commenced at different rates and volumes; a range of energy values (kcal.g−1) for protein (3.8–4.0), fat (9.0–10.0), and carbohydrate (3.8–4.0) were used to calculate parenteral and enteral intakes; probiotic choice differed; and at least seven different preterm growth charts were employed to monitor growth. Discussion: Our survey identifies variation in preterm nutrition practice across A&NZ of sufficient magnitude to impact nutrition interventions and neonatal outcomes. This presents an opportunity to use the unique skillset of neonatal dietitians to standardize practice, reduce uncertainty of neonatal care and improve the quality of neonatal research.
Collapse
Affiliation(s)
- Gemma McLeod
- Neonatology, Child and Adolescent Health Service, Nedlands, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | - Melissa Gilroy
- Mater Health Services, Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Denise Page
- Mater Health Services, Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | | | | | - Barbara E Cormack
- Starship Children's Health, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Binte Abu Bakar SY, Salim M, Clulow AJ, Nicholas KR, Boyd BJ. Human milk composition and the effects of pasteurisation on the activity of its components. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
The risk of infectious pathogens in breast-feeding, donated human milk and breast milk substitutes. Public Health Nutr 2020; 24:1725-1740. [PMID: 32539885 DOI: 10.1017/s1368980020000555] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This review collates the published reports that focus on microbial and viral illnesses that can be transmitted by breast milk, donor milk and powdered infant formula (PIF). In this context, we attempt to define a risk framework encompassing those hazards, exposure scenarios, vulnerability and protective factors. DESIGN A literature search was performed for reported cases of morbidity and mortality associated with different infant feeding modes. SETTING Exclusive breast-feeding is the recommended for infant feeding under 6 months, or failing that, provision of donated human milk. However, the use of PIF remains high despite its intrinsic and extrinsic risk of microbial contamination, as well as the potential for adverse physiological effects, including infant gut dysbiosis. RESULTS Viable pathogen transmission via breast-feeding or donor milk (pasteurised and unpasteurised) is rare. However, transmission of HIV and human T-cell lymphotropic virus-1 is a concern for breast-feeding mothers, particularly for mothers undertaking a mixed feeding mode (PIF and breast-feeding). In PIF, intrinsic and extrinsic microbial contamination, such as Cronobacter and Salmonella, remain significant identifiable causes of infant morbidity and mortality. CONCLUSIONS Disease transmission through breast-feeding or donor human milk is rare, most likely owing to its complex intrinsically protective composition of human milk and protection of the infant gut lining. Contamination of PIF and the morbidity associated with this is likely underappreciated in terms of community risk. A better system of safe donor milk sharing that also establishes security of supply for non-hospitalised healthy infants in need of breast milk would reduce the reliance on PIF.
Collapse
|
8
|
Boss M, Hartmann P, Turner J, Pritchard D, Pérez-Escamilla R, Clifford R. Development of LactaPedia: A lactation glossary for science and medicine. MATERNAL AND CHILD NUTRITION 2020; 16:e12969. [PMID: 32032481 PMCID: PMC7296804 DOI: 10.1111/mcn.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/13/2023]
Abstract
During the last decade, there have been several publications highlighting the need for consistent terminology in breastfeeding research. Standard terms and definitions are essential for the comparison and interpretation of scientific studies that, in turn, support evidence‐based education, consistency of health care, and breastfeeding policy. Inconsistent advice is commonly reported by mothers to contribute to early weaning. A standard language is the fundamental starting point required for the provision of consistent advice. LactaPedia (www.lactapedia.com) is a comprehensive lactation glossary of over 500 terms and definitions created during the development of LactaMap (www.lactamap.com), an online lactation care support system. This paper describes the development of LactaPedia, a website that is accessible free of charge to anyone with access to the Internet. Multiple methodological frameworks were incorporated in LactaPedia's development in order to meet the needs of a glossary to support both consistent health care and scientific research. The resulting LactaPedia methodology is a six‐stage process that was developed inductively and includes framework to guide vetting and extension of its content using public feedback via discussion forums. The discussion forums support ongoing usability and refinement of the glossary. The development of LactaPedia provides a fundamental first step towards improving breastfeeding outcomes that are currently well below World Health Organisation recommendations globally.
Collapse
Affiliation(s)
- Melinda Boss
- School of Allied Health, Division of Pharmacy, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Hartmann
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer Turner
- School of Allied Health, Division of Pharmacy, The University of Western Australia, Perth, Western Australia, Australia
| | - Douglas Pritchard
- School of Medicine, Division of General Practice, The University of Western Australia, Perth, Western Australia, Australia
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Rhonda Clifford
- School of Allied Health, Division of Pharmacy, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|