Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Meghan B Azad^{1

2

3

4}, Nathan C Nickel^{2

3

5}, Lars Bode⁶, Meredith Brockway^{1

3}, Amy Brown⁷, Christina Chambers⁸, Camie Goldhammer⁹, Katie Hinde¹⁰, Michelle McGuire¹¹, Daniel Munblit^{12

13

14}, Aloka L Patel¹⁵, Rafael Pérez-Escamilla¹⁶, Kathleen M Rasmussen¹⁷, Natalie Shenker^{18

19}, Bridget E Young²⁰, Luisa Zuccolo²¹

Affiliations

¹ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
² Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
³ Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada.
⁴ Human Capital & Economic Opportunity Global Working Group, Center for the Economics of Human Development, University of Chicago, Chicago, Illinois, USA.
⁵ Department of Community Health Sciences and Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶ Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, California, USA.
⁷ Department of Public Health, Policy and Social Sciences and Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK.
⁸ Mommy's Milk Human Milk Research Biorepository, Center for Better Beginnings, University of California San Diego, San Diego, California, USA.
⁹ Indigenous Breastfeeding Counsellor, Seattle, Washington, USA.
¹⁰ Center of Evolution and Medicine and School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA.
¹¹ Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho, USA.
¹² Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.
¹³ Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁴ inVIVO Planetary Health, Worldwide Universities Network (WUN), West New York, New Jersey, USA.
¹⁵ Department of Pediatrics, Section of Neonatology, Rush University Children's Hospital, Chicago, Illinois, USA.
¹⁶ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.
¹⁷ Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
¹⁸ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁹ Human Milk Foundation, Harpenden, UK.
²⁰ Division of Allergy and Immunology, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
²¹ MRC Integrative Epidemiology Unit and Department of Population Health Sciences, University of Bristol, Bristol, UK.

PMID: 33210456
PMCID: PMC7988860
DOI: 10.1111/mcn.13109

Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Meghan B Azad et al. Matern Child Nutr. 2021 Apr.

. 2021 Apr;17(2):e13109.

doi: 10.1111/mcn.13109. Epub 2020 Nov 19.

Authors

Affiliations

¹ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
² Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
³ Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Manitoba, Canada.
⁴ Human Capital & Economic Opportunity Global Working Group, Center for the Economics of Human Development, University of Chicago, Chicago, Illinois, USA.
⁵ Department of Community Health Sciences and Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶ Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, California, USA.
⁷ Department of Public Health, Policy and Social Sciences and Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK.
⁸ Mommy's Milk Human Milk Research Biorepository, Center for Better Beginnings, University of California San Diego, San Diego, California, USA.
⁹ Indigenous Breastfeeding Counsellor, Seattle, Washington, USA.
¹⁰ Center of Evolution and Medicine and School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA.
¹¹ Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho, USA.
¹² Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.
¹³ Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁴ inVIVO Planetary Health, Worldwide Universities Network (WUN), West New York, New Jersey, USA.
¹⁵ Department of Pediatrics, Section of Neonatology, Rush University Children's Hospital, Chicago, Illinois, USA.
¹⁶ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.
¹⁷ Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
¹⁸ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁹ Human Milk Foundation, Harpenden, UK.
²⁰ Division of Allergy and Immunology, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
²¹ MRC Integrative Epidemiology Unit and Department of Population Health Sciences, University of Bristol, Bristol, UK.

PMID: 33210456
PMCID: PMC7988860
DOI: 10.1111/mcn.13109

Abstract

Breastfeeding and human milk (HM) are critically important to maternal, infant and population health. This paper summarizes the proceedings of a workshop that convened a multidisciplinary panel of researchers to identify key priorities and anticipated breakthroughs in breastfeeding and HM research, discuss perceived barriers and challenges to achieving these breakthroughs and propose a constructive action plan to maximize the impact of future research in this field. Priority research areas identified were as follows: (1) addressing low breastfeeding rates and inequities using mixed methods, community partnerships and implementation science approaches; (2) improving awareness of evidence-based benefits, challenges and complexities of breastfeeding and HM among health practitioners and the public; (3) identifying differential impacts of alternative modes of HM feeding including expressed/pumped milk, donor milk and shared milk; and (4) developing a mechanistic understanding of the health effects of breastfeeding and the contributors to HM composition and variability. Key barriers and challenges included (1) overcoming methodological limitations of epidemiological breastfeeding research and mechanistic HM research; (2) counteracting 'breastfeeding denialism' arising from negative personal breastfeeding experiences; (3) distinguishing and aligning research and advocacy efforts; and (4) managing real and perceived conflicts of interest. To advance research on breastfeeding and HM and maximize the reach and impact of this research, larger investments are needed, interdisciplinary collaboration is essential, and the scientific community must engage families and other stakeholders in research planning and knowledge translation.

Keywords: breastfeeding; breastmilk; conflict of interest; human milk; infant feeding; lactation; research methodology.

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Conflict of interest statement

The authors have declared all relevant potential sources of conflict of interest, including salary/research funding, patents, stock ownership, speaking activities at sponsored conferences/workshops/events, consulting, boards, societies, committees, expert panels and community organizations, detailed in Table S1.

Figures

**FIGURE 1**
Determinants and consequences of human milk composition

**FIGURE 2**
The biopsychosocial construct of breastfeeding: functions, perspectives and implications

**FIGURE 3**
Key priorities and anticipated breakthroughs, barriers and challenges, and recommendations for research on breastfeeding and human milk (HM)

See this image and copyright information in PMC

References

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Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

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Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Authors

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Abstract

Conflict of interest statement

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