Is infant formula like breastmilk? 

    Infant formula is a far cry from the complexities and intricacies of breastmilk. Fundamentally, it is a combination of ingredients that, according to the current state of scientific evaluation, are essential for an infant's growth and development. At best, it is a crude attempt to combine ingredients available in mass quantities on the global chemical market to replicate the nutrients present in breastmilk. At worst, it is a chemical concoction designed to meet minimum regulatory requirements. Vital constituents found in breastmilk such as hormones, growth factors, enzymes, co-enzymes and a host of immunological factors, impossible to replicate, are simply left out. Adjustments made to the composition of infant formulas reflect the inadequacy and incompleteness of the product and are based on the current level of accepted scientific knowledge and technical capacity. Thus the level of completeness of infant formula as a "breastmilk substitute" can never be more than what the science of the day is capable of producing and what the manufacturers are willing to change. And manufacturers are only willing to change if they perceive there is a marketing advantage in doing so.

Changes in formulation as marketing tools

    The addition of long chain fatty acids is a case in point. With a marketing onslaught and a 20 to 30 percent hike in retail price, Mead Johnson is attempting to capture a bigger piece of the formula market. However, in order to justify the higher price tag and gain a bigger piece of the pie, claims and comparisons are bandied about. Legal or not, truthful or not, science based or not, independent or not does not matter. What is on the table is increasing the number of infants who are formula fed. With statements  of "found in breastmilk" right on the front  panel of the tin and letters to new mothers claiming to be "as close to nature as possible" and statements of the "closest ever to breastmilk".   

    Breastmilk is the obvious competitor and breastfeeding women the targets - in direct mailing to breastfeeding mothers, "I've included a free sample can of Enfamil A+", writes Karen Evans, the Mead Johnson dietitian. "Breastmilk offers the best nutrition for your baby. But if you, like many mothers, eventually decide to feed your baby formula, you can be confident that Enfamil A+'s unique formulation is as close to nature as possible."

Breastmilk provides all the essentials for normal growth and development

Long chain fatty acids are critical nutritional building blocks for infants and children well into the teenage years as components of cell membranes, and are of particular importance for visual and neurologicalbrain development. Brain growth is the most rapid during the last trimester of pregnancy and the first year of life and the full complement of breastmilk nutrients, including breastmilk sourced long chain fatty acids - DHA and ARA - together with all the critical cofactors, coenzymes, and complementary nutrients are needed for full development of these vital tissues. Only breastmilk can provide these necessary building blocks. Any other source will remain incomplete. DHA and ARA added to formula is derived from algae and fungi, without the necessary complementary ingredients or a scientific understanding of how complex these interrelations are and therefore cannot come close to the capabilities of breastmilk. To make such a claim is an outright lie.

    To study the impact of duration of breastfeeding on mental and psychomotor development, the authors compared those breastfed for 4 months or longer to those who were weaned to formula at an earlier age. There was little or no significant difference in psychomotor development, but a statistically significant difference was found between the duration of breastfeeding and scores for Bayley's mental development index. The authors note that breastfeeding for longer than four months has a positive effect on baby's mental development measured at 18 months of age.

This Danish study determined that independent of a wide variety of confounding factors, the positive impact of breastfeeding was significant into adulthood and that nutrients in breastmilk "may have long-term positive effects on cognitive and intellectual development". They found a "dose" related response, as the duration of breastfeeding was associated with higher scores in verbal and performance tests.

Mortensen, EL et al. The association between duration of breastfeeding and adult intelligence.

JAMA 287:2365-2371, 2002

In order to determine the impact of the duration of breastfeeding on cognitive development at the age of 6 years and 8 years, both verbal and performance tests of Australian children were examined and categorized according to duration of breastfeeding. Early cessation of breastfeeding was associated with reduced verbal IQ.

Oddy, WH et al. Breastfeeding and cognitive development in childhood: a prospective cohort study

Paediatr Perinat Epidemiol 17: 81- 90, 2003

This interesting study reports on the effect of maternal diet on the fatty acid composition of red blood cells of infants who are breastfed compared to those fed formulas with varying levels of fatty acids (both conventional and with DHA and/or ARA added). It demonstrates the differences in fatty acid composition of red blood cell phospholipids between breastfed and formula fed infants. 

Benito, FJ, et al. [The influence of human milk and various artificial formulae commercially available

in Spain on the fatty acids status of infants in the first two months of life]

(Abstract only available in English) An Esp Pediatr 57: 163-169, 2002

Singer notes that although clinical infant feeding trials are necessary to establish safety and efficacy of supplementation with long chain fatty acids of infant formulas, these trials "pose significant methodological difficulties when applied to infants because of the rapidly changing development of the infants central nervous system and its interdependence with a multiple of environmental factors". He notes that current trials are beset with small sample size, high attrition rates, and lack of attention to confounding variables, especially in studies with pre-term populations. As well, inadequate analysis is done to assess the benefits versus the risks of fatty acid supplementation of infant formulas.

Singer, LT. Randomized clinical trials in infancy: methodological issues.

Semin Neonatol 6:393- 410, 2001