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Kramer et al1 present evidence that breastfeeding improves children's cognitive development. They discuss 2 classes of explanation for their findings, noting that the superior cognitive development of breastfed children may be due either “to some constituent of breast milk” that promotes improved development or “to the physical and social interactions inherent in breastfeeding.”1 (p582)
There is a third class of possible explanations not addressed in the discussion. Some property of infant formula may diminish developmental potential. This alternative explanation raises the possibility that breastfed children represent a normal reference population and that formula-fed children are harmed in some way in comparison with the breastfed group. The findings appear equally compatible with either an improved outcome from breastfeeding or, alternatively, a deficit conferred by some property of infant formula.
One candidate mechanism of harm in formula-fed infants is iron-mediated subclinical brain injury. Formula may increase infant exposure to non–protein-bound iron. Apolactoferrin derived from breast milk may protect infants from early iron-mediated brain injury that would otherwise impair later neurodevelopment. A general protective effect of apolactoferrin of maternal origin was previously proposed.2 It was suggested that “apolactoferrin may be absorbed from [breast] milk in amounts sufficient to boost plasma antioxidant activity.”2 (p1344) Subsequent investigations have provided evidence that iron-mediated free radical formation is involved in brain damage in neonates3 and that non–protein bound iron is a highly significant early predictor of later neurodevelopmental outcomes.4 It has been shown that recombinant human lactoferrin added to formula or human milk attenuates, and iron present in infant formula increases, iron-mediated free radical formation and lipid peroxidation.5 There is direct evidence of an antioxidant action of human milk.6
Correspondence: Dr Sullivan, Burnett School of Biomedical Sciences, University of Central Florida, 4475 Old Bear Run, Winter Park, FL 32792 (jlsullivan3@gmail.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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