Two interesting studies came out in the past few weeks, neither of which got much publicity, and were reported with tremendous caution in the fear of sounding “anti-breastfeeding”. However, considering atopic dermatitis(AD) and Type 1 diabetes are two of the most feared “risks” of formula feeding, I think these studies deserve a little attention. True, the AD one was funded by a formula company (Danone Research) , but it’s a fascinating study all the same, and the authors were uber-conscious of the bias inherent in their funding, and reported their findings accordingly. And as I’ve stated on the blog numerous times before, I really don’t see all that much difference in bias between a study funded by formula companies, and one that is conducted, analyzed and reported by a renowned breastfeeding advocate. Both of these circumstances require a bit of skepticism and hyper-analyzing on the part of the consumer, but for some reason, the latter scenario is seldom seen as anything but altruistic.
Anyway, on to the studies at hand. The first, Dietary Intervention in Infancy and Later Signs of Beta-Cell Autoimmunity, appears in the prestigious New England Journal of Medicine. Beta-cell autoimmunity is associated with Type 1 diabetes in genetically-susceptible individuals; the theory is that exposure to complex proteins in infancy heightens risk of beta-cell autoimmunity. So, the researchers wanted to see if using a casiein hydrolysate formula (the kind us parents with milk-or-soy-protein-intolerant kids are so fond of) rather than a regular, cows-milk based formula, would prevent this beta-cell autoimmunity from occurring.
Interestingly, at least from the free abstract (money’s tight, y’all, so you’ll have to excuse my inferior research here), it sounds as if this study used primarily breastfed kids whose mothers sometimes supplemented. I’m not sure what the dosage situation was – if these were occasional bottles or an everyday thing; if they included exclusively formula fed babies as well, etc. But the important part remains the same – there was a statistically significant difference (although the difference was relatively small, as they tend to be in most of these infant feeding studies) in outcome between the regular formula kids and the hydrolyzed group when it came to developing the autoantibodies which are associated with Type 1 diabetes, favoring the casien hydrolysate formula. (There was no significant difference in the number of actual cases of type 1 diabetes, however, between the control and test group). So if you are someone with a family history of Type 1 diabetes, it may be worth it to consider a formula like Alimentum or Nutramigen, or at least talk to your doctor about the pros and cons of these types of formula. I’m a believer in them for totally unscientific reasons – they gave me my son, and saved his gut, and I will be eternally grateful for that, so I will gladly admit a ginormous positive bias towards any study showing them in good favor.
Next up, the study funded by European formula company Danone, published in the Journal of Allergy and Clinical Immunology (the link will bring you to the full text of the study, if you’re interested). This one is pretty cool, too. Atopic dermatitis (an itchy, uncomfortable skin condition, the prevalence of which is rising in Western nations) is related to allergies in some cases, but those are mostly in kids with a family history of AD. The majority of cases are in babies with no family history of the condition, so these researchers focuses on a group with low-risk of AD for more useful results from a public health perspective. They hypothesized that using a prebiotic-enhanced formula would help reduce the risk of AD:
Because there is a broad consensus that the intestinal microbiota plays an important physiological role in the postnatal development of the immune system, many attempts have been made to influence the intestinal microbiota and herewith the occurrence of atopic manifestations by dietary interventions. A heavily marketed strategy for primary prevention is dietary supplementation of potentially beneficial bacteria (probiotics) as a tool to redirect the immune system away from atopy.
They took a group of 1130 infants from various European cities/medical centers with a low risk of AD. Some were exclusively breastfed; those who were not were randomly assigned to receive either a normal formula or one supplemented with prebiotics. The results were actually kind of dramatic, as these things go.
They found that using a prebiotic-enriched formula “reduces the incidence of AD up to the first birthday in infants at low risk for atopy by 44% compared with the control group and down to a level similar to that of fully breast-fed infants. The severity of AD, however, was not affected significantly.”
So, the next time you hear that formula research isn’t worthwhile, you’ll have two studies to bolster your side of the debate. This isn’t a question of breast vs bottle; it’s about making bottle feeding the best it can possibly be for those who cannot or chose not to breastfeed. We have a right to know that prebiotics might be useful in protecting against AD, or that a baby at risk of Type 1 diabetes might fare better on a hydrolysate formula – as much right as we have to know that breastfeeding has a correlation with less incidence of gastrointestinal problems, or that receiving a formula freebie bag is associated with a shorter duration of exclusive breastfeeding…. don’t we?