Reilly, JJ

Wells, JCK

UCL Discovery

British Journal of Nutritionhttp://journals.cambridge.org/BJNAdditional services for British Journal of Nutrition:Email alerts: Click hereSubscriptions: Click hereCommercial reprints: Click hereTerms of use : Click hereNutrition Discussion ForumJohn J. Reilly and Jonathan C. K. WellsBritish Journal of Nutrition / Volume 95 / Issue 06 / June 2006, pp 1231 ­ 1231DOI: 10.1079/BJN20061769, Published online: 08 March 2007Link to this article: http://journals.cambridge.org/abstract_S0007114506001656How to cite this article:John J. Reilly and Jonathan C. K. Wells (2006). Nutrition Discussion Forum. British Journal of Nutrition,95, pp 1231­1231 doi:10.1079/BJN20061769Request Permissions : Click hereDownloaded from http://journals.cambridge.org/BJN, IP address: 144.82.107.23 on 17 Aug 2012Response to comments by Kersting et al.We welcome the response to our recent article (Reilly &Wells, 2005), in part because we wanted to encourage the col-lection and publication of more empirical data on milk energytransfer from mothers who breast-feed exclusively up untiltheir baby is 5–6 months old. Kersting et al. (2006) providenew data on the quantity of breast-milk transferred in thirty-nine mother–infant pairs, collected over a 16-year period inGermany. As we and others have noted, there is a dearth ofenergy-balance data for mother–infant pairs exclusivelybreast-feeding beyond 4 months (Butte et al. 2002; Reillyet al. 2005). Kersting et al. (2006) stated that fewer than20 % of the mothers in their sample were ‘exclusive and pre-dominant breast-feeders’ by 6 months, and it is likely that thesmall minority still breast-feeding exclusively at 6 monthswere atypical.This problem of massive attrition from longitudinal studiesof milk transfer in exclusive breast-feeding is serious, and wecannot have confidence that those who remain in such studiesrepresent all other mother–infant pairs (Butte et al. 2002).Mothers who remain in such studies, including the DortmundNutritional and Anthropometric Longitudinally DesignedStudy (Kersting et al. 2006), are highly self-selected andmay be particularly able to meet the energy requirements oftheir baby by exclusive breast-feeding. How they do so, andhow typical they are, are questions that require furtherstudy. Basing population-wide recommendations for the dur-ation of exclusive breast-feeding on the experience of asmall minority of (possibly atypical) mother–infant pairsseems to us to be premature, particularly in the light of thedoubts that our review of empirical data have presented.Kersting et al. (2006) questioned whether the UK infantweight reference data we used to estimate energy requirementswere largely based on formula-fed infants, who might havebeen heavier than exclusively breast-fed infants of the sameage. The UK 1990 weight reference data in infancy (Freemanet al. 1995) were derived from several sources, notably the Cam-bridge Infant Growth Study (Cole et al. 2002), with a higher pro-portion of the sample breast-feeding than was typical of the UKat the time. Furthermore, despite differences in the patterns ofgrowth, the weight of exclusively breast-fed infants in the Cam-bridge Infant Growth Study at 5–6 months was similar to that ofthe rest of the cohort (Cole et al. 2002).The main scientific question, based on the accumulatedbody of evidence from our systematic review (Reilly et al.2005), remains whether or not infants of average weight orabove in the UK can obtain sufficient milk energy from exclu-sive breast-feeding at 6 months of age. Larger prospectivestudies of all components of the infant energy-balanceequation are necessary to answer this question. Althoughexclusive breast-feeding provides sufficient energy for someinfants at 6 months, published data suggest that, for infantsof average weight or above, meeting infant energy needswill become increasingly difficult by 6 months. We supportthe suggestion by Kersting et al. (2006) that more energy-bal-ance research is necessary in order to address whether (andhow) the recommendation to breast-feed exclusively is achiev-able by more typical mother–infant pairs.Finally, we emphasise that the issue of the adequacy ofexclusive breast-feeding to 6 months merits greater attentionin order to promote breast-feeding successfully in the wholepopulation.John J. Reilly1 and Jonathan C. K. Wells21University of Glasgow Division of Developmental Medicine1st Floor Tower QMHYorkhill HospitalsGlasgowG3 8SJUK2MRC Childhood Nutrition Research CentreInstitute of Child HealthUniversity College London30 Guilford StLondonWC1N 1EHUKEmail: jjr2y@clinmed.gla.ac.uk10.1079/BJN20061769ReferencesButte NF, Lopez-Alarcon MG & Garza C (2002) Nutrient Adequacyof Exclusive Breastfeeding for the Term Infant During the First SixMonths of Life. Geneva: WHO.Cole TJ, Paul AA & Whitehead RG (2002) Weight reference chartsfor British long-term breastfed infants. Acta Paediatr 91,1296–1300.Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM & Preece MA(1995) Cross sectional stature and weight curves for the UK, 1990.Arch Dis Child 73, 17–24.Kersting M, Hilbig A & Schoen S (2006) Comments by Kersting et al.Br J Nutr 95, 1229–1230.Reilly JJ, Ashworth S & Wells JCK (2005) Energy intake in theexclusively breast-fed infant age 3–6 months from developedcountries: a systematic review. Br J Nutr 94, 56–63.Reilly JJ & Wells JCK (2005) Duration of exclusive breast-feeding:introduction of complementary feeding may be necessary before6 months of age. Br J Nutr 94, 869–872.Nutrition Discussion Forum 1231

Nutrition Discussion Forum: Response to comments by Kersting et al

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Nutrition Discussion Forum: Response to comments by Kersting et al

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