Giuseppe Banderali

Factors associated with initiation and duration of breastfeeding in Italy

To evaluate factors associated with initiation and duration of breastfeeding in Italy, 1601 (73%) respondents among 2192 randomly selected mothers were interviewed within 1 mo of delivery. Mothers who started breastfeeding (85%) were followed‐up for 12 mo. A compliance rate of 100% was obtained. At multiple logistic regression analysis, mother having been breastfed herself (p<0.01), nursing guidance in the maternity ward (p= 0.01) and higher social class (p= 0.03) were positively associated with initiation of breastfeeding. We found that 42%, 19%, 10% and 4% mothers were still breastfeeding at 3, 6, 9 and 12 mo after delivery, respectively. Cox multiple regression analysis showed a negative association between duration of breastfeeding and pacifier use (p<0.01), and a positive association with a higher level of maternal education (p= 0.04). Formula supplementation in the maternity ward (given to 30% of infants) was associated with a shorter duration of exclusive breastfeeding (p = 0.03). Mothers need support with breastfeeding, particularly those from lower social backgrounds and with lower levels of education. Early use of the pacifier should be discouraged.

Feeding practices of infants through the first year of life in Italy

Aim: To investigate infant feeding practices through the first year of life in Italy, and to identify factors associated with the duration of breastfeeding and early introduction of solid foods. Methods: Structured phone interviews on feeding practices were conducted with 2450 Italian‐speaking mothers randomly selected among women who delivered a healthy‐term singleton infant in November 1999 in Italy. Interviews were performed 30 d after delivery and when the infants were aged 3, 6, 9 and 12 mo. Type of breastfeeding was classified according to the WHO criteria. Results: Breastfeeding started in 91.1% of infants. At the age of 6 and 12mo, respectively, 46.8% and 11.8% of the infants was still breastfed, 68.4% and 27.7% received formula, and 18.3% and 65.2% were given cows milk. Solids were introduced at the mean age of 4.3 mo (range 1.6–6.5 mo). Introduction of solids occurred before age 3 and 4 mo in 5.6% and 34.2% of infants, respectively. The first solids introduced were fruit (73.1%) and cereals (63.9%). The main factors (negatively) associated with the duration of breastfeeding were pacifier use (p > 0.0001), early introduction of formula (p > 0.0001), lower mothers age (p > 0.01) and early introduction of solids (p= 0.05). Factors (negatively) associated with the introduction of solids foods before the age of 3 mo were mother not having breastfed (p > 0.01), early introduction of formula (p > 0.01), lower infant bodyweight at the age of 1 mo (p= 0.05) and mother smoking (p= 0.05).

Tolerance to a rice hydrolysate formula in children allergic to cow's milk and soy

Background Even hydrolysed cows milk formulae may retain residual allergens and there are few nutritional options for children with cows milk allergy (CMA) who also react to soy.

A Specific Prebiotic Mixture Added to Starting Infant Formula Has Long-Lasting Bifidogenic Effects

There is some evidence that early colonization of the intestine affects the composition of the intestinal microbiota after weaning. In the present study, the effect of prebiotics administered from the first day of life on fecal counts of bifidobacteria and lactobacilli were studied during and after the administration of the prebiotics. In this double-blind, randomized, placebo-controlled, explorative study, 20 newborns of hepatitis C virus-infected mothers who decided not to breast feed due to their concerns regarding their plasma viral load were randomly assigned to either a formula with 8 g/L of a specific prebiotic mixture (short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides, ratio 9:1) or a formula containing the same amount of maltodextrin (placebo). Clinical examination including anthropometric measurements, microbiological analysis of fecal samples, and blood leukocyte population analysis were performed at birth and 3, 6, and 12 mo age. At the age of 12 mo, hepatitis B vaccine-specific IgG serum titers (Hepatitis B virus surface antibodies) were also measured. Prebiotic supplementation resulted in more fecal bifidobacteria (P < 0.0001) and lactobacilli (P = 0.0044) compared with the placebo group. These differences between the groups were maintained during the second half of the first year without any prebiotic supplementation. There was no influence of the different diets on anthropometric data or the measured immunological variables. The data from this small explorative study indicate that early colonization of the intestine might have long-lasting effects on the composition of the intestinal microbiota.

Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review

AbstractA great deal of attention has been focused on adverse effects of tobacco smoking on conception, pregnancy, fetal, and child health. The aim of this paper is to discuss the current evidence regarding short and long-term health effects on child health of parental smoking during pregnancy and lactation and the potential underlying mechanisms. Studies were searched on MEDLINE® and Cochrane database inserting, individually and using the Boolean ANDs and ORs, ‘pregnancy’, ‘human lactation’, ‘fetal growth’, ‘metabolic outcomes’, ‘obesity’, ‘cardiovascular outcomes’, ‘blood pressure’, ‘brain development’, ‘respiratory outcomes’, ‘maternal or paternal or parental tobacco smoking’, ‘nicotine’. Publications coming from the reference list of studies were also considered from MEDLINE. All sources were retrieved between 2015-01-03 and 2015-31-05. There is overall consistency in literature about negative effects of fetal and postnatal exposure to parental tobacco smoking on several outcomes: preterm birth, fetal growth restriction, low birth weight, sudden infant death syndrome, neurodevelopmental and behavioral problems, obesity, hypertension, type 2 diabetes, impaired lung function, asthma and wheezing. While maternal smoking during pregnancy plays a major role on adverse postnatal outcomes, it may also cumulate negatively with smoking during lactation and with second-hand smoking exposure. Although this review was not strictly designed as a systematic review and the PRISMA Statement was not fully applied it may benefit the reader with a promptly and friendly readable update of the matter. This review strengthens the need to plan population health policies aimed to implement educational programs to hopefully minimize tobacco smoke exposure during pregnancy and lactation.

Epigenetic Effects of Human Breast Milk

A current aim of nutrigenetics is to personalize nutritional practices according to genetic variations that influence the way of digestion and metabolism of nutrients introduced with the diet. Nutritional epigenetics concerns knowledge about the effects of nutrients on gene expression. Nutrition in early life or in critical periods of development, may have a role in modulating gene expression, and, therefore, have later effects on health. Human breast milk is well-known for its ability in preventing several acute and chronic diseases. Indeed, breastfed children may have lower risk of neonatal necrotizing enterocolitis, infectious diseases, and also of non-communicable diseases, such as obesity and related-disorders. Beneficial effects of human breast milk on health may be associated in part with its peculiar components, possible also via epigenetic processes. This paper discusses about presumed epigenetic effects of human breast milk and components. While evidence suggests that a direct relationship may exist of some components of human breast milk with epigenetic changes, the mechanisms involved are still unclear. Studies have to be conducted to clarify the actual role of human breast milk on genetic expression, in particular when linked to the risk of non-communicable diseases, to potentially benefit the infant’s health and his later life.

The Efficacy and Safety of γ-Linolenic Acid in the Treatment of Infantile Atopic Dermatitis

The efficacy and safety of γ-linolenic acid in the treatment of atopic dermatitis was evaluated. The children (mean age, 11.4 months) with atopic dermatitis (mean duration, 8.56 months) were openly treated with 3 g/day γ-linolenic acid, for 28 days. Clinical evaluations were carried out every 7 days, and parents were asked to keep a diary, recording details of symptoms of eczema every day. Blood chemistry and immunological tests were done before and after treatment. None of the children showed complete recovery of symptoms. A gradual improvement in erythema, excoriations and lichenification was seen; significant differences were shown for itching (P < 0.01), and the use of antihistamines (P < 0.01). A significant rise in the percentage of circulating CD8 was found. No side-effects were recorded. Dietetic and pharmacological approaches are the basis of the treatment of atopic dermatitis and γ-linolenic acid appears to be a safe and efficient additional therapy for infants and young children.

Exclusive versus predominant breastfeeding in Italian maternity wards and feeding practices through the first year of life.

Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the maternity ward. Mothers were interviewed through 12 months postdelivery about feeding practices. Information about the World Heath Organization’s (WHO’s) 10 steps was collected. At hospital stay, breastfeeding was predominant in 43% of infants. Cesarean section (odds ratio [OR] = 1.75), mother’s overweight (OR = 1.74), and non-compliance with the WHO’s steps 6 (OR = 1.58), 7 (OR = 1.43), and 8 (OR = 1.76) were determinants of predominant, as opposed to exclusive, breastfeeding. Mothers exclusively, rather than predominantly, breastfeeding in the hospital showed a longer duration of full breastfeeding (mean = 3.6 vs 3.1 months), later introduction of formula (3.8 vs 3.3 months), and lower rate of introduction of formula within 1 month (23% vs 30%). Hospitals need to be compliant with the WHO’s steps, and Baby-Friendly Hospital Initiatives should be promoted.

Monitoring breastfeeding rates in Italy : national surveys 1995 and 1999

Aim: To assess and compare the rates of initiation and duration of breastfeeding in Italy in 1995 and 1999, and to examine the adherence to the ten steps to successful breastfeeding recommended by WHO. Methods: Two cohorts of mothers who delivered healthy infants in November 1995 (n= 1601) or November 1999 (n= 2450) were interviewed by telephone within 4 wk of delivery and when their infant were 3, 6, 9 and 12 mo of age. Type of breastfeeding was classified according to the WHO definitions. Adherence to the WHO ten steps was evaluated as experienced by the mothers. Results: Initiation and duration of breastfeeding increased during the 1995–1999 period (p < 0.0001). The rate of breastfeeding at birth, at discharge and when the infants were 3, 6, 9 and 12 mo of age was 85%, 83%, 42%, 19%, 10% and 4%, in 1995 and 91%, 89%, 66%, 47%, 25% and 12% in 1999. The rate of exclusive breastfeeding was higher in 1999 than 1995 at birth (39% vs 30%, p < 0.0001) and at discharge (77% vs 70%, p < 0.0001), but overall no longer duration was observed in 1999. At 4 and 6 mo of age the rate of exclusive breastfeeding was 25% and 8% in 1995 and 31% and 5% in 1999. The adherence to each WHO step was higher in 1999 than in 1995 (p < 0.05) but concomitant adherence was low (<3%).

Epidemiology of breastfeeding in Italy

To evaluate the rates of initiation and duration of breastfeeding in the major geographical areas of Italy, 1601 mothers randomly selected as representative of the November 1995 deliveries in all 20 regional districts underwent interviews within 1 mo after delivery. A cross‐sectional telephone scanner‐ready questionnaire was administered by trained personnel. Mothers who started breastfeeding were interviewed again at 3, 6, 9 and 12 mo after delivery. The results indicate that 85.3% mothers initiated breastfeeding, with significant geographical differences (rate ranging from 75.8% in the islands to 90.8% in the north‐east; p < 0.0001). The overall breastfeeding prevalence considering all 1601 mothers decreased steadily to 41.8% at 3 mo and 19.4% at 6 mo, and was even lower when considering only exclusive/predominant breastfeeding (37.3% and 8.1%, respectively). The duration of breastfeeding was shorter in the islands than in other areas, particularly the north‐east (p = 0.001). Although the rate of breastfeeding initiation is fairly high in Italy, the rapid decrease in breastfeeding practice throughout the first 6 mo requires strategies for improvement. The differences between the continental areas and the islands should be considered in programming intervention plans.