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WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1985; (724):1-206.In 1981, participants in the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements met in Italy to reexamine the interrelationships between energy and protein requirements and to recommend methods to integrate requirement scales for energy and proteins. They stated that the use of a reference man or woman to determine energy requirements should no longer be used since it is unduly restrictive and there is a wide range of body size and patterns of physical activity. The tables exhibit this wide range so users can use those values that best apply to his or her conditions. Overall the participants agreed that estimates of energy requirements should be based on actual or desirable energy requirement estimates. In terms of children, however, this principle cannot be applied since there is not enough information available about their energy expenditure. Further no one could agree on how to determine what actual intakes are needed to maintain health in its broadest sense in either developing or developed countries since observed actual intakes are not necessarily those that maintain a desirable body weight or optimal levels of physical activity. Divers patterns of physical activity in different age and sex groups are presented nonetheless to guide users in applying requirement estimates. The maintenance protein requirements identified by the 1971 consultation for the young child < 6 years old, e.g. 1 g/kg.day for 5-6 year old, and the young male adult (.54-.99 g.kg/day) remained the same. The participants made indirect estimates of protein needs for the remaining age and sex groups. They acknowledged that digestibility can affect the availability of protein and protein requirements need to be adjusted for fecal losses of nitrogen. They concluded that the natural diets for infants and preschool children contain sufficient amount of essential amino acids, but not those of the remaining groups.
Idrc Reports. 1982 Jul; 11(2):15-6.In developing countries breastfeeding offers the kind of nourishment that can make a life and death difference, yet an increasing number of mothers in the 3rd world are abandoning breastfeeding for "modern" feeding with bottles and formula. Human milk is a unique food. It is rich in proteins, carbohydrates, fats, acids, hormones, minerals, and vitamins. Scientists recognize that the interactions between ingredients in human milk are as important as the nutrients themselves. The milk's immunological properties against allergies, bacterial, and viral attack also protect infants during the 1st weeks of life. Both nutritionally and immunologically milk substitutes are inferior products. Bottle feeding can produce healthy infants under the right conditions, but in the 3rd world many factors combine to turn nursing bottles and breast milk substitutes into dangerous products. For artificial feeding to be safe, the bottles must be sterilized and the water used to dilute the formulas must be clean. These conditions often cannot be met by poor families in developing countries. Due to the high cost of formulas, mothers often overdilute them. The mother's decision to breastfeed provides important psychological and emotional benefits as well as a transition for the baby on the nutritional level. Breast milk can adequately meet all the nutritional requirements of a baby to the age of 4-6 months, without any liquid or solid supplementation. Women with significant nutritional deficiencies have been shown to produce milk of almost the same quality as well nourished mothers. The World Health Organization (WHO) report also states that while breastfeeding is still prevalent in many countries, the length of time babies are completely breastfed is decreasing and varies greatly. The reasons for stopping breastfeeding are many and interdependent; reliance on substitutes is preferred. In 1981, the WHO Annual Assembly voted 118 to 1 (the U.S. being the only exception) in favor of a marketing code for breast milk substitutes that, once incorporated into national laws, would limit publicity campaigns and restrict sales tactics. The formula industry companies, Nestle's, Wyatt, Mead Johnson, and Ross Abbott, continue to make inroads into 3rd world markets wherever they can. Sales offices have been created in over 50 countries, and manufacturing plants are located in several developing countries. Countries should enact legislation to protect pregnant and lactating mothers from any influences that could disrupt breastfeeding.
The baby killer scandal: a War on Want investigation into the promotion and sale of powdered baby milks in the Third World.
London, War on Want, 1980. 208 p.This sequel to "The Baby Killer", focusses on the advertising, marketing, promotion, and use of infant formulas in developing countries since 1974. Malnutrition and infection from bottle feeding in developing countries has continued to increase because of the lack of education, extensive advertising and promotion of formula manufacturers, and poor sanitary conditions. For example, in Papua New Guinea, 97.6% of infants were breast fed at 3 months in 1972, but by 1976, 35% of mothers surveyed were artificially feeding their babies. Breast milk is shown to be better for babies and mothers because of its protection against infection and malnutrition, high costs, and the loss of emotional bonds between mother and child. In addition, breast feeding is important for natural birth spacing. Factors which continue to influence the decline in breast feeding are urbanization, modernization, available alternatives for artificial feeding, and advertising of manufacturers. One of the major reasons for mothers to turn to bottle feeding is insufficient milk. Problems with the use of formula are the directions for use, incorrect mixing by illiterate people, lack of sanitation, and lack of responsiblity in distribution of products to developing countries by manufacturers. International and national companies have responded to the bottle feeding problem. The Nestle Company was particularly selected for boycott action. Recommended programs which aid in the development of breast feeding are outlined and priorities for changing policy in developing countries are discussed.
Socio-economic planning: legislative measures for improvement of the nutritional status of the mother/child dyad.
In: Hambraeus L, Sjolin S, eds. The mother/child dyad: nutritional aspects. Stockholm, Almqvist and Wiksell, 1979. 143-9. (Symposia of the Swedish Nutrition Foundation 15)Many legislative measures aimed at improving maternal and child nutrition were adopted by developed countries during the 20th century and some of these measures were also adopted by developing countries. These measures were reviewed and recent efforts by international, national, and institutional bodies to formulate policies to deal with nutritional problems were discussed. Measures adopted during the: 1900s with varying degrees of success included: 1) the introduction of nutritional programs into the school curriculum; 2) programs to reduce maternal nutritional deficiencies during the pregnancy; 3) measures to delay the age at marriage; 4) improvements in prenatal care; 5) hospital based programs to educate postpartum women in child nutrition; 6) programs aimed at promoting breastfeeding; 4) programs to provide low cost supplementary weaning foods; and 8) efforts to regulate the manufacture and sale of baby food products. At the international level various bodies have recommended the adoption of measures to improve working conditions for lactating and pregnant women and to reduce abusive marketing practices. At the national level, Algeria adopted policies aimed at promoting breastfeeding and improving nutritional standards through a variety of programs. China successfully promoted breastfeeding by adopting measures which make it easier for working women to breastfeed. France recently adopted policies aimed at regulating the sale of infant food products. In the future more efforts should be directed toward designing nutritional programs which take into account the needs of the local community and which provide nutritional services as an integral part of maternal and child health and community health services. Attention should also be directed toward improving the nutritional knowledge of the public and of the health professional.
Infant and young child nutrition, including the nutritional value and safety of products specifically intended for infant and young child feeding and the status of compliance with and implementation of the International Code of Marketing of Breast-milk Substitutes: report by the Director-General.
Geneva, Switzerland, WHO, March 1983. 39 p.This report to the Health Assembly is presented in 3 parts: Part I--a summary of the present global nutritional situation with particular reference to infants and young children--is based on an initial reading of the results of national surveillance and monitoring activities in over 50 countries. Part II has been prepared in accordance with resolution WHA34.23 which requested the Director-General to report to the Assembly on steps taken to assess the changes that occur with time and under various climatic conditions in the quality, nutritional value and safety of products specifically intended for infant and young child feeding. Part III, in accordance with resolution WHA34.22, summarizes information provided by Member States on action being taken to give effect to the International Code of Marketing of Breast-milk Substitutes. It should be read in conjunction with section VI of the Director-General's progress report which informed the 35th World Health Assembly of action taken by WHO and its Member States in the field of infant and young child feeding. In light of the information on the implementation of the Code contained in these 2 reports, and in the absence of any suggestions from Member States for change, the Director-General considers that it would be premature, at this time, to propose any revision of the text of the Code, either its form or content. The Health Assembly's attention will be drawn, in future biennial progress reports on infant and young child feeding, to any development which may have a bearing on the International Code, in accordance with its Article 11.7 and resolution WHA33.32.