INDIA NEEDS A FOCUSED POLICY TO TACKLE THE TB SCOURGE, SAYS DALBIR SINGH - The Daily Guardian
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INDIA NEEDS A FOCUSED POLICY TO TACKLE THE TB SCOURGE, SAYS DALBIR SINGH

Shalini Bhardwaj

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Dalbir Singh, who is co-president of the Global Coalition Against TB (GCAT), talked to this paper on TB and the challenges to tackle the disease. Excerpts:

Q: Could you elaborate on the reasons for the surge in TB in India and the role of policy to contain it?

A: India shares 27% of burden of incidence out of 10.5 million cases globally. TB continues to be a grave public health challenge since it claims more lives than any other infectious disease. Decades of unrestrained transmission, outmoded diagnostics till the recent past, an unregulated and fragmented private sector where nearly 68% Indians seek care for TB, coupled with undernourishment of significant population, rise of diabetes, smoking addictions and indoor pollution, have aggravated the growth of the disease. Other determinants like migration, poverty, proximal living spaces, stigma and social discrimination, lack of productive integration of private sector and limitations in healthcare outreach and emergence of Drug Resistant TB have also adversely affected the management of TB.

TB disproportionately affects the poor who lose nearly 35% household incomes. TB perpetuates poverty. India needs a focused national policy to handle this challenge. Since 2012, with strong advocacy by policymakers and eminent domain experts under the umbrella of the Global Coalition Against TB and other civil society groups, the government resolved to launch landmark initiatives at the policy level, including banning of outdated serological tests, making TB a notifiable disease, establishment of the National TB Research Consortium, introduction of Molecular Diagnostics (CBNAAT), integration of the private sector, enhancement of use of ICT tools, provision of social support and formulation of a dynamic National Strategic Plan (2017-25), with framework for Gender Responsive Approach. The RNTCP, which was a project, gave way to the National TB Elimination Programme which is now the apex institution with the mandate to implement plans to end TB by 2025.

Q: Is LTBI (Latent tuberculosis infection) a major concern for TB management in India?

A: 40% of India’s population is affected by latent TB. TB bacilli remain dormant and manifest as a TB disease with the weakening of the immune defences. It’s actually a binary condition of dynamic spectrum with asymptomatic LTBI non-transmissible state and symptomatic active TB that infects that can be transmitted. Though active TB treatment is cornerstone of WHO End TB strategy, the SDG deadlines can only be met by incorporating LTBI as a component our TB control policy, since it can be a huge reservoir of potentially becoming active TB. The policy must aim to screen high risk and vulnerable groups including alcohol, drug, smoking addicts, HIV, end state renal failure, transplant, silicosis and severely diabetic patients for preventive therapy.

Q: How can we involve and integrate community structures effectively into the TB prevention and care framework?

A: One third of patients are missed globally as well as in India as being undiagnosed or not reported because of lack of access to healthcare facilities. Since the government outreach has limitations, a collaborative effort with and through the communities can fill the gaps. Community engagement is imperative because it allows contextualization and adaptation of health interventions and policy needs of the community. It effectively addresses issues like stigma and social discrimination and increases psychological comfort for TB victims and survivors, strengthens patients’ support system, promotes awareness on various government schemes, innovation, and facilities, empowers local communities to lead TB response and adapt Community Centric and Gender Centric approach to improve quality services. WHO recognizes community engagement as one of the four principles of Global End TB Strategy. There are inspiring examples to emulate from Africa on reaching out to underserved nomadic and migrant communities and extending a healing touch to those who are socially isolated.

Q: How can we strengthen institutional ground-level structures to accelerate our fight against TB?

A: India has 2,50,000 local governments which are constitutionally mandated to make governance more participative by deeper engagement at the grassroots level. Public health is obligatory function of those institutions. Currently, these are being highly underutilized. Given the enormity of health challenge in TB, these can be integrated with the government structures. Local governments are closer to the people and understand ground realities better. We need to devolve more power and resources so that in collaboration with local communities, peripheral decision-making composite units can be formed under guidance of elected representatives at the block/village levels. They will enhance accountability, enable prioritization and improve facilities and delivery of services. We must promote capacities of community-based organisations of health workers like ASHA who performed commendably during the Covid crisis.

Q: What do you feel is the roadmap for India’s fight against TB, so that we are able to achieve a TB free status by 2025?

A: We must innovate to step up research and development, promote awareness and use of ICT and develop a Multi-Sectoral Approach with the comfort of all stakeholders. We can end TB by 2025 if we build synergy between the government apparatus, the public sector, governments, the civil society and with deeper engagement of local communities.

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Lifestyle choices for brain health

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Living a brain healthy lifestyle is particularly important once you reach middle age, as this is the time when changes in the brain start to occur. They may start decades before symptoms appear. This means that it is important to look after the brain throughout your life. It is never too late or too early to bring lifestyle changes as brain function can be improved at any age.

Exercise your brain: Any activity that involves thinking, learning and active networking regularly challenges your brain. These stimulating activities can improve your brain health. The best activities are those that you enjoy. Hobbies like painting, woodwork , sewing, knitting and writing provide stimulus to the brain.  Doing jigsaw puzzles, crossword , suduko, chess , card games learning to dance , playing an instrument, learning a new language challenge the brain.

Regular and enjoyable interaction with friends like travelling , volunteering with a local charity, walking with friends and family, joining a book club, catching up with friends and talking to your neighbours is active networking which is beneficial to the brain. Passive networking such as Whattsapp or Facebook do not give such benefits.

Physical exercise is neuro-protective: Regular physical exercise can reduce the risk of Dementia. It can also slow down further deterioration in those who are showing early symptoms of Dementia. Exercise for 30 mins, walk, jog, cycle,hike,swim or join a dance group….. not gyming !! To avoid risk of fall balance and coordination exercises can help you stay agile. Exercises like Yoga , Pilates, Tai chi go a long way to improve balance and coordination and avoid fall or head injury.

You can also introduce exercise in your daily routine by taking some simple steps. Walk while you are on your mobile phone, take stairs instead of lift. If you have to work for long hours while sitting on a desk, take frequent breaks and walk around or stand up for a couple of minutes.  Some of the offices are providing standing work stations in the place of work and conference rooms. Opt for that option if available , or request for that healthy change in your work place.

The human brain is an organ which improves through mental stimulation. It continues to adapt, grow and rewire itself through the growth of new neurons. Using your non-dominant hand to write, use is to control computer mouse, television remote, brushing your teeth, opening doors etc will strengthen neural connections. Exercise also improves body posture . Walking with a hunch slows down your gait is associated with increase risk of Dementia. There is clear evidence that physical exercise helps in sprouting of neurons to prevent neuro-generative disease like Alzheimer’s.

Healthy Diet: The foods we eat can have a big impact on the structure and health of our brains. Eating a brain-boosting diet can support both short- and long-term brain functions. Indian home cooked diet of Roti ,dal ,legumes vegetables , salads ( washed well) is good for brain health. Red meats, beef , pork and chicken should be limited in your daily intake.  Fish could be included in your diet but make sure it is not bred in toxic waters with high content of mercury. All Vegetables and fruits of different colours like capsicum, green, yellow and red, cabbage , green leafy vegetables , zucchini , cauliflower, kale, carrots , brocolli ( it has glutathione a very powerful antioxidant, which prevents memory decline) and fruits like apples guava, mangoes, pears, grapes bananas etc should be included in our diet regularly.

Antioxidant-rich berries that can boost brain health: Include strawberries, blackberries, blueberries, blackcurrants and mulberries in your diet. Eating more nuts and seeds may be good for the brain, as these foods contain omega-3 fatty acids and antioxidants and healthful unsaturated fats .  Walnuts and Brazil nuts, cashews, almonds and peanuts can give you protection against chronic diseases.
Sunflower seeds,flaxseed and chia seeds also reduces the risk of Alzheimer’s disease. Eggs are a source of  vitamin B-6, vitamin B-12 and folic acid. Recent research suggests that these vitamins may prevent brain shrinkage and delay cognitive decline.

Yoghurt :  Yoghurt contain beneficial bacteria known as probiotics. These bacteria stimulates the Vagus nerve, and that, in turn stimulates the production of various neurotransmitters , which get depleted under stress.

Turmeric: Turmeric is a super spice. It contains Curcumin a natural anti- inflammatory compound and a potent antioxidant. It keeps the memory sharp, boosts the brain and helps it to heal.

Healthy oils: Include healthy oils in your diets such as mustard oil , peanut oil,sunflower oil , soyabean oil, olive oil and a small amount of Ghee. Palm oil is unhealthy and is used mostly in bakery products like cakes, biscuits , sweets etc. Also these processed food have high sugar and salt content which is unhealthy as it promotes obesity , diabetes and high cholesterol which is toxic to brain and body .
Avoid snacking on junk food, sugary drinks, sweets and inculcate this habit in children as it will provide many benefits to them in their mid life and beyond in protecting their brain health.

Sleep Deprivation:
Sleep is absolutely essential for good mental health. Sleep is not a passive but active function of the brain.
In the daytime we all make Beta amyloid proteins in the brain. During sleep the brain cells known as glymphatics enlarge and pulsate to remove toxins from the brain. Due to lack of sleep the brain does not have enough time to drain beta amyloids and other neuro toxic waste . These substances continue to accumulate day after day in form of plaques and tangles in the brain, which is the main cause of Alzheimer’s disease . Harmful effects of inadequate sleep can start at the age of 50 if not earlier. It is essential to have 6-8 hours of sleep. Avoid sleeping pills as it does not give you the deep sleep required for memory consolidation in the permanent memory centres of brain.

Quit Smoking: Smoking or inhaling of tobacco smoke or passive smoking has been linked to oxidative stress. Due to this the risk of Alzheimer’s/ Dementia becomes significantly higher. Brain uses 20% of body oxygen supply from the blood. Smoking damages the structures of blood vessels making it harder for the blood to flow freely around body and brain. Due to this the brain is deprived of oxygen rich blood supply and the brain cells do not get adequate nutrients to survive, thrive and resist damage.

Alcohol in moderation: Long term exposure to excessive alcohol can shrink the brain. It can change a person’s typical behaviour without mental clarity , interfere with his or her long term memory and may cause hallucinations. All these factors can substantially increase the risk of developing Alzheimer’s/ Dementia.

Laughter is the best medicine: Laughter triggers the release of endorphins, the body’s natural feel good chemicals. Endorphins promote overall sense of well-being and de-stress the brain. So how do we bring more laughter in our lives? Practice smiling at someone like your coworkers or someone you meet regularly in the lift or bus. You will notice that smile like laughter is contagious. When you hear laughter move towards it. Spend time with playful friends. Join a laughter club.  Learn to laugh at yourself to make an embarrassing moment funny. Put up a funny poster in your home or office. Choose a computer screen saver which makes you laugh. You may think of countless other ways of humour to improve the brain health. Laughter is also as effective as antipsychotic medications for reducing anxiety in the elderly people with Dementia.

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STUDY ASSERTS BLOOD ENZYME ACTIVITY LEVEL MAY INDICATE WHICH BREAST CANCERS ARE GROWING SLOW

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Patients with metastatic hormone receptor-positive breast cancer who have low activity levels of the enzyme sTK1 in their blood serum at the start of anti-estrogen treatment live longer and go longer without their disease progressing than patients with high levels, according to a recent study by SWOG (the Southwest Oncology Group) Cancer Research Network.

The findings of the study were published in the journal ‘Clinical Cancer Research’. The results suggest that patients with low sTK1 activity levels have a slow-growing disease that can be controlled initially with single-drug endocrine therapy for a prolonged period.

It remains to be determined whether these patients gain further benefit from adding a CDK4/6 inhibitor to their endocrine therapy. The findings come from an analysis of serum samples from 432 women with breast cancer who took part in the S0226 clinical trial, which was conducted by the SWOG Cancer Research Network, a cancer clinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH).

“SWOG researchers have demonstrated that a blood serum test can identify which of these patients have a slow-growing disease that might be controlled with a simple aromatase inhibitor pill alone,” said Dr Lajos Pusztai, MD, DPhil, professor of medicine (medical oncology) at Yale Cancer Center, who is a co-author on the paper.

Study S0226 found that most women with metastatic hormone-receptor-positive breast cancer who have not had previous treatment for their metastatic breast cancer live longer when they get a combination of the endocrine therapy drugs anastrozole and fulvestrant than when they get just anastrozole.

However, not all patients see extra benefit from the combination; some do just as well on a single drug. Having a way to identify which patients would not derive added benefit from the combination could save these patients the additional side effects and extra costs associated with taking two drugs instead of one.

The work was led by Costanza Paoletti, MD, who was then with the University of Michigan Rogel Cancer Center. She and her colleagues measured the level of serum thymidine kinase 1, or sTK1, considered a marker of cellular proliferation, in 1,726 samples taken from S0226 patients before the start of their treatment and at four-time points during treatment.

The samples were evaluated using a commercially available test known as the DiviTum assay, produced by Biovica International of Uppsala, Sweden, which measures levels of the enzymatic activity of sTK1. The researchers found what was considered high levels of the enzyme in samples from 171, or 40 per cent, of the patients.

Patients with high sTK1 levels, either before treatment or at any time during treatment, tended to have a significantly shorter period of time before their disease advanced (progression-free survival time, or PFS). Those with high levels at the start of treatment, or baseline, had a median PFS of only 11.2 months compared to 17.3 months for patients with low levels at baseline.

The high-sTK1 patients also died sooner, on average, than patients with low levels of the biomarker, with median overall survival times of just 30 months versus 58 months.

Importantly, patients with low sTK1 levels did just as well on the single drug anastrozole as on the combination. This means a measurement of pretreatment sTK1 level could potentially be used to determine whether a patient should start treatment with two-drug endocrine therapy (high sTK1) or single-drug endocrine therapy (low sTK1).

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STUDY FINDS PRIMARY CAUSE OF CURRENT OBESITY EPIDEMIC

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A new study has claimed that much of the blame for the current obesity epidemic lies on modern dietary patterns characterised by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates.

These foods cause hormonal responses that fundamentally change our metabolism, driving fat storage, weight gain, and obesity. The findings of the study were published in ‘The American Journal of Clinical Nutrition’.

Statistics from the Centers for Disease Control and Prevention (CDC) show that obesity affects more than 40 per cent of American adults, placing them at higher risk for heart disease, stroke, type 2 diabetes, and certain types of cancer.

The USDA’s Dietary Guidelines for Americans 2020 – 2025 further says that losing weight “requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity.”

This approach to weight management is based on the century-old energy balance model which states that weight gain is caused by consuming more energy than we expend. In today’s world, surrounded by highly palatable, heavily marketed, cheap processed foods, it’s easy for people to eat more calories than they need, an imbalance that is further exacerbated by today’s sedentary lifestyles.

Overeating, coupled with insufficient physical activity, is driving the obesity epidemic. On the other hand, despite decades of public health messaging exhorting people to eat less and exercise more, rates of obesity and obesity-related diseases have steadily risen.

The study points to fundamental flaws in the energy balance model, arguing that an alternate model, the carbohydrate-insulin model, better explains obesity and weight gain. Moreover, the carbohydrate-insulin model points the way to more effective, long-lasting weight management strategies.

According to lead author Dr David Ludwig, Endocrinologist at Boston Children’s Hospital and Professor at Harvard Medical School, the energy balance model doesn’t help us understand the biological causes of weight gain: “During a growth spurt, for instance, adolescents may increase food intake by 1,000 calories a day. But does their overeating cause the growth spurt or does the growth spurt cause the adolescent to get hungry and overeat?”

In contrast to the energy balance model, the carbohydrate-insulin model makes a bold claim: overeating isn’t the main cause of obesity.

Instead, the carbohydrate-insulin model lays much of the blame for the current obesity epidemic on modern dietary patterns characterised by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates.

When we eat highly processed carbohydrates, the body increases insulin secretion and suppresses glucagon secretion. This, in turn, signals fat cells to store more calories, leaving fewer calories available to fuel muscles and other metabolically active tissues.

The brain perceives that the body isn’t getting enough energy, which, in turn, leads to feelings of hunger. In addition, metabolism may slow down in the body’s attempt to conserve fuel. Thus, we tend to remain hungry, even as we continue to gain excess fat.

To understand the obesity epidemic, we need to consider not only how much we’re eating, but also how the foods we eat affect our hormones and metabolism. With its assertion that all calories are alike to the body, the energy balance model misses this critical piece of the puzzle.

While the carbohydrate-insulin model is not new–its origins date to the early 1900s–The American Journal of Clinical Nutrition perspective is the most comprehensive formulation of this model to date, authored by a team of 17 internationally recognised scientists, clinical researchers, and public health experts.

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New research uncovers link between inflammation and pancreatic cancer development

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A new discovery from researchers at The University of Texas MD Anderson Cancer Center has clarified the long-established connection between inflammation and pancreatic cancer development.

The findings of the study were published in the journal ‘Science’. According to the study, pancreatic cells display an adaptive response to repeated inflammatory episodes that initially protects against tissue damage but can promote tumour formation in the presence of mutant KRAS.

The authors demonstrated that mutant KRAS — which is found in roughly 95 per cent of all pancreatic cancers — supports this adaptive response, leading to selective pressure to maintain the cancer-causing mutation.

“We discovered that a single transient inflammatory event induced long-term transcriptomic and epigenetic reprogramming of epithelial cells that cooperated with oncogenic KRAS to promote pancreatic tumours long after the inflammation was resolved,” said corresponding author Andrea Viale, MD, assistant professor of Genomic Medicine.

“In the setting of repeated pancreatitis, KRAS mutations can be acquired early on to limit tissue damage, suggesting the existence of a strong evolutionary pressure to select mutated cells and providing a possible explanation for the nearly universal presence of mutant KRAS in pancreatic cancers,” Viale added.

Inflammation has long been linked to tumour development in several cancer types, but the specific reasons behind this connection were previously unclear.

The research team, led by co-first authors Edoardo Del Poggetto, PhD, postdoctoral fellow, and I-Lin Ho, a graduate student in the Viale Laboratory, sought to study the effect of pancreatitis — a condition of inflammation in the pancreas linked with a higher risk of pancreatic cancer — on pancreatic epithelial cells.

The researchers stimulated transient inflammation in a model system of inducible KRAS-driven pancreatic cancer. Inflammation caused immediate pathological changes in pancreatic cells, but they resolved within one week.

However, activation of KRAS even months following the resolution of inflammation resulted in accelerated tumour formation compared with controls, suggesting that inflammation drives long-term changes in epithelial cells that cooperate with mutant KRAS to promote cancer development.

Deep molecular analysis of epithelial cells following a single inflammatory event demonstrated substantial reprogramming of gene expression and epigenetic regulation that persisted long after recovery of the tissue damage, a process the researchers termed “epithelial memory.”

This cellular reprogramming activated pathways related to cell survival, proliferation and embryonic development, which are similar to pathways active during cancer development. The cellular reprogramming caused by inflammation also facilitated the acquisition of acinar-to-ductal metaplasia (ADM), a reversible process in which pancreatic acinar cells acquire features of ductal cells.

Acinar cells are responsible for producing and secreting digestive enzymes, while ductal cells are responsible for delivering those enzymes to the small intestine. ADM, a process that normally occurs in response to pancreatic damage, is thought to be a pancreatic cancer precursor.

In the context of epithelial memory, repeated inflammatory episodes resulted in the rapid and extensive appearance of ADM with minimal signs of cellular damage, suggesting that cellular reprogramming protects the pancreas against an accumulation of tissue damage. These findings also clarify that ADM is not a cancer precursor state, but rather an adaptive response to inflammation. Previous research has shown that KRAS mutations can induce and stabilise ADM.

Here, the authors demonstrated that induction of mutant KRAS during repeated inflammations resulted in more pronounced ADM and virtually no tissue damage. Thus, the authors predict that cells undergoing inflammation would have a strong positive selection for KRAS mutations or other alterations that stimulate ADM and limit damage accumulations.

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MOTHERS ARE NOW HESITANT TO HAVE ANOTHER BABY DUE TO COVID-19 PANDEMIC

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New study reveals nearly half of New York City mothers who had been trying to have another baby before the coronavirus pandemic began stopped in the first few months of the outbreak.

The findings of the study were published in the journal ‘JAMA Network Open’. Led by researchers at NYU Grossman School of Medicine, the survey of 1,179 mothers in New York City also found that one-third of women who had been thinking about becoming pregnant before the pandemic but had not yet begun trying said they were no longer considering it.

“Our findings show that the initial COVID-19 outbreak appears to have made women think twice about expanding their families and, in some cases, reduce the number of children they ultimately intend to have,” said study lead author and epidemiologist Linda Kahn, PhD, MPH.

“This is yet another example of the potential long-lasting consequences of the pandemic beyond the more obvious health and economic effects,” added Kahn.

Pregnancy becomes riskier and more difficult to achieve as women age, so the delays prompted by the pandemic may lead to increased health risks for both mother and child, as well as the need for costly fertility treatments, she added.

Kahn, an assistant professor in the Departments of Pediatrics and Population Health at NYU Langone Health, noted that all of the women in the study already had at least one child age 3 or younger.

As a result, it is possible that the challenges of caring for a young child during the peak of New York City’s outbreak and subsequent lockdown may have played a role in their hesitancy to have another baby.

Early evidence has already identified a birthrate decline in the United States during the coronavirus pandemic. Recent data showed that the country saw roughly 300,000 fewer births in 2020 than experts had expected based on annual fertility trends, with a particular drop in the last two months of the year, which corresponds with fewer conceptions at the beginning of the outbreak in March.

However, until now, few investigations have explored the root causes behind individual parents’ decisions to delay pregnancy. The new study is the first to examine pregnancy plans among mothers during the first wave of COVID-19 in New York City. For the investigation, the researchers analysed data from an ongoing pregnancy and child health study. In the survey, which collected data beginning in mid-April 2020, the mothers were asked to recall their pregnancy plans before the pandemic as well as whether they were still going forward with their plans at the time of the survey.

Among the findings, the study revealed that fewer than half of mothers who had stopped trying to become pregnant were certain they would resume trying to become pregnant once the pandemic ended, suggesting that they may abandon rather than just delay their plans to expand their families, Kahn said.

In addition, those with higher stress levels and greater financial insecurity were especially likely to postpone or end their plans for an additional child.

According to the study authors, this finding highlights the importance of financial health in parents’ decisions around pregnancy and suggests that additional financial support for families may be needed to address the nation’s ongoing fertility decline, which began in 2008.

“These results emphasise the toll the coronavirus has taken not only on individual parents but perhaps on fertility rates overall,” said study senior author epidemiologist Melanie Jacobson, PhD, MPH.

Jacobson, a research scientist in the Division of Environmental Pediatrics at NYU Langone, cautions that the investigation only included women who were planning to have children and did not account for unplanned pregnancies.

She said the study authors next plan to repeat the survey with the same group of mothers and explore the potential impact of vaccination, an option not available at the time of the survey.

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Research finds breastfeeding is being overtly discouraged by infant formula websites

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Despite public health efforts to support breastfeeding and informed choice, during a news study, an analysis of websites for baby formula manufacturers found that their messages and images discourage breastfeeding while touting the benefits of the formula.

The study, led by researchers at the NYU School of Global Public Health and published in the journal Public Health Nutrition, is the first to compare information and portrayals of breastfeeding with infant formula feeding on manufacturer websites directed at U.S. consumers. “Many factors influence parents’ decision to breastfeed or use formula, including breastfeeding support and work schedules. But we also know that marketing and advertising play a critical role,” said Jennifer Pomeranz, assistant professor of public health policy and management at NYU School of Global Public Health and the study’s lead author. “It is important to understand the messages caregivers are receiving directly from formula companies, whose websites are targeting pregnant women and new parents with marketing claims disguised as feeding advice and support.”

Breastfeeding has many well-documented benefits for infants and mothers. Because breast milk is a complete source of nutrition for babies and can protect them from infections and certain diseases later in life, the U.S. and global health authorities recommend breast milk as the sole source of nutrition during a child’s first six months and encourage continued breastfeeding.

Previous research shows that marketing from formula companies can influence norms and attitudes around infant feeding and may use unsubstantiated health claims to promote formula and diminish confidence in breast milk. To prevent this, the World Health Organization urges countries to ban the marketing of formula to consumers; while the U.S. still allows it, the Surgeon General recommended that infant formula be marketed in a way that does not discourage breastfeeding.

Pomeranz and her colleagues analyzed the websites of three major formula brands that make up 98 per cent of the U.S. market, as well as two organic brands, to compare messages and images about breastfeeding and breast milk with those about infant formula feeding.

The researchers found that substantial messaging on the five formula manufacturers’ websites focused on discouraging breastfeeding. The websites actually contained more messages about breastfeeding or breast milk than formula, but much of the breastfeeding content (40 per cent) focused on challenges, such as having a low supply of breast milk or difficulty latching.

The websites were significantly more likely to mention the benefits of formula (44 per cent)–for instance, statements that formula provides brain and gastrointestinal benefits–than benefits of breastfeeding or breast milk (26 per cent).

Moreover, manufacturers compared formula feeding to breastfeeding, rather than comparing their brands positively to other brands.

Images on the websites also illustrated the benefits of formula–including the ease of feeding, with babies holding their own bottles–while making breastfeeding look difficult and labour intensive.

“Infant formula manufacturers’ repeated communication about breastfeeding problems such as reduced breast milk supply or sore nipples, coupled with images of women holding their breasts to breastfeed, implies that breastfeeding is hard, painful work. These recurring messages may ultimately discourage breastfeeding,” said Pomeranz.

“Even if websites frame their ‘advice’ as providing solutions to the problems identified, it is completely inappropriate for a formula company to disseminate information–let alone negative information–about breastfeeding to new parents and mothers in particular,” added Pomeranz.

The researchers identified other marketing tactics on formula websites, including the use of discounts or coupons, contact information for sales representatives, and claims of health and nutritional benefits of infant formula over breast milk.

“These marketing practices directed towards U.S. consumers would be legally suspect in other countries, many of which follow W.H.O. recommendations and prohibit direct-to-consumer marketing of infant formula,” added Pomeranz.

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