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The 23rd Annual Meeting of the Japanese Society for Breastfeeding Research: Returning to Breastfeeding

I wonder how many CRN website readers know that there is an association in Japan that researches breastfeeding. On October 4 and 5, the 23rd Annual Meeting of the Japanese Society for Breastfeeding Research was held in Okayama, with Dr. Yoshitaka Yamauchi, a pediatrician at National Hospital Organization, Okayama Medical Center, presiding as chair. It was attended by not only pediatricians, obstetricians, nurses, midwives, child care professionals, and psychologists, but many others who share an interest in breastfeeding. Altogether, nearly 300 people attended. It was made up of 9 lectures on education and other topics, including the keynote address, one symposium, and 28 presentations, followed by lively discussions, which made for a truly productive conference.

The practice of breastfeeding began to sharply decline more than twenty years ago, and in tandem with this, proponents of breastfeeding, who could be quite fanatical at times, made their voices heard. This situation caused much confusion in society and prompted me to organize a research group that has grown into this academic society. We named it the Japanese Society for Breastfeeding Research because of its focus on breastfeeding and aim of researching the biochemistry and nutritional value of breast milk, the physiological mechanisms of breast milk secretion and sucking behavior in infants, as well as the behavioral and psychological effect of breastfeeding on infants and mothers. One of our objectives is promoting greater knowledge and education about breastfeeding. On the morning of the first day of the meeting, a brush-up course was held for those involved in breastfeeding instruction.

This annual meeting was particularly notable for the lectures given by three presenters from abroad. An old friend of mine, Professor Lars Å Hanson, a world renowned immunologist at Göteborg University, Sweden, lectured on "Breastfeeding and its Role for Host Defense in the Infant", Dr. Jacqueline C. Kent, a physiologist at the University of Western Australia lectured on "Mother's Milk Secretion and Recent Research" and Dr. Chen Chao-Huei, a pediatrician from Taiwan, presented on "Breastfeeding in Taiwan".

Dr. Hanson discovered IgA, the secretory immunoglobin found in the digestive system, respiratory membranes, and particularly in breast milk. He explained that newborns receive bacterial flora from their mothers, which prevent the entry of pathogens to prevent illness and protect the skin and mucous membranes. During the first two days of life, these flora proliferate on the skin over the entire body, in nasal passages, and from the mouth and throat through the gastro-intestinal tract to the anus. In particular, colon bacilli reach 10-100 billion and play an important role not only in preventing infection, but also in digestion and respiration. The fetus receives the IgG immunoglobulin which passes through the placenta from the mother, and after birth, IgA antibodies in breast milk. Two biological mechanisms that prevent infection in infants were discussed in the conference.

As the infant grows and develops, it is protected by the above-mentioned bacterial flora, IgG, and secretory IgA until it becomes able to produce antibodies on its own one year after birth. Breast milk also contains lactoferrin, a protein that reduces the proliferation of bacteria and has an anti-inflammatory effect, as well as various oligosaccharides which attach to the membranes of the respiratory and digestive tracts to prevent the entry of pathogens.

Not only does breastfeeding have the beneficial effect of preventing infection in the above manner, but it also protects the mother by strengthening her immunity and lowering the incidence of cancer.

Anti-secretory factor or AF has recently become another much discussed topic. Induced by cholera toxin in the intestinal tract, it was identified in the 1980s as effective in inhibiting watery diarrhea in cholera patients. Since 2000, AF has also been found to be effective in the treatment of mastitis and is now used in advanced countries.

Furthermore, breastfeeding in advanced countries has been reported to be effective in reducing the incidence of Sudden Infant Death Syndrome (SIDS), acute otitis media, atopic dermatitis, obesity, leukemia, Type I diabetes mellitus, hypertension, and other conditions. Abundant research also indicates that breastfed infants have a higher IQ than bottle-fed infants.

In research on the relationship between breastfeeding and the mother's breast, Dr. Jacqueline Kent reported a correlation between the breast milk volume ingested by the infant and breast capacity, but found that increase in breast capacity had no correlation with breast capacity before pregnancy. While the average volume of breast milk produced does not vary much by country or ethnicity, individual differences are great, ranging from 450cc-1,150cc, with the average about 800cc. Nor is there much variation in breast milk production according to the infant's age in weeks. Volume ingested by the infant does not vary greatly. Nevertheless, wide variation, as much as threefold, in breastfeeding frequency and other patterns of individual breastfeeding behavior was reported. The lipid content in breast milk varies according to the degree of fullness of the breast. As the mammary gland cells which secrete milk become empty, the lipid content increases. Compared with the first stage of breastfeeding, later breast milk also contains high lipid content.

In the 1970s, Dr. Kent's research in the United Kingdom on changes in lipids, pH and other factors in breast milk from the beginning to end of breastfeeding indicated a change in the taste of breast milk. As a result of this research, breastfeeding has come to also play a role in nutrition and food education. The concentration of lipids was found to vary while there was little change in the volume of breast milk secreted and intake. This research seems to indicate that breastfeeding is the basis and starting point of our education in food and nutrition. Breast milk production progresses from watery to creamy, which provides babies with a range of tastes and teaches them to eat moderately, that is, to stop drinking before they are completely full. In the case of baby formula, however, there is a strong tendency for infants to keep drinking until they are full.

Dr. Chen Chao-Huei reported on breast-feeding education in Taiwan which resembled the situation in Japan in the 1960s and 1970s. In the 1980s, breastfeeding had fallen to 20-30%, and infants raised on breast milk alone only accounted for 5.4%. After 2000, however, the movements to promote breastfeeding managed to increase the practice to 54.2% during the one-month period after birth and breast-milk alone feeding to 33.2%.

The ratio of breastfeeding in Japan reported at the conference differed by institution, but it was 80-90% among healthy infants and mothers upon discharge from the hospital and 70-85% after one month. This indicates a remarkable improvement in the past decade.

Along with increased material affluence accompanied by scientific progress in the 20th century, baby formula was considered better than breast milk for infants. This was an unfortunate trend in many advanced countries. In the 21st century, however, is an age of coexistence and collaboration and we are seeing greater value placed on natural products. The practice of breastfeeding one's child epitomizes this shift and will, no doubt, continue to be further valued from now on.

At the children's hospital where I studied in the United States in the 1950s, no one talked about breastfeeding--instead salesmen from baby formula companies could be seen strutting around. But now, the very same hospital has an outpatient breastfeeding clinic.

Today, our society faces a number of growing child-related problems, among them, child abuse, refusal to attend school, and crime. To resolve these problems, we need more than just the resources and the capability required to raise children. We need to return a gentle caring attitude to society by promoting breastfeeding. We have to offer a helping hand to young mothers who are busy raising children by creating a society that makes breastfeeding an enjoyable and rewarding practice.

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