GLOBAL – Multiple leading pediatric medical societies have raised concerns about the World Health Organization’s (WHO) new guidelines on the introduction of cow’s milk in the diets of older infants and young children.

The WHO guideline, aimed at providing evidence-based recommendations on complementary feeding for healthy term infants and children between the ages of 6 and 23 months, has come under scrutiny for potentially causing unintended harm.

In a recently published position paper in the Journal of Pediatric Gastroenterology and Nutrition, eleven medical societies questioned the process used to develop the WHO guideline, citing a lack of broader stakeholder involvement and an open consultation process.

The guideline suggested that for infants aged 6–11 months who are fed milk other than breast milk, either milk formula or animal milk can be fed, and for children aged 12–23 months, animal milk should be fed instead of follow-up formulas.

This is a significant shift from previous advice, which recommended that animal milk should not be given as a drink to babies until they are 12 months old due to concerns about its iron content.

The position paper argued that the new guidelines are inappropriate for high-income countries, where caregivers can prepare formulas safely and frequently.

In addition, the societies expressed concern over the potential for excess intake of certain nutrients, such as protein, which could contribute to unhealthy growth trajectories and an increased risk of overweight and obesity.

The paper highlighted the importance of considering the risk of excess protein intake from cow’s milk, especially in settings where obesity and diet-related noncommunicable diseases are significant public health issues.

Furthermore, the paper criticizes the WHO for not considering evidence from cohort studies, which show associations between the amount of cow’s milk consumed and both iron deficiency and higher weight gain in childhood.

The studies reviewed by the WHO largely included infants born in the 1980s and 1990s, who likely had lower exposure to an obesogenic food environment compared to contemporary children.

The societies argued that in populations where overweight and obesity are prevalent, any recommendation to use cow’s milk must take these potential risks into account.

They pointed out that many countries already recommend that cow’s milk should not be used as the main drink before 12 months and should be limited in quantity after 12 months to ensure a balanced and diverse diet.

The WHO’s guideline also acknowledged concerns around formula milk, noting that while formulas have been altered to be as nutritionally similar as possible to breast milk, they lack its immunological properties and all nutrients present in breast milk.

The aggressive marketing of milk formulas and their association with child morbidity and mortality led to the approval of an International Code of Marketing of Breastmilk Substitutes by the World Health Assembly in 1981.

The controversy over the WHO guidelines followed earlier concerns raised by Specialized Nutrition Europe (SNE), which also opposed the recommendation to introduce animal milk before one year of age.

SNE stated that this recommendation contradicts the generally accepted medical advice that cow’s milk should not be introduced as a breast milk substitute before one year.

In summary, the position paper by the pediatric societies outlined the need for a more nuanced approach to complementary feeding guidelines, particularly in high-income settings.

They called for recommendations that consider the risk of excess nutrient intake and the contemporary food environment to prevent potential health issues such as obesity and iron deficiency in infants and young children.

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