AMA COMPUTER COLLEGE CAVITE

RESEARCH INVESTIGATORY

The Effect of Consumption of Animal Milk Compared to Infant

Formula for Non-Breastfed/Mixed-Fed Infants 6–11 Months of Age

SUBMITTED BY: ANNE SHEREEN CAMAÑAG

GRADE 12/ RSCH2300-2/ STEM

SUBMITTED TO: Al Gumela

WORK IMMERSION TEACHER

MAY 2022

ABSTRACT

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 Many babies do not receive breastmilk for the whole two years recommended. Alternative milk
beverages, such as infant formula and raw animal milk products, are frequently used instead. The goal of this
systematic review was to describe the effects of animal milk consumption on health outcomes in non-breastfed
or mixed-fed infants aged 6–11 months when compared to baby formula. We conducted the review using
different databases and following Cochrane standards. Anemia, gastrointestinal blood loss, weight-for-age,
length-forage, and weight-for-length were the major outcomes. Four randomized controlled trials (RCTs) and
five cohort studies were included in the study.

Except for one, all of the research were conducted in high-income nations. Cow's milk increased the
incidence of anemia (RR: 2.26, 95 percent CI: 1.15, 4.43, RCTs: RR: 4.03, 95 percent CI: 1.68, 9.65) and
gastrointestinal blood loss compared to formula milk (poor certainty of evidence) (Cohort study RR: 1.52, 95
percent CI: 0.73, 3.16, RCTs: RR: 3.14, 95 percent CI: 0.98, 10.04). Furthermore, there was only a slim chance
that animal milk consumption had a different influence on weight and length-for-age than formula milk.
Overall, the evidence was suspect, and no firm conclusions could be formed from it. More research from low-
and middle-income countries is needed to determine the best milk type for non-breastfed infants aged 6–11
months.

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 ACKNOWLEDGEMENT

First and foremost, praises and thanks to the God, the Almighty, for His showers of blessings throughout
my research work to complete the research successfully

I would like to express my gratitude to my work immersion teacher, Al Gumela , who guided me
throughout this project. I would also like to thank my friends and family who supported me and offered deep
insight into the study.

Nobody has been more important to me in the pursuit of this project than the members of my family. I
would like to thank my family, whose love and guidance are with me in whatever I pursue. They are the
ultimate role models.

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 TABLE OF CONTENTS
Title Page………………………………………………………………………………………………….…...I

Abstract………………………………………………………………………………………….………….…II

Acknowledgement…………………………………………………………………………………….….…...III

Table of Content…………………………………………………………………………………….………...IV

Introduction………………………………………………………………………………………………….…1

Methodology………………………………………………………………………………….…………….….3

Results and Discussion…………………………………………………………………………………….…...4

Conclusion……………………………………………………………………………………………….….….6

Recommendation…………………………………………………………………………………….…………7

Bibliography……………………………………………………………………………………………………8

Appendix…………………………………………………………………………………………………….…9

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 INTRODUCTION

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) advocate

exclusive breastfeeding for the first six months of life, with nursing continued for up to two years or beyond

[1,2]. Complementary feeding should begin at six months of age. Many infants, however, may not receive

breastmilk exclusively until they are 6 months old, or breastfeeding may be discontinued before the

recommended 2-year period [3]. According to the Lancet Breastfeeding series, 37% of children aged 6–24

months do not receive breast milk, with percentages ranging from 18% in low-income countries to 34% in

lower-middle-income countries to 55 percent in upper-middle-income countries [4]. Alternative milk beverages,

such as infant formula and raw animal milk products, are frequently used instead [3–5]. Cow's milk has a

greater protein content (0.9–1.2 g/100 mL). [6] Human milk has lower lactose levels (7.0 g/100 mL vs. 4.1

g/100 mL in cow's milk) and higher protein levels (1.8–2.0 in cow's milk). Human milk also contains more iron

than cow's milk (70 mg/100 mL vs. 0.07 mg/100 mL) [6]. Cow's milk consumption in infancy has been linked

to gastrointestinal blood loss, iron deficiency anemia, and higher solute load on the kidneys due to variations

between human and cow's milk [3,7–9]. Despite these risks, opinions on the safety of providing cow's milk to

children aged 6 to 12 months are divided.

The WHO's Feeding Non-Breastfed Children guiding principles According to 6–24 Months of Age,

feeding animal milk and adequate supplemental foods is a safe choice because iron deficiency caused by

gastrointestinal blood loss resolves by the age of 12 months [3,9]. Furthermore, heat-treated milk does not have

the same effects, and iron insufficiency can be avoided by taking iron supplements or eating meals with enough

iron bioavailability [3,9]. In contrast, the Dietary Guidelines for Americans (2020) advise that newborns should

not drink cow's milk as their major milk drink until they are 12 months old [10]. Infant formula has traditionally

been made from cow's milk, but it has been modified to resemble human breast milk [6].

Over the last 20 years, innovations to infant formula have been made that may increase its benefits over

cow's milk, such as the addition of oligosaccharides, lactoferrin, and Osteopontin, as well as various other

micronutrients and functionally active chemicals [6]. Nondigestible carbohydrates present in human milk,

oligosaccharides, defend against viruses and bacteria [6]. Lactoferrin is a protein that binds iron and sialic acid,
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both of which are required for growth and development [6]. The protein Osteopontin is required for bone

formation [6]. With these and other advances in formula in recent years, the goal of this study was to compile

the most recent studies on the effects of animal milk consumption versus infant formula in non-breastfed or

mixed breastfed infants aged 6–11 months.

Is the ingestion of animal milk, as opposed to infant formula, connected with favorable or harmful health

and development results for non-breastfed or mixed-fed (breastmilk and formula) infants aged 6–11 months?

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 METHODOLOGY

The student made extensive use of the internet in selecting and researching the topic for this

investigational project. The student researched the issue on the internet, focusing on Google Scholar. She started

with an interesting topic about illicit mining, but it was too tough to use, so she switched to a theme concerning

student career goals. The student was dissatisfied with the topic, so she continued to devote her complete time

and resources to finding a suitable topic that would benefit not only her own interests, but also individuals or

parents at this time. Many individuals will benefit from this; therefore, the researcher has chosen the topic

about The Effect of Consumption of Animal Milk Compared to Infant Formula for Non-Breastfed. When the

student went to his cousin's house and saw that his cousin's baby was drinking breastmilk, she wondered what

would happen if a newborn drank animal milk. This prompted the researcher to conduct an internet search for

an article on the effects of animal milk on infants, which she eventually discovered. “The Effect of

Consumption of Animal Milk Compared to Infant Formula for Non-Breastfed/Mixed-Fed Infants 6–11 Months

of Age”

The student was very conscientious about the topic she chose. She attentively examined it,

comprehended it, and attempted to understand it. She ensures that the article's publisher receives adequate

credit.

The student then applied what she had studied and comprehended in the essay to her research

assignment. She did her best to appropriately understand the article's data and results, and she double-checked

everything to make sure it was accurate.

The student followed the format suggested by the investigatory adviser. The researcher double-checks

that all of the margins, paragraphs, and steps she creates are included in the required format.

Before handing the report over to their immersion adviser, the student double-checked that everything in

his investigative project was correct and complete.

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 RESULTS AND DISCUSSION

Overall, the number of included studies in each analysis was small. As a result, most of the outcomes

received a certainty of evidence rating as low or very low. We downgraded the certainty of evidence for most of

the outcomes for indirectness because all but one of the included studies were conducted in high-income

countries and may not represent low- and middle-income populations. For instance, the risk of anemia might be

higher in low- and middle-income countries where the use of animal milk is higher in infants, and there is an

increased incidence of diarrhea illness leading to less oral intake and increase losses from the gastrointestinal

tract. Two observational cohort studies did not adjust for confounding variables and were rated at high risk of

bias. One of the RCTs was at high risk of bias due to inadequate methods of randomization. We downgraded the

certainty ratings for the risk of bias where applicable. We followed the standard guidelines of the Cochrane

Collaboration to conduct this review. We adopted a broad search strategy, used multiple databases, and

examined 4340 titles and abstracts, including published and ongoing studies. We performed our analysis

according to an a priori plan, and the protocol was published in a peer-reviewed journal. We analyzed the data

separately for randomized controlled trials and cohort studies. Most of the analyses from observational cohort

studies mirrored the evidence from randomized controlled trials, suggesting a true increased risk of anemia with

use of cow’s milk in non-breastfed infants greater than six months of age. Some of the included did not provide

the data needed for meta-analysis. We adopted the standardized methods to use data from other published

studies in case of missing data such as standard deviations for continuous outcomes. Some studies had more

than two study groups and we combined certain groups to avoid double counting of the control group. We were

transparent about any decisions made related to missing data and data analysis to the best of our knowledge; no

prior study has attempted a meta-analysis for the use of animal milk vs. formula milk in infants 6–11 months.

One review published in 2015 included children up to 3 years of age and similarly reported an increased risk of

iron deficiency anemia with the use of cow’s milk compared to follow-on formula [30]. The pooled results from

this review showed a three times higher risk of iron deficiency anemia for infants consuming cow’s milk
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compared with those drinking follow-on formula with a relative risk of 3.3. In these four studies 25–38% of

infants consuming cow’s milk developed IDA compared with 2–15% of those fed with iron fortified formula.

This study was less restrictive in age of initiation of milk feeding and followed infants until 3 years of age.

Similarly, they found the quality of evidence to be low. Additionally, they were unable to draw conclusions

about infant growth between cow’s milk and infant formula as in our study. Recent guidelines for healthy

American infants recommend avoiding the use of cow’s milk in infants less than 12 months of age, based on a

qualitative synthesis of the evidence. Our review added to the literature the qualitative and quantitative synthesis

of the data for use of animal milk during 6–11 months of age. Use of cow’s milk compared to formula milk in

infants 6–11 months of age in no breastfed/mixed-fed infants seems to increase the risk of anemia. However, it

is important to note that all the included studies in this review were conducted in high-income countries except

for one conducted in Peru, an upper-middle-income country. Thus, the generalization of these results to low-

and middle-income settings should be considered with caution. Furthermore, a standardized infant formula may

not be readily available in low- and middle-income countries and might be expensive compared to cow’s milk.

Other strategies to mitigate the anemia in this age group, such as fortified complementary foods should be

studied further in non-breastfed infants. Most of the studies included in this review were relatively old, and there

was a paucity of data from the last two decades. Moreover, only one study was from an upper-middle-income

country, and there was a paucity of data from low and middle-income countries. Future research might be

warranted to examine the effect of animal milk in low- and middle-income countries and to assess if there is a

difference in the type of animal milk and the age when animal milk is first introduced. Furthermore, future

studies are needed to assess if the risk of anemia with cow’s milk could be reduced with the fortification of

cow’s milk and complementary feeding with iron. Furthermore, future studies should assess the risk of anemia

when the cow’s milk is pasteurized, heated, or diluted.

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 CONCLUSION

Cow's milk, rather than formula, appears to increase the risk of anemia and anemia indices, such as iron

deficiency anemia and decreased blood hemoglobin and ferritin, among infants aged 6–11 months. Based on

low certainty of evidence, there was no difference in weight or length between cow's milk and newborn formula.

There was insufficient evidence on the outcome of neurodevelopment and unpleasant effects such diarrhea and

constipation, therefore no firm conclusions could be reached. The majority of the research available were

conducted in high-income nations, and future studies from low- and middle-income countries are needed to

determine the best milk type for non-breastfed/mixed-fed infants aged 6–11 months. of age.

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 RECOMMENDATION

Breast milk should be fed to your infant for at least the first 6 months of life, according to the creator of

this research investigational effort. During the first 12 months of life, you should only feed your baby breast

milk or iron-fortified formula, not cow's milk.

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BIBLIOGRAPHY

Julie M. Ehrlich 1, Joseph Catania 1, Muizz Zaman 1, Emily Tanner Smith 2, Abigail Smith 3, Olivia Tsistinas

3, Zulfiqar Ahmed Bhutta 4 and Aamer Imdad (23 January 2022) The Effect of Consumption of Animal Milk

Compared to Infant Formula for Non-Breastfed/Mixed-Fed Infants 6–11 Months of Age: A Systematic Review

and Meta-Analysis

https://www.mdpi.com/2072-6643/14/3/488/pdf?version=1643029389

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APPENDIX

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