Terminology Used in Research Articles: Are the Risks of Formula Feeding Being Accurately Portrayed?

To the editor:

As the literature about breastfeeding and its relationship with both infant and maternal outcomes grows, we would like to draw attention to the terminology used in journal articles, especially in titles and abstracts. For example, an article published in the first issue of Breastfeeding Medicine in 2017 was titled “Relationship Between Breastfeeding and Early Childhood Obesity: Results of a Prospective Longitudinal Study from Birth to 4 Years.” ¹ The casual reader may easily infer that the title implies a positive association between breastfeeding and childhood obesity. Although the aim stated in the abstract was to study the potential link between breastfeeding in infancy and obesity at age 4, the article's conclusion was that breastfeeding duration for at least 4 months may contribute to a reduced risk of obesity.

The difficulty with terminology is not a new phenomenon. In 2009 an article by Smith et al. ² found that ∼30% of the titles of articles cited in the 2005 American Academy of Pediatrics statement on Breastfeeding and the Use of Human Milk were misleading (e.g., Breastfeeding and Risk of Post Neonatal Death in the United States ³ ) with another two-thirds having “neutral” titles or mentioned the protective effect of breastfeeding rather than the risks of formula feeding. More than 70% of the abstracts made no mention of infant formula or formula feeding.

We would also like to raise the issue of assuming that not breastfeeding (i.e., formula feeding) is the norm for infant feeding by using breastfeeding as the intervention variable. ⁴ Until breastfeeding, especially exclusive breastfeeding, is seen as normative within the research community, it will be difficult to accurately represent the risks of formula feeding to health professionals and the community at large. There are significant differences in outcomes between infants who are breastfed and those who are formula fed. We need to accurately communicate those differences that are clearer when presented using breastfeeding as the biological standard.

We would ask that Breastfeeding Medicine, as the pre-eminent breastfeeding journal, consider the phrasing of all titles and abstracts of articles before publication, and recommend to researchers that when presenting their data, they use “not breastfeeding” or “formula feeding” rather than breastfeeding as the intervention or experimental variable.

We are proud that Breastfeeding Medicine does not carry advertising for infant formula; however, using breastfeeding as the intervention in published studies effectively/tacitly colludes with the formula industry and a culture that takes for granted that breastfeeding should be studied to determine its safety for human infants.