Breastfeeding and Ultra-Processed Food

The current buzz words in nutrition studies are “ultra-processed food,” defined as snacks, drinks, ready meals, and many other products created mostly or entirely from substances extracted from foods or derived from food constituents with frequently little, if any, resemblance to natural food. ¹

The end product of this process all too often includes substantial amounts of added salt, saturated fatty acids, sweeteners such as corn syrup and fructose, chemical emulsifiers, chemical flavor enhancers, and additives designed to prolong shelf life. All ingredients that have no intrinsic relationship to the original food product and of minimal or dubious nutritional value. ²

Of most importance, regular consumption of such ultra-processed foods has been increasingly associated with chronic diseases such as obesity, diabetes, hyperlipidemia, cardiovascular disease, and malignancies.^3,4 Thus avoidance or at least minimizing their ingestion, particularly in infancy and childhood, is a nutritional priority.

By the definition of ultra-processed foods, one has to include infant formula and especially “follow-up” and “toddler milks” in this category. ⁵ Given the increasing concern regarding the adverse long-term health effects of consumption of such products, one must ask what should be the proper up-to-date infant nutritional recommendations.

It is clear that the primary goal should be advocacy and support for the feeding of breast milk for at least 1 year and encouraging and supporting such feedings for another year. One can measure the enormity of meeting this challenge when one realizes that the most recent U.S. Breastfeeding Report Card ⁶ data reported, that only 56% of infants are receiving any breast milk at age 6 months and even less, 36%, are still receiving breastmilk at 1 year.

Given this reality, there is also need to address the issue what is the proper nutritional alternative “milk” especially for those infants over 1 year of age who are not receiving any human breastmilk. When one understands that all formulas are ultra-processed food products and that they have not been demonstrated to be nutritionally advantageous compared with the feeding of fresh whole (3–4% fat) cow’s milk Thus it is clear that there is no medical indication for feeding such preparations of “toddler” and like formulas.

Recent published population studies^7–9 have documented that extending the duration of breastfeeding is associated with a decrease, in parallel, of the ingestion of  ultra-processed foods. The data from these studies indicate  that there is an association, but that one cannot attribute a causative relationship, as these studies were clearly not randomized trials of breastfeeding versus not breastfeeding. Thus, the biases of a self-selected breastfeeding population preclude any conclusion as to causative processes. Very likely the mothers who extended the duration of their breastfeeding had a different life style, including dietary and health habits, that resulted in feeding of less ultra-processed foods.

Notwithstanding these methodological limitations, however, the message is clear. Avoiding ultra-processed foods including unnecessary toddler formulas, particularly after age 1, combined with extending the feeding of breastmilk for as long as possible is the best long-term health guarantee.