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Controversial study does nothing to detract from the many benefits of breastfeeding

If you've been living under a rock for the last month, you may have missed the news: The breast-versus-formula debate is finally over. The benefits of breastfeeding have been widely overstated, according to new U.S. research.

The news continues to generate a massive response and has elicited more than a few "I told you so" remarks from parents.

But it might be a good idea to temper the excitement. The new study didn't prove unequivocally that formula-feeding is on par with breastfeeding in terms of health and well-being of infants. And in fact, it did nothing to detract from the benefits of breastfeeding.

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First, the facts. Last month, the results of a large study that looked at more than 8,000 U.S. children between ages four and 14 was published in the journal Social Science and Medicine. The researchers compared formula-fed to breastfed children, including siblings that had been fed the same way and those that had been fed differently. They conducted follow-up interviews with families and looked at a variety of measures, including body mass index, math skills, reading comprehension, asthma, hyperactivity, obesity and scholastic competence.

The researchers concluded that breastfeeding was "no more beneficial than bottlefeeding for 10 of 11 long-term health and well-being outcomes" in children, according to a press release from Ohio State University, where lead study author and sociology professor Cynthia Cohen is based. That conclusion is based on the fact that when they looked at groups of siblings that had been fed differently (i.e. one breastfed, one formula-fed), there were no statistically significant differences in the health and well-being measures. The researchers also concluded that breastfeeding actually seemed linked to higher rates of asthma in breastfed infants.

The researchers went on to highlight the fact that breastfed infants tend to come from families with higher education and income and that those socioeconomic factors promote health and well-being, not how the infants are fed. Instead of fixating on the feeding debate, Cohen suggested focusing on access to daycare, housing quality and parental employment.

But Toronto pediatrician Daniel Flanders wrote a response to the study that highlights some important facts that were glossed over.

Numerous large-scale studies in the past have found very strong connections between breastfeeding and reduced respiratory-tract infections, sudden infant death syndrome (SIDS), cardiovascular disease and stress and depression, Flanders noted in his piece. Meanwhile, formula-feeding has been shown to increase the risk of lower respiratory and gastrointestinal infections, SIDS, schizophrenia and even alcoholism.

What's interesting, Flanders said, is that the study authors chose to focus on only three factors within the health and well-being spectrum, factors for which the benefits of breastfeeding are currently inconclusive: obesity, asthma and neurocognitive development.

"It's almost as if the authors were rooting for a negative outcome," he wrote.

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Furthermore, breastfeeding has also been shown to benefit mothers on numerous outcomes, including reduced risk for ovarian and breast cancer.

He also pointed out that the study made a connection between breastfeeding and asthma. But children with asthma are genetically predisposed to getting it. Breastfeeding didn't cause them to get asthma – their genetic history put them at risk, Flanders said.

And despite what the authors wrote, the data presented does show that breastfed infants actually did better than formula-fed infants on every outcome, with the exception of asthma, according to a response posted on Britain's National Health Service Choices website. Among the siblings who were fed differently, however, the study sample was too small to make those differences statistically significant. Flanders pointed out that a larger sample size might have found a statistically significant difference.

One thing the experts do agree on: Women should not feel judged or stigmatized, no matter what feeding style they choose. As Flanders put it, breastfeeding is clearly beneficial from a public-health standpoint. But for individual mothers, the choice should reflect what is best for them and their babies.

"I think a lot of the controversy stems out of individual moms being made to feel horribly, no matter what they choose or no matter how they do it," Flanders said. "It's disappointing to see that's what it's come to."

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