'Optimising' breastfeeding: what can we learn from evolutionary, comparative and anthropological aspects of lactation?
'Optimising' breastfeeding: what can we learn from evolutionary, comparative and anthropological aspects of lactation?
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DOI：
10.1186/s12916-019-1473-8
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发表时间：
2020-01-09
期刊：
影响因子：
9.3
通讯作者：
Wells, Jonathan C. K.
中科院分区：
文献类型：
--
作者：
Fewtrell, Mary S.;Shukri, Nurul H. Mohd;Wells, Jonathan C. K.
促进母乳喂养是一项重要的公共卫生干预措施，对婴儿和母亲都有好处。即使发病率和持续时间略有增加，也可能产生相当大的经济节省。然而，尽管采取了许多举措，但在大多数情况下，特别是在纯母乳喂养方面，对建议的遵守情况很差。母亲通常向保健专业人员咨询婴儿喂养和行为问题。我们认为，更广泛的考虑哺乳，纳入进化，比较和人类学方面，可以提供新的见解母乳喂养的做法和问题，加强研究，并最终有助于开发新的方法，以改善启动和维护。我们目前关注母乳喂养作为改善健康结果的一项战略，必须与哺乳的演变相结合，将其作为一种在选择压力下的灵活特征，以最大限度地提高生殖健康。对母乳喂养的动态性质缺乏了解可能部分解释了为什么一些妇女不愿意或不能遵循建议。结论我们确定了三个关键的影响卫生专业人员，研究人员和政策制定者。首先，母乳喂养是一个适应过程，在此过程中，与其他哺乳动物一样，变异性允许适应生态环境并反映母亲的表型变异性。由于这些因素在人类内部和人类之间存在差异，因此“一刀切”的方法适用于所有母婴配对的可能性是违反直觉的;灵活性是预期的。从人类学的角度来看，哺乳期是母亲和后代之间由于遗传“利益冲突”而紧张的时期。这可能是常见的母乳喂养“问题”的基础，包括感觉到的牛奶不足和有问题的婴儿哭泣。理解这一点--并采取更灵活、个性化的方法--可能会让我们采取更有创造性的方法来解决这些问题。阐明进化概念可能会加强研究母乳喂养期间母婴信号;在可能的情况下，研究应该是实验性的，以确定因果关系和机制。最后，学习行为的重要性，灵长类动物（特别是人类）哺乳的社会和文化方面可能部分解释了为什么，在文化中母乳喂养已经失去了文化的首要地位，促进从怀孕开始可能是无效的。在这样的环境中，教育儿童和年轻人可能对提高认识和提供学习机会很重要，这对我们这个物种来说可能是必不可少的，就像其他灵长类动物一样。
Background Promoting breastfeeding is an important public health intervention, with benefits for infants and mothers. Even modest increases in prevalence and duration may yield considerable economic savings. However, despite many initiatives, compliance with recommendations is poor in most settings - particularly for exclusive breastfeeding. Mothers commonly consult health professionals for infant feeding and behavioural problems. Main body We argue that broader consideration of lactation, incorporating evolutionary, comparative and anthropological aspects, could provide new insights into breastfeeding practices and problems, enhance research and ultimately help to develop novel approaches to improve initiation and maintenance. Our current focus on breastfeeding as a strategy to improve health outcomes must engage with the evolution of lactation as a flexible trait under selective pressure to maximise reproductive fitness. Poor understanding of the dynamic nature of breastfeeding may partly explain why some women are unwilling or unable to follow recommendations. Conclusions We identify three key implications for health professionals, researchers and policymakers. Firstly, breastfeeding is an adaptive process during which, as in other mammals, variability allows adaptation to ecological circumstances and reflects mothers' phenotypic variability. Since these factors vary within and between humans, the likelihood that a 'one size fits all' approach will be appropriate for all mother-infant dyads is counterintuitive; flexibility is expected. From an anthropological perspective, lactation is a period of tension between mother and offspring due to genetic 'conflicts of interest'. This may underlie common breastfeeding 'problems' including perceived milk insufficiency and problematic infant crying. Understanding this - and adopting a more flexible, individualised approach - may allow a more creative approach to solving these problems. Incorporating evolutionary concepts may enhance research investigating mother-infant signalling during breastfeeding; where possible, studies should be experimental to allow identification of causal effects and mechanisms. Finally, the importance of learned behaviour, social and cultural aspects of primate (especially human) lactation may partly explain why, in cultures where breastfeeding has lost cultural primacy, promotion starting in pregnancy may be ineffective. In such settings, educating children and young adults may be important to raise awareness and provide learning opportunities that may be essential in our species, as in other primates.