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Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother's own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low- and middle- income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth. Lorsque la mere est dans l'impossibilite d'allaiter, l'Organisation mondiale de la Sante recommande d'opter pour le lait humain provenant de donneuses, tant pour ses proprietes nutritionnelles et biologiques que pour la contribution averee qu'il apporte a la lactation et a l'allaitement quand il est utilise a bon escient. Un nombre croissant de banques de lait humain s'etablissent dans le monde entier, en particulier dans les pays a faible et moyen revenu, afin de faciliter la collecte, le traitement et la distribution de lait humain provenant de donneuses. Cependant, contrairement a d'autres produits medicaux d'origine humaine, il n'existe aucune norme minimale de qualite, de securite et d'ethique en la matiere, et aucun organe de coordination global n'a ete cree pour guider les politiques nationales. Dans le present document, nous evoquons les principaux obstacles a la progression des banques de lait humain, notamment l'absence de definition claire ou de registre de produits; les problemes relatifs a la reglementation, la qualite et la securite; ainsi que les questions ethiques entourant la commercialisation et l'exploitation potentielle des femmes. Jugeant cette progression limitee par le manque de donnees comparables, nous encourageons a mener d'autres recherches dans ce domaine pour combler les lacunes et fournir des orientations fondees sur des preuves. Nous soulignons egalement la necessite d'offrir un soutien optimal aux meres afin qu'elles puissent produire leur propre lait et allaiter autant que possible immediatement apres la naissance. La Organizacion Mundial de la Salud recomienda la leche humana donada tanto por sus ventajosas propiedades nutricionales y biologicas cuando no se dispone de la propia leche materna como por su reconocido apoyo a la lactancia y al amamantamiento cuando se utiliza de manera adecuada. Cada vez se crean mas bancos de leche humana en todo el mundo, sobre todo en los paises de ingresos bajos y medios, para facilitar la recogida, el procesamiento y la distribucion de leche humana donada. Sin embargo, a diferencia de lo que ocurre con otros productos medicos de origen humano, no existen estandares minimos de calidad, seguridad y etica para la leche humana donada ni un organismo mundial de coordinacion que sirva de base a las politicas nacionales. En este documento se exponen los principales problemas que impiden el progreso de los bancos de leche humana, como la falta de definiciones claras o de registros de productos; los problemas relacionados con la regulacion, la calidad y la seguridad; y las preocupaciones eticas sobre la comercializacion y la posible explotacion de las mujeres. Dado que el progreso de los bancos de leche humana se ve limitado por la falta de evidencias comparables, se recomienda seguir investigando en este campo para compensar los vacios de conocimiento y proporcionar una guia asistencial. Asimismo, se destaca la necesidad de apoyar al maximo a las madres para que se provean de su propia leche materna y establezcan la lactancia materna tan pronto y siempre que sea posible despues del nacimiento. [phrase omitted], Introduction The World Health Organization (WHO) recommends donor human milk for low- and very-low-birthweight infants, as well as small and sick newborns who cannot be fed their mother's own milk. [...]

Where a mother's own milk is not available or is insufficient, donor human milk (DHM) processed by a human milk bank (HMB) is the recommended next best alternative. HMBs exist in over 65 countries. However, most countries have yet to establish national policies or programmes that support the provision of DHM. In July 2019, a group of international experts in fields relevant to human milk banking gathered at a meeting organised by the Institute of Biomedical Ethics, University of Zurich, and co‐sponsored by the World Health Organisation. Prompted by the growing interest globally in creating and sustaining HMBs and addressing current safety and ethical concerns and standards, the aims of the meeting were to define knowledge gaps, determine the need for and scope of global guidelines and provide recommendations on steps that need to be taken at the international level. Following wide‐ranging discussions that included the integration of milk banks into health care systems, strategy and policy, quality and safety, the use of DHM and associated ethical considerations, the overall conclusion of the meeting was that in the absence of global recommendations on the implementation, operation and regulation of HMBs, evidence‐based guidance is urgently needed. Key points: Human milk banks (HMBs) exist in over 65 countries. Most countries with HMBs have yet to establish national policies to support the provision of donor human milk.An international group of experts in fields relevant to human milk banking met in 2019 to define knowledge gaps, determine the need and scope of global guidelines and provide recommendations.Evidence‐based guidance is urgently needed. [ABSTRACT FROM AUTHOR]

Nutrient needs are difficult to meet during infancy due to high nutrient requirements and the small quantities of food consumed. Guidelines to support food choice decisions are critical to promoting optimal infant health, growth and development and food pattern modeling can be used to inform guideline development. We employed the Optifood modeling system to determine if unfortified complementary foods could meet 13 nutrient targets for breastfed infants (6–11 months), and to describe food patterns that met, or came as close as possible to meeting targets. We also examined the impacts of eliminating food groups, increasing starchy staple foods or adding sentinel unhealthy foods. We collated a global food list from dietary studies in 37 countries and used this list to develop nutrient values for a set of 35 food subgroups. We analyzed infant dietary intakes from studies in eight countries to inform maximum quantities and frequencies of consumption for these subgroups in weekly food patterns. We found that unfortified foods could meet targets for most infants for 12 nutrients, but not for iron. For the smallest and youngest infants, with the lowest energy intakes, there were additional deficits for minerals. Best‐case food patterns that met targets or came as close as possible to meeting targets included ample amounts of diverse vegetables, diverse plant‐ and animal‐source protein foods, small amounts of whole grain foods and dairy and no refined grains or added fats or sugar. There were nutrient deficits if animal‐source foods or vegetables were eliminated or if unhealthy foods were included. Key messages: When diverse foods are available, affordable and acceptable, unfortified complementary foods can meet most infants' needs for a set of 12 key nutrients, but not for iron.For the smallest infants, there are deficits for calcium, iron, potassium and zinc even in best‐case food patterns.Best‐case food patterns include ample amounts of diverse vegetables, diverse plant‐ and animal‐source protein foods and small amounts of whole grain foods and dairy.These include no refined grains or added fats or sugar.Nutrient deficits arise if animal‐source foods or vegetables are eliminated, or if unhealthy foods are included. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the impact of sociodemographic and behavioral factors and state legislation on breastfeeding initiation (child ever fed breastmilk) and duration. Methods. We used data from a nationally representative study of children aged 6 to 71 months (N = 33 121); we calculated unadjusted and adjusted state estimates for breastfeeding initiation and duration. We used logistic regression models to examine factors associated with never breastfeeding or breastfeeding less than 6 months. We conducted a multilevel analysis of state legislation's role. Results. There were wide state variations in breastfeeding initiation and duration. The western and northwestern states had the highest rates. Covariate adjustment accounted for 25% to 30% of the disparity. Multivariate analysis showed that the adjusted odds of not being breastfed were 2.5- to 5.15-times greater in southern states compared with Oregon (reference). Children in states without breastfeeding legislation had higher odds of not being breastfed. Conclusions. Sociodemographic and maternal factors do not account for most breastfeeding rate variation. The association with breastfeeding legislation should be explored and may reflect cultural norms.

Objective Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations. Based on the 1978 WHO/National Center for Health Statistics (NCHS) growth reference, the World Health Organization has previously indicated that the standard deviation (SD) of Z-scores of these indicators is relatively constant across populations, irrespective of nutritional status. As such, the SD of Z-scores can be used as quality indicators for anthropometric data. In 2006, WHO published new growth standards. Here, we aim to assess whether the SD of height- and weight-based Z-score indicators from the 2006 WHO growth standards can still be used to assess data quality. Methods We examined data on children aged 0-59 months from 51 Demographic and Health Surveys (DHS) in 34 developing countries. We used 2006 growth standards to assign height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), weight-for-height Z-scores (WHZ) and body-mass-index-for-age Z-scores (BMIZ). We also did a stratified analysis by age group. Findings The SD for all four indicators were independent of their respective mean Z-scores across countries. Overall, the 5th and 95th percentiles of the SD were 1.35 and 1.95 for HAZ, 1.17 and 1.46 for WAZ, 1.08 and 1.50 for WHZ and 1.08 and 1.55 for BMIZ. Conclusion Our results concur with the WHO assertion that SD is in a relatively small range for each indicator irrespective of where the Z-score mean lies, and support the use of SD as a quality indicator for anthropometric data. However, the ranges of SDs for all four indicators analysed were consistently wider than those published previously by WHO. Resume Objectif Dans le monde entier, on utilise des indicateurs anthropometriques lies a la taille et au poids pour caracteriser l'etat nutritionnel des populations. En s'appuyant sur les donnees de reference pour la croissance OMS/NCHS (National Center for Health Statistics) de 1978, l'Organisation mondiale de la Sante a dans le passe affirme que l'ecart-type des valeurs de z pour ces indicateurs etait relativement constant parmi les populations, quel que soit leur etat nutritionnel. En tant que tel, l'ecart-type des valeurs de z peut etre utilise comme indicateur de qualite pour les donnees anthropometriques. En 2006, l'OMS a publie de nouvelles normes de croissance. Nous nous sommes attaches dans cette etude a evaluer si les ecarts-types des indicateurs correspondant aux valeurs du z pour les rapports taille/age et poids/age selon les normes de croissance 2006 de l'OMS etaient encore utilisables pour evaluer la qualite des donnees. Methodes Nous avons analyse des donnees concernant des enfants de 0 a 59 mois et tirees de 51 enquetes demographiques et de sante (DHS), menees dans 34 pays en developpement. Nous avons fait appel aux normes de croissance 2006 de l'OMS pour affecter des valeurs du z pour les rapports taille/age, poids/age et poids/taille et pour l'indice de masse corporelle en fonction de l'age. Nous avons egalement realise une analyse stratifiee par tranches d'age. Resultats Les ecarts-types pour les quatre indicateurs se sont reveles independants des moyennes nationales des valeurs du z correspondantes. Globalement, le 5e et le 95e percentiles de l'ecart-type etaient respectivement de 1,35 et de 1,95 pour la valeur du z du rapport taille/age, de 1,17 et de 1,46 pour la valeur du z du rapport poids/age, de 1,08 et de 1,55 pour la valeur du z du rapport poids/taille et de 1,55 pour la valeur du z de l'indice de masse corporelle. Conclusion Nos resultats confortent l'affirmation de l'OMS selon laquelle l'ecart-type serait compris dans une plage relativement etroite pour chaque indicateur, independamment de la zone ou se situe la moyenne du z correspondant, ce qui confirme la pertinence de son utilisation comme indicateur de qualite pour les donnees anthropometriques. Cependant, les plages d'encadrement trouvees pour les ecarts-types des quatre indicateurs anthropometriques sont considerablement plus larges que celles publiees auparavant par l'OMS. Resumen Objetivo Los indicadores antropometricos basados en la talla y el peso son utilizados en todo el mundo para caracterizar el estado nutricional de las poblaciones. Basandose en la referencia de crecimiento OMS/Centro Nacional de Estadisticas Sanitarias (NCHS) de 1978, la Organizacion Mundial de la Salud (OMS) ha senalado anteriormente que la desviacion estandar (DE) de la Z de esos indicadores es relativamente constante entre las poblaciones, con independencia de su estado nutricional. Las DE de los valores Z pueden utilizarse por tanto como indicadores de la calidad de los datos antropometricos. En 2006 la OMS publico sus nuevos patrones de crecimiento. En este trabajo hemos intentado determinar si la DE de los indicadores Z basados en la talla y el peso de los patrones de crecimiento OMS de 2006 se pueden seguir utilizando para evaluar la calidad de los datos. Metodos Examinamos los datos referentes a ninos de 0 a 59 meses de 51 Encuestas de Demografia y Salud (EDS) llevadas a cabo en 34 paIses en desarrollo. Utilizamos los patrones de crecimiento de 2006 para asignar valores Z de la talla para la edad (ZTE), Z del peso para la edad (ZPE), Z del peso para la talla (ZPT) y Z del indice de masa corporal para la edad (ZIMC), y realizamos ademas un analisis estratificado por grupos de edad. Resultados Las DE de los cuatro indicadores fueron independientes de sus respectivas Z medias en todos los paises. Globalmente, los percentiles 5 y 95 de la DE fueron de 1,35 y de 1,95 para la ZTE, 1,17 y 1,46 para la ZPE, 1,08 y 1,50 para la ZPT, y 1,08 y 1,55 para la ZIMC. Conclusion Nuestros resultados corroboran la afirmacion de la OMS de que la DE representa un intervalo relativamente pequeno para cada indicador con independencia de la posicion de la Z media, lo que avala su uso como indicador de la calidad de los datos antropometricos. Sin embargo, los intervalos de las DE de los cuatro indicadores de nuestro analisis fueron siempre mayores que los publicados anteriormente por la OMS. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Nutritional status, especially in children, has been widely and successfully assessed by anthropometric measures in both developing and developed countries. (1) Height and weight are the most commonly used [...]