The World Health Organisation (WHO) and health authorities (Spanish
Association of Paediatrics, Directorate General for Health and Consumer
Protection of the European Commission) recommend exclusive breastfeeding
for the first 6 months of an infant's life and thereafter, maintaining
breastfeeding together with varied complementary feeding until at least
two years of age 1-3.
Given the absence of regular national data collection, the breastfeeding
situation in Spain is difficult to describe. The most recent data are
from the National Health Survey of 2006 and 2012, published by the
National Institute of Statistics (INE), which shows that the rate of
exclusive breastfeeding for 6 months was 24.72% in 2006, observing a
slight increase to 28.53% in 2012 4.
These data reveal how far we are from the internationally proposed
targets, as the Comprehensive Implementation Plan on Infant and Young
Child Nutrition (CIP), whose global target number 5 for 2025 envisages
increasing the rate of exclusive breastfeeding in the first six months
of life to at least 50%5.
The importance of breastfeeding for newborn health is that infants who
are exclusively breastfed have a lower risk of respiratory infections,
otitis media, atopic dermatitis, asthma, sudden death, leukaemia, among
other pathologies, compared to formula-fed infants6-7. In addition,
in the long term, several studies support the protective role of
breastfeeding against the development of childhood obesity, diabetes,
hypertension and metabolic syndrome7-10.
One of the mechanisms associated with the protective role of
breastfeeding is linked to the availability in breast milk of several
hormones that influence body metabolism and development, such as leptin,
ghrelin, adiponectin, resistin and obestatin. Leptin has an anorectic
function, as it activates satiety signals and decreases the sensation of
hunger, and higher levels have been found in breastfed infants 11. Gherlin is a hormone produced by the gastric mucosa, also found in
breast milk, whose function is to increase intake (orexigenic effect).
Adiponectin is a hormone produced by adipose tissue, whose function is
to increase insulin sensitivity and increase fatty acid metabolism, with
higher plasma concentrations found in breastfed infants than in formula
fed infants 12.
It has also been observed that breastfeeding affects fat distribution
and that artificial formula within the first year of life can alter the
normal trajectory of adiposity 13.
In addition to the nutritional benefits of breastfeeding, there are
other protective effects in the area of immunology and neurodevelopment.
Thus, a new life stage has been typified that encompasses the foetal
period and the first 2 years of life, called "The first 1000 days", and
which focuses on feeding habits during this cycle, focusing on the
benefit of breastfeeding over artificial formulas and the most
appropriate approach for the introduction of complementary feeding,
noting that many aspects of long-term health are influenced by these
first 1000 days, including physical growth and metabolic programming.
With respect to the factors that intervene in the duration of exclusive
breastfeeding, it has been shown that problems in the newborn such as
low birth weight, prematurity, birth by caesarean section and multiple
births lead to a shorter duration of breastfeeding; in addition, some
ethnic groups or emigrants see artificial feeding as an external sign of
progress or wealth and therefore shorten this period 14-15.
Also, younger age of mothers, families without a father figure, lower
socioeconomic status, being primigravida and parents with low levels of
education are conditions associated with shorter duration of exclusive
Another variable involved is the length of maternity leave for mothers
in our country, which is shorter in comparison with other European
countries, and it is the return to work that makes it difficult to
continue exclusive breastfeeding16. his problem has been attributed
to the lack of family reconciliation policies in our country, a drawback
that could be overcome with the availability of breastfeeding rooms,
more flexible working hours for breastfeeding mothers, an increase in
the period of maternity leave, as well as the provision of childcare
facilities attached to work.
In tackling many of these barriers, the Maternal and Child Health teams
of the Health Centres play an essential role, which carry out adequate
monitoring of breastfeeding, recording data in clinical records and
entering them in the quality measures; likewise, actions to support and
promote breastfeeding should be developed by the National Health
Therefore, the abandonment of exclusive breastfeeding could be prevented
through good professional counselling as reflected17 in the Clinical
Practice Guideline on breastfeeding of the Ministry of Health of 2017.
Finally, it should be noted that progress in breastfeeding research is a
priority and that it would be desirable for paediatricians, nurses and
midwives to become involved in research in this field, which will have
wide-ranging benefits for maternal and child health.
1.- World Health Organization (WHO). Infant and young child nutrition. Geneva (Switzerland): WHO; 2003. Online: http://whqlibdoc.who.int/publications/2003/924159120X.pdf. [consultado 25/087/2022]
2.- Spanish Association of Paediatrics (AEP). Recommendations on
breastfeeding from the breastfeeding committee of the Spanish
Association of Paediatrics). http://www.aeped.es/sites/ default/files/recomendaciones lm 16-5-2014.pdf [consultado 25/087/2022]
3.- European Commission Directorate-General for Health and Consumer
Protection. Protection, promotion and support of breastfeeding in Europe: a blue print for action. http://www.aeped. es/sites/default/files/6-newblueprintprinter.pdf [consultado 25/087/2022]
4.- Ministry of Health and Consumer Affairs. National Institute of
Statistics. National Health Survey 2012 http://www.ine.es/jaxi/tabla.do?path=/t15/p419/a2011/p06/l0/&file=06153.px&type=pcaxis&L=0. [consultado 25/087/2022]
5.- Comprehensive implementation plan on maternal, infant and young child
nutrition. World Health Organization. WHO/NMH/NHD/14.1.
6.- Morales E, García-Esteban R, Guxens M, et al. Effects of prolonged breastfeeding and colostrum fatty acids on allergic manifestations and infections in infancy. Clinical & Experimental Allergy. 2012; 42: 918-928.
7.- Section of breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics 2012; 129: e827.
8.- Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci. 2013; 1281(1): 123-140.
9.- de Armas MGG, Megías SM, Modino SC, Bolaños PI, Guardiola PD, Álvarez TM. Importancia de la lactancia materna en la prevalencia de síndrome metabólico y en el grado de obesidad infantil. Endocrinol y Nutr. 2009;56(8):400-3.
10.- Rak K, Kornafel D, Bronkowska M. Longer Breastfeeding in Infancy Decreases Systolic Hypertension Risk in Young Adults. Polish J Food Nutr Sci. 2016; 66(3): 221-226.
11.- Kontula K, Oksanen L, Koivisto VA, Koistinen HA, Andersson S, Teramo KA, et al. Leptin Concentration in Cord Blood Correlates with Intrauterine Growth*. J Clin Endocrinol Metab. 1997; 82(10): 3328-3330.
12.- Martin LJ, Woo JG, Geraghty SR, Altaye M, Davidson BS, Banach W, et al. Adiponectin is present in human milk and is associated with maternal factors. Am J Clin Nutr. 2006; 83(5): 1106-1111.
13.- Gale C, Parkinson JRC, Logan KM, Hyde MJ, Santhakumaran S, Modi N. Effect of breastfeeding compared with formula feeding on infant body composition: a systematic review and meta-analysis. Am J Clin Nutr. 2012; 95(3): 656-669.
14.- Li R, Fein SB, Chen J, et al. Why mothers stop breastfeeding: mothers' selfreported reasons for stopping during the first year. Pediatrics. 2008; 122: S69.
15.- Hernández Aguilar MT, Lasarte Velilla JJ, Muñoz Guillén A,Díaz Marijuan C, Martín Calama J. Epidemiología de la Latancia Materna. Análisis de 6000 lactantes en la Comunidad Valenciana. Rev Pediatr Aten Primaria. 2004; 21: 19-37.
16.- Oribe M, Lertxundia A, Basterrecheaa M, Begiristaina H, Marina L, Villara M, Dorronsoroa M, Amiano P, Ibarluzea J. Prevalencia y factores asociados con la duración de la lactancia materna exclusiva durante los 6 primeros meses en la cohorte INMA de Guipúzcoa. Gac Sanit. 2015; 29(1): 4-9.
17.- Grupo de trabajo de la Guía de Práctica Clínica sobre lactancia materna. Guía de Práctica Clínica sobre lactancia materna. Ministerio de Sanidad, Servicios Sociales e Igualdad; Agencia de Evaluación de Tecnologías Sanitarias del País Vasco-OSTEBA, 2017. Guías de Práctica Clínica en el SNS.
Dr. Elena Martínez Cuevas
Centro de Salud "Gamonal Antigua"
Avda. Derechos Humanos 1,