Using formula to feed infants may be convenient but the negative effects may last too long, writes Haky Moon.

Nutrition experts are concerned that parents in Hong Kong have become obsessed with feeding their babies "formula". The experts point out that manufactured formulas are a poor substitute for natural mother's milk.

"One phenomenon unique to Hong Kong is the very aggressive marketing strategy of the infant formula companies," said Sophia Chan Siu-chee, under-secretary for Food and Health.

The frenetic pace of life in the city, abbreviated maternity leaves, the absence of enough breastfeeding facilities have become the foundation for manufacturers to mount a big advertising push. It's been so successful that nutrition experts fear parents wanting to do their best for their kids are being led astray.

In 2013, HK$2.7 billion was spent promoting formula milk. The costs for promoting baby formula were higher that what the Department of Health spent on services for the elderly, women and children, combined. Chan added that extravagantly spurious claims about the health benefits of manufactured baby food have made parents feel as if they are obligated to buy infant formula if they really care about their kids.

The greatest concern goes to soy-based formulas accounting for 20 percent of the infant formula sold in the city. That also includes the ever popular soymilk, which can take up large swaths of shelf space in supermarket aisles.

"When a child is fed a soy-based formula, it is not good. (Soy-based formulas) contain estrogen compounds - female hormones - and plant-based estrogen interferes with the baby's metabolism," said Miles Price, a certified clinical nutritionist and nutrition specialist at a local maternity support company A Mother's Touch.

Price warned that soy formulas should be used only as a last resort for feeding infants.

Price lists three concerns about the ingredients in soy formulas: trypsin inhibitors, phytic acid and phytoestrogen. He says phytoestrogen is the worst, adding that the plant-based compound can really create hormonal disruptions in infants, and can hang on for a lifetime.

"Baby boys don't want too much exposure to estrogen. Soy infant formula provides the hormonal equivalent of three to five birth control pills per day. This has a huge impact and can cause serious developmental problems in puberty," said Price.

Some nutritionists are more reserved, though generally concurring with the objections to feeding children heavy doses of soy.

Phytoestrogen may be equally harmful to female infants as to boys. "Plant-bound proteins are not as available for absorption as animal proteins like casein and whey," said Denise Fair, an accredited dietician. Casein and whey are proteins found in milk but not in soy.

"There is some concern over the phytoestrogens in soy that might cause premature puberty in girls but again there needs to be more study," Fair said.

Advertising hype

Concerns over estrogen are not limited to soy-based formulas. It's found in factory-farmed meat, and in chemicals naturally occurring in the environment. It's even in tap water. The real issue is that constant, excessive feeding of these products can do serious damage.

The first six months of an infant's life have life-long implications, argues Price. As far as he is concerned, there's little doubt that a formula-only diet is bad for kids.

For all that, many Hong Kong people prefer soy milk to cow's milk.

"Many parents will go from breastfeeding to soy formula because they want to stick to their soy (milk) as they likely will drink soy milk as they get older," says Fair.

Organizations like the Weston A Price foundation say that another danger found in soy-based products are trypsin inhibitors, which even in small amounts may "prevent normal growth".

The same non-profit organization says "several important essential enzymes such as tyrosine and trypsin, which are critical during development, are dangerously inhibited by soy, resulting in an assortment of potentially adverse physiological and neurological health effects."

A baby's brain at birth is only a quarter of the size of an adult brain. In its first year, it goes through its fast development, usually reaching 75 percent of normal adult capacity. If breastfeeding isn't available during that time, there's no other alternative than infant formulas.

"Zinc is most important for brain development in newborn babies," said Price. The effect of soy on infants is still a controversial subject that hasn't been settled among researchers. Still, there are no scientific studies to support claims by some manufacturers that infant formula "increases brain development". Experts dismiss the claims as advertising hype and without foundation.

Then there's phytic acid, an organic acid in soybeans. Research reveals that, consumed in large quantities, phytic acid blocks the absorption of minerals like calcium, magnesium, iron and particularly, zinc.

A question of custom

A local study by the Department of Health and the Chinese University of Hong Kong found a significant proportion of babies in this city are being fed unbalanced diets. The reason is that parents have become overly reliant on the second step in the baby food chain - the so-called "growing up" milk formula that follows up on infant formula, in their second year.

The World Health Organization insists this isn't enough, and that breast milk is "the perfect food for newborns".

Still in Hong Kong, the use of infant formula persists. "Formula is introduced almost immediately. We do have a high rate of formula supplementation in hospitals (in Hong Kong)," said Marie Tarrant, deputy head at the School of Nursing at the University of Hong Kong.

Only 2.3 percent of Hong Kong babies are breastfed exclusively until the age of 6 months, according to UNICEF's Baby Friendly Hospital Initiative.

"The breast feeding rate [in Hong Kong] is not too bad, and it's on the increase. But our (Hong Kong) rate, from the fourth to sixth month of exclusive breastfeeding has dropped," says Chan, under-secretary for Food and Health.

Results of the World Breastfeeding Week Annual Survey 2015 released by the UNICEF Baby Friendly Hospital Initiative Hong Kong Association, show that 86 percent of mothers who gave birth in 2014 started breastfeeding immediately after being discharged from hospital. That's up from 84 percent from the year before. But only 27 percent of babies were exclusively breastfed by the age of 4 months, according to Department of Health statistics.

Countries like Norway and Japan have a higher rate of exclusive breastfeeding at 4 months, at 48 percent and 55 percent, respectively. Most mothers in Hong Kong stop breastfeeding before their babies are a month old. That's when it comes time for the mothers to go back to work.

"Beyond their first year, they should start to eat (solid food), instead of drinking milk. But it seems, according to our department survey, that kids in Hong Kong are drinking more formula milk than in other places," said Chan.

Some organic baby food companies are attempting to fill the gap in the market, offering more solid, or paste like, food for babies older than 6 months, and in greater variety. Some have developed organic baby foods made from fruits and meats.

A change of perception

Change might be in the offing, now that the government is bringing in programs aimed at changing public perceptions of breastfeeding and infant formulas.

Alice So, 27, a regional advertising manager at a global media organization, who gave birth to her first child a year ago, believes more Hong Kong mothers are breastfeeding.

"More people are talking about it, to make mothers finally realize it's actually normal to do so, even in public. I wasn't 100 percent comfortable to breastfeed in public back in the days, so I would store my breast milk in bottles in advance."

Even if mothers are aware of the health benefits of breastfeeding, it's easier said than done in Hong Kong where the standard maternity leave is only 10 weeks.

A local study showed that most mothers stop breastfeeding during the first three months after delivery, to go back to work.

This is something the Hong Kong Food and Health Bureau wants to change.

The bureau issued policies to every government department "to give their employees one or two breaks every day for them to go and pump their breast milk, and to provide a private room for nursing mothers, where there is refrigeration for storing breast milk," said Chan.

"We have also sent out over 450 letters to all the big corporations to appeal to all the employers to support their employees in sustaining breastfeeding," said Chan.

In August 2015, the bureau started working with UNICEF to promote breastfeeding on a campaign called "Say Yes to Breastfeeding" as part of the World Breastfeeding Week program.

(China Daily 02/18/2016 page11)