Advancing Infant Nutrition Research

Early in the COVID-19 pandemic, consumers emptied store shelves of toilet paper and hand sanitizer. More than two years later, pandemic-related shortages persist. Recently, the limited availability of infant formula has caused stress for many families and been particularly devastating for those with babies who rely on specialty formulas to meet their medical needs.

Although formula shortages began in 2020, the situation worsened dramatically this February when a major supplier announced a voluntary recall and ceased production at one of its plants. Addressing the practical, logistical, and safety issues associated with such shortages falls outside of NICHD’s purview. However, the recent acute shortage underscores how important infant formula is for the health of children in this country, making this an opportune time to reflect on our institute’s work to advance infant nutrition research.

For medical, personal, societal, and socioeconomic reasons, many parents and caregivers rely partially or wholly on infant formula to keep their child well-fed. Today’s infant formulas offer babies complete nutrition, but they do not precisely replicate human milk.

Human milk is enormously complex, containing hundreds of components that vary from lactating person to person and change over time according to the baby’s needs. It is not just a composite of these components but an active biological system. Feeding a baby human milk offers protection against common childhood infections and may reduce the risk of developing other diseases, including asthma, obesity, and diabetes. One of NICHD’s aspirational goals is to optimize infant survival by synthesizing human milk, capturing all its components and properties, and individualizing it to the characteristics of the infant’s mother.

Strengthening our understanding of human milk biology is essential to advance toward this goal, and NICHD has a long track record of such research. For example, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) project is exploring human milk as a complex biological system and working to untangle the inputs of the lactating parent, the infant, and the environment. NICHD is funding multiple research projects within this space, including work to understand which human milk components contribute to breastfed infants’ lower risk of cardiovascular disease later in life, how variations in the microbial community in milk may affect mastitis, and how fortified human milk may improve the long-term health of preterm infants. 

Learning more about how the dynamic composition of human milk affects child development and future diet-related disease susceptibility is a priority for NIH. The NIH Office of Nutrition Research recently issued a request for information about the role of diet, food environment, and related exposures on the developmental origins of health and diseases. This includes ideas to enhance knowledge of human milk composition, in line with the objectives of the 2020-2030 NIH Strategic Plan for Nutrition Research.

Such research calls attention to the possibility that newly identified biologically active substances in human milk could be added to infant formula to improve child health. Last fall, NICHD co-sponsored a workshop on Bioactive Ingredients in Infant Formula focused on the state-of-the-science of bioactive human milk components and their analogs and the safety implications of their inclusion in infant formula. The workshop identified several areas of research needed to inform regulatory and public health decisions about the use of these ingredients, and NICHD recently issued a notice of special interest to support work to fill these knowledge gaps.

The COVID-19 pandemic has created myriad challenges for us all, from product shortages to the limited ability to meet in person. But it also has highlighted the importance of working toward aspirational goals. The speed with which the COVID-19 vaccines were developed, evaluated, and authorized would not have been possible without more than a decade of prior research into mRNA vaccines. I look forward to what the future holds for progress toward the synthesis of human milk and the pursuit of NICHD’s other aspirational goals.