ocal Code of Pakistan

Government of Pakistan enacted the local

code of Pakistan on 26th October, 2002 called
Protection of Breastfeeding and Young child
Nutrition Ordinance 2002

Subsequently the rules for the

implementation of the local code were issued
on 2nd November, 2009

The local code of Pakistan only allows

scientific and factual communication on to
Healthcare Professionals on the Infant Formula
Products

The scientific and factual communication to

the health workers can be done through a
detailing force, scientific events like Symposia
and RTDs involving Healthcare Professionals
ONLY

- Todays event is in line with the provision of

communicating scientific and factual
Wishingprofessionals
you all a greatwith
learning session today
information to healthcare
the core objective of enhancing the knowledge
Breastfeeding is best for babies

Information for HCPs only

IMPORTANT NOTICE:
The World Health Organization (WHO*) has recommended that pregnant women and new mothers be informed of
the benefits and superiority of breast-feeding in particular the fact that it provides the best nutrition and protect
babies from diarrhea and other illness. Mothers should be given guidance on the preparation for, and maintenance
of lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after
delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since
it will have a negative effect on breastfeeding as well as health of the infants. Similarly, mothers should be warned
of the difficulty of reversing a decision not to breast feed. Before advising a mother to use an infant formula on the
recommendation of a healthcare professional, she should be advised of the social and financial implications of her
decision: for example, if a baby is exclusively bottle-fed, more than one can (450g) per week will be needed, so
the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk is not
only the best nutrition, but also the most economical food for infants. If a decision to use an infant formula is
taken, it is important to give instructions on correct preparation methods, emphasizing that un-boiled water,
unsterilized bottles or incorrect dilution can all lead to illness of the infants. Feeding with a cup and spoon is safer
than bottle feeding.
*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in
Resolution WHA 34.22, May 1981 as well as the Protection of Breast Feeding and child nutrition ordinance 2002
and rules 2009 Pakistan

Role of low lactose & low osmolality

for fast recovery from diarrhea

Breastfeeding is best for babies

Information for HCPs only

Breastfeeding is best for babies

Information for HCPs only

Nestl's Commitment in
Encouraging Breast Feeding
In his "Memorial on the Nutrition of Infants",
printed in 1870, Henri Nestl wrote:
"During the first months, the mother's milk
will always be the most natural nutriment,
and every mother, able to do so, should
herself suckle her children".
More than 140 years later, this principle is still true
and we are more than ever committed to support
& promote breastfeeding.

Breastfeeding is best for babies

Information for HCPs only

Burden of
Diarrheal Diseases

No. of episodes per person per year

Diarrheal diseases remain a public health problem, throughout

the world,
with
approximately
1.5
billion episodes
per but
year1
Mortality
from diarrhea
is progressively
decreasing
5

incidence of diarrhea is still high during the first 2 years of

life2
1955-1979
1980-1989

1990-2000

3
2
1
0
0-5 m

6-11 m

1 year

2 years

Incidences for diarrheal episodes per child per year from three
reviews of prospective studies in developing areas, 1955-2000
1. Kaferstein, F. (2003). Food borne diseases in developing countries: aetiology, epidemiology and
strategies for prevention. International Journal of Environmental Health Research 13, S161-168.
2. Kosek M, Bern C, GuerrantRL.The global burden of diarrhoeal disease, as estimated
from studies published between 1992 and 2000. Bull World Health Organ. 2003; 81(3):

Breastfeeding is best for babies

Information for HCPs only

Mortality Country Fact Sheet

Causes of death in children under-5

UNICEF report;Pneumonia and diarrhoea: Tackling the deadliest diseases for the worlds poorest children

Breastfeeding is best for babies

Information for HCPs only

Incidence of diarrhea in developing

countries
Incidence of diarrhea in developing countries
4.8 episodes per year

Breastfeeding is best for babies

Information for HCPs only

Diarrhea
Stools of decreased consistency and increased volume due
to imbalance of secretion & absorption of water & salts in
the intestine

Loose or watery
stools at least 3
times a day.
Consistency matters
more than frequency.
Frequent passing of
formed stools is not
diarrhea.

Breastfeeding is best for babies

Information for HCPs only

Diarrhea Classification
Based on Duration

Acute Diarrhea

Short in duration (less than 2

weeks)
Intestinal Infections (Viral, Bacterial, Parasitic)

Celiac Disease
Malnutrition
Antibiotic Treatment

Persistent Diarrhea

Cows milk protein

Soy milk protein
Post infectious gastroenteritis
Other food sensitive enteropathies

(2 weeks or more)

Breastfeeding is best for babies

Complications of Diarrhea
Dehydration
Gastrointestinal complications:

Secondary carbohydrate malabsorption

Protein intolerance (Chronic)
Persistent diarrhea (Chronic)

Nutritional complications:

Malnutrition & Stunted growth (Chronic)

Transient lactose
intolerance secondary to
infective diarrhea is common
in developing countries
Gupta R, Gupta S; Indian J Med Sci; 1993 Jan; 47(I):1-7

Information for HCPs only

Breastfeeding is best for babies

Information for HCPs only

Lactose
The natural sugar found in the breast milk

Lactose helps promote:

Healthy gut flora1,2
Better calcium absorption3,4
Softer stools

1- Bullen et al, J Med Microbiol 1977;10:403-413

2- Yoshioka et al, Pediatrics 1983;72:317-321
3 -Ziegler et al, J pediatr garstroenterol Nutr 1983;2:288-294
4 - Abrams et al, Am J Clin Nutr 2002;76:442-446

Breastfeeding is best for babies

Information for HCPs only

Lactose Intolerance
Inability or failure to digest lactose
Caused by enzyme deficiency lactase
Is a clinical syndrome manifested by
abdominal pain, bloating flatulence and
diarrhea.

50 77% of infants and children hospitalized with

acute diarrhea have lactose intolerance*

*Moreira CR Fagundus Neto U Arq Gastroentero 1997; 34:262 - 269

J Pediat 1971 Nov;79(5):760-7

Breastfeeding is best for babies

Information for HCPs only

Vicious Circle of
Acute diarrhea - Diarrhea
mucosal injury - lactose intolerance
Vicious circle may prolong diarrhea recovery

Intestinal mucosal
damage

Acute diarrhea
Infections

Disaccharides
intolerance

Colic

Bacterial
fermentation
Mono-saccharides

Osmotic diarrhea

Increased osmolarity

Swagarty DL Jr, Walling AD, Klein RM, Am Family Phy. 2002 May 1; 65(9):1845-50
Andrade JAB, Moreira C, Fogundes Neto U. J.Pediatr.2000;76(Suppl.2):5119 - 26

Breastfeeding is best for babies

Information for HCPs only

Management of
Lactose intolerance
In children who have acute diarrhea, adequate
nutrition is still possible despite lactase
deficiency or Lactose intolerance
Appropriate management of lactose intolerance
is elimination of lactose from diet...*
Carbohydrate source is of prime importance in
controlling diarrhea during lactose intolerance

Nizami SQ, Bhutta ZA, Molla AM, J Trop Pedi 1996 June; 42(3):133-7

Breastfeeding is best for babies

How are infants with diarrhea

fed in low-income families?
Many families use homemade
feeds:
Diluted infant formula
Diluted cows milk
Rice-based feeds
Nutritionally inadequate

Information for HCPs only

Breastfeeding is best for babies

Criteria for selecting

Right Nutritional
Formula
Suitability
(Carbohydr
ate Source)

Fast
recovery
from
diarrhea

Sustained
growth and
developme
nt

Complete
Nutrition

Right
Nutrition
al
Formula

Price

Information for HCPs only

Breastfeeding is best for babies

Information for HCPs only

Low lactose
Low osmolality
Low out-of-pocket
for faster recovery from diarrhea

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Triple L concept

An adequate answer to an unmet need
Low lactose content to address
transient lactose intolerance
Low osmolality to prevent
acceleration of loose stools
therefore helping faster recovery
of mucosa
Low out-of-pocket to give access
to appropriate nutrition to a much
wider patient population

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Low in

Lactose
LACTOGEN Recover is 25 times lower in
lactose than a standard infant formula
Lower than any currently-available infant
formula

10

Regular IF

LACTOGEN
Recover

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover
Why a Low lactose content?

Lactose Intolerance:

Diarrhea leads to injury of the intestinal mucosa and

destruction of villi
Injured intestinal mucosa produces less of the
enzyme lactase which normally digests lactose
(milk sugar)
High lactose content in the intestine leads to:

gas production due to excessive fermentation

Increase of motility due to lowering PH as a result of high
lactic acid production
loose stools acceleration due increase of osmotic pressure
and therefore worsening of the diarrhea

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover
Why a Low lactose content?
Better weight gain:

Low lactose formula given during the re-feeding period

improved weight gain when compared to a standard,
diluted infant formula*
Infants, who were
hospitalized due
to acute enteritis, had a
positive weight gain when an
undiluted, lactose-reduced
infant formula was given
during the re-feeding period,
compared to a standard,
diluted infant formula

* Woweries J, Dressler F. Re-feeding infants with acute enteritis with a hydrolyzed infant formula. Pdiatr Grenzgeb 1997; 36: 137-144.
Original title (German): Realimentation bei akuter Suglingsenteritis mit Hydrolysatnahrung.

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Low

osmolality
LACTOGEN Recover has a 20% lower osmolality than
a standard infant formula
Its osmolality is 35% lower compared to cows milk,
as lactose is replaced by low & high DE maltodextrin

220
175

Regular IF

LACTOGEN
Recover

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Why a Low

osmolality?
High osmolality:
- Causes excessive movement of water into the intestinal
lumen
- Leading to loose stools and worsening of diarrhea

Low osmolality:
Prevents osmotic diarrhea
Helps to recover faster from diarrhea

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Why a

Low osmolality?
Better weight gain:
A formula with low osmolality leads to better weight gain in
infants with diarrhea and malnutrition*

LACTOGEN Recover: 175

mOsm/kg

Significantly higher weight

gain was obtained after
feeding a low osmolality
lactose-free formula ( 175
mOsm/kg) vs. lactose-free
formula with higher osmolality
(200 mOsm/kg) to
malnourished children with
diarrhea

*Kukuruzovic RH, Brewster DR. Milk formulas in acute gastroenteritis and malnutrition: a randomized trial. J Pediatric Child Health. 2002;
38(6): 571-7.

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Low out-ofpocket

Diarrhea is highly prevalent in low
socioeconomic groups for whom
affordability is a major concern
There is an obvious need for a
nutritionally appropriate yet
affordable solution

Breastfeeding is best for babies

Information for HCPs only

WHO Recommended: ***

Zinc supplements for 10/14 days, depending on the
availability of supplies and national policy, to reduce
the severity of the episode and to reduce the
LACTOGEN
Recover
incidence
of diarrhea
episodesin the following 2 to 3
Additional
months.
With
zinc: benefits
- Known to reduce duration and severity of acute
and
persistent diarrhea**

With nucleotides:
- Known to have trophic effect on intestinal
epithelium
- Contributing to the recovery of the
damaged intestinal mucosa*
For faster recovery from
* Slzov D, Sma P, Richter J, Krs O, Zavadilov J. Stimulation of ileal epithelium
growth and regeneration by dietary nucleotide extracts. Acta
diarrhea
Medica (Hradec Kralove). 2004;47(3):163-6.
**. Dardenne M. Zinc and immune function. Eur J Clin Nutr 2002; 56(S3): S20-S23.
** Patro B, Golicki D, Szajewska H. Meta-analysis: zinc supplementation for acute gastroenteritis in children. Aliment Pharmacol Ther. 2008 Sep
***WHO:
Diarrhea Treatment Guidelines for Clinic-Based Healthcare Workers
15;28(6):713-23.

Breastfeeding is best for babies

Information for HCPs only

LACTOGEN Recover Triple L concept

An adequate answer to an unmet need

Low lactose
Low osmolality
Low out-of-pocket

Feeding
table

For faster recovery from

diarrhea

Breastfeeding is best for babies

Information for HCPs only

IMPORTANT NOTICE
The World Health Organization (WHO*) has recommended that pregnant
women and new mothers be informed of the benefits and superiority of
breast-feeding in particular the fact that it provides the best nutrition and
protect babies from diarrhea and other illness. Mothers should be given
guidance on the preparation for, and maintenance of lactation, with
special emphasis on the importance of a well-balanced diet both during
pregnancy and after delivery. Unnecessary introduction of partial bottlefeeding or other foods and drinks should be discouraged since it will have
a negative effect on breastfeeding as well as health of the infants.
Similarly, mothers should be warned of the difficulty of reversing a
decision not to breast feed. Before advising a mother to use an infant
formula on the recommendation of a healthcare professional, she should
be advised of the social and financial implications of her decision: for
example, if a baby is exclusively bottle-fed, more than one can (450g) per
week will be needed, so the family circumstances and costs should be
kept in mind. Mothers should be reminded that breast milk is not only the
best nutrition, but also the most economical food for infants. If a decision
to use an infant formula is taken, it is important to give instructions on
correct preparation methods, emphasizing that un-boiled water,
unsterilized bottles or incorrect dilution can all lead to illness of the