Influência corporativa na produção científica sobre substitutos do leite materno para crianças de 0 a 18 meses: uma revisão sistemática

Abstract

The World Health Organization recommends exclusive breastfeeding for six months and continued breastfeeding for two years or beyond. However, factors such as perceived insufficient milk production, social pressures, and return to work often lead to discontinuation of breastfeeding and the introduction of infant formula. Marketing strategies of breast-milk substitute (BMS) companies build the claim that their products are essential for consumption, in addition to funding research to influence policies and professional practices. Recognizing and mapping industry influence is crucial to understanding the factors that influence conclusions about the supposed benefits of infant formula and the production of evidence that guides its promotion and use. Objective: To investigate corporate influence on scientific production on BMS for children aged 0 to 18 months. Methods: A systematic review was conducted to answer the following question: "What is the influence of the corporate sector on scientific production on BMS for children aged 0 to 18 months?" Searches were conducted in PubMed, Scopus, Embase, Web of Science, Global Medicus Index, and Google Scholar, following PRISMA guidelines. Duplicate studies were excluded using Rayyan software, and screening was performed by two independent reviewers, with data extraction using a specific form. The results were categorized and summarized in summary tables. Results: The review included 111 studies that evaluated the impact of infant formulas on infant health. They were conducted in 28 countries, 25 of which were multicenter, with a greater concentration in Europe and North America. Most interventions occurred at very early ages: 16.22% shortly after birth, 28.83% in the first two weeks, 15.32% between 15 and 30 days, and 28.83% in infants up to three months of age. Growth was the most frequently investigated outcome, accounting for 40% of the studies. Several components added to formulas to replicate the effects of breast milk were identified, the most common being proteins (31.1%), fatty acids (22.7%), and prebiotics and probiotics (19.3%). Among the studies analyzed, 89.2% presented a conflict of interest linked to industry. The most frequent form of conflict of interest combined industry funding, the participation of authors linked to companies, and formula donation, occurring in 68.69% of the studies. In total, 143 funding sources were recorded, 71.3% from private companies and 21.7% from government agencies. Conclusion: The vast majority of the literature analyzed is characterized by conflicts of interest, which may impact the formulation of SLM guidelines.