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Haszard JJ, Heath ALM, Taylor RW, Bruckner B, Katiforis I, McLean NH, Cox AM, Brown KJ, Casale M, Jupiterwala R, Diana A, Beck KL, Conlon CA, von Hurst PR, Daniels L. Equations to estimate human milk intake in infants aged 7 to 10 months: prediction models from a cross-sectional study. Am J Clin Nutr 2024; 120:102-110. [PMID: 38890036 DOI: 10.1016/j.ajcnut.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Obtaining valid estimates of nutrient intake in infants is currently limited by the difficulties of accurately measuring human milk intake. Current methods are either unsuitable for large-scale studies (i.e., the gold standard dose-to-mother stable isotope technique) or use set amounts, regardless of known variability in individual intake. OBJECTIVES This cross-sectional study aimed to develop equations to predict human milk intake using simple measures and to carry out external validation of existing methods against the gold standard technique. METHODS Data on human milk intake were obtained using the dose-to-mother stable isotope technique in 157 infants aged 7-10 mo and their mothers. Predictive equations were developed using questionnaire and anthropometric data (Model 1) and additional dietary data (Model 2) using lasso regression. Bland-Altman plots and intraclass correlation coefficients (ICC) also assessed the validity of existing methods (FITS and ALSPAC studies). RESULTS The strongest univariate predictors of human milk intake in infants of 8.3 mo on average (46% female) were infant age, infant body mass index (BMI), number of breastfeeds a day, infant formula consumption, and energy from complementary food intake. Mean [95% confidence interval (CI)] differences in predicted versus measured human milk intake [mean (SD): 762 (257) mL/day] were 0.0 mL/day (-26, 26) for Model 1 (ICC 0.74) and 0.5 mL/day (-21, 22) for Model 2 (ICC 0.83). Corresponding differences were -197 mL/day (-233, -161; ICC 0.32) and -175 mL/day (-216, -134; ICC 0.41) for the methods used by FITS and ALSPAC, respectively. CONCLUSIONS The Human Milk Intake Level Calculation provides substantial improvements on existing methods to estimate human milk intake in infants aged 7-10 mo, while utilizing data commonly collected in nutrition surveys. Although further validation in an external sample is recommended, these equations can be used to estimate human milk intake at this age with some confidence. This clinical trial was registered at http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436) as ACTRN12620000459921.
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Affiliation(s)
| | | | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Bailey Bruckner
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Ioanna Katiforis
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Neve H McLean
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Alice M Cox
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kimberley J Brown
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Maria Casale
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Rosario Jupiterwala
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Aly Diana
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Pamela R von Hurst
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin, New Zealand.
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Winichagoon P, Pongcharoen T, Fadjarwati T, Winarno E, Karim NA, Purevsuren E, Ahmad T, Yameen A, Hettiarachchi M, Judprasong K, Tran Thuy N, Vu Thi Thu H, Islam M, Slater C, Thomas T, Murphy-Alford AJ. Discordance in exclusive breastfeeding between maternal recall and deuterium dose-to-mother technique during the first 6 months of infants: A multi-country study in Asia. Eur J Clin Nutr 2024; 78:135-140. [PMID: 37838807 DOI: 10.1038/s41430-023-01353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/18/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE This study aimed to assess the agreement in EBF between maternal recall and the dose-to-mother (DTM) technique. METHODS Indonesia, Malaysia, Mongolia, Pakistan, Sri Lanka, Thailand, and Vietnam participated in the study. A total of 207 and 118 mother-infant pairs were assessed at 3 and 6 months of child's age. Using a standardized questionnaire, mothers were asked to recall child feeding during the previous 24 h, at 3 and 6 months. Those recalled to be EBF proceeded to be assessed using DTM technique. Non-milk oral intake (NMOI) cutoff of 86.6 g/d was used to classify EBF. RESULTS According to DTM, 66% of infants were EBF at 3 months, while only 22% were EBF at 6 months. At 3 months, the overall % agreement between maternal recall and DTM method was 68%, kappa 0.06 (95% CI: 0.07-0.20), and at 6 months, the % agreement was only 21%, kappa -0.031 (95% CI -0.168 to 0.107). Human milk intakes were similar at 3 months and 6 months when expressed as g/d, but decreased when expressed as g/kg/d, with a large variation within and between countries; Pakistan being the lowest. CONCLUSION This study showed there were declining levels of EBF from 3 to 6 months in the participating countries from Asia and the agreement between maternal recall and DTM technique to classify EBF was low. To ensure that the DTM technique can be more widely used in evaluating breastfeeding promotion programs, consensus on the appropriate NMOI cutoff and simplification of the DTM protocol is necessary.
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Affiliation(s)
- Pattanee Winichagoon
- Food and Nutrition Acedemic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand.
| | - Tippawan Pongcharoen
- Food and Nutrition Acedemic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand
| | - Tetra Fadjarwati
- Centre for Health Services Policy, Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Ermin Winarno
- Research Center for Radiation Process Technology, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - Norima A Karim
- Nutrition Science, School of Healthcare Sciences, Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | - Enkhzul Purevsuren
- National Center for Maternal and Child Health (NCMCH), Ulaanbaatar, Mongolia
| | - Tanvir Ahmad
- Pakistan Institute of Nuclear Science and Technology, Pakistan Atomic Energy Commission, Isalambad, Pakistan
| | - Ayesha Yameen
- Pakistan Institute of Nuclear Science and Technology, Pakistan Atomic Energy Commission, Isalambad, Pakistan
| | | | - Kunchit Judprasong
- Food and Nutrition Acedemic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand
| | - Nga Tran Thuy
- Department of Micronutrient Research and Application, National Institute of Nutrition, Hanoi, Vietnam
| | - Hien Vu Thi Thu
- Department of Micronutrient Research and Application, National Institute of Nutrition, Hanoi, Vietnam
| | - Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Christine Slater
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Tinku Thomas
- Division of Epidemiology and Biostatistics, St. John's Research Institute, Bangalore, India
| | - Alexia J Murphy-Alford
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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Whyte S, McLean-Smith J, Reid M. Concordance of the Deuterium Dose to Mother Method and 24-Hour Recall to Measure Exclusive Breastfeeding at 6 Weeks Postnatally in Rural/Urban Setting in Jamaica. Matern Child Health J 2022; 26:2126-2136. [PMID: 35960420 DOI: 10.1007/s10995-022-03465-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The 2030 health agenda for the United Nations Sustainable Development Goals promote exclusive breastfeeding (EBF) for the first 6 months of life as a central step towards ensuring the survival of infants. As Jamaica attempts to achieve this goal, monitoring the rates of EBF is desirable. Currently, EBF rate is measured by questionnaires which are subject to recall and social desirability biases. We determined the rate of EBF using the Deuterium-oxide dose-to-mother (DTM) method and 24-h recall. The concordance of both methods and urban-rural differences of EBF were evaluated. Additionally, the growth of infants who were exclusively breastfed was compared to the infants who were mixed-fed. METHODS Sixty-one healthy mother-child pairs were followed from birth. EBF was measured at 6 weeks. Growth was determined using standard anthropometric measurements. Differences in means were assessed by independent t-test or ANOVA. The agreement between the DTM and 24-h recall method was assessed with the kappa statistic. Differences in anthropometry and location were determined using a repeated measure model approach. RESULTS Thirty (49%) women exclusively breastfed their infants with mean breast milk intake of 1024.3 ± 256.9 g/day. There was moderate agreement between the methods (Agreement 69%, kappa 0.37, p = 0.002). Rural women (65%) were more likely to practice exclusive breastfeeding. There was no significant difference between the growth of the exclusively breastfed infant and mixed-fed infants. CONCLUSION EBF rate was successfully measured using the DTM method. Women from urban settings are less likely to practice EBF. Further research may be needed to gain an in-depth understanding of the factors affecting breastfeeding practices in urban Jamaica.
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Affiliation(s)
- Sherine Whyte
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona Campus, Kingston 7, Jamaica.
| | - Judith McLean-Smith
- Department of Nutrition, Dietetics and Food Science, Northern Caribbean University, Mandeville, Jamaica
| | - Marvin Reid
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona Campus, Kingston 7, Jamaica
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Taylor RW, Conlon CA, Beck KL, von Hurst PR, Te Morenga LA, Daniels L, Haszard JJ, Meldrum AM, McLean NH, Cox AM, Tukuafu L, Casale M, Brown KJ, Jones EA, Katiforis I, Rowan M, McArthur J, Fleming EA, Wheeler BJ, Houghton LA, Diana A, Heath ALM. Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study. JMIR Res Protoc 2021; 10:e29048. [PMID: 33881411 PMCID: PMC8100878 DOI: 10.2196/29048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food "pouches" and "baby-led weaning" (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. OBJECTIVE The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. METHODS Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide "dose-to-mother" technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. RESULTS This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. CONCLUSIONS This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29048.
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Affiliation(s)
- Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Pamela R von Hurst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Lisa A Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jill J Haszard
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | | | - Neve H McLean
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Alice M Cox
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Lesieli Tukuafu
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Maria Casale
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Kimberley J Brown
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Emily A Jones
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Ioanna Katiforis
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Madeleine Rowan
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jenny McArthur
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Ben J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Aly Diana
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Ranque CL, Stroble C, Amicucci MJ, Tu D, Diana A, Rahmannia S, Suryanto AH, Gibson RS, Sheng Y, Tena J, Houghton LA, Lebrilla CB. Examination of Carbohydrate Products in Feces Reveals Potential Biomarkers Distinguishing Exclusive and Nonexclusive Breastfeeding Practices in Infants. J Nutr 2020; 150:1051-1057. [PMID: 32055824 PMCID: PMC7198307 DOI: 10.1093/jn/nxaa028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The stable isotope deuterium dose-to-mother (DTM) technique to estimate nonbreast milk water intake demonstrates that maternal self-report methods of infant feeding overestimate the true prevalence of exclusively breastfeeding practices. OBJECTIVE We aimed to determine potential monosaccharide and oligosaccharide markers that distinguish between exclusively breastfed (EBF) versus nonexclusively breastfed (non-EBF) infants utilizing LC-MS-based methods. METHODS Data for the analysis were collected as part of a larger, longitudinal study of 192 breastfed Indonesian infants aged 2 mo and followed up at 5 mo. Feces samples were collected from infants aged 2 mo (n = 188) and 5 mo (n = 184). EBF and non-EBF strata at each time point were determined via the DTM technique. Feces samples were analyzed to determine monosaccharide content using ultra-high-performance LC-triple quadrupole MS (UHPLC-QqQ MS). Relative abundances of fecal oligosaccharides were determined using nano-LC-Chip-quadrupole time-of-flight MS (nano-LC-Chip-Q-ToF MS). RESULTS At age 2 mo, monosaccharide analysis showed the abundance of fructose and mannose were significantly higher (+377% and +388%, respectively) in non-EBF compared with EBF infants (P <0.0001). Fructose and mannose also showed good discrimination with areas under the curve (AUC) of 0.86 and 0.82, respectively. Oligosaccharide analysis showed that a 6-hexose (Hex6) isomer had good discrimination (AUC = 0.80) between EBF and non-EBF groups at 5 mo. CONCLUSION Carbohydrate products, particularly fecal mono- and oligosaccharides, differed between EBF and non-EBF infants aged under 6 mo and can be used as potential biomarkers to distinguish EBF versus non-EBF feeding practices.
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Affiliation(s)
| | - Carol Stroble
- Department of Chemistry, University of California, Davis, CA, USA
| | | | - Diane Tu
- Department of Chemistry, University of California, Davis, CA, USA
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand,Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Sofa Rahmannia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia,Faculty of Medicine, Universitas Pasundan, Bandung, Indonesia
| | | | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Ying Sheng
- Department of Chemistry, University of California, Davis, CA, USA
| | - Jennyfer Tena
- Department of Chemistry, University of California, Davis, CA, USA
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Carlito B Lebrilla
- Department of Chemistry, University of California, Davis, CA, USA,Address correspondence to CBL (e-mail: )
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