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Montana AV, Mildon A, Daniel AI, Pitino MA, Baxter JAB, Beggs MR, Unger SL, O'Connor DL, Walton K. Is Maternal Body Weight or Composition Associated with Onset of Lactogenesis II, Human Milk Production, or Infant Consumption of Mother's Own Milk? A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100228. [PMID: 38609047 PMCID: PMC11163153 DOI: 10.1016/j.advnut.2024.100228] [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: 01/09/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
Maternal adiposity impacts lactation performance, but the pathways are unclear. We conducted a systematic review to understand whether maternal adiposity (body mass index [BMI] or percentage fat mass) is associated with onset of lactogenesis II (copious milk; hours), human milk production (expressed volume/24 h), and infant consumption of mother's own milk (volume/24 h). We used random-effects standard meta-analyses to compare the relative risk (RR) of delayed lactogenesis II (>72 h) between mothers classified as underweight (BMI <18.5 kg/m2), healthy weight (BMI, 18.5-24.9 kg/m2), and overweight/obese (BMI ≥25 kg/m2) and random-effects meta-regressions to examine associations with hours to lactogenesis II and infant milk consumption. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. We included 122 articles. Mothers with underweight (RR: 0.64; 95% CI: 0.49, 0.83; I2 = 39.48%; 8 articles/data points) or healthy weight status (RR: 0.67; 95% CI: 0.57, 0.79; I2 = 70.91%; 15 articles/data points) were less likely to experience delayed lactogenesis II than mothers with overweight/obesity. We found no association between maternal BMI and time to onset of lactogenesis II (β: 1.45 h; 95% CI: -3.19, 6.09 h; P = 0.52, I2 = 0.00%; 8 articles, 17 data points). Due to limited data, we narratively reviewed articles examining BMI or percentage fat mass and milk production (n = 6); half reported an inverse association and half no association. We found no association between maternal BMI (β: 6.23 mL; 95% CI: -11.26, 23.72 mL; P = 0.48, I2 = 47.23%; 58 articles, 75 data points) or percentage fat mass (β: 7.82 mL; 95% CI: -1.66, 17.29 mL; P = 0.10, I2 = 28.55%; 30 articles, 41 data points) and infant milk consumption. The certainty of evidence for all outcomes was very low. In conclusion, mothers with overweight/obesity may be at risk of delayed lactogenesis II. The available data do not support an association with infant milk consumption, but the included studies do not adequately represent mothers with obesity. This study was registered in PROSPERO as 285344.
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Affiliation(s)
- Amanda V Montana
- Translational Medicine, The Hospital for Sick Children, Toronto ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada
| | - Alison Mildon
- Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada
| | | | - Michael A Pitino
- Translational Medicine, The Hospital for Sick Children, Toronto ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada
| | - Jo-Anna B Baxter
- Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada
| | - Megan R Beggs
- Translational Medicine, The Hospital for Sick Children, Toronto ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada
| | - Sharon L Unger
- Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada; Paediatrics, Mount Sinai Hospital, Toronto ON, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto ON, Canada
| | - Deborah L O'Connor
- Translational Medicine, The Hospital for Sick Children, Toronto ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada; Paediatrics, Mount Sinai Hospital, Toronto ON, Canada
| | - Kathryn Walton
- Translational Medicine, The Hospital for Sick Children, Toronto ON, Canada; Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, ON, Canada.
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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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Wang A, Diana A, Rahmannia S, Gibson RS, Houghton LA, Slupsky CM. Impact of milk secretor status on the fecal metabolome and microbiota of breastfed infants. Gut Microbes 2023; 15:2257273. [PMID: 37741856 PMCID: PMC10519369 DOI: 10.1080/19490976.2023.2257273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
Maternal secretor status has been shown to be associated with the presence of specific fucosylated human milk oligosaccharides (HMOs), and the impact of maternal secretor status on infant gut microbiota measured through 16s sequencing has previously been reported. None of those studies have confirmed exclusive breastfeeding nor investigated the impact of maternal secretor status on gut microbial fermentation products. The present study focused on exclusively breastfed (EBF) Indonesian infants, with exclusive breastfeeding validated through the stable isotope deuterium oxide dose-to-mother (DTM) technique, and the impact of maternal secretor status on the infant fecal microbiome and metabolome. Maternal secretor status did not alter the within-community (alpha) diversity, between-community (beta) diversity, or the relative abundance of bacterial taxa at the genus level. However, infants fed milk from secretor (Se+) mothers exhibited a lower level of fecal succinate, amino acids and their derivatives, and a higher level of 1,2-propanediol when compared to infants fed milk from non-secretor (Se-) mothers. Interestingly, for infants consuming milk from Se+ mothers, there was a correlation between the relative abundance of Bifidobacterium and Streptococcus, and between each of these genera and fecal metabolites that was not observed in infants receiving milk from Se- mothers. Our findings indicate that the secretor status of the mother impacts the gut microbiome of the exclusively breastfed infant.
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Affiliation(s)
- Aidong Wang
- Department of Food Science and Technology, University of California, Davis, CA, USA
| | - Aly Diana
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Sofa Rahmannia
- Faculty of Medicine, Universitas Pasundan, Bandung, Indonesia
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Carolyn M Slupsky
- Department of Food Science and Technology, University of California, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
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Hoffman DJ, Baratto PS. Human Milk Consumption and Motor Development: Can the Use of Stable Isotopes Improve the Evidence? J Nutr 2023; 153:1843-1845. [PMID: 37019384 DOI: 10.1016/j.tjnut.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, New Jersey Institute for Food, Nutrition, and Health, Rutgers, the State University of New Jersey, New Brunswick, NJ, United States.
| | - Paola Seffrin Baratto
- Graduate Program in Pediatrics, Child and Adolescent Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Suzan ÖK, Kaya O, Kolukısa T, Koyuncu O, Tecik S, Cinar N. Water consumption in 0-6-month-old healthy infants and effective factors: A systematic review. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:181-199. [PMID: 37433164 PMCID: PMC10506693 DOI: 10.7705/biomedica.6745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/16/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Early introduction of fluids and water affects the duration of breastfeeding, the infant immune system, and possibly causes infants to consume less breast milk, which may, in turn, affect their nutritional and immune status. OBJECTIVE This study was carried out to determine water consumption in 0-6-month-old infants and the factors affecting this consumption. MATERIALS AND METHODS A literature review was conducted in seven electronic databases (Medline, Web of Science, PubMed, ScienceDirect, Scopus, Cochrane Library, and TÜBITAK) for studies published until April 25, 2022, using the keywords: drinking water, infant, and breastfeeding. RESULTS The systematic review included 13 studies. Five studies were crosssectional, three were descriptive and quasi-experimental, and the others were case-control and cohort studies. It was reported in the examined studies that 86.2% of the infants were around 6 weeks old, 44 % of the infants were 1 month old, 77% were 3 months old, 2.5% were 4 months old, and 2.5 to 85% of the infants were around 6 months old when they first consumed water. The prominent reasons for making the infants drink water are the thought that they need it and cultural reasons. CONCLUSIONS The exclusive breastfeeding of 0-6-month-old infants is the recommendation of reliable health authorities. Nurses play a key role in implementing this practice. In this systematic review, it was seen that families gave their infants water at varying rates in the 0-6-month period, and the factors affecting this situation were revealed. If nurses determine which factors affect families in terms of the early introduction of fluids, they could be able to plan the necessary education and interventions.
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Affiliation(s)
- Özge Karakaya Suzan
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey.
| | - Ozge Kaya
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Tugce Kolukısa
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Oguz Koyuncu
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Seda Tecik
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Nursan Cinar
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey.
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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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Leong C, Gibson RS, Diana A, Haszard JJ, Rahmannia S, Ansari MB, Inayah LS, Purnamasari AD, Houghton LA. Differences in Micronutrient Intakes of Exclusive and Partially Breastfed Indonesian Infants from Resource-Poor Households are Not Accompanied by Differences in Micronutrient Status, Morbidity, or Growth. J Nutr 2021; 151:705-715. [PMID: 33438018 PMCID: PMC7948196 DOI: 10.1093/jn/nxaa381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND When maternal micronutrient intakes and statuses are compromised, reductions in micronutrient concentrations in neonatal stores and human milk may result in suboptimal micronutrient intakes, statuses, and functional outcomes of breastfed infants during the critical first 6-month period. OBJECTIVES We compared the adequacy of micronutrient intakes and statuses at 2 and/or 5 months and morbidity and growth faltering at 2, 5, and 12 months in a cohort of exclusively breastfed (EBF) and partially breastfed (PBF) infants from low-resource Indonesian households. METHODS At 2 and 5 months, the breastfeeding status and human milk intake of 212 infants were determined using the deuterium oxide dose-to-mother technique, and intakes were calculated from milk micronutrient concentrations and 3-d weighed food intakes. At 5 months, five infant micronutrient biomarkers, hemoglobin, C-reactive protein, and α-1-acid-glycoprotein were measured. Infant morbidity, weight, and length were measured at 2, 5, and 12 months. Means, medians, or proportions were reported for each group and differences between groups were statistically determined. RESULTS Median intakes of iron, thiamin, niacin, and vitamin B-12 were higher in PBF than EBF infants at 5 months (all P values < 0.05), but intakes in all infants were below adequate intakes. At 5 months, anemia was <20% in both groups, although fewer PBF versus EBF infants had vitamin B-12 deficiency (11.5% vs. 28.6%, respectively; P = 0.011). The mean ± SD length-for-age z-scores for EBF versus PBF infants at 2 months were 0.7 ± 0.9 versus -0.5 ± 1.1, respectively (P = 0.158), declining to -1.4 ± 0.9 versus -1.1 ± 1.2, respectively, at 12 months (P = 0.059). Reported morbidity rates were generally low, with no evidence of a difference between infant groups (all P values > 0.126). CONCLUSIONS Irrespective of exclusive or partial breastfeeding status, micronutrient intakes of infants were low, statuses were compromised, and growth faltering during the critical 6 months period of early infancy was present. The findings highlight the importance of improving maternal nutritional statuses and evaluating their impacts on infant outcomes.
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Affiliation(s)
- Claudia Leong
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Sofa Rahmannia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Medicine, Universitas Pasundan, Bandung, Indonesia
| | | | - Lina Sofiatul Inayah
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Afini Dwi Purnamasari
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Effects of Breastfeeding on Maternal Body Composition in Moroccan Lactating Women during Twelve Months after Birth Using Stable Isotopic Dilution Technique. Nutrients 2021; 13:nu13010146. [PMID: 33406595 PMCID: PMC7823570 DOI: 10.3390/nu13010146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding during the first six months of an infant's life is an important factor for their optimal growth and health. Breastfeeding also has maternal benefits and can assist with postpartum weight loss. As shown by previous studies, postpartum weight retention can contribute to obesity. OBJECTIVE To quantify the human milk and evaluate the effect of breastfeeding on maternal weight loss during the 12 months postpartum. METHOD This study included 70-mother-baby pairs. Infants' intake of human milk and water from other sources, as well as the body composition of the mothers, were measured at the 1st, 3rd, 6th, 9th and 12th month postpartum by using the deuterium oxide dose-to-mother technique. RESULTS There was a significant change in the mothers' body composition between the first and twelfth months in exclusive breastfeeding women compared to not-exclusive ones. Similarly, the difference between the quantities of human milk intake was highly significant in exclusive breastfeeding women compared to women who were not exclusively breastfeeding. CONCLUSION Our results showed that exclusive breastfeeding for twelve months has a significant effect on postpartum weight loss among Moroccan women and that it is an effective way to control overweight and obesity among lactating women.
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Lokonon JHF, Hounkpatin WA, Idohou-Dossou N. Participation in the "nutrition at the Centre" project through women's group improved exclusive breastfeeding practices, as measured by the deuterium oxide dose-to-mother technique. Int Breastfeed J 2020; 15:58. [PMID: 32590987 PMCID: PMC7318378 DOI: 10.1186/s13006-020-00302-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Evidence of interventions that are effective in improving exclusive breastfeeding (EBF) practices is needed to help countries revise their strategies. To assess whether mothers who had participated in the Nutrition at the Centre (N@C) project effectively demonstrated better EBF practices than did those who did not participate, we documented the processes of this nutritional intervention in Benin. METHODS This study was a cross-sectional design comparing the intervention group, namely, the Village Saving and Loan Association (VSLA-N@C), to the control group. The N@C project was an educational intervention based on behavioural and social changes related to nutrition. Through VSLA groups installed in communities, mothers were connected to the project; had weekly discussions around the process, benefits and challenges linked to EBF, and advocated during Breastfeeding Week celebrations. The study participants were mothers with children aged 4-5.5 months from the VSLA-N@C group (n = 53) and mothers (n = 50) from non-intervention areas who served as controls. With the deuterium oxide dose-to-mother technique, we quantified human milk intake (HMI) and non-milk oral intake (NMOI) and compared both groups using Student's t-test. A child is considered to be exclusively breastfed if the NMOI is less than 86.6 g/day. Multivariate regression logistics adjusted for VSLA membership, mothers' body mass index, and children's age, weight-for-age and weight-for-length, thus enabling us to measure differences in EBF rates. RESULTS Children of mothers from the VSLA-N@C group consumed significantly more human milk than those of mothers in the control group (900.2 ± 152.5 g/day vs 842.2 ± 188.6 g/day, P = 0.044). Children in the VSLA-N@C group had significantly less non-milk oral intake than did those in the control group (difference: 148.2 g/day, P = 0.000). Therefore, the EBF rate was significantly higher in the VSLA group (38% vs 8%, P < 0.0001), and mothers in VSLAs were 14 times more likely to practise EBF than were those in the control group (adjusted odds ratio [AOR] = 13.9, 95% CI 1.9-116.5, P = 0.015). CONCLUSION The EBF rate was significantly higher in the group of mothers who participated in the VSLA-N@C project than in those who did not receive the intervention. The N@C model could be promoted as a strategy for increasing EBF practices in poor and rural contexts, where it is possible to organize mothers into VSLA groups to discuss the process, benefits and challenges of EBF.
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Affiliation(s)
- Jaures H F Lokonon
- School of Nutrition, Food Sciences and Technologies, Faculty of Agronomics Sciences, University of Abomey-Calavi, Abomey-Calavi, Republic of Benin
| | - Waliou Amoussa Hounkpatin
- School of Nutrition, Food Sciences and Technologies, Faculty of Agronomics Sciences, University of Abomey-Calavi, Abomey-Calavi, Republic of Benin.
| | - Nicole Idohou-Dossou
- Laboratory of Nutrition, Department of Animal Biology, Faculty of Sciences and Techniques, University Cheikh Anta Diop, Dakar, Senegal
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Mulol H, Coutsoudis A, Amoussa Hounkpatin W, Urio E, Kenguela Wabolou P, Sissinto Y, El-Kari K. Is exclusive breastfeeding an option or a necessity in Africa? A pooled study using the deuterium oxide dose-to-mother technique. J Public Health Afr 2020; 11:932. [PMID: 33209226 PMCID: PMC7656180 DOI: 10.4081/jphia.2020.932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/01/2020] [Indexed: 11/23/2022] Open
Abstract
Given the valuable health, development, and economic benefits of human milk Exclusive Breastfeeding (EBF) is recommended by the World Health Organisation for the first six months of an infant’s life. Many resource-limited regions in Africa do not line-up with these recommendations, therefore EBF promotion efforts on the continent need to be scaled up and monitored. This study explores the human milk intake volumes of 5 countries (Benin, Central African Republic, Morocco, South Africa and Tanzania) both at country level and in a pooled sample of children at 3 months (n= 355) and at 6 months (n=193). Mean human milk intake volumes in the pooled samples were 697.6 g/day at 3 months and 714.9 g/day at 6 months. EBF was determined both by maternal recall as well as using the deuterium oxide dose-to-mother technique, using two different cut-offs of non-milk oral intake. Comparison of these results showed substantial over-reporting of EBF by maternal recall, which suggests that actual rates of EBF are even lower than reported, thus highlighting the importance of scaling-up EBF promotion strategies.
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Affiliation(s)
- Helen Mulol
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | | | | | - Khalid El-Kari
- National Centre for Energy, Sciences and Nuclear Techniques (CNESTEN), Rabat, Morocco
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Addison R, Hill L, Bode L, Robertson B, Choudhury B, Young D, Wright C, Relton C, Garcia AL, Tappin DM. Development of a biochemical marker to detect current breast milk intake. MATERNAL & CHILD NUTRITION 2020; 16:e12859. [PMID: 31216094 PMCID: PMC7038895 DOI: 10.1111/mcn.12859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023]
Abstract
The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breastfed, nine exclusively formula fed, and 11 mixed breast/formula fed. High-performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect "any breastfeeding" only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N-acetylglucosamine (GlcNAc) measured as GlcNH2 after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2[%]) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment, the GlcNH2/Man ratio with a cut-off of 1.5 correctly identified all those receiving "any breast milk," while excluding exclusively formula fed infants. The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.
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Affiliation(s)
- Ruth Addison
- NHS Ayrshire & Arran Primary Care Trust, Rainbow House Paediatric UnitAyrshire Central HospitalIrvineUK
| | - Lauren Hill
- General PaediatricsPinderfields General HospitalWakefieldUK
| | - Lars Bode
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence (LRF MOMI CORE)University of CaliforniaSan DiegoCalifornia
| | - Bianca Robertson
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence (LRF MOMI CORE)University of CaliforniaSan DiegoCalifornia
| | - Biswa Choudhury
- Glycoanalytical Core, Glycobiology Research and Training CenterUniversity of CaliforniaSan DiegoCalifornia
| | - David Young
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUK
| | - Charlotte Wright
- Section of Child Health, School of MedicineGlasgow UniversityGlasgowUK
| | - Clare Relton
- ScHARRUniversity of SheffieldSheffieldUK
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Ada L. Garcia
- Human Nutrition, School of Medicine, Dentistry and NursingGlasgow UniversityGlasgowUK
| | - David M. Tappin
- Section of Child Health, School of MedicineGlasgow UniversityGlasgowUK
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12
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Nutritional status and human milk intake of exclusively breast-fed infants at high altitude in La Paz, Bolivia. Br J Nutr 2019; 120:158-163. [PMID: 29947320 DOI: 10.1017/s0007114518001137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Breast-feeding habits are related to the nutritional status and the risk of illness and death in children under 2 years of age. For the first 6 months, infants should be exclusively breast-fed. This study aimed to evaluate the relationship between the infant's nutritional status and human milk intake by breast-fed infants at high altitude. A quantitative, descriptive, correlational study was conducted including mother/baby pairs of infants aged 2-6 months. The amount of human milk consumed by the infants was assessed by the deuterium oxide dose-to-mother technique. The lipid content of human milk was measured by creamatocrit, and anthropometric measurements were performed. A total of eighteen mother/baby pairs were assessed. The mean human milk intake was 888 (sd 149) g/d, and the intake of water from other sources was 24·3 (sd 29·8) g/d. The lipid content in human milk was 41 (sd 12) g/l. The infant's nutritional indicators were normal in all cases. A moderate positive correlation was found between milk volume and z scores weight-for-length r 0·58 (P=0·01), BMI-for-age r 0·56 (P=0·01) and weight-for-age r 0·45 (P=0·05). There was no correlation with length-for-age z score. The mean of breast milk intake in this study was similar to that found in other studies in the world. The lipid content is comparable to similar studies and was within the normal range. Children older than 3 months showed signs of stunting despite adequate volume and lipid content of breast milk.
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13
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Liu Z, Diana A, Slater C, Preston T, Gibson RS, Houghton L, Duffull SB. Development of a Parsimonious Design for Optimal Classification of Exclusive Breastfeeding. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2019; 8:596-605. [PMID: 31215140 PMCID: PMC6709417 DOI: 10.1002/psp4.12428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/18/2019] [Indexed: 12/03/2022]
Abstract
A deuterium oxide dose‐to‐mother (DTM) technique is used to determine if an infant is exclusive breastfeeding (EBF). However, the DTM method is intensive, requiring seven paired mother–infant samples during a 14‐day study period. The purpose of this study was to develop a field‐friendly protocol. Data from 790 mother–infant pairs from nine countries were analyzed using a Markov chain Monte Carlo method with Stan. The data were split into (i) model building (565 pairs) and (ii) design evaluation (225 pairs). EBF classification was based on a previously published cut‐off for nonmilk water intake. Classification based on the full design was the reference (gold standard classification). The receiver operating characteristics of parsimonious designs were used to determine an optimal parsimonious classification method. The best two postdose windows (days 7–9 and 13–14) yielded optimal categorization with similar performance in the design evaluation data. This postdose two‐sample design provided 95% sensitivity and specificity when compared with the full design.
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Affiliation(s)
- Zheng Liu
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Rochedale, New South Wales, Australia
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,Division of Medical Nutrition, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Thomas Preston
- Scottish Universities Environmental Research Centre, University of Glasgow, Glasgow, UK
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Lisa Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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14
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Liu Z, Diana A, Slater C, Preston T, Gibson RS, Houghton L, Duffull SB. Development of a nonlinear hierarchical model to describe the disposition of deuterium in mother-infant pairs to assess exclusive breastfeeding practice. J Pharmacokinet Pharmacodyn 2019; 46:1-13. [PMID: 30430351 PMCID: PMC6394541 DOI: 10.1007/s10928-018-9613-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/08/2018] [Indexed: 01/24/2023]
Abstract
The World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months after birth. The deuterium oxide dose-to-the-mother (DTM) technique is used to distinguish EBF based on a cut-off (< 25 g/day) of water intake from sources other than breastmilk. This value is based on a theoretical threshold and has not been verified in field studies. The aim of this study was to estimate the water intake cut-off value that can be used to define EBF practice. One hundred and twenty-one healthy infants, aged 2.5-5.5 months who were deemed to be EBF were recruited. After administration of deuterium to the mothers, saliva was sampled from mother and infant pairs over a 14-day period. Validation of infant feeding practices was conducted via home observation over six non-consecutive days with caregiver recall. A fully Bayesian framework using a gradient-based Markov chain Monte Carlo approach implemented in Stan was used to estimate the cut-off of non-milk water intake of EBF infants. From the original data set, 113 infants were determined to be EBF and provided 1500 paired mother-infant observations. The deuterium saliva concentrations were best described by two linked 1-compartment models (mother and infant), with body weight as a covariate on the mother's volume of distribution and infant's body weight on infant's water clearance rate. The cut-off value was based on the 90th percentile of the posterior distribution of non-milk water intake and was 86.6 g/day. This cut-off value can be used in future field studies in other geographic regions to determine exclusivity of breast feeding practices in order to determine their potential public health needs.
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Affiliation(s)
- Zheng Liu
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Kookaburra Circuit, Newcastle, NSW, 2305, Australia.
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Division of Medical Nutrition, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Thomas Preston
- Scottish Universities Environmental Research Centre, University of Glasgow, Glasgow, UK
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Lisa Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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15
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Sheftel J, Loechl C, Mokhtar N, Tanumihardjo SA. Use of Stable Isotopes to Evaluate Bioefficacy of Provitamin A Carotenoids, Vitamin A Status, and Bioavailability of Iron and Zinc. Adv Nutr 2018; 9:625-636. [PMID: 30239582 PMCID: PMC6140444 DOI: 10.1093/advances/nmy036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/25/2018] [Accepted: 05/14/2018] [Indexed: 01/25/2023] Open
Abstract
The ability of nutrition scientists to measure the status, bioavailability, and bioefficacy of micronutrients is affected by lack of access to the parts of the body through which a nutrient may travel before appearing in accessible body compartments (typically blood or urine). Stable isotope-labeled tracers function as safe, nonradioactive tools to follow micronutrients in a quantitative manner because the absorption, distribution, metabolism, and excretion of the tracer are assumed to be similar to the unlabeled vitamin or mineral. The International Atomic Energy Agency (IAEA) supports research on the safe use of stable isotopes in global health and nutrition. This review focuses on IAEA's contributions to vitamin A, iron, and zinc research. These micronutrients are specifically targeted by the WHO because of their importance in health and worldwide prevalence of deficiency. These 3 micronutrients are included in food fortification and biofortification efforts in low- and middle-income regions of the world. Vitamin A isotopic techniques can be used to evaluate the efficacy and effectiveness of interventions. For example, total body retinol stores were estimated by using 13C2-retinol isotope dilution before and after feeding Zambian children maize biofortified with β-carotene to determine if vitamin A reserves were improved by the intervention. Stable isotopes of iron and zinc have been used to determine mineral bioavailability. In Thailand, ferrous sulfate was better absorbed from fish sauce than was ferrous lactate or ferric ammonium citrate, determined with the use of different iron isotopes in each compound. Comparisons of one zinc isotope injected intravenously with another isotope taken orally from a micronutrient powder proved that the powder increased total absorbed zinc from a meal in Pakistani infants. Capacity building by the IAEA with appropriate collaborations in low- and middle-income countries to use stable isotopes has resulted in many advancements in human nutrition.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | | | | | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
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16
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Mulol H, Coutsoudis A. Limitations of maternal recall for measuring exclusive breastfeeding rates in South African mothers. Int Breastfeed J 2018; 13:19. [PMID: 29849742 PMCID: PMC5970480 DOI: 10.1186/s13006-018-0159-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Maternal recall is most commonly used to determine exclusive breastfeeding rates. A gold standard stable isotope method is available which can determine intake of breast milk versus water from sources other than breast milk and thus objectively determine exclusive breastfeeding. The objectives of this study were to determine exclusive breastfeeding rates by both maternal recall and the objective stable isotope method and discuss the limitations and usefulness of the two methods. Methods The study involved 100 mother-infant pairs in a peri-urban area in Durban, South Africa and study visits took place from July 2012 to September 2014. Maternal recall of exclusive breastfeeding was carried out using the World Health Organization’s 24 hour recall of infant feeding and this was compared to the objective measurement of exclusive breastfeeding using the stable isotope technique at three time points: six weeks, three and 5.5 months. The objective measurements were carried out using two different cut off values for exclusive breastfeeding. Kappa analysis was used to quantify the relationship between maternal recall and results from the stable isotope technique for each mother-infant pair. Results Over reporting of exclusive breastfeeding was common at the three different time points regardless of the cut off value used to assess exclusive breastfeeding by the stable isotope technique. Kappa analysis also revealed only slight or fair agreement (K < 0.24) between reported and measured exclusive breastfeeding at all time points. Conclusions Maternal recall of exclusive breastfeeding is limited in accuracy and should be restricted to large scale epidemiological surveys. The more objective gold standard stable isotope method for measuring intake volumes of breast milk should be used to evaluate interventions with smaller representative samples.
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Affiliation(s)
- Helen Mulol
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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17
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Williams AM, Stewart CP, Shahab-Ferdows S, Hampel D, Kiprotich M, Achando B, Lin A, Null CA, Allen LH, Chantry CJ. Infant Serum and Maternal Milk Vitamin B-12 Are Positively Correlated in Kenyan Infant-Mother Dyads at 1-6 Months Postpartum, Irrespective of Infant Feeding Practice. J Nutr 2018; 148:86-93. [PMID: 29378045 PMCID: PMC5955065 DOI: 10.1093/jn/nxx009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background Vitamin B-12 is an essential nutrient required for many functions including DNA synthesis, erythropoiesis, and brain development. If maternal milk vitamin B-12 concentrations are low, infants may face elevated risks of deficiency when exclusively breastfed. Objective We evaluated cross-sectional associations between infant serum vitamin B-12 concentrations and maternal milk vitamin B-12 concentrations at 1-6 mo postpartum among an unsupplemented population in rural western Kenya, and assessed biological demographic, and dietary characteristics associated with adequate infant serum vitamin B-12. Methods We modeled 1) infant serum vitamin B-12 using maternal milk vitamin B-12 concentration with linear regression; and 2) adequate (>220 pmol/L) infant serum vitamin B-12 using hypothesized biological, demographic, and dietary predictors with logistic regression. In both models, we used generalized estimating equations to account for correlated observations at the cluster-level. Results The median (quartile 1, quartile 3) infant serum vitamin B-12 concentration was 276 pmol/L (193, 399 pmol/L) and approximately one-third of infants had serum vitamin B-12 ≤220 pmol/L, indicating that they were vitamin B-12 depleted or deficient. There was a positive correlation between maternal milk and infant serum vitamin B-12 (r = 0.36, P < 0.001) and in multivariable analyses, maternal milk vitamin B-12 concentration was significantly associated with infant serum vitamin B-12 adequacy (P-trend = 0.03). Conclusions Despite a high prevalence (90%) of maternal milk vitamin B-12 concentrations below the level used to establish the Adequate Intake (<310 pmol/L), there was a low prevalence of infant vitamin B-12 deficiency. We found few factors that were associated with infant vitamin B-12 adequacy in this population, including infant feeding practices, although maternal vitamin B-12 status was not measured. The contribution of maternal milk to infant vitamin B-12 status remains important to quantify across populations, given that maternal milk vitamin B-12 concentration is modifiable with supplementation. This trial was registered at clinicaltrials.gov as NCT01704105.
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Affiliation(s)
- Anne M Williams
- Hubert Department of Global Health, Emory University, Atlanta, GA,Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,Address correspondence to AMW (e-mail: )
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA
| | | | - Daniela Hampel
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,USDA, ARS Western Human Nutrition Research Center, Davis, CA
| | - Marion Kiprotich
- Innovations for Poverty Action, New Haven, CT, USA and Kisumu, Kenya
| | - Beryl Achando
- Innovations for Poverty Action, New Haven, CT, USA and Kisumu, Kenya
| | - Audrie Lin
- School of Public Health, University of California Berkeley, Berkeley, CA
| | - Clair A Null
- Innovations for Poverty Action, New Haven, CT, USA and Kisumu, Kenya,Mathematica Policy Research, Washington DC
| | - Lindsay H Allen
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,USDA, ARS Western Human Nutrition Research Center, Davis, CA
| | - Caroline J Chantry
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,University of California Davis Medical Center, Sacramento, CA
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18
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Limon-Miro AT, Aldana-Madrid ML, Alvarez-Hernandez G, Antunez-Roman LE, Rodriguez-Olibarria G, Valencia Juillerat ME. Breast milk intake and mother to infant pesticide transfer measured by deuterium oxide dilution in agricultural and urban areas of Mexico. CHEMOSPHERE 2017; 181:682-689. [PMID: 28476008 DOI: 10.1016/j.chemosphere.2017.04.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 06/07/2023]
Abstract
Vector-borne diseases have increased pesticide use in urban areas (UA) and agricultural areas (AA) in Mexico. Breast milk can be contaminated by pesticide exposure. The objective of the study was to measure breast milk intake by deuterium oxide dilution as well as organochlorine and pyrethroid transfer from mother to infant in AA and UA of Sonora, Mexico. Human milk intake was determined by the 'dose-to-mother' technique using deuterium oxide (D2O) dilution. Mothers' body composition was also assessed by this technique and the intercept method. Pyrethroids (deltamethrin, cypermethrin and cyhalothrin) and organochlorine pesticide residues (p,p'- DDT, p,p'- DDE, p,p'- DDD) in breast milk samples were measured by gas chromatography. Sixty-two lactating women and their infants participated in the study, 32 lived in the UA and 30 lived in the AA. Breast milk intake was approximately 100 mL higher in the AA than in the UA 799 ± 193 and 707 ± 201 mL/day, respectively (p < 0.05). The concentrations of p,p'- DDT and cypermethrin levels in breast milk were higher in the UA than in the AA (p < 0.05 and p = 0.001, respectively). None of the pyrethroids and organochlorine pesticides studied surpassed the Acceptable Daily Intake (ADI) in milk for humans according to EPA and FAO/WHO. In conclusion, breast milk intake was higher in the AA compared to the UA. The p,p'- DDT and cypermethrin levels in breast milk were higher in the UA compared to the AA. Since pesticide levels in human milk did not exceed the ADI, breastfeeding is still a safe practice and should be encouraged.
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Affiliation(s)
| | | | | | | | | | - Mauro E Valencia Juillerat
- Department of Chemical and Biological Sciences, University of Sonora, Mexico; Department of Nutrition, Centro de Investigacion en Alimentacion y Desarrollo, A.C., Hermosillo, Sonora, Mexico.
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19
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Oiye S, Mwanda W, Mugambi M, Filteau S, Owino V. Exclusive Breastfeeding Is More Common Among HIV-Infected Than HIV-Uninfected Kenyan Mothers at 6 Weeks and 6 Months Postpartum. Breastfeed Med 2017; 12:283-289. [PMID: 28467097 DOI: 10.1089/bfm.2016.0126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare breastfeeding practices determined by mothers' own recall versus a stable isotope technique (deuterium oxide dilution) among human immunodeficiency virus (HIV)-infected and HIV-uninfected mothers at 6 weeks and 6 months postpartum. METHODS Exclusive breastfeeding (EBF) rates were assessed cross-sectionally at 6 weeks and 6 months postpartum among 75 HIV-positive and 68 HIV-negative women attending postnatal care. EBF was derived from maternal 24-hour recall of foods that were fed to the infant and by objective measurement of nonhuman milk-water intake using deuterium oxide (DO) dilution technique. RESULTS Multivariable logistic analyses were adjusted for infant sex, gravidity, maternal age, marital status, and maternal education. Using recall method, a greater proportion of HIV-infected mothers exclusively breastfed than HIV-uninfected mothers both at 6 weeks postpartum [94.1% versus 76.9%, respectively (adjusted odds ratio [aOR] 7.81; 95% confidence interval [CI] 1.9-31.6, p = 0.004)] and at 6 months postpartum [75% versus 59.7%, respectively (aOR 2.27; 95% CI 1.0-5.3, p = 0.058)]. At 6 weeks postpartum EBF rates from the DO technique were 23.5% and 13.8% for HIV-positive and HIV-negative mothers, respectively (aOR 0.35; 95% CI 0.11-1.04, p = 0.059). At 6 months postpartum, the DO technique determined EBF rates were 43.3% among HIV-positive and 24.2% among HIV-negative mothers, respectively (aOR 2.4; 95% CI 1.0-5.7, p = 0.048). CONCLUSIONS HIV-infected mothers are more likely to exclusively breastfeed compared with HIV-uninfected mothers. In this resource-poor setting, maternal recall overestimates EBF rates as compared with the deuterium oxide dilution technique. Validating EBF recall data using the objective DO technique is highly recommended for accurate tracking toward global targets on breastfeeding practices.
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Affiliation(s)
- Shadrack Oiye
- 1 University of Nairobi Institute of Tropical and Infectious Diseases (UNITID) , Nairobi, Kenya
| | - Walter Mwanda
- 1 University of Nairobi Institute of Tropical and Infectious Diseases (UNITID) , Nairobi, Kenya
| | - Mary Mugambi
- 2 Department of Human Nutrition and Dietetics, Technical University of Kenya, Nairobi, Kenya
| | - Suzanne Filteau
- 3 Department of Population Health, London School of Hygiene and Tropical Medicine , London, United Kingdom
| | - Victor Owino
- 2 Department of Human Nutrition and Dietetics, Technical University of Kenya, Nairobi, Kenya
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20
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Using stable isotope techniques in nutrition assessments and tracking of global targets post-2015. Proc Nutr Soc 2017; 76:495-503. [PMID: 28347373 DOI: 10.1017/s0029665117000295] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Stable isotopes are non-radioactive, safe and are applied for various purposes in human health assessment in trace amounts that minimally disturb normal physiology. The International Atomic Energy Agency supports the use of stable isotope techniques to design and evaluate interventions addressing malnutrition in all its forms with focus on infant and young child feeding; maternal and adolescent nutrition; diet quality; prevention and control of non-communicable diseases; healthy ageing and gut function. These techniques can be used to objectively measure: (1) amount of human milk consumed and whether an infant is exclusively breastfed; (2) body composition in the context of re-feeding programmes for moderate and severe acute malnutrition and as an indicator of the risk for obesity; (3) bioavailability and bioconversion of pro-vitamin A and vitamin A body stores following vitamin A intervention programmes; (4) absorption and retention of iron, zinc and protein; (5) total energy expenditure for validation of physical activity measurement and dietary assessment tools and (6) diagnosis of Helicobacter pylori. Stable isotope techniques will be invaluable in the tracking of global targets on exclusive breast-feeding childhood obesity and anaemia among women. Efforts are underway to make nuclear techniques more affordable, field-friendly and less invasive, and to develop less sophisticated but precise equipment. Advocacy for the wide adoption of the techniques is needed.
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Validity of Guatemalan Mother’s Self-Reported Breast-Feeding Practices of 3-Month-Old Infants. Food Nutr Bull 2016; 37:494-503. [DOI: 10.1177/0379572116654644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Breast-feeding practices (BFPs) can be assessed by interviewing the mother about current feeding practices and with a 24-hour recall. It is crucial to establish the accuracy of these methods, which are commonly used by public health decision makers to design health policies aimed at increasing exclusive breast-feeding rates. Objective: We aimed to validate 2 self-report BFP instruments using the dose-to-mother deuterium oxide turnover technique (DMDOT) as the reference method. Methods: Breast-feeding practices were assessed by interviewing the mother about current feeding practices and with a 24-hour recall in 36 Guatemalan mother–infant pairs. The validity of these instruments was assessed using DMDOT as the reference method. Results: Both self-report instruments overestimated exclusively breast-fed (EBF) infants. Infants classified as EBF were 50% by the reported current feeding practice, 61% by the 24-hour recall, and only 36% using DMDOT. Sensitivity to detect EBF infants from the mother’s self-report was 92% (95% CI: 62%-99%) while from the 24-hour recall was 100% (95% CI: 72%-100%, P < .01). However, specificity for both instruments was low, at 74% (95% CI: 51%-89%) for reported current feeding practice and at 61% (95% CI: 39%-79%) for the 24-hour recall ( P < .01). Conclusion: Both reported current feeding practice and the 24-hour recall instruments overestimated exclusive breast-feeding. Nevertheless, the use of reported current feeding practice provided more accurate data to assess BFPs in a public health setting. Furthermore, population-based surveys should consider the overestimation of exclusive breast-feeding caused when using these BFP instruments.
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Bila WC, Lamounier JA, Freitas AED, Silva VR, Turani SD, de Oliveira JED. Stable isotopes and body composition in children: History, fundamentals, and clinical applications. Health (London) 2013. [DOI: 10.4236/health.2013.58a3009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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