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Basrowi RW, Zulfiqqar A, Sitorus NL. Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review. Nutrients 2024; 16:1285. [PMID: 38732532 PMCID: PMC11085192 DOI: 10.3390/nu16091285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.
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Affiliation(s)
- Ray Wagiu Basrowi
- Danone Specialized Nutrition Indonesia, Jakarta 12940, Indonesia;
- Occupational Medicine Program, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 12300, Indonesia
| | - Andy Zulfiqqar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia;
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Zurutuza JI, Gonzalez S, Calderón AL, Caba M, Ramos FR. Changes in the Immunology of Breast Milk From Obese or Overweight Women: a Brief Review. Cureus 2024; 16:e52207. [PMID: 38327967 PMCID: PMC10847007 DOI: 10.7759/cureus.52207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/09/2024] Open
Abstract
A systematic search was carried out through search platforms and specialized databases, such as Academic Google, PubMed, and Scopus, using thesauri: breast feeding, obesity, immunology, and human milk in English and Spanish, and those articles published from January 2000 to December 2021, in both languages. Only those reports that included quantitative data on immunological components in the milk of normal-weight and overweight women were considered. The PRISMA 2020 guides were used, and a total of 306 articles were reviewed, of which a total of 33 were included, according to the basic inclusion criteria. It was observed that in obese mothers, there is an increase in certain immune cells, such as B lymphocytes, cytotoxic T lymphocytes, and NK cells, and cytokines, such as IL-6 and IFN-γ; other alterations included the bacterial population and proteins with antibacterial action. Also, a decrease in growth factors such as TGF-β and IFG-1 was documented in overweight women. Immunoglobulin concentrations did not show substantial changes. This brief review shows that maternal overweight is associated with changes in the biochemical and immunological parameters of milk.
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Affiliation(s)
- Jorge I Zurutuza
- Epidemiology and Biostatistics, Centro de Investigaciones Biomedicas, Universidad Veracruzana, Xalapa, MEX
| | - Santiago Gonzalez
- Chemistry, Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, MEX
| | - Ana L Calderón
- Neuropathology, Instituto Nacional de Neurología y Neurocirugia, Ciudad de Mexico, MEX
| | - Mario Caba
- Neuroscience, Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, MEX
| | - Fernando R Ramos
- Chemistry, Instituto de Quimica Aplicada, Universidad Veracruzana, Xalapa, MEX
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Andriani H, Friska E, Arsyi M, Sutrisno AE, Waits A, Rahmawati ND. A multilevel analysis of the triple burden of malnutrition in Indonesia: trends and determinants from repeated cross-sectional surveys. BMC Public Health 2023; 23:1836. [PMID: 37735644 PMCID: PMC10512541 DOI: 10.1186/s12889-023-16728-y] [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: 03/22/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia. METHODS We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics. RESULTS Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds. CONCLUSION TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.
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Affiliation(s)
- Helen Andriani
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Erlin Friska
- Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Miftahul Arsyi
- Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Alphyyanto Eko Sutrisno
- Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Alexander Waits
- Institute of Public Health, International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nurul Dina Rahmawati
- Department of Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
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Vázquez‐Vázquez ADP, Fewtrell MS, Chan‐García H, Batún‐Marrufo C, Dickinson F, Wells JCK. Do maternal grandmothers influence breastfeeding duration and infant nutrition? Evidence from Merida, Mexico. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 179:444-459. [PMID: 36790606 PMCID: PMC9826188 DOI: 10.1002/ajpa.24623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Breast-feeding is sensitive to somatic, hormonal, behavioral and psychological components of maternal capital. However, through grandmothering, older women may also influence breast-feeding by transferring informational resources to their daughters. We hypothesized that mothers with prolonged instrumental support from their own mother are more likely to have received advice and to have favorable attitudes/practices regarding breastfeeding, compared to those lacking such support, with implications for the grandchild's somatic capital. METHODS We recruited 90 mother-infant dyads (52 with grandmaternal support, 38 without) in Merida, Yucatan, Mexico. All children were first-borns, aged ~2 years. Anthropometry and body composition were assessed. Data on grandmother's breastfeeding advice and maternal breastfeeding duration were obtained by questionnaire. Maternal attitudes to breast-feeding were assessed using the Iowa Infant Feeding Attitude Scale. RESULTS Women with instrumental support were more likely to have received grandmaternal advice during pregnancy/infancy on exclusive breast-feeding duration (60% vs. 37%, p = 0.033) and the type of first complementary food (81% vs. 47%, p = 0.001). However, women with support had a less favorable attitude to breastfeeding than those without and breastfed their children for less time (median 5 vs. 10.5 months, p = 0.01). No group differences were found in children's length, weight, skinfolds or lean mass z-score. DISCUSSION Although grandmothers providing instrumental support provided advice regarding breastfeeding, their attitudes may reflect issues beyond nutritional health. Advice of maternal grandmothers did not promote extended breastfeeding, however the differences in breastfeeding attitudes were not associated with the children's nutritional status. Grandmothers should be included in public health interventions promoting breastfeeding.
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Affiliation(s)
| | - Mary S. Fewtrell
- Childhood Nutrition Research Centre, UCLGreat Ormond Street Institute of Child HealthLondonUK
| | - Hidekel Chan‐García
- Human Ecology DepartmentCentre for Research and Advanced Studies (Cinvestav)MeridaYucatanMexico
| | - Carolina Batún‐Marrufo
- Human Ecology DepartmentCentre for Research and Advanced Studies (Cinvestav)MeridaYucatanMexico
| | - Federico Dickinson
- Human Ecology DepartmentCentre for Research and Advanced Studies (Cinvestav)MeridaYucatanMexico
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCLGreat Ormond Street Institute of Child HealthLondonUK
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Josan C, Shiplo S, Fusch G, Raha S, Shea AK. Cannabis use during lactation may alter the composition of human breast milk. Pediatr Res 2022:10.1038/s41390-022-02315-1. [PMID: 36195631 DOI: 10.1038/s41390-022-02315-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cannabis is often used by women to manage symptoms of morning sickness during pregnancy, and postpartum stress and anxiety. While exclusive breastfeeding has been recommended for the first 6 months of an infant's life, the presence of cannabinoids in the milk of cannabis users complicates this recommendation. The objective of this study was to investigate the effect of maternal cannabis use on changes in the levels of macronutrients and bioactive factors in breast milk. METHODS Milk was collected from women who were 6-8 weeks postpartum and were either using cannabis post-delivery, had used cannabis during pregnancy, or were non-users. Levels of cannabinoids, macronutrients, lactose, and SIgA were assessed in the milk of all subjects. RESULTS THC was detected in the milk of women who reported cannabis use during lactation (n = 13, median: 22 ng/mL). Carboxy-THC, 11-hydroxy-THC, CBD, and CBN were also detected in the milk of women who used cannabis postpartum. Relative to non-users (n = 17), lactose levels were higher and SIgA levels were significantly lower in the milk of subjects who used cannabis during lactation (n = 14). CONCLUSIONS The presence of cannabinoids, along with altered lactose and SIgA levels in the milk of cannabis users, may have implications for infant health. IMPACT Metabolites of cannabis are found in breast milk and can accumulate in higher concentrations with ongoing consumption, which is concerning for potential exposure among infants born to mothers who consume cannabis. This work reports that lactose levels are increased and SIgA levels are decreased in the breast milk of cannabis users, relative to the milk of non-users. Change in levels of lactose and SIgA in the milk of cannabis users may have significant implications on infant health, which must be investigated in the future to better inform mothers.
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Affiliation(s)
- Chitmandeep Josan
- Department of Pediatrics and the Medical Science Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Samantha Shiplo
- Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Gerhard Fusch
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sandeep Raha
- Department of Pediatrics and the Medical Science Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Alison K Shea
- Department of Obstetrics and Gynecology, St. Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
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Resistin Modulates the Functional Activity of Colostral Macrophages from Mothers with Obesity and Diabetes. Biomedicines 2022; 10:biomedicines10102332. [DOI: 10.3390/biomedicines10102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Obesity and diabetes are major public health problems. Resistin is an adipokine that links the two diseases. There are few reports regarding colostrum cells and resistin from mothers with obesity and diabetes. Thus, this study aimed to determine the functional activity of macrophages present in the breast milk and colostrum of diabetic mothers with obesity and the effects of resistin on these cells. Methods: The women were divided according to BMI and glycemic status into normal weight non-diabetic, obese non-diabetic, normal weight type 2 diabetic, or obese type 2 diabetic groups. ELISA determined the resistin in colostrum. The cell subsets and apoptosis were determined by flow cytometry and the functional activity of cells by fluorescence microscopy. Results: The resistin levels were higher in the colostrum from diabetic mothers with obesity. The frequencies of CD14+ cells and cells expressing CD95+, independent of resistin treatment, were higher in the colostrum from diabetic mothers with obesity. The frequency of cells expressing CD14+CD95+ was higher in cells not treated with resistin in the colostrum from diabetic mothers with obesity. Apoptosis, irrespective of the presence of resistin, increased, whereas microbicidal activity decreased in cells from diabetic mothers with obesity. Conclusion: The data suggest that hyperglycemia associated with low-grade inflammation caused by obesity affects the percentage of cells expressing CD14+CD95+, death by apoptosis, and microbicidal indices; meanwhile, resistin restored the microbicidal activity of colostrum cells.
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DYNAMICS OF SIgA CONTENT IN BREAST MILK WHEN RISK FACTORS AND LACTATIONAL CHARACTERISTICS ARE CONSIDERED. ACTA MEDICA LEOPOLIENSIA 2022. [DOI: 10.25040/aml2022.1-2.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The leading role associated with an anti-infective action of breast milk belongs to secretory IgA (SIgA). Therefore, the determination of the level of SIgA in colostrum and milk of mothers with different lactation levels and mothers at risk at different levels and duration of lactation has a practical interest.
Aim. The research aims at studying the dynamics of SIgA content in breast milk, taking into account risk factors and features of lactation.
Material and Methods. The content of SIgA in colostrum and breast milk of 372 mothers with full lactation and 208 with hypogalactia, of which 72 with early and 146 with late hypogalactia at different times of lactation (1-8 days and 1-3 months) was determined. The SIgA content was also studied in mothers; 65 with preeclampsia, including 12 with early hypogalactia, 24 with late hypogalactia, 23 with full lactation, and 44 with anemia of pregnancy, including 12 with early hypogalactia, 19 with late hypogalactia and 13 with full lactation. The determination of SIgA content in colostrum and milk was performed using the method of simple radial immunodiffusion in a gel by G. Mancini et al.
Results and Discussion. The SIgA concentration in colostrum and breast milk decreased during the secretion process. In early hypogalactia, the content of SIgA did not differ significantly from the level of SIgA in colostrum and breast milk with full lactation in the early neonatal period and at 1-3 months of secretion. In the late hypogalactia, SIgA content did not differ significantly from its level in the control group. Due to the lower amount of milk received by the mother's child with hypogalactia, the supply of children with SIgA is insufficient, and the deficit is higher the sooner the hypogalactia develops. Similar changes in the dynamics of SIgA content have been found in mothers with preeclampsia and at different levels of lactation. The exception was the content of SIgA in colostrum and milk of mothers with anemia of pregnancy and early hypogalactia, which in the first five days of lactation was lower than in mothers with full lactation.
Conclusion. The SIgA concentration in colostrum and breast milk decreases during the secretion process. The level of lactation does not affect the dynamics of SIgA content, except for the SIgA content in colostrum and breast milk of mothers with anemia of pregnancy and hypogalactia in the early stages of secretion. Despite the absence of a significant difference in SIgA levels in mothers with different levels of lactation due to less colostrum and milk received by children with early and late hypogalactia, the supply of SIgA is insufficient, and the cumulative deficit is higher the faster the hypogalactia develops.
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Chao J, Ko CY, Lin CY, Tomoji M, Huang CH, Chiang HC, Yang JJ, Huang SS, Su SY. Ethnobotanical Survey of Natural Galactagogues Prescribed in Traditional Chinese Medicine Pharmacies in Taiwan. Front Pharmacol 2021; 11:625869. [PMID: 33679390 PMCID: PMC7928277 DOI: 10.3389/fphar.2020.625869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 01/14/2023] Open
Abstract
Natural medicinal materials have been used to promote breast milk secretion. Here, we investigated the natural medicinal materials prescribed in traditional Chinese medicine (TCM) pharmacies across Taiwan to induce lactation. We collected medicinal materials from 87 TCM pharmacies, identified them in the prescriptions, and analyzed their drug contents. We examined their botanical origins, biological classifications, traditional usage, and modern pharmacological properties. We used the TCM Inheritance Support System to identify core medicinal materials in galactogenous prescriptions. We collected 81 medicinal materials from 90 galactogenous prescriptions. Leguminosae accounted for 12%, whereas Apiaceae accounted for 7% of all materials examined. The primary medicinal plant parts used were roots and seeds. Nineteen frequently used medicinal materials had a relative frequency of citation of greater than or equal to 0.2. According to their efficacy, 58% were warm, 54% were sweet, and 63% were tonifying; 74% of the frequently used medicinal materials have been showed efficacy against breast cancer. The primary core medicinal material was Angelica sinensis (Oliv.) Diels, whereas the secondary core medicinal materials were Tetrapanax papyrifer (Hook.) K. Koch and Hedysarum polybotrys Hand.-Mazz. Most galactogenous prescriptions consisted of multiple materials from Leguminosae and Apiaceae. The mechanisms underlying galactogenous efficacy warrant further investigations.
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Affiliation(s)
- Jung Chao
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
| | - Chien-Yu Ko
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Chin-Yu Lin
- Institute of New Drug Development, China Medical University, Taichung, Taiwan.,Tsuzuki Institute for Traditional Medicine, China Medical University, Taichung, Taiwan
| | - Maeda Tomoji
- Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, Saitama, Japan.,Tsuzuki Institute for Traditional Medicine, China Medical University, Taichung, Taiwan
| | | | - Hung-Che Chiang
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Jeng-Jer Yang
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shyh-Shyun Huang
- School of Pharmacy, China Medical University, Taichung, Taiwan.,Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Shan-Yu Su
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Vidal K, Sultana S, Patron AP, Salvi I, Shevlyakova M, Foata F, Rahman M, Deeba IM, Brüssow H, Ahmed T, Sakwinska O, Sarker SA. Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh. Front Pediatr 2021; 9:728382. [PMID: 35083183 PMCID: PMC8785242 DOI: 10.3389/fped.2021.728382] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
Objectives: Risk factors for acute respiratory infections (ARIs) in community settings are not fully understood, especially in low-income countries. We examined the incidence and risk factors associated with ARIs in under-two children from the Microbiota and Health study. Methods: Children from a peri-urban area of Dhaka (Bangladesh) were followed from birth to 2 years of age by both active surveillance of ARIs and regular scheduled visits. Nasopharyngeal samples were collected during scheduled visits for detection of bacterial facultative respiratory pathogens. Information on socioeconomic, environmental, and household conditions, and mother and child characteristics were collected. A hierarchical modeling approach was used to identify proximate determinants of ARIs. Results: Of 267 infants, 87.3% experienced at least one ARI episode during the first 2 years of life. The peak incidence of ARIs was 330 infections per 100 infant-years and occurred between 2 and 4 months of age. Season was the main risk factor (rainy monsoon season, incidence rate ratio [IRR] 2.43 [1.92-3.07]; cool dry winter, IRR 2.10 [1.65-2.67] compared with hot dry summer) in the first 2 years of life. In addition, during the first 6 months of life, young maternal age (<22 years; IRR 1.34 [1.01-1.77]) and low birth weight (<2,500 g; IRR 1.39 [1.03-1.89]) were associated with higher ARI incidence. Conclusions: Reminiscent of industrialized settings, cool rainy season rather than socioeconomic and hygiene conditions was a major risk factor for ARIs in peri-urban Bangladesh. Understanding the causal links between seasonally variable factors such as temperature, humidity, crowding, diet, and ARIs will inform prevention measures.
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Affiliation(s)
- Karine Vidal
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Shamima Sultana
- International Center for Diarrheal Disease Research (icddr, b), Dhaka, Bangladesh
| | | | - Irene Salvi
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Maya Shevlyakova
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Francis Foata
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Mahbubur Rahman
- International Center for Diarrheal Disease Research (icddr, b), Dhaka, Bangladesh
| | - Iztiba Mallik Deeba
- International Center for Diarrheal Disease Research (icddr, b), Dhaka, Bangladesh
| | - Harald Brüssow
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland.,Department of Biosystems, Division of Animal and Health Engineering, University of Leuven, Leuven, Belgium
| | - Tahmeed Ahmed
- International Center for Diarrheal Disease Research (icddr, b), Dhaka, Bangladesh
| | - Olga Sakwinska
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Shafiqul Alam Sarker
- International Center for Diarrheal Disease Research (icddr, b), Dhaka, Bangladesh
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Kaplan O, Wainstock T, Sheiner E, Staretz-Chacham O, Walfisch A. Maternal anemia and offspring failure to thrive - results from a large population-based cohort. J Matern Fetal Neonatal Med 2019; 34:3889-3895. [PMID: 31847635 DOI: 10.1080/14767058.2019.1702018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To evaluate whether an association exists between maternal anemia and offspring failure to thrive (FTT) during childhood.Methods: A population-based cohort analysis was performed, comparing the risk for FTT among children (up to 18 years old) based on maternal hemoglobin (Hb) levels, upon postpartum discharge. Maternal Hb levels were categorized into 3 levels: <9.0 (moderate-severe anemia), 9.0-11.0 (mild anemia), and ≥11.0 g/dL (no anemia). FTT diagnosis was based on hospital records. All singletons born between 1991 and 2014 and discharged alive without congenital malformations were included. A survival curve was constructed to compare the cumulative FTT incidence, and a Weibull parametric survival analysis to assess the independent association between maternal anemia and offspring FTT while controlling for confounders.Results: Of the 214,305 included deliveries, 22,071 parturients (10.3%) were discharged with Hb <9.00; 83,932 (39.2%) with Hb between 9.0-11.0; and 108,302 (50.5%) with Hb ≥11.0 g/dL. FTT rates were 1.3% (n = 287), 1.2% (n = 967), and 1.1% (n = 1141) in the same groups, respectively (p = .003). The survival curve demonstrated a significantly higher cumulative incidence of FTT diagnosis in the moderate-severe maternal anemia group (p < .001). In the Weibull analysis, constructed for newborns with appropriate birthweight, both groups of maternal anemia were found to be independently associated with FTT related hospitalizations (mild anemia aHR, 1.1; 95%CI 1.002-1.219; p = .045, moderate-severe anemia aHR, 1.321; 95%CI, 1.141-1.529; p < .001).Conclusion: Maternal anemia is independently associated with long-term FTT in offspring, with increasing FTT rates proportional to anemia severity.
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Affiliation(s)
- Omer Kaplan
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Orna Staretz-Chacham
- Department of Neonatology, Metabolic clinic, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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11
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Corbitt M, Paredes Ruvalcaba N, Fujita M. Variation in breast milk macronutrient contents by maternal anemia and hemoglobin concentration in northern Kenya. Am J Hum Biol 2019; 31:e23238. [PMID: 30908793 DOI: 10.1002/ajhb.23238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/23/2019] [Accepted: 03/09/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study explored differing levels of macronutrients in breast milk in relation to maternal anemia and hemoglobin. METHODS Archived milk specimens and data from a cross-sectional sample of 208 breastfeeding mothers in northern Kenya, originally collected in 2006, were analyzed; data included milk fat, maternal hemoglobin concentration, and anemia status (anemia defined as hemoglobin <12 g/dL). Total protein and lactose were measured and energy was calculated. To explore the association between milk outcomes (fat, protein, lactose, and energy) and anemia, regression models were constructed with and without adjustment for maternal age, parity, and time (days) postpartum. The same models were constructed using hemoglobin as a continuous predictor in lieu of dichotomous anemia to explore the role of hemoglobin levels and anemia severity in predicting milk outcomes. RESULTS The group comparison indicated significantly higher milk protein and lower milk fat for anemic mothers relative to nonanemic counterparts. After adjustment for maternal age, parity, and time postpartum, maternal anemia was associated with significantly higher milk protein (P = 0.001) and significantly lower milk fat (P = 0.025). Hemoglobin had a significant inverse relationship with milk protein (P = 0.017) and a marginally significant positive relationship with milk fat (P = 0.060) after adjusting for the maternal variables. Neither anemia nor hemoglobin was significant in predicting lactose or milk energy. CONCLUSIONS Maternal anemia and hemoglobin concentration may be associated with complex changes in milk macronutrients. Future research should clarify the impact of maternal anemia on a range of breast milk components while accounting for other maternal characteristics.
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Affiliation(s)
- Mary Corbitt
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
| | - Masako Fujita
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
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Fujita M, Ruvalcaba NP, Wander K, Corbitt M, Brindle E. Buffered or impaired: Maternal anemia, inflammation and breast milk macronutrients in northern Kenya. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 168:329-339. [PMID: 30575959 PMCID: PMC6352968 DOI: 10.1002/ajpa.23752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/25/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Maternal anemia has adverse consequences for the mother-infant dyad. To evaluate whether and how milk nutrient content may change in ways that could "buffer" infants against the conditions underlying maternal anemia, this study assessed associations between milk macronutrients and maternal iron-deficiency anemia (IDA), non-iron-deficiency anemia (NIDA), and inflammation. METHODS A secondary analysis of cross-sectional data and milk from northern Kenya was conducted (n = 204). The combination of hemoglobin and transferrin receptor defined IDA/NIDA. Elevated serum C-reactive protein defined acute inflammation. The effects of IDA, NIDA, and inflammation on milk macronutrients were evaluated in regression models. RESULTS IDA (β = 0.077, p = .022) and NIDA (β = 0.083, p = .100) predicted higher total protein (ln). IDA (β = -0.293, p = .002), NIDA (β = -0.313, p = .047), and inflammation (β = -0.269, p = .007) each predicted lower fat (ln); however, anemia accompanying inflammation predicted higher fat (β = 0.655, p = .007 for IDA and β = 0.468, p = .092 for NIDA). NIDA predicted higher lactose (β = 1.020, p = .003). CONCLUSIONS Milk macronutrient content both increases and decreases in the presence of maternal anemia and inflammation, suggesting a more complicated and dynamic change than simple impairment of nutrient delivery during maternal stress. Maternal fat delivery to milk may be impaired under anemia. Mothers may buffer infant nutrition against adverse conditions or poor maternal health by elevating milk protein (mothers with IDA/NIDA), lactose (mothers with NIDA), or fat (mothers with anemia and inflammation). This study demonstrates the foundational importance of maternal micronutrient health and inflammation or infection for advancing the ecological understanding of human milk nutrient variation.
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Affiliation(s)
- Masako Fujita
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Katherine Wander
- Department of Anthropology, Binghamton University (SUNY)
- Laboratory for Anthropometry and Biomarkers, Binghamton University (SUNY)
| | - Mary Corbitt
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington
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Jorgensen JM, Arnold C, Ashorn P, Ashorn U, Chaima D, Cheung YB, Davis JCC, Fan YM, Goonatilleke E, Kortekangas E, Kumwenda C, Lebrilla CB, Maleta K, Totten SM, Wu LD, Dewey KG. Lipid-Based Nutrient Supplements During Pregnancy and Lactation Did Not Affect Human Milk Oligosaccharides and Bioactive Proteins in a Randomized Trial. J Nutr 2017; 147:1867-1874. [PMID: 28794206 PMCID: PMC5610548 DOI: 10.3945/jn.117.252981] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/12/2017] [Accepted: 07/10/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Human milk oligosaccharides (HMOs) and bioactive proteins are beneficial to infant health. Recent evidence suggests that maternal nutrition may affect the amount of HMOs and proteins in breast milk; however, the effect of nutrient supplementation on HMOs and bioactive proteins has not yet been well studied. OBJECTIVE We aimed to determine whether lipid-based nutrient supplements (LNSs) affect milk bioactive protein and HMO concentrations at 6 mo postpartum in women in rural Malawi. These are secondary outcomes of a previously published randomized controlled trial. METHODS Women were randomly assigned to consume either an iron and folic acid capsule (IFA) daily from ≤20 wk gestation until delivery, followed by placebo daily from delivery to 6 mo postpartum, or a multiple micronutrient (MMN) capsule or LNS daily from ≤20 wk gestation to 6 mo postpartum. Breast milk concentrations of total HMOs, sialylated HMOs, fucosylated HMOs, lactoferrin, lactalbumin, lysozymes, antitrypsin, immunoglobulin A, and osteopontin were analyzed at 6 mo postpartum (n = 647). Between-group differences in concentrations and in proportions of women classified as having low concentrations were tested. RESULTS HMO and bioactive protein concentrations did not differ between groups (P > 0.10 for all comparisons). At 6 mo postpartum, the proportions of women with low HMOs or bioactive proteins were not different between groups except for osteopontin. A lower proportion of women in the IFA group had low osteopontin compared with the LNS group after adjusting for covariates (OR: 0.5; 95% CI: 0.3, 0.9; P = 0.016). CONCLUSION The study findings do not support the hypothesis that supplementation with an LNS or MMN capsule during pregnancy and postpartum would increase HMO or bioactive milk proteins at 6 mo postpartum among Malawian women. This trial was registered at clinicaltrials.gov as NCT01239693.
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Affiliation(s)
| | | | - Per Ashorn
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Biochemistry and Molecular Medicine, University of California, Davis, Davis, CA
| | - David Chaima
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore; and,Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
| | | | - Yue-Mei Fan
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | - Emma Kortekangas
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Chiza Kumwenda
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Carlito B Lebrilla
- Chemistry, and,Biochemistry and Molecular Medicine, University of California, Davis, Davis, CA
| | - Kenneth Maleta
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
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Holm C, Thomsen LL, Norgaard A, Markova V, Michaelsen KF, Langhoff_Roos J. Iron concentration in breast milk normalised within one week of a single high-dose infusion of iron isomaltoside in randomised controlled trial. Acta Paediatr 2017; 106:256-260. [PMID: 27883237 DOI: 10.1111/apa.13681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/03/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
AIM We compared the iron concentration in breast milk after a single high dose of intravenous iron isomaltoside or daily oral iron for postpartum haemorrhage. METHODS In this randomised controlled trial, the women were allocated a single dose of intravenous 1200 mg iron isomaltoside or oral iron at a mean daily dose of 70.5 mg. We included 65 women with sufficient breast milk three days after inclusion - 30 from the intravenous iron group and 35 from the oral iron group - and collected breast milk and maternal blood samples three days and one week after allocation. RESULTS The mean (±SD) iron concentration in breast milk in the intravenous and oral groups was 0.72 ± 0.27 and 0.40 ± 0.18 mg/L at three days (p < 0.001) and 0.47 ± 0.17 and 0.44 ± 0.25 mg/L after one week (p = 0.64). Baseline samples were not available that soon after birth. CONCLUSION A single high dose of intravenous iron isomaltoside for postpartum haemorrhage led to a transient increase in the iron concentration in breast milk three days after treatment compared with oral iron. The difference disappeared one week after treatment, and mean iron concentrations were within the normal range in all samples.
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Affiliation(s)
- Charlotte Holm
- Department of Obstetrics Juliane Marie Centre Rigshospitalet University of Copenhagen Copenhagen Denmark
- Pharmacosmos A/S Holbaek Denmark
| | | | - Astrid Norgaard
- Section for Transfusion Medicine 2034 Capital Region Blood Bank Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Veronika Markova
- Department of Obstetrics Juliane Marie Centre Rigshospitalet University of Copenhagen Copenhagen Denmark
- Pharmacosmos A/S Holbaek Denmark
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports Faculty of Science University of Copenhagen Copenhagen Denmark
| | - Jens Langhoff_Roos
- Department of Obstetrics Juliane Marie Centre Rigshospitalet University of Copenhagen Copenhagen Denmark
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Fujimori M, França EL, Fiorin V, Morais TC, Honorio-França AC, de Abreu LC. Changes in the biochemical and immunological components of serum and colostrum of overweight and obese mothers. BMC Pregnancy Childbirth 2015; 15:166. [PMID: 26264971 PMCID: PMC4534120 DOI: 10.1186/s12884-015-0574-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 05/28/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Obesity in pregnancy is associated with systemic inflammation, immunological changes and adverse maternal-fetal outcomes. Information on the association between maternal obesity and breast milk composition is scarce. This study describes changes and relationships between biochemical and immunological parameters of colostrum and serum of overweight and obese women. METHODS Colostrum and blood samples were collected from 25 normal weight, 24 overweight and 19 obese women for determination of glucose, total protein, triglycerides, cholesterol, immunoglobulins, complement proteins (C3 and C4), fat and calorie content and C-reactive protein (CRP). RESULTS Glucose was higher in colostrum of obese women (p = .002). In normal weight and obese women, total protein content was higher in colostrum than in serum (p = .001). Serum triglycerides (p = .008) and cholesterol (p = .010) concentrations were significantly higher in overweight and obese women than in their normal weight counterparts, but in colostrum their concentrations were similar across the three groups. Secretory IgA (sIgA) in colostrum and IgA in serum concentrations were significantly higher (p = .001) in overweight and obese mothers, whereas IgG and IgM concentrations did not vary among the groups (p = .825). Serum C3 (p = .001) and C4 (p = .040) concentrations were higher in obese women. No differences in colostrum complement proteins were detected among the groups. Calorie content (p = .003) and fat (p = .005) concentrations in colostrum and serum CRP (p = .002) were higher in obese women. CONCLUSIONS The results corroborate the hypothesis that colostrum of overweight and obese women undergoes biochemical and immunological changes that affect its composition, namely increasing glucose concentrations, calorie content, fat and sIgA concentrations.
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Affiliation(s)
- Mahmi Fujimori
- Department of Maternal and Child Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
| | - Eduardo L França
- Institute of Biological and Health Science, Federal University of Mato Grosso, Barra do Garças, MT, Brazil.
| | - Vanessa Fiorin
- Laboratory of Scientific Writing, Department of Morphology and Physiology, School of Medicine of ABC, Santo André, SP, Brazil.
| | - Tassiane C Morais
- Department of Maternal and Child Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
- Institute of Biological and Health Science, Federal University of Mato Grosso, Barra do Garças, MT, Brazil.
| | - Adenilda C Honorio-França
- Institute of Biological and Health Science, Federal University of Mato Grosso, Barra do Garças, MT, Brazil.
| | - Luiz C de Abreu
- Department of Maternal and Child Health, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
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Morais TC, Honorio-França AC, Silva RR, Fujimori M, Fagundes DLG, França EL. Temporal fluctuations of cytokine concentrations in human milk. BIOL RHYTHM RES 2015. [DOI: 10.1080/09291016.2015.1056434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Massmann PF, França EL, Souza EGD, Souza MS, Brune MFSS, Honorio-França AC. Maternal hypertension induces alterations in immunological factors of colostrum and human milk. FRONTIERS IN LIFE SCIENCE 2014. [DOI: 10.1080/21553769.2013.876451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Quinn EA. Too much of a good thing: Evolutionary perspectives on infant formula fortification in the United States and its effects on infant health. Am J Hum Biol 2013; 26:10-7. [DOI: 10.1002/ajhb.22476] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/24/2013] [Accepted: 09/26/2013] [Indexed: 12/12/2022] Open
Affiliation(s)
- Elizabeth A. Quinn
- Department of Anthropology; Washington University in St. Louis; St. Louis, Missouri 63130
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