Nutritional status of lactating mothers and their breast milk concentration of iron, zinc and copper in rural Vietnam

Breastmilk mineral composition among well-educated mothers from Central Poland - Associations with maternal dietary intake, dietary patterns and infant psychomotor development

BACKGROUND

Maternal dietary habits could affect breastmilk mineral composition, which may influence infant development. Mineral dietary intake or supplementation slightly affects its breastmilk concentration. However, the intake of selected food groups or dietary patterns that reflect diet complexity could have a greater impact. Hence, the aim of the study was to assess breastmilk mineral composition at one, three, and six months of lactation among mothers living in urban area of Central Poland, as well as the evaluate maternal dietary determinants and associations with infant anthropometric and psychomotor development.

METHODS

The study was conducted among 43 healthy and exclusively breastfeeding mothers. In the first, third, and sixth months of lactation, we collected breastmilk samples and assessed the concentration of Ca, P, Zn, Fe, Se, Ni, As, Pb, and Cd using the ICP-MS method. Maternal dietary habits were evaluated by a food frequency questionnaire in the first month of lactation, whereas in the third and sixth by the three-day food record. Based on the collected data adherence to the Polish-adapted Mediterranean (Pl-aMED; 1 month) and the DASH diet (Mellen's Index; 3 and 6 months) was assessed. In the third and sixth months of lactation infant anthropometric parameters and the sixth month of lactation psychomotor development were evaluated.

RESULTS

Breastmilk Se, Ni, As, Pb, and Cd levels were under the LOQ in all the breastmilk samples at all study visits. Median breastmilk mineral concentrations of Ca, P, Zn, and Fe in the first, third, and sixth months of lactation varied from 381.9 to 332.7 mg/L, 161.6 to 139.1 mg/L, 2.2 to 0.8 mg/L, and 0.26 to 0.17 mg/L, respectively. Maternal dietary intake and supplementation did not affect breastmilk Ca, P, Zn, and Fe. Pl-aMED scores were associated with breastmilk Ca (β = 0.489, 95% CI 0.180 - 0.799, p = 0.003) and Zn (β = 0.499, 95% CI 0.199 - 0.798, p = 0.002) in the first month of lactation, whereas no association with the DASH diet were observed in the third and sixth month of lactation. Breastmilk Fe in the third month was associated with infant motor development (β = 0.420, 95% CI 0.113 - 0.727, p = 0.009) in the sixth month of life, but no other associations with anthropometric or psychomotor development were observed. Moreover, we estimated that few infants meet their adequate intake (AI) requirements for P, Zn, and Fe.

CONCLUSION

Our study showed that maternal adherence to Pl-aMED is a significant predictor of breastmilk Ca and Zn in the first month of lactation, which may be especially important considering that more than 75% of infants had inadequate Zn intake. Moreover, we found that breastmilk Fe positively influenced infant motor development, despite the majority of infants having inadequate intake. On the other hand, no infant had deficiency symptoms, which emphasizes the necessity to evaluate of AI norms for infants.

Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review

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.

Undernutrition and associated factors among lactating mothers in rural Yilmana Densa District, Northwest Ethiopia: A community-based cross-sectional study

Undernutrition is continued to be significant public health problem worldwide. The extra calories and nutrients required to support breastfeeding make lactating mothers at higher risk of malnutrition than general population. Undernourished lactating mothers have also been found to influence both the quantity and quality of breast milk and then the nutritional and health status of their offspring. Different evidence showed that undernutrition among lactating mothers is a serious public health problem in Ethiopia in which one of every four lactate mothers are undernourished. Despite this fact, the prevalence of undernutrition among lactating women in Ethiopian was not well investigated and very limited number of studies are conducted. This study aims to assess the prevalence of undernutrition and associated factors among lactating mothers in rural Yilmana Densa District, Northwest Ethiopia. A community-based cross-sectional study was conducted among 428 lactating mothers. The data were collected by using interviewers administered structured questionnaire; and also, anthropometric measurements were taken from the study participants. Binary logistic regression model was undertaken to identify significantly associated factors with undernutrition. The prevalence of undernutrition among lactating mothers was 22.6%. Household income, food security status, dietary diversity score, number of meals, potable water source, and latrine facility were found to be significantly associated with undernourishment of lactating mothers. A significant proportion of lactating mothers in the district suffered from undernutrition and hence, to improve nutritional status of lactating mothers, strategies should focus on nutrition counseling, advancing diversified production and consumption, improvement of access to potable water and latrine, as well as effective household food security interventions.

Mammary Leukocyte-Assisted Nanoparticle Transport Enhances Targeted Milk Trace Mineral Delivery

Nanoparticles are applied as versatile platforms for drug/gene delivery in many applications owing to their long-retention and specific targeting properties in living bodies. However, the delivery mechanism and the beneficial effect of nanoparticle-retention in many organisms remain largely uncertain. Here, the transport and metabolism of mineral nanoparticles in mammary gland during lactation are explored. It is shown that maternal intravenous administration of iron oxide nanoparticles (IONPs; diameter: ≈11.0 nm, surface charge: -29.1 mV, surface area: 1.05 m2 g-1 ) provides elevated iron delivery to mammary gland and increased iron secretion into breast milk, which is inaccessible by classical iron-ion transport approaches such as the transferrin receptor-mediated endocytic pathway. Mammary macrophages and neutrophils are found to play dominant roles in uptake and delivery of IONPs through an unconventional leukocyte-assisted iron secretion pathway. This pathway bypasses the tight iron concentration regulation of liver hepcidin-ferroportin axis and mammary epithelial cells to increase milk iron-ion content derived from IONPs. This work provides keen insight into the metabolic pathway of nanoparticles in mammary gland while offering a new scheme of nutrient delivery for neonate metabolism regulation by using nanosized nutrients.

Under-Nutrition and Associated Factors Among Lactating Mothers in Ethiopia: A Systematic Review and Meta-analysis

INTRODUCTION

Under-nutrition (body mass index < 18.5 kg/m²) is a global problem with an increasing trend in recent years. The burden is high in low and middle-income countries, especially in Africa. Lactating mothers are among the most vulnerable groups for under nutrition; particularly in sub-Saharan Africa. In Ethiopia, the prevalence of under-nutrition among this group is inconsistent and inconclusive. Therefore, we aimed to assess the pooled prevalence of under-nutrition and its associated factors among lactating mothers in Ethiopia.

METHODS

To write this review and meta-analysis, we followed the preferred reporting items for systematic review and meta-analysis guidelines. Primary articles were searched from PubMed, Hinari, Cochrane Library, science direct databases, Google, and Google scholar. STATA version 16 software and a standardized Microsoft excel format were used for analysis and data extraction, respectively. Heterogeneity between studies was checked. To determine the pooled prevalence of under-nutrition, we used a random-effect model. Begg's and Egger's tests were done to detect publication bias. Subgroup analysis was also steered and association was uttered by a pooled odds ratio with 95% CI.

RESULTS

The pooled prevalence of under-nutrition among lactating mothers was 23.84% [95% CI (19.40, 28.27)]. Educational status (no formal education) {Pooled OR 2.30 [95% CI (1.34, 3.96)]} was significantly associated with under-nutrition.

CONCLUSION

The pooled prevalence of under-nutrition was high. Maternal educational status was significantly associated with under-nutrition. Therefore, the federal ministry of health and the concerned stakeholders should give attention to these most vulnerable groups and strengthen the implementation of the previously designed strategies.

Prevalence of Undernutrition and Its Associated Factors Among Lactating Women in the Shebedino District, Sidama Regional State, Ethiopia

Background: Ensuring the nutritional status of lactating women is crucial to prevent maternal morbidity and mortality in poor countries like Ethiopia. Hence, this study aimed to assess the prevalence of undernutrition and its associated factors among lactating women in Shebedino district, Sidama Regional State, Ethiopia.

Methods: A community-based cross-sectional study was conducted among randomly selected 612 lactating women from February to March 2020. Data were collected by using an interviewer-administered, structured, and pretested questionnaire. Also, physical measurements (weight, height, and body mass index) were measured by using standardized and calibrated instruments. Data entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. A P-value of ≤.05 was used to consider the statistical significance.

Result: The prevalence of undernutrition was 25.9% (95% CI: 22.5, 29.5). Having polygamous husband (AOR = 3.47, 95% CI: 1.13, 10.68), belonged to households with less than 5 members (AOR = 1.81, 95% CI: 1.16, 2.83), abortion history in the last 6 months (AOR = 3.09, 95% CI: 1.73, 5.51), poor household wealth status (AOR = 3.85, 95% CI: 1.89, 7.81), and medium wealth status (AOR = 2.07, 95% CI: 1.06, 4.03) were factors positively associated with undernutrition.

Conclusion: Undernutrition among lactating women was high in the study area. Attention should be given to the economic status of the women, family planning services, abortion prevention, and habits of marrying more than 1 wife (polygamy).

Heavy Metals and Trace Elements in Human Breast Milk from Industrial/Mining and Agricultural Zones of Southeastern Spain

Human breast milk is the most complete foodstuff for infants but can also be a potential source of exposure to toxic chemicals. The aim of this study was to assess the levels of metal pollution in the breast milk of women living in agricultural and industrial/mining areas of the Region of Murcia (Spain) that are well known for their cases of environmental pollution. Human milk samples were collected from 50 mothers and inorganic contaminants were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). The mean or maximum concentrations of the different inorganic elements analyzed in breast milk, with the exception of manganese, exceeded the maximum limits established by the WHO and could constitute a high risk for pregnant mothers and their children. The breast milk of women living in the industrial/mining zone presented the highest levels of aluminum, zinc, arsenic, lead, mercury and nickel. On the contrary, the highest concentrations of manganese, chromium and iron were determined in the milk of women living in the agricultural zone. These results suggested and confirmed different profiles of environmental contamination of these areas.

Underweight and associated factors among lactating women in Uganda: Evidence from the Uganda demographic health survey 2016

BACKGROUND

Lactating mothers are at increased risk of being underweight because of the physiological changes that lead to disproportionately higher energy and nutrient requirements compared to their non-pregnant and non-lactating counterparts.

OBJECTIVE

We aimed to determine the prevalence and factors associated with being underweight among lactating women in Uganda.

METHODS

We used the Uganda Demographic and Health Survey (UDHS) 2016 data of 1356 women aged 20 to 49 years. Multistage stratified sampling was used to select study participants. The data were collected using validated questionnaires. We used multivariable logistic regression to determine factors associated with underweight among 20 to 49-year-old lactating women in Uganda.

RESULTS

The prevalence of underweight was 8.2% (111/1356) (95% confidence interval, [CI]: 7.0-10.0). Women who had no education were 10.21 (adjusted odds ratio, [AOR] = 10.21; 95% CI: 1.61-64.74) times as likely to be underweight as those who had higher (post-secondary) education levels. Women who were not working were 50% (AOR = 0.50; 95% CI: 0.26-0.94) less likely to be underweight compared to those who were working. Women in the Western (AOR = 0.15; 95% CI: 0.07-0.32), Eastern (AOR = 0.34; 95% CI: 0.18-0.66), and Central (AOR = 0.30; 95% CI: 0.12-0.74) regions were 85%, 66% and 70% respectively less likely to be underweight compared to those in the Northern region.

CONCLUSION

Based on the findings of this and other studies, it is important for the different stakeholders to design targeted nutrition programs for lactating women particularly those with low levels of education and those from the Northern region.

A landscape of micronutrient status in women through the reproductive years: Insights from seven regions in Asia

Optimal micronutrient status is critical to the health of women, particularly during their reproductive years. A woman’s health and nutritional status during the preconception stage thus has significant implications for pregnancy outcomes and her offspring’s health later in life. In this review, we evaluated micronutrient intakes and status (iron, folate, and vitamin B12) of women in their reproductive years and during pregnancy, along with associated health consequences and dietary causes, across seven regions in Asia, namely, Hong Kong, Indonesia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. A structured literature search, targeting peer-reviewed publication databases, as well as data from international and national sources in the public domain, was conducted. Our review of the nutritional landscape demonstrates that micronutrient deficiency–related conditions, especially anemia and its associated health consequences, are common among Asian women of reproductive age, yet the dietary causes are poorly studied. Inadequate or borderline dietary intake of micronutrients and low consumption of micronutrient supplements were evident, despite existing recommendations, food fortification, and supplementation strategies. Evaluation of current programs through nutrition monitoring and improvement of supplementation strategies, such as supplementing with multiple micronutrients, alongside food-based programs, will help better support the health of women through their reproductive years.

Nearly one-third of lactating mothers are suffering from undernutrition in pastoral community, Afar region, Ethiopia: Community-based cross-sectional study

Background

Undernutrition is responsible for a significant proportion of maternal and child morbidity and mortality. Lactating women are nutritionally vulnerable groups because this period places a high nutritional demand on the mother and leads to nutritional stress. Poor nutrition during lactation has a significant negative consequence to mothers and children’s survival, growth, and development. Therefore this study aimed to assess the nutritional status of lactating mothers and associated factors in pastoral community, Afar region, Ethiopia.

Methods

A community-based cross-sectional study was conducted from January 5/2020 to February 10/2020, in the Abala district. The data were collected from a sample of 366 lactating mothers whose children aged less than 24 months. Data was collected through face-to-face interviews and anthropometric measurements. Study participants were recruited using a systematic sampling technique. Anthropometric measurements (both body mass index and mid-upper arm circumference) were taken from each mother using calibrated equipment and standardized techniques. Data were entered into Epi-data version 4.2 and exported to SPSS version 22 for analysis. Predictor variables with a P-value < 0.25 at bivariable analysis were candidates for the final model. Statistical significance was declared at P-value of < 0.05 in the multivariable logistic regression.

Result

This study showed that 120(32.8%) and 122(33.3%) surveyed mothers were undernourished using a cut-off body mass index <18.5 kg/m² and mid-upper arm circumference <23 Centimeter, respectively. Lactating mothers who didn’t meet the minimum dietary diversity score were more than five (Adjusted odds ratio (AOR) = 5.103; 95% confidence interval (CI): 2.128, 12.238) times more likely to be undernourished than those who met the minimum dietary diversity score. Mothers with short birth intervals were also more than four (AOR = 4.800; 95% CI: 2.408, 9.567) time more likely to be undernourished.

Conclusion

Nearly one-third of lactating mothers were undernourished. Undernutrition among lactating mothers was significantly associated with maternal dietary diversity score and birth interval. Health education on proper and adequate maternal dietary feeding practices, and proper family planning utilization during lactation should be emphasized.

The Gut‒Breast Axis: Programming Health for Life

The gut is a pivotal organ in health and disease. The events that take place in the gut during early life contribute to the programming, shaping and tuning of distant organs, having lifelong consequences. In this context, the maternal gut plays a quintessence in programming the mammary gland to face the nutritional, microbiological, immunological, and neuroendocrine requirements of the growing infant. Subsequently, human colostrum and milk provides the infant with an impressive array of nutrients and bioactive components, including microbes, immune cells, and stem cells. Therefore, the axis linking the maternal gut, the breast, and the infant gut seems crucial for a correct infant growth and development. The aim of this article is not to perform a systematic review of the human milk components but to provide an insight of their extremely complex interactions, which render human milk a unique functional food and explain why this biological fluid still truly remains as a scientific enigma.

The Triad Mother-Breast Milk-Infant as Predictor of Future Health: A Narrative Review

The benefits of human milk for both mother and infant are widely acknowledged. Human milk could represent a link between maternal and offspring health. The triad mother-breast milk-infant is an interconnected system in which maternal diet and lifestyle might have effects on infant's health outcome. This link could be in part explained by epigenetics, even if the underlining mechanisms have not been fully clarified yet. The aim of this paper is to update the association between maternal diet and human milk, pointing out how maternal diet and lifestyle could be associated with breast-milk composition, hence with offspring's health outcome.

Investigation of Iron and Zinc Concentrations in Human Milk in Correlation to Maternal Factors: An Observational Pilot Study in Poland

The aim of this study was to evaluate iron and zinc concentrations in the mature human milk (HM) and to investigate the relationship between these concentrations and maternal factors. HM samples were collected between 4–6 weeks postpartum from 32 healthy, exclusively breastfeeding mothers. The assessment of dietary intake during breastfeeding was based on a food frequency questionnaire and three-day dietary records. Nutritional status of participants was assessed with body mass index and body composition analysis, measured with bioelectrical impedance. HM intake was assessed with infants’ weighting, whereas iron and zinc contents in HM were determined by inductively coupled plasma mass spectrometer. The median intake of HM was 492.5 mL (466–528.5) and the concentrations of HM iron and zinc were 0.33 mg/L (0.26–0.46) and 2.12 mg/L (1.97–2.45), respectively. Maternal total zinc and iron intake (diet + supplementation) was positively correlated with their concentrations in HM. Consumption frequency of meat, vegetables and legumes was revealed to be a significant factor influencing zinc concentration in HM. Regarding iron, it was the consumption frequency of meat, fish and seafood, vegetables and legumes, nuts and seeds. The intake of iron from HM was low, and after assuming a mean fractional iron absorption, it was only 0.038 mg/d. Our results show that maternal diet influences iron and zinc content in HM, suggesting that adequate intake of food rich in investigated minerals may be a positive factor for their concentrations in HM.

Dietary Intake and Milk Micronutrient Levels in Lactating Women with Full and Partial Breastfeeding

BACKGROUND

Micronutrient intake and status in lactating women may impact micronutrient levels in milk.

OBJECTIVES

This study aimed to determine the micronutrient intake and status in lactating women, and their association with micronutrient levels in human milk.

METHODS

Lactating women were enrolled at 4-6 months postpartum. A 24h food recall was examined and nutrient intakes were analyzed using INMUCAL software. Human milk samples were collected to analyze calcium, copper, iron, and zinc levels. Plasma zinc and serum ferritin levels were determined.

RESULTS

Thirty-four women participated; 19 were classified as full breastfeeding and 15 as partial breastfeeding. Mean levels of calcium, copper, iron, and zinc in human milk were 243, 0.2, 0.2, and 1.56 mg/L, respectively. The prevalence of zinc deficiency (plasma zinc < 10.7 µmol/L) was 11.8%. No lactating women had iron deficiency. Nutrient intakes were lower than the recommended amounts in 38%-70% of participants, and were not correlated with corresponding nutrient levels in human milk. Multiple linear regression showed significant association between zinc levels in human milk and plasma for lactating women with full breastfeeding (β = 0.034, 95% confidence interval [0.003, 0.067], p = 0.040).

CONCLUSIONS

Lactating women were at risk of micronutrient deficiency. There was an association between zinc levels in human milk and plasma of lactating women with full breastfeeding. As the nutritional status of lactating women influences the quality of human milk, we should encourage good nutrient intake for lactating women.

Determining the Actual Zinc and Iron Intakes in Breastfed Infants: Protocol for a Longitudinal Observational Study

BACKGROUND

Zinc and iron deficiencies among breastfed infants during the first 6 months of life have been reported in previous studies. The amounts of zinc and iron intakes from breast milk are factors that contribute to the zinc and iron status of breastfed infants.

OBJECTIVE

This study aims to quantitatively determine zinc and iron intakes by breastfed infants during the first 4 months of life and to investigate the factors that predict zinc and iron status in breastfed infants.

METHODS

Pregnant women at 28 to 34 weeks of gestation were enrolled. Zinc and iron status during pregnancy was assessed. At delivery, cord blood was analyzed for zinc and iron levels. Participants and their babies were followed at 2 and 4 months postpartum. Maternal dietary intakes and anthropometric measurements were performed. The amount of breast milk intake was assessed using the deuterium oxide dose-to-mother technique. Breast milk samples were collected for determination of zinc and iron levels. The amount of zinc and iron consumed by infants was calculated. Zinc and iron status was determined in mothers and infants at 4 months postpartum.

RESULTS

A total of 120 pregnant women were enrolled, and 80 mother-infant pairs completed the study (56 provided full breastfeeding, and 24 provided breast milk with infant formula). All data are being managed and cleaned. Statistical analysis will be done.

CONCLUSIONS

This study will provide information on zinc and iron intakes in exclusively breastfed infants during the first 4 months of life and explore predictive factors and the possible association of zinc and iron intakes with infant growth and nutrient status.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19119.

Association of maternal diet, micronutrient status, and milk volume with milk micronutrient concentrations in Indonesian mothers at 2 and 5 months postpartum

BACKGROUND

Maternal micronutrient deficits during preconception and pregnancy may persist during lactation and compromise human milk composition.

OBJECTIVE

We measured micronutrient concentrations in human milk and investigated their association with maternal micronutrient intakes, status, and milk volume.

METHODS

Infant milk intake (measured via a deuterium dose-to-mother technique), milk micronutrient and fat concentrations, and maternal micronutrient intakes were assessed at 2 and 5 mo postpartum in 212 Indonesian lactating mother-infant pairs. Maternal hemoglobin, ferritin, transferrin receptors, retinol binding protein (RBP), zinc, selenium, and vitamin B-12 were measured at 5 mo (n = 163). Multivariate or mixed effects regression examined associations of milk micronutrient concentrations with maternal micronutrient intakes, status, and milk volume.

RESULTS

Prevalence of anemia (15%), and iron (15% based on body iron), selenium (2.5%), and vitamin B-12 deficiency (0%) were low compared with deficiencies of zinc (60%) and vitamin A (34%). The prevalence of inadequate intakes was >50% for 7 micronutrients at 2 and 5 mo. Median milk concentrations for most micronutrients were below reference values, and nearly all declined between 2 and 5 mo postpartum and were not associated substantially with milk volume (except for β-carotene, α-carotene, and β-cryptoxanthin). At 5 mo postpartum, associations between maternal micronutrient status and corresponding milk concentrations reported as mean percentage difference in human milk concentration for each unit higher maternal biomarker were significant for hemoglobin (1.9%), iron biomarkers (ranging from 0.4 to 7%), RBP (35%), selenium (70%), and vitamin B-12 (0.1%), yet for maternal intakes only a positive association with β-carotene existed.

CONCLUSIONS

Most milk micronutrient concentrations declined during lactation, independent of changes in human milk production, and few were associated with maternal micronutrient intakes. The significant associations between maternal biomarkers and milk micronutrient concentrations at 5 mo warrant further study to investigate whether the declines in milk micronutrients are linked to shifts in maternal status.

Undernutrition and Associated Factors among Lactating Women: Community-Based Cross-Sectional Study in Moyale District, Borena Zone, Southern Ethiopia

Background. Undernutrition is one of the most widespread public health problems that affect both developed and developing countries. In Ethiopia, it is one of the factors leading to unacceptable high morbidity and mortality among women. However, little is documented on undernutrition among lactating women particularly in such a purely pastoral community. Therefore, this study was designed to assess prevalence of undernutrition and its associated factors among lactating women living in pastoral community of Moyale District, Borena Zone, Southern Ethiopia, 2018. Methods. A community-based cross-sectional study was conducted. Data were collected from a random sampled 545 lactating women using structured interviewer-administered questionnaire. Height and weight measurements of the study participants were also taken to compute body mass index. Data were entered in to Epi info version 7 and then exported to SPSS version 21 software for analysis. Descriptive statistics like frequency, mean, and percentage were computed to describe characteristics of the sample. Multivariable analysis was carried out, association between independent and dependent variables were measured using adjusted odds ratios, and its 95% confidence interval and P value below 0.05 were considered statistically significant. Results. This study showed that prevalence of undernutrition among lactating women was 17.7%. Dietary diversity (AOR = 2.49, 95% CI: 1.43–4.36), monthly income (AOR = 5.22, 95% CI: 1.40–19.40), extra meal taking (AOR = 2.76, 95% CI: 1.43–5.29, delivery place (AOR = 2.65, 95% CI: 1.24–5.65), and household food insecurity (AOR = 6.57, 95% CI: 3.50–12.34) were independent variables showing statistically significant association with undernutrition of lactating women. Conclusion and recommendations. The study revealed that magnitude of undernutrition among lactating women was high. Dietary diversity, monthly income, extra meal, delivery place, and household food insecurity were found to be predictor of undernutrition. Finally, we recommend that governmental and nongovernmental organizations should organize timely interventions targeting lactating women.

Double Burden of Underweight and Overweight among Women in South and Southeast Asia: A Systematic Review and Meta-analysis

The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ∼5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.

Poor dietary diversity and low adequacy of micronutrient intakes among rural Indonesian lactating women from Sumedang district, West Java

Information on micronutrient adequacy of diets of rural Indonesian lactating women is lacking, despite their high nutrient requirements. This is of concern because deficits in micronutrient intakes may compromise the health of both mothers and infants. This study aimed to assess micronutrient adequacy and dietary diversity (DD) among rural lactating women and explore relationships between micronutrient adequacy, DD, and intakes of energy and food groups consumed. We measured in-home 12-h weighed food records and 12-h recalls over three non-consecutive days from 121 exclusively breastfeeding women at 2-5 months postpartum. Next, we calculated intakes of energy and 11 micronutrients and estimated probability of adequacy (PA) for usual intakes of 11 micronutrients for each women taking into account national fortification of wheat flour with thiamin, riboflavin, folate, zinc, and iron. We assessed DD from nine food groups consumed. Energy and macronutrient balance were within recommended ranges, yet population prevalence of adequacy was less than 50% for niacin, vitamins B6 and C, and less than 60% for calcium, vitamin B12 and vitamin A, all micronutrients not targeted by the national wheat flour fortification program. In contrast, population prevalence of adequacy for the fortified micronutrients was at least 60%, with iron and zinc attaining 79% and 97%, respectively. Overall mean population prevalence of micronutrient adequacy was 57% and mean (±SD) DD score was 4.3±1.2. Mean PAs, a composite measure based on individual PAs over 11 micronutrients, were strongly correlated with energy intakes and with DD scores. In the multivariate models with maternal education and wealth index as covariates, organ meats were the most important determinant of mean PA after controlling for energy intake. In conclusion, despite wheat flour fortification, lactating mothers remained at risk of multiple micronutrient inadequacies. Increasing intakes of animal source foods including organ meats, and fruits and vegetables should be considered.

Prevalence of infant and maternal anemia during the lactation period in Japan

BACKGROUND

The perinatal period is associated with a high risk of infant anemia. The aim of the present study was to determine the prevalence of infant and maternal anemia during the late lactation period and the risk factors for anemia in Japan.

METHODS

This retrospective cohort study was based on data from health checkups of healthy infants at 6-7 and 9-10 months of age and their mothers who visited Akitsu Children's Clinic between September 2013 and August 2015. Complete blood count data from infant blood samples obtained at 6-7 months and 9-10 months and from maternal blood samples obtained at 6-7 months, information on feeding methods, and other related parameters were analyzed.

RESULTS

Data from 388 mother-infant pairs were analyzed. The prevalence of infant anemia was 21.1% at 6-7 months and 29.1% at 9-10 months. The prevalence of anemia in exclusively breast-fed infants was 28.4% at 6-7 months and 40.0% at 9-10 months. The risk factors for infant anemia at 9-10 months were exclusive breast-feeding, lower gestational age at birth, male sex, and high weight gain. The prevalence of maternal anemia was 10.5%. There was no correlation between infant and maternal hemoglobin in exclusively breast-fed infants.

CONCLUSIONS

Japanese infants who were breast-fed exclusively had a high prevalence of anemia. A nationwide strategy to prevent anemia is required to prevent infant anemia, even in a nutrition-rich country such as Japan.

Analysis of aluminum, minerals and trace elements in the milk samples from lactating mothers in Hamadan, Iran

The present cross-sectional study is aimed at analyzing the breast milk of lactating mothers in Hamadan, Iran for aluminum and several minerals and trace elements. Ten governmental health care centers were utilized to facilitate collection of breast milk samples. The breast milk samples were collected at 1, 2, 6, 7, and 12 months postpartum from one hundred healthy lactating women, who delivered full-term newborns. Detection of sodium (Na), zinc (Zn), calcium (Ca), iron (Fe), copper (Cu), magnesium (Mg) and aluminum (Al) levels was conducted with the use of Inductively Coupled Plasma Mass Spectrometry (ICP-MS). This method has shown high accuracy, precision, sensitivity, and linearity for the wide range of concentrations. The accumulated data were not normally distributed; thus, the non-parametric Mann-Whitney U test was used in the statistical analysis of the results. Mean concentrations of Fe, Zn, Cu, Ca, Mg, and Na were 0.75, 1.38, 0.35, 255, 34.58, and 155.72 μg/mL, respectively. The mean level of Al, a well-known neurotoxic metal, was determined to be an alarming 0.191 μg/mL. Moreover, 95% of participants contained very harmful concentrations of Al in their milk. This study also revealed Zn deficiency in about 50% of milk samples. Further investigation is needed to elucidate sources of exposure and factors that may influence maternal and fetal exposure to aluminum.

Zinc Content in Breast Milk and Its Association with Maternal Diet

BACKGROUND

Zinc is an indispensable element, being involved in many biological processes. Correspondingly, insufficient zinc intake in early youth can detrimentally affect the function of a growing body. The aim of this study was to determine zinc content in breast milk among lactating women in Latvia and factors (maternal diet; mother's and baby's characteristics; breastfeeding pattern) affecting it.

METHODS

In total, 62 mature milk (at least one month postpartum) samples were collected and pooled within 24 h. Zinc content (mg 100 mL-1) was determined using inductively coupled plasma mass spectrometry (ICP-MS; Agilent 7700×, Agilent Technologies, Tokyo, Japan).

RESULTS

Zinc content in mature breast milk ranged from 0.01 to 0.34 mg 100 mL-1 with a median (interquartile range) content of 0.10 (0.05⁻0.15) mg 100 mL-1. Time postpartum was a significant negative predictor for zinc content in breast milk (r = -0.500; p = 0.000). Median maternal zinc intake was 10.70 (7.24⁻15.27) mg. Yet, zinc content in breast milk was unaffected by maternal dietary zinc intake (r = 0.155; p = 0.221).

CONCLUSIONS

Maternal dietary zinc intake was nearly the recommended intake for lactating women (11 mg), but due to low zinc content in breast milk, babies in Latvia might not receive sufficient zinc intake. Future research should aim for the assessment of zinc status by evaluating plasma or serum levels of both mothers and babies.

Zinc Deficiency among Lactating Mothers from a Peri-Urban Community of the Ecuadorian Andean Region: An Initial Approach to the Need of Zinc Supplementation

Zinc is an important mineral for biological and physiological processes. Zinc deficiency (ZD) is one of the most common micronutrient deficiencies worldwide and a crucial determinant of pregnancy outcomes and childhood development. Zinc levels and the zinc supplementation rate among lactating women have not been assessed neither in Ecuador nor in the Andean region. We conducted a pilot study including 64 mothers of infants between eight days to seven months old from a primary care center located in Conocoto, a peri-urban community of Quito, Ecuador. The mothers were interviewed and a fasting blood sample was taken to determine plasma zinc levels. The prevalence of ZD was calculated and compared with the prevalence of ZD among Ecuadorian non-pregnant non-lactating women, and the sample was analysed considering zinc supplementation during pregnancy. The prevalence of ZD among the participants was 81.3% (95% CI: 71.7⁻90.9), higher than the reported among non-pregnant non-lactating women (G² = 18.2; p < 0.05). Zinc supplementation rate was 31.2%. No significant differences were found comparing the groups considering zinc supplementation. The insights obtained from this study encourage extending studies to document zinc levels and its interactions among breastfeeding women in areas with a high prevalence of ZD in order to determine the need of zinc supplementation.

Overview of Nutrients in Human Milk

The WHO recommends exclusive breastfeeding for the first 6 mo of life to promote optimal infant health and development. Understanding the micro- and macronutrient concentrations of human milk and how each nutrient fluctuates with lactational stage, maternal factors, and supplementation is imperative for supporting good breastfeeding practices. Where maternal undernutrition compromises human milk quality, a thorough awareness of the effectiveness of interventions can direct efforts to achieve both maternal and infant nutrient sufficiency. This review of current knowledge covers trends in nutrient concentrations over the course of lactation and describes the influence of maternal intake, status, supplementation, and other factors on human milk concentrations of each nutrient.

The effects of a lipid-based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV-infected Malawian mothers and associations with maternal and infant biomarkers

We evaluated effects of antiretroviral (ARV) therapy and lipid-based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV-infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post-partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant-pairs in the Breastfeeding, Antiretrovirals, and Nutrition study. The participants received ARV, LNS, ARV and LNS, or no intervention from 0 to 28 weeks post-partum. ARVs negatively affected copper and zinc milk concentrations, but only at 2 weeks, whereas LNS had no effect. Among all treatment groups, approximately 80-90% of copper and zinc and <50% of iron concentrations met the current adequate intake for infants at 2 weeks and only 1-19% at 24 weeks. Pregnancy haemoglobin was negatively correlated with milk iron at 2 and 6 weeks (r = -.18, p < .02 for both). The associations of the milk minerals with each other were the strongest correlations observed (r = .11-.47, p < .05 for all); none were found with infant biomarkers. At 2 weeks, moderately anaemic women produced milk higher in iron when ferritin was higher or TfR lower. At 6 weeks, higher maternal α-1-acid glycoprotein and C-reactive protein were associated with higher milk minerals in mildly anaemic women. Infant TfR was lower when milk mineral concentrations were higher at 6 weeks and when mothers were moderately anaemic during pregnancy. ARV affects copper and zinc milk concentrations in early lactation, and maternal haemoglobin during pregnancy and lactation could influence the association between milk minerals and maternal and infant iron status and biomarkers of inflammation.

[Nutritional and sociodemographic characteristics of nursing mothers: a systematic review]

A systematic review of nutritional and sociodemographic characteristics of nursing mothers, using the published literature from 2004 to 2014 in the Biblioteca Virtual de Saúde and Medline databases. Using the following key words, 561 articles were identified: "Human Milk" and "Milk Banks"; keywords: "Profile," "Nutritional," "Milk Donor," "Nursing Mother" and "Nursing Mothers"; available abstracts; date and language. From these, 84.1% were excluded for not dealing with the established subject, 1.8% for being a review and 7.5% for the unavailability of abstracts for study. Thirty-seven articles were selected, of which 18.9% analyzed the profile of the HM donor. Of the total, 89.2% reported age, the majority between 20 and 30 years of age. The level of schooling was mentioned in 32.4% ranging from elementary school and higher education. With respect to income, a higher prevalence of low socioeconomic status was observed. About the nutritional status, 45.9% of the studies measured the body mass index and 29.4% reported the predominance of excess weight. There were deficiencies, particularly of vitamin A, with frequencies between 9% and 26%. A majority of young adult mothers, varied schooling, low income and nutritional deficiencies were noted, demanding interventions to improve health and increase HM donations.

Macro- and Micronutrients of Human Milk Composition: Are They Related to Maternal Diet? A Comprehensive Systematic Review

BACKGROUND

This study aims at systematically reviewing the observational and interventional studies on the association of maternal macro- and micronutrient intake with breast milk content.

METHODS

We systematically searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till October 2016 with the following search strategy: ("human milk" OR "breast milk" OR "breast milk composition" OR "human breast milk composition" OR "composition breast milk" OR "mother milk" OR "human breast milk") AND ("maternal diet" OR "maternal nutrition"). We also searched Google scholar for increasing the sensitivity of our search. The search was not limited to title and abstract due to the possibility that the desired outcome might have been considered a secondary aim. We excluded conference papers, editorials, letters, commentary, short survey, and notes. The search was refined to English language, and we did not consider any time limitation. To increase the sensitivity and to select more studies, the reference list of the published studies was checked as well.

RESULTS

This review included 59 observational and 43 interventional studies on maternal diet related to breast milk composition. Different studies determined the associations and effects of some maternal dietary intake of micro and macronutrients and its reflection in human milk.

CONCLUSION

Maternal dietary intake, particularly fatty acids, and some micronutrients, including fat soluble vitamins, vitamin B₁, and vitamin C, was related to their content in breast milk composition.

Concentrations of trace elements in human milk: Comparisons among women in Argentina, Namibia, Poland, and the United States

Human milk contains essential micronutrients for growth and development during early life. Environmental pollutants, such as potentially toxic metals, can also be transferred to the infant through human milk. These elements have been well-studied, but changing diets and environments and advances in laboratory technology require re-examining these elements in a variety of settings. The aim of this study was to characterize the concentrations of essential and toxic metals in human milk from four diverse populations. Human milk samples (n = 70) were collected in Argentina (n = 21), Namibia (n = 6), Poland (n = 23), and the United States (n = 20) using a standardized mid-feed collection procedure. Milk concentrations of calcium, zinc, iron, copper, manganese, lead, arsenic, and cadmium were determined using inductively coupled plasma mass spectrometry (ICP-MS). We used standard multiple linear regression models to evaluate differences among populations, while including infant age, infant sex, and maternal parity status (multiparous or primiparous) as covariates. Concentrations of all elements, except zinc, varied across populations after controlling for infant age, infant sex, and maternal parity. Calcium and magnesium showed more differences across populations than iron or copper. There were no significant differences among population in zinc concentrations. Mean concentrations of lead, but not arsenic, were low compared to recently published values from other populations. The concentrations of trace elements in human milk are variable among populations. Limitations due to small sample sizes and environmental contamination of some samples prevent us from drawing robust conclusions about the causes of these differences.

Factors associated with underweight among lactating women in Womberma woreda, Northwest Ethiopia; a cross-sectional study

Background

Ensuring nutritional status of women is important because the malignant effects of malnutrition are procreated to the next generation through women and their off-springs. Malnutrition causes 3.5 million death of women and children each year and almost 11% of the disease burden in the world. Therefore, this study was conducted to assess nutritional status and factors associated with underweight among lactating women in Womberma woreda, Northwest Ethiopia, 2016.

Methods

A Community-based cross-sectional study was carried out in Womberma woreda, Northwest Ethiopia. A total of 668 lactating women who have 6–24 months of child were included in the study. Study participants were selected using a multistage sampling technique. Data were collected using interview-administered questionnaire. Body mass index (BMI) was used to measure the nutritional status of lactating women. Women’s body weight and height were measured using the standard anthropometric measurement procedures. Data were entered using EpiData software and analysis was done using SPSS software. Descriptive, bivariate and multivariable logistics regression analysis were used to present the findings. Variables with a p-value less than 0.05 on multiple variable logistic regression were taken as significant variables.

Results

Lactating women with normal nutritional status (BMI = 18.5–24.99 kg/m²) were 498 (74.5%), and underweight women (BMI < 88.5 kg/m²) were 170(25.4%). Respondents with less than five family size (AOR: 0.46, 95% CI: 0.26, 0.81, p-value = 0.007), women whose age of first pregnancy was less than 18 years old (AOR: 3.72, 95% CI: 2.33, 6.49 at p-value = 0.0001), home delivery for the recent child birth (AOR: 2.36, 95% CI: 1.50, 3.72 at p-value = 0.0001), and the absence of nutritional education programs in the community (AOR: 5.5, 95% CI: 1.8, 16.79 at p-value = 0.003) were the significant variables with underweight of lactating women.

Conclusions

Nutritional status of lactating women in the study area was poor. One fourth of lactating women was underweight. Factors associated with underweight of lactating women include; respondents with less than five family size, women whose age of first pregnancy was less than 18 years old, home delivery for the recent childbirth, and the absence of nutritional education programs in the community. Early childbearing and short birth intervals between births should be discouraged. Programs which encourage institutional delivery and community-based nutritional education are important to improve women nutritional status.

Iron concentration in breast milk normalised within one week of a single high-dose infusion of iron isomaltoside in randomised controlled trial

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.

The Effect of Low Dose Iron and Zinc Intake on Child Micronutrient Status and Development during the First 1000 Days of Life: A Systematic Review and Meta-Analysis

Adequate supply of micronutrients during the first 1000 days is essential for normal development and healthy life. We aimed to investigate if interventions administering dietary doses up to the recommended nutrient intake (RNI) of iron and zinc within the window from conception to age 2 years have the potential to influence nutritional status and development of children. To address this objective, a systematic review and meta-analysis of randomized and quasi-randomized fortification, biofortification, and supplementation trials in women (pregnant and lactating) and children (6–23 months) delivering iron or zinc in doses up to the recommended nutrient intake (RNI) levels was conducted. Supplying iron or zinc during pregnancy had no effects on birth outcomes. There were limited or no data on the effects of iron/zinc during pregnancy and lactation on child iron/zinc status, growth, morbidity, and psychomotor and mental development. Delivering up to 15 mg iron/day during infancy increased mean hemoglobin by 4 g/L (p < 0.001) and mean serum ferritin concentration by 17.6 µg/L (p < 0.001) and reduced the risk for anemia by 41% (p < 0.001), iron deficiency by 78% (ID; p < 0.001) and iron deficiency anemia by 80% (IDA; p < 0.001), but had no effect on growth or psychomotor development. Providing up to 10 mg of additional zinc during infancy increased plasma zinc concentration by 2.03 µmol/L (p < 0.001) and reduced the risk of zinc deficiency by 47% (p < 0.001). Further, we observed positive effects on child weight for age z-score (WAZ) (p < 0.05), weight for height z-score (WHZ) (p < 0.05), but not on height for age z-score (HAZ) or the risk for stunting, wasting, and underweight. There are no studies covering the full 1000 days window and the effects of iron and zinc delivered during pregnancy and lactation on child outcomes are ambiguous, but low dose daily iron and zinc use during 6–23 months of age has a positive effect on child iron and zinc status.

The Serum Concentrations of Trace Elements and Vitamin A in Turkish Six-Month-Old Infants with Different Feeding Practices

Breast feeding is the first and most important step of a healthy diet. Breast milk contains important vitamins and trace elements such as iron, zinc, copper, and vitamin A. The aim of our study was to evaluate the levels of hemoglobin, hematocrit, mean corpuscular volume, serum iron, iron binding capacity, ferritin, serum zinc, copper and vitamin A in three groups of infants, which were determined based on feeding practices. The infants in all groups were not given prophylactic iron in the first 6 mo. Two hundred fifty-nine infants were included in the study. One hundred fifty-one (58.3%) were fed with breast milk, 91 (35.1%) were fed with breast milk+formula, and 17 (6.6%) were fed with formula only. Serum copper and vitamin A levels were found to be low in formula-only fed infants compared to other groups with a statistically significant difference (p=0.017, p=0.022 respectively). The serum zinc level was found to be low in 15.9% of the breast fed infants, 17.6% of the breast milk+formula fed infants, and 23.5% of the formula-only fed infants. Although the formula-only fed infants had lower values, the difference was not statistically significant among groups (p=0.716). We think that formula fed infants potentially have low levels of copper and vitamin A in the first 6 mo and may be offered supplements. Alternatively, formula mineral and vitamin contents could be enriched. We think that further studies on this subject are needed.

Copper, zinc and iron levels in infants and their mothers during the first year of life: a prospective study

BACKGROUND

Essential micronutrients are important for maintenance of life. Deficiency of micronutrients is more likely to be encountered in children, and women studies are required to investigate the status of micronutrients in children and women. This study aimed to longitudinally evaluate changes in zinc, copper, and iron levels in breastfed infants and their mothers during the first year of life.

METHODS

Serum and hair samples were obtained from 35 healthy breastfed infants (51% males, 49% females) and their mothers 2, 6, and 12 months after delivery. All of the samples were assessed using an atomic absorption spectrophotometer. Serum iron levels were determined by a Roche/Hitachi/Modular analyzer. Statistical analyses were performed using SPSS-PC (Version 21.00) software.

RESULTS

Hair zinc (p < 0.05) and serum iron (p < 0.001) levels of infants were significantly decreased towards the end of the first year. Infants' serum copper levels were increased towards the end of the first year. Maternal serum and hair copper levels and serum iron levels were significantly decreased towards the end of the first year. There were no significant correlations between dietary zinc, copper, iron intake, and trace element levels of infants and their mothers.

CONCLUSIONS

Infants' hair zinc levels, maternal and infants' hair copper levels, and infants' and maternal serum iron levels declined towards the end of the first year. Infants need more zinc after 6 months of age. Infants' and mothers' daily iron intake was less than the recommended intake.

Bifidobacteria strains isolated from stools of iron deficient infants can efficiently sequester iron

BACKGROUND

Bifidobacteria is one of the major gut commensal groups found in infants. Their colonization is commonly associated with beneficial effects to the host through mechanisms like niche occupation and nutrient competition against pathogenic bacteria. Iron is an essential element necessary for most microorganisms, including bifidobacteria and efficient competition for this micronutrient is linked to proliferation and persistence. For this research we hypothesized that bifidobacteria in the gut of iron deficient infants can efficiently sequester iron. The aim of the present study was to isolate bifidobacteria in fecal samples of iron deficient Kenyan infants and to characterize siderophore production and iron internalization capacity.

RESULTS

Fifty-six bifidobacterial strains were isolated by streaking twenty-eight stool samples from Kenyan infants, in enrichment media. To target strains with high iron sequestration mechanisms, a strong iron chelator 2,2-dipyridyl was supplemented to the agar media. Bifidobacterial isolates were first identified to species level by 16S rRNA sequencing, yielding B. bifidum (19 isolates), B. longum (15), B. breve (11), B. kashiwanohense (7), B. pseudolongum (3) and B. pseudocatenulatum (1). While most isolated bifidobacterial species are commonly encountered in the infantile gut, B. kashiwanohense was not frequently reported in infant feces. Thirty strains from culture collections and 56 isolates were characterized for their siderophore production, tested by the CAS assay. Siderophore activity ranged from 3 to 89% siderophore units, with 35 strains (41%) exhibiting high siderophore activity, and 31 (36%) and 20 (23%) showing intermediate or low activity. The amount of internalized iron of 60 bifidobacteria strains selected for their siderophore activity, was in a broad range from 8 to118 μM Fe. Four strains, B. pseudolongum PV8-2, B. kashiwanohense PV20-2, B. bifidum PV28-2a and B. longum PV5-1 isolated from infant stool samples were selected for both high siderophore activity and iron internalization.

CONCLUSIONS

A broad diversity of bifidobacteria were isolated in infant stools using iron limited conditions, with some strains exhibiting high iron sequestration properties. The ability of bifidobacteria to efficiently utilize iron sequestration mechanism such as siderophore production and iron internalization may confer an ecological advantage and be the basis for enhanced competition against enteropathogens.

Zinc and Vitamin Supplementation in an Under-5 Indigenous Population of Guatemala: Influence of Lay Health Promoters in Decreasing Incidence of Diarrhea

BACKGROUND

Malnutrition is an urgent problem in the developing world, especially for children under 5 years of age. The article describes the utilization of a standard of practice designed to prevent illness in a malnourished, under-5 indigenous population and reinforced by weekly basic health messages taught by lay community health promoters.

METHOD

The two villages were chosen for observation after administration of the standard of care among the Maya-Kíché, the most numerous Mayan group in Guatemala. The standard of practice, 20 mg of daily oral zinc, was administered for 10 days in the home and followed by daily vitamin supplementation that continued throughout the 3 months of the project. All patients received four monthly clinic visits, with one of the village groups receiving weekly health promoter visits.

RESULTS

Data evaluated after the quality improvement project showed significant differences in adherence to the zinc regimen (χ(2) = 3.677, p ≤ .05) as well as lower rates of diarrheal illnesses (χ(2) = 5.850, p ≤ .05), with both of these improved in the health promoter group.

DISCUSSION

This study suggests that the training and implementation of para-health professionals from the lay community in response to specific health care needs could be considered a best practice in developing countries.

IMPLICATIONS

Public health professionals are key to health promoter training and direction, and their importance in the global setting cannot be understated.

Psychological and social factors associated with late pregnancy iron deficiency anaemia in rural Viet Nam: a population-based prospective study

Objectives

The aim of this study was to examine the relationships between psychological and social factors and late pregnancy IDA among pregnant women in rural Viet Nam.

Methods

Pregnant women from 50 randomly-selected communes within Ha Nam province were recruited and assessed at 12 - 20 weeks gestation (Wave 1, W1). They were followed up in the last trimester (Wave 2, W2). IDA was defined as Haemoglobin < 11 g/dL and serum ferritin < 15 ng/mL. Symptoms of Common Mental Disorders (CMD) were assessed by the Edinburgh Postnatal Depression Scale-Vietnam (EPDS-V). Persistent antenatal CMD was defined as having an EPDS-V score ≥ 4 in both W1 and W2. Hypothesis models were tested by Structural Equation Modeling analyses.

Results

A total of 378 women provided complete data at both W1 and W2. The incidence risk of IDA in the third trimester was 13.2% (95% confidence interval (CI): 9.8-16.7). Persistent CMD was found in 16.9% (95% CI: 13.1-20.7) pregnant women and predicted by intimate partner violence, fear of other family members, experience of childhood abuse, coincidental life adversity, and having a preference for the sex of the baby. There was a significant pathway from persistent CMD to IDA in late pregnancy via the length of time that iron supplements had been taken. Receiving advice to take iron supplements and higher household wealth index were indirectly related to lower risk of late pregnancy IDA. Early pregnancy IDA and being multi-parous also contributed to late pregnancy IDA.

Conclusions

Antenatal IDA and CMD are prevalent public health problems among women in Viet Nam. The link between them suggests that while direct recommendations to use iron supplements are important, the social factors associated with common mental disorders should be addressed in antenatal care in order to improve the health of pregnant women and their infants.

Iron supplementation in pregnancy and breastfeeding and iron, copper and zinc status of lactating women from a human milk bank

This study evaluated the influence of iron supplementation in pregnancy and breastfeeding on iron status of lactating women from a Brazilian Human Milk Bank. Blood and mature breast milk samples were collected from 145 women for assessment of iron status, as well as copper and zinc status. Haemoglobin, serum iron and ferritin were determined, respectively, by electronic counting, colorimetry and chemiluminescence. Transferrin and ceruloplasmin were analysed by nephelometry. Serum copper and zinc were measured by atomic absorption spectrophotometry, and serum alkaline phosphatase was measured by a colorimetric method. Iron, zinc and copper in breast milk were determined by spectrometry. Mean values of iron, copper and zinc (blood and breast milk) were compared by ANOVA, followed by Tukey's test. Iron supplementation was beneficial to prevent anaemia in pregnancy but not effective to treat anaemia. During breastfeeding, iron supplementation had a negative effect on maternal copper status, confirming an interaction between these micronutrients.

Maternal anemia induces changes in immunological and nutritional components of breast milk

OBJECTIVE

The effects of low maternal hemoglobin levels on the immunological and nutritional components of breast milk at different maturation stages were investigated.

METHODS

Colostrum, transitional and mature milk were collected from 25 mothers with normal hemoglobin levels (control group) and 18 mothers with hemoglobin levels below 11 g/dL (anemia group). Total protein, antibodies, complement proteins, fat and calorie, lipase, iron, transferrin levels, total iron-binding capacity, latent iron-binding capacity (LIBC) and transferrin saturation index (TSI) were determined.

RESULTS

In contrast to the control group, anemic mothers had higher total protein levels in milk, lower IgA and IgG levels in colostrum, lower C3 protein levels in milk, lower C4 protein levels in colostrum and transitional milk, higher fat in the colostrum and lower calorie content in mature milk. In both groups, lipase was lower in mature milk and iron concentration was similar. Transitional and mature milk from anemic mothers had higher LIBC and lower TSI values.

CONCLUSION

A decrease in maternal hemoglobin levels causes immunological and nutritional alterations in milk at different maturation stages. Special measures must therefore be taken for mothers at risk of developing anemia to ensure they can provide high-quality milk to their babies.

Evaluation of the impact of a food program on the micronutrient nutritional status of Argentinean lactating mothers

This study was conducted to evaluate the impact of a food aid program (Plan Más Vida, PMV) on the micronutrient nutritional condition of lactating mothers 1 year after its implementation. The food program provided supplementary diets (wheat- and maize-fortified flour, rice or sugar, and fortified soup) to low-income families from the province of Buenos Aires, Argentina. A prospective, non-experimental study was carried out to evaluate the micronutrient nutritional status of lactating mothers (n = 178 at baseline and n = 151 after 1 year). Biochemical tests (hemoglobin, ferritin, zinc, vitamin A, and folic acid), anthropometric assessments (weight and height) and dietary surveys (24-h recall) were performed. We found no significant changes in anthropometric values 1 year after the intervention. The risk for vitamin A (retinol 20-30 μg/dl) and folate deficiency significantly decreased 1 year after PMV implementation (56.3 vs. 29.9 and 50.3 vs. 3.4 %, respectively; p < 0.001). Anemia was seen in 25.8 % of lactating mothers at baseline, without statistically significant differences 1 year after (p = 0.439). The nutritional data obtained after assessing the early impact of PMV actions may be useful to provincial health authorities to perform periodic evaluations in the future.

Toxic metals in breast milk samples from Ankara, Turkey: assessment of lead, cadmium, nickel, and arsenic levels

Toxic metals are one of the significant groups of chemical contaminants that humans are exposed to by oral, inhalation, and dermal routes. Exposure to these chemicals begins with intrauterine life and continues during lactation period at the first years of life. Breastfeeding has a much more special place than other nutrition options for infants. However, when possibility of contaminant transfer by breast milk is considered, its safety and quality is essential. Regarding infant and mother health and limited number of information on this field in Turkey, measuring contamination levels in breast milk is important. Therefore, in the present study, lead (Pb), cadmium (Cd), nickel (Ni), and arsenic (As) levels were measured by atomic absorption spectrometry in 64 breast milk samples obtained from mothers from Ankara, Turkey. Pb and Ni levels in breast milk samples were found to be 391.45±269.01 μg/l and 43.94±33.82 μg/l (mean ± SD), respectively. Cd was found only in one of 64 samples, and the level was 4.62 μg/l. As level was below the limit of quantification (LOQ, 7.6 μg/l) in all samples. These findings will accurately direct strategies and solutions of protection against contaminants in order to reduce their levels in biological fluids.

Maternal smoking does not influence vitamin A and E concentrations in mature breastmilk

OBJECTIVES

The aim of this study was to analyze the effects of maternal smoking on the total antioxidant status (TAS) and the concentrations of vitamins A and E in human breastmilk.

METHODOLOGY

The study group (n=20) comprised postpartum women who declared smoking more than five cigarettes per day (confirmed by urinalysis of the cotinine concentration). The control group included 25 nonsmoking postpartum women. Breastmilk samples were collected between day 30 and day 32 after delivery. TAS was determined by Rice-Evans and Miller method, whereas the amount of vitamins A and E was measured by high-performance liquid chromatography.

RESULTS

No significant differences were observed between breastmilk samples from smoking and nonsmoking mothers in terms of TAS and vitamin A and E concentrations. Additionally, no significant correlations were found between urinary cotinine and TAS (R=0.35, p=0.144) or vitamin A (R=0.14, p=0.571) and vitamin E (R=0.31, p=0.228) concentrations in breastmilk samples from smoking mothers.

CONCLUSIONS

Maternal smoking is not reflected by decreased TAS and vitamin A and E concentrations in mature milk.

Marginal maternal zinc deficiency in lactating mice reduces secretory capacity and alters milk composition

Dietary analysis predicts that marginal Zn deficiency is common in women of reproductive age. The lack of reliable biomarkers limits the capacity to assess Zn status and consequently understand effects of maternal Zn deficiency. We determined effects of marginal maternal Zn deficiency on mammary gland function, milk secretion, and milk composition in mice. Mice (n = 12/diet) were fed marginal (ZD; 15 mg Zn/kg diet) or adequate (ZA; 30 mg Zn/kg diet) Zn diets for 30 d prior to conception through mid-lactation. Mice fed the ZD had a higher plasma Zn concentration (~20%; P < 0.05) but lower milk Zn concentration (~15%; P < 0.05) compared with mice fed the ZA. ZnT2 abundance was higher (P < 0.05) in mice fed the ZD compared with mice fed the ZA; no effect on ZnT4 abundance was detected. The Zn concentration of mammary gland mitochondria tended to be ~40% greater in mice fed ZD (P = 0.07); this was associated with apoptosis and lower milk secretion (~80%; P < 0.01). Total milk protein was ~25% higher (P < 0.05), although the abundance of the major milk proteins (caseins and whey acidic protein) was lower (P < 0.05) in mice fed the ZD. Proteomic analysis of milk proteins revealed an increase (P < 0.05) in four proteins in mice fed the ZD. These findings illustrate that marginal maternal Zn deficiency compromises mammary gland function and milk secretion and alters milk composition. This suggests that lactating women who consume inadequate Zn may not produce and/or secrete an adequate amount of high quality milk to provide optimal nutrition to their developing infant.