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Lokken-Toyli KL, Diaz-Ochoa VE, Camacho L, Stull-Lane AR, Van Hecke AER, Mooney JP, Muñoz AD, Walker GT, Hampel D, Jiang X, Labuda JC, Depew CE, McSorley SJ, Stephensen CB, Tsolis RM. Vitamin A deficiency impairs neutrophil-mediated control of Salmonella via SLC11A1 in mice. Nat Microbiol 2024; 9:727-736. [PMID: 38374245 PMCID: PMC10914596 DOI: 10.1038/s41564-024-01613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
In sub-Saharan Africa, multidrug-resistant non-typhoidal Salmonella serovars are a common cause of fatal bloodstream infection. Malnutrition is a predisposing factor, but the underlying mechanisms are unknown. Here we show that vitamin A deficiency, one of the most prevalent micronutrient deficits afflicting African children, increases susceptibility to disseminated non-typhoidal Salmonella disease in mice and impairs terminal neutrophil maturation. Immature neutrophils had reduced expression of Slc11a1, a gene that encodes a metal ion transporter generally thought to restrict pathogen growth in macrophages. Adoptive transfer of SLC11A1-proficient neutrophils, but not SLC11A1-deficient neutrophils, reduced systemic Salmonella burden in Slc11a1-/- mice or mice with vitamin A deficiency. Loss of terminal granulopoiesis regulator CCAAT/enhancer-binding protein ϵ (C/EBPϵ) also decreased neutrophil-mediated control of Salmonella, but not that mediated by peritoneal macrophages. Susceptibility to infection increased in Cebpe-/- Slc11a1+/+ mice compared with wild-type controls, in an Slc11a1-expression-dependent manner. These data suggest that SLC11A1 deficiency impairs Salmonella control in part by blunting neutrophil-mediated defence.
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Affiliation(s)
- Kristen L Lokken-Toyli
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Vladimir E Diaz-Ochoa
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Lizbeth Camacho
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Annica R Stull-Lane
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Amber E R Van Hecke
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Jason P Mooney
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Ariel D Muñoz
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Gregory T Walker
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Daniela Hampel
- Western Human Nutrition Research Center, US Department of Agriculture, Davis, CA, USA
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Xiaowen Jiang
- Western Human Nutrition Research Center, US Department of Agriculture, Davis, CA, USA
| | - Jasmine C Labuda
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Claire E Depew
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Stephen J McSorley
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Charles B Stephensen
- Western Human Nutrition Research Center, US Department of Agriculture, Davis, CA, USA
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Renée M Tsolis
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA.
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2
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Wang D, Shahab-Ferdows S, Lweno ON, Hampel D, Method B, Yelverton CA, Nguyen CH, Aboud S, Allen LH, Fawzi WW. The effects of prenatal and postnatal high-dose vitamin B-12 supplementation on human milk vitamin B-12: a randomized, double-blind, placebo-controlled trial in Tanzania. Am J Clin Nutr 2024; 119:730-739. [PMID: 38432714 DOI: 10.1016/j.ajcnut.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Vitamin B-12 status in human milk (HM) has critical implications for infant growth and development. Few studies have separately evaluated the effects of prenatal and postnatal maternal high-dose vitamin B-12 supplementation on HM vitamin B-12 concentration. OBJECTIVES This randomized controlled trial aimed to assess the effects of prenatal and postnatal vitamin B-12 supplementation on HM vitamin B-12 at 6 wk and 7 mo postpartum. METHODS Pregnant women were enrolled in Dar es Salaam, Tanzania, between 2001 and 2004. From recruitment (12-27 weeks of gestation) through 6 wk postpartum, participants were randomly assigned to daily oral multiple micronutrient supplementation or placebo. From 6 wk to 18 mo postpartum, a subset of participants was randomly assigned to a postnatal supplement or placebo. The supplement included 50 μg/d of vitamin B-12 and various other vitamins. HM vitamin B-12 concentrations were analyzed at 6 wk and 7 mo postpartum for 412 participants. RESULTS The prevalence of HM vitamin B-12 of <310 pmol/L was 73.3% and 68.4% at 6 wk and 7 mo postpartum, respectively. Prenatal supplementation increased HM vitamin B-12 concentration (percent difference: 34.4; 95% CI: 17.0, 54.5; P < 0.001) at 6 wk; this effect was not present at 7 mo. Postnatal supplementation increased HM vitamin B-12 concentration (percent difference: 15.9; 95% CI: 1.91, 31.9; P = 0.025) at 7 mo. Effect modification between prenatal and postnatal supplementation on HM vitamin B-12 status at 7 mo was found, with the effects of prenatal and postnatal supplements more pronounced among those receiving control during the other period; the prenatal supplement had a greater effect with postnatal control, and the postnatal supplement had a greater effect with prenatal control. CONCLUSIONS Prenatal maternal vitamin B-12 supplementation has benefits on short-term HM status, and postnatal maternal vitamin B-12 supplementation has benefits on long-term HM status. This trial was registered at clinicaltrials.gov as NCT00197548. https://clinicaltrials.gov/ct2/show/NCT00197548.
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Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States.
| | - Setareh Shahab-Ferdows
- Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
| | - Omar N Lweno
- Ifakara Health Institute, Bagamoyo Research and Training Center, Bagamoyo, Tanzania
| | - Daniela Hampel
- Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States; Department of Nutrition, University of California, Davis, CA, United States
| | - Balama Method
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cara A Yelverton
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Christine H Nguyen
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lindsay H Allen
- Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
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3
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Smith TJ, Arnold CD, Fischer PR, Trehan I, Hiffler L, Sitthideth D, Stein-Wexler R, Yeh J, Jones KS, Hampel D, Tancredi DJ, Schick MA, McBeth CN, Tan X, Allen LH, Sayasone S, Kounnavong S, Hess SY. A Predictive Model for Thiamine Responsive Disorders among Infants and Young Children: Results from a Prospective Cohort Study in Lao People's Democratic Republic. J Pediatr 2024:113961. [PMID: 38369233 DOI: 10.1016/j.jpeds.2024.113961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To develop a predictive model for thiamine responsive disorders (TRD) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDD) based on response to therapeutic thiamine in a high-risk setting. STUDY DESIGN Children aged 21 days to <18 months hospitalized with signs or symptoms suggestive of TDD in northern Lao PDR were treated with parenteral thiamine (100mg daily) for ≥3 days in addition to routine care. Physical examinations and recovery assessments were conducted frequently for 72 hours after thiamine was initiated. Individual case reports were independently reviewed by three pediatricians who assigned a TRD status (TRD or non-TRD), which served as the dependent variable in logistic regression models to identify predictors of TRD. Model performance was quantified by empirical area under the receiver operating characteristic curve (AUROC). RESULTS 449 children (median [Q1, Q3] 2.9 [1.7, 5.7] months old; 70.3% exclusively/predominantly breastfed) were enrolled; 60.8% had a TRD. Among 52 candidate variables, those most predictive of TRD were exclusive/predominant breastfeeding, hoarse voice/loss of voice, cyanosis, no eye contact and no diarrhea in the previous 2 weeks. The AUROC (95% CI) was 0.82 (0.78, 0.86). CONCLUSIONS In this study, the majority of children with signs or symptoms of TDD responded favorably to thiamine. While five specific features were predictive of TRD, the high prevalence of TRD suggests that thiamine should be administered to all infants and children presenting with any signs or symptoms consistent with TDD in similar high-risk settings. The usefulness of the predictive model in other contexts warrants further exploration and refinement.
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Affiliation(s)
- Taryn J Smith
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;.
| | - Charles D Arnold
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA;; Pediatrics Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE;; Khalifa University, Abu Dhabi, UAE
| | - Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA;; Lao Friends Hospital for Children, Luang Prabang, Lao PDR
| | | | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Rebecca Stein-Wexler
- Department of Radiology, University of California Davis Health System, Sacramento, California, USA
| | - Jay Yeh
- Department of Pediatrics, Division of Cardiology, University of California Davis Health System, Sacramento, California, USA
| | - Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Daniela Hampel
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;; USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Michael A Schick
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Christine N McBeth
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Xiuping Tan
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Lindsay H Allen
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;; USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
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4
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Siddiqua TJ, Akhtar E, Haq MA, Shahab-Ferdows S, Hampel D, Islam S, Ahmed T, Allen LH, Raqib R. Effects of vitamin B12 supplementation on oxidative stress markers and pro-inflammatory cytokines during pregnancy and postpartum among Bangladeshi mother-child pairs. BMC Nutr 2024; 10:3. [PMID: 38172996 PMCID: PMC10765711 DOI: 10.1186/s40795-023-00785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is limited research to determine whether vitamin B12 (B12) supplementation during pregnancy and lactation is protective against oxidative stress and pro-inflammatory cytokines and whether this effect is transferred to breastfed infants via milk. In addition, associations among maternal plasma/ milk and infant B12 status and immune function markers are poorly characterized. OBJECTIVES To evaluate effects of oral B12 supplementation during pregnancy and postpartum on maternal and infant 8-hydroxy-2'-deoxyguanosine (8-OH-dG, an oxidative stress marker) and proinflammatory cytokine levels, and examine associations between maternal plasma, breastmilk and infant B12 status as well as immune function markers. METHOD In a blinded, placebo-controlled trial, Bangladeshi women (n = 68, 18-35 years, hemoglobin < 11 g/dL, gestational weeks 11-14) received either 250 μg/day B12 or placebo throughout pregnancy up to 3-months postpartum. Samples were collected from mothers at baseline and 3-months postpartum and from infants at 3-months to measure B12 status indicators, 8-OH-dG and proinflammatory cytokines. RESULTS Maternal postpartum B12 was positively associated with infant plasma B12. Higher milk B12 concentrations were associated with increased infant B12 (beta (β) = 277, 95% confidence interval (CI) = (132, 423), p<0.001) and lower total homocysteine (β = -7.63, 95% CI = (-12.40, -2.86), p = 0.002) levels. Maternal B12 supplementation reduced plasma 8-OH-dG concentrations among postpartum mothers and infants compared to the placebo group. Supplementation increased plasma TNF-α and IL-6 levels among mothers and IL-10 and IFN-γ levels among infants. CONCLUSION Milk and maternal plasma B12 at 3 months were associated with infant B12. Maternal B12 supplementation modulates 8-OH-dG and several cytokines which may protect against immune response-induced oxidative stress. TRIAL REGISTRATION (clinicaltrials.gov: NCT01795131- 1st posted on 20/02/2013).
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Affiliation(s)
| | - Evana Akhtar
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Md Ahsanul Haq
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | - Daniela Hampel
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Sharmin Islam
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Lindsay H Allen
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA
| | - Rubhana Raqib
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
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Reyes SM, Brockway MM, McDermid JM, Chan D, Granger M, Refvik R, Sidhu KK, Musse S, Monnin C, Lotoski L, Geddes DT, Jehan F, Kolsteren P, Allen LH, Hampel D, Eriksen KG, Rodriguez N, Azad MB. Human Milk Micronutrients and Child Growth and Body Composition in the First 2 years: A Systematic Review. Adv Nutr 2024; 15:100082. [PMID: 37315898 PMCID: PMC10831887 DOI: 10.1016/j.advnut.2023.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
Human milk (HM) provides a plethora of nutritional and non-nutritional compounds that support infant development. For many compounds, concentrations vary substantially among mothers and across lactation, and their impact on infant growth is poorly understood. We systematically searched MEDLINE, Embase, the Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born infants. Outcomes included weight-for-length, length-for-age, weight-for-age, body mass index (in kg/m2)-for-age, and growth velocity. From 9992 abstracts screened, 144 articles were included and categorized based on their reporting of HM micronutrients, macronutrients, or bioactive components. Micronutrients (vitamins and minerals) are reported here, based on 28 articles involving 2526 mother-infant dyads. Studies varied markedly in their designs, sampling times, geographic and socioeconomic settings, reporting practices, and the HM analytes and infant anthropometrics measured. Meta-analysis was not possible because data were sparse for most micronutrients. The most-studied minerals were zinc (15 articles, 1423 dyads) and calcium (7 articles, 714 dyads). HM iodine, manganese, calcium, and zinc concentrations were positively associated with several outcomes (each in ≥2 studies), whereas magnesium (in a single study) was negatively associated with linear growth during early lactation. However, few studies measured HM intake, adjusted for confounders, provided adequate information about complementary and formula feeding, or adequately described HM collection protocols. Only 4 studies (17%) had high overall quality scores. The biological functions of individual HM micronutrients are likely influenced by other HM components; yet, only 1 study analyzed data from multiple micronutrients simultaneously, and few addressed other HM components. Thus, available evidence on this topic is largely inconclusive and fails to address the complex composition of HM. High-quality research employing chronobiology and systems biology approaches is required to understand how HM components work independently and together to influence infant growth and to identify new avenues for future maternal, newborn, or infant nutritional interventions.
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Affiliation(s)
- Sarah M Reyes
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meredith Merilee Brockway
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Deborah Chan
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Refvik
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karanbir K Sidhu
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suad Musse
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larisa Lotoski
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Donna T Geddes
- School of Molecular Sciences, the University of Western Australia, Perth, Western Australia, Australia
| | - Fyezah Jehan
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Lindsay H Allen
- Department of Nutrition, University of California, Davis, Davis, CA, USA; United States Department of Agriculture, Western Human Nutrition Research Center, Agriculture Research Service, Davis, CA, USA
| | - Daniela Hampel
- Department of Nutrition, University of California, Davis, Davis, CA, USA; United States Department of Agriculture, Western Human Nutrition Research Center, Agriculture Research Service, Davis, CA, USA
| | - Kamilla G Eriksen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Natalie Rodriguez
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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6
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Brockway MM, Daniel AI, Reyes SM, Granger M, McDermid JM, Chan D, Refvik R, Sidhu KK, Musse S, Patel PP, Monnin C, Lotoski L, Geddes D, Jehan F, Kolsteren P, Allen LH, Hampel D, Eriksen KG, Rodriguez N, Azad MB. Human Milk Macronutrients and Child Growth and Body Composition in the First Two Years: A Systematic Review. Adv Nutr 2024; 15:100149. [PMID: 37981047 PMCID: PMC10831902 DOI: 10.1016/j.advnut.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
Among exclusively breastfed infants, human milk (HM) provides complete nutrition in the first mo of life and remains an important energy source as long as breastfeeding continues. Consisting of digestible carbohydrates, proteins, and amino acids, as well as fats and fatty acids, macronutrients in human milk have been well studied; however, many aspects related to their relationship to growth in early life are still not well understood. We systematically searched Medline, EMBASE, the Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born healthy infants. From 9992 abstracts screened, 57 articles reporting observations from 5979 dyads were included and categorized based on their reporting of HM macronutrients and infant growth. There was substantial heterogeneity in anthropometric outcome measurement, milk collection timelines, and HM sampling strategies; thus, meta-analysis was not possible. In general, digestible carbohydrates were positively associated with infant weight outcomes. Protein was positively associated with infant length, but no associations were reported for infant weight. Finally, HM fat was not consistently associated with any infant growth metrics, though various associations were reported in single studies. Fatty acid intakes were generally positively associated with head circumference, except for docosahexaenoic acid. Our synthesis of the literature was limited by differences in milk collection strategies, heterogeneity in anthropometric outcomes and analytical methodologies, and by insufficient reporting of results. Moving forward, HM researchers should accurately record and account for breastfeeding exclusivity, use consistent sampling protocols that account for the temporal variation in HM macronutrients, and use reliable, sensitive, and accurate techniques for HM macronutrient analysis.
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Affiliation(s)
- Meredith Merilee Brockway
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Canada; Faculty of Nursing, University of Calgary, Canada
| | - Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Sarah M Reyes
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada
| | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | | | - Deborah Chan
- Department of Pediatrics and Child Health, University of Manitoba, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada
| | - Rebecca Refvik
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | - Karanbir K Sidhu
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | - Suad Musse
- Department of Food and Human Nutritional Sciences, University of Manitoba, Canada
| | - Pooja P Patel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, USA
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Canada
| | - Larisa Lotoski
- Department of Pediatrics and Child Health, University of Manitoba, Canada
| | - Donna Geddes
- School of Molecular Sciences, The University of Western Australia, Australia
| | - Fyezah Jehan
- Department of Pediatrics, Aga Khan University, Pakistan
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Belgium
| | - Lindsay H Allen
- Western Human Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, USA; Department of Nutrition, University of California, Davis, USA
| | - Daniela Hampel
- Western Human Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, USA; Department of Nutrition, University of California, Davis, USA
| | - Kamilla G Eriksen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Natalie Rodriguez
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Canada
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Canada.
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7
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Brockway MM, Daniel AI, Reyes SM, Gauglitz JM, Granger M, McDermid JM, Chan D, Refvik R, Sidhu KK, Musse S, Patel PP, Monnin C, Lotoski L, Geddes DT, Jehan F, Kolsteren P, Bode L, Eriksen KG, Allen LH, Hampel D, Rodriguez N, Azad MB. Human Milk Bioactive Components and Child Growth and Body Composition in the First 2 Years: A Systematic Review. Adv Nutr 2024; 15:100127. [PMID: 37802214 PMCID: PMC10831900 DOI: 10.1016/j.advnut.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
Human milk (HM) contains macronutrients, micronutrients, and a multitude of other bioactive factors, which can have a long-term impact on infant growth and development. We systematically searched MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born infants. From 9992 abstracts screened, 141 articles were included and categorized based on their reporting of HM micronutrients, macronutrients, or bioactive components. Bioactives including hormones, HM oligosaccharides (HMOs), and immunomodulatory components are reported here, based on 75 articles from 69 unique studies reporting observations from 9980 dyads. Research designs, milk collection strategies, sampling times, geographic and socioeconomic settings, reporting practices, and outcomes varied considerably. Meta-analyses were not possible because data collection times and reporting were inconsistent among the studies included. Few measured infant HM intake, adjusted for confounders, precisely captured breastfeeding exclusivity, or adequately described HM collection protocols. Only 5 studies (6%) had high overall quality scores. Hormones were the most extensively examined bioactive with 46 articles (n = 6773 dyads), compared with 13 (n = 2640 dyads) for HMOs and 12 (n = 1422 dyads) for immunomodulatory components. Two studies conducted untargeted metabolomics. Leptin and adiponectin demonstrated inverse associations with infant growth, although several studies found no associations. No consistent associations were found between individual HMOs and infant growth outcomes. Among immunomodulatory components in HM, IL-6 demonstrated inverse relationships with infant growth. Current research on HM bioactives is largely inconclusive and is insufficient to address the complex composition of HM. Future research should ideally capture HM intake, use biologically relevant anthropometrics, and integrate components across categories, embracing a systems biology approach to better understand how HM components work independently and synergistically to influence infant growth.
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Affiliation(s)
- Meredith Merilee Brockway
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Allison I Daniel
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah M Reyes
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Deborah Chan
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Rebecca Refvik
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Karanbir K Sidhu
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Suad Musse
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Pooja P Patel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, Unites States
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Larisa Lotoski
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fyezah Jehan
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
| | - Lars Bode
- Department of Pediatrics, Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California, San Diego (UC San Diego), San Diego, CA, United States
| | - Kamilla G Eriksen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lindsay H Allen
- Department of Nutrition, University of California, Davis, CA, United States; Western Human Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, Washington, DC, Unites States
| | - Daniela Hampel
- Department of Nutrition, University of California, Davis, CA, United States; Western Human Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, Washington, DC, Unites States
| | - Natalie Rodriguez
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.
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8
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Perrin MT, Mansen K, Israel-Ballard K, Richter S, Bode L, Hampel D, Shahab-Ferdows S, Allen LH, Maggio FC, Njuguna E, Tran HT, Wesolowska A. Investigating donor human milk composition globally to develop effective strategies for the nutritional care of preterm infants: Study protocol. PLoS One 2023; 18:e0283846. [PMID: 37018290 PMCID: PMC10075430 DOI: 10.1371/journal.pone.0283846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/18/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Globally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle-income countries. In the absence of mother's milk, the World Health Organization recommends using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal disorder. The use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality, yet very little is known about the nutritional composition of DHM. Additional knowledge gaps include how DHM composition is influenced by milk banking practices, and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers. METHODS We designed a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings that will examine and compare a broad range of nutrients and bioactive factors in human milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM. We will then simulate the random pooling of 2 to 10 donors to evaluate the impact of pooling as a potential strategy for milk banks to manage nutrient variability in DHM. Finally, we will evaluate whether commercially available fortifiers meet nutrient recommendations when used with DHM. DISCUSSION We expect that results from this study will improve nutritional care globally for the growing number of preterm infants who receive donor human milk.
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Affiliation(s)
- Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Kimberly Mansen
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, WA, United States of America
| | | | - Scott Richter
- Department of Mathematics and Statistics, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Lars Bode
- Department of Pediatrics and Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, San Diego, CA, United States of America
| | - Daniela Hampel
- United States Department of Agriculture/Agriculture Research Service, Western Human Nutrition Research Center, Davis, CA, United States of America
- Department of Nutrition, University of California Davis, Davis, CA, United States of America
| | - Setareh Shahab-Ferdows
- United States Department of Agriculture/Agriculture Research Service, Western Human Nutrition Research Center, Davis, CA, United States of America
| | - Lindsay H Allen
- United States Department of Agriculture/Agriculture Research Service, Western Human Nutrition Research Center, Davis, CA, United States of America
| | | | - Emily Njuguna
- Pumwani Maternity and Referral Hospital, Nairobi, Kenya
| | - Hoang Thi Tran
- Human Milk Bank at Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Pediatrics, School of Medicine and Pharmacy, Da Nang University, Da Nang, Vietnam
| | - Aleksandra Wesolowska
- Department of Medical Biology, Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Medical University of Warsaw, Warsaw, Poland
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9
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Batalha MA, dos Reis Costa PN, Ferreira ALL, Freitas-Costa NC, Figueiredo ACC, Shahab-Ferdows S, Hampel D, Allen LH, Pérez-Escamilla R, Kac G. Maternal Mental Health in Late Pregnancy and Longitudinal Changes in Postpartum Serum Vitamin B-12, Homocysteine, and Milk B-12 Concentration Among Brazilian Women. Front Nutr 2022; 9:923569. [PMID: 35898719 PMCID: PMC9309881 DOI: 10.3389/fnut.2022.923569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background Little is known regarding the association between mental health distress during pregnancy and postpartum maternal serum biomarkers of vitamin B-12 status and milk B-12 concentration. Objective To evaluate the association between depressive and anxiety symptoms in the third trimester of pregnancy and changes in postpartum serum B-12, homocysteine, and B-12 milk concentration. Methods A total of 101 women (18–40 years) were studied in a prospective cohort with data at the third trimester of pregnancy (baseline) and three postpartum time-points (TPs): 2–8 days (TP1), 28–50 days (TP2), and 88-119 days (TP3) postpartum. B-12 concentrations in milk were measured by competitive chemiluminescent enzyme immunoassay at TP1, TP2, and TP3. Serum B-12 and homocysteine concentrations were evaluated at baseline, TP1, TP2, and TP3 by chemiluminescent immunoassays. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory at baseline. Spearman's correlation test and multiple linear mixed-effect models were performed. Results The prevalence of depressive and anxiety state symptoms was 35.6 and 39.6% at baseline. High prevalence of low milk B-12 concentration (<310 pmol/L) were observed at TP1 (53.2%), TP2 (71.4%), and TP3 (71.1%). Women with anxiety symptoms at baseline presented higher median concentrations of serum homocysteine at TP1 and lower concentrations of serum and milk B-12 at TP2 compared with women without anxiety symptoms [8 (7; 9) vs. 6 (5; 8) and 266 (188; 369) vs. 332 (272; 413)]. Milk B-12 concentrations were positively and significantly correlated with maternal serum B-12 concentrations at different TP. Women with anxiety symptoms at baseline exhibited a decrease in daily postpartum homocysteine concentrations compared to women without anxiety symptoms (β = −0.002, SE = 0.001, p = 0.024). Conclusion Anxiety symptoms at the end of pregnancy were associated with longitudinal changes in maternal serum homocysteine concentrations during the first 3 months postpartum.
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Affiliation(s)
- Mônica Araujo Batalha
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Paula Normando dos Reis Costa
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Ana Lorena Lima Ferreira
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Nathalia C. Freitas-Costa
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Amanda C. Cunha Figueiredo
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Setareh Shahab-Ferdows
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
| | - Daniela Hampel
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
- Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Lindsay H. Allen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
- Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
- *Correspondence: Gilberto Kac
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10
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Hampel D, Shahab-Ferdows S, Schulze K, Allen L. Comprehensive Analysis of B-vitamins in Human Milk. Curr Dev Nutr 2022. [DOI: 10.1093/cdn/nzac063.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
B-vitamins are metabolic co-factors and an inadequate supply to the exclusively breast-fed infant can affect healthy growth and development. We developed a UPLC-MS/MS method for analyzing thiamin (T), thiamin-monophosphate, riboflavin, flavin adenine dinucleotide, flavin mononucleotide, nicotinamide, nicotinic acid, nicotinamide mononucleotide, nicotinamide dinucleotide, nicotinamide riboside, nudifloramide, pantothenic acid, pyridoxal, pyridoxal 5-phosphate, pyridoxamine, pyridoxine, 4-pyridoxic acid, biotin, 5-methyl-tetrahydrofuran (5MeTHF), and tryptophan in human milk.
Methods
Optimized results were obtained using a Phenomenex NX-C18 column, 250 × 3 mm, 3 µm, and a gradient of an aqueous solution of 10 mM ammonium formate + 0.05% ammonium hydroxide (A) and acetonitrile (B) from 99% to 5% A in a 12 min run (SCIEX ExionLC-AD -QTRAP6500+). Defatted and deproteinized milk (100 µL) was used and quantified by area ratio responses (external to internal standards). 50 milk samples from community-dwelling rural Bangladeshi mothers at 3.2 ± 0.2 months postpartum were analyzed and results were compared to the Adequate Intakes (AI) for infants 0–6 months.
Results
Analyte recoveries in pooled human milk ranged from 65–130% across vitamins with an overall process efficiency from 81–92% (T: 190%). Additional analytes were detectable but not yet quantifiable: nicotinamide dinucleotidephosphate, pyridoxamine 5-phosphate, 4-deoxypyridoxine, folic acid, and thiamin-diphosphate. 5MeTHF was detectable but given the sample preparation, only as a small concentration. Milk from Bangladeshi mothers had a large range of vitamin concentrations within and between analytes, including for samples meeting the AI. One sample (2%) reached the AI for vitamin B1, none for B2; 14% for niacin, 98% for pantothenic acid, 72% for B6, and 34% for biotin.
Conclusions
This method enables a comprehensive evaluation of milk B-vitamin concentrations to assess status and effects of maternal interventions on milk B-vitamins. Future application will be expanded to other matrices with further validation of the analytes currently only ascertainable qualitatively.
Funding Sources
Bill & Melinda Gates Foundation (OPP1148405), USDA/ARS Intramural Project (5306-51,530-019-00).
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11
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Diana A, Rahmannia S, Suhadi YZ, Luftimas DE, Rizqi H, Purnamasari AD, Jihadillah A, Ansari MB, Haq DAZ, Pratiwi AN, Scott S, Hampel D, Allen LH, Haszard JJ, Houghton LA, Gibson RS, Fahmida U. Chicken liver and eggshell crackers as a safe and affordable animal source food for overcoming micronutrient deficits during pregnancy and lactation in Indonesia: a double-blind, randomised placebo-controlled trial (SISTIK Growth Study). Wellcome Open Res 2022; 7:167. [PMID: 35865219 PMCID: PMC9270652 DOI: 10.12688/wellcomeopenres.17879.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Indonesia ranks fifth in terms of the number of stunted children and there has been little change in the stunting prevalence in the last decade. In earlier observational studies conducted in 2014-2015, we identified several key underlying problems with the potential to impact stunting in Sumedang district, West Java, Indonesia. Deficits in intakes of growth-limiting micronutrients were observed, most notably calcium, iron, zinc, and vitamin A, emphasizing the need for a food-based intervention to overcome these micronutrient deficits in the diets of mothers and their infants. Methods: A double-blind placebo-controlled cluster randomised trial comparing the effect of daily consumption of 75 grams of locally produced micronutrient-enriched crackers (MEC) (intervention group) compared to placebo crackers (control group) by mothers at two-time intervals: (i) from the 8-14 weeks of pregnancy to delivery (i.e., 28-34 weeks of consumption of MEC) on birth length, and (ii) from the 8-14 weeks of pregnancy to 5 months post-partum on attained linear growth and linear growth velocity of breast-fed infants. A total of 324 pregnant women from 28 clusters (villages) located in 3 sub-districts in Sumedang district, West Java, Indonesia, will be randomly assigned to either intervention (n=14 villages) or control (n=14 villages). Discussion: This will be the first study in Indonesia to use crackers based on powdered eggshells and chicken liver, in a form which is acceptable, safe, and has a long shelf life. If daily consumption of MEC for 6 months during pregnancy can enhance birth length, or their continued daily consumption for 5 months postpartum improves both attained and incremental linear growth at 5 months of age, then scaling-up in Indonesia may be considered. Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT04564222; 25
th September 2020
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Affiliation(s)
- Aly Diana
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON), Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, 13120, Indonesia
| | - Sofa Rahmannia
- Faculty of Medicine, Universitas Pasundan, Bandung, 40117, Indonesia
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Yenni Zuhairini Suhadi
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Dimas Erlangga Luftimas
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Haidar Rizqi
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Afini Dwi Purnamasari
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Ayunda Jihadillah
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Mohammad Brachim Ansari
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Dearly Ayu Zahrotun Haq
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Aisyah Nur Pratiwi
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Samuel Scott
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Poverty Health and Nutrition Division, New Delhi, 110012, India
| | - Daniela Hampel
- Department of Nutrition, University of California, One Shields Ave, Davis, 95616, USA
- USDA, ARS-Western Human Nutrition Research Center, Davis, CA, 95616, USA
| | - Lindsay H Allen
- Department of Nutrition, University of California, One Shields Ave, Davis, 95616, USA
- USDA, ARS-Western Human Nutrition Research Center, Davis, CA, 95616, USA
| | - Jillian J Haszard
- Biostatistics Centre, University of Otago, Dunedin, 9054, New Zealand
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, 9016, New Zealand
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, 9016, New Zealand
| | - Umi Fahmida
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON), Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, 13120, Indonesia
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12
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Young BE, Westcott J, Kemp J, Allen L, Hampel D, Garcés AL, Figueroa L, Goudar SS, Dhaded SM, Somannavar M, Saleem S, Ali SA, Hambidge KM, Krebs NF. B-Vitamins and Choline in Human Milk Are Not Impacted by a Preconception Lipid-Based Nutrient Supplement, but Differ Among Three Low-to-Middle Income Settings-Findings From the Women First Trial. Front Nutr 2022; 8:750680. [PMID: 35004801 PMCID: PMC8733746 DOI: 10.3389/fnut.2021.750680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/22/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction: Optimal human milk (HM) B-vitamin concentrations remain undefined, especially in areas where undernutrition is prevalent. The impact of supplementation pre-conception through pregnancy on HM B-vitamin composition remains unknown. Methods: Human milk (HM) was collected at 2-weeks postpartum from 200 women in Guatemala, India, and Pakistan (the Women First Trial). The women were randomized to start a lipid-based nutrient supplement before conception, at end of the first trimester, or not at all; intervention continued until delivery. HM concentrations of eight B-vitamins and choline were assessed via ultra-performance liquid chromatography-tandem mass spectrometry. Maternal diet was assessed in early pregnancy, and infant growth followed through 6 months post-delivery. Results: Despite supplement exposure averaging 15.7 (pre-conception arm) and 6.0 months (prenatal arm), HM B-vitamins did not differ between arms, but site differences were evident. Guatemala had higher HM concentrations of vitamin B3 than Pakistan and India. Pakistan had higher HM concentrations of thiamin and vitamin B6 than India and Guatemala. Cohort average HM vitamin B2 (162 ± 79 μg/L) and B6 (31.8 ± 24.6 μg/L) fell below values defined as deficient in 81.5 and 85.5% of samples, potentially reflecting sampling procedures and timing. Maternal dietary intakes of only vitamin B6 and choline were associated with the corresponding concentrations in HM (p < 0.005). No HM B-vitamin concentrations were associated with infant growth. Conclusion: Prenatal supplementation for at least 6 months had no impact on HM B-vitamin concentrations at 2-weeks postpartum. Results suggest that the adequacy of HM composition was generally maintained, with potential exceptions of vitamin B2 and B6.
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Affiliation(s)
- Bridget E Young
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jamie Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lindsay Allen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Daniela Hampel
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Ana L Garcés
- Department of Maternal and Newborn Health, Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Department of Maternal and Newborn Health, Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Manjunath Somannavar
- KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Aziz Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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13
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Hinnouho GM, Hampel D, Shahab-Ferdows S, Barffour MA, McAnena L, Arnold CD, Ryan Wessells K, Kounnavong S, Allen LH, McNulty H, Hess SY. Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B 12 status among young Laotian children: a randomized controlled trial. Eur J Nutr 2022; 61:3423-3435. [PMID: 35534778 PMCID: PMC9464137 DOI: 10.1007/s00394-022-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the effects of intervention with a daily multiple micronutrient powder (MNP) on thiamine, riboflavin, folate, and B12 status among young Laotian children. METHODS Children (n = 1704) aged 6-23 mo, participating in a double-blind placebo-controlled randomized trial were individually randomized to receive daily either MNP (containing 0.5 mg of thiamine, 0.5 mg riboflavin, 150 μg folic acid, and 0.9 μg vitamin B12 along with 11 other micronutrients) or placebo and followed for ~ 36 weeks. In a randomly selected sub-sample of 260 children, erythrocyte thiamine diphosphate (eThDP), plasma folate and B12 concentrations, and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were assessed at baseline and endline. RESULTS There was no treatment effect on endline eThDP concentrations (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo group; p = 0.924), EGRac (1.46 ± 0.3 vs. 1.49 ± 0.3; p = 0.184) and B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p = 0.678). Likewise, the prevalence of thiamine, riboflavin, and B12 deficiencies did not differ significantly between the two groups. However, endline folate concentration was significantly higher in the MNP compared to the placebo group (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L, respectively; p < 0.001), and correspondingly, the prevalence of folate deficiency was significantly lower in the MNP group (1.6% vs 17.4%; p = 0.015). CONCLUSIONS Compared to a placebo, daily MNP for 9 months increased only folate but not thiamine, riboflavin, or B12 status in young Laotian children. TRIAL REGISTRATION The trial was registered at www. CLINICALTRIALS gov (NCT02428647) on April 29 2015.
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Affiliation(s)
- Guy-Marino Hinnouho
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA. .,Helen Keller International, Washington, DC, USA.
| | - Daniela Hampel
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,USDA, ARS Western Human Nutrition Research Center, Davis, CA USA
| | | | - Maxwell A. Barffour
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,University of Missouri School of Medicine, Columbia, MO USA ,Public Health Program, College of Health and Human Services, Missouri State University, Springfield, MO USA
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland UK
| | - Charles D. Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
| | - K. Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Lindsay H. Allen
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,USDA, ARS Western Human Nutrition Research Center, Davis, CA USA
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland UK
| | - Sonja Y. Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
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14
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Hampel D, Shahab-Ferdows S, Newman JW, Allen LH. Improving LC-MS analysis of human milk B-vitamins by lactose removal. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1183:122968. [PMID: 34628184 PMCID: PMC8752959 DOI: 10.1016/j.jchromb.2021.122968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 11/21/2022]
Abstract
Lactose in human milk affects B-vitamin analysis by fouling the ion source. Typical extraction methods are inefficient for lactose removal. Chromatographic separation from analytes enables lactose mechanical removal.
Our previously reported, first validated, UPLC-MS/MS-based simultaneous analysis of five human milk B-vitamins revealed severe matrix effects. High levels of endogenous lactose fouled the electrospray ionization source affecting the analysis. We evaluated solid-phase extraction (SPE), liquid–solid extraction (LSE), protein precipitation (PPT), and liquid chromatography effluent diversion for lactose-removal. SPE failed to separate lactose from vitamins; LSE using 2-propanol reduced lactose and vitamin recoveries. PPT-solvent, milk volume, and reconstitution solvent influenced flavin adenine dinucleotide, pyridoxal and nicotinamide recoveries. Using an optimized LC-gradient enabled chromatographic separation of lactose from vitamins and its removal using a post-column switch-valve. Only 40 µL milk was subjected to methanol-PPT and non-polar matrix removal by methyl tert-butyl ether. B-vitamin recoveries were established (81.9–118.6%; CV ≤ 11.9%; precision: 4.9–13.7%) with greatly reduced matrix effects, and improved process efficiency, and recovery.
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Affiliation(s)
- Daniela Hampel
- USDA, ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA; Department of Nutrition, University of California, One Shields Ave, Davis, CA 95616, USA.
| | - Setareh Shahab-Ferdows
- USDA, ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA
| | - John W Newman
- USDA, ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA; Department of Nutrition, University of California, One Shields Ave, Davis, CA 95616, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA; Department of Nutrition, University of California, One Shields Ave, Davis, CA 95616, USA
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Batalha MA, Ferreira ALL, Freitas-Costa NC, Figueiredo ACC, Carrilho TRB, Shahab-Ferdows S, Hampel D, Allen LH, Pérez-Escamilla R, Kac G. Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk. Am J Clin Nutr 2021; 114:1560-1573. [PMID: 34113959 DOI: 10.1093/ajcn/nqab191] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Little is known regarding the associations between maternal factors and B-vitamin and choline concentrations in early milk and the trajectories of these vitamins during lactation. OBJECTIVES In this hypothesis-generating study, we modeled the association between maternal and offspring factors and longitudinal changes in milk B-vitamin and choline concentrations throughout lactation. METHODS A hundred women were studied in a prospective birth cohort and milk samples from 52 women were collected at 2-8 d, 76 women at 28-50 d, and 42 women at 88-119 d postpartum. Maternal dietary intake during pregnancy and lactation was assessed by an FFQ. Linear mixed-effects models with interaction terms were used to evaluate changes in milk B-vitamin and choline concentrations over time based on maternal factors and the early postpartum concentrations of these micronutrients. RESULTS The women with higher early postpartum milk concentrations of niacin (βinteraction = -0.02; SE = 0.00; P < 0.001), pantothenic acid (βinteraction = -0.10; SE = 2.56; P < 0.001), vitamin B-12 (βinteraction= -0.10; SE = 0.03; P < 0.001), and choline (βinteraction= -0.90; SE = 0.18; P < 0.001) exhibited a decrease in their concentrations throughout lactation. The participants with overweight and obesity prepregnancy experienced an increase in milk vitamin B-12 concentrations over time (βinteraction = 0.04; SE = 0.02; P = 0.06). In contrast, a decrease in vitamin B-12 concentration was observed among women with vitamin B-12 intake below the RDA during pregnancy (βinteraction= -0.08; SE = 0.05; P = 0.07). The women with niacin intake below the RDA during lactation experienced an increase in milk concentrations over time (βinteraction = 0.01; SE = 0.01; P = 0.03). A gestational age at birth >40 wk was associated with an increase in milk choline concentration throughout lactation (βinteraction = 0.54; SE = 0.16; P< 0.01). CONCLUSIONS Changes in B-vitamin and choline concentrations in human milk over time may be associated with the early concentrations of these micronutrients in milk, maternal prepregnancy BMI, dietary intake, and gestational age at delivery.
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Affiliation(s)
- Mônica A Batalha
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Ana L L Ferreira
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Nathalia C Freitas-Costa
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Amanda C C Figueiredo
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Thais R B Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Setareh Shahab-Ferdows
- USDA/Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA
| | - Daniela Hampel
- USDA/Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lindsay H Allen
- USDA/Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
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16
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Allen LH, Hampel D, Shahab-Ferdows S, Andersson M, Barros E, Doel AM, Eriksen KG, Christensen SH, Islam M, Kac G, Keya FK, Michaelsen KF, de Barros Mucci D, Njie F, Peerson JM, Moore SE. The Mothers, Infants, and Lactation Quality (MILQ) Study: A Multi-Center Collaboration. Curr Dev Nutr 2021; 5:nzab116. [PMID: 34712893 PMCID: PMC8546155 DOI: 10.1093/cdn/nzab116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Little valid information is available on human milk nutrient concentrations, especially for micronutrients (MNs), and there are no valid reference values (RVs) across lactation. In this multi-center collaborative study, RVs will be established for human milk nutrients across the first 8.5 mo postpartum. Well-nourished, unsupplemented women in Bangladesh, Brazil, Denmark, and The Gambia (n = 250/site) were recruited during the third trimester of pregnancy. Milk, blood, saliva, urine, and stool samples from mothers and their infants are collected identically at 3 visits (1-3.49, 3.5-5.99, 6.0-8.49 mo postpartum). Milk analyses include macronutrients, selected vitamins, trace elements and minerals, iodine, metabolomics, amino acids, human milk oligosaccharides, and bioactive peptides. We measure milk volume; maternal and infant diets, anthropometry, and morbidity; infant development, maternal genome, and the infant and maternal microbiome. RVs will be constructed based on methods for the WHO Child Growth Standards and the Intergrowth-21st Project. This trial was registered at clinical trials.gov as NCT03254329.
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Affiliation(s)
- Lindsay H Allen
- USDA, Agricultural Research Service (ARS) Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Daniela Hampel
- USDA, Agricultural Research Service (ARS) Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Setareh Shahab-Ferdows
- USDA, Agricultural Research Service (ARS) Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Maria Andersson
- Nutrition Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
| | - Erica Barros
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Kamilla Gehrt Eriksen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Gilberto Kac
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Farhana Khanam Keya
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Fanta Njie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia, West Africa
| | - Janet M Peerson
- USDA, Agricultural Research Service (ARS) Western Human Nutrition Research Center, Davis, CA, USA
| | - Sophie E Moore
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia, West Africa
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Measelle JR, Baldwin DA, Gallant J, Chan K, Green TJ, Wieringa FT, Borath M, Prak S, Hampel D, Shahab-Ferdows S, Allen LH, Kroeun H, Whitfield KC. Thiamine supplementation holds neurocognitive benefits for breastfed infants during the first year of life. Ann N Y Acad Sci 2021; 1498:116-132. [PMID: 34101212 PMCID: PMC9291201 DOI: 10.1111/nyas.14610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 12/25/2022]
Abstract
Women reliant on mostly rice‐based diets can have inadequate thiamine intake, placing breastfed infants at risk of thiamine deficiency and, in turn, physical and cognitive impairments. We investigated the impact of maternal thiamine supplementation doses on infants’ cognitive, motor, and language development across the first year. In this double‐blind, four‐parallel‐arm, randomized controlled trial, healthy mothers of exclusively breastfed newborn infants were recruited in Kampong Thom, Cambodia. At 2 weeks postnatal, women (n = 335) were randomized to one of four treatment groups to consume one capsule/day with varying amounts of thiamine for 22 weeks: 0, 1.2, 2.4, and 10 mg. At 2, 12, 24, and 52 weeks of age, infants were assessed with the Mullen Scales of Early Learning (MSEL) and the Caregiver Reported Early Development Instrument (CREDI). Multiple regression and mixed effects modeling suggest that by 6 months of age, the highest maternal thiamine dose (10 mg/day) held significant benefits for infants’ language development, but generally not for motor or visual reception development. Despite having achieved standardized scores on the MSEL that approximated U.S. norms by 6 months, infants showed a significant drop relative to these norms in both language domains following trial completion, indicating that nutritional interventions beyond 6 months may be necessary.
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Affiliation(s)
| | - Dare A Baldwin
- Department of Psychology, University of Oregon, Eugene, Oregon
| | - Jelisa Gallant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kathleen Chan
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Tim J Green
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Frank T Wieringa
- UMR-204, Institut de recherche pour le développement, Montpellier, France
| | - Mam Borath
- National Sub-Committee for Food Fortification, Cambodia Ministry of Planning, Phnom Penh, Cambodia
| | - Sophonneary Prak
- National Nutrition Programme, Maternal and Child Health Centre, Cambodia Ministry of Health, Phnom Penh, Cambodia
| | - Daniela Hampel
- USDA/ARS Western Human Nutrition Research Center, Davis, California.,Department of Nutrition, University of California, Davis, California
| | - Setareh Shahab-Ferdows
- USDA/ARS Western Human Nutrition Research Center, Davis, California.,Department of Nutrition, University of California, Davis, California
| | - Lindsay H Allen
- USDA/ARS Western Human Nutrition Research Center, Davis, California.,Department of Nutrition, University of California, Davis, California
| | - Hou Kroeun
- Helen Keller International Cambodia, Phnom Penh, Cambodia
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Abstract
Abstract
Objectives
Comprehensive metabolic profiling of human milk is a useful tool for examining its composition and relationship to maternal and infant metabolism and status.
Methods
A pooled milk sample was used to evaluate the Biocrates MxP® Quant 500 kit for human milk metabolomics (107 small molecules and 523 lipids) using an ABSciex 5500QTRAP mass-spectrometer in LC-MS/MS and flow injection analysis (FIA) mode. Additionally, milk from Brazilian mothers (A: 2–8, B: 28–50, C: 88–119d postpartum, ntotal = 25) was analyzed.
Results
424 of the 630 assay metabolites were detected in the milkpool above the limit of quantitation (LOQ); 31 metabolites were below the lower limit of quantitation (LLOQ), while 7 were above the upper limit (ULOQ), mostly free fatty acids including arachidonic acid, docohexaenoic acid, and eicosapentaenoic acid. Bile acids were only detected below LLOQ. Concentrations measured in 5 different sample volumes (2–20μL, n = 10) showed satisfactory reproducibility (CV 3.7–20.0%) for 458 metabolites. Acceptable intraday variation (80–120%, 6 replicates) was achieved for 409 metabolites when spiking with 3 levels of QC-standards, but only for 127 metabolites after dilution (1:2 and 1:5). However, 396 metabolites revealed a good intraday variation when only considering the 1:2-dilution.
Conclusions
The MxP Quant® 500 kit was successfully employed for human milk providing data for over 400 metabolites in 10μL milk. and thus offers ability to use the same assay for both human plasma and milk, enhancing comparability of results by reducing analytical bias and increasing our ability to study milk as a biological system.
Funding Sources
Bill & Melinda Gates Foundation (OPP1148405), USDA/ARS Intramural Project (5306–51,530-019–00), and CNPq (Brazilian National Council for Science and Technology).
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Affiliation(s)
- Daniela Hampel
- Western Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture
| | - Setareh Shahab-Ferdows
- Western Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture
| | | | - Lindsay Allen
- Western Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture
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19
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Gallant J, Chan K, Green TJ, Wieringa FT, Leemaqz S, Ngik R, Measelle JR, Baldwin DA, Borath M, Sophonneary P, Yelland LN, Hampel D, Shahab-Ferdows S, Allen LH, Jones KS, Koulman A, Parkington DA, Meadows SR, Kroeun H, Whitfield KC. Low-dose thiamine supplementation of lactating Cambodian mothers improves human milk thiamine concentrations: a randomized controlled trial. Am J Clin Nutr 2021; 114:90-100. [PMID: 33829271 PMCID: PMC8246599 DOI: 10.1093/ajcn/nqab052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Infantile beriberi-related mortality is still common in South and Southeast Asia. Interventions to increase maternal thiamine intakes, and thus human milk thiamine, are warranted; however, the required dose remains unknown. OBJECTIVES We sought to estimate the dose at which additional maternal intake of oral thiamine no longer meaningfully increased milk thiamine concentrations in infants at 24 wk postpartum, and to investigate the impact of 4 thiamine supplementation doses on milk and blood thiamine status biomarkers. METHODS In this double-blind, 4-parallel arm randomized controlled dose-response trial, healthy mothers were recruited in Kampong Thom, Cambodia. At 2 wk postpartum, women were randomly assigned to consume 1 capsule, containing 0, 1.2 (estimated average requirement), 2.4, or 10 mg of thiamine daily from 2 through 24 weeks postpartum. Human milk total thiamine concentrations were measured using HPLC. An Emax curve was plotted, which was estimated using a nonlinear least squares model in an intention-to-treat analysis. Linear mixed-effects models were used to test for differences between treatment groups. Maternal and infant blood thiamine biomarkers were also assessed. RESULTS In total, each of 335 women was randomly assigned to1 of the following thiamine-dose groups: placebo (n = 83), 1.2 mg (n = 86), 2.4 mg (n = 81), and 10 mg (n = 85). The estimated dose required to reach 90% of the maximum average total thiamine concentration in human milk (191 µg/L) is 2.35 (95% CI: 0.58, 7.01) mg/d. The mean ± SD milk thiamine concentrations were significantly higher in all intervention groups (183 ± 91, 190 ± 105, and 206 ± 89 µg/L for 1.2, 2.4, and 10 mg, respectively) compared with the placebo group (153 ± 85 µg/L; P < 0.0001) and did not significantly differ from each other. CONCLUSIONS A supplemental thiamine dose of 2.35 mg/d was required to achieve a milk total thiamine concentration of 191 µg/L. However, 1.2 mg/d for 22 wk was sufficient to increase milk thiamine concentrations to similar levels achieved by higher supplementation doses (2.4 and 10 mg/d), and comparable to those of healthy mothers in regions without beriberi. This trial was registered at clinicaltrials.gov as NCT03616288.
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Affiliation(s)
- Jelisa Gallant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS Canada
| | - Kathleen Chan
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS Canada
| | - Tim J Green
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Frank T Wieringa
- UMR-204, Institut de recherche pour le développement, UM/IRD/SupAgro, Montpellier, France
| | - Shalem Leemaqz
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Rem Ngik
- Helen Keller International Cambodia, Phnom Penh, Cambodia
| | | | - Dare A Baldwin
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Mam Borath
- National Subcommittee for Food Fortification, Cambodia Ministry of Planning, Phnom Penh, Cambodia
| | - Prak Sophonneary
- National Nutrition Programme, Maternal and Child Health Centre, Cambodia Ministry of Health, Phnom Penh, Cambodia
| | - Lisa N Yelland
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia,School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Daniela Hampel
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Setareh Shahab-Ferdows
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Kerry S Jones
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Albert Koulman
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Damon A Parkington
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sarah R Meadows
- NIHR BRC Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Hou Kroeun
- Helen Keller International Cambodia, Phnom Penh, Cambodia
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Hampel D, Shahab-Ferdows S, Nguyen N, Kac G, Allen LH. High-Throughput Analysis of Water-Soluble Forms of Choline and Related Metabolites in Human Milk by UPLC-MS/MS and Its Application. Front Nutr 2021; 7:604570. [PMID: 33614690 PMCID: PMC7892616 DOI: 10.3389/fnut.2020.604570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Choline and related metabolites are key factors in many metabolic processes, and insufficient supply can adversely affect reproduction and fetal development. Choline status is mainly regulated by intake, and human milk is the only choline source for exclusively breastfed infants. Further, maternal status, genotype, and phenotype, as well as infant outcomes, have been related to milk choline concentrations. In order to enable the rapid assessment of choline intake for exclusively breastfed infants and to further investigate the associations between milk choline and maternal and infant status and other outcomes, we have developed a simplified method for the simultaneous analysis of human milk choline, glycerophosphocholine, phosphocholine, and the less abundant related metabolites betaine, carnitine, creatinine, dimethylglycine (DMG), methionine, and trimethylamine N-oxide (TMAO) using ultraperformance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS). These analytes have milk concentrations ranging over 3 orders of magnitude. Unlike other recently described LC-based methods, our approach does not require an ion-pairing reagent or high concentrations of solvent modifiers for successful analyte separation and thus avoid signal loss and potential permanent contamination. Milk samples (10 μl) were diluted (1:80) in water : methanol (1:4, v:v) and filtered prior to analysis with an optimized gradient of 0.1% propionic acidaq and acetonitrile, allowing efficient separation and removal of contaminants. Recovery rates ranged from 108.0 to 130.9% (inter-day variation: 3.3–9.6%), and matrix effects (MEs) from 54.1 to 114.3%. MEs were greater for carnitine, creatinine, and TMAO at lower dilution (1:40, p < 0.035 for all), indicating concentration-dependent ion suppression. Milk from Brazilian women (2–8, 28–50, and 88–119 days postpartum, ntotal = 53) revealed increasing concentration throughout lactation for glycerophosphocholine, DMG, and methionine, while carnitine decreased. Choline and phosphocholine were negatively correlated consistently at all three collection time intervals. The method is suitable for rapid analysis of human milk water-soluble forms of choline as well as previously not captured related metabolites with minimal sample volumes and preparation.
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Affiliation(s)
- Daniela Hampel
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Setareh Shahab-Ferdows
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
| | - Ngoc Nguyen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Gilberto Kac
- Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Lindsay H Allen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
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21
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da Silva MT, Mujica-Coopman MF, Figueiredo ACC, Hampel D, Vieira LS, Farias DR, Shahab-Ferdows S, Allen LH, Brito A, Lamers Y, Kac G, S Vaz J. Maternal plasma folate concentration is positively associated with serum total cholesterol and low-density lipoprotein across the three trimesters of pregnancy. Sci Rep 2020; 10:20141. [PMID: 33214613 PMCID: PMC7677547 DOI: 10.1038/s41598-020-77231-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Increased first-trimester low-density lipoprotein (LDL-C) concentration has been associated with adverse pregnancy outcomes, such as gestational diabetes. The B vitamins folate, B-6, and total B-12 are key for the methyl group-dependent endogenous synthesis of phosphatidylcholine, which is needed for lipoprotein synthesis, e.g., very low-density lipoprotein (VLDL), the precursor of circulating LDL-C. Maternal B-vitamin concentration usually declines across trimesters. Whether changes in maternal B-vitamin concentrations are associated with total cholesterol (TC), triglycerides (TG), and lipoprotein concentrations is unknown. Therefore, we explored the association between plasma folate, vitamin B-6 in the form of pyridoxal 5′-phosphate (PLP), and total B-12 with serum TC, LDL-C, HDL-C, and TG concentrations across trimesters. This secondary analysis used data of a prospective pregnancy cohort study included apparently healthy adult women (n = 179) from Rio de Janeiro, Brazil. The biomarkers were measured in fasting blood samples collected at 5–13, 20–26, and 30–36 weeks of gestation. The associations between B vitamins and lipid concentrations across trimesters were explored using linear mixed-effect models. Among B vitamins, only plasma folate was positively associated with TC (β = 0.244, 95% CI 0.034–0.454) and LDL-C (β = 0.193, 95% CI 0.028–0.357) concentrations. The positive relationship of maternal folate and TC and LDL-C concentrations may indicate the importance of folate as a methyl donor for lipoprotein synthesis during pregnancy.
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Affiliation(s)
- Manoela T da Silva
- Graduate Program in Food and Nutrition, Faculty of Nutrition, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, RS, 96010-610, Brazil
| | - Maria F Mujica-Coopman
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Amanda C C Figueiredo
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Department of Social and Applied Nutrition, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Daniela Hampel
- USDA-ARS Western Human Nutrition Research Center, Department of Nutrition, University of California, Davis, CA, USA
| | - Luna S Vieira
- Graduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Dayana R Farias
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Department of Social and Applied Nutrition, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Setareh Shahab-Ferdows
- USDA-ARS Western Human Nutrition Research Center, Department of Nutrition, University of California, Davis, CA, USA
| | - Lindsay H Allen
- USDA-ARS Western Human Nutrition Research Center, Department of Nutrition, University of California, Davis, CA, USA
| | - Alex Brito
- Laboratory of Pharmacokinetics and Metabolomic Analysis, Institute of Translational Medicine and Biotechnology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Population Health, Nutrition and Health Research Group, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Yvonne Lamers
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Department of Social and Applied Nutrition, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Juliana S Vaz
- Graduate Program in Food and Nutrition, Faculty of Nutrition, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, RS, 96010-610, Brazil. .,Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Department of Social and Applied Nutrition, Rio de Janeiro Federal University, Rio de Janeiro, Brazil. .,Graduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil.
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22
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Gibson RS, Rahmannia S, Diana A, Leong C, Haszard JJ, Hampel D, Reid M, Erhardt J, Suryanto AH, Sofiah WN, Fathonah A, Shahab-Ferdows S, Allen LH, Houghton LA. Association of maternal diet, micronutrient status, and milk volume with milk micronutrient concentrations in Indonesian mothers at 2 and 5 months postpartum. Am J Clin Nutr 2020; 112:1039-1050. [PMID: 32844187 PMCID: PMC7528569 DOI: 10.1093/ajcn/nqaa200] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/29/2020] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Sofa Rahmannia
- Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Claudia Leong
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Daniela Hampel
- USDA/ARS Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Malcolm Reid
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | | | | | - Wina Nur Sofiah
- Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Annisha Fathonah
- Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Setareh Shahab-Ferdows
- USDA/ARS Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Lindsay H Allen
- USDA/ARS Western Human Nutrition Research Center, Davis, CA, USA
- Department of Nutrition, University of California, Davis, CA, USA
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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23
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Donohue JA, Solomons NW, Hampel D, Shahab-Ferdows S, Orozco MN, Allen LH. Micronutrient supplementation of lactating Guatemalan women acutely increases infants' intake of riboflavin, thiamin, pyridoxal, and cobalamin, but not niacin, in a randomized crossover trial. Am J Clin Nutr 2020; 112:669-682. [PMID: 32649760 PMCID: PMC7690764 DOI: 10.1093/ajcn/nqaa147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal supplementation during lactation could increase milk B-vitamin concentrations, but little is known about the kinetics of milk vitamin responses. OBJECTIVES We compared acute effects of maternal lipid-based nutrient supplement (LNS) consumption (n = 22 nutrients, 175%-212% of the RDA intake for the nutrients examined), as a single dose or at spaced intervals during 8 h, on milk concentrations and infant intake from milk of B-vitamins. METHODS This randomized crossover trial in Quetzaltenango, Guatemala included 26 mother-infant dyads 4-6 mo postpartum who were randomly assigned to receive 3 treatments in a random order: bolus 30-g dose of LNS (Bolus); 3 × 10-g doses of LNS (Divided); and no LNS (Control), with control meals. Mothers attended three 8-h visits during which infant milk consumption was measured and milk samples were collected at every feed. Infant intake was assessed as $\mathop \sum \nolimits_{i\ = \ 1}^n ( {{\rm{milk\ volum}}{{\rm{e}}_{{\rm{feed\ }}n}} \times \ {\rm{nutrient\ concentratio}}{{\rm{n}}_{{\rm{feed}}\ n}}} )$ over 8 h. RESULTS Maternal supplementation with the Bolus or Divided dose increased least-squares mean (95% CI) milk and infant intakes of riboflavin [milk: Bolus: 154.4 (138.2, 172.5) μg · min-1 · mL-1; Control: 84.5 (75.8, 94.3) μg · min-1 · mL-1; infant: Bolus: 64.5 (56.1, 74.3) μg; Control: 34.5 (30.0, 39.6) μg], thiamin [milk: Bolus: 10.9 (10.1, 11.7) μg · min-1 · mL-1; Control: 7.7 (7.2, 8.3) μg · min-1 · mL-1; infant: Bolus: 5.1 (4.4, 6.0) μg; Control: 3.4 (2.9, 4.0) μg], and pyridoxal [milk: Bolus: 90.5 (82.8, 98.9) μg · min-1 · mL-1; Control: 60.8 (55.8, 66.3) μg · min-1 · mL-1; infant: Bolus: 39.4 (33.5, 46.4) μg; Control: 25.0 (21.4, 29.2) μg] (all P < 0.001). Only the Bolus dose increased cobalamin in milk [Bolus: 0.054 (0.047, 0.061) μg · min-1 · mL-1; Control: 0.041 (0.035, 0.048) μg · min-1 · mL-1, P = 0.039] and infant cobalamin intake [Bolus: 0.023 (0.020, 0.027) μg; Control: 0.015 (0.013, 0.018) μg, P = 0.001] compared with Control. Niacin was unaffected. CONCLUSIONS Maternal supplementation with LNS as a Bolus or Divided dose was similarly effective at increasing milk riboflavin, thiamin, and pyridoxal and infant intakes, whereas only the Bolus dose increased cobalamin. Niacin was unaffected in 8 h. This trial was registered at clinicaltrials.gov as NCT02464111.
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Affiliation(s)
- Juliana A Donohue
- Present address for JAD: Basics Nutrition Research, 18555 SW Teton Ave., Tualatin, OR 97062, USA
| | - Noel W Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
| | - Daniela Hampel
- Western Human Nutrition Research Center, Agricultural Research Service, USDA, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Setareh Shahab-Ferdows
- Western Human Nutrition Research Center, Agricultural Research Service, USDA, Davis, CA, USA
| | - Mónica N Orozco
- Center for Atitlán Studies, Universidad del Valle de Guatemala, Sololá, Guatemala
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24
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Whitfield KC, Shahab-Ferdows S, Kroeun H, Sophonneary P, Green TJ, Allen LH, Hampel D. Macro- and Micronutrients in Milk from Healthy Cambodian Mothers: Status and Interrelations. J Nutr 2020; 150:1461-1469. [PMID: 32211800 PMCID: PMC7269724 DOI: 10.1093/jn/nxaa070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/17/2020] [Accepted: 02/28/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Except for low thiamin content, little is known about vitamins or macronutrients in milk from Cambodian mothers, and associations among milk nutrients. OBJECTIVES We measured fat-soluble vitamins (FSVs) and water-soluble vitamins (WSVs), and macronutrients, and explored internutrient associations in milk from Cambodian mothers. METHODS Milk from women (aged 18-45 y, 3-27 wk postpartum, n = 68) who participated in a thiamin-fortification trial were analyzed for vitamins B-2 (riboflavin, FAD), B-3 (nicotinamide), B-5, B-6 (pyridoxal, pyridoxine), B-7, B-12, A, E [α-tocopherol and γ-tocopherol (γ-TPH)], carotenoids, carbohydrate (CHO), fat, and protein. Milk vitamin B-1 [thiamin, thiamin monophosphate (TMP), thiamin pyrophosphate (TPP)] was previously assessed for fortification effects. Milk nutrient concentrations were compared with the Adequate Intake (AI) values for infants aged 0-6 mo. Pearson correlation was used to examine internutrient associations after excluding nutrients affected by fortification. RESULTS Fortification increased thiamin and B-1 and decreased γ-TPH. Less than 40% of milk samples met the AIs for all vitamins, and 10 samples did not reach any AI values for the analyzed nutrients. CHO, fat, and energy values were met in 1.5-11.8%, and protein in 48.5%, of the samples. Whereas fat, protein, and energy were related (all r < 0.5; P < 0.001) and associated with FSVs and WSVs, CHO correlated only with some WSVs. TPP was not correlated with B-1 vitamers, but with other WSVs (r = 0.28-0.58; P < 0.019). All FSVs, except α-carotene, were correlated with each other (r = 0.42-0.98; P < 0.002). TPP, FAD, B-2, and B-3 were associated with almost all FSVs (r = 0.24-0.63; P < 0.044). CONCLUSIONS Cambodian women might not provide sufficient nutrients to their exclusively breastfeeding infants. Besides thiamin, all other vitamins measured were much lower than the AI. There were many strong correlations among macronutrients and vitamins; the extent to which these are explained by maternal diet, milk volume, maternal physiology, or genetics requires additional exploration.
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Affiliation(s)
- Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada,Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Setareh Shahab-Ferdows
- USDA/ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA
| | - Hou Kroeun
- Helen Keller International Cambodia, Phnom Penh, Cambodia
| | - Prak Sophonneary
- National Nutrition Programme, Maternal and Child Health Centre, Ministry of Health, Phnom Penh, Cambodia
| | - Timothy J Green
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada,Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Lindsay H Allen
- USDA/ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Daniela Hampel
- USDA/ARS Western Human Nutrition Research Center, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA,Address correspondence to DH (e-mail: ; )
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Hampel D, Shahab-Ferdows S, Nguyen N, Kac G, Lindsay A. High-Throughput Analysis of Water-Soluble Choline and Related Metabolites in Human Milk. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa056_018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Choline and related metabolites play important roles in metabolic processes. Inadequate provision of these nutrients to the exclusively breast-fed infant can negatively impact its healthy growth and development.
Methods
We developed an UPLC-MS/MS method for analyzing choline (Cho), phospho-choline (PCho), glycerophospho-choline (GPCho), total choline (tCho = Cho + PCho + GPCho), betaine, carnitine, creatinine, dimethyl glycine (DMG), methionine, and trimethylamine N-oxide (TMAO) in human milk.
Results
Optimized results were obtained using a Phenomenex Luna Silica (2) column, 100 × 2 mm, 3 µm, and a gradient of 0.1% aqueous propionic acid (A) and acetonitrile (B) from 60% to 90% A over 2 min (Waters ACQUITY UPLC I-Class - SCIEX 4500TQ mass spectrometer). Sample preparation required only 5–10µL of milk, diluted 1:80 in methanol/water, 4:1, v/v, prior to analysis. Quantification was done using isotopically labeled internal standards and an external standard curve. Pooled human milk used for method validation showed recovery rates from 108–131% for all analytes, and an overall process efficiency from 54 to 114%. All standard curves revealed good linearity (r > 0.999). Milk from apparently healthy Brazilian mothers (1–120days pp) revealed large concentration ranges within and between analytes (IQR, mg/L): Cho 10.3, 20.3; GPcho 48.7, 101; PCho 134, 221; tCho 120, 166; betaine 0.25, 0.53; carnitine 3.35, 5.06; creatinine 2.92, 3.90; DMG 0.26, 0.54; methionine 0.47, 0.90. 63% of the milk samples reached the tCho value used for the Adequate Intake (1–6 mo).
Conclusions
Our newly implemented method enabled the simultaneous analysis of water-soluble forms of choline and related metabolites in human milk in minute amounts of sample, and requiring only minimalistic sample preparation.
Funding Sources
Bill & Melinda Gates Foundation (OPP1148405), USDA/ARS Intramural Project (5306–51,530-019–00), and CNPq (Brazilian National Council for Science and Technology).
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26
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Lima HK, Vogel K, Hampel D, Wagner-Gillespie M, Fogleman AD. The Associations Between Light Exposure During Pumping and Holder Pasteurization and the Macronutrient and Vitamin Concentrations in Human Milk. J Hum Lact 2020; 36:254-263. [PMID: 32293945 DOI: 10.1177/0890334420906828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND During pumping, storage, and pasteurization human milk is exposed to light, which could affect the concentrations of light-sensitive vitamins. Currently, milk banks do not regulate light exposure. RESEARCH AIM The aim of this paper was to determine the influence of light exposure during pumping, storage, and pasteurization on (1) macronutrients, (2) select water-soluble vitamins, and (3) select fat-soluble vitamins. METHODS All 13 participants donated 4 milk samples each. Each sample underwent 1 of 4 treatments: raw and light protected, raw and light exposed, pasteurized and light protected, and pasteurized and light exposed. Samples were analyzed for macronutrients and Vitamins B1, B2, retinol, γ-tocopherol, α-tocopherol, and β-carotene. RESULTS β-carotene concentrations were not influenced by light exposure. Vitamin B1 was significantly (p < 0.05) affected by light-exposure (M = 0.23, SD = 0.01mg/L) compared to light-protected (M = 0.27, SD = 0.01mg/L) samples. Vitamin B2 concentrations were reduced (p < 0.05) by light-exposure in raw (M = 62.1, SD = 0.61µg/L) and pasteurized (M = 73.7, SD = 0.72µg/L) samples compared to light-protected raw samples (M = 99.7, SD = 0.66µg/L). No other tested nutrients were affected by light exposure. CONCLUSIONS If milk is exposed to excessive amounts of light, Vitamins B1 and B2 concentrations may degrade below the current Adequate Intake recommendations for infants 0-6 months of age, increasing the risk of insufficient vitamin supply to the exclusively human milk-fed infant. Thus, pumped or processed human milk should be protected from light to preserve milk vitamin concentrations.
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Affiliation(s)
- Hope K Lima
- 6798 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA.,6933 Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
| | - Kenneth Vogel
- 6798 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA
| | - Daniela Hampel
- 6798 Department of Nutrition, University of California Davis, and USDA/ARS Western Human Nutrition Research Center, Davis, CA, USA
| | - Montana Wagner-Gillespie
- 6798 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA.,WakeMed Mothers' Milk Bank, Cary, NC
| | - April D Fogleman
- 6798 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA
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Perrin MT, Pawlak R, Allen LH, Hampel D. Total Water-Soluble Choline Concentration Does Not Differ in Milk from Vegan, Vegetarian, and Nonvegetarian Lactating Women. J Nutr 2020; 150:512-517. [PMID: 32133524 DOI: 10.1093/jn/nxz257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/26/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Choline is an essential nutrient for brain growth and other processes in the developing neonate. The impact of a maternal plant-based diet on the choline composition of breast milk is unknown. OBJECTIVE We assessed the water-soluble choline content of milk from lactating women in the United States following 3 dietary patterns: vegan, vegetarian, and nonvegetarian. METHODS We conducted a cross-sectional study of 74 healthy lactating women who provided a single breast-milk sample using a standardized collection protocol. Participants completed a food-frequency screener and were classified as follows: nonvegetarians (NONVEG) consumed meat; vegetarians (VEGT) consumed milk, dairy, and/or fish; and vegans (VEGAN) consumed animal products less than monthly. Primary outcomes measured were the concentration (in milligrams per liter) and distribution (percentage) of choline from the following water-soluble forms: free choline, phosphocholine (PCho), and glycerophosphocholine (GPC). Differences between diet groups were evaluated with ANOVA. RESULTS There was a wide range in breast-milk total water-soluble choline (4-301 mg/L), with no significant difference (P > 0.05) by maternal diet pattern. There were differences in choline forms, with VEGAN having a greater mean ± SD concentration and distribution of choline derived from GPC (62.7 ± 25.3 mg/L) than VEGT (47.7 ± 21.2 mg/L) and NONVEG (42.4 ± 14.9 mg/L) (P = 0.0052). There was a lower mean ± SD percentage of choline from PCho (P = 0.0106) in VEGAN (32.5% ± 18.3%) than in VEGT (46.1% ± 18.3%) and NONVEG (44.8% ± 15.7%). Lactation stage and maternal BMI were significantly associated with some choline forms. CONCLUSIONS There was a wide range of water-soluble choline concentrations in the milk of healthy lactating women following vegan, vegetarian, and nonvegetarian diets, with no observed difference in total water-soluble choline concentration by maternal diet. This suggests that maternal plant-based diet by itself is not a risk factor for low breast-milk choline.
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Affiliation(s)
- Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Roman Pawlak
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Lindsay H Allen
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Daniela Hampel
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, USA.,Department of Nutrition, University of California-Davis, Davis, CA, USA
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Allen LH, Hampel D. Human Milk as the First Source of Micronutrients. Nestle Nutr Inst Workshop Ser 2020; 93:67-76. [PMID: 31991436 DOI: 10.1159/000503359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/28/2022]
Abstract
Well-nourished mothers are assumed to produce adequate concentrations of nutrients in their milk for optimal infant growth and development and infants should be exclusively breastfed during the first 6 months. It is important to know the nutrient content of human milk as this information is used to set recommended adequate intakes (AIs) for infants. Our review of existing information reveals that the AI recommendations are based on poor data. The milk content of a few nutrients may not be adequate to provide requirements for 6 months even in well-nourished mothers. Importantly, the concentrations of many micronutrients in milk are low when the mother consumes a poor quality diet. Our new efficient methods for milk nutrient analysis have enabled us to illuminate the large differences in milk micronutrient concentrations across populations, to examine the effects of milk collection protocols on nutrient concentrations, and to study the effects of maternal supplementation in pregnancy and/or lactation on milk micronutrient and infant status. The ongoing Mothers, Infants and Lactation Quality study proposes to answer some of these uncertainties. Two hundred and fifty healthy, well-nourished, unsupplemented mother-infant dyads in each of the 4 countries are being studied. The range of milk nutrient concentrations across the first 9 months postpartum will provide "Reference Values" against which other studies and surveys can evaluate the quality of milk and possibly target nutrients for treatment with supplements or fortification.
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Affiliation(s)
- Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, Davis, California, USA, .,Department of Nutrition, University of California, Davis, California, USA,
| | - Daniela Hampel
- USDA, ARS Western Human Nutrition Research Center, Davis, California, USA.,Department of Nutrition, University of California, Davis, California, USA
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Abstract
1. The aim was to evaluate the acaricidal effects of pure active components of essential oils against poultry red mite (Dermanyssus gallinae) as an alternative to chemical acaricides (organophosphates and pyrethroids).2. The toxicities of five pure active components of essential oils (eugenol from clove bud, eucalyptol from rosemary, limonene from citrus fruits, linalool from lavender and cinnamaldehyde from cinnamon) were tested on D. gallinae females in an impregnated paper assay.3. The active substances were dissolved in water and Tween 20 and applied at concentrations ranging from 0.002 to 0.06 µl/cm2. Toxicity was expressed as a lethal dose (LD50 or LD90).4. The highest mortality was observed with eugenol. The LD90 was estimated to be 5.1 µg/cm2 for this substance, followed by cinnamaldehyde, the LD90 of which was estimated to be 11.0 µg/cm2. Limonene and eucalyptol were generally less effective in controlling D. gallinae.
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Affiliation(s)
- I Radsetoulalova
- Department of Animal Breeding, Mendel University in Brno, Brno, Czech Republic
| | - J Hubert
- Crop Research Institute, Ruzyne, Czechia
| | - D Hampel
- Department of Statistics and Operation Analysis, Mendel University in Brno, Brno, Czech Republic
| | - M Lichovnikova
- Department of Animal Breeding, Mendel University in Brno, Brno, Czech Republic
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30
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Daniels L, Gibson RS, Diana A, Haszard JJ, Rahmannia S, Luftimas DE, Hampel D, Shahab-Ferdows S, Reid M, Melo L, Lamers Y, Allen LH, Houghton LA. Micronutrient intakes of lactating mothers and their association with breast milk concentrations and micronutrient adequacy of exclusively breastfed Indonesian infants. Am J Clin Nutr 2019; 110:391-400. [PMID: 31152543 PMCID: PMC6669051 DOI: 10.1093/ajcn/nqz047] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Breast milk is the sole source of nutrition for exclusively breastfed infants in the first 6 mo of life, yet few studies have measured micronutrient concentrations in breast milk in light of maternal diet and subsequent infant micronutrient intakes. OBJECTIVES We evaluated the adequacy of micronutrient intakes of exclusively breastfed Indonesian infants by measuring milk volume and micronutrient concentrations and assessed maternal micronutrient intakes and their relationship with milk concentrations. METHODS Mother-infant (2-5.3 mo) dyads (n = 113) were recruited for this cross-sectional study. Volume of breast-milk intake via the deuterium dose-to-mother technique over 14 d and analyzed micronutrient concentrations were used to calculate micronutrient intakes of exclusively breastfed infants. Maternal 3-d weighed food records were collected to assess median (IQR) micronutrient intakes. Multivariate regression analyses examined the association of usual maternal micronutrient intakes with milk micronutrient concentrations after adjustment for confounding variables. RESULTS Mean ± SD intake of breast-milk volume was 787 ± 148 mL/d. Median daily infant intakes of iron, zinc, selenium, magnesium, sodium, and B-vitamins (thiamin, riboflavin, niacin, pantothenic acid, B-6, and B-12) were below their respective Adequate Intakes. Inadequacies in maternal intakes (as % < estimated average requirements) were >40% for calcium, niacin, and vitamins A, B-6, and B-12. Significant positive associations existed between maternal usual intakes of vitamin A, niacin and riboflavin and milk retinol, nicotinamide, and free riboflavin concentrations in both unadjusted and adjusted (for infant age, milk volume, and parity) analyses (all P < 0.05). CONCLUSIONS The majority of micronutrient intakes for these exclusively breastfed infants and their mothers fell below recommendations, with associations between maternal intakes and breast-milk concentrations for 3 nutrients. Data on nutrient requirements of exclusively breastfed infants are limited, and a better understanding of the influence of maternal nutritional status on milk nutrient concentrations and its impact on the breastfed infant is needed.
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Affiliation(s)
| | | | - Aly Diana
- Departments of Human Nutrition.,Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | | | - Sofa Rahmannia
- Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Dimas E Luftimas
- Faculty of Medicine, Universitas Padjadjaran, West Java, Indonesia
| | - Daniela Hampel
- USDA/ARS Western Human Nutrition Research Center, Davis, CA.,Department of Nutrition, University of California, Davis, CA
| | | | - Malcolm Reid
- Chemistry, University of Otago, Dunedin, New Zealand
| | - Larisse Melo
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Yvonne Lamers
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Lindsay H Allen
- USDA/ARS Western Human Nutrition Research Center, Davis, CA.,Department of Nutrition, University of California, Davis, CA
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Hampel D, Shahab-Ferdows S, Hossain M, Islam MM, Ahmed T, Allen LH. Validation and Application of Biocrates Absolute IDQ® p180 Targeted Metabolomics Kit Using Human Milk. Nutrients 2019; 11:E1733. [PMID: 31357543 PMCID: PMC6723914 DOI: 10.3390/nu11081733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Human-milk-targeted metabolomics analysis offers novel insights into milk composition and relationships with maternal and infant phenotypes and nutritional status. The Biocrates AbsoluteIDQ® p180 kit, targeting 40 acylcarnitines, 42 amino acids/biogenic amines, 91 phospholipids, 15 sphingolipids, and sum of hexoses, was evaluated for human milk using the AB Sciex 5500 QTRAP mass-spectrometer in liquid chromatography-tandem mass-spectrometry (LC-MS/MS) and flow-injection analysis (FIA) mode. Milk (<6 months lactation) from (A) Bangladeshi apparently healthy mothers (body mass index (BMI) > 18.5; n = 12) and (B) Bangladeshi mothers of stunted infants (height-for-age Z (HAZ)-score <-2; n = 13) was analyzed. Overall, 123 of the possible 188 metabolites were detected in milk. New internal standards and adjusted calibrator levels were used for improved precision and concentration ranges for milk metabolites. Recoveries ranged between 43% and 120% (coefficient of variation (CV): 2.4%-24.1%, 6 replicates). Milk consumed by stunted infants vs. that from mothers with BMI > 18.5 was lower in 6 amino acids/biogenic amines but higher in isovalerylcarnitine, two phospholipids, and one sphingomyelin (p < 0.05 for all). Associations between milk metabolites differed between groups. The AbsoluteIDQ® p180 kit is a rapid analysis tool suitable for human milk analysis and reduces analytical bias by allowing the same technique for different specimens. More research is needed to examine milk metabolite relationships with maternal and infant phenotypes.
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Affiliation(s)
- Daniela Hampel
- USDA/ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA.
- Department of Nutrition, University of California, One Shields Ave, Davis, CA 95616, USA.
| | - Setareh Shahab-Ferdows
- USDA/ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Lindsay H Allen
- USDA/ARS Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA 95616, USA
- Department of Nutrition, University of California, One Shields Ave, Davis, CA 95616, USA
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Golden CD, Borgerson C, Rice BL, Allen LH, Anjaranirina EJG, Barrett CB, Boateng G, Gephart JA, Hampel D, Hartl DL, Knippenberg E, Myers SS, Ralalason DH, Ramihantaniarivo H, Randriamady H, Shahab-Ferdows S, Vaitla B, Volkman SK, Vonona MA. Cohort Description of the Madagascar Health and Environmental Research-Antongil (MAHERY-Antongil) Study in Madagascar. Front Nutr 2019; 6:109. [PMID: 31428615 PMCID: PMC6690017 DOI: 10.3389/fnut.2019.00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/01/2019] [Indexed: 12/19/2022] Open
Abstract
The Madagascar Health and Environmental Research-Antongil (MAHERY-Antongil) study cohort was set up in September 2015 to assess the nutritional value of seafood for the coastal Malagasy population living along Antongil Bay in northeastern Madagascar. Over 28 months of surveillance, we aimed to understand the relationships among different marine resource governance models, local people's fish catch, the consumption of seafood, and nutritional status. In the Antongil Bay, fisheries governance takes three general forms: traditional management, marine national parks, and co-management. Traditional management involves little to no involvement by the national government or non-governmental organizations, and focuses on culturally accepted Malagasy community practices. Co-management and marine national parks involve management support from either an non-govermental organization (NGO) or the national government. Five communities of varying governance strategies were enrolled into the study including 225 households and 1031 individuals whose diets, resource acquisition strategies, fisheries and agricultural practices, and other social, demographic and economic indicators were measured over the span of 3 years. Clinical visits with each individual were conducted at two points during the study to measure disease and nutritional status. By analyzing differences in fish catch arising from variation in governance (in addition to intra-annual seasonal changes and minor inter-annual changes), the project will allow us to calculate the public health value of sustainable fisheries management approaches for local populations. There is hope that coastal zones that are managed sustainably can increase the productivity of fisheries, increasing the catch of seafood products for poor, undernourished populations.
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Affiliation(s)
- Christopher D. Golden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Madagascar Health and Environmental Research, Maroantsetra, Madagascar
| | - Cortni Borgerson
- Madagascar Health and Environmental Research, Maroantsetra, Madagascar
- Department of Anthropology, Montclair State University, Montclair, NJ, United States
| | - Benjamin L. Rice
- Madagascar Health and Environmental Research, Maroantsetra, Madagascar
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Lindsay H. Allen
- ARS Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA, United States
- Department of Nutrition, University of California, Davis, Davis, CA, United States
| | | | - Christopher B. Barrett
- CH Dyson School of Applied Economics & Management, Cornell University, Cornell, NY, United States
| | - Godfred Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jessica A. Gephart
- National Center for Socio-Environmental Synthesis (SESYNC), Annapolis, MD, United States
| | - Daniela Hampel
- ARS Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA, United States
- Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Daniel L. Hartl
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | | | - Samuel S. Myers
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Dera H. Ralalason
- Service de District de la Santé Publique de Maroantsetra, Ministère de la Santé Publique d'Analanjirofo, Maroantsetra, Madagascar
| | | | | | - Setareh Shahab-Ferdows
- ARS Western Human Nutrition Research Center, United States Department of Agriculture, Davis, CA, United States
| | - Bapu Vaitla
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah K. Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Infectious Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, United States
- College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, MA, United States
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Hampel D, Young R, Shahab-Ferdows S, Dewey K, Ashorn P, Maleta K, Ashorn U, Vosti S, Allen L. Maternal Lipid-based Nutrient and Multiple Micronutrient Supplementation Affect B-vitamins in Milk Differently in Malawian Compared to Ghanaian Mothers (P24-045-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz044.p24-045-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Little is known about the influence of maternal micronutrient (MN) supplementation during pregnancy/lactation on human milk (HM) MN concentrations. We evaluated B-vitamin (BV) concentrations in milk from mothers in Ghana and Malawi who participated in the International Lipid-Based Nutrient Supplements (iLiNS) Project.
Methods
Women (<20 wk gestation) were randomized to receive: 1 x daily iron/folic acid (IFA) during pregnancy only, or a multiple micronutrient (MMN) tablet or LNS containing equal amounts of vitamins during pregnancy and 6 mo of lactation. HM at 6mo postpartum was analyzed for vitamins B1, B2, B3 (nicotinamide only), B5, B6, and B12 and compared to the recommended Adequate Intakes (AI) for infants 0–6 mo, which are based on values from milk from well-nourished mothers, assuming 780 mL/d milk intake.
Results
Concentrations and responses to supplementation differed greatly between countries. Comparing the IFA groups’ concentrations (geom. mean), women in Ghana had significantly lower HM B1 (121 vs. 183 µg/L), B2 (139 vs. 321 µg/L), and B6 (21.3 vs. 89.2 µg/L), and significantly higher B3 (1057 vs. 151 µg/L) and B12 (439 vs. 239 pmol/L). In Ghana, use of MMN/LNS increased all HM BV (10 - 30%); but even with supplementation, only up to 5.7% (B1, B2, B3, B6), and 47.9 and 73.2% (B5 and B12) of the samples reached AI values. In Malawi, only HM B2 was significantly increased by MMN/LNS (371 vs. 321 µg/L), resulting in 47.2% of samples reaching the AI value, compared to 36.0% in the IFA group. None of Malawian samples reached the AI value for B3, and 9.0 to 34.6% reached the AI values for the remaining vitamins.
Conclusions
HM BV concentrations differed greatly by geographic origin, possibly due to differences in diet or fortification. Maternal MMN/LNS supplementation during pregnancy/lactation increased all HM B-vitamins in Ghana. Only HM B2 was increased in Malawi, for reasons that are unclear.
Funding Sources
Bill & Melinda Gates Foundation (OPP49817), USDA/ARS Intramural Project (5306–51,530-019–00), U.S. Agency for International Development (USAID, AID-OAA-A-12–00005), and the Food and Nutrition Technical Assistance III Project (FANTA). All authors declare no conflict of interest.
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Affiliation(s)
| | - Rebecca Young
- Department of Nutrition, University of California, Davis
| | | | - Kathryn Dewey
- Department of Nutrition, University of California, Davis
| | - Per Ashorn
- Center for Child Health Research, Tampere University, Tampere, Finland
| | - Kenneth Maleta
- School of Public health and Family Medicine, College of Medicine, Malawi
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Hampel D, Shahab-Ferdows S, Hossain M, Islam MM, Ahmed T, Allen L. Human Milk Metabolomics Using Biocrates AbsoluteIDQ® p180 Kit Assay (OR06-04-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz036.or06-04-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Targeted metabolomics are commercially available for human plasma, but not for human milk. However, metabolite analyses could provide a novel and efficient approach to understanding human milk composition and relationships to maternal and infant status.
Methods
Pooled human milk was used to evaluate and validate the Biocrates AbsoluteIDQ® p180 kit for human milk metabolomics (40 acylcarnitines, 42 acids/biogenic amines, 91 phospholipids, 15 sphingolipids, sum of hexoses) using an ABSciex 5500QTRAP mass spectrometer in LC-MS/MS and flow injection analysis (FIA) mode. In a feasibility study, milk collected <6 mo lactation from A) Bangladeshi healthy mothers (BMI >18.5, n = 12) and from B) mothers with stunted infants (HAZ-score < −2; n = 13) were analyzed.
Results
120 of the detectable 188 assay metabolites were found in the pooled milk, including all of the sphingolipids and amino acids. Additional internal standards (IS) were prepared for lysine and some biogenic amines for higher accuracy. Higher amounts of glutamate, taurine, and putrescine in milk required higher levels of calibrators than for plasma in LC-MS/MS mode. For metabolites of low abundance diluted calibrators (0.25 and 0.5) were added. FIA provided results for 94 of 146 metabolites above LOD without any carry-over. Metabolite recoveries (levels) varied between 64.1 and 127.0%. Intra-assay variations (6 replicates) for all detectable metabolites ranged between 3.4 and 18.4%. Human milk given to healthy compared to malnourished infants was higher in the amino acids citrulline, glutamate, glycine, and phenylalanine, and carnitine, while histamine and dodecanoylcarnitine were lower (Student's t-test, P < 0.05 for all).
Conclusions
The AbsoluteIDQ® p180 can be used for human milk application and thus allows the application of the same assay for both human plasma and milk, enhancing comparability of results by reducing analytical bias due to different analytical techniques.
Funding Sources
Bill & Melinda Gates Foundation (OPP1148405 & OPP1164613), USDA/ARS Intramural Project (5306–51,530-019–00).
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Affiliation(s)
| | | | | | - M Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh
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Allen LH, Hampel D. Water-Soluble Vitamins in Human Milk Factors Affecting Their Concentration and Their Physiological Significance. Nestle Nutr Inst Workshop Ser 2019; 90:69-81. [PMID: 30865992 DOI: 10.1159/000490296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most B vitamins and vitamin C are among the nutrients in milk most strongly affected by maternal status and/or dietary intake. Recent analytical methods are more efficient and valid, revealing major differences in water-soluble vitamins across population groups. An inadequate supply in milk can be detrimental to the breastfed infant's health and development although cutoff points below which risk is increased are often uncertain, and little attention has been paid to adverse effects of low milk water-soluble vitamins on infant health and function. Concentrations change during lactation: thiamine, niacin, and pantothenic acid increase; B6, B12, and ascorbic acid gradually decrease; while riboflavin concentrations are stable, as is choline after an initial increase. Folate fluctuates until stabilizing in late lactation. Water-soluble vitamin concentrations in milk are also influenced by maternal supplementation, and, for some, by parity, preterm delivery, smoking, and maternal illness. However, there is relatively little change in concentrations during a feed nor is diurnal variation a major influence. Reported concentrations are used to set adequate intakes for infants and incremental requirements for lactation. However, the status of available data is poor due to the small number of participants in most studies, uncertainties about maternal nutritional status, and variable times of milk collection postpartum.
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Pawlak R, Vos P, Shahab-Ferdows S, Hampel D, Allen LH, Perrin MT. Vitamin B-12 content in breast milk of vegan, vegetarian, and nonvegetarian lactating women in the United States. Am J Clin Nutr 2018; 108:525-531. [PMID: 29931273 DOI: 10.1093/ajcn/nqy104] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/23/2018] [Indexed: 01/27/2023] Open
Abstract
Background The nutritional profile of human milk varies significantly between women, and the impact of maternal diet on these variations is not well understood. Objective We analyzed breast-milk vitamin B-12 concentration and vitamin B-12 supplement use pattern among women who adhered to different dietary patterns: vegan, vegetarian, and nonvegetarian. Design A total of 74 milk samples, 26 from vegan, 22 from vegetarian, and 26 from nonvegetarian breastfeeding mothers, were analyzed. Results The prevalences of low vitamin B-12 (<310 pmol/L) were 19.2% for vegans, 18.2% for vegetarians, and 15.4% for nonvegetarians, which was not significant by diet group (P = 1.00). The median (quartile 1, quartile 3) vitamin B-12 values were 558 pmol/L (331, 759 pmol/L) for vegans, 509 pmol/L (368, 765 pmol/L) for vegetarians, and 444 pmol/L (355, 777 pmol/L) for nonvegetarians (P = 0.890). The use of individual vitamin B-12 supplements was higher in vegans (46.2%) than in vegetarians (27.3%) and nonvegetarians (3.9%) (P = 0.001). In linear regression analysis, the use of individual vitamin B-12 supplements was a significant positive predictor of milk vitamin B-12 concentration (β ± SE: 172.9 ± 75.2; standardized β = 0.263; P = 0.024; R2 = 0.069), the use of a multivitamin had a significant negative relation with milk vitamin B-12 concentrations (β ± SE -222.0 ± 98.7; standardized β = -0.258; P = 0.028, R2 = 0.067;), whereas the use of a B-complex vitamin and prenatal vitamin were not predictive of vitamin B-12 milk concentration (P > 0.05). Conclusions Almost 20% of our study participants were classified as having low breast-milk vitamin B-12 concentrations (<310 pmol/L), independent of maternal diet pattern. Approximately 85% of participants categorized as having low vitamin B-12 were taking vitamin B-12 supplements at doses in excess of the Recommended Dietary Allowance, which suggests that more research is needed to determine breast-milk adequacy values.
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Affiliation(s)
| | - Paul Vos
- Biostatistics, East Carolina University, Greenville, NC
| | | | - Daniela Hampel
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA.,Department of Nutrition, University of California, Davis, CA
| | - Lindsay H Allen
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA.,Department of Nutrition, University of California, Davis, CA
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Abstract
Exclusive breastfeeding is recommended by the WHO for the first 6 mo of life because human milk protects against gastrointestinal infections and supplies balanced and adequate nutrient contents to the infant. However, reliable data on micronutrient concentrations in human milk are sparse, especially because some micronutrients are affected by maternal diet. Microbiological and competitive protein-binding assays, nuclear magnetic resonance or inductively coupled plasma spectroscopy, and chromatographic analyses are among the methods that have been applied to human-milk micronutrient analysis. However, the validation or evaluation of analytical methods in terms of their suitability for the complex human-milk matrix has been commonly ignored in reports, even though the human-milk matrix differs vastly from blood, plasma, or urine matrixes. Thus, information on the validity, accuracy, and sensitivity of the methods is essential for the estimation of infant and maternal intake requirements to support and maintain adequate milk micronutrient concentrations for healthy infant growth and development. In this review, we summarize current knowledge on methods used for analyzing water- and fat-soluble vitamins as well as iron, copper, zinc, iodine, and selenium in human milk and their different forms in milk; the tools available for quality control and assurance; and guidance for preanalytical considerations. Finally, we recommend preferred methodologic approaches for analysis of specific milk micronutrients.
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Affiliation(s)
- Daniela Hampel
- US Department of Agriculture, Agricultural Research Service,Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Daphna K Dror
- US Department of Agriculture, Agricultural Research Service,Western Human Nutrition Research Center, Davis, CA
| | - Lindsay H Allen
- US Department of Agriculture, Agricultural Research Service,Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
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Williams AM, Stewart CP, Shahab-Ferdows S, Hampel D, Kiprotich M, Achando B, Lin A, Null CA, Allen LH, Chantry CJ. Infant Serum and Maternal Milk Vitamin B-12 Are Positively Correlated in Kenyan Infant-Mother Dyads at 1-6 Months Postpartum, Irrespective of Infant Feeding Practice. J Nutr 2018; 148:86-93. [PMID: 29378045 PMCID: PMC5955065 DOI: 10.1093/jn/nxx009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background Vitamin B-12 is an essential nutrient required for many functions including DNA synthesis, erythropoiesis, and brain development. If maternal milk vitamin B-12 concentrations are low, infants may face elevated risks of deficiency when exclusively breastfed. Objective We evaluated cross-sectional associations between infant serum vitamin B-12 concentrations and maternal milk vitamin B-12 concentrations at 1-6 mo postpartum among an unsupplemented population in rural western Kenya, and assessed biological demographic, and dietary characteristics associated with adequate infant serum vitamin B-12. Methods We modeled 1) infant serum vitamin B-12 using maternal milk vitamin B-12 concentration with linear regression; and 2) adequate (>220 pmol/L) infant serum vitamin B-12 using hypothesized biological, demographic, and dietary predictors with logistic regression. In both models, we used generalized estimating equations to account for correlated observations at the cluster-level. Results The median (quartile 1, quartile 3) infant serum vitamin B-12 concentration was 276 pmol/L (193, 399 pmol/L) and approximately one-third of infants had serum vitamin B-12 ≤220 pmol/L, indicating that they were vitamin B-12 depleted or deficient. There was a positive correlation between maternal milk and infant serum vitamin B-12 (r = 0.36, P < 0.001) and in multivariable analyses, maternal milk vitamin B-12 concentration was significantly associated with infant serum vitamin B-12 adequacy (P-trend = 0.03). Conclusions Despite a high prevalence (90%) of maternal milk vitamin B-12 concentrations below the level used to establish the Adequate Intake (<310 pmol/L), there was a low prevalence of infant vitamin B-12 deficiency. We found few factors that were associated with infant vitamin B-12 adequacy in this population, including infant feeding practices, although maternal vitamin B-12 status was not measured. The contribution of maternal milk to infant vitamin B-12 status remains important to quantify across populations, given that maternal milk vitamin B-12 concentration is modifiable with supplementation. This trial was registered at clinicaltrials.gov as NCT01704105.
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Affiliation(s)
- Anne M Williams
- Hubert Department of Global Health, Emory University, Atlanta, GA,Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,Address correspondence to AMW (e-mail: )
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA
| | | | - Daniela Hampel
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,USDA, ARS Western Human Nutrition Research Center, Davis, CA
| | - Marion Kiprotich
- Innovations for Poverty Action, New Haven, CT, USA and Kisumu, Kenya
| | - Beryl Achando
- Innovations for Poverty Action, New Haven, CT, USA and Kisumu, Kenya
| | - Audrie Lin
- School of Public Health, University of California Berkeley, Berkeley, CA
| | - Clair A Null
- Innovations for Poverty Action, New Haven, CT, USA and Kisumu, Kenya,Mathematica Policy Research, Washington DC
| | - Lindsay H Allen
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,USDA, ARS Western Human Nutrition Research Center, Davis, CA
| | - Caroline J Chantry
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA,University of California Davis Medical Center, Sacramento, CA
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Brito A, Grapov D, Fahrmann J, Harvey D, Green R, Miller JW, Fedosov SN, Shahab-Ferdows S, Hampel D, Pedersen TL, Fiehn O, Newman JW, Uauy R, Allen LH. The Human Serum Metabolome of Vitamin B-12 Deficiency and Repletion, and Associations with Neurological Function in Elderly Adults. J Nutr 2017; 147:1839-1849. [PMID: 28794205 PMCID: PMC5610547 DOI: 10.3945/jn.117.248278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/21/2017] [Accepted: 06/21/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The specific metabolomic perturbations that occur in vitamin B-12 deficiency, and their associations with neurological function, are not well characterized. OBJECTIVE We sought to characterize the human serum metabolome in subclinical vitamin B-12 deficiency and repletion. METHODS A before-and-after treatment study provided 1 injection of 10 mg vitamin B-12 (with 100 mg pyridoxine and 100 mg thiamin) to 27 community-dwelling elderly Chileans (∼74 y old) with vitamin B-12 deficiency, as evaluated with serum vitamin B-12, total plasma homocysteine (tHcy), methylmalonic acid (MMA), and holotranscobalamin. The combined indicator of vitamin B-12 status (cB-12) was computed. Targeted metabolites [166 acylcarnitines, amino acids, sugars, glycerophospholipids, and sphingolipids (liquid chromatography-tandem mass spectrometry)], and untargeted metabolites [247 chemical entities (gas chromatography time-of-flight mass spectrometry)] were measured at baseline and 4 mo after treatment. A peripheral nerve score was developed. Differences before and after treatment were examined. For targeted metabolomics, the data from 18 individuals with adequate vitamin B-12 status (selected from the same population) were added to the before-and-after treatment data set. Network visualizations and metabolic pathways are illustrated. RESULTS The injection increased serum vitamin B-12, holotranscobalamin, and cB-12 (P < 0.001), and reduced tHcy and serum MMA (P < 0.001). Metabolomic changes from before to after treatment included increases (P < 0.001) in acylcarnitines, plasmalogens, and other phospholipids, whereas proline and other intermediaries of one-carbon metabolism-that is, methionine and cysteine-were reduced (P < 0.001). Direct significant correlations (P < 0.05 after the false discovery rate procedure) were identified between acylcarnitines, plasmalogens, phospholipids, lyso-phospholipids, and sphingomyelins compared with vitamin B-12 status and nerve function. Multiple connections were identified with primary metabolites (e.g., an inverse relation between vitamin B-12 markers and tryptophan, tyrosine, and pyruvic, succinic, and citric acids, and a direct correlation between the nerve score and arginine). CONCLUSIONS The human serum metabolome in vitamin B-12 deficiency and the changes that occur after supplementation are characterized. Metabolomics revealed connections between vitamin B-12 status and serum metabolic markers of mitochondrial function, myelin integrity, oxidative stress, and peripheral nerve function, including some previously implicated in Alzheimer and Parkinson diseases. This trial was registered at www.controlled-trials.com as ISRCTN02694183.
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Affiliation(s)
- Alex Brito
- USDA Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
| | - Dmitry Grapov
- NIH West Coast Metabolomics Center, University of California, Davis, Davis, CA
| | - Johannes Fahrmann
- NIH West Coast Metabolomics Center, University of California, Davis, Davis, CA
| | - Danielle Harvey
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA
| | - Joshua W Miller
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Sergey N Fedosov
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | | | - Daniela Hampel
- USDA Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Theresa L Pedersen
- USDA Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
| | - Oliver Fiehn
- NIH West Coast Metabolomics Center, University of California, Davis, Davis, CA
| | - John W Newman
- USDA Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
- NIH West Coast Metabolomics Center, University of California, Davis, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Ricardo Uauy
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Lindsay H Allen
- USDA Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
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Hampel D, Shahab-Ferdows S, Gertz E, Flax VL, Adair LS, Bentley ME, Jamieson DJ, Tegha G, Chasela CS, Kamwendo D, van der Horst CM, Allen LH. 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. Matern Child Nutr 2017; 14:e12503. [PMID: 28851037 PMCID: PMC5832511 DOI: 10.1111/mcn.12503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 12/03/2022]
Abstract
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.
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Affiliation(s)
- Daniela Hampel
- USDA, ARS Western Human Nutrition Research Center, Davis, California, USA.,Department of Nutrition, University of California, Davis, California, USA
| | | | - Erik Gertz
- USDA, ARS Western Human Nutrition Research Center, Davis, California, USA
| | - Valerie L Flax
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda S Adair
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Margaret E Bentley
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Charles S Chasela
- UNC Project, Lilongwe, Malawi.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, Davis, California, USA.,Department of Nutrition, University of California, Davis, California, USA
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Engle-Stone R, Nankap M, Ndjebayi AO, Allen LH, Shahab-Ferdows S, Hampel D, Killilea DW, Gimou MM, Houghton LA, Friedman A, Tarini A, Stamm RA, Brown KH. Iron, Zinc, Folate, and Vitamin B-12 Status Increased among Women and Children in Yaoundé and Douala, Cameroon, 1 Year after Introducing Fortified Wheat Flour. J Nutr 2017; 147:1426-1436. [PMID: 28592513 PMCID: PMC5483962 DOI: 10.3945/jn.116.245076] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/31/2017] [Accepted: 05/03/2017] [Indexed: 01/21/2023] Open
Abstract
Background: Few data are available on the effectiveness of large-scale food fortification programs.Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon.Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ∼300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15-49 y and children 12-59 mo of age.Results: Wheat flour was consumed in the past 7 d by ≥90% of participants. Postfortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower postfortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children postfortification, mean plasma concentrations were greater for ferritin and lower for sTfR after adjustments for potential confounders. Mean plasma zinc concentrations were greater postfortification and the prevalence of low plasma zinc concentration in women after fortification (21%) was lower than before fortification (39%, P < 0.001); likewise in children, the prevalence postfortification (28%) was lower than prefortification (47%, P < 0.001). Mean plasma total folate concentrations were ∼250% greater postfortification among women (47 compared with 15 nmol/L) and children (56 compared with 20 nmol/L), and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a nonrepresentative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater postfortification.Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, CA;
| | | | | | - Lindsay H Allen
- Department of Nutrition, University of California, Davis, Davis, CA
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Setareh Shahab-Ferdows
- Department of Nutrition, University of California, Davis, Davis, CA
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Daniela Hampel
- Department of Nutrition, University of California, Davis, Davis, CA
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - David W Killilea
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, CA
| | | | | | | | - Ann Tarini
- Helen Keller International, New York, NY
| | | | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA
- Bill & Melinda Gates Foundation, Seattle, WA
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Hampel D, Shahab-Ferdows S, Islam MM, Peerson JM, Allen LH. Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation. J Nutr 2017; 147:603-611. [PMID: 28202638 PMCID: PMC5368580 DOI: 10.3945/jn.116.242941] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/29/2016] [Accepted: 01/17/2017] [Indexed: 01/12/2023] Open
Abstract
Background: Human milk is the subject of many studies, but procedures for representative sample collection have not been established. Our improved methods for milk micronutrient analysis now enable systematic study of factors that affect its concentrations.Objective: We evaluated the effects of sample collection protocols, variations in circadian rhythms, subject variability, and acute maternal micronutrient supplementation on milk vitamin concentrations.Methods: In the BMQ (Breast-Milk-Quality) study, we recruited 18 healthy women (aged 18-26 y) in Dhaka, Bangladesh, at 2-4 mo of lactation for a 3-d supplementation study. On day 1, no supplements were given; on days 2 and 3, participants consumed ∼1 time and 2 times, respectively, the US-Canadian Recommended Dietary Allowances for vitamins at breakfast (0800-0859). Milk was collected during every feeding from the same breast over 24 h. Milk expressed in the first 2 min (aliquot I) was collected separately from the remainder (aliquot II); a third aliquot (aliquot III) was saved by combining aliquots I and II. Thiamin, riboflavin, niacin, and vitamins B-6, B-12, A, and E and fat were measured in each sample.Results: Significant but small differences (14-18%) between aliquots were found for all vitamins except for vitamins B-6 and B-12. Circadian variance was significant except for fat-adjusted vitamins A and E, with a higher contribution to total variance with supplementation. Between-subject variability accounted for most of the total variance. Afternoon and evening samples best reflected daily vitamin concentrations for all study days. Acute supplementation effects were found for thiamin, riboflavin, and vitamins B-6 and A at 2-4 h postdosing, with 0.1-6.17% passing into milk. Supplementation was reflected in fasting, 24-h postdose samples for riboflavin and vitamin B-6. Maximum amounts of dose-responding vitamins in 1 feeding ranged from 4.7% to 21.8% (day 2) and 8.2% to 35.0% (day 3) of Adequate Intake.Conclusions: In the milk of Bangladeshi mothers, differences in vitamin concentrations between aliquots within feedings and by circadian variance were significant but small. Afternoon and evening collection provided the most-representative samples. Supplementation acutely affects some breast-milk micronutrient concentrations. This trial was registered at clinicaltrials.gov as NCT02756026.
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Affiliation(s)
- Daniela Hampel
- USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA; and
| | | | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Janet M Peerson
- USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Lindsay H Allen
- USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, CA;
- Department of Nutrition, University of California, Davis, Davis, CA; and
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Chebaya P, Karakochuk CD, March KM, Chen NN, Stamm RA, Kroeun H, Sophonneary P, Borath M, Shahab-Ferdows S, Hampel D, Barr SI, Lamers Y, Houghton LA, Allen LH, Green TJ, Whitfield KC. Correlations between Maternal, Breast Milk, and Infant Vitamin B12 Concentrations among Mother-Infant Dyads in Vancouver, Canada and Prey Veng, Cambodia: An Exploratory Analysis. Nutrients 2017; 9:E270. [PMID: 28287490 PMCID: PMC5372933 DOI: 10.3390/nu9030270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 11/16/2022] Open
Abstract
Vitamin B12 plays an essential role in fetal and infant development. In regions where animal source food consumption is low and perinatal supplementation is uncommon, infants are at risk of vitamin B12 deficiency. In this secondary analysis, we measured total vitamin B12 concentrations in maternal and infant serum/plasma and breast milk among two samples of mother-infant dyads in Canada (assessed at 8 weeks post-partum) and in Cambodia (assessed between 3-27 weeks post-partum). Canadian mothers (n = 124) consumed a daily vitamin B12-containing multiple micronutrient supplement throughout pregnancy and lactation; Cambodian mothers (n = 69) were unsupplemented. The maternal, milk, and infant total vitamin B12 concentrations (as geometric means (95% CI) in pmol/L) were as follows: in Canada, 698 (648,747), 452 (400, 504), and 506 (459, 552); in Cambodia, 620 (552, 687), 317 (256, 378), and 357 (312, 402). The majority of participants were vitamin B12 sufficient (serum/plasma total B12 > 221 pmol/L): 99% and 97% of mothers and 94% and 84% of infants in Canada and Cambodia, respectively. Among the Canadians, maternal, milk, and infant vitamin B12 were all correlated (p < 0.05); only maternal and infant vitamin B12 were correlated among the Cambodians (p < 0.001).
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Affiliation(s)
- Philip Chebaya
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Kaitlin M March
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Nancy N Chen
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Rosemary A Stamm
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand.
| | - Hou Kroeun
- Helen Keller International-Cambodia Country Office, Phnom Penh 12301, Cambodia.
| | - Prak Sophonneary
- National Nutrition Programme, Maternal and Child Health Centre, Ministry of Health, Phnom Penh 12202, Cambodia.
| | - Mam Borath
- National Sub-Committee for Food Fortification, Ministry of Planning, Phnom Penh 12000, Cambodia.
| | - Setareh Shahab-Ferdows
- US Department of Agriculture, ARS Western Human Nutrition Research Centre, University of California, Davis, CA 95616, USA.
| | - Daniela Hampel
- US Department of Agriculture, ARS Western Human Nutrition Research Centre, University of California, Davis, CA 95616, USA.
- Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Susan I Barr
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Yvonne Lamers
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand.
| | - Lindsay H Allen
- US Department of Agriculture, ARS Western Human Nutrition Research Centre, University of California, Davis, CA 95616, USA.
- Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Tim J Green
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
- South Australia Health and Medical Research Institute, Adelaide, South Australia 5000, Australia.
| | - Kyly C Whitfield
- Food, Nutrition, and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V6H 3N1, Canada.
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada.
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Abstract
According to the World Health Organization (WHO), infants should be exclusively breastfed for the first six months of life. However, there is insufficient information about the concentration of nutrients in human milk. For some nutrients, including B-vitamins, maternal intake affects their concentration in human milk but the extent to which inadequate maternal diets affect milk B-vitamin content is poorly documented. Little is known about infant requirements for B-vitamins; recommendations are generally set as Adequate Intakes (AI) calculated on the basis of the mean volume of milk (0.78 L/day) consumed by infants exclusively fed with human milk from well-nourished mothers during the first six months, and the concentration of each vitamin in milk based on reported values. Methods used for analyzing B-vitamins, commonly microbiological, radioisotope dilution or more recently chromatographic, coupled with UV, fluorometric and MS detection, have rarely been validated for the complex human milk matrix. Thus the validity, accuracy, and sensitivity of analytical methods is important for understanding infant requirements for these nutrients, the maternal intakes needed to support adequate concentrations in breast milk. This review summarizes current knowledge on methods used for analyzing the B-vitamins thiamin, riboflavin, niacin, vitamin B-6 and pantothenic acid, vitamin B-12, folate, biotin, and choline in human milk, their chemical and physical properties, the different forms and changes in concentration during lactation, and the effects of deficiency on the infant.
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Affiliation(s)
| | - Lindsay H Allen
- a USDA, ARS Western Human Nutrition Research Center , Davis , California , USA
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Whitfield KC, Karakochuk CD, Kroeun H, Hampel D, Sokhoing L, Chan BB, Borath M, Sophonneary P, McLean J, Talukder A, Lynd LD, Li-Chan ECY, Kitts DD, Allen LH, Green TJ. Perinatal Consumption of Thiamine-Fortified Fish Sauce in Rural Cambodia: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:e162065. [PMID: 27532780 DOI: 10.1001/jamapediatrics.2016.2065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Infantile beriberi, a potentially fatal disease caused by thiamine deficiency, remains a public health concern in Cambodia and regions where thiamine-poor white rice is a staple food. Low maternal thiamine intake reduces breast milk thiamine concentrations, placing breastfed infants at risk of beriberi. OBJECTIVE To determine if consumption of thiamine-fortified fish sauce yields higher erythrocyte thiamine diphosphate concentrations (eTDP) among lactating women and newborn infants and higher breast milk thiamine concentrations compared with a control sauce. DESIGN, SETTING, AND PARTICIPANTS In this double-blind randomized clinical trial, 90 pregnant women were recruited in the Prey Veng province, Cambodia. The study took place between October 2014 and April 2015. INTERVENTIONS Women were randomized to 1 of 3 groups (n = 30) for ad libitum fish sauce consumption for 6 months: control (no thiamine), low-concentration (2 g/L), or high-concentration (8 g/L) fish sauce. MAIN OUTCOMES AND MEASURES Maternal eTDP was assessed at baseline (October 2014) and endline (April 2015). Secondary outcomes, breast milk thiamine concentration and infant eTDP, were measured at endline. RESULTS Women's mean (SD) age and gestational stage were 26 (5) years and 23 (7) weeks, respectively. April 2015 eTDP was measured among 28 women (93%), 29 women (97%), and 23 women (77%) in the control, low-concentration, and high-concentration groups, respectively. In modified intent-to-treat analysis, mean baseline-adjusted endline eTDP was higher among women in the low-concentration (282nM; 95% CI, 235nM to 310nM) and high-concentration (254nM; 95% CI, 225nM to 284nM) groups compared with the control group (193nM; 95% CI, 164nM to 222M; P < .05); low-concentration and high-concentration groups did not differ (P = .19). Breast milk total thiamine concentrations were 14.4 μg/dL for the control group (95% CI, 12.3 μg/dL to 16.5 μg/dL) (to convert to nanomoles per liter, multiply by 29.6); 20.7 μg/dL for the low-concentration group (95% CI, 18.6 μg/dL to 22.7 μg/dL ); and 17.7 μg/dL for the high-concentration group (95% CI, 15.6 μg/dL to 19.9 μg/dL). Mean (SD) infant age at endline was 16 (8) weeks for the control group, 17 (7) weeks for the low-concentration group, and 14 (8) for the high-concentration group. Infant eTDP was higher among those in the high-concentration group (257nM; 95% CI, 222nM to 291nM; P < .05) compared with the low-concentration (212nM; 95% CI, 181nM to 244nM) and control (187nM; 95% CI, 155nM to 218nM) groups. CONCLUSIONS AND RELEVANCE Compared with women in the control group, women who consumed thiamine-fortified fish sauce through pregnancy and early lactation had higher eTDP and breast milk thiamine concentrations and their infants had higher eTDP, which was more pronounced in the high group. Thiamine-fortified fish sauce has the potential to prevent infantile beriberi in this population. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02221063.
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Affiliation(s)
- Kyly C Whitfield
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada2Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hou Kroeun
- Helen Keller International Cambodia, Phnom Penh, Cambodia
| | - Daniela Hampel
- US Department of Agriculture, ARS Western Human Nutrition Research Center, University of California, Davis5Department of Nutrition, University of California, Davis
| | - Ly Sokhoing
- Helen Keller International Cambodia, Phnom Penh, Cambodia
| | - Benny B Chan
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mam Borath
- National Subcommittee for Food Fortification, Ministry of Planning, Phnom Penh, Cambodia
| | - Prak Sophonneary
- National Nutrition Programme, Maternal and Child Health Centre, Ministry of Health, Phnom Penh, Cambodia
| | - Judy McLean
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Larry D Lynd
- Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eunice C Y Li-Chan
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - David D Kitts
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay H Allen
- US Department of Agriculture, ARS Western Human Nutrition Research Center, University of California, Davis5Department of Nutrition, University of California, Davis
| | - Timothy J Green
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada9South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia10Discipline of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
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Williams AM, Chantry CJ, Young SL, Achando BS, Allen LH, Arnold BF, Colford JM, Dentz HN, Hampel D, Kiprotich MC, Lin A, Null CA, Nyambane GM, Shahab-Ferdows S, Stewart CP. Vitamin B-12 Concentrations in Breast Milk Are Low and Are Not Associated with Reported Household Hunger, Recent Animal-Source Food, or Vitamin B-12 Intake in Women in Rural Kenya. J Nutr 2016; 146:1125-31. [PMID: 27075905 PMCID: PMC4841927 DOI: 10.3945/jn.115.228189] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/09/2016] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast milk vitamin B-12 concentration may be inadequate in regions in which animal-source food consumption is low or infrequent. Vitamin B-12 deficiency causes megaloblastic anemia and impairs growth and development in children. OBJECTIVE We measured vitamin B-12 in breast milk and examined its associations with household hunger, recent animal-source food consumption, and vitamin B-12 intake. METHODS In a cross-sectional substudy nested within a cluster-randomized trial assessing water, sanitation, hygiene, and nutrition interventions in Kenya, we sampled 286 women 1-6 mo postpartum. Mothers hand-expressed breast milk 1 min into a feeding after 90 min observed nonbreastfeeding. The Household Hunger Scale was used to measure hunger, food intake in the previous week was measured with the use of a food-frequency questionnaire (FFQ), and vitamin B-12 intake was estimated by using 24-h dietary recall. An animal-source food score was based on 10 items from the FFQ (range: 0-70). Breast milk vitamin B-12 concentration was measured with the use of a solid-phase competitive chemiluminescent enzyme immunoassay and was modeled with linear regression. Generalized estimating equations were used to account for correlated observations at the cluster level. RESULTS Median (IQR) vitamin B-12 intake was 1.5 μg/d (0.3, 9.7 μg/d), and 60% of women consumed <2.4 μg/d, the estimated average requirement during lactation. Median (IQR) breast milk vitamin B-12 concentration was 113 pmol/L (61, 199 pmol/L); 89% had concentrations <310 pmol/L, the estimated adequate concentration. Moderate or severe hunger prevalence was 27%; the animal-source food score ranged from 0 to 30 item-d/wk. Hunger and recent animal-source food and vitamin B-12 intake were not associated with breast milk vitamin B-12 concentrations. Maternal age was negatively associated with breast milk vitamin B-12 concentrations. CONCLUSION Most lactating Kenyan women consumed less than the estimated average requirement of vitamin B-12 and had low breast milk vitamin B-12 concentrations. We recommend interventions that improve vitamin B-12 intake in lactating Kenyan women to foster maternal health and child development. The main trial was registered at clinicaltrials.gov as NCT01704105.
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Affiliation(s)
- Anne M Williams
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA
| | - Caroline J Chantry
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA
| | - Sera L Young
- Department of Population Medicine and Diagnostic Sciences, Program in International Nutrition, Cornell University, Ithaca, NY
| | - Beryl S Achando
- Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT
| | - Lindsay H Allen
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Benjamin F Arnold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and
| | - John M Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and
| | - Holly N Dentz
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT
| | - Daniela Hampel
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | | | - Audrie Lin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and
| | - Clair A Null
- Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT; Mathematica Policy Research, Washington, DC
| | | | - Setti Shahab-Ferdows
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA;
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Haber JA, Solomons NW, Hampel D, Orozco MN, Allen LH. The Effect Of Maternal Supplementation With A Lipid‐Based Nutrient Supplement On Infant Micronutrient Intake In Guatemalan Women And Infants. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.1150.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Juliana A. Haber
- University of California DavisUSDA ARS Western Human Nutrition Research CenterDavisCA
| | - Noel W. Solomons
- Center for Studies of Sensory Impairment, Aging and MetabolismGuatemala CityGuatemala
| | - Daniela Hampel
- University of California DavisUSDA ARS Western Human Nutrition Research CenterDavisCA
| | - Mónica N. Orozco
- Center for Atitlán StudiesUniversidad del Valle de GuatemalaSololáGuatemala
- Center for Studies of Sensory ImpairmentAging and MetabolismGuatemala CityGuatemala
| | - Lindsay H. Allen
- University of California DavisUSDA ARS Western Human Nutrition Research CenterDavisCA
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Hampel D, Shahab-Ferdows S, Adair LS, Bentley ME, Flax VL, Jamieson DJ, Ellington SR, Tegha G, Chasela CS, Kamwendo D, Allen LH. Thiamin and Riboflavin in Human Milk: Effects of Lipid-Based Nutrient Supplementation and Stage of Lactation on Vitamer Secretion and Contributions to Total Vitamin Content. PLoS One 2016; 11:e0149479. [PMID: 26886782 PMCID: PMC4757446 DOI: 10.1371/journal.pone.0149479] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/31/2016] [Indexed: 01/16/2023] Open
Abstract
While thiamin and riboflavin in breast milk have been analyzed for over 50 years, less attention has been given to the different forms of each vitamin. Thiamin-monophosphate (TMP) and free thiamin contribute to total thiamin content; flavin adenine-dinucleotide (FAD) and free riboflavin are the main contributors to total riboflavin. We analyzed milk collected at 2 (n = 258) or 6 (n = 104), and 24 weeks (n = 362) from HIV-infected Malawian mothers within the Breastfeeding, Antiretrovirals and Nutrition (BAN) study, randomly assigned at delivery to lipid-based nutrient supplements (LNS) or a control group, to investigate each vitamer's contribution to total milk vitamin content and the effects of supplementation on the different thiamin and riboflavin vitamers at early and later stages of lactation, and obtain insight into the transport and distribution of these vitamers in human milk. Thiamin vitamers were derivatized into thiochrome-esters and analyzed by high-performance liquid-chromatography-fluorescence-detection (HPLC-FLD). Riboflavin and FAD were analyzed by ultra-performance liquid-chromatography-tandem-mass-spectrometry (ULPC-MS/MS). Thiamin-pyrophosphate (TPP), identified here for the first time in breast milk, contributed 1.9-4.5% to total thiamin. Free thiamin increased significantly from 2/6 to 24 weeks regardless of treatment indicating an active transport of this vitamer in milk. LNS significantly increased TMP and free thiamin only at 2 weeks compared to the control: median 170 versus 151 μg/L (TMP), 13.3 versus 10.5 μg/L (free thiamin, p<0.05 for both, suggesting an up-regulated active mechanism for TMP and free thiamin accumulation at early stages of lactation. Free riboflavin was consistently and significantly increased with LNS (range: 14.8-19.6 μg/L (LNS) versus 5.0-7.4 μg/L (control), p<0.001), shifting FAD:riboflavin relative amounts from 92-94:6-8% to 85:15%, indicating a preferred secretion of the free form into breast milk. The continuous presence of FAD in breast milk suggests an active transport and secretion system for this vitamer or possibly formation of this co-enymatic form in the mammary gland.
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Affiliation(s)
- Daniela Hampel
- USDA, ARS Western Human Nutrition Research Center, Davis, California, United States of America
- Department of Nutrition, University of California Davis, Davis, California, United States of America
- * E-mail:
| | - Setareh Shahab-Ferdows
- USDA, ARS Western Human Nutrition Research Center, Davis, California, United States of America
| | - Linda S. Adair
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Margaret E. Bentley
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Valerie L. Flax
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Denise J. Jamieson
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sascha R. Ellington
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Charles S. Chasela
- UNC Project, Lilongwe, Malawi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Lindsay H. Allen
- USDA, ARS Western Human Nutrition Research Center, Davis, California, United States of America
- Department of Nutrition, University of California Davis, Davis, California, United States of America
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Allen LH, Hampel D, Shahab-Ferdows S, York ER, Adair LS, Flax VL, Tegha G, Chasela CS, Kamwendo D, Jamieson DJ, Bentley ME. Antiretroviral therapy provided to HIV-infected Malawian women in a randomized trial diminishes the positive effects of lipid-based nutrient supplements on breast-milk B vitamins. Am J Clin Nutr 2015; 102:1468-74. [PMID: 26537941 PMCID: PMC4658457 DOI: 10.3945/ajcn.114.105106] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 09/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little information is available on B vitamin concentrations in human milk or on how they are affected by maternal B vitamin deficiencies, antiretroviral therapy, or maternal supplementation. OBJECTIVE The objective was to evaluate the effects of antiretroviral therapy and/or lipid-based nutrient supplements (LNSs) on B vitamin concentrations in breast milk from HIV-infected women in Malawi. DESIGN Breast milk was collected from 537 women recruited within the Breastfeeding, Antiretrovirals, and Nutrition study at 2 or 6 wk and 24 wk postpartum. Women were assigned to receive antiretrovirals and LNSs, antiretrovirals only, LNSs only, or a control. Antiretrovirals and LNSs were given to the mothers from weeks 0 to 28. The antiretrovirals were zidovudine/lamivudine and nelfinavir or lopinavir/ritonavir. LNSs provided 93-118% of the Recommended Dietary Allowances of thiamin, riboflavin, niacin, pyridoxine, and vitamin B-12. Infants were exclusively breastfed. RESULTS LNSs increased milk concentrations of all vitamins except thiamin, whereas antiretrovirals lowered concentrations of nicotinamide, pyridoxal, and vitamin B-12. Although antiretrovirals alone had no significant effect on riboflavin concentrations, they negatively affected the LNS-induced increase in this vitamin. Thiamin was not influenced by the study interventions. Concentrations of all B vitamins were much lower than usually accepted values. CONCLUSIONS All B vitamins were low in milk, and all but thiamin were increased by maternal supplementation with LNSs. Antiretrovirals alone decreased concentrations of some B vitamins in milk. When LNS was given in addition to antiretrovirals, the negative effect of antiretrovirals offset the positive effect of LNSs for all vitamins except thiamin. This trial was registered at clinicaltrials.gov as NCT00164762.
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Affiliation(s)
- Lindsay H Allen
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA; Department of Nutrition, University of California, Davis, CA;
| | - Daniela Hampel
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA; Department of Nutrition, University of California, Davis, CA
| | | | - Emily R York
- USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA; Department of Nutrition, University of California, Davis, CA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Valerie L Flax
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | | | - Charles S Chasela
- the UNC Project, Lilongwe, Malawi; and Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Shahab-Ferdows S, Engle-Stone R, Hampel D, Ndjebayi AO, Nankap M, Brown KH, Allen LH. Regional, Socioeconomic, and Dietary Risk Factors for Vitamin B-12 Deficiency Differ from Those for Folate Deficiency in Cameroonian Women and Children. J Nutr 2015; 145:2587-95. [PMID: 26446486 DOI: 10.3945/jn.115.210195] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 09/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Representative data on folate and vitamin B-12 dietary intake and status in low-income countries are rare, despite the widespread adoption of folic acid fortification. OBJECTIVE The purpose of this study was to evaluate folate and vitamin B-12 intake, status, and risk factors for deficiency before implementation of a national fortification program in Cameroon. METHODS A nationally representative cross-sectional cluster survey was conducted in 3 ecologic zones of Cameroon (South, North, and the 2 largest cities, Yaoundé/Douala), and information on dietary intake was collected from 10 households in each of 30 randomly selected clusters per zone. In a subset of women and their 12- to 59-mo-old children (n = 396 pairs), plasma folate and vitamin B-12, as well as breast milk vitamin B-12, were analyzed. RESULTS Vitamin B-12 and folate dietary intake patterns and plasma concentrations were similar for women and children. In the subsample, 18% and 29% of women and 8% and 30% of children were vitamin B-12 (≤ 221 pmol/L) and folate (< 10 nmol/L) deficient, respectively. Mean dietary folate ranged from 351 μg dietary folate equivalents/d in the North to 246 μg dietary folate equivalents/d in Yaoundé/Douala; plasma folate was negatively associated with socioeconomic status (P = 0.001). Plasma vitamin B-12 deficiency was similar in the South and North, 29% and 40%, respectively, but was only 11% in Yaoundé/Douala, and was positively associated with socioeconomic status. Mean breast milk vitamin B-12 was statistically significantly lower in the North (101 pmol/L) than in the South (296 pmol/L) or Yaoundé/Douala (349 pmol/L). CONCLUSIONS Folate intake and status are inadequate among women and young children in Yaoundé/Douala, whereas low vitamin B-12 intake and status are more common in poor and rural areas, especially in the North. Different strategies may be needed to control deficiency of these nutrients in different regions of Cameroon.
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Affiliation(s)
| | - Reina Engle-Stone
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Daniela Hampel
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | | | | | - Kenneth H Brown
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
| | - Lindsay H Allen
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA; Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; and
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