Lactation and pregnancy in Iran. II. Diet and nutritional status

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Vitamin A and Breast-Feeding: A Comparison of Data from Developed and Developing Countries

The vitamin A status of lactating women, its effect on the vitamin A content of human milk, and the adequacy of human milk as a source of vitamin A for the infant were assessed, comparing data from developing countries with those from developed countries. The vitamin A concentration in breast milk during the first two weeks of lactation is nearly double that at one month. It is even higher in preterm milk than in term milk during the first several months. Human milk alone provides sufficient vitamin A to prevent clinical deficiency throughout the first 12 months of life, even in presumably more poorly nourished populations in developing countries. However, it is not sufficient to allow liver storage after about six months of lactation.

Food Patterns during An Economic Crisis among Pregnant Women in Purworejo District, Central Java, Indonesia

A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

Maternal and child health services: evaluating mothers' perceptions and participation

Urban mothers' perceptions and their actual practices in respect of antenatal care, postnatal care, childbirth and breast-feeding were reviewed through a predesigned questionnaire provided to all mothers (n = 114) staying for a day in the Clinical Research Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. Only 8% of mothers surveyed were pregnant and 71% had access to a maternal and child health clinic near their homes. Although 61% of the mothers replied that antenatal care is needed, 45% of all mothers actually used the service. Similarly, 79% of them felt that postnatal care is needed, yet only 26% attended the clinics. Only 6% of all mothers had their previous children delivered at a hospital or clinic. The majority (91%) were delivered at home, traditional birth attendants assisting in childbirth in most cases (74%). In spite of mass campaigning against the use of pre-lacteal foods (like honey and sugar water), these were given to 90% of the newborns. Underutilization of maternal and child health clinics was mostly due to the clinics only being open during the busy hours of family work and because of the misbehaviour of the staff. Changing clinic opening times, supervising staff properly and educating mothers will help to overcome their taboos and to motivate them to use 'institutional services'.

Contribution of cowpea (Vigna unguiculata) in a mixed diet to the nutrient intake of rural children in Ibadan

1. Sixty-four subjects from the rural areas of Ibadan participated in a study to determine the contribution of cowpea (Vigna unguiculata) foods to the total intake of nutrients in a mixed diet. The subjects were randomly selected from those who, according to their mothers, reacted to cowpea foods (reactors) and those who did not (non-reactors). 2. The results showed that for all subjects, protein, energy and riboflavin needs were not met from the total diet consumed. However, the requirements for vitamin A, thiamin and iron were met. 3. Between 30 months and 3 years of age, cowpeas contributed 36.2 and 30.3% of protein intake for nonreactors and reactors respectively. Corresponding values for energy intake were 17.3 and 17.2% respectively. Lower percentages were contributed by the diets of 4- to 6-year-olds. 4. Irrespective of the classification system used, some of the subjects were found to be suffering from mild to moderate malnutrition, with a few severe cases.

Zinc, copper and iron concentrations in the plasma and diets of lactating Nigerian women

Zinc, copper, iron, protein and energy intakes of 232 lactating women (consuming self-selected diets during the first 3 months post-partum) were computed from food intake values obtained using a 3 d dietary-recall method. Non-pregnant, non-lactating women (100) served as controls. Blood samples of subjects were also analysed for packed cell volume and haemoglobin concentrations as well as for plasma Zn, Cu and Fe levels by atomic absorption spectrophotometry. Except for Fe, intakes of all nutrients measured were significantly lower than recommended dietary allowances for lactation. Daily mean (and SD) Zn, Cu, Fe (mg), protein (g) and energy (MJ) intakes for lactating women were 8.2 (1.6), 1.6 (0.5), 29.0 (5.8), 52.4 (9.2) and 10.21 respectively. There was a significant intercorrelation between the different nutrients in the diet. Mean (and SD) plasma Zn, Cu and Fe concentrations (micrograms/l) during the first 3 months of lactation were 666.0 (76.0), 1290.0 (150.0) and 730.0 (185) respectively. These values were significantly (P less than 0.05) lower in the case of Zn and Fe and higher in the case of Cu than those of non-pregnant, non-lactating women. Maternal plasma levels of the trace elements also varied significantly with nutritional status as indexed by haemoglobin status. Correlation analysis between dietary and plasma trace element concentrations was significant for Zn (r 0.26, P less than 0.0001) and Fe (r 0.17, P less than 0.05). Dietary protein intake was significantly correlated with plasma Zn (r 0.18, P less than 0.005) and Fe (r 0.12, P less than 0.05). While maternal weight, arm circumference and skinfold thickness measurements tended to decrease with increase in the period of lactation, growth performance of entirely breast-fed babies was satisfactory as at the 12th week post-partum.

Breastfeeding in developing countries

The calculated protein and calorie requirements and nutritional status of intrauterine-growth-retarded infants of poor mothers in underdeveloped countries were compared with the estimated amounts of protein and calories supplied in the mother's milk and their nutritional status both before and during lactation. These mothers were only able to provide 69% of the infants' protein requirements at birth, falling to 51% at three months of age 123% of calorie requirements were supplied at birth, falling to 55% at three months. Conversely, in terms of g protein per 100 kcal, 56% of requirements were met at birth, rising to 95% at three months-figures which reflect the decreasing protein requirement with age. Socioeconomic factors determine nutritional status in developing countries and it is the responsibility of governments to ensure the health and adequate nutrition of mothers and infants.