Buffered or impaired: Maternal anemia, inflammation and breast milk macronutrients in northern Kenya

Abstract

Background: Maternal anemia has adverse consequences for the mother-infant dyad. To evaluate whether and how milk nutrient content may change in ways that could "buffer" infants against the conditions underlying maternal anemia, this study assessed associations between milk macronutrients and maternal iron-deficiency anemia (IDA), non-iron-deficiency anemia (NIDA), and inflammation.Methods: A secondary analysis of cross-sectional data and milk from northern Kenya was conducted (n = 204). The combination of hemoglobin and transferrin receptor defined IDA/NIDA. Elevated serum C-reactive protein defined acute inflammation. The effects of IDA, NIDA, and inflammation on milk macronutrients were evaluated in regression models.Results: IDA (β = 0.077, p = .022) and NIDA (β = 0.083, p = .100) predicted higher total protein (ln). IDA (β = −0.293, p = .002), NIDA (β = −0.313, p = .047), and inflammation (β = −0.269, p = .007) each predicted lower fat (ln); however, anemia accompanying inflammation predicted higher fat (β = 0.655, p = .007 for IDA and β = 0.468, p = .092 for NIDA). NIDA predicted higher lactose (β = 1.020, p = .003).Conclusions: Milk macronutrient content both increases and decreases in the presence of maternal anemia and inflammation, suggesting a more complicated and dynamic change than simple impairment of nutrient delivery during maternal stress. Maternal fat delivery to milk may be impaired under anemia. Mothers may buffer infant nutrition against adverse conditions or poor maternal health by elevating milk protein (mothers with IDA/NIDA), lactose (mothers with NIDA), or fat (mothers with anemia and inflammation). This study demonstrates the foundational importance of maternal micronutrient health and inflammation or infection for advancing the ecological understanding of human milk nutrient variation.

Variation in breast milk macronutrient contents by maternal anemia and hemoglobin concentration in northern Kenya

“…Data collection took place during a prolonged drought and food shortage; many mothers were coping with the food shortage by reducing food variety, meal size or the number of meals for their consumption (Apland & Fujita, , , ; Apland, Fujita, & Chang, ; Fujita, ; Fujita, Apland, & Chang, ), and prioritizing their children in allocating limited amount of foods within households (Fujita, ). Our subsequent research found that low BMI (Fujita, ; Fujita, Brindle, Lo, Castro, & Cameroamortegui, ), vitamin A deficiency (Fujita, ; Fujita et al, ; Fujita, Lo, & Brindle, ), and iron deficiency (Fujita, Paredes Ruvalcaba, Wander, Corbitt, & Brindle, ; Fujita, Paredes Ruvalcaba, Wander, Corbitt, & Brindle, ; Fujita & Wander, ) were prevalent among these mothers.…”

“…Future research should replicate this study and further examine the impacts of other maternal characteristics on breast milk as another avenue of how maternal health may impact milk and, ultimately, infant well-being. Our team is currently investigating the effects of maternal micronutrient deficiencies, inflammation/infection, and anemia on milk in a separate study (Fujita et al, 2018a(Fujita et al, , 2018b. A limitation of this study was that the milk specimens had been subjected to prolonged cryogenic storage at −80 C and underwent freeze/thaw cycles prior to being assayed.…”

“…Protein may be more valuable to the growing child for tissue accretion while fat may be crucial for mothers facing high levels of nutritional stress. This shift in milk nutrient concentrations may also function as a way for mothers to maintain relatively stable milk energy, facilitating the buffering of infants from the impact of nutritional stress underlying maternal anemia (Fujita et al, , ; Pond, ; Quinn et al, ; Quinn, Diki Bista, & Childs, ) as part of an evolved maternal strategy (Power & Schulkin, ). This interpretation is consistent with our observation of a nonsignificant association between maternal anemia and milk energy.…”

Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta‐analysis

“…Ideally, prospective cohort data with maternal Hb values at multiple time periods across the continuum of preconception, pregnancy, and postpartum would allow us to better assess the role of the timing and guide potential trimester‐specific cutoff decisions. While it was beyond the scope of the current review, the association between postpartum maternal Hb and maternal and child health outcomes may also merit further examination, including a possible relationship between maternal anemia during lactation and breastmilk macronutrient composition . Furthermore, the majority of the literature that examines the role of the timing on health outcomes has focused on low Hb.…”

Correlation between maternal hemoglobin and serum transferrin receptor with lactoferrin concentration in breastfeeding mothers

“…Breastfeeding mothers can also be negatively affected by IDA, considering that maternal nutritional status is closely associated with the quality of human milk; therefore, impairment in human milk content may occur due to maternal anemia. Maternal anemia can alter the quality of human milk both in the nutrient and non-nutrient content [14].…”