How Much Human Milk Do Infants Consume? Data from 12 Countries Using a Standardized Stable Isotope Methodology ,

Abstract

The WHO has developed new growth curves based on breast-fed infants. Recommendations for energy intake have been adopted based on measurements of total energy expenditure. Data on human milk (HM) intake are needed to estimate the energy intake from this food source. However, objective HM data from around the world have not been available, because these measurements are difficult to obtain. Stable isotope methods have been developed to provide objective measurements over a 14-d period. A pooled analysis of 1115 data points of HM intake, obtained using the dose to the mother deuterium oxide turnover method, was undertaken in infants aged 0-24 mo from 12 countries across 5 continents. A hierarchical model was needed to estimate mean HM intake and its variance within and between countries given the complexity of the data. The overall mean HM intake was 0.78 (95% CI = 0.72, 0.84) kg/d, and the age-specific estimates indicated that intake increased over the first 3-4 mo and remained above 0.80 kg/d until 6-7 mo. The variability of intake increased in late infancy. Boys consumed 0.05 kg/d more than girls (P < 0.01). HM intake was strongly, inversely associated with non-HM water intake [r = -0.448 (95% CI -0.511 to -0.385); P < 0.0001]. These objective isotope values of HM intake improve our understanding of the magnitude and variability of HM intake within and across populations and help to estimate nutrient intakes in breast-fed infants.

Are infants born in baby-friendly hospitals being exclusively breastfed until 6 months of age?

“…BM intake among our infants was lower than those reported by others using test weighing method (Coulibaly et al, 2004;Islam et al, 2008) and 'dose to mother' deuterium dilution method (Galpin et al, 2007;Moore et al, 2007). Our urban findings are in contrast to the most recent findings of the pooled analysis of data across five continents, which reported the human milk intake to remain 4800 ml/day until 6-7 months of age among infants from rural areas (Da Costa et al, 2010). The only Asian country included in this pooled analyses was Bangladesh, which reported a higher mean BM intake of 863 ml/day among all infants (n ¼ 94) from rural Bangladesh at 2-3 months of age and 883 ml/day among exclusively breastfed infants (n ¼ 73; Moore et al, 2007).…”

Estimation of human body concentrations of DDT from indoor residual spraying for malaria control

“…The uptake efficiency of ΣDDT and ΣDDE from breast milk was assumed to be 95% (LaKind et al, 2000). The breast milk consumption rate was assumed to be 800 g/d for the first year and 600 g/d for the second year (Bouwman et al, 2006;da Costa et al, 2010). Further, we set the lipid content of the breast milk constant at 3.5% (Bouwman et al, 2006).…”

Using stable isotope techniques in nutrition assessments and tracking of global targets post-2015

“…Indispensable amino acids become labelled within the food matrix and following preparation and ingestion of the meal, the appearance of labelled amino acids in the blood gives a unique measure of bioavailability. If a labelled test meal is accompanied by a trace quantity of a differently labelled reference protein, such as 13 C-labelled single cell protein of known digestibility, the ratio of the appearance of these two tracers in plasma amino acids, compared with the ratio in the meal is an index of its digestibility/bioavailability. MS instrumentation using newer sensitive methods (GC-pyrolysis-IRMS, liquid chromatography-MS), allows for minimally invasive sampling, such as the use of saliva.…”

“…Stable isotope techniques have been used in studies of human nutrition for over 50 years (2) . With the development of MS and infrared spectroscopy techniques coupled with wide commercial availability of tracers labelled with stable isotopes including 13 C, 15 N, 2 H and 18 O, detailed metabolic pathways can be investigated (3) .…”