Micronutrient intakes of lactating mothers and their association with breast milk concentrations and micronutrient adequacy of exclusively breastfed Indonesian infants

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.

Quantifying breast milk intake by term and preterm infants for input into paediatric physiologically based pharmacokinetic models

“…The rate of human milk consumption by term infants from approximately 20 days to 6 months PNA was consistent with published analyses that also examined WHMI (Figure ). Linear regression models by Arcus‐Arth et al () and Daniels et al () appeared to predict similar rates of WHMI as the nonlinear regression model of this review until 6 months of age. Data past 6 months of age were not comparable due to the inclusion of only EBF infants >6 months of age in this review, whereas Arcus‐Arth et al () included PBF infants >6 months of age and Daniels et al () modelled intake from a cross‐sectional study of 113 infants with data only until 5–6 months of age.…”

“…Linear regression models by Arcus‐Arth et al () and Daniels et al () appeared to predict similar rates of WHMI as the nonlinear regression model of this review until 6 months of age. Data past 6 months of age were not comparable due to the inclusion of only EBF infants >6 months of age in this review, whereas Arcus‐Arth et al () included PBF infants >6 months of age and Daniels et al () modelled intake from a cross‐sectional study of 113 infants with data only until 5–6 months of age. As a strength of this review, WHMI of EBF term infants were captured by the regression model for >6 months of age and will therefore provide conservative values for subsequent risk assessments.…”

“…Regression equations describing the mean weight‐normalized human milk intake (WHMI) of exclusively breastfeeding term infants across postnatal age, with postnatal age untransformed (a) and log‐transformed (b). Data are presented from this review, Arcus‐Arth et al () and Daniels et al ()…”

“…The linear regression equations using individual subject data from five studies acquired by Arcus‐Arth et al () and a single study by Daniels et al () are shown in Figures a and b for comparison.…”

Breast milk vitamin B12 concentration and incidence of diarrhea and respiratory infections among infants in urban Tanzania: a prospective cohort study

“…In addition, we did not have information on the concentrations of other micronutrients in breast milk [12], maternal antibodies, the frequency of breastfeeding and gut microbiota [13] which may also influence the incidence of diarrhea and respiratory infections. Other residual confounders that should be investigated in future studies of micronutrient concentration and adequacy in breast milk include breast milk volume, infant micronutrient intake from breast milk, infant weight, infant age, parity, and micronutrient status of the mothers during pregnancy [14]. Further, no information was available on diarrhea severity, which may modify its relationship to B12 status [15].…”