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ARS Home » Pacific West Area » Davis, California » Western Human Nutrition Research Center » Obesity and Metabolism Research » Research » Publications at this Location » Publication #329335
Title: Vitamin B-12 in breast milk and diet, and riboflavin in breastmilk, are very low in Kenyan lactating women, although vitamin B-6 is sufficient.

Author
item WILLIAMS, ANNE - Emory University
item CHANTRY, CAROLINE - University Of California
item STEWART, CHRISTINE - University Of California
item HAMPEL, DANIELA - University Of California
item Allen, Lindsay - A
item YOUNG, SERA - Cornell University
item Shahab-Ferdows, Setti

Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 10/9/2015
Publication Date: 3/2/2016
Citation: Williams, A., Chantry, C., Stewart, C., Hampel, D., Allen, L.H., Young, S., Shahab-Ferdows, S. 2016. Vitamin B-12 in breast milk and diet, and riboflavin in breastmilk, are very low in Kenyan lactating women, although vitamin B-6 is sufficient.. Meeting Abstract. 18th Int. Society for Res. in Human Milk and Lactation Conf., Stellenbosch, S. Africa, 3/3-7/16.

Interpretive Summary: Background: Breastmilk B-vitamin concentrations can fluctuate with maternal intake. Low maternal intake of B-vitamins may result in low B-vitamin breastmilk concentrations and consequently B-vitamin deficiency in their infants because infants 0–6 months are recommended to be exclusively breastfed. This deficiency could play a role in the physical and cognitive stunting that is widespread in lower-income countries. Breastmilk nutrient analysis provides a snapshot of maternal status and infant diet, and data from resource poor settings on these B-vitamins in breastmilk are sparse. Objective: To assess distributions of riboflavin, vitamin B-6, and vitamin B-12 in breastmilk of rural Kenyan women 1-6 mo. postpartum, and to examine relationships between recent maternal dietary intake and concentrations of these vitamins in milk. Methods: Maternal dietary data, breastmilk, and infant feeding practices were collected from 300 mother-infant dyads between June and November 2014. Mothers hand-expressed 5 mL of breast milk 1-min into a feed, following 90-min of observed nonbreastfeeding. Riboflavin, vitamin B-6 and vitamin B-12 intake were estimated using a 24-h dietary recall (n = 300). Breastmilk riboflavin and vitamin B-6 concentrations were quantified using an ultra-high performance liquid chromatography tandem massspectrometry (n = 132) from a subset of women. Vitamin B-12 in breastmilk was measured using a solid-phase competitive chemiluminescent enzyme immunoassay (n= 300). Results: Median (Q1, Q3) maternal intake of riboflavin was 1.4 (1.0, 2.0) mg/d, and 40% of mothers consumed less than the estimated average requirement (EAR) during lactation (1.3 mg/ d). However, median (Q1, Q3) breastmilk total riboflavin was 45 (33, 62) g/L and all mothers had a concentration below the value used to define the adequate intake (350 lg/L; 0.3 mg/d) for infants 0-6 mo. Median (Q1, Q3) maternal intake of vitamin B-6 was 2.6 (1.8, 3.6) mg/d, and 12% of mothers consumed less than the EAR during lactation (1.7 mg/d). Median breastmilk vitamin B-6 was 178 (124, 217) lg/L and approximately one quarter (28%) of mothers had breastmilk vitamin B-6 concentrations less than those used to define the adequate intake (130 lg/L; 0.1 mg/ d) for infants 0-6 mo. Median (Q1, Q3) maternal B-12 intake was 1.5 (0.3, 9.7) g/day and 60% failed to consume the EAR during lactation (2.4lg/day). Median breastmilk vitamin B-12 was 0.15 (0.08, 0.28) lg/L and 90% of women had concentrations below the value used to define the adequate intake (0.42 lg/L; 0.4 lg/d) for infants 0-6 mo. Conclusion: The low concentrations of vitamin B-12 and riboflavin in breastmilk suggest that Kenyan infants are at risk of deficiency. Maternal dietary data indicate sufficient intake vitamin B-6 but riboflavin and vitamin B-12 intake is below recommendations. There was adequate vitamin B-6 in breastmilk, which agreed with the data on dietary adequacy. We see a need for interventions to improve maternal vitamin B-12 and ribo- flavin status during lactation to foster healthy dyads and improve child development.

Technical Abstract: Background: Breastmilk B-vitamin concentrations can fluctuate with maternal intake. Low maternal intake of B-vitamins may result in low B-vitamin breastmilk concentrations and consequently B-vitamin deficiency in their infants because infants 0–6 months are recommended to be exclusively breastfed. This deficiency could play a role in the physical and cognitive stunting that is widespread in lower-income countries. Breastmilk nutrient analysis provides a snapshot of maternal status and infant diet, and data from resource poor settings on these B-vitamins in breastmilk are sparse. Objective: To assess distributions of riboflavin, vitamin B-6, and vitamin B-12 in breastmilk of rural Kenyan women 1-6 mo. postpartum, and to examine relationships between recent maternal dietary intake and concentrations of these vitamins in milk. Methods: Maternal dietary data, breastmilk, and infant feeding practices were collected from 300 mother-infant dyads between June and November 2014. Mothers hand-expressed 5 mL of breast milk 1-min into a feed, following 90-min of observed nonbreastfeeding. Riboflavin, vitamin B-6 and vitamin B-12 intake were estimated using a 24-h dietary recall (n = 300). Breastmilk riboflavin and vitamin B-6 concentrations were quantified using an ultra-high performance liquid chromatography tandem massspectrometry (n = 132) from a subset of women. Vitamin B-12 in breastmilk was measured using a solid-phase competitive chemiluminescent enzyme immunoassay (n= 300). Results: Median (Q1, Q3) maternal intake of riboflavin was 1.4 (1.0, 2.0) mg/d, and 40% of mothers consumed less than the estimated average requirement (EAR) during lactation (1.3 mg/ d). However, median (Q1, Q3) breastmilk total riboflavin was 45 (33, 62) lg/L and all mothers had a concentration below the value used to define the adequate intake (350 lg/L; 0.3 mg/d) for infants 0-6 mo. Median (Q1, Q3) maternal intake of vitamin B-6 was 2.6 (1.8, 3.6) mg/d, and 12% of mothers consumed less than the EAR during lactation (1.7 mg/d). Median breastmilk vitamin B-6 was 178 (124, 217) lg/L and approximately one quarter (28%) of mothers had breastmilk vitamin B-6 concentrations less than those used to define the adequate intake (130 lg/L; 0.1 mg/ d) for infants 0-6 mo. Median (Q1, Q3) maternal B-12 intake was 1.5 (0.3, 9.7) lg/day and 60% failed to consume the EAR during lactation (2.4lg/day). Median breastmilk vitamin B-12 was 0.15 (0.08, 0.28) lg/L and 90% of women had concentrations below the value used to define the adequate intake (0.42 lg/L; 0.4 lg/d) for infants 0-6 mo. Conclusion: The low concentrations of vitamin B-12 and riboflavin in breastmilk suggest that Kenyan infants are at risk of deficiency. Maternal dietary data indicate sufficient intake vitamin B-6 but riboflavin and vitamin B-12 intake is below recommendations. There was adequate vitamin B-6 in breastmilk, which agreed with the data on dietary adequacy. We see a need for interventions to improve maternal vitamin B-12 and ribo- flavin status during lactation to foster healthy dyads and improve child development.