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

Authors: DANIELS, LISA - University Of Otago; GIBSON, ROSALIND - University Of Otago; DIANA, ALY - University Of Otago; HASZARD, JILLIAN - University Of Otago; RAHMANNIA, SOFA - Padjadjaran University; LUFTIMAS, DIMAS - Padjadjaran University; HAMBEL, DANIELA - University Of California, Davis; Shahab-Ferdows, Setti; REID, MALCOLM - University Of Otago; MELO, LARISSE - University Of British Columbia; LAMERS, YVONNE - University Of British Columbia; Allen, Lindsay - A; HOUGHTON, LISA - University Of Otago

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/11/2019
Publication Date: 6/1/2019
Citation: Daniels, L., Gibson, R.S., Diana, A., Haszard, J.J., Rahmannia, S., Luftimas, D.E., Hambel, D., Shahab-Ferdows, S., Reid, M., Melo, L., Lamers, Y., Allen, L.H., Houghton, L.A. 2019. Micronutrient intakes of lactating mothers and their association with breast milk concentrations and micronutrient adequacy of exclusively breastfed Indonesian infants. American Journal of Clinical Nutrition. 110(2):391-400. https://doi.org/10.1093/ajcn/nqz047.
DOI: https://doi.org/10.1093/ajcn/nqz047

Interpretive Summary: 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 as well as micronutrients in the mother’s diet, and infant micronutrient intakes. Objectives: We evaluated the adequacy of micronutrient intakes of exclusively breastfed Indonesian infants by measuring milk volume and milk micronutrient concentrations, and assessed maternal micronutrient intakes and their relationship with milk concentrations. Methods: Mothers and their infant (2–5.3 mo) (n = 113 pairs) were recruited for this cross-sectional study. Volume of breast-milk intake, measured by the deuterium dose-to-mother technique over 14 d, and analyzed milk micronutrient concentrations were used to calculate micronutrient intakes of exclusively breastfed infants. Maternal 3-d weighed food records were collected to assess median 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 recommended Adequate Intakes. Inadequacies in maternal intakes (as % < estimated average requirements) were present in >40% of women 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.

Technical 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 Ade-quate 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 recom-mendations, 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.