Micronutrient supplementation of lactating Guatemalan women acutely increases infants' intake of riboflavin, thiamin, pyridoxal, and cobalamin, but not niacin, in a randomized crossover trial

Abstract

Background: Maternal supplementation during lactation could increase milk B-vitamin concentrations, but little is known about the kinetics of milk vitamin responses.

Objectives: We compared acute effects of maternal lipid-based nutrient supplement (LNS) consumption (n = 22 nutrients, 175%-212% of the RDA intake for the nutrients examined), as a single dose or at spaced intervals during 8 h, on milk concentrations and infant intake from milk of B-vitamins.

Methods: This randomized crossover trial in Quetzaltenango, Guatemala included 26 mother-infant dyads 4-6 mo postpartum who were randomly assigned to receive 3 treatments in a random order: bolus 30-g dose of LNS (Bolus); 3 × 10-g doses of LNS (Divided); and no LNS (Control), with control meals. Mothers attended three 8-h visits during which infant milk consumption was measured and milk samples were collected at every feed. Infant intake was assessed as $\mathop \sum \nolimits_{i\ = \ 1}^n ( {{\rm{milk\ volum}}{{\rm{e}}_{{\rm{feed\ }}n}} \times \ {\rm{nutrient\ concentratio}}{{\rm{n}}_{{\rm{feed}}\ n}}} )$ over 8 h.

Results: Maternal supplementation with the Bolus or Divided dose increased least-squares mean (95% CI) milk and infant intakes of riboflavin [milk: Bolus: 154.4 (138.2, 172.5) μg · min-1 · mL-1; Control: 84.5 (75.8, 94.3) μg · min-1 · mL-1; infant: Bolus: 64.5 (56.1, 74.3) μg; Control: 34.5 (30.0, 39.6) μg], thiamin [milk: Bolus: 10.9 (10.1, 11.7) μg · min-1 · mL-1; Control: 7.7 (7.2, 8.3) μg · min-1 · mL-1; infant: Bolus: 5.1 (4.4, 6.0) μg; Control: 3.4 (2.9, 4.0) μg], and pyridoxal [milk: Bolus: 90.5 (82.8, 98.9) μg · min-1 · mL-1; Control: 60.8 (55.8, 66.3) μg · min-1 · mL-1; infant: Bolus: 39.4 (33.5, 46.4) μg; Control: 25.0 (21.4, 29.2) μg] (all P < 0.001). Only the Bolus dose increased cobalamin in milk [Bolus: 0.054 (0.047, 0.061) μg · min-1 · mL-1; Control: 0.041 (0.035, 0.048) μg · min-1 · mL-1, P = 0.039] and infant cobalamin intake [Bolus: 0.023 (0.020, 0.027) μg; Control: 0.015 (0.013, 0.018) μg, P = 0.001] compared with Control. Niacin was unaffected.

Conclusions: Maternal supplementation with LNS as a Bolus or Divided dose was similarly effective at increasing milk riboflavin, thiamin, and pyridoxal and infant intakes, whereas only the Bolus dose increased cobalamin. Niacin was unaffected in 8 h. This trial was registered at clinicaltrials.gov as NCT02464111.

Keywords: B vitamins; Guatemala; human milk; infant; lipid-based nutrient supplement; maternal.

Published by Oxford University Press on behalf of the American Society for Nutrition 2020.

Figures

FIGURE 2

Percentage change in AUC milk B-vitamin content. The AUC was approximated using rectangles: the milk micronutrient concentration at each feed (from the second to the last feed) was multiplied by the time that had elapsed since the previous feed. All rectangles representing products of milk concentration and time were summed over the 8-h period to calculate the AUC secretion to milk. Error bars are SEs. n = 26. Thiamin = thiamin + (thiamin monophosphate × 0.871) + (thiamin pyrophosphate × 0.707). Niacin = nicotinamide.

FIGURE 4

P values for kinetic profiles of vitamin transfer to milk with the theoretical divided Bolus dose. (A) Riboflavin, (B) thiamin, (C) pyridoxal, (D) niacin, (E) cobalamin. S1, timing of supplement 1: ∼08:00, supplement (Bolus or Divided) or no supplement (Control) provided; S2, timing of supplement 2: ∼10:00, supplement (Divided) or no supplement (Bolus, Control) provided; S3: timing of supplement 3: ∼12:00, supplement (Divided) or no supplement (Bolus, Control) provided. There was some variation in the exact timing of the supplement, but no variation was present as calculated using the interval system. Interval 0: 07:00–08:00 (before supplementation), Interval 1: 08:00–10:00 (0–2 h postsupplement), Interval 2: 10:00–12:00 (2–4 h postsupplement), Interval 3: 12:00–14:00 (4–6 h postsupplement), Interval 4: 14:00–16:00 (≥6 h postsupplement). Thiamin = thiamin + (thiamin monophosphate × 0.871) + (thiamin pyrophosphate × 0.707). Niacin = nicotinamide. n = 26 for all models. Treatment P values are based upon linear regression with mixed effects, accounting for pair matching. Letters denote significant pairwise differences for the interaction between treatment and time, adjusting for multiple comparisons. Tukey's test was used for pairwise comparisons. Significance at P < 0.05.

FIGURE 1

CONSORT participant flow diagram. Participants who were lost during the washout either withdrew from the study (n = 1) or were excluded based on health concerns (n = 1). CONSORT, Consolidated Standards of Reporting Trials.

FIGURE 3

Mean infant vitamin intakes during 8 h expressed as percentages of their AIs, assuming infants would consume 33% of their 24-h intake over this time. Error bars are SEs. n = 26. Thiamin = thiamin + (thiamin monophosphate × 0.871) + (thiamin pyrophosphate × 0.707). Niacin = nicotinamide. AI, Adequate Intake.