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

Lisa Daniels, Rosalind S Gibson, Aly Diana, Jillian J Haszard, Sofa Rahmannia, Dimas E Luftimas, Daniela Hampel, Setareh Shahab-Ferdows, Malcolm Reid, Larisse Melo, Yvonne Lamers, Lindsay H Allen, Lisa A Houghton, Lisa Daniels, Rosalind S Gibson, Aly Diana, Jillian J Haszard, Sofa Rahmannia, Dimas E Luftimas, Daniela Hampel, Setareh Shahab-Ferdows, Malcolm Reid, Larisse Melo, Yvonne Lamers, Lindsay H Allen, Lisa A Houghton

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.

Keywords: breast-milk intake; breast-milk micronutrient concentrations; breast-milk volume; exclusively breastfed infants; maternal micronutrient intakes.

Copyright © American Society for Nutrition 2019.

Figures

FIGURE 1
FIGURE 1
Breast-milk intake of exclusively breastfed infants aged 2–5.3 mo (n = 113).
FIGURE 2
FIGURE 2
Association between breast-milk intake per kg of body weight and infant age (n = 113). The estimated line from regression of breast-milk volume per kg of body weight (mL) = −2.24 × [infant age (wk)] + 164.

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