RESUMO
BACKGROUND/OBJECTIVES: Ferrous fumarate is recommended for the fortification of complementary foods based on similar iron absorption to ferrous sulfate in adults. Two recent studies in young children have reported that it is only 30% as well absorbed as ferrous sulfate. The objective of this study was to compare iron absorption from ferrous fumarate and ferrous sulfate in infants, young children and mothers. SUBJECTS/METHODS: Non-anemic Mexican infants (6-24 months), young children (2-5 years) and adult women were randomly assigned to receive either 4 mg Fe (women) or 2.5 mg Fe (infants and young children) as either [(57)Fe]-ferrous fumarate or [(58)Fe]-ferrous sulfate added to a sweetened drink based on degermed maize flour and milk powder. Iron absorption was calculated based on incorporation of isotopes into erythrocytes after 14 days. RESULTS: Within each population group, no significant differences (P > 0.05) in iron absorption were found between ferrous fumarate and ferrous sulfate. Mean iron absorption from ferrous fumarate vs ferrous sulfate was 17.5 vs 20.5% in women (relative bioavailability (RBV) =86), 7.0 vs 7.2% in infants (RBV = 97) and 6.3 vs 5.9% in young children (RBV = 106). CONCLUSIONS: Ferrous fumarate is as well absorbed as ferrous sulfate in non-anemic, iron sufficient infants and young children, and can be recommended as a useful fortification compound for complementary foods designed to prevent iron deficiency. Further studies are needed to clarify its usefulness in foods designed to treat iron deficiency.
Assuntos
Laticínios , Compostos Ferrosos/administração & dosagem , Alimentos Fortificados , Zea mays/metabolismo , Adulto , Anemia Ferropriva/prevenção & controle , Bebidas , Disponibilidade Biológica , Pré-Escolar , Avaliação de Medicamentos , Feminino , Compostos Ferrosos/farmacocinética , Compostos Ferrosos/farmacologia , Farinha , Humanos , Lactente , Absorção Intestinal , Ferro/sangue , Ferro da Dieta/administração & dosagem , Ferro da Dieta/farmacocinética , Modelos Lineares , México , EdulcorantesRESUMO
As part of the efforts to reduce iron deficiency anemia (IDA), the Mexican Federal program PROGRESA distributes complementary foods to toddlers and pregnant women living in extreme poverty. Complementary foods were originally fortified with hydrogen-reduced iron, which proved a limited efficacy. The supplement was reformulated to provide higher iron bioavailability. This investigation aims to assess the sensory changes and the acceptance of new versions of the complementary foods fortified with either reduced iron, ferrous fumarate, or ferrous sulfate, stored at room temperature for 2, 4, and 6 mo. Complementary foods were presented without flavor (plain) or flavored with either chocolate or vanilla. The complementary foods were evaluated in toddlers and their mothers using a hedonic scale. The percentage of overall acceptance for the baby foods was higher in toddlers (80% to 88%) than in their mothers (63% to 68%). The complementary foods with a better acceptance were those fortified with reduced iron (63% to 68%) and ferrous fumarate (61% to 80%) independently of the flavoring added. The acceptance of the beverage intended for women was better for those fortified with reduced iron (52% to 63%) or ferrous fumarate (44% to 63%) in their vanilla-flavored version. For women, the most accepted sources of iron were reduced iron (50% to 60%) and ferrous fumarate (50% to 58%).
Assuntos
Anemia Ferropriva/tratamento farmacológico , Manipulação de Alimentos/métodos , Conservação de Alimentos/métodos , Alimentos Fortificados , Ferro da Dieta/farmacocinética , Adulto , Disponibilidade Biológica , Pré-Escolar , Comportamento do Consumidor , Estudos Cross-Over , Relação Dose-Resposta a Droga , Feminino , Alimentos Fortificados/normas , Humanos , Lactente , Recém-Nascido , Masculino , Valor Nutritivo , Paladar , Fatores de TempoRESUMO
BACKGROUND: The fat concentration of human milk is associated with maternal adiposity, but there is no clear understanding of the mechanisms controlling milk fat concentration. OBJECTIVE: We evaluated the effect of postpartum body mass index (BMI; in kg/m(2)) on the metabolic distribution of an oral dose of [13C]linoleic acid in lactating women. DESIGN: Ten lactating women stratified by BMI (either <22.5 or >23.5) at 5 mo postpartum received orally 2.5 mg [13C]linoleic acid/kg body wt. Exhaled air, milk, and plasma samples were collected in relation to tracer administration. Linoleic acid was determined by gas chromatography. Dietary intake, serum, milk composition, [13C]linoleic acid enrichment in milk and plasma, and exhaled 13CO2 (by isotope ratio mass spectrometry) were assessed. RESULTS: Women with a higher BMI exhaled more 13CO2 than did women with a lower BMI (22.8 +/- 9.4% compared with 8.6 +/- 3.5% of dose, P < 0.03). Cumulated 72-h transfer of [13C]linoleic acid to milk was not significantly different between groups (14.8 +/- 6.5% compared with 17.7 +/- 6.7% of dose). Within the first 9 h after dose administration, 51.6 +/- 4.9% of the total isotope transfer into milk had passed in women with a higher BMI, but only 24.0 +/- 15.3% had passed in those with a lower BMI (P = 0.02). CONCLUSIONS: Women with a lower BMI, who were reputed as having less body fat, oxidized and secreted into milk less dietary linoleic acid within 12 h after tracer administration than did women with a higher BMI. In both groups, a large proportion of [13C]linoleic was retained in the maternal compartment, most likely fat tissue, in a slow turnover pool, and released slowly in later hours.
Assuntos
Tecido Adiposo/metabolismo , Composição Corporal/fisiologia , Lactação/metabolismo , Ácido Linoleico/administração & dosagem , Ácido Linoleico/metabolismo , Leite Humano/química , Adolescente , Adulto , Estatura , Índice de Massa Corporal , Testes Respiratórios , Dióxido de Carbono/análise , Isótopos de Carbono , Cromatografia Gasosa , Feminino , Humanos , Ácido Linoleico/farmacocinética , OxirreduçãoAssuntos
Antropometria , Aleitamento Materno , Desenvolvimento Infantil/fisiologia , Doenças Transmissíveis/epidemiologia , Países Desenvolvidos , Alimentos Infantis/normas , Adulto , Criança , Pré-Escolar , Doenças Transmissíveis/etiologia , Feminino , Humanos , Lactente , Leite Humano/microbiologia , Leite Humano/fisiologia , Pesquisa , DesmameAssuntos
Composição Corporal/fisiologia , Índice de Massa Corporal , Lactação/metabolismo , Ácido Linoleico/metabolismo , Leite Humano/química , Testes Respiratórios , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Marcação por Isótopo , Ácido Linoleico/análise , México , Oxirredução , Fatores de TempoRESUMO
This study was designed to test whether breast-feeding protects infants reared in unfavorable environments from growth-stunting by averting acute infections. The body weight and length, feeding mode and morbidity of 170 healthy infants were assessed at 15-d intervals from birth to 6 mo. Birth weight and length were not different between groups, but at 6 mo, breast-fed infants were heavier and tended to be taller (P = 0.1) than infants fed formula. Relative to NCHS values, infants had lower mean birth weights than a sample of American and European BF infants. At 6 mo, the weight of BF infants caught up to the weight of NCHS standards, while infants fed formula fell to around -1 NCHS-Z-score for weight and length. The cumulative 6-mo weight increments were negatively related to the number of episodes of diarrhea, and positively to duration of lactation (P = 0.03, R(2) = 0.17). The 6-mo length gain was negatively related to infections but not to duration of lactation (P = 0.004, R(2) = 0.19). Never-ill infants attained a better weight (P = 0.04) and length (P = 0.02) than infants who suffered one or more episodes of diarrhea. Weight and length gain of infants suffering at least one episode of diarrhea was positively related to breast-feeding and socioeconomic status. Weight increments of 15-d were positively related to breast-feeding and negatively to the introduction of solids. In conclusion, breast-feeding positively affected the growth performance of the recipient infants by averting infections and possibly by improving nutrient intake during infections.
Assuntos
Aleitamento Materno , Transtornos do Crescimento/prevenção & controle , Pobreza , Adulto , Análise de Variância , Estatura , Diarreia Infantil/epidemiologia , Diarreia Infantil/prevenção & controle , Feminino , Nível de Saúde , Humanos , Incidência , Recém-Nascido , Estudos Longitudinais , Idade Materna , México/epidemiologia , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , Fatores Socioeconômicos , População Urbana , Aumento de PesoRESUMO
The relationship between maternal dietary intakes of energy or fat maternal body composition and the milk fat concentration is an important element in understanding the role of breast-milk in infant nutrition. In most studies in both developing and developed countries, no relation between maternal energy intake and milk fat content was observed. In only one published study, in which maternal fat intake comprised a very low 5% of calories, was a short term reduction in milk lipid observed in some subjects. On the other hand, a positive relation between maternal fatness and milk fat is evident in both well-nourished and under-nourished women when appropriate methodologies have been used. Low milk fat concentrations are associated with higher milk volumes probably because infant demand determines milk intake, compensating, at least partially, for low milk fat. No impairment of infant growth was associated with low milk fat, in studies where it has been measured. The mechanism for the relationship between body fat and milk fat is a fertile field for additional investigation.
Assuntos
Dieta , Gorduras na Dieta/administração & dosagem , Metabolismo Energético , Metabolismo dos Lipídeos , Leite Humano/metabolismo , Tecido Adiposo/metabolismo , Peso Corporal , Feminino , HumanosRESUMO
The milk composition of women on a typical rural Mexican diet was compared with that secreted by American women, consuming a diet typical of affluent countries. Milk concentrations of free fatty acids, cholesterol, total amino acids, and selected key minerals were analyzed at 4 or 6 months postpartum. The total milk fat concentration was lower in the Otomi (22.7 +/- 6.7 mg/g milk) than in the American women (31.3 +/- 5.4 mg/g milk, p = 0.001). Although the absolute concentration did not differ, cholesterol, expressed in terms of total lipid, was higher in the Otomi milk (3.9 +/- 1.1 vs. 3.1 +/- 0.7 mg/g fat, p = 0.005). Saturated medium-chain (C10:0-C14:0) and unsaturated intermediate-chain fatty acids (C16:1 and C18:2) were higher in the Otomi than in the American milk (p < 0.03). The concentrations of C16:0, C18:0, and C18:1 were significantly lower in Otomi than in American milk. The milk concentrations of protein and nonprotein nitrogen were comparable between the two groups. The concentrations of serine, proline, cystine, methionine, and tryptophan were higher in the Otomi than in the American milk (p < 0.05-0.001). The concentrations of valine and isoleucine were significantly lower in the Otomi milk (p = 0.05). Expressed per gram of milk protein, the cystine, methionine, lysine, and tryptophan concentrations were higher, and the glutamine/glutamate, valine, isoleucine, and arginine levels were lower in the Otomi milk. The concentrations of phosphorus and copper were lower in the Otomi than in the American milk at 4 months postpartum (p = 0.05). These differences in milk fatty acid and amino acid patterns and mineral content are unlikely to affect infant growth, but may have other biological consequences yet to be ascertained.
Assuntos
Aminoácidos/análise , Dieta , Ácidos Graxos/análise , Leite Humano/química , Minerais/análise , Zea mays , Aminoácidos/classificação , Colesterol/análise , Estudos de Coortes , Ácidos Graxos/classificação , Feminino , Humanos , México , Minerais/classificação , Minerais/metabolismo , População Rural , Fatores de Tempo , Estados UnidosRESUMO
It remains unclear whether breast-feeding protects infants against acute respiratory infection (ARI). To determine if breast-feeding protects against ARI as it does against diarrhea, 170 healthy newborns were followed for 6 mo. Feeding mode, incidence and duration of ARI and diarrhea were recorded biweekly. Infants were classified as fully or partially breast-fed, or formula-fed. Incidence and prevalence were computed monthly. The effects of duration of breast-feeding and potential confounders were analyzed by multiple and logistic regression analyses. Incidence and prevalence of ARI were significantly lower in fully breast-fed infants than in formula-fed infants from birth up to 4 mo, as was the mean duration of individual episodes (5.1 +/- 3.5 vs. 6.4 +/- 3.6 d, respectively). Incidence of ARI was negatively associated with duration of breast-feeding and positively associated with the presence of siblings (P < 0.05). The prevalence of ARI was associated only with the duration of breast-feeding (P < 0.05). Infants that were never breast-fed and that had one or more siblings were more likely to have an episode of ARI than those fully breast-fed for at least 1 mo. Incidence, prevalence, and duration of individual episodes of diarrhea were also lower in breast-fed infants. Incidence (r = -0.17, P < 0.02) and prevalence (r = -0.19, P < 0.008) were negatively associated with duration of full breast-feeding. Introduction of solid food was not associated with further episodes of diarrhea. The present results demonstrate protection against ARI as a result of breast-feeding similar to that for diarrhea, i.e., lower incidence and percentage of days ill, and episodes of shorter duration.
Assuntos
Aleitamento Materno , Diarreia Infantil/prevenção & controle , Infecções Respiratórias/prevenção & controle , Doença Aguda , Intervalos de Confiança , Fatores de Confusão Epidemiológicos , Diarreia Infantil/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , México/epidemiologia , Prevalência , Infecções Respiratórias/epidemiologia , Fatores de Risco , Fatores de TempoRESUMO
Energy-sparing mechanisms may be elicited to meet increased energy requirements imposed by lactation on women who reside in poor, rural communities in developing countries. The objectives of this study were to measure total energy expenditure and its components, basal and activity energy expenditure, and to investigate their relationships with lactation performance in a total of 40 rural Mesoamerindians stratified according to postpartum body mass index. Total energy expenditure and fat-free mass were measured by the doubly labeled water method, and basal metabolic rate was determined by indirect calorimetry at 3 and 6 mo postpartum. Physical activity level was taken as the ratio of total energy expenditure to basal metabolic rate. Milk energy output, which is not included in total energy expenditure, was computed from 24-h milk intake (test-weighing) and energy concentration of milk (bomb calorimetry). Anthropometric measurements revealed negligible mobilization of tissue stores. Mean (+/- SD) total energy expenditures were 8912 +/- 1296 kJ/d and 9253 +/- 1298 kJ/d for the lower and higher body mass index groups, respectively. Adjusted for fat-free mass, total energy expenditure was higher in the lower body mass index group (P = 0.05). Adjusted for fat-free mass, basal metabolic rate did not differ between groups. Physical activity level was significantly higher in the lower body mass index group (P = 0.03). Lactation performance did not differ between groups and was not associated with total energy expenditure or its components. Despite the maintenance of energy balance and heightened energy requirements of lactation, energy-sparing mechanisms were not evident in these lactating Mesoamerindians.
PIP: The authors measured total energy expenditure and its components, basal and activity energy expenditure, and investigated their relationships with lactation performance among 40 rural Mesoamerindians stratified according to postpartum body mass index. Total energy expenditure and fat-free mass were measured by the doubly-labeled water method, and basal metabolic rate was determined by indirect calorimetry at 3 and 6 months postpartum. The ratio of total energy expenditure to basal metabolic rate identified the physical activity level, while milk energy output was computed from 24-hour milk intake test and the energy concentration of milk. Anthropometric measurements identified negligible mobilization of tissue stores. Mean total energy expenditures were 8912 kJ/day and 9253 kJ/day for the lower and higher body mass index groups, respectively. Adjusted for fat-free mass, total energy expenditure was higher in the lower body mass index group, although the basal metabolic rate did not differ between groups. The physical activity level was significantly higher in the lower body mass index group. Lactation performance did not differ between groups and was not associated with total energy expenditure or its components. Despite the maintenance of energy balance and heightened energy requirements of lactation, energy-sparing mechanisms were not evident in these lactating Mesoamerindians.
Assuntos
Metabolismo Energético , Indígenas Norte-Americanos , Lactação/metabolismo , Atividade Motora/fisiologia , Adolescente , Adulto , Metabolismo Basal , Índice de Massa Corporal , Ingestão de Alimentos , Feminino , Humanos , Estudos Longitudinais , México , Leite Humano/metabolismoRESUMO
Early growth faltering has been described in breast-fed infants 4-6 months of age from less-developed communities. The timing and magnitude of growth faltering, however, depends on the appropriateness or comparability of the reference used to evaluate growth performance. In this paper we compared the growth performance of a group of rural Mesoamerindian breast-fed infants from birth through 6 months of age to that of a reference group of breast-fed infants reared under favourable nutritional and environment conditions in the United States. The validity of this assessment is based upon the comparability of infant feeding mode. Mean weights and lengths and corresponding weight-for-age and length-for-age percentiles and z-scores were significantly lower among the Mesoamerindian (Otomi Indian) infants (p = 0.001). Mean weight-for-length percentiles and z-scores did not differ between groups. Weight gain (g/day) was significantly lower among the Otomi infants throughout the entire 6 months (p = 0.001). Length velocities of the Otomi infants were lower than reference infants at 3-6 months (p = 0.001). The growth pattern of the Otomi infants differed from that of the reference group: decreases in growth velocities and weight-for-age and length-for-age z-scores were significantly more precipitous for the Otomi infants between 4 and 6 months of age (p = 0.001). We conclude that growth faltering was evident among the Otomi infants between 4 and 6 months of age, relative to a reference growth of breast-fed infants.
PIP: During 1986-89, for the first 6 months of life biweekly measurements were taken of the weight and length of 114 breast fed, healthy Mesoamerindian (Otomi) infants living in rural Capulhuac, Mexico, and their mothers were asked about infant feeding. Results were compared with a reference sample of 45 predominantly breast fed infants from Houston, Texas. The Otomi infants had birth weights and lengths lower than the National Center for Health Statistics (NCHS) medians, perhaps due to suboptimal gestational weight gains. They had significantly lower growth velocities (i.e., weight gain/day throughout entire 6 months and length gain/month for 3-6 months) than the reference infants (p = 0.001). They also had significantly lower NCHS percentiles and NCHS z-scores for weight-for-age and length-for-age than the Texas infants (p = 0.001). For example, at 6 months, the weight and length velocities of the Otomi were about 70% of the reference infants. The mean weight-for-length percentiles and z-scores were not significantly different between the 2 groups, however. Between 4 and 6 months of age, the decreases in growth velocities and NCHS weight-for-age and NCHS length-for-age z-scores of the Otomi infants were much more steep than those for the reference group (p = 0.001); for example, the decrease in weight-for-age was 0.44 for Otomi infants compared to 0.29 for the reference group, and the decrease in length-for-age was 0.43 and 0.18, respectively. In conclusion, the Otomi Indian breast fed infants experienced growth faltering between 4 and 6 months.
Assuntos
Aleitamento Materno , Crescimento , Indígenas Norte-Americanos , Estatura , Peso Corporal , Desenvolvimento Infantil , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Valores de Referência , População Rural , Estados UnidosRESUMO
This research was designed to evaluate the circadian variation in the lipid content of the milk obtained from 10 lactating Mexican women as well as the effects of a meal eaten by the mother and of previous milk sampling on the milk volume and fat yield. In addition, predictions were made to determine the most appropriate sampling schedule to obtain a milk sample representative of 24-hour production. Every 4 h over a 24-hour period, the contents of the left breast of predominantly breast-feeding volunteers were completely extracted, using an Engell pump, and analysed for lipid content. In a separate experiment, 6 volunteers were sampled hourly from 9.00 to 13.00 h on 2 consecutive days, one after eating breakfast and the second while fasting. Significant circadian variations of volume (p < 0.05) and lipid yield (p < 0.001) were noted, peaking at 8.00-12.00 and 16.00-20.00 h, respectively. No effects of eating breakfast or of the volume and fat content of the preceding pumping on the actual volume or fat yield were found. In this population, sampling at 12.00, 20.00 and 24.00 h is the most representative of the 24-hour lipid yield, tending to overestimate it by 2.59 g/24 h with a predictive range of 97-124%.
Assuntos
Ritmo Circadiano , Alimentos , Lactação , Lipídeos/biossíntese , Leite Humano/metabolismo , Adulto , Feminino , Humanos , México , População RuralRESUMO
The mammary gland integrated by secretory acini has two main physiological goals: the lactogenesis and the milk ejection. The first is controlled by estrogens, prolactin and cortisol; the former by oxytocin. Milk is synthesized through five mechanisms namely: I. Cellular synthesis and exocytosis; 2. Cellular synthesis and exocytosis packed in cell membrane fragment; 3. Passive transport through both cell membranes; 4. Active transport via receptors through both cell membranes, and 5. Paracellular transport. The human milk has a high concentration of lactose and relatively low concentrations of fat and protein in comparison to other species. Its composition varies little in relationship to maternal diet, nevertheless, it holds a close correlation, with body composition of the mother. Exclusively breast-fed infants grow in a similar manner to those formula-fed up to 4-6 months; afterwards growth decelerates, to spurt up the need for complementary food. It has been amply demonstrated that human milk protects against acute infections, both bacterial and viral. The current hospital practices of perinatal care should be changed in our country in order to favour the initiation of breast-feeding. Concerned physicians should have more and precise knowledge about the physiology of lactation in order to help mothers to pursue a successful lactation.
Assuntos
Lactação/fisiologia , Mama/anatomia & histologia , Mama/fisiologia , Aleitamento Materno , Feminino , Humanos , Transtornos da Lactação/fisiopatologia , Leite Humano/química , Leite Humano/imunologia , Leite Humano/metabolismo , GravidezRESUMO
To investigate the energy requirements of infants living under unfavorable environmental conditions in rural Mexico, we measured the total energy expenditure (TEE) of 40 Otomi infants at approximately 4 or approximately 6 mo of age. Total energy expenditure was estimated by the doubly labeled water method: 100 mg 2H2O/kg and 250 mg 18O/kg were administered orally, after which urine was collected serially for 7 or 10 d. Isotopic enrichment of urine samples was analyzed by gas-isotope-ratio mass spectrometry. Weight and length were measured monthly from birth to 6 mo. Fat free mass was estimated from 18O dilution spaces. Total energy expenditures (mean +/- SD) were 310 +/- 58 and 318 +/- 29 kJ.kg-1 x d-1 at approximately 4 and approximately 6 mo, respectively. Total energy expenditure was higher than that previously observed for breast-fed infants reared under more protected environments (268 +/- 29 kJ.kg-1 x d-1). Weight, length and weight gain were 5.9 +/- 0.8 kg, 60 +/- 2 cm and 2.9 +/- 2.4 g.kg-1 x d-1 at 4.25 mo and 7.1 +/- 0.8 kg, 65 +/- 2 cm and 1.0 +/- 1.2 g.kg-1 x d-1 at 6.27 mo. Growth faltering was evident at 6 mo by clinically significant declines in growth velocities and National Center for Health Statistics Z-scores. Body fat of the Otomi infants averaged 21 +/- 6 and 18 +/- 5 g/100 g at approximately 4 and approximately 6 mo, respectively. Higher rates of TEE narrowed the margin of energy available for growth and thereby contributed to growth faltering in the Otomi infants.
Assuntos
Aleitamento Materno , Metabolismo Energético/fisiologia , Crescimento/fisiologia , Adolescente , Adulto , Antropometria , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , México , Leite Humano/química , Modelos Biológicos , População RuralRESUMO
To determine whether growth faltering during early infancy was attributable to inadequate intake of human milk, the nutrient intakes and growth of 30 Otomi infants from Capulhuac, Mexico, were studied at 4 or 6 mo of age. Growth was monitored monthly from 1 through 6 mo of age. The 2H dose-to-the-mother method was used to measure human milk intake. Energy, protein, lactose, and fat concentrations in milk were analyzed by standard techniques. Mean (+/- SD) human milk intakes were 885 +/- 145 and 869 +/- 150 g/d at 4 and 6 mo, respectively. Protein and lactose concentrations in milk were normal but fat and consequently energy concentrations were abnormally low. Energy intakes averaged 81 +/- 14 kcal.kg-1.d-1 at 4 mo and 72 +/- 14 kcal.kg-1.d-1 at 6 mo. Growth faltering by 6 mo was evidenced by the significant decline in growth velocities and National Center for Health Statistics Z scores. Weight gain at 6 mo was 8.1 +/- 3.5 g/d and length gain was 1.0 +/- 0.34 cm/mo. Weight-for-age and length-for-age Z scores were -0.81 +/- 0.94 and -1.51 +/- 0.83, respectively. Growth velocities were not significantly correlated with nutrient intakes. Growth faltering among the Otomi infants despite energy intakes comparable to those of breast-fed infants in more protected environments may have resulted from an increase in the need for nutrients or from a growth-limiting nutrient, other than energy, in their diet.
Assuntos
Aleitamento Materno , Ingestão de Alimentos/fisiologia , Transtornos do Crescimento/etiologia , Leite Humano , Adulto , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Indígenas Norte-Americanos , Lactente , Masculino , México , Leite Humano/química , Pobreza , População RuralRESUMO
Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.
PIP: Researchers analyzed data on 30 postpartum women from the Otomi Indian community living in rural Capulhuac, Mexico to examine interrelationships among lactation performance, maternal body size/composition, and dietary intake to learn which maternal factors limit lactation and thus infant growth. Infant food supplementation was minimal. Current diet did not affect milk production or levels of energy and fat in milk. Even though the body mass index (BMI) was lower than the normal range (19.8-26 kg/sq meter) for only 2 women, 8 women had 20% body fat indicating considerable undernutrition. Women consumed a mean of 68% and 80% of energy and protein requirements. Mean energy intakes (kcal/kg/day) at 4 and 6 months postpartum were 33.8 and 35.1 respectively, compared with the recommended 51. Mean protein intakes (g/kg/day) were 0.75 and 0.84 respectively compared with the recommended 1.1 3-day intake records based on memory, estimation of portion sizes, food preparation, and food composition data led to the above energy intake results, but they may not have been accurate since a mean of 35 would not allow much physical activity. Fats and carbohydrates mainly from maize made up 17% and 76% respectively of the Otomi diet suggesting a suboptimal diet. Yet human milk production rates (885 g/day at 4 months and 869 g/day at 6 months) tended to equal or be higher than those of women of higher socioeconomic status (711-925 g/day) and other poor women (525-789 g/day). The greater the levels of maternal body fat the smaller the amount of milk women produced (p=.006). Total nitrogen, protein nitrogen, lactose, and nonprotein nitrogen levels fell within the range of that of privileged women. Fat and energy levels in the milk were lower than those of privileged women, however heavy women (p=.002) with high BMI (p=.05) and body fat (p=.004) levels tended to have high levels of energy and fat in the milk. Energy levels in milk were not linked with milk production. Neither milk production nor composition were related to dietary intake.
Assuntos
Antropometria , Composição Corporal , Indígenas Norte-Americanos , Transtornos da Lactação/epidemiologia , Inquéritos Nutricionais , Tecido Adiposo/química , Adulto , Constituição Corporal , Água Corporal , Peso Corporal , Estudos Transversais , Proteínas Alimentares/análise , Ingestão de Energia , Metabolismo Energético , Humanos , Transtornos da Lactação/complicações , Transtornos da Lactação/etiologia , México/epidemiologia , Leite Humano/química , Fatores de RiscoRESUMO
Information on nutritional status of the rural Mexican population is mostly obtained from cross-sectional studies. This investigation evaluates semi-longitudinally the nutritional level of a sample of the rural population of Mexico. A total of 15,552 individuals in 2,587 households from 208 rural communities were evaluated. Body weight and height of rural boys and girls were found to be significantly lower than in their urban counterparts. Severe forms of weight for age or height for age inadequacy were more frequent in females than in males, in smaller communities than in larger ones, and in economically depressed zones than in those with a good economy. Our data showed a lower frequency of mild and moderate forms of possible malnutrition than previous studies (20 vs 50%) using as a criterion weight for age. These differences are explained on the basis of sampling bias.
PIP: The nutritional status of 15,552 individuals of both sexes in 2587 households from 208 rural communities in Mexico was evaluated in a semilongitudinal nationwide study. Research was carried out from March 1982 to February 1983. The communities were randomly selected from among the 3000 with Mexican Institute of Social Security-COPLAMAR primary health care services. The 8 geoeconomic zones identified by Bassols-Batalla were represented. 10 families with at least 1 infant under 1 year old were selected in communities with under 5000 inhabitants, while 20 such families were selected from communities with 5001-20,000 inhabitants. Body weight, height or length, and arm and calf circumferences were measured in all household members in March-April 1982, and again in July-August 1982 and January-February 1983. The proportion of household heads employed primarily in agriculture ranged from 88% in the smaller communities to 32% in the larger. Families in small communities were mainly peasants in subsistence farming, while household heads in larger communities who were employed in agriculture were mostly owners of small plots. 40-54% of the mothers in communities of different sizes had 3 years or less of school attendance. Comparison of growth curves of the rural population with reference data from urban children showed similar median body weight in both groups at 2 years of age. But by age 18, median weight and height, respectively, were 8.6 kg lower and 9 cm shorter for rural boys and 5.5 kg lower and 5 cm shorter for rural girls. The most severe forms of inadequacy in weight for age were more frequent in females than males, in smaller communities than larger, and in the economically depressed zones. Severe inadequacy of height for age was more frequent in the states located on the southern Pacific Coast and the Gulf of Mexico. The frequency of mild and moderate forms of malnutrition according to weight for age was 20%, lower than the rate of 50% estimated in previous published studies. Selection of a broader range of rural communities rather than just the most marginal, and the bias introduced by selecting the sample from among communities with primary health services may explain the lower rate in this study.
Assuntos
Estado Nutricional , Saúde da População Rural , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Distúrbios Nutricionais/epidemiologia , Inquéritos Nutricionais , Fatores SocioeconômicosRESUMO
Although information about the pregnancy outcome of alcoholic mothers is relatively abundant, no information is available about the effects of ethanol consumption on the infant's postnatal growth. This investigation aims to describe the physical growth of 32 infants born to mothers accustomed to drinking pulque, a mild alcoholic beverage, on a daily basis during pregnancy and lactation and to quantitate the ethanol disposed through the milk, as well as to identify cases of newborns with fetal alcohol syndrome. No full-blown cases of the syndrome were found: birth weight was similar to their non-drinking counterpart, but the relative risk of newborns to drinking mothers to have a low birth weight was 3.39. Ethanol found in milk accounted for 40 mg/day available to the infant. The postnatal growth of infants of ethanol drinkers was similar to that of controls. Further studies on their mental development are required in order to understand the extent of the effects of such a habit.
PIP: The physical growth of 32 infants born to mothers accustomed to drinking pulque, a mild alcoholic beverage, on a daily basis during pregnancy and lactation was studied. 110 clinically healthy mothers aged 15-44 years with parity from 2 to 4 were recruited during the last trimester of gestation from among the pregnant women of San Mateo Capulhuac, a village of 4000 inhabitants, where the prevalence of natural lactation is 95% up to 6 months postpartum. All were exclusively breast feeding their infants. The final sample included 94 nonsmoking mothers; of these, 32 drank 1-2 liters of pulque per day during pregnancy. A group of 62 nondrinking mothers of similar age, parity, and height for age ratio served as controls. 6 mothers received, .12-.31 gm/kg Blood and milk samples were taken at intervals up to 189 minutes after pulque had been consumed. Weight for age, weight for height, and height for age were calculated based on reference data published by the US National Center for Health Statistics (NCHS). The group of pulque-drinking mothers had an average age of 29.0 + 5.9 years, height of 151.0 + 5.0 cm while nondrinking mothers were 25.5 + 6.0 years and 149.0 + 5.2 cm, respectively. The estimated ethanol ingestion per day varied from 3.3 to 58 gm/day. No full-blown cases of the fetal alcohol syndrome were found: birth weight was similar to their nondrinking counterparts but the relative risk of newborns to drinking mothers to have a low birth weight was 3.39. Ethanol found in milk accounted for 40 mg/day available to the infant. Compared with the NCHS reference both groups had significantly lower mean length and weight from 3 months of age (p .001). This was reflected by a low percentage of infants with adequate weight and length/age ratios (47 and 58%, respectively). More than 90% ad an adequate weight/length ratio.
Assuntos
Alcoolismo/complicações , Etanol/efeitos adversos , Crescimento/efeitos dos fármacos , Lactação , Complicações na Gravidez , Adulto , Desenvolvimento Embrionário e Fetal , Etanol/farmacocinética , Etanol/farmacologia , Feminino , Transtornos do Espectro Alcoólico Fetal , Humanos , Indígenas Norte-Americanos , Lactente , Recém-Nascido , Masculino , México , Leite Humano/metabolismo , GravidezRESUMO
Studies on human lactation were examined in order to gather some answers about questions concerning the effect of maternal food intake, size, fatness and economic status on milk production. Up to date, evidence in the literature is insufficient to permit definitive answers, but a general conclusion can be drawn: milk volume varies little among mothers with largely variable energy intakes, sizes and economic status. There is a great need for more controlled studies focusing on the relationship between maternal energy balance and milk output. Although many studies have separately addressed the nutritional changes in mothers throughout lactation (1-8) and milk consumption by infants (9-17), very few have correlated maternal nutritional conditions and the volume of milk consumed. This report will consider investigations published from 1975 and on, combining data on maternal nutritional status and milk production in the same individual. The rationale is that around 1975 more accurate and standardized methodology began to be used in related studies. Milk output is estimated by the summary of the differences of body weights of infants obtained before and after each milking episode during 24 hours. Before 1975 the balances used for such a purpose had very poor precision, and this interfered seriously on the inter and intra-personal variability of the measurements. Electronic scales made available after that year gave enough reliability to the procedure. This report is comprised of studies from birth to four months postpartum, when energy supplementation is less common, and quantitatively less important. Nutritional status of the mothers will be analyzed on the basis of four categorizing variables: social and economic status, anthropometry, food intake and body composition.
Assuntos
Ingestão de Energia/fisiologia , Lactação/fisiologia , Estado Nutricional , Antropometria , Composição Corporal , Feminino , Alimentos Fortificados , Humanos , Leite Humano , Gravidez , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
A major concern for pediatrician is evaluate the infant nutritional status for clinical, epidemiological and research purposes. This paper describes different anthropometric procedures such as weight, length or height, as well as head and arm circumferences and skinfolds; give some relevant hints in order to prevent subjects, instruments and operator errors. Standardization methods are discussed and cut point to accept consistency and validity between operators are suggested. It's also discussed how to manage the raw data in order to evaluate nutritional status in terms of size, growth tendency or weight/age, length/age and weight/length indices; besides, the most important classification of the nutritional status are given. Finally, the procedures for calculating muscular and fat arm areas and corporal adiposity in order to obtain body composition are presented.