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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 #317732

Title: Antiretroviral therapy provided to HIV-infected Malawian women in a randomized trial diminishes the posiitive effect of lipid-based nutrient supplements on breast milk B-vitamins

item ALLEN, LINDSAY - US Department Of Agriculture (USDA)
item HAMPEL, DANIELA - University Of California
item SHAHAB-FERDOWS, SETAREH - University Of California
item YORK, EMILY - University Of California
item ADAIR, LINDA - University Of North Carolina
item FLAX, VALERIE - University Of North Carolina
item TEGHA, GERALD - Kamuzu Central Hospital
item CHASELA, CHARLES - Kamuzu Central Hospital
item KAMWENDO, DEBORAH - Kamuzu Central Hospital
item JAMIESON, DENISE - Centers For Disease Control And Prevention (CDC) - United States
item BENTLEY, MARGARET - University Of North Carolina

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/3/2015
Publication Date: N/A
Citation: N/A

Interpretive Summary: Only little is known about the amounts of B-vitamins in human milk and how maternal deficiencies, antiretroviral (ARV) treatment for HIV infection, or micronutrient supplementation influence their concentrations in the milk. In order to assess the effects of ARV treatment and micronutrient supplementation on breast milk, we measured vitamins B1, B2, B3, B6, and B12 in milk collected from HIV-infected Malawian mothers at 2/6 weeks and 24 weeks postpartum. The participants were randomly assigned to either receive ARV or LNS, both ARV and LNS, or a control group and their infants were exclusively breast-fed. Micronutrient supplementation resulted in higher vitamin concentrations in the milk for all vitamins analyzed except B1, while ARV treatment lowered concentrations of B3, B6, and B12. When ARV and LNS were taken, the ARV offset the positive effect of LNS for all vitamins but B1, which was not influenced by any of the treatments provided. In general, the B-vitamin concentrations in the milk were much lower than the usually accepted values for adequacy.

Technical Abstract: Background: There is little information on B-vitamin concentrations in human milk or how they are affected by maternal B-vitamin deficiencies, antiretroviral (ARV) therapy or maternal supplementation. Objective: To evaluate effects of ARV therapy and/or lipid-based nutrient supplements (LNS) on B-vitamin concentrations in breast milk of HIV-infected women in Malawi. Design: Breast milk was collected from 537 women recruited within the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study at 2/6 wk, and 24 wk postpartum. Women were assigned to: ARV/LNS, ARV, LNS, and control. ARV and LNS were given to the mothers from weeks 0 to 28. ARVs were zidovudine/lamivudine and nelfinavir or lopinavir/ritonavir. LNS provided 93-118% of the Recommended Daily Allowances of thiamin, riboflavin, niacin, pyridoxine and vitamin B12. Infants were exclusively breastfed. Results: LNS increased milk concentrations of all vitamins except thiamin, at all time points. ARV lowered concentrations of nicotinamide, pyridoxal, and B12 at 2/6 wk and of nicotinamide at 24 wk. ARV negatively affected the LNS-induced increase in concentrations of riboflavin. Thiamin was not influenced by study interventions at either time point. Concentrations of all B-vitamins were much lower than usually accepted values. Conclusions: All B-vitamins were low in milk, and all but thiamin were increased by maternal supplementation with LNS. ARV alone decreased concentrations of some B-vitamins in milk. When LNS was given in addition to ARV, the negative effect of ARV offset the positive effect of LNS for all vitamins except thiamin.