Location: Obesity and Metabolism ResearchTitle: The effects of a lipid-based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV+ Malawian mothers and associations with maternal and infant biomarkers Author
|Van Der Horst, Charles|
Submitted to: Maternal and Child Nutrition
Publication Type: Review Article
Publication Acceptance Date: 7/12/2017
Publication Date: 8/29/2017
Citation: Hampel, D., Shahab-Ferdows, S., Gertz, E.R., Flax, V.L., Adair, L.S., Bentley, M.E., Jamieson, D.J., Tegha, G., Chasela, C.S., Kamwendo, D., Van Der Horst, C.M., Allen, L.H. 2017. The effects of a lipid-based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV+ Malawian mothers and associations with maternal and infant biomarkers. Maternal and Child Nutrition. Matern Child Nutr. 2017:e12503.doi: 10.1111/mcn.12503. Interpretive Summary: We examined effects of antiretroviral (ARV) therapy and lipid-based nutrient supplements (LNS) on iron, copper and zinc concentrations in milk of exclusively breastfeeding HIV-infected Malawian mothers and their relationship with maternal and infant biomarkers. Milk at 2/6 and 24 weeks postpartum and blood during pregnancy were collected from 537 mothers and infants. The mothers received ARV, LNS, ARV/LNS, or no-intervention. ARVs reduced copper and zinc concentrations in milk at 2 weeks, while LNS had no effect. 80-90% of the copper and zinc concentrations in milk met the requirements for infant intake (~50% of iron) early in lactation, only 1-10% (11-18% of iron) were adequate at 24 weeks. Maternal hemoglobin status during pregnancy and lactation affects maternal iron status in lactation, milk iron and copper and infant iron biomarkers.
Technical Abstract: We evaluated effects of antiretroviral (ARV) therapy and lipid-based nutrient supplements (LNS) on iron, copper and zinc in milk of exclusively breastfeeding HIV-infected Malawian mothers, and their correlations with maternal and infant biomarkers. Breast milk at 2, 6, and 24 weeks (wk) postpartum and blood during pregnancy were collected from 535 mothers in the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study. The participants were assigned to ARV, LNS, ARV and LNS, or no intervention from 0-28wk postpartum. ARVs negatively affected copper and zinc milk concentrations, but only at 2wk, while LNS had no effect. Among all treatment groups, approximately 80-90% of copper and zinc, and less than 50% of iron concentrations met the current Adequate Intake for infants at 2wk and only 1-19% at 24wk. Pregnancy hemoglobin (Hb) was correlated with milk iron at 2 and 6wk (r=-0.18, p<0.02 for both). Correlations were strongest among the milk minerals (r=0.11-0.47, p<0.05 for all); none were found with infant biomarkers. At 2wk, moderate maternal anemia was correlated with higher milk iron when maternal ferritin was higher or TfR lower. At 6wk, higher maternal AGP and CRP were associated with higher milk minerals in mildly anemic women. Infant TfR was lower when milk mineral concentrations were higher at 6wk and when mothers were moderately anemic during pregnancy. ARV affects copper and zinc milk concentrations in early lactation, and maternal Hb during pregnancy and lactation could influence the association between milk minerals and maternal and infant iron status and biomarkers of inflammation.