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

Authors: DANIELA, LISA - University Of Otago; GIBSON, ROSALIND - University Of Otago; DIANA, ALY - University Of Otago; HASZARD, JILLIAN - University Of Otago; Hampel, Daniela; Shahab-Ferdows, Setti; MALCOLM, REID - University Of Otago; MELO, LARISSE - University Of British Columbia; LAMERS, YVONNE - University Of British Columbia; Allen, Lindsay - A; HOUGHTON, LISA - University Of Otago; LUFTIMAS, DIMAS - Padjadjaran University; RAHMANNIA, SOFA - Padjadjaran University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/11/2019
Publication Date: 6/1/2019
Citation: Daniela, L., Gibson, R.S., Diana, A., Haszard, J.J., Hampel, D., Shahab-Ferdows, S., Malcolm, R., Melo, L., Lamers, Y., Allen, L.H., Houghton, L.A., Luftimas, D.E., Rahmannia, S. 2019. Micronutrient intakes of lactating mothers and their association with breastmilk concentrations and micronutrient adequacy of exclusively breastfed Indonesian infants. American Journal of Clinical Nutrition. 110(2):391-400. https://doi.org/10.1093/ajcn/nqz047.
DOI: https://doi.org/10.1093/ajcn/nqz047

Interpretive Summary: Human milk is the recommended sole source of food for infants up to 6 months of age but little is known about its vitamin and mineral content in relation to the mother’s diet and the infants’ intake. We measured volume, vitamin and mineral concentrations in milk of Indonesian mothers, and maternal micronutrient intake to evaluate the adequacy of micronutrient intakes by exclusively breastfeeding infants. Mothers and their infants (113 dyads) participated in this cross-sectional study. The infant’s breast milk intake was determined with the deuterium dose-to-mother technique, and milk micronutrient concentrations were analyzed and used to calculate micronutrient intakes of the infants. Mother’s food records were used to assess their median (IQR) micronutrient intakes. The median milk intake of infants was 787'148 mL/day. Average daily infant intakes of iron, zinc, selenium, magnesium, sodium, and multiple B-vitamins were below their recommended Adequate Intakes (AIs). More than 40% of the women did not consume sufficient amounts of calcium, niacin, or vitamins A, B6 and B12, and maternal intake of vitamin A, niacin and riboflavin was related to the concentrations of these vitamins in milk. More insight into the influence of maternal nutritional status on milk nutrient concentrations, and its impact on the exclusively breastfed infant, is needed.

Technical Abstract: Background: Breastmilk is the sole source of nutrition for exclusively breastfed infants in the first 6 months of life, yet few studies have measured micronutrient concentrations in breastmilk 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. Design: Mother-infant (2 to 5.3 months) dyads (n=113) were recruited for this cross-sectional study. Volume of breastmilk intake via the deuterium dose-to-mother technique over 14 days and analysed micronutrient concentrations were used to calculate micronutrient intakes of exclusively breastfed infants. Maternal three-day 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 breastmilk volume was 787'148 mL/day. Median daily infant intakes of iron, zinc, selenium, magnesium, sodium, and B-vitamins (thiamin, riboflavin, niacin, pantothenic acid, B6 and B12) were below their respective Adequate Intakes (AIs). Inadequacies in maternal intakes (as % < Estimated Average Requirements) were greater than 40% for calcium, niacin, and vitamins A, B6 and B12. 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 breastmilk concentrations for three 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.