PEDIATRICS Vol. 78 No. 5 November 1986, pp. 909-919
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Lactational Capacity of Marginally Nourished Mothers: Relationships Between Maternal Nutritional Status and Quantity and Proximate Composition of Milk

Kenneth H. Brown MD1, Naheed Ahmed Akhtar MBBS1, Alastair D. Robertson PhD1, and M. Giashuddin Ahmed MS1

1 From the Divisions of Human Nutrition and Geographic Medicine, Department of International Health, School of Hygiene and Public Health, and Gastroenterology and Nutrition Unit, Department of Pediatrics, School of Medicine, The Johns Hopkins University, Baltimore; and Save the Children Fund, United Kingdom, Children's Nutrition Unit, Dhaka, and International Centre for Diarrhoeal Disease Research, Bangladesh (formerly the Cholera Research Laboratories), Dhaka, Bangladesh

Longitudinal studies of the nutritional status of 60 lactating Bangladeshi mothers from an underprivileged, periurban community and of the quantity and composition of their milk were completed to determine the relationships between maternal nutritional status and lactational capacity. Daily milk production was estimated by 24-hour test-weighing; the nitrogen, fat, lactose, and total energy concentrations of extracted milk samples were analyzed at various stages of lactation to estimate total milk nutrient production. Although the mothers were poorly nourished compared with international reference populations, their lactational capacity was not severely impaired. Average milk production peaked at 750 g/d when the infants were between 5 and 7 months of age. Nitrogen and fat concentrations declined with (log) infant age; lactose concentration increased with (log) infant age (P < .001). Average concentrations of milk nutrients when the infants were 3 months of age were: nitrogen, 0.161 g/dL; fat, 2.804 g/dL; lactose, 7.92 g/dL; energy, 61.0 kcal/dL. Fat and energy concentrations were significantly greater, and fat and energy amounts tended to be greater, for mothers with larger triceps skinfold thickness or arm circumference. Changes in nutritional status within individual women were also significantly related to the amount and composition of their milk: within-woman increases in triceps skinfold thickness were associated with increases in fat and energy concentrations (P < .01) and within-woman increases in body weight were associated with increases in the amounts of milk and all major nutrients (P < .01). Milk production declined significantly during certain months of the year, just before the major harvest period. The findings suggest that, despite their remarkably good lactational capacity, the mothers' milk production was limited to some extent by their nutritional status and may, therefore, be further increased with nutritional improvment.

Key Words: human milk • breastfeeding • infant growth • malnutrition • nutritional status

Submitted on July 1, 1985
Accepted on February 24, 1986




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