Concurrent iron and zinc deficiencies in lactating mothers and their children 6-23 months of age in two agro-ecological zones of rural Ethiopia.

PURPOSE: The aim of this study is to examine the co-occurrences of low serum ferritin and zinc and anaemia among mothers and their children in two agro-ecological zones of rural Ethiopia. METHODS: Data were collected from 162 lactating mothers and their breast fed children aged 6-23 months. The data were collected via a structured interview, anthropometric measurements, and blood tests for zinc, ferritin and anaemia. Correlation, Chi-square and multivariable analysis were used to determine the association between nutritional status of mothers and children, and agro-ecological zones. RESULTS: Low serum levels of iron and zinc, anaemia and iron deficiency anaemia were found in 44.4, 72.2, 52.5 and 29.6% of children and 19.8, 67.3, 21.8, 10.5% of mothers, respectively. There was a strong correlation between the micronutrient status of the mothers and the children for ferritin, zinc and anaemia (p < 0.005). Deficiency in both zinc and ferritin and one of the two was observed in 19.1, and 53.7% of the mothers and 32.7 and 46.3%, of their children, respectively. In the 24 h before the survey, 82.1% of mothers and 91.9% of their infants consumed foods that can decrease zinc bioavailability while only 2.5% of mothers and 3.7% of their infants consumed flesh foods. CONCLUSION: This study shows that micronutrient deficiencies were prevalent among lactating mothers and their children, with variation in prevalence across the agro-ecological zones. This finding calls for a need to design effective preventive public health nutrition programs to address both the mothers' and their children's needs.

Lactation Duration and Midlife Atherosclerosis.

OBJECTIVE: To evaluate lactation duration in relation to subsequent atherosclerosis in women during midlife. METHODS: The Coronary Artery Risk Development in Young Adults study is a multicenter prospective cohort that enrolled 2,787 women in 1985-1986 (ages 18-30 years, 52% black, 48% white), of whom 2,014 (72%) attended the 20-year follow-up examination in 2005-2006. We selected 846 women (46% black) without heart disease or diabetes at baseline who delivered one or more times after the baseline evaluation, had cardiometabolic risk factors measured at baseline, and had maximum common carotid intima-media thickness (mm) measured at the 20-year follow-up examination in 2005-2006. Lactation duration was summed across all postbaseline births for each woman and (n, women) categorized as: 0 to less than 1 month (n=262), 1 to less than 6 months (n=210), 6 to less than 10 months (n=169), and 10 months or greater (n=205). Multiple linear regression models estimated mean common carotid intima-media thickness (95% confidence interval) and mean differences among lactation duration groups compared with the 0 to less than 1-month group adjusted for prepregnancy obesity, cardiometabolic status, parity, and other risk factors. RESULTS: Lactation duration had a graded inverse association with common carotid intima-media thickness; mean differences between 10 months or greater compared with 0 to less than 1 month ranged from -0.062 mm for unadjusted models (P trend <.001) to -0.029 mm for models fully adjusted for prepregnancy body mass index (BMI) and cardiometabolic risk factors, parity, smoking, and sociodemographics (P trend=.010). Stepwise addition of potential mediators (BMI, systolic blood pressure at the 20-year follow-up examination) modestly attenuated the lactation and common carotid intima-media thickness association to -0.027 and -0.023 mm (P trend=.019 and .054). CONCLUSION: Shorter lactation duration is associated with subclinical atherosclerosis independent of prepregnancy cardiometabolic risk factors and traditional risk factors. The magnitude of differences in carotid artery intima-media thickness may represent greater vascular aging. Lactation may have long-term benefits that lower cardiovascular disease risk in women. LEVEL OF EVIDENCE: II.

Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake.

The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70% of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90% of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20% (Hb levels < 123 g/l) and that of Fe deficiency was 5% (plasma ferritin levels < 15 µg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (ß 0·03, 95% CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy.

Lactation pattern and the risk for hormone-related female cancer in Japan: the Ohsaki Cohort Study.

Although breastfeeding is associated with a reduction in the risk for breast cancer, its relationship with another hormone-related female cancer, endometrial cancer, has not been fully investigated. The objective of the present study was to prospectively examine the association between lactation pattern and the risk for incidence of breast cancer and endometrial cancer in Japanese women. We analyzed data for 26 680 women registered in the Ohsaki National Health Insurance Cohort Study, who were 40-79 years old at the baseline. During the 11 years of follow-up, we identified 148 incident cases of breast cancer and 32 incident cases of endometrial cancer. Compared with breastfeeding only, multivariate hazard ratios and 95% confidence intervals for the risk of breast cancer incidence were 1.12 (0.92-1.37) for women who had performed mixed feeding and 1.80 (1.14-2.86) for those who fed their babies only with formula (P-trend=0.014). For endometrial cancer incidence, multivariate hazard ratios and 95% confidence intervals were 1.32 (0.86-2.03) for women who had performed mixed feeding and 3.26 (1.23-8.61) for those who had performed only formula feeding (P-trend=0.018). Our findings appear to raise the possibility that nonbreastfeeding is positively associated with the risks for both breast cancer incidence and endometrial cancer incidence. Confirmation of our findings would require further investigation.

Serum persistent organic pollutants and duration of lactation among Mexican-American women.

BACKGROUND: Research suggests that estrogenic endocrine-disrupting chemicals interfere with lactation. OBJECTIVES: (1) to determine if estrogenic persistent organic pollutants (POPs) are associated with shortened lactation duration; (2) to determine whether previous breastfeeding history biases associations. METHODS AND RESULTS: We measured selected organochlorines and polychlorinated biphenyls (p, p'-DDE, p, p'-DDT, o, p'-DDT, beta-hexachlorocyclohexane, hexachlorobenzene, and PCBs 44, 49, 52, 118, 138, 153, and 180) in serum from 366 low-income, Mexican-American pregnant women living in an agricultural region of California and assessed breastfeeding duration by questionnaires. We found no association between DDE, DDT, or estrogenic POPs with shortened lactation duration, but rather associations for two potentially estrogenic POPs with lengthened lactation duration arose (HR [95% CI]: 0.6 [0.4, 0.8] for p, p'-DDE & 0.8 [0.6, 1.0] for PCB 52). Associations between antiestrogenic POPs (PCBs 138 and 180) and shortened lactation duration were attributed to a lactation history bias. CONCLUSION: Estrogenic POPs were not associated with shortened lactation duration, but may be associated with longer lactation duration.

Consultoria em aleitamento materno no Hospital de Clínicas de Porto Alegre / Breastfeeding consultancy at Hospital de Clínicas de Porto Alegre, Brazil

Apesar de todos os benefícios amplamente reconhecidos, o aleitamento materno deixou de ser uma prática universal. Podemos observar as conseqüências dessa mudança de comportamento ao longo do tempo, como o aumento da morbimortalidade infantil. Diariamente, no contato com as mães, percebemos o quanto a amamentação em determinadas condições pode parecer complicada, mesmo que a mulher esteja decidida a amamentar. No Hospital de Clínicas de Porto Alegre, desde 1996, contamos com um grupo de consultoras em lactação, formado por duas enfermeiras e uma nutricionista. Neste trabalho, desejamos compartilhar a experiência adquirida em 7 anos de trabalho junto a mães e bebês, atuando como facilitadoras do processo de amamentação

Despite all its widely reported benefits, breastfeeding is no longer a universal practice. The consequences of this change in behavior throughout time are evident, such as increased infant morbidity and mortality rates. In our daily contact with mothers, we have realized how much breastfeeding may seem complicated under certain conditions, even when women have decided to breastfeed their babies. In 1996, Hospital de Clínicas de Porto Alegre formed a group of lactation consultants, composed of two nurses and one nutritionist. In this paper, we share the experience acquired in 7 years of work with mothers and babies, acting as facilitators in the breastfeeding process

Situação de amamentação entre mulheres trabalhadoras e alunas de graduação e pós-graduação de uma universidade pública / Breast-feeding situation among working women, graduate and post-graduate students at a university

Não só mulheres trabalhadoras convivem com a necessidade de manutenção da amamentação, como também estudantes em diversos níveis de formação. Buscamos, assim, identificar as condições de aleitamento materno de funcionárias, docentes e alunas de uma universidade paulista, por ocasião do retorno às atividades profissionais e acadêmicas, bem como identificar os elementos dificultadores ou facilitadores da manutenção da lactação no ambiente de trabalho ou escolar. Entrevistamos 51 (100 por cento) nutrizes e, entre elas, 49 por cento já haviam introduzido algum substituto do leite materno na dieta da criança ao reassumirem suas atividades e 15,7 por cento já haviam desmamado a criança. O aleitamento exclusivo era praticado por 25 por cento dessas mulheres, e 5,8 por cento das crianças tinham aleitamento predominante. A falta de apoio nas instituições e condições ambientais para ordenha do leite, bem como a falta de berçário para manter a proximidade com a criança, foram as principais dificuldades apontadas pelas mulheres para a manutenção da amamentação

Maternal education, breastfeeding behaviours and lactational amenorrhoea: studies among two ethnic communities in Ile Ife, Nigeria.

Breastfeeding is an important child survival strategy. This report aims to describe the unique contributions of education, ethnicity, and other variables to breastfeeding outcomes. The study was conducted among two groups of lactating mothers in Ile Ife, southwestern Nigeria, using structured questionnaires focusing on their breastfeeding history and current practice. Breastfeeding initiation was delayed in both groups, and primary education is the most significant predictor of initiation of breastfeeding within 6 hours of delivery (OR = 3.92, p = 0.0117). Breastfeeding duration (SD) was 13.7 (4.3) months for the Yorubas and 17.5 (3.4) for the Hausas. Its only significant predictors are education (p < = 0.0001), with an average decrease in breastfeeding duration of 3.2 and 6.6 months with mother's education to the primary and post-primary levels respectively, compared with mothers with no education. In turn, breastfeeding duration is the most significant predictor of the duration of lactational amenorrhoea (p = 0.0000). Mothers with some formal education are also more likely to start feeding human milk substitutes at 2 weeks (OR = 3.83, p = 0.024). The most important variable determining breastfeeding in this study is education. The educated mother is more likely to be involved in economic activity away from the home. To protect breastfeeding in these communities, there is a need for programmes to support the breastfeeding mother who works.

PIP: The contribution of maternal education to breast feeding behaviors among the two main ethnic groups, Yoruba and Hausa, in Ile Ife, Nigeria, was assessed through a random survey of lactating mothers who brought their infants to the Urban Comprehensive Health Center for first immunization. The 50 Yoruba mothers had significantly more years of education and fewer children than the 62 Hausa respondents. 87% of Hausa women compared to only 8% of Yorubas were full-time housewives; the proportions in polygamous unions were 66% and 26%, respectively. Primary education significantly increased the likelihood of breast feeding initiation within the first 6 hours of delivery (odds ratio, 3.92). The duration of breast feeding averaged 13.7 months among Yorubas and 17.5 months among Hausa mothers. This duration was significantly longer for full-time housewives (17.6 months) than women who worked away from home (14.1 months). There was an average decrease in breast feeding duration of 3.2 and 6.6 months with mother's education to the primary and secondary levels, respectively, compared with mothers with no education. At 15 months after delivery, 29% of Yorubas and 67% of Hausa mothers were still experiencing lactational amenorrhea. Belonging to the Hausa group contributed 4.4 additional months of postpartum amenorrhea. Hausa mothers were significantly less likely than Yorubas or mothers with some formal education to use human milk substitutes. To protect breast feeding in educated working women, measures such as child care centers at or near the workplace and promotion of the use of expressed breast milk are recommended.

Biomedical factors associated to high fertility at high altitude / Factores biomédicos asociados a la alta fertilidad en la altura

El presente estudio ha sido diseñado para analizar la información del Censo Nacional de Perú, 1993 y la Encuesta Demográfica de Población, 1991-1992 reralizada en el Perú (Perú, 1994; ENDES, 1992) para determinar la población que habita en la alturas de Perú y la tasa Global de fecundidad (TGF).El estudio ha sido diseñado para investigar en poblaciones que viven al nivel del mar y en la altura, la edad de menarquia, la edad de menopausia, la prevalencia de embarazos en la adolescencia, el porcentaje de embarazos durante la lactancia materna en mujeres que nunca utilizaron contraceptivos, y los niveles de prolactina sérica durante los tres primeros meses posteriores al parto en mujeres que dan lactancia materna exclusiva. La duración de la vida reproductiva fue mayor al nivel del mar que en la altura, donde a mayor altitud de residencia menor es la duración de la vida reproductiva. Exceptuando a Arequipa, las poblaciones de las regiones administrativas ubicadas en la altura tienen un mayor TGF que las localidades en la costa del Perú (La Libertad, Grau y Lima). Las tres regiones localizada en la selva tienen también una alta TGF. La TGF según regiones naturales fue de 2.1 niños por mujer en Lima Metropolitana, 3.3 en el resto de la costa, 4.9 en la altura, y 5.1 en la selva. En 224 madres que nunca usaron métodos contraceptivos, el intervalo entre hijos fue menor en Cerro de Pasco (2.7 +/- 0.15 años) que en Cusco (3.1 +/- 0.29 años) o Lima (3.8 +/- 0.36 años). El porcentaje de mujeres que se embarazaron durante la lactancia aumentó conforme aumentó la altitud de residencia. Los niveles de prolactina sérica fueron significativamente mayores en las lactantes de nivel del mar que en la altura (P menor que 0.01). En conclusión nuestros datos sugieren que en la altura hay más eficiencia reproductiva

Patrones de lactancia y ablactación en el primer semestre de la vida / The patterns of lactation and weaning in infants less than six month

Se informa acerca de los patrones de lactancia y ablactación en niños menores de seis meses. Se interrogó a 145 madres de lactantes que asistieron a consulta ambulatoria de un hospital de niños. Se encontró que 13.7 por ciento de las madres ofrecían exclusivamente pecho materno; el destete ocurrió en el primer mes de vida en 36.3 de los niños, las razones aducidas por la madre fueron hipogaláctea y rechazo del seno; se apreció cierta tendencia a la introducción temprana de fórmulas industrializadas, lo que seguramente influye en lactancia mixta. El uso de fórmulas fue recomendado por el médico en dos de cada tres (65.5 por ciento). Respecto a la ablactación, su inicio fue decidido en el seno familiar en 53.3 por ciento de los niños. En el presente estudio, como en dos anteriores llevados a efecto en el mismo hospital, se hacen evidente la falta de información a las madres sobre las ventajas de la leche materna. Por otro lado, todo parece indicar que los médicos no promueven la alimentación al seno y no intervienen activamente para sugerir cuando iniciar la ablactación