Child factor in measurement dependability.

A primary consideration in longitudinal growth studies is the identification of growth from error components. While previous research has considered matters of measurement accuracy and reproducibility in detail, few reports have investigated the errors of measurement due to aspects of the physiology and cooperation of the child. The present study directly assesses this source of measurement undependability for the first time. Investigation of total measurement error variance in 925 recumbent length replicates taken over stasis intervals in growth identifies that between 60% and 70% of total measurement unreliability is due to a child factor undependability. Individual differences are significant and longitudinal growth analyses should consider two to three times the technical error of measurement statistic as a reasonable estimate of the total unreliability for any single measurement of an infant's recumbent length. These results raise issues regarding analytic methods as applied to serial growth data.

Nutrient composition of human milk.

A complex interplay of maternal homeostatic mechanisms influences nutrient transfer to nursing infants, and with a few exceptions, excess maternal intake or a moderate deficiency in the maternal diet does not appreciably alter nutrient transfer to infants unless it has persisted for some time. Milk vitamins D and K contents, even in apparently well-nourished women, may not always provide adequate amounts for infants. Investigations provide evidence that human milk possesses many unique characteristics and that maternal and environmental influences are stronger than previously recognized and appreciated. A complete body of knowledge does not exist to serve as a basis for dietary recommendations to ensure optimal nutrition for mothers and infants. The success of lactation usually is measured in terms of infant performance, and cost and consequence to the mother are seldom considered. Human milk feeding is recommended for the entire first year of life, but few studies focus on the nursing dyad for more than 3 months' duration. Continued study is needed so that nutritional adequacy may be maintained and appropriate dietary guidance can be provided. When human milk feeding is not practiced, modern and reliable data on human milk constituents and their significance to infants also are essential for the preparation of formulas, especially those not based on bovine milk. The adequacy of human milk substitutes cannot be predicted from compositional analysis because of possible differences in compartmentalization and molecular form of nutrients, and such preparations must be evaluated using specific indices of nutrient use, together with traditional anthropometric measures in infants.

Nutritional guidance is needed during dietary transition in early childhood.

OBJECTIVE: To assess dietary nutritional quality during dietary transition to a modified adult-style diet in the second year of life. DESIGN: A total of 55 children from 12 to 18 months old and their parents were studied. Dietary intake and indices of growth were measured monthly. Dietary data were collected monthly and tabulated using the Minnesota Nutrient Data System. Data were evaluated using repeated-measures analysis of variance, time trend, and correlational analyses. RESULTS: Mean energy intake increased from 12 to 18 months of age (926+/-24 kcal to 1062+/-33 kcal) with contributions from energy-yielding macronutrients remaining relatively constant. Throughout the study, fat intakes were below 30% of energy for 22% to 33% of the sample. Micronutrient intake patterns were diverse with intake for some nutrients (vitamins A, C, B(6), B(12), and D and calcium) remaining above recommended levels despite changes over the course of the study. Folate intakes increased from 79% of the recommended value at 12 months old to approximately 100% at 18 months old. Zinc and vitamin E intakes were well below recommended levels throughout the study, and iron decreased markedly from 96% of the recommended level at 12 months old to 76% at 18 months old. APPLICATIONS/CONCLUSIONS: These data show that intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. Furthermore, because a considerable portion of children studied were consuming low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist. These findings argue strongly for the development of dietary guidance that not only addresses fat restriction, but also assists parents in selecting diets that support optimum growth and development in young children.nutrient intake, infants, dietary density.

Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes.

OBJECTIVE: Current recommendations for infant feeding encourage breast-feeding through the first year. This research was conducted to evaluate associations among breast-feeding, maternal control of child feeding, and the dietary intake of toddlers during the second year of life. In particular, we sought to determine whether breast-feeding through the first year and subsequent toddler intake was mediated via maternal control of child feeding. DESIGN/SUBJECTS: Fifty-five white infants and their mothers were monitored longitudinally from age 12 or 13 months to age 18 months. MAIN OUTCOME MEASURES: Breast-feeding through the first year and maternal control in infant feeding were evaluated as predictors of energy intake at age 18 months. STATISTICAL ANALYSES PERFORMED: Regression analysis was used to evaluate predictors of toddler energy intake at age 18 months. A mediation model tested if the relationship between breast-feeding and infant intake was mediated by maternal control in feeding. RESULTS: Breast-feeding through the first year was associated with higher toddler energy intakes at age 18 months through its influence on maternal control in feeding. Mothers who breast-fed their infants for at least 12 months used lower levels of control in feeding. Lower levels of maternal control in feeding were associated with higher toddler energy intakes. The highest energy intakes among children aged 18 months were observed among taller and leaner toddlers. APPLICATIONS/CONCLUSIONS: Our findings suggest that breast-feeding through the first year may have an effect on children's energy intake by shaping mothers' child-feeding practices. These findings may be used by clinicians to assist parents in making informed decisions about choice of infant-feeding method and to provide anticipatory guidance regarding infant-feeding style when initiating dietary diversity.

Maternal folate status during extended lactation and the effect of supplemental folic acid.

BACKGROUND: Folate requirements during lactation are not well established. OBJECTIVE: We assessed the effects of dietary and supplemental folate intakes during extended lactation. DESIGN: Lactating women (n = 42) were enrolled in a double-blind, randomized, longitudinal supplementation trial and received either 0 or 1 mg folic acid/d. At 3 and 6 mo postpartum, maternal folate status was assessed by measuring erythrocyte, plasma, milk, and dietary folate concentrations; plasma homocysteine; and hematologic indexes. Infant anthropometric measures of growth, milk intake, and folate intake were also assessed. RESULTS: In supplemented women, values at 6 mo for erythrocyte and milk folate concentrations and for plasma homocysteine were not significantly different from those at 3 mo. In supplemented women compared with unsupplemented women at 6 mo, values for erythrocyte folate (840 compared with 667 nmol/L; P < 0.05), hemoglobin (140 compared with 134 g/L; P < 0.02), and hematocrit (0.41 compared with 0.39; P < 0.02) were higher and values for reticulocytes were lower. In unsupplemented women, milk folate declined from 224 to 187 nmol/L (99 to 82 ng/mL), whereas plasma homocysteine increased from 6.7 to 7.4 micromol/L. Dietary folate intake was not significantly different between groups (380+/-19 microg/d) and at 6 mo was correlated with plasma homocysteine in unsupplemented women (r = -0.53, P < 0.01) and with plasma folate in supplemented women (r = 0.49, P < 0.02). CONCLUSIONS: A dietary folate intake of approximately 380 microg/d may not be sufficient to prevent mobilization of maternal folate stores during lactation.

Human milk: nutritional aspects of a dynamic food.

The composition and volume of human milk progressively changes with the onset and duration of lactation and can be influenced by maternal nutritional factors. Current evidence indicates that infant demand is the major determinant of the quantity of milk transferred to the nursing infant. Human milk is remarkable for its variability, and ranges of intakes of milk constituents are comparable with normal patterns of infant growth and development. Lipids are by far the most variable constituents in human milk with both long-term maternal nutrition states and daily intake capable of exerting an influence. Maternal vitamin intake bears a strong relationship to milk content, and appropriate intakes of vitamins D and K may not always be furnished to nursing infants. Major and trace minerals in human milk are not greatly affected by maternal diet, with selenium and iodine being notable exceptions. Compartmentalization and molecular forms of the trace elements in human milk are associated with high infant bioavailability. The success of lactation should be measured using maternal and infant indices of nutritional adequacy.

Self-selected diets of lactating women often fail to meet dietary recommendations.

OBJECTIVE: To assess longitudinally nutrient intakes of lactating women during the postpartum period. DESIGN: Dietary data from lactating women were collected by means of 2-day food records at 3 and 6 months postpartum. Intake of energy and selected nutrients was tabulated and compared with dietary standards. SUBJECTS: The 52 lactating women enrolled in the study lived in a university community, were apparently healthy, had a body mass index within normal range, were successfully nursing a term infant, and planned to nurse for at least 6 months. STATISTICAL ANALYSES PERFORMED: Paired t tests and Stuart-Maxwell chi(2) analyses. RESULTS: Mean energy intakes were below the Recommended Dietary Allowance. Mean intakes of most nutrients met or exceeded recommended standards except for zinc and vitamins D and E at both 3 and 6 months postpartum. Calcium and folate intakes were also below standards at 6 months. Although mean iron intake exceeded the standard at both measurement times, there was a significant decline from 3 to 6 months. Relative frequencies of mothers meeting various percentages of standards differed significantly from 3 to 6 months for calcium; iron; folate; and vitamins E, D, and B-6. At 6 months, significant increases were noted in the number of women reporting calcium, folate, and vitamin B-6 intakes at less than one half of the recommended amounts. APPLICATIONS/CONCLUSIONS: Guidance for lactating women should stress food sources of nutrients likely to be limited in their diets: calcium; zinc; folate; and vitamins E, D, and B-6.

Maternal folate status and lactation.

Folate plays an essential role in DNA, RNA, and protein biosynthesis. For this reason, the physiological need for this vitamin is increased during periods of rapid anabolic activity such as pregnancy and lactation. Although the importance of folate and the consequences of suboptimal folate status during pregnancy, especially during the periconceptional period, are well appreciated, little is known about the value of folate during lactation. The limited number of studies available on folate intake during lactation suggest that many women do not consume an adequate amount of folate and that recommended target intakes may be too low. Although inadequate maternal folate intake does not affect milk folate concentration unless maternal deficiency is severe, potential consequences of suboptimal folate nutrition to both the mother and her future offspring should also be considered.

Do milk-borne cytokines and hormones influence neonatal immune cell function?

Cytokines, growth factors and various hormones collectively control the proliferation, survival, differentiation and function of immune cells. A wide array of these compounds is present in maternal milk and ingested by neonates during a period of rapid maturation of gut-associated and peripheral lymphoid tissues. The functional consequences of most milk immunomodulatory constituents in neonates are unknown. However, there is evidence that milk prolactin acts as a developmental regulator of the neonatal immune system, supporting the premise that milk constituents with immunomodulatory activity may serve as neonatal immunodevelopment agents.

Regulation of milk lipid secretion and composition.

Triacylglycerols make up 98% of the lipid content of milk, ranging in different species from 0 to 50% of the total milk volume. The fatty aid composition of the triacylglycerols depends on the species, the dietary fatty acid composition, and the carbohydrate-to-lipid ratio of the diet. The rate of lipid synthesis in the lactating mammary gland depends on the stage of mammary development and is decreased by fasting and starvation in ruminants and rodents but not in species that fast during lactation, such as seals and hibernating bears. Regulatory agents include insulin, prolactin, and non-esterified fatty acids. Dietary trans fatty acids may depress milk lipid synthesis under certain conditions. Evidence is presented that fatty acids may play a major regulatory role in acute changes in de novo mammary fatty acid synthesis, acting primarily on the activity of acetyl coenzyme A carboxylase.

Milk-borne prolactin and neonatal development.

Milk is primarily regarded as a food furnishing essential nutrients for infant growth and development, but milk can also serve as a vehicle for mother to neonate transfer of molecules that regulate development. A wide array of biologically active compounds such as hormones, cytokines and enzymes are present in milk, especially early milk. The premise that prolactin (PRL) in milk is an important and possibly essential developmental factor for the newborn is explored. Both PRL and structurally modified isoforms are abundant in early milk and gradually diminish with the progression of lactation. Milk PRL is absorbed and biologically active in the neonate. Assays of PRL variants, experimental paradigms to test them as developmental regulators and the body of evidence supporting the hypothesis that milk PRL regulates differentiation and maturation of neonatal neuroendocrine, reproductive, and immune systems is presented.

Bioactive and immunoreactive prolactin variants in human milk.

Human milk from mothers of term (T) and preterm (PT) infants was collected during early (days 2-7), mature (2-16 weeks), or late (> 16 weeks) lactation. PRL-like bioactivity (B) was measured by Nb2 cell proliferation, and PRL immunoreactivity (I) was determined by RIA. PRL activity is reported in PRL equivalents (1 PRL equivalent = 1 ng NIDDK reference material). Milk from early lactation contained significantly greater PRL-like B compared to I (T:B, 132.5 +/- 13.0; I, 83.43 +/- 12; PT:B, 195.8 +/- 56; I, 74.45 +/- 13.7). PRL-like B and I declined as lactation progressed (T mature: B, 41.74 +/- 8.9; I, 27.19 +/- 5.5; T late: B, 17.84 +/- 5.5; I, 27.33 +/- 1.8; PT mature: B, 59.85 +/- 16; I, 45.16 +/- 4.3). Milk PRL B to I ratios were consistently greater than serum B to I ratios during early lactation (milk: T, 1.4 +/- 0.3; PT, 3.6 +/- 1.3; serum: T, 1.0 +/- 0.2; PT, 0.58 +/- 0.12). During early lactation, high PRL-like B was widely distributed among several (n = 4-6) bioactive forms differing in molecular mass [8 to > 66 kilodaltons (kDa)] in T milk, but the majority of B in PT milk was detected in two or three forms. During mature and late lactation, lower PRL-like B was associated with two or three peaks (20 to > 66 kDa). A large fraction of PRL-like B (67%-84%) was associated with the phosphorylated (P-) fraction of human milk. Four immunoreactive forms (24, 30, 32, and 40 kDa) of P-PRL were identified by immunoblot analyses. Alkaline phosphatase treatment converted the 40-kDa immunoreactive P-PRL to 24-kDa PRL, increased the B of the P-fraction by 2-fold, but did not change total PRL I detected. PRL in the Concanavalin-A-retained fraction accounted for 59-69% of PRL in milk based on RIA results. No PRL-like B was detected in the Concanavalin-A-retained fraction of human milk; however, treatment of the glycosylated fraction of milk with peptide-N-glycosidase F increased thymidine incorporation by Nb2 cells 1.67-fold compared to that in controls. The results of this study show that human milk contains considerably greater PRL-like activity than previous reports based on RIA detection. The appearance and regulation of multiple bioactive PRL variants in milk throughout the course of lactation may serve as a mechanism by which milk PRL influences neonatal development.

Classical selenium-dependent glutathione peroxidase expression is decreased secondary to iron deficiency in rats.

While there are reports that classical selenium-dependent glutathione peroxidase (Se-GPX1) activity is decreased during iron deficiency, the relationship between tissue iron status and Se-GPX1 activity remains speculative. This study was undertaken to investigate the mechanism for the decrease in Se-GPX1 activity during iron deficiency. Male weanling Sprague-Dawley rats were given free access to either an iron-deficient or an iron-adequate diet for eight weeks, after which blood, livers, kidneys, hearts, brains and testes were surgically excised. During iron deficiency, Se-GPX1 mRNA levels in liver tissue were decreased by approximately 55%. Similarly, the concentration of immunoreactive Se-GPX1 protein and total selenium-dependent glutathione peroxidase (Se-GPX) activity were decreased by 55% and 60%, respectively. In kidney, heart and brain total Se-GPX activities were depressed as much as 33%. Selenium concentration in liver was reduced by 42%, whereas the decrease in Se concentrations in kidney, heart, and brain ranged from 17 to 25%. Concentrations of plasma Se also were reduced by 18%, but testes showed little change in either Se-GPX activity or Se concentration during iron deficiency. Results suggest that the synthesis of Se-GPX1 protein is decreased during iron deficiency possibly due to pretranslational regulation.

Hormones and growth factors in milk.

Research dealing with hormones/growth factors in milk has progressed rapidly during the last 10 yr from their identification in milk to their regulation of various functions in the maternal organism and in the neonate. Many hormones, growth factors, and bioactive substances present in the maternal organism are present in colostrum and milk, often exceeding concentrations that occur in maternal plasma. Some appear in milk in different, sometimes multiple, forms from that found in maternal serum, reflecting to some extent synthesis and posttranslational processing by mammary tissue. Recent research has indicated that many milk hormones/growth factors survive the environment of the gut of the neonate, become absorbed into the neonatal circulation, and exert important functions in the neonate.

Prolactin variants in term and preterm human milk: altered structural characteristics, biological activity and immunoreactivity.

This study was undertaken to determine if PRL variants differing in structural characteristics as well as biological activity and immunoreactivity are present in human milk and to assess whether the physiological state of the mammary gland (premature initiation of lactation, progression of lactation) influences the forms or activity of human milk-borne PRL. Human milk samples were collected in early (day 1-5) or mature lactation (1-4 months) from women delivering term (T) or preterm (PT) infants. Milk was fractionated on Sephadex G-100, Concanavalin A-Sepharose, or Phosphogel to estimate molecular weight (MW), degree of glycosylated PRL(G), and degree of phosphorylated (P) PRL, respectively. Prolactin-like bioactivity (B) was measured by the PRL-dependent proliferation of the Nb-2 lymphoma cell and PRL-like immunoreactivity (I) by radioimmunoassay (RIA) using NIDDK reagents. Milk obtained from mothers of T infants contained significantly greater B than I-PRL at each stage of lactation (early: B = 132 +/- 13.9 P.E./ml, I = 83.43 +/- 12 P.E./ml, mature: B = 41.74 +/- 8.9 P.E./ml, I = 27.19 +/- 5.5 P.E./ml; P < 0.01-0.001). PRL-like bioactivity was greatest in early milk produced by mothers of T infants and declined as lactation progressed. No differences in B or I-PRL were evident for milk collected from mothers of preterm infants at any stage of lactation. In early lactation the PRL-like bioactivity of milk collected from mothers of T infants was significantly greater than in unfractionated milk collected from mothers of PT infants (P < 0.05). The number of PRL variants present in milk was characteristic of the stage of lactation and gestation (T early > PT early; T early > T mature). Early milk from mothers of T infants contained an average of 5 bioactive PRL variants, early milk from mothers of PT infants an average of 4 bioactive variants, and mature milk from mothers of T infants an average of 3 bioactive variants. The distribution of molecular weights associated with PRL variants in milk infranatant was variable among subjects within a specific stage of lactation/gestation. However, the representative range of molecular weights of PRL variants identified in milk sample was similar between groups (T early: < 8, 16, 20, 24, 25-28, 32, 42, > 66; PT early: 16, 20, 23, 25-28, 32, > 66; T mature: 20, 25-28, 32, 35, > 66).(ABSTRACT TRUNCATED AT 400 WORDS)

Selenium status of infants is influenced by supplementation of formula or maternal diets.

Plasma selenium of infants fed proprietary formula was significantly less than that in infants fed human milk. Addition of selenite to the formula (0.253 mumol Se/L) increased plasma selenium and activities of glutathione peroxidase (GPx) and total peroxidase (Px). However, erythrocyte selenium decreased significantly during the 12-wk study in infants receiving human milk or formula with or without supplemental selenite. Infants fed human milk from women receiving 0 or 200 micrograms supplemental selenium as selenomethionine or selenium-enriched yeast had plasma selenium that paralleled changes in their selenium intake. Plasma GPx and Px activities were unrelated to human milk selenium intake. Milk from women given either selenium supplement prevented the decline in infant erythrocyte selenium. Results of these studies suggest that the method of feeding modifies the infant's apparent selenium status and that the molecular form of selenium provided and/or its interaction with other milk constituents are determinants of infant selenium status.

Selenium status of lactating women is affected by the form of selenium consumed.

The impact of providing selenomethionine (2.7 mumol Se) or selenium-enriched yeast (2.9 mumol Se) on the selenium status of lactating and nonlactating women with customary intakes of approximately 1.3 mumol Se/d was studied. Plasma selenium declined in unsupplemented lactating women but not in nonlactating women. Selenomethionine increased plasma selenium in both lactating and nonlactating women whereas selenium-enriched yeast increased plasma selenium only in nonlactating women. Erythrocyte selenium concentration was not significantly modified by lactation. Plasma glutathione peroxidase (GPx) activity decreased with duration of lactation in unsupplemented women and selenomethionine or selenium-enriched yeast supplementation prevented the decline. Milk selenium declined markedly for 20 wk after parturition in unsupplemented women. Selenomethionine significantly increased milk selenium concentrations whereas selenium-enriched yeast prevented a decline. These results clearly show that the source of selenium provided to lactating women can significantly influence selected indexes of selenium status, including milk selenium concentration.