NUTRITION DURING LACTATION

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In-Hospital Breastfeeding Rates (US, 2001)

90 80 70 60 50 40 30 20 10 0

Healthy People 2010 Goal

40.7 23.2 Mixed Exclusive 42.2 46.3

Percent

California

National

Breastfeeding Rates at 6 mo (2001)

Exclusive 100 90 80 70 60 50 40 30 20 10 0 Mixed

Healthy People 2010 Goal

Percent

20.1 24.1 Pacific Region

15.3 17.2 National

Breastfeeding : A Learned Behavior

Physiological process virtually all mothers are capable of doing Is a learned behavior not all mother decide to do Mothers partner also plays an important role

Advantages

Nutritionally superior to any alternatives Bacteriologically safe & always fresh Contains various antiinfectious factors & immune cells The least allergenic to any infant food

Breast-fed babies are less likely to be overfed Promotes good jaw & tooth development Cost less Promotes close mother-child contact More convenient once the process is established

American Academy of Pediatrics (AAP) & American Dietetic Association (ADA)

Exclusive breastfeeding for 6 months, and breastfeeding with complementary foods for at least 12 months as an optimal feeding pattern for infants

American Academy of Pediatrics (AAP)

Females infected with the human immunodeficiency virus (HIV) should be counseled not to beast-feed Females who are at risk for being infected with the virus should be educated about the risk of infecting their infant with HIV through breast milk

The Baby Friendly Hospital Initiative

Global effort to the incidence & duration of breast-feeding To become baby friendly, a hospital must agree to implement the Ten steps to Successful Breast-feeding

Ten steps to successful breast-feeding

Have a written breast-feeding policy that is routinely communicated to all health care staff Train all health care staff in the skills necessary to implement this policy Inform all pregnant females about the benefits and management of breast-feeding

Help the mother initiate breast-feeding within a half hour of birth Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infant Give new born infants no food or drink other than breast milk unless medically indicated

Practice rooming-in Encourage breast-feeding on demand Give no artificial teats or pacifiers Foster the establishment of breast feeding support groups, and refer mothers to them on discharge from the hospital or clinic

Nutritional requirements

Lactation is nutritionally demanding Increased intake of most nutrient is advised Milk production is most affected by the frequency of suckling Milk composition varies according to mothers diet, but in general the effect is to reduce quantity, not quality

Energy

Production 100 ml of milk need 85 kcal expenditure 1st 6 mo of lactation 750 ml/day (550 1200 ml/day) RDA : + 330 kcal (1st 6 mo) + 400 kcal (2nd 6 mo)

2nd 6 mo - production 600 ml/day E req - consuming solid food Energy intake at least 1800 kcal/day Inadeq maternal fluid intake affects milk volume

After birth women are in a hurry to lose weight In general lose - 1 kg / mo during the 1st 4 6 mo of lactation Exercise >> lactic acid of breast milk influence milk taste

Breastfeeding and maternal weight loss (Dewey et al. Am J Clin Nutr 1993;58:162-6)

Fat

20 35% of total calories Presence of long-chain PUFA crucial for fetal & infant retina & brain development AI n-6 PUFA : 13g/day AI n-3 PUFA : 1.3 g/day

Human Milk Composition

Influences of maternal diet
a. CHO, protein & minerals not influenced by maternal diet b. Fat and vitamins influenced by maternal diet

Human Milk Composition Influences of maternal nutritional status

- milk composition remains relatively constant unless malnutrition is severe - the volume of milk produced may with malnutrition

Water
Drink a glass of milk, juice or water at each meal and each time the infant nurses

Nutrient supplements

Most women can obtain all the nutrients from a well balanced diet Some may need iron to refill their depleted iron stores

Particular foods

Foods with strong or spicy flavors (e.g. garlic) may alter the flavor of breast milk Infants who develop symptoms of food allergy more comfortable if the mothers diet exclude the most common offenders (cows milk, eggs, peanuts)

Increased Requirements

Practices incompatible with lactation

Alcohol - easily enters breast milk Smoking - transfer nicotine Medicinal drugs Environmental contaminants Caffeine

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Comparison of Human Milk to Cows Milk and Soy Formulas

Nutrient/Sourc e Energy Human Milk 20 kcal/oz 1.1 g/dL lactalbumin 60: 40 3.6 g/dL Human fat (AA & DHA)* 7.2 g/dL Lactose Cows Milk Formula 20 kcal/oz 1.5 g/dL nonfat milk + whey 60:40 + whey 18:82 - whey 3.6-3.8 g/dL butterfat, coconut, soybean, palm oils Soy Formula 20 kcal/oz 1.8-2.1 g/dL soy pro isolate + met, taurine 0 3.6-3.8 g/dL butterfat, coconut, soybean, palm oils

Protein/Source

Whey:Casein

Total Fat/Source

Carbohydrate/ Source

6.7-6.9 g/dL 7.0-7.2 g/dL Sucrose, corn *Unique to human milk Lactose syrup solids