Mothers and Breast fed Babies

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In rural Nepal, an impressive study conducted by researchers from the Johns Hopkins School of Hygiene and Public Health on 45,000 married women, showed that retinol palmitate (7,000 mg RE/week) or beta-carotene (42 mg/week) supplementation during childbearing years in the women can lower mortality related to pregnancy (up to 12 weeks post-partum) by an astonishing 44 per cent. This survival effect of either supplementation was evident after 1 year on the trial as reflected by a reduced relative risk of 0.54 (p<0.02).

In Tanzania, Lietz and associates from the University of Dundee and Oxford Brookes University, recruited 99 rural women during their third trimester of pregnancy and randomly allocated them to receive red palm oil or RPO (12g daily), sunflower oil (12g daily), or a control group. All 3 groups received dietary advice to promote the intake of green-leafy vegetables.

At 3 months post-partum, women on the RPO had significantly higher concentrations of beta-carotene and alpha-carotene concentrations in plasma and breast milk compared to either the sunflower oil group or control group. Surprisingly, however, the concentrations of retinol in plasma and breast milk in the RPO group did not increase. The investigators attributed this perhaps to the slow response of breast milk retinol concentrations to beta-carotene supplementation and the relatively short period of 6 months in the present study.

Another beneficial effect observed was that RPO and sunflower oil supplementations both retarded the decline in breast-milk retinol concentrations during the progression of lactation. Good news for breastfed infants!

Interestingly, the group given sunflower oil had increased concentrations of alpha-tocopherol in plasma and breast milk compared to control. Since sunflower oil contains no carotenoids, it is inferred that the alpha-tocopherol in the oil had a positive influence on breast milk retinol concentrations during the progression of lactation.

The lesson learnt here is that the consumption of an oil rich in the provitamin A carotenoids or alpha-tocopherol promotes retinol levels in breast milk - an important point for mothers who breastfeed.

Subclinical vitamin A deficiency (VAD) has been observed in breast-fed infants, suggesting that lactating women in malnourished populations may have insufficient vitamin A stores. If material vitamin A status is poor, the health of the mother is not only compromised, but their breast-fed infants are likely to be sub-clinically vitamin A-deficient by 6 months of age.

In Honduras, Canfield and Kaminsky recruited lactating mothers and their nursing infants (Aged 1-24 months) from the marginal barrios of Tegucigalpa. The beta-carotene supplements were provided as capsules, beadlets or RPO incorporated into a breakfast meal. The total dose of beta-carotene administered for the different treatments was 90 mg. In the case of RPO, 15 mg beta-carotene equivalent was given 6 times over 10 days.

The results of the study were interesting on two counts. Firstly, the serum and breast milk concentrations of beta-carotene increased dramatically, irrespective of the source of the carotenoid. For mothers who consumed beta-carotene as RPO, the concentrations of beta-carotene and alpha -carotene in serum and breast milk increased some 2- to 3-folds.

Secondly, the vitamin A status of the breast-fed infants were also improved as reflected by increases in their serum retinol concentrations of up to 16 per cent!

The above findings provide another strong argument for the use of RPO in food-based strategies to improve the vitamin A status of women of child bearing age and their infants, particularly in impoverished regions where vitamin A deficiency is still a significant public health problem.

In India, Bhaskaram and co-workers from the National Institute of Nutrition at Hyderabad punched a hole in the general belief that vitamin A supplementation of lactating mothers can help improve the retinol content of their breast-milk and thus prevent sub-clinical vitamin A deficiency in their breast-fed infants.

In their double blind placebo-controlled prospective study, 102 women who had full-term normal deliveries were randomly allocated to receive either a single 2-ml oral dose of 200,000 IU retinyl palmitate or 2 ml of groundnut oil (placebo). Breast milk samples, cord blood at birth and venous blood samples of infants (at 3 weeks, 3 months and 6 months of age) were collected and analysed for retinol and retinol binding protein (RBP).

The above investigators reported that vitamin A-supplemented mothers had significantly higher retinol content in breastmilk during the first 30 days of lactation (good news). However, the vitamin A status of their exclusively breastfed infants did not improve compared with the controls ("bad" news!). These results are of course not consistent with the findings of the Honduras study cited above.

Source : Nutrition Briefs Volume 2/December 2000, Published by Malaysian Palm Oil Promotion Council, Kuala Lumpur, Malaysia.

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