Breast Milk Iodine and Iodine Status of Breast-Fed Infants.

Background: Breast milk is the only source of iodine for exclusively breast-fed infants. Iodine status of breast-fed infants depends on iodine in breast milk and also number of feeding in 24 hours. Iodine deficiency and iodine excess both have bad impact on infant’s health. Objective: To measure the iodine in breast milk and to evaluate iodine status of their breast-fed infants. Materials and method: This observational analytical study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka with active cooperation of Kumudini Women’s Medical College Hospital, Mirzapur, Tangail involving fifty lactating mothers and their exclusively breast-fed infants. Early morning urine and breast milk samples were collected in dry and clean plastic container free from any chemical contamination. Urinary iodine was used as indicator for assessing iodine status. All statistical analyses were done by using SPSS (statistical programme for social science) 12 version software package for Windows. Results: The median (range) urinary iodine concentration of lactating mothers and their breast-fed infants were 225.25 μg/L (61.50-530.00) and 225.75 μg/L (100.50-526.00) respectively. The median (range) breast-milk iodine concentration was 157 μg/L (54.50-431.50) which was more than three times of recommended minimum concentration (50 μg/L). Only 2 (4%) lactating mothers had mild biochemical iodine deficiency (UIE, 50-99 μg/L). There was no biochemical iodine deficiency of breast-fed infants. Iodine in breast milk of lactating mothers was positively correlated with their urinary iodine excretion (p<0.01). Infant’s urinary iodine was positively correlated with iodine concentration in breast milk (p<0.01) and with urinary iodine of lactating mothers (p<0.01). Conclusion: Lactating mothers and their breast-fed infants in this study were iodine sufficient. If iodine content of breast-milk is within normal range, 10-12 numbers of feeding in 24 hours for infants is enough to get sufficient iodine from their mother’s milk.

The Characteristics and Diagnostic Methods of Food Protein Induced Proctocolitis / 대한소아소화기영양학회지

Food protein induced proctocolitis (FPIPC) is a non-IgE mediated food allergy. FPIPC occurs exclusively among breast-fed infants within the first months of life. FPIPC is often diagnosed clinically in normal-conditioned infants with rectal bleeding. But FPIPC among infancy with rectal bleeding is less general than conceived. The endoscopic findings reveal an edematous and erythematous mucosa with superficial erosions or ulcerations, bleeding and lymphoid nodular hyperplasia. The prominent eosinophilic infiltrates in the rectosigmoid mucosa are important for the histopathologic diagnosis of FPIPC. However, in explaining eosinophilic infiltration within the lamina propria of the mucosa, it is necessary to differentiate whether it is a part of normal findings or occurs due to inflammatory reactions. Oral food challenge and elimination test is performed to identify the same clinical reaction as the symptom of FPIPC by the administration of a specific type of food to infants. The most common causal food is cow's milk. Thus oral food challenge and elimination test can be the effective way of confirming FPIPC, reducing the possibility of misdiagnosis. The purpose of this report is to identify the characteristics of FPIPC, to introduce its diagnostic methods, and to suggest the future direction of research.

Clinical Features and the Natural History of Dietary Protein Induced Proctocolitis: a Study on the Elimination of Offending Foods from the Maternal Diet / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to identify the clinical features and natural history of dietary protein induced proctocolitis (DPIPC) and to detect the causative foods of DPIPC, and to evaluate the effect of elimination of the foods on the course of the disease. METHODS: Between March 2003 and July 2004, data from 30 consecutive patients with DPIPC who were followed for over 6 months, was reviewed. The diagnostic criterion used for DPIPC was an increase in the number of eosinophils in the lamina propria (> or =60 per 10 high-power fields). In breast feeding mothers, 5 highly allergenic foods were eliminated from the maternal diet for 7 days, namely, allergenic food groups such as dairy products, eggs, nuts and soybean, fish and shellfish, and wheat and buckwheat. We observed the disappearance or appearance of hematochezia after elimination or challenge with the offending foods. RESULTS: Before diagnosis infants were breast-fed (93.3%) or formula-fed (6.7%). Mean age at symptom onset was 11.5+/-5.1 (5~24) weeks, and mean age at diagnosis was 17.8+/-9.5 (8~56) weeks. Duration from symptom onset to diagnosis was 6.3+/-6.7 (0~36) weeks. Mean peripheral blood eosinophil count was 478+/-320 (40~1,790)/mm3 and eosinophilia (>250/mm3) was observedin 90.0% of patients. None of patients were found to have an increased serum IgE level. Of 15 patients that received sigmoidoscopy, nodular hyperplasia with erosion was observed in 93.3%. Of 27 patients whose mother ate the diet eliminated the 5 food groups, hematochezia diappeared in 74.1% of patients. Offending foods were identified as dairy products (37.5%), wheat and buckwheat (27.5%), fish and shellfish (20.0%), nuts and soybean (7.5%) and eggs (7.5%). A free maternal diet without patient's clinical symptoms was achieved at 29.4+/-8.7 (9~44) weeks of patient's age, and a free baby diet without blood in stools was achieved at 37.5+/-9.7 (12~56) weeks of age. CONCLUSION: DPIPC commonly occurs in exclusively breast-fed babies. Elimination of the above-mentioned 5 hyper-allergenic food groups from the maternal diet for 7days enables the detection of the offending foods. DPIPC is a transient disorder and 96.0% of patients can tolerate the offending foods at 12 months of age.

Protein, Ca, Mg and P Intakes of Breast-fed Infants during Lactation

This study was longitudinally conducted to evaluate the intakes of protein, Ca, Mg and P of exclusively breast-fed infants compared with the Recommended Dietary Allowances (RDA) for Korean infants. Twenty Korean lactating women and their infants during the first 3 months of lactation in Incheon area were participated. Protein, Ca and Mg, and P contents in the milk were determined using semimicro Kjeldahl (N X 6.38) , atomic absorption spectrophotometer and colorimeter, respectively, and also the milk consumption of the infants was measured by the test-weighing method. Protein contents of the milk were 1.96, 1.63, 1.51, 1.25 and 1.16 g/100 ml, and protein intakes of the breast-fed infants were 9.00, 9.85, 9.17, 8.97 and 7.76 g/day at 7, 15, 30, 60 and 90 days postpartum. The average protein intake per body weight of the breast-fed infants was 1.84 g/kg/day. The average intakes of Ca, Mg, P were 172.1 mg/day, 15.2 mg/day and 91.4 mg/day, respectively, and the average Ca/P ratio was 1.91. There was positive correlation between protein and Ca, protein and p, and Ca and P contents while negative correlation between Mg and P, The body weight of breast-fed infants increased normally from 3.6+/-0.41 g at birth to three month during lactation. It is suggested that the breast-fed infants in Incheon area consume almost adequately protein, Ca and P from the milk compared with RDA for Korean infants.

Vitamin A Intake of Exclusively Breast-Fed Infants in Cheongju and Anseong areas

This study was longitudinally conducted to evaluate vitamin A intake of exclusively breast-fed infants compared with the Recommended Dietary Allowances (RDA) for Korean infants. Twenty-seven Korean lactating women and their infants during the first 6 months of lactation in Cheongju and Anseong areas were participated. Retinol and beta-carotene contents in the milk were determined using HPLC and also the milk consumption of the infants was measured by the test-weighing methods. Vitamin A (retinol and beta-carotene) contents of the milk were 65.7, 57.2, 48.1, 43.9, 38.2, 38.7 and 44.0 R.E./100 ml, and vitamin A intakes of the breast-fed infants were 361, 402, 348, 331, 304, 305 and 322 R.E./day at 0.5, 1, 2, 3, 4, 5 and 6 month of lactation, respectively. The average intake of vitamin A was 339.1 R.E./day and the percentage to RDA was 96.9% during 6 months. Vitamin A intakes per body weight of the breast-fed infants were 96.7, 88.3, 62.1, 50.0, 41.8, 39.3 and 39.6 R.E./kg/day at 0.5, 1, 2, 3, 4, 5 and 6 month. The body weight increased normally from 3.4 +/- 0.5 kg at birth during lactation. It is suggested that the breast-fed infants in Cheongju and Anseong areas consumed adequately vitamin A from the milk compared with RDA for Korean infants.

Concentrations of Major Minerals and Trace Elements in Sera of The Breast-fed and Formula-fed Infants / 대한지역사회영양학회지

The serum concentrations of the major minerals(calcium, phosphorus, magnesium, sodium, potassium) and trace elements(iron, Zinc, copper manganese)were datermined in 23 breast fed infants living in Eumsung, Choong-buk region. The results obtained are summarized as follows: 1)The mean levels of calcium, phosphorus, magnesium, sodium and potassium of the serum of total subjects were 8.15+/-0.33mg/dI, 11.06+/-0.16mg/dI, 2.00+/-0.14mg/dI, 3.4476+/-17.99mg/dI and 9.06+/-2.04mg/dI respectively. 2)The serum concentrations of iron, zinc, copper and manganese in total subjects averaged 95.83+/-0.33mg/dI, 93.79+/-7.06 microgram/dI and 98.57+/-7.06 microgram/dI and 4.93+/-0.62 microgram/dI respecitively. 3)Breast fed infants had significantly higher serum calcim, magnesium, sodium and iron concentrations than the formula fed groups. Otherwise, serum potassium, copper and manganese levels in breast milk fed infants were significantly lower than those in formula fed infants. 4) In formula fed infants, serum potassium and copper levels increased increased significantly with months after birth.