Impact of breast pumping on lactogenesis stage II after cesarean delivery: a randomized clinical trial.

OBJECTIVE: Women at risk for delayed onset of lactation are often advised to pump their breasts before lactogenesis stage II to hasten the timing of this process. The effectiveness of this clinical practice has not been previously evaluated. This study investigates the effects of breast pumping before the onset of lactation on early milk transfer and subsequent breastfeeding duration among women giving birth by cesarean delivery. METHODOLOGY: Sixty women were randomly assigned to either the pumping group (n = 30), which used a double electric breast pump for six 10- to 15-minute sessions from 24 to 72 hours postpartum, or to the control group (n = 30), which held the pump to their breasts without suction for the same amount of time. Milk transfer was assessed by test weighing infants before and after 3 breastfeeding sessions daily. Test weight data were fitted to a second-order polynomial curve, to predict milk transfer over time. RESULTS: Breast pumping between 24 and 72 hours after cesarean delivery did not improve milk transfer. Participants in the pumping group tended to have lower milk transfer than did controls. Primiparae in the pumping group breastfed for ~5 months less than their counterparts in the control group; however, this difference was not statistically significant. CONCLUSIONS: Breast pumping did not improve milk transfer during the first 72 hours postpartum and may negatively affect breastfeeding duration among primiparous women. lactation, lactogenesis, breast milk, breast pumping, milk expression, breastfeeding, cesarean delivery.

Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, Connecticut.

The goal of the present study was to examine the association of the Food Stamp Program with the food security and dietary intake of low-income children from Hartford, CT, who were enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC). We compared the food and nutrition situation of low-income preschoolers who received food stamps (FS, n = 59) with that of those who did not receive food stamps (NFS, n = 40). Children were an average age of 2.7 +/- 0.6 y, and 95% were receiving WIC benefits at the time of the study. Groups were comparable in demographic characteristics, but the socioeconomic status of the FS group was lower than that of the NFS group (P < 0.05). Food security was assessed with the Radimer/Cornell hunger scale, and dietary intake was assessed with a single 24-h recall and a 14-item food frequency questionnaire. Multivariate analyses within the FS group indicated that a monthly duration of food stamps of <4 wk was a predictor of household food security (odds ratio 0.10, 95% confidence interval 0.02-0.56). Food stamp use was associated with above-median energy-adjusted intakes of vitamin B-6 (3.13, 1.16-8.45), folate (2.92, 1.09-7.81) and iron (3.72, 1.31-10.54). The NFS children were more likely to consume <8 mg iron/d (3.73, 1.09-12.80). These results suggest that the Food Stamp Program is associated with food security and preschoolers' micronutrient intake.

Biobehavioral factors are associated with obesity in Puerto Rican children.

The purpose of this case-control study was to identify predictors of obesity among Puerto Rican children from Hartford, CT. The study included 53 prepubertal children, 31 girls and 22 boys, between 7 and 10 y of age. Children were classified as obese [n = 29, body mass index (BMI) >/= 85th percentile] or controls (n = 24, BMI < 85th percentile). Multivariate logistic regression analyses indicated that frequency of fruit juice consumption [odds ratio (OR), 95% confidence interval (CI); 4.02, 1.48-10.95], hours of daily TV viewing (1.86, 1.02-3.42), maternal BMI (1.39, 1.10-1.77) and lower dairy product intake (0.41, 0.19-0.93) were associated with obesity. Television viewing was correlated (P < 0.05) with lower physical activity in girls, and with higher snacking frequency and sweets consumption in boys. Obese children were more likely than controls to have higher systolic and diastolic blood pressures and to have experienced more ear infections and diarrhea during the previous year. Results provide evidence of the multifactorial nature of childhood obesity in this community.

Measurement of sensitivity to olfactory flavor: application in a study of aging and dentures.

Olfaction involves a dual sensory process for perceiving odors orthonasally (through the nostrils) and retronasally (through the mouth). This investigation entailed developing a measure of sensitivity to an odor delivered in an orally sampled food (orange flavoring in a sucrose-sweetened gelatin) and examining sensitivity in the elderly. In experiment 1, olfactory flavor sensitivity was 49 times lower in elderly (n = 21) than in young (n = 28) subjects. In experiment 2, with 73 elderly women, higher olfactory flavor sensitivity correlated significantly with higher orthonasal perception (Connecticut Chemosensory Clinical Research Center test). Some women, however, exhibited low olfactory flavor sensitivity despite high orthonasal perception; none had high olfactory flavor sensitivity and low orthonasal perception. Those who wore complete or palatal covering dentures had lower olfactory flavor sensitivity than those who were dentate or wore dentures that did not cover the palate. Through multiple regression analysis, orthonasal perception and denture status were found to be independent contributors to predicting olfactory flavor sensitivity. In summary, elderly subjects showed depressed olfactory flavor sensitivity (i.e. retronasal sensitivity) that related to poor orthonasal olfactory perception and denture characteristic. Thus, while good orthonasal olfaction may be necessary for good olfactory flavor sensitivity, it is not sufficient. Other factors, some associated with oral conditions, may impede release and retronasal transport of odors from the mouth to the olfactory receptors.

Phase II study of CI-958 in colorectal cancer.

PURPOSE: We completed a phase II trial of CI-958 (NSC 635371) in patients with advanced colorectal cancer given at a dose of 700 mg/m2 every 21 days. METHODS: All 15 patients had metastatic disease and had been previously treated with one 5-fluorouracil-based regimen in an adjuvant (six) or metastatic (nine) setting. RESULTS: None of the patients treated with CI-958 had an objective response to treatment. Median survival was 4.8 months after the start of treatment. Leukopenia was the major toxicity, but no patient experienced febrile neutropenia. An acute febrile reaction was seen after infusion in four of the first nine patients treated. This was abrogated by pretreatment with dexamethasone in the remaining patients. CONCLUSIONS: CI-958 was not effective at this dose and schedule in patients with previously treated advanced colorectal cancer.

Energy intake and glycemia in lactating women with type 1 diabetes.

OBJECTIVE: To describe glycemia and insulin administration in lactating women with type 1 diabetes and compare their energy intake, lactation onset, and postpartum weight to lactating women without diabetes. DESIGN: A prospective observational study conducted at 2, 3, 6, 14, 42, and 84 days postpartum. Insulin dosage and glucose levels after fasting and at 80 and 110 minutes after eating (by measuring capillary blood glucose concentrations and glycated hemoglobin [HbA1c] values) are described for women with type 1 diabetes. Dietary intake, weight, and lactation onset for women with type 1 diabetes are compared with those without the disease. SUBJECTS/SETTING: Fourteen lactating women with type 1 diabetes and 25 women without diabetes (control subjects) were recruited from private obstetrician offices and high-risk prenatal clinics at 3 major medical centers. STATISTICAL ANALYSES: A repeated-measures 2-factor analysis of variance was used to determine group, time, and interaction effects between women with type 1 diabetes and the control group at 2, 3, 7, 14, 42, and 84 days postpartum. RESULTS: Seven women with type 1 diabetes breast-fed through 84 days postpartum, although they perceived later onset of milk and had fasting and postprandial hyperglycemia. Their HbA1c levels increased by 20%, confirming relative hyperglycemia. After adjustment for prepregnancy weight, women with type 1 diabetes consumed 7 kcal fewer per kilogram per day than control subjects. Average insulin dose was returned to prepregnancy levels of 45.3 +/- 3.6 U/d (least square means +/- standard error of the mean) by 1 week. APPLICATION: Achieving desired metabolic control during the establishment of lactation is difficult. A better understanding of energy and insulin needs and their relationship to lactation in women with type 1 diabetes is needed.

Prenatal and perinatal factors associated with breast-feeding initiation among inner-city Puerto Rican women.

OBJECTIVE: To identify factors associated with the initiation of breast-feeding in a predominantly Puerto Rican population living in inner-city Hartford, Conn. DESIGN: Retrospective study of 144 Latino women (mean +/- standard deviation age = 26.3 +/- 5.7 years) with children at least 1 year old but younger than 6 years old (mean +/- standard deviation age = 3.0 +/- 1.2 years) at the time of the survey. Women were recruited from agencies sponsoring health programs for mothers and children. They were interviewed in their homes (69%) or at the Hispanic Health Council, Hartford, Conn (31%). SUBJECTS/SETTING: Low-income Latino women who had at least 1 preschooler at the time of the interview. The women lived in inner-city Hartford, and the overwhelming majority were Puerto Rican and received welfare assistance and food stamps. Seventy-eight percent of the women chose to be interviewed in Spanish; the other 22% were interviewed in English. STATISTICAL ANALYSES: Explanatory variables that related to breast-feeding initiation (P < or = .2) in bivariate chi 2 analyses were entered into a multivariate logistic regression model that was reduced using backward stepwise elimination procedures. RESULTS: Multivariate analyses indicated that breast-feeding the previous child, shorter length of maternal residence in the United States, not receiving prenatal bottle-feeding advice, more recent birth, and higher birth weight were positively associated with breast-feeding initiation. A major reason for choosing not to breast-feed was that women felt socially uncomfortable doing it. APPLICATIONS: Breast-feeding initiation was more likely in Latino women who received prenatal breast-feeding counselling and postpartum support. Mothers of low-birth-weight infants and women breast-feeding for the first time may need additional help. These findings can be used by programs like the Special Supplemental Nutrition Program for Women, Infants, and Children to increase breast-feeding initiation.

Obesity among offspring of women with type 1 diabetes.

OBJECTIVE: To determine subsequent growth and body composition of children born to women with type 1 diabetes compared with controls. DESIGN: Prospective cohort study. SETTING: Follow-up of offspring born to women with type 1 diabetes and controls from an earlier study of diabetes and lactation. SUBJECTS: Seventeen nondiabetic offspring of women with type 1 diabetes and 18 offspring of control women (age range 5.9 to 9.0 years). OUTCOME MEASURES: Anthropometric measures at follow-up included height, weight, triceps and subscapular skinfold thickness. Information on usual nutrient intakes and physical activity patterns was elicited through questionnaires. Body composition was determined from skinfold thickness measures and bioelectrical impedance analysis. A child was identified as obese if he or she met at least 2 of the following 4 criteria for obesity: (1) weight-for-height equal to or greater than 120% of the National Center for Health Statistics (NCHS) reference median plus triceps skinfold greater than the 85th percentile; (2) body mass index (BMI) greater than the 95th percentile for age and sex; (3) percent body fat (from impedance measures) equal to or greater than 25 for boys and 30 for girls; or (4) percent body fat (from sum of skinfold measures) equal to or greater than 25 for boys and 30 for girls. RESULTS: There were 7 obese children in the type 1 diabetes group and none in the control group (p = 0.007). Obese children did not differ from nonobese children in birth weight, body fat patterning, nutrient intake, physical activity patterns, maternal pregravid weight or blood glucose control during the last trimester of pregnancy. Mothers of obese children, however, had fewer years of education and gained more weight during pregnancy compared with mothers of nonobese children in the type 1 diabetes group (p < 0.05). CONCLUSION: Obesity during childhood is a significant problem among nondiabetic children of women with type 1 diabetes. The association of childhood obesity with lower maternal education and excessive pregnancy weight gain warrants further investigation.

Determinants of body size perceptions and dieting behavior in a multiethnic group of hospital staff women.

OBJECTIVE: This study was designed to identify determinants of body size perceptions and their relationship to dietary behavior in a multiethnic group of women. DESIGN: A single interview consisting of the Massara and Stunkard body image cards (1979) and questionnaires on sociocultural background, anthropometry, and dieting history were administered to volunteers from the staff of a hospital. SUBJECTS: The sample was a convenience sample of 186 women representing a range of staff positions recruited from Methodist Hospital in Brooklyn, NY; 174 completed the study. Data on 150 women are presented in this article. RESULTS: Height and weight-for-height were stronger predictors of accuracy of perceived body size than ethnicity. Tall, slight women were more likely to overestimate and short, heavy women were more likely to underestimate actual body size. Ethnicity had an interactive effect with height as taller European Americans were more likely to perceive their body size as larger than actual compared with Afro-Caribbeans and African Americans. Women with a history of dieting were more likely to overestimate their size and to view it as different from what is perceived as attractive to others. APPLICATIONS/CONCLUSIONS: Based on the results, we conclude that body size is a stronger predictor of accuracy of perceived body size than ethnicity; and dieters overestimate their body size and believe it to be heavier than their social group would prefer.

Olfactory dysfunction and related nutritional risk in free-living, elderly women.

OBJECTIVE/DESIGN: To determine the nutritional risk associated with measured olfactory dysfunction in free-living, elderly women through analytic observational methods. Olfactory perception was measured orthonasally (odor: butanol threshold and odor identification) and retronasally (flavor: orange flavor threshold in sweetened gelatin). SETTING/SUBJECTS: Elderly women were recruited from New Haven, Conn, through posters and direct contact. Screening of 120 elderly women identified 80 with high personal functioning to participate (mean age = 76 +/- 6 years, range = 65 to 93 years). All data were collected in subjects' homes. MAIN OUTCOME MEASURES: Nutritional risk was assessed in several ways: food behavior questionnaire; food preference questionnaire; interviews based on the National Cancer Institute food frequency questionnaire; five nonconsecutive, 24-hour food records; and weight, height, waist, and hip measurements. STATISTICAL ANALYSES: Correlation and regression analyses determined the separate association between olfactory perception and nutrition variables. RESULTS: Nearly half of the women (37 of 80) had olfactory dysfunction. The following nutritional risk pattern was associated with lower olfactory perception: lower interest in food-related activities (eg, enjoying cooking, eating a wide variety of foods); lower preference for foods with predominant sour/bitter taste (eg, citrus fruits) or pungency (eg, horseradish); higher intake of sweets; less intake of low-fat milk products; and nutrient intake profile indicative of higher risk for cardiac disease. APPLICATIONS: Olfactory dysfunction may make it more difficult for elderly women to maintain a diet to control risk for chronic disease. Practitioners should target nutrition intervention to elderly women with measured or self rated difficulty in preventing odors or olfactory flavor. Capitalizing on primary-taste quality and texture may help to compensate for the loss of olfactory flavor perception.

Vitamin E in plasma and milk of lactating women with insulin-dependent diabetes mellitus.

We measured levels of plasma and milk alpha-tocopherol in women with insulin-dependent diabetes mellitus (IDDM), women without IDDM, and healthy reference women. Milk collections were made at 7, 14, 42, and 84 days postpartum; blood was collected at 3, 14, and 42 days. Postprandial glucose at 80 min was used to describe metabolic control of women with IDDM postpartum. There was no difference between the groups for plasma alpha-tocopherol, which was within normal reported levels. Tocopherol (micrograms/g lipid) decreased by approximately 50% in all groups between 7 and 14 days. The trend for milk tocopherol was similar when expressed as micrograms/dl. Metabolic control did not have a significant effect on mean milk or plasma alpha-tocopherol. We have shown that this group of women with IDDM produced a milk with vitamin E content similar to control and reference women. We conclude that the infant of the breast-feeding woman with IDDM who is in good metabolic control during pregnancy and who receives good prenatal counseling most likely receives adequate vitamin E from the mother's milk.

Total lipid and fatty acid composition of milk from women with and without insulin-dependent diabetes mellitus.

Milk lipid and fatty acids were measured from women with insulin-dependent diabetes mellitus (IDDM), a comparison group of women without diabetes, and reference women. Milk samples were collected 80 min after breakfast at 2, 3, 7, 14, 42, and 84 d postpartum (pp). Total lipid and medium-chain fatty acids (MCFAs) in the group with IDDM were similar to or greater than those of control and reference groups at all times and were within normal, reported ranges. Milk long-chain polyunsaturated fatty acids (LC-PUFAs) were lower in women with IDDM from 14 to 84 d pp. Lower milk LC-PUFAs may be a result of altered fatty acid metabolism in women with IDDM.

Nutritional consequences of chronic maternal conditions during pregnancy and lactation: lupus and diabetes.

Few treated chronic conditions preclude the ability of a mother to conceive. However, consequences of the condition may undermine the pregnancy or aggravate maternal disease. Most chronic conditions require nutritional intervention beyond the normal needs of pregnancy. Insulin-dependent diabetes mellitus (IDDM) and systemic lupus erythematosus (SLE) are two common autoimmune disorders that affect women of childbearing age. Little has been published about the long-term consequences of current medication regimens for SLE and their interactions with either nutrient metabolism or requirements. More information is available on macronutrient dietary needs and metabolism during pregnancy and lactation in women with IDDM, but little is published about the metabolism of other nutrients in this condition. Thus, the nutritional consequences of treating these diseases during pregnancy and lactation must be evaluated continually.

Perinatal lactation protocol and outcome in mothers with and without insulin-dependent diabetes mellitus.

This study compared the course of lactation from days 2 to 84 postpartum in 33 women with insulin-dependent diabetes mellitus (IDDM); 33 women without diabetes selected by using gestational age of the infant, method of delivery, sex of the infant, and prior lactation experience as a means of ensuring similar patterns in factors known to influence success (control subjects); and 11 healthy reference subjects who delivered vaginally. Nutritionists visited the mothers on days 2, 3, 7, 14, 42, and 84 postpartum; obtained prenatal and perinatal medical information; and questioned the mothers on their breast-feeding experience. Women with IDDM were able to establish lactation despite postpartum separation from their infants, delays in the start of breast-feeding, reduced frequency of feeding, increased use of supplemental feedings, and the high rate of cesarean section. Clinicians must recognize the need to provide appropriate counseling so that mothers with IDDM will not be discouraged by problems with breast-feeding.

Prolactin concentrations in serum and milk of mothers with and without insulin-dependent diabetes mellitus.

Diabetes may affect the secretion of prolactin, the principal lactogenic hormone. Because adequate amounts are critical to the establishment of lactation, we assessed the prolactin status of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 women without diabetes, and 11 reference women participating in a study of lactation from 2 to 84 d postpartum. Circulating concentrations of serum prolactin declined temporally for all women and did not differ significantly among any of the groups. During the first postnatal week, milk immunoreactive prolactin concentrations were lower for women with IDDM than for control and reference women and the inverse relationship between lactose and milk prolactin, which was significant at day 2 postpartum for reference women, was delayed until day 14 postpartum for women with IDDM. Early breast-feeding activity, increased breast-feeding frequency, and good glycemic control enhance prolactin secretion and should be promoted during lactation in women with IDDM.

Delayed lactogenesis in women with insulin-dependent diabetes mellitus.

Breast milk lactose, total nitrogen, conductivity, osmolality, and intake by infants of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 control women without diabetes, and 11 reference women were determined in a 3-mo study of lactation. Milk of women with IDDM had significantly lower lactose and higher total nitrogen (2-3 d postpartum), and their infants had significantly less milk intake (7-14 d postpartum) than did control or reference women. Total nitrogen was negatively correlated with milk lactose for women with IDDM at all times and for control women through day 14 postpartum. The data indicate delayed lactogenesis for women with IDDM, which was more likely to occur with poor metabolic control. Differences in milk composition of women with IDDM do not preclude them from breast-feeding their infants.

Effect of fish oil on the fatty acid composition of human milk and maternal and infant erythrocytes.

To examine the effect of fish oil supplementation on the fatty acid (FA) composition of human milk and maternal and infant erythrocytes, five lactating women were supplemented with 6 g of fish oil daily for 21 d. Usual maternal diets contained 1,147 mg of total n-3 FA, with 120 mg from very long-chain (> C18) n-3 FA. Supplementation increased dietary levels to 3,092 mg of total n-3 FA and 2,006 mg of very long-chain n-3 FA. Milk samples were collected daily, prior to fish oil ingestion, and at 4-h intervals on days 1, 7, 14 and 21. Milk n-3 FA content increased within 8 h and reached steady state levels within one week. The n-6 fatty acid content decreased. Erythrocyte eicosapentaenoic acid content increased from 0.24% to 1.4% (P < 0.01) in mothers and from 0.11% to 0.70% (P < 0.05) in infants. Docosapentaenoic acid increased from 1.4% to 2.2% (P < 0.05) in mothers and from 0.30% to 0.78% (P < 0.01) in infants. There was no significant change in docosahexaenoic acid or n-6 fatty acid content. Maternal platelet aggregation responses were variable. No differences in milk or plasma tocopherol levels were noted.