Increments in whole body bone mineral content associated with weight and length in pre-term and full-term infants during the first 6 months of life.

BACKGROUND: The objective of the present study was to assess bone mineral content (BMC) of the whole skeleton in pre-term and full-term healthy infants and the factors influencing BMC, such as bone area, birth weight, birth length, current weight, current length, gender, and gestational age. METHODS: Forty-eight healthy full-term infants and 34 healthy premature infants fed predominantly with intact human milk were studied. BMC was measured monthly with dual energy X-ray absorptiometry (DEXA). At the same time, length and weight were measured and registered. Pre-term infants were studied at 60-day intervals. RESULTS: For both full-term and pre-term infants, BMC increased during the first months of life. However, the values of pre-term infants never reached the values of full-term infants, even after correcting for age and weight. For both full-term and pre-term infants, BMC was significantly correlated at the second month with birth weight (r = 0.901), birth length (r = 0.860), gestational age (r = 0.803), bone area (r = 0.960), current weight (r = 0.920), and current length (r = 0.840, p <0.001 for all correlation coefficients). Multivariate analysis revealed that bone area was the most important factor in predicting BMC. CONCLUSIONS: Pre-term children have lower BMC than full-term children. The main factor explaining this apparent osteopenia is bone area. Pre-term children have a higher daily mineralization rate than full-term children, but this catch-up mineralization is not enough to reach BMC levels seen in full-term children.

[Proposal for a death certificate to improve recording and reporting of perinatal mortality]. / Propuesta de un certificado de defunción para mejorar el registro y reporte de la muerte en el periodo perinatal.

OBJECTIVE: To analyze perinatal births and deaths recording at the Mexican Institute of Social Security (MISS), and to evaluate the correct classification of perinatal deaths. MATERIAL AND METHODS: From January to March 2000, data were collected from the 37 MISS districts on the total number of births and deaths occurring during 1999, deaths occurring before the seventh day of life, and gestational age and weight at birth. Early neonatal and infant mortality rates were analyzed including or separating newborns with < 1,000 g and < 28 weeks of gestational age. RESULTS: During 1999 there were 634,892 live births--whose gestational age and birth weight are unknown- and 3,984 stillbirths > or = 28 gestation weeks. There were 4,556 newborns who died before the seventh day of extrauterine life; 1,385 of them (30.4%) weighted less than 1,000 g and had a gestational age < 28 weeks. The analysis of mortality with and without these newborns shows a decrease of two points in early neonatal and infant mortality rates. CONCLUSIONS: This study shows that classification and reporting of perinatal mortality are inappropriate. A proposal is made to develop information systems that include weight and gestational age of all births. A new perinatal death certificate replacing current fetal and general death certificates would allow proper mortality classification and comparisons between countries.

A fortifier comprising protein, vitamins, and calcium-glycerophosphate for preterm human milk.

BACKGROUND: The infant's own mother's milk, fortified with proteins, minerals, and vitamins, is considered the best food for low-birth-weight infants. This paper describes the process to obtain a liquid human milk fortifier. METHODS: The fortifier comprises a protein concentrate, calcium, phosphate, and zinc salts, as well as vitamins A and D. A powdered whey protein extracted from bovine milk was concentrated from 31.5-76.8 g/100 g using repetitive dialysis. The protein concentrate was dissolved in a 0.2 M phosphate buffer pH 7.4 and mixed with calcium-glycerophosphate and calcium-gluconate, vitamins A and D, folic acid, and zinc. Each 10 mL of this liquid fortifier has 0.78 g protein, 53 mg calcium, 36 mg phosphate, and 0.93 mg zinc. RESULTS: Repetitive dialysis did not modify the protein structure as demonstrated by electrophoresis. A total of 95% of lactose content was discarded. Enriching human milk using this human milk fortifier increased the concentration per deciliter of all added nutrients; proteins increased from 1.68-2.35 g, calcium from 26-90 mg, and phosphorus, from 15-51 mg. CONCLUSIONS: A liquid human milk fortifier was successfully manufactured using a noncomplex procedure. An intake of 180-200 mL/kg/day of the fortified human milk by the premature infant would satisfy the infant's nutritional requirements and achieve expected growth and development.

Qualitative analysis of human milk produced by women consuming a maize-predominant diet typical of rural Mexico.

The milk composition of women on a typical rural Mexican diet was compared with that secreted by American women, consuming a diet typical of affluent countries. Milk concentrations of free fatty acids, cholesterol, total amino acids, and selected key minerals were analyzed at 4 or 6 months postpartum. The total milk fat concentration was lower in the Otomi (22.7 +/- 6.7 mg/g milk) than in the American women (31.3 +/- 5.4 mg/g milk, p = 0.001). Although the absolute concentration did not differ, cholesterol, expressed in terms of total lipid, was higher in the Otomi milk (3.9 +/- 1.1 vs. 3.1 +/- 0.7 mg/g fat, p = 0.005). Saturated medium-chain (C10:0-C14:0) and unsaturated intermediate-chain fatty acids (C16:1 and C18:2) were higher in the Otomi than in the American milk (p < 0.03). The concentrations of C16:0, C18:0, and C18:1 were significantly lower in Otomi than in American milk. The milk concentrations of protein and nonprotein nitrogen were comparable between the two groups. The concentrations of serine, proline, cystine, methionine, and tryptophan were higher in the Otomi than in the American milk (p < 0.05-0.001). The concentrations of valine and isoleucine were significantly lower in the Otomi milk (p = 0.05). Expressed per gram of milk protein, the cystine, methionine, lysine, and tryptophan concentrations were higher, and the glutamine/glutamate, valine, isoleucine, and arginine levels were lower in the Otomi milk. The concentrations of phosphorus and copper were lower in the Otomi than in the American milk at 4 months postpartum (p = 0.05). These differences in milk fatty acid and amino acid patterns and mineral content are unlikely to affect infant growth, but may have other biological consequences yet to be ascertained.

Whey protein/casein ratio and nonprotein nitrogen in preterm human milk during the first 10 days postpartum.

BACKGROUND: This study was designed to describe the longitudinal changes in the casein and whey fractions and the total and nonprotein nitrogen contents of preterm human milk for the first 10 days postpartum. METHODS: Eleven mothers delivering at 30 to 34 weeks of gestation were studied, six throughout the first 10 days and five on the first postpartum day. Four milk samples were collected every day by expression of one breast with an electric breast pump. Casein and whey protein were separated from the defatted milk by isoelectric precipitation in calcium chloride and by subsequent ultracentrifugation. The milk nitrogen content was determined before and after acid precipitation. Whey protein and casein were characterized by electrophoresis in polyacrylamide gel. RESULTS: Total and protein nitrogen showed a sharp decrease during the first 3 postpartum days, whereas the nonprotein nitrogen did not change markedly (mean concentration, 0.58 mg.ml-1). Casein content expressed as nitrogen in preterm human milk was 0.35 mg.ml-1 between days 3 and 5 and 0.60 mg.ml-1 between days 6 and 10. The whey protein-casein ratio before day 2, was 100:0, at day 3, 86:14, at day 5, 76:24, and at day 10, 70:30. Three days after delivery, casein levels rose progressively, increasing markedly after day 6. CONCLUSIONS: These findings suggest that delivering before term affects neither casein production nor its chemical characteristics.

[Mother-infant rooming-in and exclusive breast feeding]. / Alojamiento conjunto madre-hijo y lactancia humana exclusiva.

OBJECTIVE: To determine the influence of joined mother-child hospital lodging (JL) on the frequency of exclusive human lactation (EHL) from birth to four months of age. MATERIAL AND METHODS: Non-randomized cohort study performed at the lactation clinic of the "Luis Castelazo Ayala" Hospital of the Mexican Social Security Institute from January 1993 to October 1994 which included 178 healthy mother-child pairs (MCP) with term pregnancy. The jointly lodged group (JL) consisted of 90 MCP in which mothers received assessment for lactation; 88 MCP were lodged separately and no assessment was provided. Results were statistically analyzed to determine frequency and variable associations. RESULTS: Feeding was recorded as either EHL, powdered milk or both. Groups with or without JL were stratified by form of birth, either labor or Cesarean section. With the Mantel-Haenszel X2 and logarithmic range, differences were significant with p < 0.05. During the study, global lactation was similar among groups. In the first month, EHL was higher in the JL group, 61 vs 42% independently of the form of birth (p < 0.05). The only variable which influenced EHL was JL. CONCLUSIONS: Mother-child JL favours EHL during the first month post-partum.

Early growth faltering of rural Mesoamerindian breast-fed infants.

Early growth faltering has been described in breast-fed infants 4-6 months of age from less-developed communities. The timing and magnitude of growth faltering, however, depends on the appropriateness or comparability of the reference used to evaluate growth performance. In this paper we compared the growth performance of a group of rural Mesoamerindian breast-fed infants from birth through 6 months of age to that of a reference group of breast-fed infants reared under favourable nutritional and environment conditions in the United States. The validity of this assessment is based upon the comparability of infant feeding mode. Mean weights and lengths and corresponding weight-for-age and length-for-age percentiles and z-scores were significantly lower among the Mesoamerindian (Otomi Indian) infants (p = 0.001). Mean weight-for-length percentiles and z-scores did not differ between groups. Weight gain (g/day) was significantly lower among the Otomi infants throughout the entire 6 months (p = 0.001). Length velocities of the Otomi infants were lower than reference infants at 3-6 months (p = 0.001). The growth pattern of the Otomi infants differed from that of the reference group: decreases in growth velocities and weight-for-age and length-for-age z-scores were significantly more precipitous for the Otomi infants between 4 and 6 months of age (p = 0.001). We conclude that growth faltering was evident among the Otomi infants between 4 and 6 months of age, relative to a reference growth of breast-fed infants.

PIP: During 1986-89, for the first 6 months of life biweekly measurements were taken of the weight and length of 114 breast fed, healthy Mesoamerindian (Otomi) infants living in rural Capulhuac, Mexico, and their mothers were asked about infant feeding. Results were compared with a reference sample of 45 predominantly breast fed infants from Houston, Texas. The Otomi infants had birth weights and lengths lower than the National Center for Health Statistics (NCHS) medians, perhaps due to suboptimal gestational weight gains. They had significantly lower growth velocities (i.e., weight gain/day throughout entire 6 months and length gain/month for 3-6 months) than the reference infants (p = 0.001). They also had significantly lower NCHS percentiles and NCHS z-scores for weight-for-age and length-for-age than the Texas infants (p = 0.001). For example, at 6 months, the weight and length velocities of the Otomi were about 70% of the reference infants. The mean weight-for-length percentiles and z-scores were not significantly different between the 2 groups, however. Between 4 and 6 months of age, the decreases in growth velocities and NCHS weight-for-age and NCHS length-for-age z-scores of the Otomi infants were much more steep than those for the reference group (p = 0.001); for example, the decrease in weight-for-age was 0.44 for Otomi infants compared to 0.29 for the reference group, and the decrease in length-for-age was 0.43 and 0.18, respectively. In conclusion, the Otomi Indian breast fed infants experienced growth faltering between 4 and 6 months.

[Mother-infant rooming-in and beginning of breast feeding in a tertiary care hospital]. / Alojamiento conjunto madre-hijo e inicio de amamantamiento, en un hospital de tercer nivel de atención.

OBJECTIVE: To establish a mother-baby's rooming-in program (RI) in a hospital that provides a tertiary level of care. MATERIAL AND METHODS: Babies born to healthy mothers were included, both delivered vaginally (P) and by cesarean section (C). Information was gathered on the cause for RI suspension, the type of infant's feeding and the mother's opinion about the program. RESULTS: Sixty-eight per cent of P infants and 98% of C infants participated in the program. The time from delivery to RI was uncovered; for P babies it was 5.8 hours and for C babies it was 17 hours. The RI was suspended in 1% of P and 6.7% of C infants, but with no justifiable medical reason in the infants. The mother's opinion about RI was very favorable. Only 50% of the infants started breast feeding within the first 6 hours after birth; however, all of them were breastfed at the time of discharge. CONCLUSIONS: It is possible to establish RI and initiate breast feeding in a tertiary care hospital, even in mothers with cesarean section.

PIP: The objective of this study was to establish a mother-baby rooming-in program (RI) in a hospital that provides a tertiary level of care. Babies born to healthy mothers were included, both delivered vaginally (P) and by cesarean section (C). Information was gathered on the cause for RI suspension, the type of infant feeding, and the mother's opinion about the program. 68% of P infants and 98% of C infants participated in the program. The time from delivery to RI was determined; for P babies it was 5.8 hours and for C babies it was 17 hours. The RI was suspended in 1% of P and 6.7% of C infants, but with no justifiable medical reason. The mothers' opinion about RI was very favorable. Only 50% of the infants started breast feeding within the first 6 hours after birth; however, all of them were breast feeding at the time of discharge. The authors conclude that it is possible to establish RI and initiate breast feeding in a tertiary care hospital, even in mothers who had a cesarean section.

Higher total energy expenditure contributes to growth faltering in breast-fed infants living in rural Mexico.

To investigate the energy requirements of infants living under unfavorable environmental conditions in rural Mexico, we measured the total energy expenditure (TEE) of 40 Otomi infants at approximately 4 or approximately 6 mo of age. Total energy expenditure was estimated by the doubly labeled water method: 100 mg 2H2O/kg and 250 mg 18O/kg were administered orally, after which urine was collected serially for 7 or 10 d. Isotopic enrichment of urine samples was analyzed by gas-isotope-ratio mass spectrometry. Weight and length were measured monthly from birth to 6 mo. Fat free mass was estimated from 18O dilution spaces. Total energy expenditures (mean +/- SD) were 310 +/- 58 and 318 +/- 29 kJ.kg-1 x d-1 at approximately 4 and approximately 6 mo, respectively. Total energy expenditure was higher than that previously observed for breast-fed infants reared under more protected environments (268 +/- 29 kJ.kg-1 x d-1). Weight, length and weight gain were 5.9 +/- 0.8 kg, 60 +/- 2 cm and 2.9 +/- 2.4 g.kg-1 x d-1 at 4.25 mo and 7.1 +/- 0.8 kg, 65 +/- 2 cm and 1.0 +/- 1.2 g.kg-1 x d-1 at 6.27 mo. Growth faltering was evident at 6 mo by clinically significant declines in growth velocities and National Center for Health Statistics Z-scores. Body fat of the Otomi infants averaged 21 +/- 6 and 18 +/- 5 g/100 g at approximately 4 and approximately 6 mo, respectively. Higher rates of TEE narrowed the margin of energy available for growth and thereby contributed to growth faltering in the Otomi infants.

Ethanol consumption during pregnancy and lactation. Changes in the nutritional status of predominantly breastfeeding mothers.

The purpose of this investigation was to study the effects of ethanol, consumed as a mild fermented beverage called "pulque", during pregnancy and lactation on the food intake and some anthropometric indices of body composition of a group of lactating mothers in a town in central Mexico. Thirty two mothers who drank pulque during pregnancy and lactation and 61 non-drinking women with comparable characteristics were evaluated anthropometrically, their dietary and ethanol intake recorded during a 6-month postpartum period. Energy [(8360 +/- 2997 vs. 7156 +/- 2177 J) and protein (52.7 +/- 20.9 vs. 44.6 +/- 16.1 g)] 24-h intake, height, weight, body mass index, arm muscle and fat areas were greater in drinking mothers than in controls. Average total ethanol consumption varied from 0.48 - 0.55 g-1 kg-1.d-1. Drinking mothers lost weight less frequently. Additional energy provided by pulque might explain such a difference. More precise information about the changes in their body composition and energy balance are in order for confirmation.

[Morbidity reduction in preterm newborns fed with milk of their own mothers]. / Disminución de la morbilidad en neonatos pretérmino alimentados con leche de su propia madre.

In order to study the effect of feeding on the morbidity, 118 premature newborn, were followed on successive basis; 59 fed with infant term formula (F) and 59 fed with own mother's milk (LH). The patients were classified in 3 groups according to birth weight: I, < 999 g (n = 4/4); II, 1000-1499 g (n = 37/37) and III, 1500-1999 g (n = 18/18), each group F and LH having equal numbers. Growth, morbidity and clinical management were recorded. Necrotizing enterocolitis (P < 0.001), urinary tract infection (P < 0.01) and infectious diarrhea (P < 0.01) were less frequent in LH infants and as a consequence these infants needed less antimicrobial therapy (P < 0.001), nevertheless the human milk contained flora bacteria. The LH infants of group II need fewer red cell transfusions (P < 0.001) and each group was similar and only the babies < 999 g had increments of approximately 15 g/kg/day. This study highlights the importance of feeding the premature infant with own mother's milk; however, the infant growth increments were less than the expected suggesting that human milk must be fortified with proteins and minerals, considering the mothers as a true human milk bank.

Human milk intake and growth faltering of rural Mesoamerindian infants.

To determine whether growth faltering during early infancy was attributable to inadequate intake of human milk, the nutrient intakes and growth of 30 Otomi infants from Capulhuac, Mexico, were studied at 4 or 6 mo of age. Growth was monitored monthly from 1 through 6 mo of age. The 2H dose-to-the-mother method was used to measure human milk intake. Energy, protein, lactose, and fat concentrations in milk were analyzed by standard techniques. Mean (+/- SD) human milk intakes were 885 +/- 145 and 869 +/- 150 g/d at 4 and 6 mo, respectively. Protein and lactose concentrations in milk were normal but fat and consequently energy concentrations were abnormally low. Energy intakes averaged 81 +/- 14 kcal.kg-1.d-1 at 4 mo and 72 +/- 14 kcal.kg-1.d-1 at 6 mo. Growth faltering by 6 mo was evidenced by the significant decline in growth velocities and National Center for Health Statistics Z scores. Weight gain at 6 mo was 8.1 +/- 3.5 g/d and length gain was 1.0 +/- 0.34 cm/mo. Weight-for-age and length-for-age Z scores were -0.81 +/- 0.94 and -1.51 +/- 0.83, respectively. Growth velocities were not significantly correlated with nutrient intakes. Growth faltering among the Otomi infants despite energy intakes comparable to those of breast-fed infants in more protected environments may have resulted from an increase in the need for nutrients or from a growth-limiting nutrient, other than energy, in their diet.

Lactation performance of rural Mesoamerindians.

Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.

PIP: Researchers analyzed data on 30 postpartum women from the Otomi Indian community living in rural Capulhuac, Mexico to examine interrelationships among lactation performance, maternal body size/composition, and dietary intake to learn which maternal factors limit lactation and thus infant growth. Infant food supplementation was minimal. Current diet did not affect milk production or levels of energy and fat in milk. Even though the body mass index (BMI) was lower than the normal range (19.8-26 kg/sq meter) for only 2 women, 8 women had 20% body fat indicating considerable undernutrition. Women consumed a mean of 68% and 80% of energy and protein requirements. Mean energy intakes (kcal/kg/day) at 4 and 6 months postpartum were 33.8 and 35.1 respectively, compared with the recommended 51. Mean protein intakes (g/kg/day) were 0.75 and 0.84 respectively compared with the recommended 1.1 3-day intake records based on memory, estimation of portion sizes, food preparation, and food composition data led to the above energy intake results, but they may not have been accurate since a mean of 35 would not allow much physical activity. Fats and carbohydrates mainly from maize made up 17% and 76% respectively of the Otomi diet suggesting a suboptimal diet. Yet human milk production rates (885 g/day at 4 months and 869 g/day at 6 months) tended to equal or be higher than those of women of higher socioeconomic status (711-925 g/day) and other poor women (525-789 g/day). The greater the levels of maternal body fat the smaller the amount of milk women produced (p=.006). Total nitrogen, protein nitrogen, lactose, and nonprotein nitrogen levels fell within the range of that of privileged women. Fat and energy levels in the milk were lower than those of privileged women, however heavy women (p=.002) with high BMI (p=.05) and body fat (p=.004) levels tended to have high levels of energy and fat in the milk. Energy levels in milk were not linked with milk production. Neither milk production nor composition were related to dietary intake.

Nutritional status of a nationwide sample of rural Mexican populations.

Information on nutritional status of the rural Mexican population is mostly obtained from cross-sectional studies. This investigation evaluates semi-longitudinally the nutritional level of a sample of the rural population of Mexico. A total of 15,552 individuals in 2,587 households from 208 rural communities were evaluated. Body weight and height of rural boys and girls were found to be significantly lower than in their urban counterparts. Severe forms of weight for age or height for age inadequacy were more frequent in females than in males, in smaller communities than in larger ones, and in economically depressed zones than in those with a good economy. Our data showed a lower frequency of mild and moderate forms of possible malnutrition than previous studies (20 vs 50%) using as a criterion weight for age. These differences are explained on the basis of sampling bias.

PIP: The nutritional status of 15,552 individuals of both sexes in 2587 households from 208 rural communities in Mexico was evaluated in a semilongitudinal nationwide study. Research was carried out from March 1982 to February 1983. The communities were randomly selected from among the 3000 with Mexican Institute of Social Security-COPLAMAR primary health care services. The 8 geoeconomic zones identified by Bassols-Batalla were represented. 10 families with at least 1 infant under 1 year old were selected in communities with under 5000 inhabitants, while 20 such families were selected from communities with 5001-20,000 inhabitants. Body weight, height or length, and arm and calf circumferences were measured in all household members in March-April 1982, and again in July-August 1982 and January-February 1983. The proportion of household heads employed primarily in agriculture ranged from 88% in the smaller communities to 32% in the larger. Families in small communities were mainly peasants in subsistence farming, while household heads in larger communities who were employed in agriculture were mostly owners of small plots. 40-54% of the mothers in communities of different sizes had 3 years or less of school attendance. Comparison of growth curves of the rural population with reference data from urban children showed similar median body weight in both groups at 2 years of age. But by age 18, median weight and height, respectively, were 8.6 kg lower and 9 cm shorter for rural boys and 5.5 kg lower and 5 cm shorter for rural girls. The most severe forms of inadequacy in weight for age were more frequent in females than males, in smaller communities than larger, and in the economically depressed zones. Severe inadequacy of height for age was more frequent in the states located on the southern Pacific Coast and the Gulf of Mexico. The frequency of mild and moderate forms of malnutrition according to weight for age was 20%, lower than the rate of 50% estimated in previous published studies. Selection of a broader range of rural communities rather than just the most marginal, and the bias introduced by selecting the sample from among communities with primary health services may explain the lower rate in this study.

[Plasma clearance of ethanol and its excretion in the milk of rural women who consume pulque]. / Depuración plasmática de etanol y su excreción en la leche de mujeres rurales que consumen pulque.

Women from rural areas of the central plateau of Mexico drink during pregnancy and lactation a mild alcoholic beverage called pulque as a galactogogue. Ethanol present in milk could have a harmful effect on growth and development of breast-fed children. The purpose of this study was to quantify the ethanol consumed as pulque by eleven lactating rural women as well as its clearance rate in blood and milk. Mothers were separated in two groups depending upon the ethanol ingested in a single dose of pulque 0.21 +/- 0.08 g/kg of body weight (group A) and 0.44 +/- 0.11 g/kg (group B). Maximal concentration of ethanol was reached in milk at 60 minutes and almost equaled that in plasma. Both groups showed a similar clearance pattern regardless of the volume of pulque ingested. Clearance rates between groups were different: ethanol concentration in milk at 60 min were 8.4 +/- 3.0 mg/dL for group A and 26.2 +/- 7.0 mg/dL for group B. Two hours later ethanol levels were 3.6 +/- 3.4 mg/dL and 23.3 +/- 9.4 mg/dL respectively. Clearance rates were slower in mothers showing the highest concentration of ethanol in milk. The present data demonstrate that there is no differential elimination of ethanol in maternal blood and milk following ingestion of a moderate amount of pulque during lactation. The amount of ethanol received by infants through milk is relatively low and therefore it is unlikely to have harmful effects on them. Pulque consumption adds about 350 kcal/day to the customary dietary intake of these lactating women.

PIP: This work assessed the quantity of ethanol consumed in pulque, a mildly alcoholic beverage from the maguey cactus, and its clearance rate in the blood and milk of 11 rural women in the state of Mexico. 27% of women in the rural and semirural areas of central Mexico drink pulque with their meals. Pulque is believed to stimulate milk production in lactating women. The 11 women lived in the community of San Mateo Capulhuac. All exclusively breast fed their infants, who ranged in age from 3-12 months. On the study day the women breakfasted on tortillas, beans, soup and tea, accompanied by their usual quantity of pulque. During the study, samples of milk and blood were taken from the women at 60, 90, and 120 minutes after 1st ingestion of pulque. The volume of pulque consumed was measured and a sample was saved to determine the ethanol content. Mature pulque showed little variation in ethanol concentration or in total carbohydrates, independently of temperature or duration of storage. The average concentration of ethanol in pulque produced in San Mateo Capulhuac was 3.08 + or - 1.09 g/dL, with a minimum of 1.35 and a maximum of 4.70. The 11 mothers were divided into 2 groups depending on whether the maximum concentration of ethanol quantified in their blood and milk was less than 20 mg/dL (group A) or greater than 20 (group B). The mothers in group A had younger infants, lower body weights, and smaller volumes of pulque ingested on average than the mothers in group B. The average dose of ethanol ingested with pulque was .21 + or - .08 g/kg body weight for group A and .44 + or - .22 g/kg of body weight for group B. concentrations of ethanol in the blood were similar to those in milk for both groups at 60, 90, and 120 minutes. The maximum ethanol concentration occurred 60 minutes after ingestion. Maximum concentrations of ethanol in milk were 8.4 + or - 3.0 mg/dL for group A and 26.2 + or - 7.0 mg/dL for group B, slightly lower than the maximal plasma concentrations in each group. Ethanol levels in blood and milk of group A declined rapidly, with 63% of the ethanol disappearing from the blood and 52% from the milk at 120 minutes. At 120 minutes the ethanol concentration had declined by only 5.5% in the blood and 11% in the milk of group B. Pulque contributes about 350 kcal per day to these women, who have daily caloric intakes averaging 2100 kcal. The relatively small amount of ethanol taken in by infants through milk is unlikely to have harmful effects.

Effects of ethanol consumption during pregnancy and lactation on the outcome and postnatal growth of the offspring.

Although information about the pregnancy outcome of alcoholic mothers is relatively abundant, no information is available about the effects of ethanol consumption on the infant's postnatal growth. This investigation aims to describe the physical growth of 32 infants born to mothers accustomed to drinking pulque, a mild alcoholic beverage, on a daily basis during pregnancy and lactation and to quantitate the ethanol disposed through the milk, as well as to identify cases of newborns with fetal alcohol syndrome. No full-blown cases of the syndrome were found: birth weight was similar to their non-drinking counterpart, but the relative risk of newborns to drinking mothers to have a low birth weight was 3.39. Ethanol found in milk accounted for 40 mg/day available to the infant. The postnatal growth of infants of ethanol drinkers was similar to that of controls. Further studies on their mental development are required in order to understand the extent of the effects of such a habit.

PIP: The physical growth of 32 infants born to mothers accustomed to drinking pulque, a mild alcoholic beverage, on a daily basis during pregnancy and lactation was studied. 110 clinically healthy mothers aged 15-44 years with parity from 2 to 4 were recruited during the last trimester of gestation from among the pregnant women of San Mateo Capulhuac, a village of 4000 inhabitants, where the prevalence of natural lactation is 95% up to 6 months postpartum. All were exclusively breast feeding their infants. The final sample included 94 nonsmoking mothers; of these, 32 drank 1-2 liters of pulque per day during pregnancy. A group of 62 nondrinking mothers of similar age, parity, and height for age ratio served as controls. 6 mothers received, .12-.31 gm/kg Blood and milk samples were taken at intervals up to 189 minutes after pulque had been consumed. Weight for age, weight for height, and height for age were calculated based on reference data published by the US National Center for Health Statistics (NCHS). The group of pulque-drinking mothers had an average age of 29.0 + 5.9 years, height of 151.0 + 5.0 cm while nondrinking mothers were 25.5 + 6.0 years and 149.0 + 5.2 cm, respectively. The estimated ethanol ingestion per day varied from 3.3 to 58 gm/day. No full-blown cases of the fetal alcohol syndrome were found: birth weight was similar to their nondrinking counterparts but the relative risk of newborns to drinking mothers to have a low birth weight was 3.39. Ethanol found in milk accounted for 40 mg/day available to the infant. Compared with the NCHS reference both groups had significantly lower mean length and weight from 3 months of age (p .001). This was reflected by a low percentage of infants with adequate weight and length/age ratios (47 and 58%, respectively). More than 90% ad an adequate weight/length ratio.

Maternal nutritional status and milk volume. Is there a cause-effect relationship?

Studies on human lactation were examined in order to gather some answers about questions concerning the effect of maternal food intake, size, fatness and economic status on milk production. Up to date, evidence in the literature is insufficient to permit definitive answers, but a general conclusion can be drawn: milk volume varies little among mothers with largely variable energy intakes, sizes and economic status. There is a great need for more controlled studies focusing on the relationship between maternal energy balance and milk output. Although many studies have separately addressed the nutritional changes in mothers throughout lactation (1-8) and milk consumption by infants (9-17), very few have correlated maternal nutritional conditions and the volume of milk consumed. This report will consider investigations published from 1975 and on, combining data on maternal nutritional status and milk production in the same individual. The rationale is that around 1975 more accurate and standardized methodology began to be used in related studies. Milk output is estimated by the summary of the differences of body weights of infants obtained before and after each milking episode during 24 hours. Before 1975 the balances used for such a purpose had very poor precision, and this interfered seriously on the inter and intra-personal variability of the measurements. Electronic scales made available after that year gave enough reliability to the procedure. This report is comprised of studies from birth to four months postpartum, when energy supplementation is less common, and quantitatively less important. Nutritional status of the mothers will be analyzed on the basis of four categorizing variables: social and economic status, anthropometry, food intake and body composition.

Changes in the composition of mammary tissue, liver and muscle of rat dams during lactation and after weaning.

This investigation was conducted to evaluate the changes in the total content of protein and RNA in liver and muscles of rat dams before and after acute separation from their litters. Groups of 8-12 rats fed ad libitum were killed on the 12th (group L12) and 20th d (group L20) of lactation and on the 1st (group W1) and 7th d (group W7) after weaning. Nonpregnant, nonlactating rats paired for age served as controls. Dry matter, protein, DNA and RNA levels of the mammary gland, liver and muscles of the right hindlimb were determined. Wet weight and total organ or tissue protein, DNA and RNA were higher in mammary glands of L12 and L20 than in age-matched controls. These values were lower in groups W1 and W7 than in the lactating groups. No changes were noted in the total liver protein or DNA content, but total liver RNA was greater in groups L12 and L20 than in controls or group W1. Total muscle dry matter, DNA and RNA were significantly lower in groups L12 and L20 than in groups W1 and W7. Muscle protein content increased progressively from the 12th to 20th d of lactation to a peak in group W1, and it decreased to values found in age-matched controls in group W7. Although the muscle protein mass of the hindlimb during peak lactation (group L12) was only 63% of that in nonlactating control rats, within 1 d of weaning it was significantly higher than in nonlactating rats. Similar changes in RNA suggest that these changes in protein content are related to an adaptative mechanism designed to handle the surplus of plasma amino acids not used by the mammary gland after weaning.

[Anthropometric evaluation of nutritional status in children. Procedures, standardization and significance]. / Evaluación antropométrica del estado de nutrición de los niños. Procedimientos, estandarización y significado.

A major concern for pediatrician is evaluate the infant nutritional status for clinical, epidemiological and research purposes. This paper describes different anthropometric procedures such as weight, length or height, as well as head and arm circumferences and skinfolds; give some relevant hints in order to prevent subjects, instruments and operator errors. Standardization methods are discussed and cut point to accept consistency and validity between operators are suggested. It's also discussed how to manage the raw data in order to evaluate nutritional status in terms of size, growth tendency or weight/age, length/age and weight/length indices; besides, the most important classification of the nutritional status are given. Finally, the procedures for calculating muscular and fat arm areas and corporal adiposity in order to obtain body composition are presented.