Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants.

BACKGROUND: Necrotizing enterocolitis (NEC) is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. Human milk (HM) feeding has been associated with lower risk of NEC. However, mothers of VLBW infants often experience insufficient milk production, resulting in mixed feedings of HM and formula. Moreover, medical complications often limit the volume of feeding they can be given. OBJECTIVE: To determine if high proportions of (50% or greater) HM enteral feeding within the first 14 days of life are protective against NEC. METHOD: This was a prospective cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days: <50% (low human milk, LHM, n=46) and > or =50% (high human milk, HHM, n=156). The outcome of interest was development of NEC (Bell stage 2 or 3). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) and to assess potential confounding due to perinatal risk factors. RESULT: Two hundred and two infants were studied. Confirmed NEC occurred in 5/46 (10.6%) of the LHM group, as compared with 5/156 (3.2%) of the HHM. Gestational age was the only perinatal factor associated with risk of NEC. After adjustment for gestational age, HHM was associated with a lower risk of NEC ((OR=0.17, 95% CI: 0.04 to 0.68), P=0.01). CONCLUSION: Enteral feeding containing at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC.

Effect of energy restriction and exercise on vitamin B-6 status of women during lactation.

PURPOSE: Lactation increases vitamin B-6 requirements because its concentration in breast milk is related to maternal intake and it is essential for infants. Exercise may also increase the requirement because it increases utilization and excretion of vitamin B-6. Therefore, the purpose of this study was to determine whether energy restriction and exercise affected vitamin B-6 status of lactating women. METHODS: Breastfeeding women with a body mass index > or = 25 and < or = 30 kg x m(-2) were randomly assigned at 4 wk postpartum to either restrict energy intake by 500 kcal x d(-1) and exercise for 45 min x d(-1), 4 d x wk(-1) (weight loss group, WG) or maintain usual diet and not exercise (control group, CG) for 10 wk. Women were given a supplement containing 2.0 mg of vitamin B-6. Measurements included vitamin B-6 concentrations in breast milk and plasma, plasma pyridoxal 5'-phosphate, and erythrocyte alanine aminotransferase activity. RESULTS: The WG lost more weight (-4.4 +/- 0.4 vs -0.9 +/- 0.5 kg, P < 0.01) than the CG. Cardiovascular fitness increased by 12% in the WG, compared to 3% in the CG (P = 0.09). Milk vitamin B-6 concentrations increased in both groups (161 +/- 107 and 191 +/- 85 nmol x L(-1), WG and CG, respectively, P = 0.05). There were no significant differences in other vitamin B-6 parameters. Weight and length gain (2.06 +/- 0.21 and 1.83 +/- 0.17 kg; 8.6 +/- 0.6 and 7.2 +/- 0.5 cm; WG and CG, respectively) of infants was not significantly different between groups. CONCLUSIONS: Energy restriction and exercise from 4 to 14 wk postpartum in overweight, breastfeeding women consuming adequate dietary intakes and 2.0 mg of supplemental vitamin B-6 does not adversely affect vitamin B-6 status or infant growth.

The effect of weight loss in overweight, lactating women on the growth of their infants.

BACKGROUND: The retention of weight gained during pregnancy may contribute to obesity. Lactation should promote weight loss, but weight loss is highly variable among lactating women. The risks associated with the restriction of energy intake during lactation have not been adequately evaluated. The purpose of this study was to determine whether weight loss by women during lactation affects the growth of their infants. METHODS: We randomly assigned 40 breast-feeding women who were overweight (defined as a body-mass index [the weight in kilograms divided by the square of the height in meters] of 25 to 30) at 4 weeks post partum either to restrict their energy intake by 500 kcal per day and to exercise for 45 minutes per day for 4 days per week (the diet-and-exercise group) or to maintain their usual dietary intake and not exercise more than once per week for 10 weeks (the control group). We measured the weight and fat mass of the women and the weight and length of the infants before, during, and at the end of the study period. RESULTS: The mean (+/-SD) energy intake decreased by 544+/-471 kcal per day in the diet-and-exercise group. As compared with the control group, the women in the diet-and-exercise group lost more weight (4.8+/-1.7 kg vs. 0.8+/-2.3 kg, P<0.001) and fat mass (4.0+/-2.0 kg vs. 0.3+/-1.8 kg, P<0.001). The gains in weight and length of the infants whose mothers were in the diet-and-exercise group (1925+/-500 g and 7.8+/-2.0 cm, respectively) were not significantly different from those of the infants whose mothers were in the control group (1861+/-576 g and 7.3+/-1.7 cm). CONCLUSIONS: Weight loss of approximately 0.5 kg per week between 4 and 14 weeks post partum in overweight women who are exclusively breast-feeding does not affect the growth of their infants.

Weight change during lactation does not alter the concentrations of chlorinated organic contaminants in breast milk of women with low exposure.

The purpose of this longitudinal study was to evaluate whether a loss of body fat during lactation between 4 and 20 wk postpartum increases the concentration of environmental contaminants in breast milk. We examined this relationship in two different cohorts of exclusively breastfeeding women: (1) California women with low exposure to contaminants (n = 10 whose weight was stable [mean change, 0.0 +/- 0.2 kg] and n = 11 who lost weight [mean loss, -4.1 +/- 0.4 kg]) and (2) Hispanic women (n = 30) who had recently immigrated to North Carolina, primarily from Mexico, and were presumed to have a higher prior exposure to contaminants. Breast milk samples were analyzed for hexachlorobenzene (HCB) and DDT and its related products. There was no significant relationship between change in body composition and change in milk contaminant concentrations in either California or North Carolina women. Concentrations of HCB were similar between the California and North Carolina women, but those of DDT and related products were higher in the North Carolina subjects. Results suggest that moderate weight loss in lactating women with low exposure to environmental contaminants does not increase contaminant concentration in breast milk.

Energy expenditure, physical activity, and body composition of ambulatory adults with hereditary neuromuscular disease.

Persons with neuromuscular disease (NMD) have progressive weakness and wasting of skeletal muscle, reduced fat-free mass, and increased fat mass relative to healthy control subjects. To test the hypothesis that resting energy expenditure (REE), estimated total daily energy expenditure (TEE), and physical activity patterns are altered in ambulatory adults with NMD, 26 adult men and women with slowly progressive NMD and 19 able-bodied control subjects similar in age and weight were evaluated. REE was measured after an overnight fast by indirect calorimetry, TEE by heart rate monitoring, and body composition by air-displacement plethysmography. REE was not significantly different between NMD and control subjects; however, TEE was significantly reduced in NMD subjects compared with control subjects, respectively (women: 7.8 +/- 1.5 compared with 10.5 +/- 2.8; men: 10.2 +/- 3.6 compared with 12.7 +/- 2.6 MJ/d; P < or = 0.01), indicating that NMD subjects expended less energy in physical activity than did control subjects. NMD subjects also tended toward an increased energy cost of physical activity, particularly at higher activity levels (P = 0.06). Multiple regression analysis indicated that for all subjects combined, adiposity was positively associated with age and TEE and negatively associated with time spent in the active heart rate range and fat-free mass (P < or = 0.0001). This relation did not differ between NMD and control subjects, nor did it differ between men and women. We hypothesize that because of their reduced physical activity and increased adiposity, persons with NMD may be at risk for developing secondary conditions such as cardiovascular disease, hypertension, and diabetes.

Effects of exercise on plasma lipids and metabolism of lactating women.

To examine the effects of exercise on plasma lipids and metabolism during lactation, sedentary, exclusively breast-feeding women were randomly assigned to an exercise (E) or control (C) group at 6-8 wk postpartum. E subjects performed aerobic exercise 45 min.d-1, 5 d.wk-1, for 12 wk. Resting metabolic rate (RMR), energy expenditure, body composition, and dietary intake were measured at 6-8, 12-14, and 18-20 wk postpartum. Maximum oxygen uptake (VO2max), postprandial insulin, glucose, and thermic response, and plasma lipid levels were measured at 6-8 and 18-20 wk. VO2max increased by 25% vs 5% in the E vs the C group, respectively (P < 0.0001). RMR was similar between groups and did not change over time. Weight and percent body fat declined (P < 0.01) during the study, but there was no difference between E and C groups. Exercise marginally increased high-density lipoprotein cholesterol levels (P < 0.08), but did not affect other lipid concentrations. Insulin response decreased as VO2max increased (P = 0.05). There was no effect of time or group on glucose or thermic response. Exercise improves cardiovascular fitness during lactation, but does not increase the rate of postpartum weight loss.

A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition.

BACKGROUND: The potential risks and benefits of regular exercise during lactation have not been adequately evaluated. We investigated whether regular aerobic exercise had any effects on the volume or composition of breast milk. METHODS: Six to eight weeks post partum, 33 sedentary women whose infants were being exclusively breast-fed were randomly assigned to an exercise group (18 women) or a control group (15 women). The exercise program consisted of supervised aerobic exercise (at a level of 60 to 70 percent of the heart-rate reserve) for 45 minutes per day, 5 days per week, for 12 weeks. Energy expenditure, dietary intake, body composition, and the volume and composition of breast milk were assessed at 6 to 8, 12 to 14, and 18 to 20 weeks post partum. Maximal oxygen uptake and the plasma prolactin response to nursing were assessed at 6 to 8 and 18 to 20 weeks. RESULTS: The women in the exercise group expended about 400 kcal per day during the exercise sessions but compensated for this energy expenditure with a higher energy intake than that recorded by the control women (mean [+/- SD], intake, 2497 +/- 436 vs. 2168 +/- 328 kcal per day at 18 to 20 weeks; P < 0.05). Maximal oxygen uptake increased by 25 percent in the exercising women but by only 5 percent in the control women (P < 0.001). There were no significant differences between the two groups in maternal body weight or fat loss, the volume or composition of the breast milk, the infant weight gain, or maternal prolactin levels during the 12-week study. CONCLUSIONS: In this study, aerobic exercise performed four or five times per week beginning six to eight weeks post partum had no adverse effect on lactation and significantly improved the cardiovascular fitness of the mothers.

Energy expenditure in lactating women: a comparison of doubly labeled water and heart-rate-monitoring methods.

Estimates of total daily energy expenditure (TDEE) by heart-rate (HR) monitoring were compared with those made by the doubly labeled water (DLW) method in nine exclusively breast-feeding women. Subjects recorded HR and dietary intake daily during the 8-d, isotope-measurement period. Milk energy output was determined by 3-d test weighing and analysis of 24-h milk samples. Total energy output (milk energy and TDEE) averaged 12.36 +/- 1.03 MJ/d with DLW compared with 11.74 +/- 1.3 MJ/d with HR monitoring, a 5.8% difference (NS). Individual differences ranged from -27.1% to +17.6%. The high water turnover and relatively low level of activity during lactation made the slopes of deuterium and 18O disappearance more similar, resulting in increased error in estimates of TDEE by DLW. Therefore, the DLW method may not be appropriate for use in lactating women. There are considerable individual deviations in estimating TDEE by HR monitoring, but it is satisfactory for estimating TDEE of groups.

Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: the DARLING Study.

Factors associated with concentrations of energy-yielding nutrients in human milk were examined at 3, 6, 9, and 12 mo postpartum in the DARLING (Davis Area Research on Lactation, Infant Nutrition and Growth) Study. Samples were obtained by complete expression of alternate breasts over 24 h. Milk energy density was highly correlated with lipid concentration; both were positively related to maternal percent of ideal body weight (%IBW) at 6, 9, and 12 mo and negatively related to milk volume at 3 mo and to parity at 12 mo. Milk protein concentration was negatively related to milk volume at 6 and 9 mo and positively related to nursing frequency at 6 mo and %IBW at 9 mo. Milk lactose concentration was positively related to milk volume at 6 and 9 mo and to continued amenorrhea at 9 mo. In a subsample who completed dietary records, protein intake was positively associated with lipid concentration after 16 wk postpartum but not before. These findings suggest that milk composition is more sensitive to maternal factors such as body composition, diet, and parity during later lactation than during the first few months.

Lactation performance of exercising women.

To determine whether vigorous exercise affects lactation performance, we compared well-nourished exercising (n = 8) and sedentary (n = 8) women whose infants were 9-24 wk old and exclusively breast-fed. Measurements included resting metabolic rate (RMR); maximum oxygen consumption (VO2max); plasma prolactin, cortisol, insulin, and T3; and body composition. Each subject completed a 3-d record of dietary intake, physical activity, and milk volume (by test weighing) and collected 24-h milk samples. Exercising women differed significantly from control subjects in VO2max (46.4 vs 30.3 mL.kg-1.min-1), percent body fat (21.7 vs 27.9%), total energy expenditure (3169 vs 2398 kcal/d), and energy intake (2739 vs 2051 kcal/d). There was no difference between the groups in plasma hormones or milk energy, lipid, protein, or lactose content. Exercising subjects tended to have higher milk volume (839 vs 776 g/d) and energy output in milk (538 vs 494 kcal/d). Thus, there was no apparent adverse effect of vigorous exercise on lactation performance.