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Abstract

The objectives of this study were to describe and compare retinol, α-tocopherol and γ-tocopherol, fat, energy, and nitrogen concentrations between the foremilk and hindmilk fractions of 24-hour milk collected by 24 mothers of very preterm (< 28 weeks' gestation) infants and to relate milk vitamins A and E content to maternal vitamin intake. Concentrations of retinol were significantly higher in hindmilk than in foremilk (1.6-fold), as were concentrations of α-tocopherol (1.6-fold), γ-tocopherol (1.5-fold), fat (1.7-fold), energy (1.3-fold), and nitrogen (1.05-fold). Retinol, α-tocopherol, and γ-tocopherol were positively related (P < .05) to milk fat and energy but not to maternal intake. Estimates of vitamins A and E intakes of infants fed hindmilk with added human milk fortifier surpassed current recommended upper level of intakes. The higher fat-soluble vitamin content of hindmilk produced by mothers of very low birth weight infants needs to be considered in the design and recommendations for use of human milk fortifier. J Hum Lact . 24(2):159-167.

Los objetivos de este estudio fueron describir y comparar concentraciones de retinol, α y γ tocoferol, grasa, energía y nitrógeno en fracciones de leche materna del principio y del final de muestras obtenidas en 24 horas de 24 madres de bebes muy pretermino (< 28 semanas de gestación) y la relación del contenido de vitamina A y E en la leche con la ingesta materna de vitaminas. Las concentraciones de retinol fueron significativamente mas altas en la leche del final que en la del principio (1.6 veces mas), como las concentraciones de α-tocoferol (1.6 veces mas), γ-tocoferol (1.5 veces mas), grasa (1.7 mas), energía (1.3 mas), y nitrógeno (1.05 veces mas). El retinol, α-tocoferol, γ-tocoferol se relacionaron positivamente (P < .05) con la energía y grasa de la leche, pero no con la ingesta materna. Estimados de ingesta o consumo de vitamina A y E de los bebes alimentados con leche del final junto a fortificantes de leche materna sobrepasaron los niveles mas altos de ingesta recomendados. El alto contenido de vitaminas solubles producida en la leche del final de madres de bebes de muy bajo peso al nacer necesita consideración en el diseño y las recomendaciones del uso de fortificantes de leche materna (HMF).

Keywords

very low birth weight preterm infant hindmilk vitamin A vitamin E human milk

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References

American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496-506.

Schanler RJ Suitability of human milk for the low-birthweight infant. Clin Perinatol. 1995;22:207-222.

Canadian Paediatric Society , Nutrition Committee. Nutrient needs and feeding of premature infants. CMAJ. 1995;152:1765-1785.

Schanler RJ Fortified human milk: Nature's way to feed premature infants. J Hum Lact. 1998;14:5-11.

Cooke RJ , Ainsworth SB , Fenton AC Postnatal growth retardation: a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:F428-F430.

Ehrenkranz RA Growth outcomes of very low-birth weight infants in the newborn intensive care unit. Clin Perinatol. 2000;27:325-345.

Dobbing J. Early nutrition and later achievement. Proc Nutr Soc. 1990; 49:103-109.

Lucas A. , Morley R. , Cole TJ , Lister G. , Leeson-Payne C. Early diet in preterm babies and developmental status at 18 months. Lancet. 1990; 335:1477-1481.

Hay WW Jr , Lucas A. , Heird WC , et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics. 1999;104:1360-1368.

10.

Valentine CJ , Hurst NM , Schanler RJ Hindmilk improves weight gain in low-birth-weight-infants fed human milk. J Pediatr Gastroenterol Nutr. 1994;18:474-477.

11.

Kirsten D. , Bradford L. Hindmilk feedings. Neonatal Netw. 1999;18: 68-70.

12.

Griffin TL , Meier PP , Bradford LP , Bigger HR , Engstrom JL Mother's performing creamatocrit measures in the NICU: accuracy, reactions, and cost. J Obstet Gynecol Neonatal Nurs. 2000;29:249-257.

13.

Chappell JE , Francis T. , Clandinin MT Vitamin A and E content of human milk at early stages of lactation. Early Hum Dev. 1985;11:157-167.

14.

Dostalova L. , Salmenpera L. , Vaclavinkova V. , Heinz-Erian P. , Schuep W. Vitamin concentration of term milk of European mothers. In: Berger H , ed. Vitamins and Minerals in Pregnancy and Lactation. Nestle Nutrition Workshop Series No. 16. New York, NY: Vevey/Raven Press; 1988: 275-298.

15.

Newman V. Vitamin A and breast-feeding: a comparison of data from developed and developing countries. Food Nutr Bull. 1994;15:161-177.

16.

Villard L. , Bates CJ Effect of vitamin A supplementation on plasma and breast milk vitamin A levels in poorly nourished Gambian women. Hum Nutr Clin Nutr. 1987;41C:47-58.

17.

Willett WC , Stamfer MJ , Underwook BA , Speizer FE , Rosner B. , Hennekens CH Validation of a dietary questionnaire with plasma carotenoid and alpha-tocopherol levels. Am J Clin Nutr. 1983;38:631-639.

18.

Willett WC , Sampson L. , Stampfer MJ , et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985;122:51-65.

19.

Hunter DJ , Sampson L. , Stampfer MJ , Colditz GA , Rosner B. , Willett WC Variability in portion sizes of commonly consumed foods among a population of women in the United States. Am J Epidemiol. 1988;127: 1240-1249.

20.

Willett WC , Sampson L. , Browne ML , et al. The use of self-administered questionnaire to assess diet four years in the past. Am J Epidemiol. 1988;127:188-199.

21.

Stryker WS , Salivini S. , Stampfer MJ , Sampson L. , Colditz GA , Willett WC Contributions of specific foods to absolute intake and between-person variation of nutrient consumption. J Am Diet Assoc. 1991;91:172-178.

22.

Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press; 2001.

23.

Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press; 2000.

24.

Ballard JL , Khoury JC , Wedig K. , Wang L. , Eilers-Walsman BL , Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr. 1991;119:417-425.

25.

Bieri JG , Tolliver TJ , Catignani G. Simultaneous determination of α-tocopherol and retinol in plasma or red cells by high pressure liquid chromatography. Am J Clin Nutr . 1979;32:2143-2149.

26.

Garza C. , Butte NF , Dewey KG Determination of the energy content of human milk. In: Jensen RG , Neville MC , eds. Human Lactation 1: Milk Component and Methodologies. New York, NY: Plenum Press; 1985:121-125.

27.

Atkinson SA , Lonnerdal B. Nonprotein nitrogen fractions of human milk. In: Jensen RG , ed. Handbook of Milk Composition. San Diego, CA: Academic Press; 1995 :369-387.

28.

Neville MC , Keller RP , Seacat J. , Casey CE , Allen JC , Archer P. Studies on human lactation. I. Within-feed and between-breast variation in selected components of human milk. Am J Clin Nutr. 1984;40:635-646.

29.

Saarela T. , Kokkonen J. , Koivisto M. Macronutrient and energy contents of human milk fractions during the first six months of lactation. Acta Paediatr. 2005 ;94:1176-1181.

30.

Neville MC Volume and caloric density of human milk. In: Jensen RG , ed. Handbook of Milk Composition. San Diego, CA : Academic Press ; 1995:99-113.

31.

Hill PD , Aldag JC , Chatterton RT , Zinaman M. Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J Hum Lact. 2005 ;21:22-30.

32.

Keenan TW , Patton S. The structure of milk: Implications for sampling and storage. A. The milk lipid globule membrane. In: Jensen RG , ed. Handbook of Milk Composition. San Diego, CA: Academic Press; 1995 :5-50.

33.

Atkinson SA Effects of gestational stage at delivery on human milk components. In: Jensen RG , ed. Handbook of Milk Composition. San Diego, CA: Academic Press; 1995:222-237.

34.

Greer F. Vitamins A, E and K In: Tsang R, Uauy R, Keletzko B, Zlotkin S, eds. Nutrition of the Preterm Infant . Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, OH: Digital Educational Publishing; 2005:141-172.

35.

The American Society for Nutritional Sciences, Life Sciences Research Office. Nutrient requirements for preterm infant formulas. J Nutr. 2002; 132(6S-1).

36.

Aurvag AK , Henriksen C. , Drevon CA , Iversen PO , Nakstad B. Improved vitamin A supplementation regimen for breastfed very low birth weight infants. Acta Paediatr. 2007;96:1296-1302.

37.

Thomas MR , Chan GM , Book LS Comparison of macronutrient concentration of preterm human milk between two milk expression techniques and two techniques for quantitation of energy. J Pediatr Gastroenterol Nutr. 1986;5:597-601.

38.

Dorea JG , Horner MR , Bezerra VL , Campanate ML Variation in major constituents of fore- and hindmilk of Brazilian women. J Trop Pediatr. 1982;28:303-305.

39.

Hall B. Uniformity of human milk. Am J Clin Nutr. 1979;32:304-312.

40.

Lonnerdal B. Effects of maternal dietary intake on human milk composition. J Nutr. 1986;116:499-513.

41.

Bates CJ Vitamin A in pregnancy and lactation. Proc Nutr Soc. 1983; 42:65-79.

42.

Canfield LM , Giuliano AR , Graver EJ Carotenoids, retinoids, and vitamin K in human milk. In: Jensen RG , ed. Handbook of Milk Composition . San Diego, CA: Academic Press; 1995:693-705.

43.

Ortega RM , Andres P. , Martinez RM , Lopez-Sobaler AM Vitamin A status during the third trimester of pregnancy in Spanish women: Influence on concentration of vitamin A in breast milk. Am J Clin Nutr. 1997;66:564-568.

44.

Lammi-Keefe CJ , Jensen RG Fat-soluble vitamins in human milk. Nutr Rev. 1984;42:365-371.

45.

Lammi-Keefe CJ , Jensen RG State of the art, lipids in human milk: a review. 2: Composition and fat-soluble vitamins. J Pediatr Gastroenterol Nutr. 1984;3:172-198.

46.

Emmett PM , Rogers IS Properties of human milk and their relationship with maternal nutrition. Early Hum Dev. 1997;49(suppl): S7-S28.

47.

Thomas MR , Pearsons MH , Demkowicz M. , Chan IM , Lewis CG Vitamin A and vitamin E concentration of the milk from mothers of pre-term infants and milk of mothers of term infants. Acta Vitaminol Enzymol. 1981;3:135-144.

48.

Slusher T. , Hampton R. , Bode-Thomas F. , Pam S. , Akor F. , Meier P. Promoting the exclusive feeding of own mother's milk through the use of hindmilk and increased maternal milk volume for hospitalized, low birth weight infants (<1800 grams) in Nigeria: a feasibility study. J Hum Lact . 2003;19:191-198.

49.

Vasan U. , Meier W. , Kirsten D. , Meier R. Lactoengineering of own mothers' milk: effects on weight gain for preterm infants <1000 g at birth [abstract]. Hot Topics. 1997:401-402.

Nutrient Composition of Hindmilk Produced by Mothers of Very Low Birth Weight Infants Born at Less Than 28 Weeks' Gestation

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