Abstract
Background/ObjectivesInfant linear-growth faltering remains a major public health issue in low- and middle-income countries and suboptimal breast milk composition may be a local, population-specific risk factor. The relationship between early post-natal breast milk fatty acid (FA) composition and infant growth at 1 and 2 years of age was investigated prospectively in 563 families in Dhaka, Bangladesh.Subjects/MethodsA maternal breast milk sample drawn before infant age 6 weeks was analyzed for percentage composition of 26 FAs, and infant length for age Z score (LAZ) was measured longitudinally to infant age 2 years. Individual FAs were tested as predictors of the infant growth outcomes.ResultsOf 26 tested FAs, %gamma-linolenic acid (%GLA) was mostly significantly associated with increase in LAZ from 6 to 52 weeks (ΔLAZ(52−6w)), and also to 104 weeks. The association was consistent over all breast milk stages with estimated effect size of +0.05 ΔLAZ(52−6w) per 20% change in %GLA (p value = 3 × 10−6), and stronger for ΔLAZ(104−6w) at +0.06 (p value = 8 × 10−7), explaining 1% of the outcome variance. Infant serum zinc measurements at 6 and 18 weeks of age were included in adjusted analyses, suggesting at least partial independence of infant zinc levels. The association was strongest in 417/563 (74.1%) families with %GLA <0.2%. Breast milk arachidonic acid fraction was within normal range with weaker evidence of association in early breast milk stages.ConclusionsThis study found that %GLA in breast milk was independently associated with infant linear growth, albeit with small effect size, in a predominantly slum-dwelling, low-income, Bangladeshi cohort.
Highlights
Breast milk from well-nourished mothers supplies complete nutrition for a neonatal infant, with a composition that adjusts to meet the changing metabolic and nutrient needs of the infant [1]
Systematic meta-analyses have largely failed to find a significant effect for breastfeeding interventions on post-natal infant anthropometric outcomes [4], the estimated effects are highly heterogeneous, with country income and intervention setting contributing the greatest proportion of heterogeneity [5]
Long chain polyunsaturated fatty acids (LCPUFAs) are one class of micronutrient for which there is a strong biological basis for a key role in infant physical growth and cognitive development [6], but maternal or infant supplementation with LCPUFAs has resulted in little significant improvement in post-natal anthropometry outcomes through 1 or 2 years of life [7,8,9]
Summary
Breast milk from well-nourished mothers supplies complete nutrition for a neonatal infant, with a composition that adjusts to meet the changing metabolic and nutrient needs of the infant [1]. Long chain polyunsaturated fatty acids (LCPUFAs) are one class of micronutrient for which there is a strong biological basis for a key role in infant physical growth and cognitive development [6], but maternal or infant supplementation with LCPUFAs has resulted in little significant improvement in post-natal anthropometry outcomes through 1 or 2 years of life [7,8,9]. This suggests that if deficiencies exist that affect infant growth, they are specific and local
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