Breast Milk Retinol Research Articles

Short-Term Daily Consumption of Provitamin A Carotenoid–Biofortified Maize Has Limited Impact on Breast Milk Retinol Concentrations in Zambian Women Enrolled in a Randomized Controlled Feeding Trial

Background: Provitamin A carotenoid–biofortified maize is a conventionally bred staple crop designed to help prevent vitamin A deficiency. Lactating women are a potential target group, because regularly eating biofortified maize may increase vitamin A in breast milk—a critical source of vitamin A for breastfeeding infants.Objective: We assessed whether daily consumption of biofortified orange maize would increase the retinol concentration in the breast milk of Zambian women.Methods: Lactating women (n = 149) were randomly assigned to receive orange maize delivering 600 μg retinol equivalents (REs)/d as carotenoid plus placebo (OM), low-carotenoid white maize plus 600 μg REs/d as retinyl palmitate (VA), or white maize plus placebo (WM). Boiled maize (287 g dry weight/d) was served as 2 meals/d, 6 d/wk for 3 wk. We measured initial and final breast milk plasma retinol and β-carotene concentrations, and plasma inflammatory protein concentrations.Results: Groups were comparable at enrollment, with an overall geometric mean milk retinol concentration of 0.95 μmol/L (95% CI: 0.86, 1.05 μmol/L); 56% of samples had milk retinol <1.05 μmol/L. Median capsule and maize intake was 97% and 258 g dry weight/d, respectively. Final milk β-carotene did not vary across groups (P = 0.76). Geometric mean (95% CI) milk retinol concentration tended to be higher in the OM [1.15 μmol/L (0.96, 1.39 μmol/L)] and VA [1.17 μmol/L (0.99, 1.38 μmol/L)] groups than in the WM group [0.91 μmol/L (0.72, 1.14 μmol/L); P = 0.13], and the proportion of women with milk retinol <1.05 μmol/L was 52.1%, 42.9%, and 36.7% in the WM, OM, and VA groups, respectively (P-trend = 0.16).Conclusions: Daily biofortified maize consumption did not increase mean milk retinol concentration in lactating Zambian women; however, there was a plausible downward trend in the risk of low milk retinol across intervention groups. This trial was registered at clinicaltrials.gov as NCT01922713.

Effect of Short‐Term Maternal Supplementation with Small Amounts of Vitamin A or Beta‐Carotene on Breast Milk Retinol Concentrations among Lactating Filipino Women

This study assessed the effect of daily supplementation with low doses of vitamin A (VA, as retinyl palmitate) or β‐carotene, in amounts that could be provided by fortified or biofortified foods, on breast milk and plasma retinol concentrations after 1 d or 3 wk of supplementation, and after 1 wk of discontinuing supplementation.Lactating women (18–45 y; n=85) were randomly assigned to receive capsules containing 600 μg RAE/d as either retinol (VA group) or β‐carotene (BC group) in corn oil, or 0 μg RAE/d (oil only; control). The daily dose was delivered as 2 capsules/d along with low‐VA meals, 6 d/week for 3 wk. Fasting blood samples were collected at baseline (d 0) and after 3‐wk of supplementation (d 22). Fasting breast milk samples were collected on days 0, 1, 2, 22 and 29, using both “full” and “casual” milk collection methods. Milk was also collected before and after a single meal (d1AM and d1PM) to assess the effect of one dose of VA or BC on milk VA. Plasma and milk retinol and BC concentrations were measured by HPLC, inflammatory markers by ELISA, milk fat by creamatocrit, and β‐carotene‐15,15″‐mono‐oxygenase (BCO1) polymorphisms by PCR.At baseline, the prevalence of low plasma retinol (22% &lt;1.05 μmol/L) and low milk retinol (64% (full) and 53% (casual) &lt;28 nmol/g fat) did not differ by group. After 3 wk of supplementation, controlling for baseline, mean plasma retinol concentration was greater in the VA group (inflammation‐adjusted mean±SE 1.56 ± 0.29 μmol/L) relative to the control group (1.31 ± 0.44 μmol/L; P&lt;0.01), whereas that of the BC group (1.48 ± 0.33 μmol/L) did not differ from either the VA or control groups (P&gt;0.1). Controlling for baseline, mean milk retinol concentration at d 22 was greater in the VA group relative to the control group (full: 33.8 ± 18.4 vs 24.0 ± 7.3 nmol/g fat; casual: 32.0 ± 13.4 vs 24.1 ± 9.4 nmol/g fat; P&lt;0.01); this difference persisted 1 wk after discontinuing supplementation (day 29; P&lt;0.05). In full milk samples, the mean milk retinol concentration in the BC group (d 22: 27.8 ± 10.1 nmol/g fat) did not differ from that of the control group at d 22 or d 29. In casual samples, the mean milk retinol concentration was greater in the BC group (d22: 29.2 ± 9.4 nmol/g fat) vs the control group on day 22 (P&lt;0.05) but not d 29, and did not differ from the VA group at either time. Mean milk retinol concentrations did not increase in response to a single VA or BC capsule (d1AM vs d1PM), or to a single day of VA or BC capsule receipt (d1AM vs d2AM) relative to the control group. BCO1 variants were prevalent but did not modify the effect of BC capsules on plasma or milk retinol (although power to detect interactions was limited).In summary, an effect of supplementation with small daily doses of retinol was detected in both plasma and breast milk after only 3 wk of supplementation, suggesting that breast milk is useful for evaluating food‐based interventions with retinol, such as fortification. The effect of BC was less consistent, so evaluation of the response to increased provitamin A intake may require a larger sample size or longer duration of supplementation.Support or Funding InformationThis study was supported by the Bill &amp; Melinda Gates Foundation.

Vitamin A supplementation for postpartum women.

In areas where vitamin A deficiency (VAD) is a public health concern, the maternal dietary intake of vitamin A may be not sufficient to meet either the maternal nutritional requirements, or those of the breastfed infant, due the low retinol concentrations in breast milk. To evaluate the effects of vitamin A supplementation for postpartum women on maternal and infant health. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 February 2016), LILACS (1982 to December 2015), Web of Science (1945 to December 2015), and the reference lists of retrieved studies. Randomised controlled trials (RCTs) or cluster-randomised trials that assessed the effects of vitamin A supplementation for postpartum women on maternal and infant health (morbidity, mortality and vitamin A nutritional status). Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. Fourteen trials of mainly low or unclear risk of bias, enrolling 25,758 women and infant pairs were included. The supplementation schemes included high, single or double doses of vitamin A (200,000 to 400,000 internation units (IU)), or 7.8 mg daily beta-carotene compared with placebo, no treatment, other (iron); or higher (400,000 IU) versus lower dose (200,000 IU). In all trials, a considerable proportion of infants were at least partially breastfed until six months. Supplement (vitamin A as retinyl, water-miscible or beta-carotene) 200,000 to 400,000 IU versus control (placebo or no treatment) Maternal: We did not find evidence that vitamin A supplementation reduced maternal mortality at 12 months (hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.44 to 2.21; 8577 participants; 1 RCT, moderate-quality evidence). Effects were less certain at six months (risk ratio (RR) 0.50, 95% CI 0.09 to 2.71; 564 participants; 1 RCT; low-quality evidence). The effect on maternal morbidity (diarrhoea, respiratory infections, fever) was uncertain because the quality of evidence was very low (50 participants, 1 RCT). We found insufficient evidence that vitamin A increases abdominal pain (RR 1.28, 95% CI 0.95 to 1.73; 786 participants; 1 RCT; low-quality evidence). We found low-quality evidence that vitamin A supplementation increased breast milk retinol concentrations by 0.20 µmol/L at three to three and a half months (mean difference (MD) 0.20 µmol/L, 95% CI 0.08 to 0.31; 837 participants; 6 RCTs). Infant: We did not find evidence that vitamin A supplementation reduced infant mortality at two to 12 months (RR 1.08, 95% CI 0.77 to 1.52; 6090 participants; 5 RCTs; low-quality evidence). Effects on morbidity (gastroenteritis at three months) was uncertain (RR 6.03, 95% CI 0.30 to 121.82; 84 participants; 1 RCT; very low-quality evidence). There was low-quality evidence for the effect on infant adverse outcomes (bulging fontanelle at 24 to 48 hours) (RR 2.00, 95% CI 0.61 to 6.55; 444 participants; 1 RCT). Supplement (vitamin A as retinyl) 400,000 IU versus 200,000 IUThree studies (1312 participants) were included in this comparison. None of the studies assessed maternal mortality, maternal morbidity or infant mortality. Findings from one study showed that there may be little or no difference in infant morbidity between the doses (diarrhoea, respiratory illnesses, and febrile illnesses) (312 participants, data not pooled). No firm conclusion could be drawn on the impact on maternal and infant adverse outcomes (limited data available).The effect on breast milk retinol was also uncertain due to the small amount of information available. There was no evidence of benefit from different doses of vitamin A supplementation for postpartum women on maternal and infant mortality and morbidity, compared with other doses or placebo. Although maternal breast milk retinol concentrations improved with supplementation, this did not translate to health benefits for either women or infants. Few studies reported on maternal and infant mortality and morbidity. Future studies should include these important outcomes.

Lipid-Based Nutrient Supplements Providing Approximately the Recommended Daily Intake of Vitamin A Do Not Increase Breast Milk Retinol Concentrations among Ghanaian Women

Background: Vitamin A deficiency remains a global public health problem. Daily supplementation with a lipid-based nutrient supplement (LNS) has potential for increasing milk vitamin A concentrations.Objective: The objective of this study was to determine whether daily supplementation with approximately the recommended daily intake of vitamin A in an LNS or a multiple-micronutrient supplement (MMN) during pregnancy and the first 6 mo postpartum has an effect on breast milk retinol concentration at 6 mo postpartum.Methods: Women ≤20 wk pregnant (n = 1320) were randomly assigned to receive either the MMN providing 18 micronutrients, including 800 μg retinol equivalents of vitamin A, or the LNS with the same nutrients as the MMN group, plus 4 minerals and macronutrients, until 6 mo postpartum; a control group received iron and folic acid during pregnancy and a placebo (calcium tablet) during the first 6 mo postpartum. Breast milk samples collected at 6 mo postpartum were analyzed for retinol and fat concentrations by HPLC and creamatocrit, respectively, in a subsample of 756 women.Results: The breast milk retinol concentration was (mean ± SD) 56.3 ± 2.1 nmol/g fat, with no significant differences between groups [iron and folic acid (n = 243): 59.1 ± 2.8; MMN (n = 260): 55.4 ± 2.5; LNS (n = 253): 54.7 ± 2.5 nmol/g fat; P = 0.45], regardless of whether the woman had or had not received a high-dose vitamin A supplement (200,000 IU) soon after childbirth. Around 17% of participants had low milk retinol (≤28 nmol/g fat). We estimated that 41% of infants were potentially receiving vitamin A at amounts above the Tolerable Upper Intake Level (600 μg retinol activity equivalents/d), with no group differences in percentages with low or high milk retinol concentration.Conclusion: Daily consumption of approximately the recommended intake of vitamin A did not increase breast milk retinol concentrations in this sample of Ghanaian women. This trial was registered at clinicaltrials.gov as NCT00970866.

Dose to the Mother Method: Milk Intake and Vitamin A Transfer to the Lactating Infant of Mexican Mothers, Using Stable Isotopes

ObjectiveTo assess the breast milk intake and transfer of vitamin A (VA) from the mother to the breastfed child in lactating Mexican women from rural and urban areas.MethodsMilk intake was assessed with the dose to the mother method, briefly deuterated water is administered to the mother and the appearance of the isotope is measured in the breastfed child's and mother's saliva; deuterium enrichment (stable isotope) is analyzed by FTIR. Breast milk retinol (BMR) concentration was determined by HPLC and the cutoff to define VA deficiency was 1.05 µmol/L.ResultsSubjects were 27 and 32 women‐child pairs from urban and rural areas of northwest Mexico, respectively. Mean breast milk intake 727.35 ± 224 mL and it was significantly lower in children from the rural area (P=0.04). Mean BMR concentration was 1.11 μmol/L and 53% of women had VAD. BMR concentration was lower for the rural area (P=0.038). By combining both determinations (DTM and BMR), results showed that breastfed children from the rural and urban area reached only 47% and 64% of their VA recommended dietary intake (P=0.051), respectively.ConclusionVAD is still a public health problem in Mexico and requires new approaches to fight it effectively.Study supported by Universidad de Sonora.

Influence of Inflammation on Breast Milk Retinol Concentrations of Apparently Healthy Women in Rural Zambia

Breast milk retinol concentration may be less influenced by inflammation than plasma retinol. However, evidence is available from only a single study which was conducted in early lactation. We investigated this question in a cross‐sectional sample of apparently healthy, lactating mothers (n=144) at 4‐12 months postpartum in rural Zambia. We measured milk and plasma retinol by HPLC and inflammatory proteins by ELISA. Inflammation (CRP &gt; 5 mg/L and/or AGP &gt; 1 g/L) was highly prevalent (69.2%), even though women with malaria parasitemia and/or fever or diarrhea in the past week were excluded from the study. Women with inflammation were older and had both higher parity and BMI. Unadjusted analyses suggested an elevated prevalence of low plasma retinol (7.4 vs. 2.3%; p=0.23), but reduced prevalence of low milk retinol (51.5 vs. 65.1%; p=0.14), with concurrent inflammation. In adjusted models; however, only plasma retinol was significantly associated with inflammatory proteins (p=0.04 for test of CRP and AGP parameters). Inflammatory proteins were not associated with milk retinol, expressed either as vitamin A per volume (μmol/L; p=0.63) or per gram milk fat (μg/g fat; p=0.37). Our findings are consistent with prior research, suggesting that breast milk retinol concentration may be useful for evaluating vitamin A interventions in populations with a high prevalence of infection and/or subclinical inflammation.

Effect of Zinc and High-Dose Vitamin A Supplementation to Retinol and Zinc Levels of Breast Milk in the Malnutrition Pregnant Women in Third Trimester

Zinc and high-dose vitamin A supplementation in the malnutrition pregnant women in third trimester could increase retinol and zinc levels in breast milk. This research applied an experimental design of double blind randomized tests (pre-test and post-test) on two groups (trial and control groups) to analyze the effect of zinc and high-dose vitamin A supplementation. Variables of interest were measured two times, pre-test and post-test. Data were collected through questionnaire-based interviews, laboratory tests of blood samples and breast milk. Based on the inclusion criteria, 32 malnutrition pregnant women were selected as samples. The sample was randomly assigned to two groups, trial and control groups. Based on t-tests, the effects of supplementation were analyzed. The results showed that there was no significant differences of zinc (p < 0.386) and retinol levels (p < 0.948) of breast milk between pre and post-tests within control group and trial group. The conclusion is there was no difference on zinc and retinol levels of breast milk between the control and trial groups. These results suggested that zinc and high-dose vitamin A supplementation has no effect to retinol and zinc levels of breast milk in the control and trial groups.

PENILAIAN STATUS VITAMIN A SECARA BIOKIMIA

VITAMIN A ASSESSMENT BY BIOCHEMICAL METHODS Vitamin A has an important preventive effects on maternal and child mortality. Vitamin A deficiency (VAD) is one of the most devastating dietary deficiencies. Several methods are available to assess VAD. Tradisionally, clinical signs and symptoms of xerophthalmia were used to identify the severity of population with vitamin A deficiency. Biochemical assessment methods available which include serum retinol, serum retinol binding protein, serum retinyl ester, serum carotenoids, dose response test, the deuterated retinol isotope dilution test and breast milk retinol concentrations. The determination of of retinol in blood (serum retinol concentrations) is one of the most frequently used methods, have been used extensively to identify populations at risk of vitamin A deficiency. However, this method has several limitations. The major drawback of serum retinol is taking blood samples are required. Beside that, serum retinol is decreased only in sever VAD, when liver stores are nearly exhausted. Because the majority of vitamin A in the body is stored in the liver, then the tests to measure vitamin A stores should be developed in order to know the vitamin A status. Vitamin A concentration in breast milk is a prospective indicator of VAD. Breast milk collection is less invasive and usually easier than blood drawing, do not have to be further processed at the field station, thus shortening sample preparation. For the future indicator of vitamin A, methods that are in development include using isotope dilution. Keywords : breast milk retinol, serum retinol, vitamin A analysis

Vitamin A status and body composition in Mexican lactating women from rural and urban areas using the stable isotope “dose to the mother” technique (645.11)

Objective: To assess the association between breast milk vitamin A (VA) concentration and body composition in lactating Mexican women from rural and urban areas. Methods: Milk production was assessed with the dose to the mother method (DTM), briefly deuterated water is administered to the mother and the appearance of the isotope is measured in the breastfed child’s and mother’s saliva; deuterium enrichment (stable isotope) is analyzed by FTIR, and additional to breast milk production we can also assess the mother’s body composition. Breast milk (BM) retinol was determined by HPLC and the cutoff to define VA deficiency was 1.05 µmol/L. Results: Subjects were 27 and 32 women from urban and rural areas of northwest Mexico, respectively. 53% of women had VA deficiency, and prevalence was similar for both areas (P=0.735). BM retinol concentration was lower for the rural area (P=0.038). When using WHO cutoff points for body fat percentage for non‐lactating women, 63 % and 56% of the study subjects had increased body fat. There was a tendency in reduction of BM Retinol when body fat increases (r= ‐ 0.251; P=0.055). Conclusion: Increase in body fat has a negative impact on BM retinol concentration of lactating women from rural and urban areas of northwest Mexico.Grant Funding Source: Supported by Universidad de Sonora

Evaluating the effectiveness of a nutrition‐sensitive agriculture intervention in Western Kenya: design of the Mama SASHA cohort study of vitamin A (1019.2)

The 2013 Lancet Maternal and Child Nutrition series identified evaluations of nutrition‐sensitive agricultural interventions as a research priority. The Mama SASHA study in Western Kenya links delivery of vitamin A (VA) rich orange‐flesh sweet potato (OFSP) to antenatal care to improve VA and nutritional status of pregnant and lactating women and their children. The evaluation strategy includes a nested longitudinal study following women and their infants from pregnancy to 9 months postpartum. VA status is assessed using infection‐adjusted plasma retinol binding protein and breastmilk retinol (postpartum). Maternal and child infection, iron, and anemia status, anthropometry, diet, health services uptake, and food security status are also measured. 505 eligible pregnant women, attending ANC at 4 control and 4 intervention facilities, were consented and enrolled. At enrollment women in control and intervention communities did not differ with respect to VA, iron, anemia or anthropometric status; food security or dietary diversity scores; demographic characteristics; awareness of vitamin A; or consumption of vitamin A rich foods in the past 7 days. Only 10 women consumed OFSP in the previous 7 days; all in intervention communities. The longitudinal study will contribute to rigorous evaluation of the OFSP intervention on maternal and child VA status and allow assessment of program impact pathways.Grant Funding Source: Bill and Melinda Gates Foundation

Breast Milk Retinol and Plasma Retinol-Binding Protein Concentrations Provide Similar Estimates of Vitamin A Deficiency Prevalence and Identify Similar Risk Groups among Women in Cameroon but Breast Milk Retinol Underestimates the Prevalence of Deficiency among Young Children1–3

Breast milk vitamin A (BMVA) has been proposed as an indicator of population vitamin A status but has rarely been applied in large-scale surveys or compared with conventional vitamin A biomarkers. We assessed the prevalence of, and risk factors for, low BMVA and its relation to vitamin A intake, plasma retinol-binding protein (pRBP), and markers of inflammation in a national survey in Cameroon. We randomly selected 30 clusters in each of 3 strata (South, North, and Cities). Casual milk samples were collected from approximately 5 women per cluster (n = 440). pRBP, plasma C-reactive protein (pCRP), plasma α1-acid glycoprotein (pAGP), and 24-h vitamin A intake were assessed in 10 women aged 15–49 y and 10 children aged 12–59 mo per cluster, including a subset of lactating women (n = 253). Low BMVA was infrequent: 7.2% (95% CI: 4.7, 9.8) of values were <1.05 μmol/L, and 9.3% (95% CI: 5.8, 12.7) were <8 μg/g fat, consistent with the low prevalence of pRBP <0.78 μmol/L among women (< 5%) but lower than the prevalence of pRBP <0.83 μmol/L among children (35%). Risk factors for both low BMVA and pRBP included living in the North and low maternal education. BMVA was positively associated with inflammation-adjusted pRBP among women in the lowest vitamin A intake tertile [<115 μg retinol activity equivalents (RAEs)/d, P < 0.01] but not in the highest tertile (>644 μg RAEs/d, P > 0.4). Controlling for milk fat, BMVA was negatively associated with pCRP (P < 0.02) but not pAGP (P > 0.5). BMVA and pRBP provide similar estimates of vitamin A deficiency prevalence and identify the same risk groups among women in Cameroon, but BMVA underestimates the prevalence of vitamin A deficiency among young children.

Comparison of a new high-resolution monolithic column with core-shell and fully porous columns for the analysis of retinol and α-tocopherol in human serum and breast milk by ultra-high-performance liquid chromatography†

The reduction of analysis time, cost, and improvement of separation efficiency are the main requirements in the development of high-throughput assay methods in bioanalysis. It can be achieved either by ultra-high-performance liquid chromatography (UHPLC) using stationary phases with small particles (<2 μm) at high back pressures or by using opposite direction--monolithic stationary phases with low back pressures. The application of new types of monolithic stationary phases for UHPLC is a novel idea combining these two different paths. The aim of this work was to test the recently introduced second-generation of monolithic column Chromolith® HighResolution for UHPLC analysis of liposoluble vitamins in comparison with core-shell and fully porous sub-2 μm columns with different particle sizes, column lengths, and shapes. The separation efficiency, peak shape, resolution, time of analysis, consumption of mobile phase, and lifetime of columns were calculated and compared. The main purpose of the study was to find a new, not only economical option of separation of liposoluble vitamins for routine practice.

The effect of short‐term frozen storage of human milk on the validity of Vitamin A assays using the iCHECKTM rapid analyzer

BackgroundBreast milk retinol concentration is an indicator of both infant nutrient intake and population vitamin A status. Milk is easily and non‐invasively collected and rapid field methods for vitamin A analysis now exist.ObjectiveTo confirm or refute the assertion of restricting fluorescent assaying of milk vitamin A to “unfrozen” samples (Schweigert et al, Sight &amp; Life Magazine 2011 (2) 18–22).MethodsFull‐breast expression milk samples were collected in 21 women from Mam‐Mayan rural communities in the Western Highlands of Guatemala. A milk‐fat packing volume (creamatocrit), expressed in volume percent (vol%), was measured on a hematocrit microcentrifuge. Retinol concentration was assayed, both fresh and after 20–26 d at −20°C, on an iCHECKTM rapid field analyzer (Bioanalyt, Telbow, Germany).ResultsRespective retinol concentrations were 539±221 μg/L (fresh) and 528±205 μg/L (post‐freezing) (p=0.45), with a Pearson correlation coefficient (P) and Spearman coefficient (S) both of r=0.959 (p=0.001). The corresponding values for creamatocrit were 8.1±3.1 vol% vs 9.0±4.0 vol% (p=0.17), with r=0.774 (p=0.001)(P) and r=0.844 (p=0.001)(S).ConclusionsMilk samples can be stored for at least 3 wks without affecting the validity of iCHECKTMassays. Funded by Sight &amp; Life of Basel and Tufts University School of Medicine

Application of core–shell technology for determination of retinol and alpha-tocopherol in breast milk

Breast milk is a main source of fat-soluble vitamins for newborns and it is needful to monitor the nutritional status prior to its application. In this work a novel, high-throughput and low-cost method for monitoring of retinol and alpha-tocopherol in breast milk was developed, validated and compared with reference method using monolithic column.For this purpose five various porous shell and monolithic columns were tested on the basis of relationship between HETP and linear mobile phase velocity, analysis time and consumption of solvents. Finally the core–shell analytical column Kinetex C18 (2.6μm, 100Å, 100×4.6mm) was chosen as the best and optimal values of flow rate, injection volume and temperature of analysis were established.The detection of retinol and alpha-tocopherol was carried out at 325 and 295nm, respectively by diode array detector. The LOD 0.004μmol/L and 0.078μmol/L, the LOQ 0.012μmol/L and 0.182μmol/L for retinol and alpha-tocopherol, respectively were calculated. The validation data showed good linearity, repeatability of retention time with RSD 0.22% and 0.12%, repeatability of peak area with RSD 6.94% and 1.75%, recovery 114.1–116.3% and 99.0–108.6% for retinol and alpha-tocopherol, respectively. Moreover, the newly developed method substantially decreased the solvent consumption by about 263mL per 100 samples with the total time of analysis 1.75min in comparison with analysis time 1.80 of the reference method.

High Prevalence of Vitamin A Deficiency Is Detected by the Modified Relative Dose-Response Test in Six-Month-Old Senegalese Breast-Fed Infants ,

To alleviate vitamin A (VA) deficiency (VAD) in Senegal, understanding the relationship between VA status of lactating women and their 6-mo-old infants is important. This study measured 6-mo-old infants' VA intake from human milk and assessed the VA status of mothers and infants. A comprehensive study was undertaken in 34 mother-infant pairs. Nonpregnant lactating women and their infants were included. None of the infants had received a VA supplement. Mothers were grouped as supplemented with 2 doses of 200,000 IU (60,000 μg; 210 μmol) retinol as retinyl palmitate (n = 13) or nonsupplemented (n = 19) after delivery. Breast milk intake was measured by the deuterium dilution technique. Plasma and breast milk retinol concentrations were measured by HPLC. Infants' VA liver stores were assessed by the modified relative dose-response (MRDR) test. Plasma retinol detected 15% VAD among infants and the MRDR test (≥0.06) indicated 73.5% with low VA liver stores. Infants' milk VA intakes were close to estimated requirements (375 μg/d). No correlation was found between infants' plasma retinol and MRDR value. Infants' MRDR value was lower in the group from supplemented mothers (0.055 ± 0.017 vs. 0.073 ± 0.017; P = 0.009), but no difference was observed between plasma retinol concentrations of both groups of mothers; 8.8% of mothers were VA deficient based on plasma retinol (≤0.7 μmol/L). Low VA liver stores were prevalent among Senegalese infants at the beginning of the complementary feeding period. Postpartum VA-supplemented mothers significantly enhanced their infants' VA liver stores.

Rapid sample preparation procedure for determination of retinol and α-tocopherol in human breast milk

The liposoluble vitamins (retinol and α-tocopherol) concentration in human breast milk is of a cardinal knowledge especially for nutrition of prematurely born. It enables the feeding optimization of these important micronutrients for preterm infants.The novel rapid liquid–liquid extraction procedure for human breast milk investigation was developed and validated according to FDA guidelines. The recovery of retinol was 82–90% measured at three concentration levels 1.0, 2.5 and 5.0μmol/L, for α-tocopherol 92–109% at concentration levels 2.5, 5.0 and 10.0μmol/L. The repeatability of extraction procedure expressed as relative standard deviation was 3.26% for retinol and 4.79% for α-tocopherol.Developed extraction procedure was applied on 120 human breast milk samples. The separation of vitamins was completed using advantages of a monolithic column which accomplished demands of acceleration made by modern bio-analytical HPLC methodology. The analytes of interest were detected by diode-array detector at wavelengths 325nm for retinol and 290nm for α-tocopherol.

Impact of maternal vitamin A supplementation on the mother–infant pair in Brazil

Vitamin A deficiency (VAD) is a major public health problem. The supplementation of lactating women could be an effective strategy to combat it. The objective of this study was to assess the impact of maternal vitamin A supplementation on the mother-infant pair. This was a double blind, placebo-controlled randomized clinical assay in which 33 women received 200 000 IU of vitamin A and 33 women received soy oil between 20th and 30th postpartum days. Maternal blood and milk samples were collected immediately before supplementation and 3 months after delivery, when blood was also collected from the babies. Retinol concentrations 0.70 μmol/l in serum and 1.05 μmol/l in milk were considered to indicate VAD. Increase in serum retinol level was observed in the supplemented group compared with the pre-supplementation levels (1.05 and 1.17 μmol/l, respectively; P=0.026) and to the post-supplementation levels of the control group (1.02 μmol/l; P=0.032). Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 μmol/l, respectively; P<0.0001) and to the post-supplementation levels of the supplemented group (1.56 μmol/l; P=0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P=0.002). VAD was present in 66.1% (39/59) of infants, with mean serum retinol levels of 0.64±0.30 μmol/l in the control group and of 0.69±0.26 μmol/l in the supplemented group. Supplementation had a positive impact on maternal vitamin A status. No effect on infant status was detectable 2 months after supplementation with a single dose.

Effect of dietary fat supplementation during late pregnancy and first six months of lactation on maternal and infant vitamin A status in rural Bangladesh.

Dietary fat intake is extremely low in most communities with vitamin A deficiency. However, its role in vitamin A status of pregnant and lactating women is poorly understood. The aim of the study was to examine the effect of supplementing women with fat from mid-/late pregnancy until six months postpartum on their vitamin A status and that of their infants. Women recruited at 5-7 months of gestation were supplemented daily with 20 mL of soybean-oil (n = 248) until six months postpartum or received no supplement (n = 251). Dietary fat intake was assessed by 24-hour dietary recall at enrollment and at 1, 3 and 6 months postpartum. Concentrations of maternal plasma retinol, beta-carotene, and lutein were measured at enrollment and at 1, 3 and 6 months postpartum, and those of infants at six months postpartum. Concentration of breastmilk retinol was measured at 1, 3 and 6 months postpartum. The change in concentration of plasma retinol at three months postpartum compared to pregnancy was significantly higher in the supplemented compared to the control women (+0.04 vs -0.07 micromol/L respectively; p < 0.05). Concentrations of plasma beta-carotene and lutein declined in both the groups during the postpartum period but the decline was significantly less in the supplemented than in the control women at one month (beta-carotene -0.07 vs -0.13 micromol/L, p < 0.05); lutein -0.26 vs -0.49 micromol/L, p < 0.05) and three months (beta-carotene -0.04 vs -0.08 micromol/L, p < 0.05; lutein -0.31 vs -0.47 micromol/L, p < 0.05). Concentration of breastmilk retinol was also significantly greater in the supplemented group at three months postpartum than in the controls (0.68 +/- 0.35 vs 0.55 +/- 0.34 micromol/L respectively, p < 0.03). Concentrations of infants' plasma retinol, beta-carotene, and lutein, measured at six months of age, did not differ between the groups. Fat supplementation during pregnancy and lactation in women with a very low intake of dietary fat has beneficial effects on maternal postpartum vitamin A status.

Vitamin A status of healthy children in Manisa, Turkey

BackgroundVitamin A deficiency is a major public health nutrition problem in the developing world. Even subclinical Vitamin A deficiency is associated with increased childhood mortality. Severe maternal vitamin A deficiency may cause increased mortality in the first months of life. There have been a limited number of studies regarding vitamin A status in Turkey. The aim of this study was to assess vitamin A status of healthy children in Manisa, Turkey.MethodsVitamin A status of 100 healthy children aged 36-48 months is evaluated. The children were seen during routine examination. Serum retinol concentrations were measured by high-performance liquid chromatography. Duration of breast feeding, age solid foods introduced, use of supplementary vitamins, weight and height, and intake of specific groups of nutrients on a daily, weekly and monthly basis were collected from a questionnaire completed by the mothers. Height and weight z-scores were calculated according to national standards. Mothers of 20 of the 100 children were known to have normal serum and breast milk retinol concentrations. Children with normal serum retinol concentration were compared with the children with VAD. Student's t-test and Mann-Whitney test were used to compare independent variables. The Pearson correlation analysis test was used to test relation between numeric variables.ResultsMean retinol concentration was 0.98 ± 0.32 μmol/L in the whole study group. Serum retinol concentrations were normal (>0.70 μmol/L) in 89% of the children. When children with normal serum retinol concentrations were compared with those with retinol concentrations lower than 0.70 μmol/L, there was no difference in terms of age, gender, weight and height at the time of study, z-scores, birth weight, birth length, duration of breast feeding, time to begin solid food, rate of supplementary vitamin use, and rate of infections (P > 0.05). There was not any relation between vitamin A concentrations and weight and height at the time of study, z-scores, birth weight, birth length, duration of breast feeding, time to begin solid food, vitamin use, and frequency of intake of specific groups of nutrients (P > 0.05).ConclusionsThis study showed that VAD is a moderate health problem in Manisa.

A Randomized Trial Evaluating the Effect of 2 Regimens of Maternal Vitamin A Supplementation on Breast Milk Retinol Levels

The aim of this study was to assess the effect of 2 different megadoses of retinyl palmitate on the level of retinol in the breast milk of healthy women. In total, 199 women were randomly allocated to 3 groups and supplemented in the postpartum period with a single retinyl palmitate dose of 200 000 IU (S1), a double dose of 200 000 IU 24 hours apart (S2), or no supplementation (C). Retinol content of colostrum and mature milk at 4 weeks was determined by high-performance liquid chromatography (HPLC). For colostrum, no significant difference was found between the groups (P = .965). The retinol content in mature milk differed between group C and groups S1 and S2 (P < .05). The double dose of vitamin A did not significantly increase the retinol content of milk at 4 weeks postpartum in comparison to a single dose; however, future research is needed to determine the optimal timing of the second dose of vitamin A.