title: Assessment of body composition and breast milk volume in lactating mothers in pastoral communities in Pokot, Kenya, using deuterium oxide.
abstract: BACKGROUND
  In sub-Saharan Africa, the practice of breast-feeding infants is common. Records documenting the intake of breast milk amongst infants are limited. This study evaluated the association between maternal body composition and the intake of breast milk in infants from the pastoral communities within Pokot, Kenya.
  
  
  METHODS
  The study was conducted in 10 lactating mothers who were participating in a longitudinal study aimed at determining maternal body composition, iron stores and vitamin A status during the third trimester pregnancy and four months after they had given birth. Maternal and infant anthropometric measurements were made, and maternal blood samples were taken to determine serum retinol and ferritin levels. Infant milk intake and maternal fat-free mass (FFM) and percent body fat (% BF) were measured using 'the dose to the mother method'. A measured deuterium oxide ((2)H(2)O) dose was given to the mother. Urine and breast milk from the mother, and saliva samples from the infant, were collected on days 1, 8 and 14 after dosing.
  
  
  RESULTS
  The mean (+/- SD) maternal mid upper arm circumference (MUAC) and body mass index (BMI) were 21.8 (0.9) cm and 18.6 (1.0) kg/height (m(2)), respectively. Infant weight and weight/age Z score were 4.956 (0.874) kg and -1.750 (0.77), respectively. Throughout the study, the infants gained 20 (4) g/day in body weight and had a milk intake of 555 (22) ml/day. The energy intake of the infant was 1,602 (148) kJ/day and was lower (p < 0.05) than the 2,404 (423) kJ/day estimated requirement by the FAO/WHO/UNU. The maternal FFM, %BF, Hb, Hct, ferritin and retinol were 32.8 (3.1) kg, 17.24 (7.0), 11.5 (1.3) g/dl, 33.9 (4.9), 16.2 (0.1) microg/l and 0.894 (0.16) micromol/l, respectively. Infant milk intake was significantly and positively correlated to maternal pregnancy triceps (r = 0.679) p < 0.05) and pregnancy MUAC (r = 0.725) p < 0.05). Maternal pregnancy MUAC was an important predictor of infant breast milk intake.
  
  
  CONCLUSIONS
  Data on volume of breast milk consumed by the infants suggests, at least for this group of infants, that adequate growth may not be achieved. There is a possibility that lactating mothers practicing exclusive breast-feeding and living under harsh conditions may experience periods of low breast milk volume. Body composition and biochemical findings among this group of Pokot mothers indicate dietary inadequacies that require nutritional intervention.
authors.affiliation: Department of Human Nutrition and Dietetics, FHS, Moi University, Eldoret, Kenya. gaettyang@yahoo.com
authors.forename: G A
authors.initials: GA
authors.lastname: Ettyang
authors.forename: W D
authors.initials: WD
authors.lastname: van Marken Lichtenbelt
authors.forename: F
authors.initials: F
authors.lastname: Esamai
authors.forename: W H M
authors.initials: WH
authors.lastname: Saris
authors.forename: K R
authors.initials: KR
authors.lastname: Westerterp
mesh_terms: D001132:Arm / Q000502:physiology; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D017666:Deuterium Oxide / Q000008:administration & dosage* / Q000652:urine; D002149:Energy Intake / Q000502:physiology; D005260:Female; D005293:Ferritins / Q000097:blood; D006400:Hematocrit / Q000379:methods; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology*; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology; D007630:Kenya / Q000453:epidemiology; D007774:Lactation / Q000502:physiology*; D008137:Longitudinal Studies; D008895:Milk, Human / Q000378:metabolism; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D012463:Saliva / Q000378:metabolism; D012885:Skinfold Thickness; D014801:Vitamin A / Q000097:blood
chemical_list: D006454:Hemoglobins; D014801:Vitamin A; D005293:Ferritins; D017666:Deuterium Oxide