title: Lipid-based nutrient supplements do not decrease breast milk intake of Malawian infants.
abstract: BACKGROUND
  The potential for small-quantity lipid-based nutrient supplements (LNS) to promote growth and development after 6 mo of age is currently being investigated. Because infants self-regulate energy intake, consumption of LNS may reduce breast milk intake and potentially decrease the beneficial effects of breast milk.
  
  
  OBJECTIVE
  The objective was to test the hypothesis that the breast milk intake of 9- to 10-mo-old rural Malawian infants receiving LNS would not be lower than that of infants receiving no supplementation.
  
  
  METHODS
  This was a substudy of the International Lipid-based Nutrient Supplements (iLiNS) DOSE trial, in which 6-mo-old infants were randomly assigned to receive 10, 20, or 40 g LNS/d containing 56, 117, or 241 kcal/d, respectively, or no LNS until 18 mo of age. A subset was randomly selected to estimate breast milk intake at 9-10 mo of age with the dose-to-mother deuterium oxide dilution method. The noninferiority margin was <10% of total energy requirements.
  
  
  RESULTS
  Baseline characteristics (n = 376) were similar across groups. The mean (± SD) daily breast milk intake of unsupplemented infants was 730 ± 226 g. The differences (95% CIs) in mean intake of infants provided with 10, 20, or 40 g LNS/d, compared with controls, were +62 (-18, +143), +30 (-40, +99), and +2 (-68, +72) g/d, respectively. Non-breast milk oral water intake did not differ by group (P = 0.39) and was inversely (r = -0.22, P < 0.01) associated with breast milk intake.
  
  
  CONCLUSIONS
  In this rural Malawian population, breast milk intake at 9-10 mo of age was not reduced by supplementation with complementary foods with 10-40 g LNS/d.
authors.affiliation: Department of International Health, University of Tampere School of Medicine, Tampere, Finland (CK and PA); the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA (MJH and KGD); the Department of Nutrition and Public Health Intervention Research, London School of Hygiene and Tropical Medicine, London, United Kingdom (JH); and the Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi (CK and KM).
authors.forename: Chiza
authors.initials: C
authors.lastname: Kumwenda
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.forename: Jaimie
authors.initials: J
authors.lastname: Hemsworth
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Haskell
mesh_terms: D001942:Breast Feeding; D002657:Child Development; D017666:Deuterium Oxide; D004041:Dietary Fats / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004044:Dietary Proteins / Q000627:therapeutic use; D019587:Dietary Supplements / Q000009:adverse effects*; D004326:Drinking; D002149:Energy Intake; D005228:Fatty Acids, Essential / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000009:adverse effects; D007228:Infant Nutrition Disorders / Q000517:prevention & control; D007227:Infant Nutritional Physiological Phenomena; D008295:Malawi; D008297:Male; D018977:Micronutrients / Q000627:therapeutic use; D008903:Minerals / Q000627:therapeutic use; D009035:Mothers; D011865:Radioisotope Dilution Technique; D012423:Rural Health
chemical_list: D004041:Dietary Fats; D004044:Dietary Proteins; D005228:Fatty Acids, Essential; D018977:Micronutrients; D008903:Minerals; D017666:Deuterium Oxide