title: Lipid-Based Nutrient Supplements Providing Approximately the Recommended Daily Intake of Vitamin A Do Not Increase Breast Milk Retinol Concentrations among Ghanaian Women.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; Department of Nutrition and Food Science, University of Ghana, Accra, Ghana; and.
authors.forename: Moses K
authors.identifier: http://orcid.org/0000-0003-2447-9020
authors.initials: MK
authors.lastname: Klevor
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA;
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Haskell
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Accra, Ghana; and.
authors.forename: Anna
authors.initials: A
authors.lastname: Lartey
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Accra, Ghana; and.
authors.forename: Seth
authors.initials: S
authors.lastname: Adu-Afarwuah
authors.affiliation: Nutriset S.A.S., Malaunay, France.
authors.forename: Mamane
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; kgdewey@ucdavis.edu.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D000328:Adult; D001942:Breast Feeding; D019587:Dietary Supplements; D005260:Female; D005869:Ghana; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation / Q000378:metabolism*; D008055:Lipids / Q000494:pharmacology*; D018977:Micronutrients / Q000494:pharmacology; D008895:Milk, Human / Q000378:metabolism*; D009752:Nutritional Status / Q000187:drug effects*; D011181:Postnatal Care; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011295:Prenatal Care; D064167:Recommended Dietary Allowances; D014801:Vitamin A / Q000097:blood / Q000494:pharmacology; D014802:Vitamin A Deficiency / Q000188:drug therapy; D014815:Vitamins / Q000097:blood / Q000494:pharmacology; D055815:Young Adult
chemical_list: D008055:Lipids; D018977:Micronutrients; D014815:Vitamins; D014801:Vitamin A
keywords: breast milk; children; deficiency; lactation; micronutrient supplement; pregnancy; vitamin A