title: Vitamin B-12 Concentrations in Breast Milk Are Low and Are Not Associated with Reported Household Hunger, Recent Animal-Source Food, or Vitamin B-12 Intake in Women in Rural Kenya.
abstract: Breast milk vitamin B-12 concentration may be inadequate in regions in which animal-source food consumption is low or infrequent. Vitamin B-12 deficiency causes megaloblastic anemia and impairs growth and development in children.
  
  
  
  We measured vitamin B-12 in breast milk and examined its associations with household hunger, recent animal-source food consumption, and vitamin B-12 intake.
  
  
  
  In a cross-sectional substudy nested within a cluster-randomized trial assessing water, sanitation, hygiene, and nutrition interventions in Kenya, we sampled 286 women 1-6 mo postpartum. Mothers hand-expressed breast milk 1 min into a feeding after 90 min observed nonbreastfeeding. The Household Hunger Scale was used to measure hunger, food intake in the previous week was measured with the use of a food-frequency questionnaire (FFQ), and vitamin B-12 intake was estimated by using 24-h dietary recall. An animal-source food score was based on 10 items from the FFQ (range: 0-70). Breast milk vitamin B-12 concentration was measured with the use of a solid-phase competitive chemiluminescent enzyme immunoassay and was modeled with linear regression. Generalized estimating equations were used to account for correlated observations at the cluster level.
  
  
  
  Median (IQR) vitamin B-12 intake was 1.5 μg/d (0.3, 9.7 μg/d), and 60% of women consumed <2.4 μg/d, the estimated average requirement during lactation. Median (IQR) breast milk vitamin B-12 concentration was 113 pmol/L (61, 199 pmol/L); 89% had concentrations <310 pmol/L, the estimated adequate concentration. Moderate or severe hunger prevalence was 27%; the animal-source food score ranged from 0 to 30 item-d/wk. Hunger and recent animal-source food and vitamin B-12 intake were not associated with breast milk vitamin B-12 concentrations. Maternal age was negatively associated with breast milk vitamin B-12 concentrations.
  
  
  
  Most lactating Kenyan women consumed less than the estimated average requirement of vitamin B-12 and had low breast milk vitamin B-12 concentrations. We recommend interventions that improve vitamin B-12 intake in lactating Kenyan women to foster maternal health and child development. The main trial was registered at clinicaltrials.gov as NCT01704105.
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA;
authors.forename: Anne M
authors.initials: AM
authors.lastname: Williams
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA;
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Chantry
authors.affiliation: Department of Population Medicine and Diagnostic Sciences, Program in International Nutrition, Cornell University, Ithaca, NY;
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
authors.affiliation: Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT;
authors.forename: Beryl S
authors.initials: BS
authors.lastname: Achando
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA;
authors.forename: Lindsay H
authors.initials: LH
authors.lastname: Allen
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Arnold
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and.
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT;
authors.forename: Holly N
authors.initials: HN
authors.lastname: Dentz
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA;
authors.forename: Daniela
authors.initials: D
authors.lastname: Hampel
authors.affiliation: Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT;
authors.forename: Marion C
authors.initials: MC
authors.lastname: Kiprotich
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA; and.
authors.forename: Audrie
authors.initials: A
authors.lastname: Lin
authors.affiliation: Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT; Mathematica Policy Research, Washington, DC.
authors.forename: Clair A
authors.initials: CA
authors.lastname: Null
authors.affiliation: Innovations for Poverty Action, Nairobi, Kenya, and New Haven, CT;
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Nyambane
authors.affiliation: USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, CA;
authors.forename: Setti
authors.initials: S
authors.lastname: Shahab-Ferdows
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, CA; cpstewart@ucdavis.edu.
authors.forename: Christine P
authors.initials: CP
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000818:Animals; D001942:Breast Feeding; D003430:Cross-Sectional Studies; D004032:Diet; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D006815:Hunger; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D007774:Lactation / Q000378:metabolism*; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D008895:Milk, Human / Q000378:metabolism*; D009035:Mothers; D049590:Postpartum Period; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000378:metabolism; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000378:metabolism*; D055815:Young Adult
chemical_list: D014805:Vitamin B 12
keywords: Africa; Kenya; animal-source foods; breast milk; food security; hunger; lactation; vitamin B-12