Breast milk intake is not reduced more by the introduction of energy dense complementary food than by typical infant porridge

The effect of different energy densities of complementary foods on breast milk consumption is not well understood. In this study, we tested the hypothesis that provision of fortified spread (FS), a micronutrient fortified, energy-dense (22 kJ/g), ready-to-use food, to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour (CSB). Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospective, parallel group, investigator-blinded, randomized controlled complementary feeding trial. Infants were randomized to receive 25 g/d of FS, 50 g/d of FS, or 72 g/d of CSB. The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique. Outcomes were compared using repeated measures ANOVA. A total of 41 mother-infant pairs completed the study. At enrollment, 88% of the infants had received corn porridge. At baseline, the infants consumed 129 +/- 18 g.kg body wt(-1) x d(-1) (mean +/- SD) of breast milk. After 1 mo of complementary feeding with 25 g/d FS, 50 g/d FS, or 72 g/d CSB, their breast milk consumption was 115 +/- 18 g.kg body wt(-1) x d(-1), a significant reduction; however, the effects of the complementary foods did not differ from one another (F-value model = 4.33, P = 0.0008 for effect of time and P = 0.69 for effect of type of food). The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge.     

Zinc and iron nutrition in Chilean children fed fortified milk provided by the Complementary National Food Program

OBJECTIVE: Chilean infants are at risk for isolated zinc and iron deficiencies because of a low consumption of animal products in low socioeconomic sectors. In 1999, the National Complementary Food Program of Chile manufactured a new milk (2 kg of powdered milk/mo) fortified with iron (Fe; 10 mg/L), zinc (Zn; 5 mg/L), and copper (0.5 mg/L) to be provided to infants until age 18 mo and to pregnant women. We analyzed the nutrition status of zinc and iron at age 18 mo in infants who consumed the fortified cow's milk. METHODS: Forty-two healthy male children with normal growth and from lower socioeconomic groups were studied. A nutrition survey was conducted; blood and hair samples for Zn in plasma and hair, hemoglobin, hematocrit, and serum ferritin were obtained. RESULTS: Mean intakes were: energy, 106 +/- 27 kcal. kg(-1). d(-1); protein, 3.8 +/- 1.1 g. kg(-1). d(-1); Zn, 5.2 +/- 1.9 g/d (0.98 mg Zn/MJ; 68% of World Health Organization recommendations); Fe, 11.2 +/- 5.5 mg/d; and dietary fiber, 9.8 +/- 3.9 g/d. Plasma Zn in 54.8% of children was no greater than 12.3 microM/L; 36% had hair Zn level no greater than 1.23 microM/g and 39% had serum ferritin levels no greater than 10 microg/dL (12% were anemic). Hair Zn was correlated to socioeconomic level (Spearman's rank correlation, r = -0.53; P < 0.001) and plasma Zn was correlated to the z weight/length (r = 0.47; P < 0.05), subscapular skinfold (r = 0.46; P < 0.05), and Zn intake (r = 0.46; P < 0.05). CONCLUSIONS: The fortified powdered cow's milk provided to infants until age 18 mo by the Complementary Food Program in Chile favorably affects the Fe status of these children, but possibly not the Zn nutrition; we suggest re-evaluation of the levels of Zn fortification.     

Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras

BACKGROUND: The optimal age at which to introduce complementary foods is a topic of considerable debate. OBJECTIVE: This study was designed to evaluate this issue in a nutritionally vulnerable population in Honduras. DESIGN: Mothers of low-birth-weight (1500-2500 g) term (ie, small-for-gestational-age) infants were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, mothers were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or to feed complementary solid foods (jarred rice cereal, chicken, and fruit and vegetables) twice daily from 4 to 6 mo while continuing to breast-feed at their initial frequency (SF; n = 60). At 4 and 6 mo, breast milk and total energy intake were measured for a nonrandom subsample (those who could stay overnight in a central unit: 32 EBF and 31 SF). RESULTS: At 4 mo, breast milk intake in the subsample was not significantly different between groups (EBF: 729 +/- 135 g/d; SF: 683 +/- 151 g/d: P >0.2); from 4 to 6 mo it increased (by 28 g/d) in the EBF group but decreased (by 39 g/d) in the SF group (P < 0.005). Nonetheless, total energy intake (including solid foods) increased more from 4 to 6 mo in the SF than in the EBF group. However, there were no significant differences between groups in weight or length gain during the intervention or subsequently (6-12 mo). CONCLUSION: There was no growth advantage of complementary feeding of small-for-gestational-age, breast-fed infants between 4 and 6 mo of age.     

Nonbreast-fed HIV-1-exposed Burkinabe infants have low energy intake between 6 and 11 months of age despite free access to infant food aid

In a WHO-coordinated, mother-to-child HIV transmission (MTCT) prevention trial in Burkina Faso, HIV-1-infected mothers were advised to either stop breast-feeding by 6 mo or totally avoid it. Participants were provided with cereal-based, infant fortified mix (IFM) from 6 to 12 mo postpartum along with infant feeding counseling. Our objective was to describe nonbreast-fed infants' food consumption and adequacy of nutrient intake. A 1-d weighed food record and one 24-h dietary recall were performed in 68 nonbreast-fed, non-HIV-infected 6- to 11-mo-old infants. Mean food energy density and feeding frequency were satisfactory in 6-8 mo olds [0.8 ± 0.2 kcal/g (3.3 ± 0.9 kJ/g) and 7.2 ± 1.6 times/d] and in 9-11 mo olds [0.9 ± 0.2 kcal/g (3.6 ± 0.8 kJ/g) and 7.7 ± 2.1 times/d]. Median energy intake was 523 kcal [range: 82-1053 (2187 kJ, range: 345-4401)] in 6-8- and 811 kcal [range: 34-1543 (3392 kJ, range: 144-6452)] in 9-11-mo-old infants, respectively. Approximately 75% of their energy intake was provided by subsidized foods (milk that mothers obtained from support networks and IFM). One-half of the infants had intakes < 80 kcal/kg (<334 kJ/kg) on the day of the survey, mainly because IFM and milk were consumed in amounts that were too low. Thus, coverage of energy needs required a diet with sufficient amounts of both IFM and milk in these vulnerable infants. These findings argue for the development of adequate, sustainable infant fortified foods and their rapid integration into MTCT prevention services. They also lend support to the recent revision of WHO infant feeding guidance for future MTCT prevention programming that recommends breast-feeding up to 12 mo postpartum (under cover of antiretroviral prophylaxis) as the safest feeding option for infants of HIV-infected mothers.     

Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana

BACKGROUND: Micronutrient deficiencies are common during infancy, and optimal approaches for their prevention need to be identified. OBJECTIVE: The objective was to compare the efficacy and acceptability of Sprinkles (SP), crushable Nutritabs (NT), and fat-based Nutributter (NB; 108 kcal/d), which provide 6, 16, and 19 vitamins and minerals, respectively, when used for home fortification of complementary foods. DESIGN: Ghanaian infants were randomly assigned to receive SP (n = 105), NT (n = 105), or NB (n = 103) daily from 6 to 12 mo of age. We assessed dietary intake, morbidity, and compliance weekly. Hemoglobin and plasma ferritin, TfR, C-reactive protein, and zinc were measured at 6 and 12 mo. We used an exit interview to assess acceptability. A randomly selected control group of infants who received no intervention (NI; n = 96) were assessed at 12 mo. RESULTS: All supplements were well accepted, and the mean percentage of days that supplements were consumed (87%) did not differ between groups. At 12 mo, all 3 intervention groups had significantly higher ferritin and lower TfR concentrations than did the NI control group. Mean (+/- SD) hemoglobin was significantly higher in NT (112 +/- 14 g/L) and NB (114 +/- 14 g/L) but not in SP (110 +/- 14 g/L) infants than in NI infants (106 +/- 14 g/L). The prevalence of iron deficiency anemia was 31% in the NI control group compared with 10% in the intervention groups combined (P < 0.0001). CONCLUSION: All 3 options for home fortification of complementary foods are effective for reducing the prevalence of iron deficiency in such populations.     

Effects of early extra fluid and food intake on breast milk consumption and infant nutritional status at 5 months of age in an urban and a rural area of Burkina Faso

OBJECTIVE: To assess the effects of early extra fluid and food intake on breast milk consumption and the effects of food intake on 5-month-old infant nutritional status. DESIGN: Cross-sectional surveys. Infants were selected by random choice. SETTINGS: Urban and rural Burkina Faso. SUBJECTS: A total of 97 urban and 69 rural infants were recruited, but 67 and 51, respectively, completed the surveys. Infant selection criteria were: age (5 +/- 0.5-month old), thriving, breastfed, having Burkinabè parents in study area for a year, study conditions accepted by parents. INTERVENTION: Surveys were conducted respectively in January and February 2001 (urban), and 2002 (rural) during the cool season. They were performed by home visit. With the help of health workers and traditional midwives, families were informed of the studies' objectives and gave agreement. Food intakes were estimated by test-weighing for breast milk and precise weighing techniques for other foods. Socioeconomic status of households, anthropometry of infants and mothers were also recorded. Breast milk samples were collected from each mother's breast and analysed for lipid and fatty acid concentrations. RESULTS: Daily breast milk intake did not differ between urban (776 +/- 262 g) and rural areas (835 +/- 265 g). Porridge intake was, respectively, 128 +/- 105 and 96 +/- 49 g. Median extra fluid intake was, respectively, 79 and 122 g. In both areas, porridge and fluid intake had no effect on breast milk consumption. In urban areas, infant nutritional status at 5 months was better than at birth. CONCLUSION: Breast milk intake and nutritional status of predominantly breastfed infants at 5 months of age, living in both urban and rural settings, were not affected by the consumption of extra fluid or food intake.     

Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods

We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean +/- SD weight-for-length Z-score = -0.92 +/- 0.88) and moderately stunted (length-for-age Z-score = -1.49 +/- 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (kJ/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk.     

0～6月龄纯母乳喂养儿每日母乳摄入量评估

母乳能为婴儿提供出生后最初6个月所需的能量和绝大多数营养素。健康、纯母乳喂养儿的平均每日母乳摄入量是制定婴儿营养素适宜摄入量的重要依据。称重法和氘标水法是估计婴儿母乳摄入量的主要方法。本文检索了近30年母亲健康的0～6月龄健康、纯母乳喂养儿的平均母乳(成熟乳)摄入量,估算为日均776.6±141.5 g,即749.6ml/d;取整数为780 g/d或750 ml/d。因此,在估计我国0～6月龄婴儿营养素适宜摄入量时,推荐采用婴儿母乳摄入量780 g/d(或750 ml/d)。[营养学报,2013,35(2):134-136,141]     

Lactation counseling increases breast-feeding duration but not breast milk intake as measured by isotopic methods

The importance of exclusive breast-feeding in the first 6 mo of life is widely recognized, but most mothers still do not reach this goal. Several studies have shown that face-to-face lactation counseling is effective in increasing not only exclusive breast-feeding rates but also the total duration of breast-feeding. However, it is unclear whether counseling could increase breast milk intake. The purpose of this study was to evaluate the effect of lactation counseling on breast milk intake, assessed through the deuterium dilution method. This was a blind, randomized intervention trial of lactation counseling in a sample of 188 babies born in Pelotas, selected with the same criteria used for the WHO Multicentre Growth Reference Study (MGRS). The main outcomes were breast-feeding pattern and duration for all infants as well as breast milk intake for a subsample of 68 infants at the age of 4 mo. Mothers in the control group were almost twice as likely to stop breast-feeding by 4 mo as those in the intervention group (prevalence ratio 1.85; P = 0.04). Cox regression confirmed that the velocity of weaning was twice as high in the control group. Breast milk and total water intakes did not differ between the groups. The deuterium dilution technique proved to be a practical means of assessing breast milk intake. Lactation counseling reduced early weaning, but breast milk intake at 4 mo was not affected.     

Complementary feeding with cow's milk alters sleeping metabolic rate in breast-fed infants

Although it is widely accepted that energy expenditure in infants is a function of feeding pattern, the mechanism behind this is not well understood. The objectives of this observational study were as follows: 1) to compare minimal observable energy expenditure (MOEE) between 2 subgroups of breast-fed infants, a BM group in which breast milk was the only source of milk and a BCM group given cow's milk in addition to breast milk; and 2) to identify potential mediators of a feeding pattern effect. For this purpose, infants were classified by feeding group on the basis of a mother's recall. Respiration calorimetry was used to measure MOEE in 62 infants (n = 35 BM, n = 27 BCM) aged 8.7 mo in Pelotas, southern Brazil. Breast-milk intake was measured using deuterium oxide, complementary food intake by 1-d food weighing, total energy expenditure and total body water using doubly labeled water; anthropometric indices were calculated. MOEE was 1672 +/- 175 kJ/d in BM compared with 1858 +/- 210 kJ/d in BCM infants (P < 0.001). Mass-specific MOEE was 201 +/- 24.6 and 216 +/- 31.9 kJ/(kg . d) in BM and BCM infants, respectively (P = 0.041). MOEE (kJ/d) was mediated by protein intake and fat-free mass (R(2) = 41.4%). We conclude that complementary feeding with cow's milk alters the sleeping metabolic rate in breast-fed infants. These findings deserve attention in relation to "metabolic programming" and the development of obesity later in life.     

Human milk intake and growth faltering of rural Mesoamerindian infants.

To determine whether growth faltering during early infancy was attributable to inadequate intake of human milk, the nutrient intakes and growth of 30 Otomi infants from Capulhuac, Mexico, were studied at 4 or 6 mo of age. Growth was monitored monthly from 1 through 6 mo of age. The 2H dose-to-the-mother method was used to measure human milk intake. Energy, protein, lactose, and fat concentrations in milk were analyzed by standard techniques. Mean (+/- SD) human milk intakes were 885 +/- 145 and 869 +/- 150 g/d at 4 and 6 mo, respectively. Protein and lactose concentrations in milk were normal but fat and consequently energy concentrations were abnormally low. Energy intakes averaged 81 +/- 14 kcal.kg-1.d-1 at 4 mo and 72 +/- 14 kcal.kg-1.d-1 at 6 mo. Growth faltering by 6 mo was evidenced by the significant decline in growth velocities and National Center for Health Statistics Z scores. Weight gain at 6 mo was 8.1 +/- 3.5 g/d and length gain was 1.0 +/- 0.34 cm/mo. Weight-for-age and length-for-age Z scores were -0.81 +/- 0.94 and -1.51 +/- 0.83, respectively. Growth velocities were not significantly correlated with nutrient intakes. Growth faltering among the Otomi infants despite energy intakes comparable to those of breast-fed infants in more protected environments may have resulted from an increase in the need for nutrients or from a growth-limiting nutrient, other than energy, in their diet.     

Association between fat content of breast milk and maternal nutritional status and infants' weight in tabriz, iran

The aim of this study was to investigate the relationship between breast milk fat content with maternal anthropometric status, energy and macronutrient intake and weight for age Z-score of exclusively breastfed infants. Breast milk samples and information on energy and macronutrients intake (using 24-hour recall method for 3 days) were collected from 182 lactating women. Weight and height of mothers and infants were measured and the body mass index (BMI) and weight for age Z-score (WAZ) were calculated. The fat content of the milk samples was measured by the Gerber method. The mean daily energy intake was 2390 ± 405 kcal which was lower than the recommended values for mothers. The mean fat content of the milk samples was 3.52 ± 1.41 g/dl, which was significantly associated with dietary carbohydrate consumption (β= 0.39, P<0.004) and BMI (β= 0.28, P<0.02). A significant association between the WAZ of infants and maternal BMI (β= 0.36, P<0.001) was recorded. The WAZ of infants whose mothers' breast milk lipid content was more than 3 g/dl was significantly higher than those whose mothers had lower breast milk lipid content (P<0.031). Further studies need to be done on the effect of fat content of breast milk on infant's weight and how maternal factors regulate the composition of breast milk.     

Energy metabolism, body composition, and milk production in healthy Swedish women during lactation

Variables of relevance to energy requirements during reproduction were studied in 23 healthy lactating Swedish women. Body composition and resting metabolic rate (RMR) were studied before pregnancy and three times postpartum. Energy intake was studied before pregnancy and, together with breast-milk production, 2 mo postpartum. The women gained 5.8 +/- 4.2 kg fat during pregnancy and their average fat content was unchanged during the first 2 mo of lactation whereas a slight loss (1.7 +/- 4.2 kg) occurred during the following 4 mo. RMR increased slightly during lactation in spite of a decrease in fat-free body weight 2 and 6 mo postpartum. Energy intake increased during lactation (280 +/- 440 kcal/d). The women produced 740 +/- 150 g breast milk/d containing 0.64 +/- 0.08 kcal/g. The results indicate that current estimates of energy needs during lactation may be too high.     

Breast milk and lipid intake distributions for assessing cumulative exposure and risk

Breast milk consumption is the primary route of infant exposure to certain lipophilic toxicants that have accumulated over decades in maternal adipose tissue, as well as to less persistent toxicants from maternal exposure during lactation. Such infant exposures occur at a time of rapid growth and development when susceptibility to certain toxicants can be greatest. Breast milk and lipid intake rates are presented for the 0-6 and 0-12 month age periods for infants fed according to the American Academy of Pediatrics' current recommendations (exclusive breast-feeding for 0-6 months and continued breast-feeding to 12 months). Intake rates are normalized to infant bodyweight to account for the covariance of consumption and bodyweight. Frequency distributions describe the population variability in intake. For age 0-12 months, daily average milk intake is 100.7 +/- 22.7 g/kg day (mean +/- SD), with a 95th percentile of 153.5 g/kg day. Breast milk intake distributions are also developed for infants exclusively breast-fed (no significant calories from non-breast milk sources) over their first year, and for the entire (nursing and non-nursing) infant population. For short-term exposures, intake can be derived from the regression equation presented here. Lipid intake estimated assuming a 4% lipid content (current risk assessment practice) is compared and found comparable to that derived from measured lipid content. The national trend of increased breast-feeding found in surveys further supports including the breast milk pathway in risk assessment.     

Nutritional transition during infancy in East Java, Indonesia: 1. A longitudinal study of feeding pattern, breast milk intake and the consumption of additional foods

Infant feeding pattern was studied longitudinally from birth to 52 weeks among all infants born in the period September 1982-December 1984 in three villages in Madura, East Java (n = 687). Genuine demand breast-feeding was practised but it is the custom to force-feed infants from as early as the third day after birth until about 16 weeks. In a sub-sample the intake of breast milk and additional foods were measured, longitudinally in 76 infants and cross-sectionally in 77 infants. Breast milk intake ranged from 745 g per 24 h in the first month to 640 g per 24 h in the 12th month. Force-feeding did not have a negative influence on breast milk intake. The main constraint in infant feeding is the low intake of additional foods, which remained at 180 kcal and 3 g protein per day from the age of 16 weeks onwards.     

Effects of varied energy density of complementary foods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children

BACKGROUND: Information is needed to design studies of the effects of complementary feeding regimens on children's intakes of complementary foods (CFs) and breast milk. OBJECTIVE: We evaluated the effects of varied energy density of CFs on the time until stabilization of dietary intakes and on total daily energy intakes (EIs) and breast-milk intakes. DESIGN: CFs with low [0.4 kcal/g (LD)] and high [1.5 kcal/g (HD)] energy density were fed 3 times/d to 10 children (aged 9-18 mo) during 2 randomly assigned sequences of three 8-d diet periods (HD-LD-HD or LD-HD-LD) along with ad libitum breastfeeding. CF and breast-milk intakes were measured. RESULTS: Intakes of the HD diet and breast milk did not vary by day of period, but intake of the LD diet increased progressively. During days 5-7 of the last 2 diet periods in each sequence, more of the LD than of the HD diet was consumed (752 +/- 252 and 439 +/- 111 g/d, respectively; P < 0.001), but EIs from CFs were greater with the HD diet. Breast-milk consumption was slightly less (192 +/- 115 and 234 +/- 121 g/d, respectively; P = 0.03) but total daily EI was greater (774 +/- 175 and 441 +/- 85 kcal/d, respectively; P < 0.001) during the HD than during the LD diet period. CONCLUSIONS: New information on the effects of newly introduced diets on daily intakes of these diets and of breast milk can be used to design future studies. Total daily EIs were greater with the HD diet despite its negative effects on breast-milk intakes.     

Breast milk and energy intake in exclusively, predominantly, and partially breast-fed infants

OBJECTIVE: To investigate the extent to which breast milk is replaced by intake of other liquids or foods, and to estimate energy intake of infants defined as exclusively (EBF), predominantly (PBF) and partially breast-fed (PartBF). DESIGN: Cross-sectional. SETTING: Community-based study in urban Pelotas, Southern Brazil. SUBJECTS: A total of 70 infants aged 4 months recruited at birth. MAIN OUTCOME MEASURES: Breast milk intake measured using a "dose-to-the-mother" deuterium-oxide turnover method; feeding pattern and macronutrient intake assessed using a frequency questionnaire. RESULTS: Adjusted mean breast milk intakes were not different between EBF and PBF (EBF, 806 g/day vs PBF, 778 g/day, P=0.59). The difference between EBF and PartBF was significant (PartBF, 603 g/day, P=0.004). Mean intakes of water from supplements were 10 g/day (EBF), 134 g/day (PBF) and 395 g/day (PartBF). Compared to EBF these differences were significant (EBF vs PBF, P=0.005; EBF vs PartBF, P<0.001).The energy intake of infants receiving cow or formula milk (BF+CM/FM) in addition to breast milk tended to be 20% higher than the energy intake of EBF infants (EBF, 347 kJ/kg/day vs BF+CM/FM, 418 kJ/kg/day, P=0.11). CONCLUSIONS: There was no evidence that breast milk was replaced by water, tea or juice in PBF compared to EBF infants. The energy intake in BF+CM/FM infants tended to be 20% above the latest recommendations (1996) for breast-fed and 9% above those for formula-fed infants. If high intakes are maintained, this may result in obesity later in life. SPONSORSHIP: International Atomic Energy Agency through RC 10981/R1.     

Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children

BACKGROUND: Information is needed on the minimum energy density and feeding frequency of complementary foods that can provide adequate energy intakes (EIs) for healthy breastfed children. OBJECTIVES: The objectives of the study were to evaluate the effects of various energy densities and feeding frequencies of complementary foods on EI from these foods, breast milk consumption, and total EI from both sources. DESIGN: During 9 separate, randomly ordered dietary periods lasting 3-6 d each, we measured intakes of food and breast milk by 18 healthy breastfed children 8-11 mo of age who, 3, 4, or 5 times/d, were fed porridge with a coded energy density of 0.5, 1.0, or 1.5 kcal/g. Food intake was measured by weighing the feeding bowl before and after meals, and breast milk intake was measured by test weighing. RESULTS: The mean amounts of complementary foods consumed were inversely related to their energy density and positively related to the number of meals/d (P < 0.001 for both); EIs from foods were positively related to both factors. Breast milk intake decreased slightly but progressively, with greater energy density and feeding frequency of complementary foods; total EIs (kcal/d) increased in relation to both factors (P < 0.001 for both). CONCLUSIONS: The energy density and feeding frequency of complementary foods affect infants' total daily EI and breast milk consumption. Recommendations can be developed for the appropriate combinations of these dietary factors that are compatible with adequate EI, although longer-term effects of complementary feeding practices on breast milk intake and breastfeeding duration need further community-based studies.     

Prevention of iron deficiency by milk fortification. II. A field trial with a full-fat acidified milk

In a longitudinal study from age 3 to 15 mo, 276 term, healthy, spontaneously weaned infants received a full-fat acidified milk fortified with 15 mg of elemental Fe as ferrous sulfate and 100 mg of ascorbic acid/100 g of powder and 278 control infants received milk without additives. At ages 9 and 15 mo significant differences were encountered in all measures of Fe nutriture in favor of the fortified group (p less than 0.001). Anemia (Hg less than 110 g/L) was present in 25.7% of unfortified infants compared with only 2.5% in those fortified at age 15 mo. Saturation of transferrin less than 9% was present in 33.8% and serum ferritin less than 10 micrograms/L in 39.1% of the nonfortified infants. The figures for the fortified group were 7 and 8.5% respectively. The efficiency of the fortified acidified milk in eradicating Fe deficiency in the infants while discouraging use by other family members make this milk a useful targeted product in programs of supplementary food distribution in the underdeveloped world.     

Protein requirements of infants: a reexamination of concepts and approaches

Estimates of protein requirements of infants aged 3-4 mo by FAO/WHO/UNU (1.47 +/- 0.26 g.kg-1.d-1 as crude protein, N X 6.25) are judged to be overestimates. From simulation analyses we suggest that 1.1 +/- 0.1 - 0.2 g.kg-1.d-1 is a more reasonable estimate. This is consistent with statements that 1) breast milk that provides an average of 16 g protein/1000 kcal or a fixed-composition formula that contains 17 g protein/1000 kcal is adequate for essentially all such infants and 2) average protein intakes from that milk or formula would be approximately 1.65 or 1.75 g.kg-1.d-1, close to current average requirements estimates. It appears that there has been a difference in the concepts of requirement usually applied to infants and to adults and a systematic misinterpretation of breast-milk data in estimating requirements. A plea is issued for the application of epidemiologic approaches as a part of requirement estimation.