Diet, energy expenditure, and body composition of lactating Ribeirinha women in the Brazilian Amazon.

Lactation is the most energetically demanding part of human reproduction; yet, compared with pregnancy, we know little about the strategies women in different settings employ to cope with these increased energy demands. This paper takes a biocultural approach and reports longitudinal data on the anthropometry, dietary intakes and energy expenditure of a sample of 23 rural, lactating Ribeirinha women living in subsistence-based communities in the eastern Amazon. The dietary intakes of these lactating women were insufficient to meet their lactating energy needs and were least sufficient during resguardo, a 40-day period in the immediate postpartum when the women observed a series of food taboos and work restrictions. Instead, the women in this study met the increased energy demands of lactation by drawing on their energy reserves and reducing their energy expenditure in physical activity. The women showed a significant reduction in weight (P<0.001), BMI (P<0.001) and in circumferences (hip, P=0.01; waist, P=0.03) and skinfolds (thigh, P=0.03) in the gluteal femoral region. Total daily energy expenditure (TDEE) was lowest during resguardo and increased as lactation progressed (P=0.01). While the practice of resguardo reduced maternal energy expenditure and allowed women more time to spend with their newborn infants, it came at a cost (low dietary intake), which appears to be related to the loss of the adult woman from subsistence activities. By taking a biocultural approach this study illustrates the role the social environment plays in shaping the experience of lactating women.