Impact of a Postpartum Lifestyle Intervention on Lactation outcomes, Breastmilk Composition and Infant Growth

项目总结/摘要 在美国，超过50%的女性在怀孕时超重或肥胖。肥胖的女性 2.6倍更有可能经历哺乳失败，独立于母乳喂养的意图， 对两代人的健康造成不良影响。炎症是肥胖的代谢标志， 与泌乳失败有关，但机制研究评估泌乳失败的机制 在女性中是稀疏的。我们现在有一个独特的机会，通过生活方式来解决这一知识差距 妊娠准备干预（LIPP）研究，一项生活方式（营养）的随机对照试验 和运动）干预超重和I类肥胖的妇女谁是计划随后的 在接下来的两年里怀孕。LIPP参与者在产后三个月和基线后招募 代谢测量，随机接受密切监督的生活方式干预，包括热量 限制饮食，改为地中海饮食模式和锻炼9-21个月，或标准护理。的 LIPP哺乳研究旨在了解这种干预对哺乳结果和母乳的影响 混合物.我们的总体假设是，一个有利的产后代谢环境， 通过更长的哺乳期对两代人的代谢健康产生持久影响， 改变母乳脂肪酸组成。我们将通过以下具体步骤来评估这一假设 目标：目标1。量化产后生活方式干预对哺乳期的影响， 基本机制;目标2。为了确定生活方式干预和随后的饮食和 能量消耗模式对母乳脂肪酸组成和婴儿生长的影响;探索性目标3。到 确定母亲生活方式干预对母乳代谢模式的影响。产后 这一时期作为改善孕产妇和婴儿终身健康的一个关键时期，没有得到充分利用。 从科学上讲，LIPP哺乳期研究将从根本上严格告知我们对哺乳期的理解。 哺乳结果的潜在机制和母乳成分的母体预测因子， 利用母LIPP研究的RCT设计。从公共卫生的角度来看，LIPP Lactation提供 这是一个独特的机会，可以确定离散的代谢目标，以干预肥胖妇女， 两代人的健康。

PROJECT SUMMARY/ABSTRACT Over 50% of women in the U.S. are overweight or obese when they enter pregnancy. Women with obesity are 2.6 times more likely to experience lactation failure, independent of intention to breastfeed, contributing to adverse health outcomes for two generations. Inflammation, a metabolic hallmark of obesity, has been associated with lactation failure, but mechanistic studies evaluating the mechanisms underlying lactation failure in women are sparse. We now have a unique opportunity to address this knowledge gap through The Lifestyle Intervention in Preparation for Pregnancy (LIPP) study, a randomized controlled trial of a lifestyle (nutritional and exercise) intervention in women with overweight and class I obesity who are planning a subsequent pregnancy in the next two years. LIPP participants are recruited three months post-partum and after baseline metabolic measurements, are randomized to a closely supervised lifestyle intervention, consisting of caloric restriction with a shift to a Mediterranean diet pattern and exercise for 9-21 months, or standard care. The LIPP Lactation study seeks to understand the impact of this intervention on lactation outcomes and breastmilk composition. Our overall hypothesis is that a favorable post-partum metabolic environment has a durable impact on the metabolic health of two generations through longer lactation duration and altered breastmilk fatty acid composition. We will evaluate this hypothesis through the following specific aims: Aim 1. To quantify the effect of a post-partum lifestyle intervention on lactation duration and identify underlying mechanisms; Aim 2. To determine the impact of a lifestyle intervention and subsequent dietary and energy expenditure patterns on breastmilk fatty acid composition and infant growth; Exploratory Aim 3. To identify the impact of maternal lifestyle intervention on breastmilk metabolomic patterns. The post-partum period has been under-leveraged as a critical period to improve lifelong maternal and infant health. Scientifically, the LIPP Lactation study will fundamentally and rigorously inform our understanding of the mechanisms underlying lactation outcomes and the maternal predictors of breastmilk composition by leveraging the RCT design of the parent LIPP study. From a public health standpoint, LIPP Lactation provides a unique opportunity to identify discrete metabolic targets for intervention in women with obesity, to improve the lifelong health of two generations.