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

项目摘要/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 与母乳喂养的意图无关，经历哺乳失败的可能性高出2.6倍，导致 两代人的不良健康后果。炎症，肥胖的一个代谢标志，一直是 与哺乳失败有关，但机制研究评估了哺乳失败的机制 在女人身上是稀少的。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鸿沟 妊娠准备干预(LIPP)研究，一项关于生活方式(营养)的随机对照试验 和运动)对超重和I类肥胖的女性进行干预，这些女性计划进行后续的 在接下来的两年怀孕。LIPP参与者在产后三个月和基线后被招募 新陈代谢测量，随机进入密切监督的生活方式干预，包括卡路里 限制，转向地中海饮食模式，锻炼9-21个月，或标准护理。这个 理柏哺乳研究试图了解这种干预对哺乳结局和母乳的影响 组成。我们的总体假设是产后良好的新陈代谢环境 更长的哺乳期和更长的哺乳时间对两代人代谢健康的持久影响 改变母乳中的脂肪酸组成。我们将通过以下具体实例来评估这一假设 目的：目的1.量化产后生活方式干预对哺乳期的影响，并确定 基本机制；目标2。确定生活方式干预和随后的饮食和 母乳脂肪酸组成与婴儿生长发育的能量消耗模式：探索性目标3至 确定母亲生活方式干预对母乳代谢模式的影响。产后 这一时期一直被认为是改善终身母婴健康的关键时期。 从科学上讲，利普哺乳研究将从根本上和严格地帮助我们理解 哺乳结局的机制和母乳成分的母体预测因子 利用母公司LIPP研究的随机对照试验设计。从公共健康的角度来看，理柏乳业提供了 一个独特的机会来确定对肥胖女性进行干预的离散代谢目标，以改善 两代人的终生健康。

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.