Maternal Nutrition and Lactation in India

印度的孕产妇营养和哺乳

• 批准号: 8823428
• 负责人: REYNALDO MARTORELL
• 金额: $ 19.99万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8823428
• 关键词: Address; Age-Months; Anemia; Birth; Body Composition; Body fat; Body mass index; Bottle feeding; Breast Feeding; Carbohydrates; Child; Child Nutrition; Child health care; Choline; Copper; Data; Data Collection; Deuterium Oxide; Diet; Dietary Intervention; Dietary intake; Dose; Enrollment; Exclusive Breastfeeding; Failure; Fatty acid glycerol esters; Folic Acid; Food; Frequencies; Fright; Future; Goals; Growth; Height; Human Milk; IL8 gene; Immune; Immunoglobulin A; Immunoglobulins; India; Infant; Infant Health; Infant Malnutrition; Inflammation; Inflammatory; Intake; Intervention; Intestines; Iodine; Iron; Knowledge; Lactation; Lactoferrin; Life; Macronutrients Nutrition; Malnutrition; Maternal and Child Health; Measurement; Measures; Methodology; Methods; Micronutrients; Milk; Milk Substitutes; Mothers; Nutrient; Nutritional; Nutritional Requirements; Nutritional status; Outcome; Output; Pathway interactions; Pattern; Performance; Permeability; Population; Prevention; Preventive Intervention; Proteins; Recommendation; Reference Values; Research; Riboflavin; Risk; Role; Route; Rural; Sample Size; Sampling; Selenium; Serum; Source; Techniques; Testing; Thiamine; Triceps Brachii Muscle; United States National Center for Health Statistics; Upper arm; Vitamin A; Vitamin B 12; Vitamin B6; Vitamin D; Weight; Woman; Work; Zinc; base; cost effective; cytokine; density; design; evidence base; improved; in utero; innovation; insight; meetings; mother nutrition; novel; nutrition; prevent; programs; public health relevance; stable isotope; wasting

DESCRIPTION (provided by applicant): Wasting and stunting are common in breastfed infants under six months in India and elsewhere but we know little about the prevention of these conditions. This research will generate critical knowledge about maternal malnutrition and lactation performance that will guide future maternal and child interventions. The mother should be the only nutrition portal to reach the young breastfed infant. Breast milk is undeniably the optimal source of vital nutrients and maternal immunoglobulins required for infant health and survival; however for too long the assumption has been that poor, thin women in India can produce as much high quality milk as the child demands. Fear of opening the door to inappropriate breast milk substitutes has discouraged research about potential effects of maternal malnutrition on breast milk. What little research exists often suffers from methodological limitations (such as small sample sizes and reliance on test weighing). We plan to enroll 232 lactating women with children 2-4 months of age. We propose preliminary work to allow us to assess the feasibility of using deuterium oxide (dose-to-mother technique) to measure milk volume and body composition in rural India. Our hypothesis is that the poor nutritional status of Indian women contributes to suboptimal lactation performance such that the child's high nutrient requirements are not met. In addition, we plan to explore whether maternal malnutrition leads to an altered inflammatory and immune milk profile and impaired infant intestinal permeability; which would further place the child at risk for early growth failure. Our key hypotheses are: Hypothesis 1: Women in rural India produce less milk and of lower energy and micronutrient density than necessary to meet children's optimal intakes. Hypothesis 2: Maternal malnutrition (low BMI, % body fat, mid upper arm circumference, and suboptimal micronutrient status) is associated with decreased breast milk quality (milk fat %, quantity and inadequate micronutrient concentrations) Hypothesis 3: Maternal malnutrition is associated with an inflammatory milk profile (higher Na:K ratios and pro-inflammatory cytokines) and breast milk inflammation is associated with infant intestinal permeability. This innovative research will provide critical information to inform maternal-focused nutrition strategies. The end goal would be to make national recommendations for the improvement of maternal and child health and nutrition outcomes in India and elsewhere.

描述（由申请人提供）：在印度和其他地方，6个月以下母乳喂养的婴儿消瘦和发育迟缓很常见，但我们对预防这些疾病知之甚少。这项研究将产生关于产妇营养不良和哺乳表现的重要知识，这些知识将指导未来的母婴干预措施。母亲应该是母乳喂养的婴儿获得营养的唯一途径。母乳无疑是婴儿健康和存活所需的重要营养素和母体免疫球蛋白的最佳来源;然而，长期以来，人们一直假设印度贫穷、瘦弱的妇女可以生产出孩子所需的高质量牛奶。由于担心为不适当的母乳替代品打开大门，因此阻碍了关于母亲营养不良对母乳潜在影响的研究。现有的少量研究往往受到方法学的限制（例如样本量小和依赖测试加权）。 我们计划入组232名有2-4个月婴儿的哺乳期妇女。我们提出的初步工作，使我们能够评估使用氧化氘（剂量到母亲的技术），以测量在印度农村的牛奶量和身体成分的可行性。我们的假设是，印度妇女的营养状况差，导致次优的哺乳性能，使孩子的高营养需求得不到满足。此外，我们还计划探索产妇营养不良是否会导致炎症和免疫乳汁特征改变以及婴儿肠道通透性受损;这将进一步使儿童面临早期生长失败的风险。我们的主要假设是：假设1：印度农村妇女生产的牛奶较少，能量和微量营养素密度低于满足儿童最佳摄入量所需的水平。假设二：母亲营养不良（低BMI、体脂百分比、上臂围和次优微量营养素状态）与母乳质量下降（乳脂百分比、数量和微量营养素浓度不足）相关。假设3：母亲营养不良与炎症性乳汁特征（较高的Na：K比率和促炎细胞因子）相关，母乳炎症与婴儿肠道通透性相关。 这项创新研究将提供重要信息，为以产妇为重点的营养战略提供信息。最终目标是为改善印度和其他地方的妇幼保健和营养成果提出国家建议。