‘Optimising’ breastfeeding: what can we learn from evolutionary, comparative and anthropological aspects of lactation?

Background: Promoting breastfeeding is an important public health intervention, with benefits for infants and mothers. Even modest increases in prevalence and duration may yield considerable economic savings. However, despite many initiatives, compliance with recommendations is poor in most settings – particularly for exclusive breastfeeding. Mothers commonly consult health professionals for infant feeding and behavioural problems. Main body: We argue that broader consideration of lactation, incorporating evolutionary, comparative and anthropological aspects, could provide new insights into breastfeeding practices and problems, enhance research and ultimately help to develop novel approaches to improve initiation and maintenance. Our current focus on breastfeeding as a strategy to improve health outcomes must engage with the evolution of lactation as a flexible trait under selective pressure to maximise reproductive fitness. Poor understanding of the dynamic nature of breastfeeding may partly explain why some women are unwilling or unable to follow recommendations. Conclusions: We identify three key implications for health professionals, researchers and policymakers. Firstly, breastfeeding is an adaptive process during which, as in other mammals, variability allows adaptation to ecological circumstances and reflects mothers’ phenotypic variability. Since these factors vary within and between humans, the likelihood that a ‘one size fits all’ approach will be appropriate for all mother-infant dyads is counterintuitive; flexibility is expected. From an anthropological perspective, lactation is a period of tension between mother and offspring due to genetic ‘conflicts of interest’. This may underlie common breastfeeding ‘problems’ including perceived milk insufficiency and problematic infant crying. Understanding this – and adopting a more flexible, individualised approach – may allow a more creative approach to solving these problems. Incorporating evolutionary concepts may enhance research investigating mother–infant signalling during breastfeeding; where possible, studies should be experimental to allow identification of causal effects and mechanisms. Finally, the importance of learned behaviour, social and cultural aspects of primate (especially human) lactation may partly explain why, in cultures where breastfeeding has lost cultural primacy, promotion starting in pregnancy may be ineffective. In such settings, educating children and young adults may be important to raise awareness and provide learning opportunities that may be essential in our species, as in other primates

Psychosocial factors associated with physical activity level among undergraduate students in a public university in Malaysia

This cross-sectional study aimed to determine the association of psychosocial factors with physical activity levels among undergraduate students aged 18 to 30 years. A sample of 261 students from Universiti Putra Malaysia (n = 261; 138 males; 123 females) participated in the study. The respondents have been selected through a probability-based cluster sampling. A self-administered questionnaire was used to gather information regarding the socio-demographic characteristics(age, ethnicity, family household number, allowance income, and parent’s monthly income), psychosocial factors (self-efficacy, social support, and perceived benefit), and physical activity levels, which was accessed using Global Physical Activity Questionnaire (GPAQ). Multiple linear regression analysis was performed to determine factors associated with physical activity levels. The highest percentage of respondents (63.2%) were classified as having a moderate physical activity, followed by vigorous (24.9%)and low physical activity (11.9%). The findings of multiple linear regression revealed that self-efficacy (Beta = 0.137, p = 0.049) and physical performance (Beta = 0.193, p = 0.002) were significant predictors of physical activity levels. Therefore, enhancements in self-efficacy and positive perception toward having better physical performance could be used as a strategy to increase physical activity levels among students in the university

Randomized controlled trial investigating the effects of a breastfeeding relaxation intervention on maternal psychological state, breast milk outcomes and infant behavior and growth

Background: Biological signaling and communication between mothers and infants during breastfeeding may shape infant behavior and feeding. This signaling is complex and little explored in humans, although it is potentially relevant for initiatives to improve breastfeeding rates. Objectives: The aim of this study was to investigate physiological and psychological aspects of mother-infant signaling during breastfeeding experimentally, testing the effects of a relaxation intervention on maternal psychological state, breast milk intake, milk cortisol levels, and infant behavior and growth. Methods: Primiparous breastfeeding mothers and full-term infants were randomly assigned to receive relaxation therapy [intervention relaxation group; n = 33 (RG)] or to the control group [n = 31 (CG); no relaxation therapy] at 2 wk postpartum. Both groups received standard breastfeeding support. Home visits were conducted at 2 (HV1), 6 (HV2), 12 (HV3) and 14 (HV4) wk to measure maternal stress and anxiety, breast milk intake and milk cortisol, and infant behavior and growth. Results: RG mothers had lower stress scores postintervention than the CG (HV3 ∆ = -3.13; 95% CI: -5.9, -0.3) and lower hindmilk cortisol at HV1 (∆ = -44.5%; 95% CI: -76.1%, -12.9%) but not at HV2. RG infants had longer sleep duration (∆ = 82 min/d; 95% CI: 16, 149 min/d) at HV2 and higher gains in weight and body mass index standardized deviation score than the CG infants (∆ = 0.76; 95% CI: 0.3, 1.22; and ∆ = 0.59; 95% CI: 0.09, 1.1, respectively). RG infants had a mean milk intake at HV3 that was 227 g/d higher than that of the CG infants (P = 0.031) after controlling for gender and milk intake at HV1. Conclusions: The trial shows the effectiveness of a simple relaxation intervention for improving maternal and infant outcomes and identifies some potential signaling mechanisms for investigation in future and larger studies, especially in settings where mothers are more stressed, such as those with preterm or low birth weight infants. This trial was registered at clinicaltrials.gov as NCT01971216

Chrononutrition is associated with melatonin and cortisol rhythm during pregnancy: Findings from MY-CARE cohort study

Chrononutrition has been suggested to have an entrainment effect on circadian rhythm which is crucial for metabolic health. Investigating how chrononutrition affects maternal circadian rhythm can shed light on its role during pregnancy. This study aims to determine chrononutrition characteristics of healthy primigravida during pregnancy and its association with melatonin and cortisol rhythm across gestation. A total of 70 healthy primigravidas were recruited from ten randomly selected government maternal and child clinics in Kuala Lumpur, Malaysia. During the second and third trimesters, chrononutrition characteristics including meal timing, frequency, eating window, breakfast skipping, and late-night eating were determined using a 3-day food record. Pregnant women provided salivary samples at five time-points over a 24 h period for melatonin and cortisol assay. Consistently across the second and third trimesters, both melatonin and cortisol showed a rhythmic change over the day. Melatonin levels displayed an increment toward the night whilst cortisol levels declined over the day. Majority observed a shorter eating window (≤12 h) during the second and third trimesters (66 and 55%, respectively). Results showed 23 and 28% skipped breakfast whereas 45 and 37% ate within 2 h pre-bedtime. During the third trimester, a longer eating window was associated with lower melatonin mean (β = –0.40, p = 0.006), peak (β = –0.42, p = 0.006), and AUCG (β = –0.44, p = 0.003). During both trimesters, a lower awakening cortisol level was observed in pregnant women who skipped breakfast (β = –0.33, p = 0.029; β = –0.29, p = 0.044). Only during the second trimester, breakfast-skipping was significantly associated with a greater cortisol amplitude (β = 0.43, p = 0.003). Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm. Dietary intervention targeting these characteristics may be useful in maintaining maternal circadian rhythm

Human milk: From complex tailored nutrition to bioactive impact on child cognition and behavior

Human milk is a highly complex liquid food tailor-made to match an infant's needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed 'Lactocrine Programming'. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions

Human milk: From complex tailored nutrition to bioactive impact on child cognition and behavior

Human milk is a highly complex liquid food tailor-made to match an infant's needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed 'Lactocrine Programming'. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions.All authors participated in the four-day hybrid meeting on ‘Lactational Programming: joining forces to optimize research on how maternal milk composition influences child cognition and behavior’ (Zeist, the Netherlands, 16-19 November 2020), which was financed by an Early Career Partnership 2020 Grant of the Royal Netherlands Academy of Arts and Sciences (awarded to Beijers). Funding sources for individual authors: Netherlands Organization for Scientific Research VICI grant (016.Vici.185.038-to de Weerth), The National Center for Advancing Translational Sciences Clinical Science and Translational Award (UL1TR001863-to Dettmer), NWO Food Cognition and Behaviour (057-14-003-to Korosi), Turku University Foundation, Maire Taponen Foundation and Finnish Psychiatry Foundation (-to Aatsinki), Polish National Science Centre OPUS grant (2015/17/B/NZ8/02436 -to Ziomkiewicz), Canadian Research Chair in Human Nutrition and Metabolism and funding from Natural Science and Engineering Council of Canada NSERC (RGPIN-2017-04746-to Field), The USDA National Institute of Food and Agriculture Hatch Project (1021411-to Slupsky), USDA NRI (2007-35203-18098 and 2013-67016-20523-to Bartol), Spanish Ministry of Science and Innovation grant (PID2019-105606RB-I00-to Rodríguez), UC San Diego Chair of Collaborative Human Milk Research, endowed by the Family Larsson-Rosenquist Foundation, Switzerland (-to Bode), Wellcome Trust (220225/Z/20/Z-to Moore), Tier 2 Canada Research Chair and Fellow in the CIFAR Humans and the Microbiome Program, Canadian Institutes of Health Research (CIHR), Research Manitoba, the Canada Foundation for Innovation, the Bill and Melinda Gates Foundation, the Manitoba Children’s Hospital Foundation, Prolacta Biosciences, Mitacs, CIFAR, and the Garfield G. Weston Foundation (-to Azad), CIHR Vanier Canada Graduate Scholarship (-to Turner), European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (ERC starting grant, no. 639226-to Collado), Netherlands Organization for Scientific Research VENI grant (016.195.197-to Beijers).Peer reviewe

Iodine and selenium status and uptake, and iodine nutritional knowledge of women of childbearing-age in Palmerston North, New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Manawatu, New Zealand

Objective: To explore the iodine and selenium status and intakes, and iodine nutritional knowledge of women of childbearing-age in Palmerston North, New Zealand (NZ), after the implementation of mandatory fortification of bread with iodine. Method: Fifty women of childbearing-age (non-pregnant and not breastfeeding) were interviewed (recruited) for the assessment of dietary intake and nutritional knowledge using a researcher-led questionnaire, including a semi-quantitative food frequency questionnaire and 24-hour dietary recall. Fifty 24-hour urine samples were obtained and total volumes were measured. Iodine and selenium were analysed using the inductive-coupled plasma mass spectrometry. Result: The median urinary iodine concentration was 64.7 mcg/l, which represents a mild iodine deficiency (ID), according to the WHO. Based on the individual iodine status, 70% of the participants were iodine deficient, categorised as marginal (30%), mild (30%) and moderate (10%). Iodine intake estimated from urinary iodine excretion (UIE) showed that 34% did not achieve the Estimated Average Requirement (EAR)(<100 mcg/day) and 46% met the Recommended Dietary Intake (RDI)(150 mcg/day). The median iodine intake was 129.8 mcg/day, indicating suboptimal intake. The major contributors to iodine intake were milk (35.6%), bread (24.6%), fish and seafood (15%) and egg (13.8%). The majority of respondents were unaware of the mandatory fortification of bread with iodine (70%) and also unaware of the ID problem in NZ (52%). The median excretion of selenium was 31.6 mcg/day and the intake estimated from urinary excretion was 57.5 mcg/day, with both values above the safe range for women (30 mcg/day), according to the WHO. Based on the 24-hour recall, the majority (70%) had inadequate selenium intake (<50 mcg/day), whilst only 20% met the RDI intake of 60 mcg/day. There was a moderate correlation between the urinary selenium excretion and UIE (Spearman’s rank order; r (50)=0.547,p<0.05). Conclusion: ID is still a problem in this population, although mandatory fortification has been implemented. However, this study shows improved iodine status and intake compared to previous studies and it thus signifies the benefits of iodine-fortified bread. In order to help eliminate ID in NZ, an additional strategy, such as the implementation of iodine fortification in another food vehicle should be considered

The COVID-19 infodemic through facebook: comparison of content and the accuracy of breastfeeding information

Background: The coronavirus disease (COVID-19) pandemic has resulted in a significant increase in the number of people seeking online support and information, particularly on social media. Nevertheless, the nature and trend of internet information, as well as its accuracy, are questionable. This study aimed to assess and compare the content, type/form, and degree of accuracy of breastfeeding information on Facebook before and during the COVID-19 pandemic (n = 288/phase). Methodology: The data were gathered from Malaysian public and group/page Facebook posts (n = 456). Keyword searches were conducted using Malay and English breastfeeding terms. The dataset was screened and entered into a structured codebook. The Delphi approach was used to assess the accuracy of posts’ content performed by breastfeeding experts. Results: Sharing personal experience (53.2%) was the most common topic in breastfeeding-related posts, followed by seeking questions (39.3%) and knowledge (8.0%). Sharing personal stories and knowledge posts were higher during COVID-19 than before (p = 0.001), although the seeking questions category was higher before the pandemic (p = 0.001). Most information posted was in text form (94.5%). About half of the posts (46.5%) were misleading, while (43.7%) were accurate. There was a significant difference in the accuracy of online posts before and during the COVID-19 pandemic (p = 0.001). Conclusions: Compared to the pre-pandemic phase, forms/types of information on Facebook remained consistent, whereas the breastfeeding information content and its degree of accuracy differed during the pandemic.We need to explore other aspects of breastfeeding online content as well as its engagement, especially during a pandemic. Knowing the infant feeding-related topics that have been discussed and questioned on social media, as well as the accuracy of the data, allows policymakers and scientific communities to plan strategies for spreading credible breastfeeding information online. This includes creating interactive online media types of visual guidelines, web resources, and breastfeeding apps

Differences in maternal characteristics and their associations with breastfeeding attitudes among primiparous mothers

Background: The benefits of breastfeeding are well documented, yet substantially below half of all mothers globally meet the recommendation to exclusively breast-feed for 6 months. Objective: This study aimed to examine whether there were differences in maternal factors, including maternal characteristics and breastfeeding attitudes, between those who were eligible versus non-eligible to be included in a randomised trial, as= exclusive breastfeeding was the eligibility criteria for the trial. It also aimed to investigate associations between maternal factors and breastfeeding attitudes. Method: Primiparous pregnant mothers (n=88) completed questionnaires on demographic factors including maternity care and breastfeeding attitude using self-administered questionnaire and Iowa Infant Feeding Attitude Scale (IIFAS). Two weeks post-birth, mothers were screened for eligibility to be included in a randomised trial including assessing for exclusive breastfeeding (EBF). Findings were compared between inclusion (all EBF mothers) and exclusion groups (non-EBF). Results: Inclusion group mothers were significantly younger than those in the exclusion group (26.7±2.8 v 28.5±2.5, p=0.007) and the majority had their husband as the primary maternity care person after birth (X2=12.8, p=0.01). Inclusion group mothers had a more positive perception toward breastfeeding in public and at work on the IIFAS scale (p<0.05). The overall IIFAS score was positively associated with higher breastfeeding confidence (r=0.285, p=0.008), education levels (r=0.31, p=0.003), household income (r=0.32, p=0.003), and age (r=0.28, p=0.008). Conclusion: EBF mothers (inclusion group) tend to be younger, had husband as primary care, and have more positive perception towards breastfeeding outside home. Overall, maternal characteristics and paternal support could influence breastfeeding practices and should be targeted for future intervention. Maternal attitude and perceptions about breastfeeding in public could be improved to encourage exclusive breastfeeding

Associations of father’s breastfeeding attitude and support with the duration of exclusive breastfeeding among first-time mothers

Introduction: Initiating and sustaining breastfeeding are influence by many factors including involvement, attitude and support from the partner. Research on breastfeeding mostly investigate maternal factors, although the father’s behaviour and role may influence the success of breastfeeding. Hence, this study aimed to determine the associations of father’s attitude and support with the duration of exclusive breastfeeding new parents. Methods: The study involved 104 new parents in Kuala Lumpur, Malaysia, recruited at three randomly selected antenatal clinics using purposive sampling. Fathers’ breastfeeding attitude was measured using Iowa-Infant-Feeding-Attitude-Scale, whereas paternal support using Subjective Norms and Paternal-Breastfeeding-Influence-Scale questionnaires. Mothers were asked about breastfeeding practice. Results: Exclusive breastfeeding duration rates at six months was 27.9%. The average score for paternal attitude on breastfeeding was 61.0 ±6.3, indicating father’s positive attitude towards breastfeeding. The mean score of paternal breastfeeding supports for subjective norms surrounding breastfeeding and overall support score were 4.3+0.6 and 4.06+0.6, respectively, demonstrating frequent paternal engaging and support in breastfeeding. Duration of exclusive breastfeeding were positively associated with the paternal attitude (β=0.235, p=0.027) and overall mean score for breastfeeding support (β=2.166, p=0.028), but negatively associated with support strategies score (β= -2.203, p=0.026). Conclusion: Overall, paternal support and positive attitude were associated with breastfeeding duration. It is important to increase public awareness on the important roles of fathers during the breastfeeding process such as emphasizing the husband’s role in supporting their wives to breastfeed, as well as the importance of paternal role in caring the baby, especially among new couples