Äidin ravintoainepuutokset varhaisraskaudessa ja imeväisen ravitsemustila eteläintialaisessa kaupunkiympäristössä

Äidin ravintoainepuutokset varhaisraskaudessa ja imeväisen ravitsemustila eteläintialaisessa kaupunkiympäristössä Raskauden aikana elimistön metaboliset ja fysiologiset vaatimukset ovat suuremmat kuin muulloin. Äidin ravitsemustila vaikuttaa raskauden ja synnytyksen onnistumisen lisäksi myös yli sukupolven syntyvän lapsen kasvuun ja kehitykseen. Mikroravintoainepuutokset ensimmäisen 1000 päivän kriittisen ajanjakson aikana, alkaen äidin raskaudesta ja päättyen lapsen toiseen syntymäpäivään, voivat vaikuttaa pysyvästi lapsen kasvuun ja kehitykseen. Tämä väitöskirja selvittää äidin ravitsemustilaa Etelä-Intiassa arvioimalla kahden Intiassa merkittävän mikroravintoainepuutoksen, anemian ja B12-vitamiinin, yleisyyttä ja riskitekijöitä. Tässä väitöskirjatyössä tutkitaan myös imeväisen ravitsemuksen keskeisiä tekijöitä: yksinomaisesta imetyksestä annetun suosituksen noudattamista vauvamyönteisissä sairaaloissa ja sinkin puutetta imetetyillä imeväisillä mittaamalla sinkin kuljetusta äidinmaidossa ja imeväisen sinkkitilaa. Tutkimuskysymyksiin vastataan kahdessa eri väestössä. Ensiksi, 366 eteläintialaista kaupunkilaista naista tutkittiin ennen 15. raskausviikkoa (poikkileikkaustutkimus). He kuuluivat matalaan sosioekonomiseen ryhmään.Toiseksi, imeväiskohortti muodostui eri sosioekonomisista ryhmistä tulevien äitien täysiaikaisena syntyneistä lapsista, joita seurattiin 6 kuukauden ikään. Anemian esiintyvyys äideillä oli korkea (30.3 %). Pienisoluista anemiaa esiintyi 20.2 prosentilla. Raskaana olevista naisista 51.1 prosentilla havaittiin matala B12-vitamiinipitoisuus ja 42.4 prosentilla puutteellinen B12-vitamiinitila. Kohonnut metyylimalonihappopitoisuus (> 0.26 μmol/l), kohonnut homokysteiinipitoisuus (>10 μmol/L) ja punasolujen matala folaattipitoisuus(<283 nmol/L) havaittiin 75.8%, 43.3 % ja 22.2% naisista. Raskaana olevien sekä aneemisten että ei-aneemisten naisten useiden mikro- ja makroravintoaineiden saannit alittivat suositukset. Aneemisilla naisilla raudan imeytymistä estävien ravintoaineiden kuten mangaanin, fosforin ja sinkin saannit olivat korkeita. B12-vitamiinin saannin mediaani (25. ja 75. persentiili)oli 1.25 (0.86, 1.96) μg päivässä. B12-vitamiinin energiavakioitu saanti korreloi merkitsevästi plasman B12-vitamiinipitoisuuteen (r = 0.164, P = 0.002). Raskaana olevilla naisilla, joilla raudan ja useiden muiden ravintoaineiden saanti oli matala, korkea kalsiumin ja fosforin saanti olivat itsenäisessä yhteydessä korkeampaan anemian riskiin: suhteellinen riski (95 % luottamusväli) 1.79 (1.16-2.76) ja 1.96 (1.31-2.96) vastaavassa järjestyksessä. Samalla kuin matala kehon paino yhdistyi korkeampaan B12–vitamiinipitoisuuteen, tärkeitä heikentyneeseen B12-vitamiinitilaan yhteydessä olevia tekijöitä olivat,ettei käyttänyt jogurttia tai kalaa sekä ensisynnyttäjäisyys. Havaitsimme eteläintialaisilla naisilla heikon myöntyväisyyden suositeltuunyksinomaiseen imetykseen huolimatta siitä, että synnytys oli tapahtunut vauvamyönteisessä sairaalassa. Äidinmaidon saanti väheni merkitsevästi 166:sta 87:aan ml/kg/päiväja muualta kuin rintamaidosta tulevan veden määrä lisääntyi merkitsevästi 23:sta 51:een ml/kg/päivä ensimmäisestä kuudenteen kuukauteen (P<0.01). Pääasiallinen syy aikaiseen lisäruokien aloitukseen olilapsen itku, minkä äiti tulkitsi johtuvan riittämättömästä maidon saannista. Sinkin saanti äidinmaidosta oli matalaa johtuen matalista äidinmaidon saantimääristä huolimatta siitä, että sinkin pitoisuudet äidin maidossa olivat normaaleja. Äidinmaidon sinkkipitoisuus ja sinkin saanti vähenivät ensimmäisestä kuukaudesta kuuden kuukauden ikään (P<0.001 molemmille). Keskimääräinen (± keskihajonta) sinkkipitoisuus oli 3 ja 6 kuukauden iässä 93.0 ± 27.1 ja 99.6 ± 30.1 μg/dL, vastaavassa järjestyksessä. Kaikkiaan tässä väitöskirjatyössä esitetyt tulokset osoittavat eteläintialaisten kaupunkilaisten äitien ja imeväisten epäsuotuisan ravitsemustilan. Välittömiä poliittisia toimenpiteitä tarvitaan äitien ja lasten ravitsemustilan parantamiseksi, jotta saavutettaisiin WHO:n vuosituhattavoitteiden ensimmäiset askeleet. Raskaana olevien naisten mikroravintoainetilan parantamisen tulisi kohdistua ruokiin ja koko ruokavalion laadun parantamiseen sekä kriittisten ravintoaineiden(rauta, folaatti, B12-vitamiini) saannin kannalta tärkeiden ruokien saannin lisäämiseen. Lisäksi imetyksen edistäminen ja äidinmaidon määrän lisääminen ovat ensimmäisiä askeleita äidin maidon ja sinkin saannin turvaamiseksi imeväisillä.Pregnancy is a critical period in the life cycle with increased metabolic and physiological demands. The nutritional status of the mother has intergenerational effects, not only affecting her pregnancy and birth outcomes, but also impacting the growth and development of her child. Micronutrient deficiencies during the critical window period of the first 1000 days, starting from the mother’s pregnancy through her child’s second birthday, can have long lasting implications for growth and development of the child. This thesis explores the maternal nutritional status in urban South India by evaluating the prevalence and modifiable risk factors of two specific micronutrient deficiencies highly rampant in India namely anaemia & vitamin B12 deficiency. This thesis also explores a key issue pertaining to infant feeding practices (compliance to exclusive breastfeeding in baby friendly hospitals (BFH) in infants less than 6 months of age), as well as deficiency of zinc in breastfed infants by assessing the zinc transfer through breast milk and infant zinc status. Research questions of this thesis were addressed in two different populations. The maternal cohort consisted of pregnant women (n = 366) in early pregnancy (≤ 14 weeks of gestation) from urban South India belonging to a low socioeconomic status (cross-sectional study), while the infant cohort consisted of term infants, followed from birth to 6 months of age, and their mothers from urban South India belonging to diverse socioeconomic status (prospective observational study). In the maternal cohort we observed a high prevalence of anaemia (30.3%) and microcytic anaemia (20.2%). Low plasma vitamin B12 concentration was observed in 51.1% of the pregnant women, while 42.4% had impaired vitamin B12 status. Elevated methylmalonic acid (MMA> 0.26 µmol/l), elevated homocysteine (Hcy >10 µmol/L) and low erythrocyte folate (<283 nmol/L) was observed among 75.8%, 43.3% and 22.2% of women, respectively. Although mean intake of several macro- and micronutrients were well below the recommended daily allowances (RDA) for both pregnant anaemic and non-anaemic women, intake of iron absorption inhibitors such as manganese, phosphorus and zinc were high in anemic pregnant women. The median (25th, 75th percentile) dietary intake of vitamin B12 was 1.25 (0.86, 1.96) µg/day. Energy-adjusted dietary vitamin B12 intake significantly correlated with plasma B12 concentration (r = 0.164, P = 0.002). Among the pregnant women, who had a low intake of iron and several other nutrients, higher intake of calcium and phosphorus (dietary components known to inhibit iron absorption), were independently associated with a higher risk of anaemia, relative risk (RR), (95% CI): 1.79 (1.16-2.76), and 1.96 (1.31-2.96), respectively. While lower maternal body weight was associated with higher vitamin B12 concentration prevalence ratio (PR) (95% CI): 0.57 (0.39, 0.84)), the important predictors of impaired vitamin B12 status were non- consumption of yoghurt (PR (95% CI): 1.63 (1.03, 2.58)), non-consumption of fish (PR (95% CI): 1.32 (1.01, 1.71)) and primiparity (PR (95% CI): 1.41 (1.05, 1.90)). Among South Indian term infants and their mothers we observed poor compliance to exclusive breastfeeding and early introduction of complementary foods despite being born in a BFH, where counselling for breastfeeding is the norm (complementary foods introduced as early as 1 month among 44% of the infants, only 14% remained as exclusively breastfed by month 6). Intake of breast milk significantly declined from 166 to 87 ml/kg/day and non breast milk water intake significantly increased from 23 to 51 ml/kg/day from month 1to 6 (P<0.01). The primary reason for the early introduction of complementary foods was a crying infant, perceived by her to be due to insufficient breast milk. Breast milk zinc intakes were also low owing to low volumes of breast milk intake, despite breast milk zinc concentrations being in the normal range. Breast milk zinc concentration and intake significantly declined from months 1 to 6 (P<0.001 for both). Mean infant serum zinc concentration at months 3 and 6 were 93.0 ± 27.1 and 99.6 ± 30.1 µg/dL, respectively. Collectively, the results presented in this thesis points towards the sub-optimal nutritional status of mothers and infants from urban South India and calls for the immediate attention of policy makers to formulate action oriented strategies that would improve the maternal and child nutritional status as a primary step towards achievement of the Millennium Development Goals. Primary efforts towards improving the micronutrient status of pregnant women should focus on a food based strategy, aiming to improve the overall quality of the diet, and increasing the intake of specific foods that are high in nutrients critical to this stage such as iron, folate and vitamin B12. In addition, promotion of breastfeeding and thereby increasing the volumes of milk produced should be the first important step towards improving breast milk intake and zinc intake among infants

Äidin ravintoainepuutokset varhaisraskaudessa ja imeväisen ravitsemustila eteläintialaisessa kaupunkiympäristössä

Äidin ravintoainepuutokset varhaisraskaudessa ja imeväisen ravitsemustila eteläintialaisessa kaupunkiympäristössä Raskauden aikana elimistön metaboliset ja fysiologiset vaatimukset ovat suuremmat kuin muulloin. Äidin ravitsemustila vaikuttaa raskauden ja synnytyksen onnistumisen lisäksi myös yli sukupolven syntyvän lapsen kasvuun ja kehitykseen. Mikroravintoainepuutokset ensimmäisen 1000 päivän kriittisen ajanjakson aikana, alkaen äidin raskaudesta ja päättyen lapsen toiseen syntymäpäivään, voivat vaikuttaa pysyvästi lapsen kasvuun ja kehitykseen. Tämä väitöskirja selvittää äidin ravitsemustilaa Etelä-Intiassa arvioimalla kahden Intiassa merkittävän mikroravintoainepuutoksen, anemian ja B12-vitamiinin, yleisyyttä ja riskitekijöitä. Tässä väitöskirjatyössä tutkitaan myös imeväisen ravitsemuksen keskeisiä tekijöitä: yksinomaisesta imetyksestä annetun suosituksen noudattamista vauvamyönteisissä sairaaloissa ja sinkin puutetta imetetyillä imeväisillä mittaamalla sinkin kuljetusta äidinmaidossa ja imeväisen sinkkitilaa. Tutkimuskysymyksiin vastataan kahdessa eri väestössä. Ensiksi, 366 eteläintialaista kaupunkilaista naista tutkittiin ennen 15. raskausviikkoa (poikkileikkaustutkimus). He kuuluivat matalaan sosioekonomiseen ryhmään.Toiseksi, imeväiskohortti muodostui eri sosioekonomisista ryhmistä tulevien äitien täysiaikaisena syntyneistä lapsista, joita seurattiin 6 kuukauden ikään. Anemian esiintyvyys äideillä oli korkea (30.3 %). Pienisoluista anemiaa esiintyi 20.2 prosentilla. Raskaana olevista naisista 51.1 prosentilla havaittiin matala B12-vitamiinipitoisuus ja 42.4 prosentilla puutteellinen B12-vitamiinitila. Kohonnut metyylimalonihappopitoisuus (> 0.26 μmol/l), kohonnut homokysteiinipitoisuus (>10 μmol/L) ja punasolujen matala folaattipitoisuus(<283 nmol/L) havaittiin 75.8%, 43.3 % ja 22.2% naisista. Raskaana olevien sekä aneemisten että ei-aneemisten naisten useiden mikro- ja makroravintoaineiden saannit alittivat suositukset. Aneemisilla naisilla raudan imeytymistä estävien ravintoaineiden kuten mangaanin, fosforin ja sinkin saannit olivat korkeita. B12-vitamiinin saannin mediaani (25. ja 75. persentiili)oli 1.25 (0.86, 1.96) μg päivässä. B12-vitamiinin energiavakioitu saanti korreloi merkitsevästi plasman B12-vitamiinipitoisuuteen (r = 0.164, P = 0.002). Raskaana olevilla naisilla, joilla raudan ja useiden muiden ravintoaineiden saanti oli matala, korkea kalsiumin ja fosforin saanti olivat itsenäisessä yhteydessä korkeampaan anemian riskiin: suhteellinen riski (95 % luottamusväli) 1.79 (1.16-2.76) ja 1.96 (1.31-2.96) vastaavassa järjestyksessä. Samalla kuin matala kehon paino yhdistyi korkeampaan B12–vitamiinipitoisuuteen, tärkeitä heikentyneeseen B12-vitamiinitilaan yhteydessä olevia tekijöitä olivat,ettei käyttänyt jogurttia tai kalaa sekä ensisynnyttäjäisyys. Havaitsimme eteläintialaisilla naisilla heikon myöntyväisyyden suositeltuunyksinomaiseen imetykseen huolimatta siitä, että synnytys oli tapahtunut vauvamyönteisessä sairaalassa. Äidinmaidon saanti väheni merkitsevästi 166:sta 87:aan ml/kg/päiväja muualta kuin rintamaidosta tulevan veden määrä lisääntyi merkitsevästi 23:sta 51:een ml/kg/päivä ensimmäisestä kuudenteen kuukauteen (P<0.01). Pääasiallinen syy aikaiseen lisäruokien aloitukseen olilapsen itku, minkä äiti tulkitsi johtuvan riittämättömästä maidon saannista. Sinkin saanti äidinmaidosta oli matalaa johtuen matalista äidinmaidon saantimääristä huolimatta siitä, että sinkin pitoisuudet äidin maidossa olivat normaaleja. Äidinmaidon sinkkipitoisuus ja sinkin saanti vähenivät ensimmäisestä kuukaudesta kuuden kuukauden ikään (P<0.001 molemmille). Keskimääräinen (± keskihajonta) sinkkipitoisuus oli 3 ja 6 kuukauden iässä 93.0 ± 27.1 ja 99.6 ± 30.1 μg/dL, vastaavassa järjestyksessä. Kaikkiaan tässä väitöskirjatyössä esitetyt tulokset osoittavat eteläintialaisten kaupunkilaisten äitien ja imeväisten epäsuotuisan ravitsemustilan. Välittömiä poliittisia toimenpiteitä tarvitaan äitien ja lasten ravitsemustilan parantamiseksi, jotta saavutettaisiin WHO:n vuosituhattavoitteiden ensimmäiset askeleet. Raskaana olevien naisten mikroravintoainetilan parantamisen tulisi kohdistua ruokiin ja koko ruokavalion laadun parantamiseen sekä kriittisten ravintoaineiden(rauta, folaatti, B12-vitamiini) saannin kannalta tärkeiden ruokien saannin lisäämiseen. Lisäksi imetyksen edistäminen ja äidinmaidon määrän lisääminen ovat ensimmäisiä askeleita äidin maidon ja sinkin saannin turvaamiseksi imeväisillä.Pregnancy is a critical period in the life cycle with increased metabolic and physiological demands. The nutritional status of the mother has intergenerational effects, not only affecting her pregnancy and birth outcomes, but also impacting the growth and development of her child. Micronutrient deficiencies during the critical window period of the first 1000 days, starting from the mother’s pregnancy through her child’s second birthday, can have long lasting implications for growth and development of the child. This thesis explores the maternal nutritional status in urban South India by evaluating the prevalence and modifiable risk factors of two specific micronutrient deficiencies highly rampant in India namely anaemia & vitamin B12 deficiency. This thesis also explores a key issue pertaining to infant feeding practices (compliance to exclusive breastfeeding in baby friendly hospitals (BFH) in infants less than 6 months of age), as well as deficiency of zinc in breastfed infants by assessing the zinc transfer through breast milk and infant zinc status. Research questions of this thesis were addressed in two different populations. The maternal cohort consisted of pregnant women (n = 366) in early pregnancy (≤ 14 weeks of gestation) from urban South India belonging to a low socioeconomic status (cross-sectional study), while the infant cohort consisted of term infants, followed from birth to 6 months of age, and their mothers from urban South India belonging to diverse socioeconomic status (prospective observational study). In the maternal cohort we observed a high prevalence of anaemia (30.3%) and microcytic anaemia (20.2%). Low plasma vitamin B12 concentration was observed in 51.1% of the pregnant women, while 42.4% had impaired vitamin B12 status. Elevated methylmalonic acid (MMA> 0.26 µmol/l), elevated homocysteine (Hcy >10 µmol/L) and low erythrocyte folate (<283 nmol/L) was observed among 75.8%, 43.3% and 22.2% of women, respectively. Although mean intake of several macro- and micronutrients were well below the recommended daily allowances (RDA) for both pregnant anaemic and non-anaemic women, intake of iron absorption inhibitors such as manganese, phosphorus and zinc were high in anemic pregnant women. The median (25th, 75th percentile) dietary intake of vitamin B12 was 1.25 (0.86, 1.96) µg/day. Energy-adjusted dietary vitamin B12 intake significantly correlated with plasma B12 concentration (r = 0.164, P = 0.002). Among the pregnant women, who had a low intake of iron and several other nutrients, higher intake of calcium and phosphorus (dietary components known to inhibit iron absorption), were independently associated with a higher risk of anaemia, relative risk (RR), (95% CI): 1.79 (1.16-2.76), and 1.96 (1.31-2.96), respectively. While lower maternal body weight was associated with higher vitamin B12 concentration prevalence ratio (PR) (95% CI): 0.57 (0.39, 0.84)), the important predictors of impaired vitamin B12 status were non- consumption of yoghurt (PR (95% CI): 1.63 (1.03, 2.58)), non-consumption of fish (PR (95% CI): 1.32 (1.01, 1.71)) and primiparity (PR (95% CI): 1.41 (1.05, 1.90)). Among South Indian term infants and their mothers we observed poor compliance to exclusive breastfeeding and early introduction of complementary foods despite being born in a BFH, where counselling for breastfeeding is the norm (complementary foods introduced as early as 1 month among 44% of the infants, only 14% remained as exclusively breastfed by month 6). Intake of breast milk significantly declined from 166 to 87 ml/kg/day and non breast milk water intake significantly increased from 23 to 51 ml/kg/day from month 1to 6 (P<0.01). The primary reason for the early introduction of complementary foods was a crying infant, perceived by her to be due to insufficient breast milk. Breast milk zinc intakes were also low owing to low volumes of breast milk intake, despite breast milk zinc concentrations being in the normal range. Breast milk zinc concentration and intake significantly declined from months 1 to 6 (P<0.001 for both). Mean infant serum zinc concentration at months 3 and 6 were 93.0 ± 27.1 and 99.6 ± 30.1 µg/dL, respectively. Collectively, the results presented in this thesis points towards the sub-optimal nutritional status of mothers and infants from urban South India and calls for the immediate attention of policy makers to formulate action oriented strategies that would improve the maternal and child nutritional status as a primary step towards achievement of the Millennium Development Goals. Primary efforts towards improving the micronutrient status of pregnant women should focus on a food based strategy, aiming to improve the overall quality of the diet, and increasing the intake of specific foods that are high in nutrients critical to this stage such as iron, folate and vitamin B12. In addition, promotion of breastfeeding and thereby increasing the volumes of milk produced should be the first important step towards improving breast milk intake and zinc intake among infants

A Narrative Review of Childhood Picky Eating and Its Relationship to Food Intakes, Nutritional Status, and Growth

A main characteristic of children perceived as picky eaters is their tendency to avoid certain foods or food groups. The goal of this narrative review is to provide an overview of published studies that have examined whether picky eating in childhood is in fact associated with measurable differences in food and/or nutrient intakes and growth. While picky eaters appear to consume less vegetables compared to non-picky eaters, no consistent differences were observed for the intakes of other food groups or the intakes of energy, macronutrients and dietary fiber. Although, in some studies, picky eaters had lower intakes of certain vitamins and minerals, the levels consumed generally exceeded the recommended values, suggesting nutritional requirements are being met. No consistent relationship between childhood picky eating and growth status was observed, although significant differences in body weight/growth between picky and non-picky eaters were most discernible in studies where multiple defining criteria were used to identify picky eating. The research area would benefit from the adoption of a uniform definition of picky eating. More longitudinal assessments are also required to understand the long-term impact of picky eating on nutritional status and growth

Analysis of dietary patterns and nutritional adequacy in lactating women : a multicentre European cohort (ATLAS study)

Eating habits of lactating women can influence the nutrient composition of human milk, which in turn influences nutrient intake of breastfed infants. The aim of the present study was to identify food patterns and nutritional adequacy among lactating women in Europe. Data from a multicentre European longitudinal cohort (ATLAS study) were analysed to identify dietary patterns using cluster analysis. Dietary information from 180 lactating women was obtained using 3-d food diaries over the first 4 months of lactation. Four dietary patterns were identified: ‘vege-oils’, ‘fish-poultry’, ‘confectionery-salads’ and ‘mixed dishes’. Nutrition adequacy was not significantly different between clusters, but the ‘vege-oils’ cluster tended to yield the highest nutrition adequacy measured by Mean Adequacy Ratio. Compared with European dietary reference values (DRVs) for lactating women, women in all clusters had inadequate intakes of energy, pantothenic acid, folate, vitamin C, vitamin A, vitamin D, zinc, iodine, potassium and linoleic acid. Adequate intake for fibre and α-linolenic acid was only achieved in the ‘vege-oils’ cluster. Overall, fat intake was above DRVs. The present study showed that various dietary patterns do not adequately supply all nutrients, indicating a need to promote overall healthy dietary habits for European lactating women

Subclinical Mastitis in a European Multicenter Cohort : Prevalence, Impact on Human Milk (HM) Composition, and Association with Infant HM Intake and Growth

Background: Subclinical mastitis (SCM) is an inflammatory condition of the mammary gland. We examined the effects of SCM on human milk (HM) composition, infant growth, and HM intake in a mother–infant cohort from seven European countries.  Methods: HM samples were obtained from 305 mothers at 2, 17, 30, 60, 90, and 120 days postpartum. SCM status was assessed using HM Sodium (Na): Potassium (K) ratio &gt;0.6. Levels of different macro- and micronutrients were analyzed in HM.  Results: SCM prevalence in the first month of lactation was 35.4%. Mean gestational age at delivery was lower and birth by C-section higher in SCM mothers (p ≤ 0.001). HM concentrations of lactose, DHA, linolenic acid, calcium, and phosphorous (p &lt; 0.05 for all) was lower, while total protein, alpha-lactalbumin, lactoferrin, albumin, arachidonic acid to DHA ratio, n-6 to n-3 ratio and minerals (iron, selenium, manganese, zinc, and copper) were higher (p &lt; 0.001 for all) in mothers with SCM. There were no differences in infant growth and HM intake between non-SCM and SCM groups.  Conclusion: We document, for the first time, in a large European standardized and longitudinal study, a high prevalence of SCM in early lactation and demonstrate that SCM is associated with significant changes in the macro- and micronutrient composition of HM. Future studies exploring the relation of SCM with breastfeeding behaviors and developmental outcomes are warranted

Human milk fatty acid composition and its association with maternal blood and adipose tissue fatty acid content in a cohort of women from Europe

Purpose: Human milk (HM) composition is influenced by factors, like maternal diet and body stores, among other factors. For evaluating the influence of maternal fatty acid (FA) status on milk FA composition, the correlation between FA content in HM and in maternal plasma, erythrocytes, and adipose tissue was investigated. Methods: 223 European women who delivered at term, provided HM samples over first four months of lactation. Venous blood and adipose tissue (only from mothers who consented and underwent a C-section delivery) were sampled at delivery. FAs were assessed in plasma, erythrocytes, adipose tissue, and HM. Evolution of HM FAs over lactation and correlations between FA content in milk and tissues and between mother’s blood and cord blood were established. Results: During lactation, arachidonic acid (ARA) and docosahexaenoic acid (DHA) significantly decreased, while linoleic acid (LA), alpha-linolenic acid (ALA), and eicosapentaenoic acid (EPA) remained stable. Positive correlations were observed between HM and adipose tissue for palmitic, stearic, oleic, and polyunsaturated fatty acids (PUFAs). Correlations were found between milk and plasma for oleic, LA, ARA, ALA, DHA, monounsaturated fatty acids (MUFAs), and PUFAs. No correlation was observed between erythrocytes and HM FAs. LA and ALA were more concentrated in maternal blood than in infant blood, contrary to ARA and DHA, supporting that biomagnification of LCPUFAs may have occurred during pregnancy. Conclusions: These data show that maternal adipose tissue rather than erythrocytes may serve as reservoir of PUFAs and LCPUFAs for human milk. Plasma also supplies PUFAs and LCPUFAs to maternal milk. If both, adipose tissue and plasma PUFAs, are reflection of dietary intake, it is necessary to provide PUFAs and LCPUFAs during pregnancy or even before conception and lactation to ensure availability for mothers and enough supply for the infant via HM

Vitamin B-12 Intake and Status in Early Pregnancy among Urban South Indian Women

AIM: To evaluate the vitamin B(12) status of South Indian women in early pregnancy and its relationship with sociodemographic, anthropometry and dietary intake. METHODS: Cross-sectional study among 366 pregnant urban South Indian women ≤14 weeks of gestation with outcome variables defined as low vitamin B(12) blood concentration (<150 pmol/L) and impaired vitamin B(12) status [low vitamin B(12) plus elevated methylmalonic acid (MMA) >0.26 μmol/L)]. RESULTS: Low plasma vitamin B(12) concentration was observed in 51.1% of the women, while 42.4% had impaired B(12) status. Elevated MMA, elevated homocysteine ( >10 μmol/L) and low erythrocyte folate (<283 nmol/L) was observed among 75.8%, 43.3% and 22.2% of women, respectively. The median (25(th), 75(th) percentile) dietary intake of vitamin B(12) was 1.25 (0.86, 1.96) μg/day. Lower maternal body weight was associated with higher vitamin B(12) concentration [prevalence ratios (PR) (95% CI) 0.57 (0.39, 0.84)). The predictors of impaired vitamin B(12) status were non-use of yoghurt [PR (95%CI) 1.63 (1.03, 2.58)], non-use of fish [PR (95% CI) 1.32 (1.01, 1.71)] and primiparity [PR (95% CI) 1.41 (1.05, 1.90)]. CONCLUSION: A high prevalence of vitamin B(12) deficiency in early pregnancy among urban South Indian women was related to primiparity and to a low consumption of yoghurt and fish