Maternal Body Composition & Breastmilk Fat Content Among Lactating Mothers

Transcription

1 Maternal Body Composition & Breastmilk Fat Content Among Lactating Mothers CeSSIAM, Quetzaltenango, Guatemala Ruijia Niu, Tufts University MPH Candidate

2 Outline Projects & Training Method Results Brief Discussion Future Implications

3 Activities

4 Main Projects Arm1: Nutrition content in breastmilk of mothers with different postpartum days in Xela Arm 2: Body composition and hydration status of mothers with different postpartum days in Xela

5 Other Projects Sensitivity test of SECA BIA on immediate ingestion of 2L water

6 Other Projects Omega-3 fatty acids content in breastmilk of mothers living in different geographic locations in Guatemala

7 Trainings Standardization of infant anthropometric measurement; SECA bioelectrical impedance analysis (BIA) background, operation and basic data analysis; Creamatocrit analysis of breastmilk; Conversational Spanish

8 Methods of Main Project Consent & Interview Recruitment Urine Coll. Breastmilk Collection Sample Dissemination Creamatocrit Data Entry Urine Osmolality BIA

9 Statistical Analysis Dependent Variable Body Fat Mass % Body Weight (kg) BMI (kg/m 2 ) Hydration: Extracellular Water (ECW)/Total Body Weight (TBW) % Independent Variables Postpartum Days, Age Postpartum Days, Age, Height Postpartum Days, Age Postpartum Days, Age, Height, Weight Statistical Test Kruskal Wallis Test + Linear Regression

10 Statistical Analysis cont. Dependent Variable Fat Mass% calculated from BMI Hydration from BIA (%) Breastmilk Fat Content (g/l) Independent Variables Fat Mass% from BIA Urine Osmolality (mosm/kg) Fat Mass%, Age, Postpartum Days Statistical Analysis Paired T-test + Linear Regression Linear Regression Linear Regression

11 Results

12 Descriptive Statistics basic information Group Mean±SD (Range) Postpartum Days 40 days 75 days 120 days 185 days p-value 42±2.9 (37-46) 73±4.2 (69-81) 120±7.0 ( ) 186±4.4 ( ) Age (year) 27.7±5.4 (21-37) 23.8±6.0 (17-32) 23.0±4.1 (18-29) 25.1±4.1 (19-32) 0.59 Height (cm) 153.2±4.2 ( ) 150.8±4.4 ( ) 148.2±6.8 ( ) 151.3±4.9 ( ) 0.46 Waist Circumference (cm) 88.4±5.3 (78-94) 88.4±13.0 (69-110) 86.5±7.8 (74-101) 82.9±7.7 (74-98) 0.07 Breastfeeding times per day 9±5.1 (2-20) 11±7.9 (4-30) 13±6.5 (7-30) 11±7.0 (5-30) 0.66

13 Descriptive Statistics basic information continue Group/No. of Women (n=40) WHO Adolescent Pregnancy (15-19 years old) Education (No. of Women) 40 days (n=10) 75 days (n=10) 120 days (n=10) 185 days (n=10) Total p-value Primary Secondary Higher Low Milk Fat (<30 g/l)

14 Descriptive Statistics anthropometry categories Group/No. of Women (n=40) 40 days (n=10) 75 days (n=10) 120 days (n=10) 185 days (n=10) Total Stunting (height<145cm) Overweight (25 BMI<30) Obesity (30 BMI) Underweight (BMI<18.5) 0

15 Group/No. of Women (n=40) Hyperhydration from Urine Osm. (<90 mosm) Descriptive Statistics hydration status categories 40 days (n=10) 75 days (n=10) 120 days (n=10) 185 days (n=10) Total Lax Cutoff Hypohydration from Urine Osm. (>900 mosm) Hypohydration from BIA (<70%) Rigorous Cutoff Hypohydration from Urine Osm. (>700 mosm) Hypohydration from BIA (<73.2%)

16 Body Fat Mass Percentage Kruskal-Wallis Boxplot of Fat Mass% Test: by Postpartum p = 0.95 Days There was no significant difference. 40days 75days 120days 185days Median P. 25 th -75 th

17 Body Fat Mass Percentage Scatterplot for Fat Mass% from BIA and Postpartum Days Infant Age_day Fitted values No linear relationship with or without adjustments; p = 0.89 (adjusted for maternal age)

18 Body Weight Weight_kg Kruskal-Wallis Test: p = 0.80 There was no significant difference. Boxplot of Maternal Body Weight (kg) by Postpartum Days 40days 75days 120days 185days Median P. 25 th -75 th

19 Body Weight Scatterplot for Maternal Weight (kg) and Postpartum Days Weight_kg Infant Age_day Fitted values No linear relationship with or without adjustments p = 0.63 (adjusted for maternal age & height)

20 Body Mass Index (BMI) BMI_kg/m Kruskal-Wallis Test: p = 0.92 There was no significant difference. Boxplot of Maternal BMI(kg/m2) by Postpartum Days 40days 75days 120days 185days Median P. 25 th -75 th

21 Body Mass Index (BMI) Scatterplot for BMI (kg/m2) and postpartum days BMI_kg/m Infant Age_day Fitted values No linear relationship with or without adjustments p = 0.90 (adjusted for maternal age)

22 Hydration ECW/TBW% ECW/TBW_BIA_% Kruskal-Wallis Test: p = 0.20 There was no significant difference. Boxplot of Maternal Hydration% by Postpartum Days 40days 75days 120days 185days Median P. 25 th -75 th

23 Hydration ECW/TBW% Scatterplot for Hydration(ECW/TBW%) and Postpartum Days % 70.0% Infant Age_day Fitted values Stat. significant linear association with adjustments of age & height; β-coefficient = , 95%CI [-0.069, ] (p = 0.04)

24 Comparison of Body Fat Mass% from: BMI vs. BIA FM% from BMI = 1.20 x BMI x age x sex (R2 0.79, SEE = 4.1% BF%) (Deurenberg et al., 1991) BMI Histogram of Body Fat Mass% from BMI 15 FM% from Mean Standard Deviation Frequency 10 5 BMI ± Fat Mass% from BMI Calculation BIA ± 4.92 BIA Histogram of Body Fat Mass% from BIA 15 Frequency Fat Mass% from BMI Calculation

25 Comparison of Body Fat Mass% from: BMI vs. BIA Paired T-test H 0 : Same FM% from BMI and BIA H a : Different FM% from BMI and BIA There was statistically significant difference between the two FM% values (p = ).

26 Comparison of Body Fat Mass% from: BMI vs. BIA 45 Scatterplot for Fat Mass% from BMI and BIA Fat Mass % from BIA Fitted values Linear Association (p = 0.001, R = 0.79) FM% from BMI = 0.59*FM% from BIA

27 Comparison of Hydration: BIA vs. Urine Osmolality Hydration Mean Standard Deviation ECW/TBW % 76.0 ± 5.9 Urine Osmolality (mosm/kg) 599 ± 228 Distribution of ECW/TBW% 15 Distribution of Urine Osmolality 10 Frequency 10 5 Frequency ECW/TBW_BIA_% Urine Osmolality_mosm/L

28 Comparison of Hydration: BIA vs. Urine Osmolality 90 Scatterplot of Urine Osmolality & ECW/TBW% Urine Osmolality_mosm/L Fitted values There was no linear association between Urine Osmolality and ECW/TBW% (p = 0.30).

29 Comparison of Hydration: BIA vs. Urine Osmolality Partial linear regression with 700 cutoff 90 Scatterplot of Urine Osmolality & ECW/TBW% Urine Osmolality_mosm/L Fitted values There was no partial linear association between Urine Osmolality and ECW/TBW% with 700mOsm cutoff. (p=0.75 & 0.20, below and above respectively)

30 Comparison of Hydration: BIA vs. Urine Osmolality Partial linear regression with 900 cutoff 90 Scatterplot of Urine Osmolality & ECW/TBW% Urine Osmolality_mosm/L Fitted values No partial linear association below 900mOsm cutoff. (p=0.49); but they were associated above 900 (p= with β-coe=0.07) however, only 4 samples.

31 Comparison of the two hydration cutoffs Urine Osm. N=40 Hypohydration ( 900mOsm) Euhydration (<900mOsm) ECW/TBW% Hypohydration (<70%) Euhydration ( 70%) Total Total Fisher s Exact: p=0.04 There is a difference between the two hydration measurements with lax cutoffs.

32 Comparison of the two hydration cutoffs Urine Osm. N=40 Hypohydration ( 700mOsm) Euhydration (<700mOsm) ECW/TBW% Hypohydration (<73.2%) Euhydration ( 73.2%) Total Total Pearson Chi 2 test: p=0.58 There is no difference between the two hydration measurements with rigorous cutoffs.

33 Comparison of Hydration: Total Body Water from BIA vs. Urine Osmolality Hydration Mean Standard Deviation TBW (L) 27.0 ± 3.1 Urine Osmolality (mosm/kg) 599 ± 228 Distribution of Total Body Water Distribution of Urine Osmolality Frequency 5 Frequency Total Body Water_L Urine Osmolality_mosm/L

34 Comparison of Hydration: Total Body Water from BIA vs. Urine Osmolality 35 Scatterplot of Urine Osmolality vs. Total Body Water Urine Osmolality_mosm/L Fitted values There was no linear association between Urine Osmolality and TBW (p = 0.54).

35 Breastmilk Fat Content vs. Maternal Fat Mass% from BIA Mean Standard Deviation Breastmilk Fat Content (g/l) 31.5 ± 16.7 Maternal Fat Mass % from BIA 35.3 ± 6.7 Distribution of Breastmilk Fat Content (g/l) Distribution of FM% from BIA Frequency 0 5 Frequency Breastmilk Fat Content_g/L Fat Mass % from BIA

36 Breastmilk Fat Content vs. Maternal Fat Mass% from BIA Scatterplot for breastmilk fat content(g/l) and maternal body fat% from BIA 80 Breastmilk Fat Content (g/l) Fat Mass % from BIA Fitted values Linear Regression: p= , R = 0.90 Breastmilk fat content (g/l) = 0.89*Fat mass% from BIA

37 Breastmilk Fat Content vs. Maternal Fat Mass% from BMI Mean Standard Deviation Breastmilk Fat Content (g/l) 31.5 ± 16.7 Maternal Fat Mass % from BMI 30.4 ± 4.9 Distribution of Breastmilk Fat Content (g/l) Distribution of FM% from BMI Frequency Frequency Breastmilk Fat Content_g/L Fat Mass% Calculated from BMI

38 Breastmilk Fat Content vs. Maternal Fat Mass% from BMI Scatterplot for breastmilk fat content(g/l) and maternal body fat% from BMI 80 Breastmilk Fat content_g/l Fat Mass% Calculated from BMI Fitted values Linear Regression: p= , R = 0.91 Breastmilk fat content (g/l) = 1.05*Fat mass% from BMI = 1.05*(1.20 x BMI x age - 5.4)

39 Brief Discussion similar results from previous study Barbosa et al. 1997: Longitudinal study in rural Mexico 40 women followed from giving birth to 6 months FM% from deuterium dilution Milk collection from 1 breast at 10, 14, 18 of the day Milk fat extraction by modified Jeejeebhoy method \ Milk fat was positively related with body fat mass at 3 and 6 postpartum months In discussion, mentioned the same association was found in studies in Bangladesh, Honduras and Gambia

40 Brief Discussion - a very similar study Nikniaz et al. 2009: Study in urban & rural areas of Iran 182 mothers with postpartum days 15ml milk sample collected before feeding in the morning Fat analysis using Gerber Method Multi-linear regression with data of diet intake \

41 Brief Discussion Prentice et al. 1981: Breastmilk fat content followed the change of mean of maternal subcutaneous fat measured by triceps skinfold. Michaelsen et al. 1994: Fat content +ve association with pregnancy weight gain at 4 mo Support the hypothesis laying-down fat stores are more easily utilized in breastmilk synthesis Nommsen et al. 1991: Fat content +vely related to percent of ideal body weight (%IBW) for 6-12 month postpartum Mandel et al. 2006: Creamatocrit % was NOT associated with maternal BMI for 2-6 & month postpartum

42 Deliverables Three Abstracts Eeq_iykNByMWQySmVsdkMwSVE

43 Future Implications Longitudinal study on body composition change during lactation For studying hydration status, control of 24h diet, season, time of day, etc. is also important To further investigate the correlation between breastmilk fat content and maternal body composition, more mothers with various postpartum days are recommended to be included.

44 Bibliography Barbosa, L., Butte, N. F., Villalpando, S., Wong, W. W., & Smith, E. O. (1997). Maternal energy balance and lactation performance of Mesoamerindians as a function of body mass index. The American journal of clinical nutrition, 66(3), Brewer, M. M., Bates, M. R., & Vannoy, L. P. (1989). Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women. Am J Clin Nutr, 49(2), Butte NF, Hopkinson JM. Body composition changes during lactation are highly variable among woman. J Nutr 1998;128:318S 385S. Deurenberg P, Weststrate JA, Seidell JC. Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. British Journal of Nutrition. 1991;65(2): doi: /bjn Mandel, D., Lubetzky, R., Dollberg, S., Barak, S., & Mimouni, F. B. (2005). Fat and energy contents of expressed human breast milk in prolonged lactation. Pediatrics, 116(3), e432-e435. Michaelsen, K. F., Larsen, P. S., Thomsen, B. L., & Samuelson, G. (1994). The Copenhagen Cohort Study on Infant Nutrition and Growth: breast-milk intake, human milk macronutrient content, and influencing factors. The American journal of clinical nutrition, 59(3), Nikniaz, L., Mahdavi, R., Arefhoesseini, S., & Khiabani, M. S. (2009). Association between fat content of breast milk and maternal nutritional status and infants' weight in tabriz, iran. Malaysian journal of nutrition, 15(1). Nommsen, L. A., Lovelady, C. A., Heinig, M. J., Lönnerdal, B., & Dewey, K. G. (1991). Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: the DARLING Study. The American journal of clinical nutrition, 53(2), Oyesiku L, Solomons NW, Doak CM, Vossenaar M. Highland Guatemalan women are extremely short of stature, and no lactation duration effects on body composition are observed in a cross-sectional survey. Nutr Res Feb;33(2): doi: /j.nutres Powers JS, Buchowski M, Wang L, Powers JS, Otoo-Boameh A. Total body water in elderly adults assessing hydration status by bioelectrical impedance analysis vs urine osmolality. Journal of the American Geriatrics Society. 2012;60(2): doi: /j x Prentice, A., Prentice, A. M., & Whitehead, R. G. (1981). Breast-milk fat concentrations of rural African women: 2. Long-term variations within a community. British journal of Nutrition, 45(3),

45 Acknowledgement Dr. Odilia Bermudez Dr. Noel Solomons CeSSIAM team in Xela & Guatemala City special thanks to Alejandra M., Alejandra Z., Claudia G., Déborah F., Martita E., Rosario M. Dr. Mireille Aramati Dr. Virginia Chomitz

46 Gracias! Q & A