CHAPTER 4 LACTATION AND HUMAN MILK

PART 1

1. The Mammary Gland 1.1 Early Development of the Breast - Mammogenesis : • Mammary gland development begin in utero • Infant is born with a small amount of rudimentary mammary tissue. Maternal and placental hormones near term entering the fetal bloodstream stimulate these immature mamary gland, and newborns often secrete a thin, milklike fluid ( witches milk ) for several days after birth. • During puberty, high level of estrogen and progesterone stimulate rapid development of the glands and growth of the breast. • During adolescence and young adulthoodm secretion of progesteron during each menstrual cycle stimulates further growth of the mammary glands and ducts • During pregnancy, final development and maturation of the breast occur, stimulated by high levels of circulating ovarian hormones. By term, the glands are fully formed and capable of producing breast milk to feed the newborn. 1.2 The Anatomy of the Breast

A lactiferus ( mammary )duct B lobules C lactiferus sinus ( ampulla ) D nipple E fat F pectoralis mayor muscle G chest wall / rib cage -

Enlargement (Alveoli) : A secretory cells B myoepithelial cells C ductule

Mammary gland : a compound tubuloalveolar gland embedded in a cushion of adipose tissue There re 15 to 20 small pores in the nipple to empty the sinuses. There are 15 to 20 lobes in each breast. The average breast of an adult woman before pregnancy weigh about 150 to 200 g.

Physiology of Lactation Milk production : two-step process .Five principal secretory pathways within the mammary epithelial cells : 1. Oxytocin circulates to the breast and stimulates milk secretion from the alveoli 2. they become crowded with ribosomes.Factors that affect the composition of the plasma also influence the composition of the milk.3 Breast Development During Pregnancy . Oxytocin stimulates the uterus to contract which help control postpaartum bleeding and they aid in uterine involution. Other components are pulled intact from the maternal plasma and transffered directly into the milk . in the weeks before parturitionm. from precursors derived from the maternal bloodstream 2.During the second half of pregnancy. .4 Birth and The early Hormonal Process of Lactation . . passed to the secretory cells and then secreted into the milk 3. Some substances are produced by the other cells in the breast. 1. while the ductal system proliferates under the influence of estrogen. lipid droplets an secretory granules.c . fatty acids and fat-soluble vitamins  in lipid droplets in mamary epithelial cells cytoplasm  migrate to the cell surface  pinched off in small envelopes of cell membrane  forming milk-fat globules 3. lactose ( synthesized in the Golgi ). following the osmotic pull • Breast milk : over 90% water and isoosmotic with maternal plasma 4. milk proteins. endoplasmic reticulum. milk-secreting cells. watersoluble vitamins and minerals 2. 2. Transcytosis of intact protein . Apocrine secretion of milk-fat globules • Milk fat : de novo fatty acid synthesis from glucose and fatty acids taken up from maternal plasma • Triglycerides. . . the alveoli become distended by accumulated colostrum. yellowish liquid called colostrum and. . 2. carrefully regulated by the secretory cells • Water  diffuses acros the alveolar cell membrane into the milk. produced by the posterior portion of pituitary gland. synthesis of milk and milk ejection or milk letdown. Exocytosis of Golgy-derived vesicles • Water-soluble components  synthesized in ribosomes  packed in Golgi apparatus  transported to the alveolar surface  secreted by exocytosis • Exocytosis e.1 Synthesis of Milk .Progesterone promotes an increase in the number and size of alveoli. has two major functions postpartum : 1.Oxytocin.As the mammary glands mature during pregnancy. Most of the components of milk are synthesized in the secretory cells of the mammary gland. The alveolar cells produce a thin.1.Prolactin stimulates the final differnetiation of alveolar cells in the breast to mature. Transport through channels in the cell membrane • Ions  pass through channels.The mammary glands are fully mature and capable of lactation by the beginning of the third trimester.The constituens of milk are derived from : 1. .The ducts and alveoli mature as prolactin and human placental lactogen (hPL) levels sharply rise in later pregnancy. secretory activity in the alveolar cells steadily increases.

.The process that moves the milk from the alveoli through the ducts to the nipple so it becomes available for the infant. The Pericellular Pathway • Certain situation e.g.Nipple stimulation  sensory nerves signals to the brain  posterioir pituitary release oxytocin  interact with myoepithelial cells sorounding the alveoli  contraction 2.Nipple stimulation  sensory nerves signals to the brain  anterior pituitary release prolactin.Prolactin : • Prolactin stimulates protein synthesis and lactose formation. Lipoprotein lipase increasing uptake of fatty acid from the maternal plasma and slows lipoprotein lipase activity in adipose cells elsewhere in the body. posterior pituitary release oxytocin . .Blood levels of prolactin 200 – 300 µg/mL and remain elevated for 2 -3 weeks postpartum even in women who are not breastfeeding.Full lactation is delayed about 46 – 72 hours after parturition . Suckling by the infant  initiate neuroendocrine reflex. albumin.2 Milk Ejection ( or Milk Letdown ) .Fall in progesteron  high level of prolactin triggers the onset of mature milk secretion . also increases the fat content in the milk by stimulating lipoprotein lipase. maternal blood cells to pass into the breast milk • 2. electrolytes. .3 Hormonal Control of Milk Secretion and Ejection . inflamation  substance passing between loosely joined cells into the breast milk • Allows intact plasma protein e.g early stages of lactation.Immunoglobulin A : produced by white blood cells in the breast tissue  released into the bloodstream  taken up by receptor-mediated pinocytosis into the mammary secretory cells  repackaged into secretory IgA  transffered across the secretory cell  secreted into milk 5.

2 Lipid Content of Human Milk . .Transitional Milk : milk between colostrum and mature milk . • High concentration of carotenoids ( 10 times higher than mature milk ) • Lower calories ( 58 kcal/100ml ) than mature milk ( 70 kcal/100 ml ) • Principal protein : IgA  protect newborn form gastrointestinal tract infection • Multiparous women produce greater volumes of colostrum than primiparous women . even from the same woman at different stages of lactation.Over 95% triglycerides.M.At one feeding. milk production changes from a solution high in protein and electrolytes and low in fat and lactose to one lower in protein and electrolytes but high in lactose and fat. the mammary gland involutes.2 – 5 g/100 ml ( average 4. from day to day.Fat content is increased steadily during the first week post partum.Lipases present in the newborn intestines and the breastmilk itself .58 – 72 kcal/100 ml ( generally 65 kcal/100ml ) . 10% from protein 4. the protein builds up and inhibit secretion by the epitelial cells .If milk is not regulargly removed from the alveoli.1 Energy Content of Human Milk . protein and salts containing a suspesension of fat and also contains enzymes to help the newborn digest and absorb nutrients.Breastmilk fundamentally is a solution of sufar. Prolactin levels in the blood are doubled after 10 – 15 minutes of suckling. milk production slows and the milk composition reverts quickly to an immature. 2.4 Balancing Milk Production with Infant Demand .Distension of the alveoli by accumulated milk. Composition of Maturre Human Milk 4. immune factors to protect the infant from infection and hormones and growth factors that influence infant growth .First 2 – 3 weeks postpartum. diurnally and from the beginning of a single feeding to the end. . the fat content is gradually increases from the beginning of the feed to the end .5% cholesterol ( precursor for synthesis of myelin. prepartum type. pressure and distension of the secretory epithelium inhibits milk production. Maturational Changes in Human Milk .Colostrum : • 3 – 7 days postpartum • Thicker and more viscous.2 g/100 ml ) . 0. There is rise and fall of prolactin levels proportional to the intensity and frequency of nipple stimulation Oxytocin :  interact with myoepithelial cells sorounding the alveoli  contraction  pushing milk out into the ducts toward the nipple If suckling does not begun by the fourth postpartum day. 3.50% from fat.Multiparous women often produce mature milk sooner than first-time mothers 4. connective tissue and fat gradually replace many of the alveoli. slightly yellow and not as milky as mature milk. small amount of phospholipids. glycolipids and FFA. cell membranes and steroid hormones of the newborn ) .• • • - Stimulates the secretory cells in the alveoli to produce milk.Fat content tends to be lowest at about 6:00 A. then plateaus .The concentration of the individual component varies considerably from mother to mother. . 40% from lacotose.

and oligosaccharides ( glucose. the second most abundant free amino acid in human milk.Secretory immunoglobulin A • found only in human mik • synthesized from immunoglobulin A and other protein • colustrum is rich in SIgA ( 5 times higher than in mature human milk ) • resist hydrolisis by enzymes and acid • blankets the epithelium of the intestine. phospates and calcium.Linear phospoproteins. having a charged end that binds callcium.Lactose is the major carbohydrate ( 90% ). . up tp 10% of milk protein in the first few postpartum weeks is not digested.During digestion the curd are precipitated into sizable clumps. by four months postpartum only about 3% of dietary protein goes unabsorbed. galactose.7 – 0.Rich in taurine. the remaining of 10 % is a variety of mono.Lactose enhance the absorption of calcium from breast milk 4. blocking adhesion and invasion by bacteria and viruses The Protein Quality of Human Milk .0.40% of total protein . lactoferrin 10-20% and secretory immunoglobulin A 10% .3 Carbohydrate Content of Human Milk .Alpha-lactalbumin 30%. Whey Proteins .- After an average feeding. fructose adm glucosamines ) . taurine is important in bile acid metabolism and may . 30 times that in cow’s milk  in infant.Lactoferin • found only in human milk • iron-binding protein • antibacterial properties : inhibits the growth of certain iron-requiring bacteria in the intestines • stimulus for growth and development of lymphocytes in the newborn’s intestine • provide source of amino acids for growth .7g/100 mL .4 Protein Content of Human Milk . which are tougher and less readily digestible 2. Multiparous women generally have less fat in the milk Maternal nutrition can markedly affect the milk-fat concentration and the type of fats present in the breast milk 4.Because of the high content of IgA in early milk and the immaturity of the newborn’s digestive tract.Milk-specific proteins divided into : 1. Casein Proteins . about 20% of the milk femains in the gland and this ‘hindmilk’ is particularty rich in fat.9 g/100ml . form stable micelles .Alpha-lactalbumin : • component of lactase synthetase ( enzyme that synthesizes lactose from glucose and galactose ) • has calcium and zinc binding sites • provide rich source of amino acids for the newborn .

Vitamin A • 200 µg/100 ml ( first week postpartum )  40 .2 µg/100 ml in mature milk • Vitamin K synthesized by intestinal bacteria contributes to the needs during later infancy. Taurine is poorly synthesized by the newborn because the enzyme systems arre still developing in early incancy.2 – 0.15 µg/100 ml • 75% is 25-OH vitamin D .Thiamin • 1-2 µg/100 ml in colostrum.05 – 0. because the enzyme systems mature late in fetal life.Vitamin D • 0. 4.3 mg/100 ml ( in mature milk ) • Mixture of several tocopherols.Vitamin E • 0.8 – 1 mg/100ml ( in colostrum ) and 0. in mature milk 10 – 30 µg/100 ml .N-acetyl glucosamine : promote the growth of Lactobacillus bifidus in the colon . peptides and urea but not significantly contribute to nutritional needs.stored in developing mammary gland . Contain only moderate amount of phenylalanine. 4.5 Nonprotein Nitrogen Content of Human Milk . seven – ten fold in mature milk ( with maximum levels at 2 – 3 months postpartum • Varies considerably over the course of lactation and between individual woman . Water.Folate • 5 – 14 µg/100 ml . in the newborn the intestine is sterile  it is recommended that all infants receive supplementation of vitamin K during the newborn period • Recommended intake of 12 µg/day.Soluble Vitamins in Human Milk . high in colostrum and declines gradually over the course of lactation • Niacin : 75 µg/100 ml ( in colostrum ) – 100-200 µg/100 ml ( in mature milk .- function as neurotransmitter.Vitamin B6 • 18 µg/100 ml by three weeks postpartum ( Vitamin B6 are low in colostrum and increased markedly during first two weeks postpartum .Carnitine : essential in the oxidation of fatty acids for energy .6 Vitamin Content of Human Milk Fat-Soluble Vitamins in Human Milk .Vitamin C • 4-6 mg/100 ml • 10 times higher that in maternal plasma .Small amounts of free amino acids. tyrosine and methionine compared to much higher conten in cow’s milk.Riboflavin and Niacin • Riboflavin : 35 µg/100 ml. alpha-tocopherol 83% of total .secreted into colustrum 34 – 750 µg/100 ml.Vitamin K • 0.60 µg/100 ml after several months • 90% as retinyl esters in the milk-fat globules  hydrolyzed by lipases in intestinal tract • Smaller amounts of retinol and beta-carotene  retinol is absorbed • Beta caroten : .

Sodium.Calcium. . chromium and copper and also trace minerals. potassium and chloride concentration in colostrum are high but concentrations in mature milk 1/3 – 2/3 lower than in colostrum Major Minerals in Human Milk .• - - Bound to specific folate-binding protein in the whey fraction. sulphur.Mature breast milk contains all of the essential minerals needed for infant growth and development. and levels of many minerals content gradually decline over the course of lactation.The mineral content of breast milk varies significantly with the stage of lactation.03 – 0.32 µg/100 ml • Completely vegetarian women produce milk with vitamin B12 0. in the form of folylpolyglutamates • Folate continues to be secreted into the milk although maternal dietary intake is low Vitamin B12 • 0.22 – 0.Calcium  20-35 mg/100ml  2/3 in casein micelles. 20% higher than in colostrum 4. phosphorous.Zinc • Concentration at 1.The mineral content also vary significantly during a single feeding. 1/3 form soluble complex with citrate  highly bioavailable ( infant absorb 2/3 calcium in breast milk compare to ¼ .7 Mineral Content of Human Milk . phosphorus.26 µg/100 ml in mature milk. . with smaller amount of zinc. magnesium  bound to casein protein . sodium and chloride ). The calcium and zinc levels are higher in the fore milk but the sodium and iron level are lower than the hindmilk. . iron.5mg/day or 20 – 90 µg/100 ml ) • Concentrations are highest immediately after birth.Iron • Low in iron ( less than 0.05 mg/100ml • The most abundant trace element in human milk • Actively transported .12 months postpaartum are 0.2/5 in bovine milk Trace Minerals in Human Milk . well-balanced and the bio-availibility for the infant is high. slightly higher in the evening than in the morning and higher in women who are multiparous • Lactoferrin avidly binds iront and transport it in the milk • Iron in breast milk is highly bioavailable. . infant absorbs 50 – 70% compared with less than 10% from cow’s milk or formula.4. magnesium) and electrolytes ( pottasium. lactoferrin and inosine and its metabolite increase availibility of iron .3. Ascorbic acid. 0. Colostrum is richer in minerals than mature milk.Most abundant minerals are major mineral (calcium.1 and 0.005 µg/100 ml Biotin and Panthotenic Acid • Biotin : 0.6 µg/100 ml and gradually increase over the course of lactation • Biotin actively secreted into breast milk at levels several hundred times greater than the level in plasma • Panthotenic acid : 0. level fall 20-50% from 2 weeks to 9-12 months postpartum • Level varies widely among women and from day to day in the same woman.

with values in milk generaly 5 – 7 times those in maternal plasma.9 Anti-Infective Factors in Human Milk Anti-infective factors produced throughout lactation. glycerol and retinol Amylases and Proteases . . Lipase Mammary epithelium  synthesized several lipases in inactive form  contact with bile salts in the upper intestine of the newborn  become active( bile-salt stimulated lipases ) augement the activity of infant pancreatic lipase  act on milk-fat globules. a selenium-containing enzyme. Immune Cells . The activity of the enzyme in milk is positively correlated with the selenium content of the milk.Several types of white blood cells. Iodine • Iodine metabolims during lactation is unique : the mammary gland acidly accumulates iodine • Iodine concentration in milk : 20 – 30 times higher than in maternal plasma • Levels in milk are strongly correlated with maternal intake of iodine form the diet. • Levels in milk are directly related to maternal plasma levels. Picolinic acid. increase the absorption of fatty acids. found in human milk .8 Digestive Enzymes in Human Milk The digestive enzymes help the immature gastrointestinal tract of the newborn digest and absorb nutrients in the milk. • There’s day to day and diurnal variation • Bioavailibility is high. resistant to digestion. Copper • 10 – 60 µg/100 ml • 20 – 30% higher in colostrum than in mature milk. - - 4. citrate and zinc-binding protein facilitate zinc absorption from human milk. The absorption of the zinc given with breastmilk was higher than with cow’s milk.6 – 0.Mammary cells  secrete amylase into milk (resistant to proteolysis in newborn stomach)  passes into small intestine  aids the digestion of nonlactose carbohydrates in milk. varies with geographic location and selenium content of the diet.Infant pancreatin amylase activity is low . level declines gradually over the first 4 months of lactation then stable up to12 months Manganese • 0.3 µg/100 ml • Primarily bound to casein and other proteins • Concentrations are highest in colostrum and decline over the course of lactation.3 µg/100 ml from first month to third month of lactation Selenium • 1. breaking down triglycerides and retinyl esters. Levels fall rapidly during the first month postpartum then decline more slowly. • Glutathione peroxidase. particularly in the early stages of lactation.• - Levels in colostrum 4 – 5 times higher than in mature milk. particularly abundant in colostrum. is present in milk and may help protect the milk from oxidative damage.Breast milk proteases  aid protein digestion in the infant intestine 4. and protect the newborn from disesase particularly gastrointestinal disease.

Lactoferrin  complexing with iron  inhibits growth of certain bacteria Lysozyme . insulin and thyroid hormones also present in small amount in milk. lactoferrin and complement ) Immunoglobulins .Transportin iron in milk . . DDT.Potent antibacterial factor Nonlactose Carbohydrates . . . organohalogen componds including dioxin. preventing the attachement of pathogenic bacteria in the intestine and neutralizing toxins secreted by certain bacteria. temporarily protecting infant while its own immune system matures .10 Growth Factors and Hormones in Human Milk . and repair in the mammary gland during lactation . although maternal exposure must be high for this to occur ( greater than 40 mg/dL ) 5.1 Pesticides. halocarbons and others.A variety of moderate chain-length oligosaccharides are present in small amount  many have anti-infective properties.Cortisol.2 Radioactivity - . Contaminant in Human Milk 5.Lactobacillus : • dominant bacteria in the colon during infancy • break down lactose to acetic acid and other metabolites that inhibit the growth of pathogenic bacteria .Major immunoglobulin is Secretory immunoglobulin A ( SigA ) with small amounts of IgG and IgM Lactoferin . cyclic hydrocarbons.There is little information available on their pottential short or long-term effect on infant health. lysozyme.Present in large amount through out lactation . their functional significance is uncertain. the reminder are lymphocytes ( produce antibodies.Levels of pesticides in human milk tend to be higher than in cow’s milk . Chemicals and Heavy Metals .Breaks down the cell walls of pathogenic microbes .Trace amounts of other chemicals have been indentified in milk e.Also has protective effects against bacteria and viruses (antiviral activity) in the digestive tract .Infant poisoning from lead transferred through breast milk has been reported. .Growth Factors : • May stimulate growth of intestinal epithelium in the newborn • May strengthen the integrity of mucosal barrier • May promote growth. .g.Several factors that promotes cell growth and differentiation called growth factors.Usually only trace amounts of heave metals find their way into human milk. differentiation.Maternal exposure to antigen  maternal lymph nodes  production of white blood cells that synthesize antibodie to the antigen  antibodies are produced by the white blood cells in the mammary gland  transferred into milk  provide passive immunity.90% are phagocytic cells. polybrominated biphenyls (PBBs).Major chemical contamints are pesticides e. Level in human milk tend to be much lower than levels in water or cow’s milk. polychlorinated biphenyls (PCBs). 5. 4.g.Glucoasamine promote the growth of Lactobacillus bifidus in the lower intestinal tract .

Well-nourished women who are breast-feeding tend to have lower rates of protein turnover and lower rates of muscle protein breakdown ( measured by urinary 3methylhistidine excretion Micronutrient Metabolism . 5.High prolactin  increase mobilization of fat from adipose tissue and directing dietary lipids toward the mammary gland . 7.g.A woman who gains about 13 kg during pregnancy looses about 5 kg during delivery. if the nursing mother has certain serious infection.1 Measuring Milk Output . Norway and Sweden scientist concluded that concentrations of radioactivity were so low they didi not pose a threat to nursing infant.Cholesterol and high-density lipoprotein levels tend to be higher in lactating women .2 Milk Output during Lactation .Milk intake : 4 – 5 months : 400 – 1200 g/day with average 750 – 800 g/day After solid food introduced between 4 – 7 months : 770 g/day at 6 months.Milk production requires 500 – 650 kcal/day . Maternal Metabolism during Lactation 7.2 Wei/ght Loss and Energy Expenditure Patterns of Weight Loss during Lactation . herpes simplex . 445 g/ day at 12 months . viruses and bacteria can be transmitted to the infant in the breast milk e.The most commonly used method of measuring milk intake and milk production : test weighing : the infant is carefully weighed before and after each feeding and the amount of weight gained is used to determine milk intake. 635 g/ day at 9 months. hepatitis B.g. e.However.Enchanced absorption from dietary sources. Milk Volume 6. Lipid and Protein Metabolism .1 Substrates for Milk Synthesis The metanbolism of nutrient is altered to give priority to milk production : energy and nutrients from diet and maternal stores are channeled into the mammary gland. HIV - 6. 2 kg during the first week through diuresis of body water. Austria. .The mammary gland carefully balances production with the infant demand. twinns’ mother produce 2000 – 3000 g/day.Ordinarily. TBC. . but the amounts were very small. 6. there were increase levels of radioactivity found in breastmilk samples from women throughout Europe. once lactation is establish .In 1986. Singel infant moms can use breast pump to extract additional milk after feeding to increase milk production by 20 – 40 7.Breast feeding mothers have the potential to produce far more milk than is needed to meet usual infant demands. .Triglyceride levels are lower in lactating women .Pregnant women and lactating women were advised to avoid food from cow’s milk and leagy vegetables as the levels of radioacitvity increased markedly.3 Viruses and Bacteria . after an explosion at the Chernobyl nuclear power plant in Russia. . and continue to lose weight during lactation as most body fat accumulated during gestation is mobilized to supply the needs of the breast-feeding infant.In reports from Italy.Primary stimulus for milk production is extraction of milk from the breast by the suckling infant. human milk provides substantial immunologycal protection .

calcium..E and C.Other study measured weight and triceps skinfold thickness for 2 years postpartum. Changes in Body Fat . most women are in negative energy balance: 110 – 343 kcal/day in well-nourished women  average weight loss during first 6 months postpartum is 0. weight loss continues during months 6 – 12 but at a slowe rate.For women who breast-feed past six months.Maternal needs duriing breast-feeding are typically higher than in any other period of a woman’s life. but more rapid weight loss can reduce a mother’s ability to produce adequate milk. fat is more readily mobilized from femoral adipose tissue ( hips and thighs ) than in nonlactating women. even during pregnancy .Weight changes postpartum vary widely among individual. or formula feeding or combines breast and formula feeding. . college-educated and Caucasioan women indicated that the energy intakes are often below recommended amount but the intake of protein.During the first 4 – 6 months of lactation. . zinc.Women who are significantly overweight can lose up to 2 kg per month without adversely affecting lactation. The study found that women who breastfed for at least 12 months had weight loss and loss in skinfold thickness significantly greater than women who breastfed for less than 3 months. calcium. Dietary Surveys of lactating Mothers . Weight Loss : Breast-feeding versus Formula Feeding .One study found that suprailiac and subscapular measurement typically decrease during first 4 – 6 months postpartum  body fat percentage is decreasing as fat is mobilized to meet the energy needs of lactation.In USA total energy expenditure of lactating women not including milk production is 1800 – 1900 kcal/ day compared to 2200 kcal/ day for light – moderately active nonlactating women. iron. 8.2 Recommended Dietary Allowance for Lactating Woman .In lactating women. underlying maternal needs. .8 kg/month. . reduced thermic effect of food  small reduction in daily energy expenditure. The nutrient which was most likely to be low were vitamin A.Little information is available on the intake of lactating women from other socioeconomic levels or minority group.6 – 0. 9. maternal nutritiion status when beginning lactation. .Healthy infant  doubles its weight in the first 4 – 6 months. with babies who were exclusively breast-feeding. . weight gained during pregnancy and parity.Enery –sparing adaptation : lower basal metabolic rates. lost weight in the six months after delivery. Energy Expenditure during Lactation .Data for well nourished.1 Nutritional Demands of Lactation . . all the energy. Maternal Nutritional Needs During Lactation 9.Divided into recommendation for 0 – 6 months and 6 – 12 months postpartum - .Weight loss in postpartum period is influenced by several factor e. .Women. thiaminm riboflavin and niacin to be at least 80% of the RDAs for lactation or even exceed the RDAs. magnesium and iron. . protein and micronutrient provided by the mother. Data indicate dietary intakes may be suboptimal.Factor determines : the volume and composition of m ilk produced.All lactating mother should maintain adequate daily energy intake : minimum 1500 calories daily. vitamin A and C. 9. avoid strict diets and weight loss medications .D. There were nonsignificant differences in weight loss or loss of body fat between the women.g.

85 kcal for every 100 ml of milk roduced  extra 640 kcal/day for first 6 months and 510 kcal/day for the second 6 months of lactation . 9.Conversion of maternal protein into milk is estimated to be 70% efficient  protein requirement : 15 g/ day for the first six months and 12g/ day thereafter.3 RDAs for Energy .Zinc : 7 mg/ day during first six months and 4 mg/day during second six months .5 mg/ day .Vitamin E : 4 mg for the first six months and 3 mg thereafter .8 RDAs for Trace Minerals .Vitamin D : 10 µg/day to maintain calcium balance .Vitamin A : 500 RE for first six months.The differences reflect the difference in milk production : estimated to be 750 ml/day for 0 – 6 months and 600 ml/day for 6 -12 months 9.7 RDAs for Major Minerals .Thiamin : 1.1 mg/day .6 RDAs for Water-Soluble Vitamins .7 during the second six months .Vitamin B6 : 0.Vitamin K : no addiitional is recommended during lactation in US 9.9 RDA for water 650 ml extra fluid each day during fist six months and 530 ml thereafter 9. .Riboflavin : 1.Vitamin B12 : 0.. thin.4 RDA for Protein . should consume additional 650 kcal druing first six months of lactation 9.10 RDAs for Electrolytes Although increase.Vitamin C : daily increment 35 mg for the first six months and 30 mg for the second six months .8 mg during the firs six months and 1.Folate : 280 µg/day for the first six months and 260 µg/day for the second six months  400 µg/day to prevent neural tube defects .Iodine : 200 µg/day 9. six months of breast-feeding would deplete liver stores about 25 – 50 % . requirement of sodium and pottasium easily met by current adult intakes. and 400 RE for 6 – 12 months postpartum  maternal liver conntain about 200mg of stored vitamin A  if all the extra vitamin A from breast milk come from maternal stores.6 µg/day 9.5 RDAs for Fat-Soluble Vitamins .Selenium : 20 µg/day .Iron : for lactating women who resume their menses : 0.Niacin : 20 mg .Calcium and phosporus : 1200 mg/day .Conversion of maternal energy into milk is estimated to be 85% efficient.Energy supplied by fat stores during pregnancy  2-3kg adipose tissue of a woman who gain 12 kg during gestation could povide 100-150kcal/day during 6 months  RDA call for extra 500 kcal/day throughout lactation  woman who have not gain sufficient weight during prengancy.6 mg .016 mg per extra gram of protein  2. - . Therefore no additional intake of these electrolytes is recommended.Magnesium : 75 mg/day during the first six months and 60 mg/day during the second six months 9.

Sign up to vote on this title
UsefulNot useful