|Chronic Energy Deficiency : Consequences and Related Issues (International Dietary Energy Consultative Group - IDECG, 1987, 201 pages)|
|Pregnancy, lactation and childhood: Report of working group 1*|
In the last few years, there have been many studies of breast milk output with doubly-labelled water and test-weighing procedures that take better account of cultural factors in the family. The main conclusions are:
1. Contrary to existing belief, if allowance is made for the weight of the baby, the milk output of women in developing countries, or of socioeconomically disadvantaged women, is as great as that of more privileged women, i.e., 750-800 mL/d.
2. Except in very high parity women, there is no evidence that milk output is limited by the secretory capacity of the breast.
3. In the populations that have been studied, there is no evidence that altering the energy intake of the mother affects the total energy output in breast milk.
4. One of the most important variables controlling milk output is the infant's weight.
5. It can no longer be assumed that maternal fat stores laid down during pregnancy are available or drawn upon for the support of lactation.
1. Lactation is a process which concerns the infant as well as the mother. Policies for the promotion of breast-feeding should try to ensure that lactation is adequate not only for normal growth in the normal infant, but for catch-up growth by the low birth-weight baby or the baby exposed to infections.
2. The recommendations in the 1985 report of extra energy intake by the mother to support the cost of lactation should be maintained. If fat stores cannot be drawn upon, the increments in intake may need to be even greater.
3. To the extent that the energy intake from breast milk in developing, countries may be greater than previously supposed, it will be appropriate to postpone the introduction of supplementary feeding.
4. Programs for the supplementary feeding of mothers are unlikely to be an effective mean of increasing breast milk output.
1. Studies on lactation, using modern methods, should be replicated in populations more severely deprived than those studied so far.
2. More work is needed on the physiology and biochemistry of milk production and secretion, in order to get a better understanding of the controlling factors.
3. The reason needs to be investigated, why supplementation of the mother apparently has different effects in pregnancy and in lactation.
4. Research is needed on energy expenditure in lactating women. Does the mother economize, as she apparently does in pregnancy ?
5. If reductions in the amount and changes in the pattern of energy expenditure do occur during lactation, their social implications must be examined.
6. Further research is needed on the effect on breast milk output of supplementary feeding of the infant, in terms of amount and timing.