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close this bookMaternal Diet, Breast-Feeding Capacity, and Lactational Infertility (UNU/WHO, 1983, 107 pages)
close this folder3. Effect of diet on maternal health and lactational performance
View the document(introductory text...)
View the documentBody size and composition
View the documentProtein status of the mother
View the documentMaternal vitamin status
View the documentDiet and breast-milk composition
View the documentDiet and the quantity of milk produced
View the documentThe effect of maternal dietary supplementation on milk output and composition
View the documentGeneral conclusion
View the documentReferences

General conclusion

3.27. It has to be concluded that the cost-effectiveness of maternal dietary supplementation as far as improving lactational capacity is concerned still has to be proved. One thing is certain, any public health programme adopting this approach will have to be carefully designed and administered if a truly convincing result is to be achieved. An improved diet during pregnancy leading to a reduction in the number of small-for-age babies seems to offer a greater potential. It is not improbable, however, that dietary well-being over a much longer time-span will be needed before an improvement in the overall pregnancy-lactation cycle will be achieved. This emphasizes the need for agencies funding applied research of this type to be prepared to do so for as long as is necessary to adequately establish the crucial biological facts. It is feared that the present inconclusive situation has been partly brought about by the lack of long-term funding for community-based fundamental and applied research. As will also be discussed, the mother and her well-being must also not be ignored in these investigations.

A major difficulty in assessing the success of dietary supplementation programmes is identifying the magnitude of change that it is reasonable to expect. The "standard" that has been used for most theoretical reasoning is 850 ml, although to satisfy the total energy needs of the average child up to the WHO/FAO estimated requirement solely from breast-feeding, for up to six months as advocated by authorities, would indicate a figure nearer 1,200 ml. We have seen, however, that the majority of studies among well-fed mothers have revealed a mean peak production value of only 760 ml. In these circumstances, it is arguable that a greater volume could not have been expected in the Gambia, as the mothers were already providing milk up to the customary norm. Chavez in Mexico (48) also achieved a mean peak value of only 718 ml in his supplemented mothers. Perhaps it is only under conditions of extreme dietary deprivation, when milk volume is very low, that maternal supplementation is likely to achieve a meaningful and worthwhile increment. It is quite obvious that a realistic and biologically attainable target needs to be identified with more certainty.