The maternal dietary status and nutritional composition of human milk during exclusive breastfeeding period

Abstract

The Malaysian Dietary Guidelines (2013) advocate exclusive breastfeeding for the first six months of babies’ lives for multi-beneficial effects on both child and maternal health. In Islam, breastfeeding a child is encouraged up to the age of two years. Studies on nutritional composition of breast milk are majorly done in the Western countries. The human milk nutritional content of Malaysian mothers whose diets are typically different than their Western counterparts’ due to traditional postpartum practices, has never been investigated. The objectives of this study were: 1) to analyze the nutritional composition of human milk among Malay mothers during exclusive breastfeeding period, 2) to assess the mothers’ dietary intake during this period, and 3) to evaluate the association between maternal dietary intake and their human milk nutritional composition. A total of 32 mothers were recruited. Sociodemographic and anthropometry data were recorded during the 3rd trimester of pregnancy. After delivery, 10-30ml of human milk samples were collected once each during the colostral and transitional milk phases (within the 1st month postpartum), and every 30 days during the mature milk phase (between 2nd and 6th months postpartum). The basic macronutrients (carbohydrates, protein, and total fat) and fatty acids contents of the human milk were determined using proximate analysis and gas chromatography methods, respectively. Maternal diet history was obtained on each day prior to human milk sampling. Dietary nutrient intakes were statistically adjusted using residual method to account for possibility of energy misreporting. Total energy and nutrient intakes were compared to the Recommended Nutrients Intakes (RNI) for Malaysia for pregnant and lactating women (2017). The findings of this study demonstrated that the total calorie, total fat, saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA), and monounsaturated fatty acids (MUFA) consumption were the lowest, whereas protein intake was the highest during confinement period. In addition, the maternal nutritional intakes of total calorie, total fat, SFA, PUFA, MUFA, dietary fiber, calcium, and water, did not meet recommended values throughout the exclusive breastfeeding period. Compared to the standard reference, the total energy, total carbohydrate, SFA, and MUFA content of the human milk was lower, whereas protein was within the reference range. In contrast, total fat and PUFA were comparatively higher than the standard reference. Palmitic acid and oleic acid were identified to be the most represented fatty acids in the human milk samples. Even though the maternal dietary intake was found to be suboptimal in this study, this was not associated with human milk nutritional composition. In conclusion, mothers in this study failed to meet the nutritional requirement during exclusive breastfeeding period, and this may be likely influenced by the traditional postpartum dietary practices. Appropriate dietary action should be taken to improve maternal nutritional intake during this crucial time. Other than highlighting healthy and balanced nutrition, dietary advice for breastfeeding women should also address the cultural food taboos commonly practiced by local mothers during confinement. Further investigation is needed to determine the association between maternal diet and human milk quality of Malaysian mothers. Keywords: exclusive breastfeeding, maternal dietary intake, human milk, nutritional composition, postpartum dietary practices