Association of Maternal Diet Quality Indices and Dietary Patterns during Lactation and the Growth of Exclusive Breastfed Infant

Maternal dietary intake during lactation might affect the growth rate of an exclusive breastfed infant. The present study was conducted to evaluate the effect of maternal dietary patterns and quality during lactation on the growth of the exclusive breastfed infant. Methods: 484 healthy lactating mothers with their infant were enrolled in this study. Only exclusive breastfed infants were included in this study which was conducted in Iran. Dietary intake of lactating mothers was assessed using a validated and reliable semi-quantitative food frequency questionnaire. Diet quality indices such as alternative Healthy eating index (HEI), Dietary energy density (DED), and adherence to Mediterranean dietary pattern score, Nordic and dietary approaches to stop hypertension (DASH) eating pattern were created. Anthropometric features of infant (weight, height, and head circumference) were recorded at birth, two and four months. Results: Weight, length, weight for height and head circumference of infants at two months and four months age were mostly in the normal range among those that mothers adhered more to the HEI in lactation period (normal weight: 61%; normal height: 59%). The prevalence of stunting at four months of age among those whose mothers adhered more to the HEI was 31% lower than those with the least adherence to HEI. Mothers in the top tertiles of HEI score had the lowest frequency of having underweight infants (18% vs. 33%; P=0.03). Odds ratio of being overweight or obese at four months age was the lowest among those infants whose mothers adhered more to the HEI (OR: 0.67 vs 0.91; Ptrend=0.03). However, there was not any significant association between adherence of mothers to Mediterranean diet as well as DASH diet and Nordic eating pattern and the growth of infants (none of weight, height or head circumference). Infant weight, length, weight for height and head circumference at two months and four months did not show significant differences among different tertile categories of mothers’ DED. Conclusions: Higher diet quality indices and more adherence of lactating mother to HEI (as an indicator of diet quality) may be associated with better growth indices of the breastfed infant. However, it seems that DED of the lactating mother does not affect the growth of the breastfed infant. Adherence to the different dietary patterns such as Mediterranean, DASH or Nordic among mothers had no different effect on the growth indices of the infants. However, higher diet quality indices and more adherence of lactating mother to HEI may be associated with better growth indices of the breastfed infant. Breastfeeding is a complete way that is not affected much by the dietary patterns of the mother. However, better diet quality might be associated with better growth.




References:
[1] Fewtrell MS, Morgan JB, Duggan C, Gunnlaugsson G, Hibberd PL, Lucas A, et al. Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations? The American journal of clinical nutrition. 2007;85(2):635S-8S.
[2] Riordan J. Breastfeeding and Human Lactation. 3rd Edition. Jones and Bartlett, Sudbury, MA; 2005
[3] Strode MA, Dewey KG, Lonnerdal B. Effects of short-term caloric restriction on lactational performance of well-nourished women. Acta Paediatr Scand 1986;75:2229-229.
[4] Institute of Medicine. Dietary reference intakes for energy, carbohydrate. fiber, fat, fatty acids, cholesterol, protein, and amino acids (2002). Washington DC: The National Academy Press
[5] Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: Design and applications. J Am Diet Assoc. 1995; 95(10):1103-8.
[6] Kant AK, Schatzkin A & Ziegler RG (1995) Dietary diversity and subsequent cause of specific mortality in the NHANES I epidemiologic follow-up study. J Am Coll Nutr 14, 233–238
[7] Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean 288 diet and survival in a Greek population. N Engl J Med. 2003; 348:599–608.
[8] Fung, Teresa T., et al. "The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer." The American journal of clinical nutrition 92.6 (2010): 1429-1435
[9] Jonas Peltner, Silke Thiele; Association between the Healthy Eating Index-2010 and nutrient and energy densities of German households’ food purchases, European Journal of Public Health, Volume 27, Issue 3, 1 June 2017, Pages 547–552.
[10] Haghighatdoost, Fahimeh, et al. "Healthy eating index and cardiovascular risk factors among Iranians." Journal of the American College of Nutrition 32.2 (2013): 111-121.
[11] Ford, E. S., A. H. Mokdad, and S. Liu. "Healthy Eating Index and C-reactive protein concentration: findings from the National Health and Nutrition Examination Survey III, 1988–1994." European journal of clinical nutrition 59.2 (2005): 278-283.
[12] Mendoza JA, Drewnowski A, Christakis DA. Dietary energy density is associated with obesity and the metabolic syndrome in US adults. Diabetes Care 2007;30:974 –9.
[13] Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, Hu FB. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular risk. Am J Clin Nutr. 2001;73:61-67.
[14] Pryer JA, Cook A, Shetty P. Identification of groups who report similar patterns of diet among a representative national sample of British adults aged 65 years of age or more. Public Health Nutr. 2001;4:787- 795. 15.
[15] Ledikwe JH, Smiciklas-Wright H, itchell DC, Miller CK, Jensen GL. Dietary patterns of rural older adults are associated with weight and nutritional status. J Am Geriatr Soc. 2004;52:589-595.
[16] US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans 2005. 6th ed. Washington, DC: US Government Printing Office; January 2005.
[17] Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, et al. Low-energy-density diets are associated with high diet quality in adults in the United States. J Am Diet Assoc 2006;106:1172–80.