Picciano M F
Department of Nutrition, Pennsylvania State University, University Park, Pennsylvania, USA.
Pediatr Clin North Am. 2001 Feb;48(1):53-67. doi: 10.1016/s0031-3955(05)70285-6.
A complex interplay of maternal homeostatic mechanisms influences nutrient transfer to nursing infants, and with a few exceptions, excess maternal intake or a moderate deficiency in the maternal diet does not appreciably alter nutrient transfer to infants unless it has persisted for some time. Milk vitamins D and K contents, even in apparently well-nourished women, may not always provide adequate amounts for infants. Investigations provide evidence that human milk possesses many unique characteristics and that maternal and environmental influences are stronger than previously recognized and appreciated. A complete body of knowledge does not exist to serve as a basis for dietary recommendations to ensure optimal nutrition for mothers and infants. The success of lactation usually is measured in terms of infant performance, and cost and consequence to the mother are seldom considered. Human milk feeding is recommended for the entire first year of life, but few studies focus on the nursing dyad for more than 3 months' duration. Continued study is needed so that nutritional adequacy may be maintained and appropriate dietary guidance can be provided. When human milk feeding is not practiced, modern and reliable data on human milk constituents and their significance to infants also are essential for the preparation of formulas, especially those not based on bovine milk. The adequacy of human milk substitutes cannot be predicted from compositional analysis because of possible differences in compartmentalization and molecular form of nutrients, and such preparations must be evaluated using specific indices of nutrient use, together with traditional anthropometric measures in infants.
母体稳态机制的复杂相互作用影响着向哺乳婴儿的营养物质传递，并且除了少数例外情况，母体摄入量过多或饮食中适度缺乏营养并不会明显改变向婴儿的营养物质传递，除非这种情况持续了一段时间。即使是营养状况明显良好的女性，其乳汁中维生素D和K的含量也可能并不总能为婴儿提供足够的量。研究表明，母乳具有许多独特的特性，而且母体和环境的影响比以前认识和意识到的更强。目前还没有完整的知识体系可作为为母亲和婴儿确保最佳营养的饮食建议的基础。泌乳的成功通常根据婴儿的表现来衡量，而很少考虑对母亲的成本和影响。建议在婴儿出生后的第一年全程进行母乳喂养，但很少有研究关注哺乳二元组超过3个月的情况。需要持续进行研究，以便维持营养充足并提供适当的饮食指导。当不采用母乳喂养时，关于母乳成分及其对婴儿重要性的现代可靠数据对于配方奶粉的制备也至关重要，尤其是那些不以牛乳为基础的配方奶粉。由于营养物质在区室化和分子形式上可能存在差异，不能通过成分分析来预测母乳替代品的充足性，并且必须使用营养物质利用的特定指标以及婴儿传统的人体测量指标来评估此类制剂。
