食用生物强化和强化玉米可降低母乳中视黄醇含量低的发生率，但不会增加储备充足的赞比亚母乳喂养婴儿的维生素A储备：一项随机对照试验。
Biofortified and fortified maize consumption reduces prevalence of low milk retinol, but does not increase vitamin A stores of breastfeeding Zambian infants with adequate reserves: a randomized controlled trial.
作者信息
Palmer Amanda C, Jobarteh Modou L, Chipili Mackford, Greene Matthew D, Oxley Anthony, Lietz Georg, Mwanza Rose, Haskell Marjorie J
机构信息
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA.
出版信息
Am J Clin Nutr. 2021 May 8;113(5):1209-1220. doi: 10.1093/ajcn/nqaa429.
BACKGROUND
Replacement of conventional staples with biofortified or industrially fortified staples in household diets may increase maternal breast milk retinol content and vitamin A intakes from complementary foods, improving infant total body stores (TBS) of vitamin A.
OBJECTIVES
To determine whether biofortified or industrially fortified maize consumption by Zambian women and their breastfeeding infants could improve milk retinol concentration and infant TBS.
METHODS
We randomly assigned 255 lactating women and their 9-mo-old infants to a 90-d intervention providing 0 µg retinol equivalents (RE)/d as conventional maize or ∼315 µg RE/d to mothers and ∼55 µg RE/d to infants as provitamin A carotenoid-biofortified maize or retinyl palmitate-fortified maize. Outcomes were TBS, measured by retinol isotope dilution in infants (primary), and breast milk retinol, measured by HPLC in women (secondary).
RESULTS
The intervention groups were comparable at baseline. Loss to follow-up was 10% (n = 230 mother-infant pairs). Women consumed 92% of the intended 287 g/d and infants consumed 82% of the intended 50 g/d maize. The baseline geometric mean (GM) milk retinol concentration was 1.57 μmol/L (95% CI: 1.45, 1.69 μmol/L), and 24% of women had milk retinol <1.05 μmol/L. While mean milk retinol did not change in the biofortified arm (β: 0.11; 95% CI: -0.02, 0.24), the intervention reduced low milk retinol (RR: 0.42; 95% CI: 0.21, 0.85). Fortified maize increased mean milk retinol (β: 0.17; 95% CI: 0.04, 0.30) and reduced the prevalence of low milk retinol (RR: 0.46; 95% CI: 0.25, 0.82). The baseline GM TBS was 178 μmol (95% CI: 166, 191 μmol). This increased by 24 µmol (± 136) over the 90-d intervention period, irrespective of treatment group.
CONCLUSIONS
Both biofortified and fortified maize consumption improved milk retinol concentration. This did not translate into greater infant TBS, most likely due to adequate TBS at baseline. This trial was registered at clinicaltrials.gov as NCT02804490.
背景
在家庭饮食中用生物强化或工业强化主食替代传统主食，可能会增加母乳中视黄醇含量以及辅食中的维生素A摄入量，从而改善婴儿体内维生素A的总体储备（TBS）。
目的
确定赞比亚妇女及其哺乳期婴儿食用生物强化或工业强化玉米是否能提高母乳视黄醇浓度和婴儿TBS。
方法
我们将255名哺乳期妇女及其9个月大的婴儿随机分为两组，进行为期90天的干预，一组提供0微克视黄醇当量（RE）/天的传统玉米，另一组为母亲提供约315微克RE/天，为婴儿提供约55微克RE/天的维生素A原类胡萝卜素生物强化玉米或视黄醇棕榈酸酯强化玉米。主要观察指标是通过视黄醇同位素稀释法测量婴儿的TBS，次要观察指标是通过高效液相色谱法测量妇女母乳中的视黄醇。
结果
干预组在基线时具有可比性。随访失访率为10%（n = 230对母婴）。妇女食用了计划的每日287克玉米的92%，婴儿食用了计划的每日50克玉米的82%。基线时母乳视黄醇浓度的几何平均数（GM）为1.57微摩尔/升（95%置信区间：1.45，1.69微摩尔/升），24%的妇女母乳视黄醇<1.05微摩尔/升。虽然生物强化组的母乳视黄醇平均水平没有变化（β：0.11；95%置信区间：-0.02，0.24），但干预降低了低母乳视黄醇水平（相对危险度：0.42；95%置信区间：0.21，0.85）。强化玉米提高了母乳视黄醇平均水平（β：0.17；95%置信区间：0.04，0.30），并降低了低母乳视黄醇的患病率（相对危险度：0.46；95%置信区间：0.25，0.82）。基线时GM TBS为178微摩尔（95%置信区间：166，191微摩尔）。在90天的干预期内，无论治疗组如何，TBS均增加了24微摩尔（±136）。
结论
食用生物强化玉米和强化玉米均可提高母乳视黄醇浓度。但这并未转化为婴儿TBS的增加，很可能是由于基线时TBS充足。该试验已在clinicaltrials.gov上注册，注册号为NCT02804490。
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