Nutrient Needs During Lactation

NUTRIENT NEEDS DURING LACTATION

ICMR nutrient recommendations for a lactating mother is based on the composition of breast milk and the fact that 850 ml of milk is produced daily. However the milk secretion continues to increase in the early periods of lactation upto six months and then gradually decreases. Therefore the nutrient requirements are given for the two periods in lactation ie., 0-6 months and 6-12 months.

1. Energy

The lactating mother requires additional energy for the production of milk which is calculated from the volume of milk secreted, its energy content and the efficiency of conversion of food energy to milk energy. Based on the optimal output of 850 ml/day, energy content of 65 k.cal / 100 ml of breast milk and conversion efficiency of 80 percent, the additional allowance recommended during first six months of lactation is 550 k.cal / day. This is after taking into account the energy contribution from fat stores deposited during pregnancy. Most Indian mothers continue to lactate even after six months but the milk production is reduced. Hence ICMR has recommended an additional allowance of 400 k.cal / day for the period from 6 -12 months of lactation.

2. Protein

For production of milk, protein requirement also increases, as the produced milk contains 1.15g of proteins /100ml. The recommended additional protein intake during lactation is 25g per day for 0-6 months and 18g per day for 6-12 months.

3. Fat

ICMR has suggested an intake of 45g of visible fat per day. Although the total fat in breast milk is not influenced by the mothers diet, the composition of milk fat does. The fat also provides energy density to meet the higher energy requirement during lactation.

4. Calcium

Mothers milk contains 30-40 mg of calcium per 100 ml. Since about 850ml of milk is produced, around 300mg of calcium is secreted through milk per day. Therefore the additional intake of calcium is essential to enable the retention of 300mg of extra calcium daily. Since the dietary calcium retention in lactating women is 60 percent, ICMR has recommend 1000 mg of calcium per day for a lactating mother.

5. Iron

Since most mothers have lactational amenorrhea, it results in saving of nearly 1mg iron per day which otherwise would have been lost due to menstruation. This saving is more than sufficient to compensate for the negligible amount secreted in mother's milk and hence iron requirement during lactation is same as that of a normal adult woman ie, 30mg/day.

6. Vitamins

Vitamin A

The additional need of vitamin A during lactation is based on the amount secreted in mother's milk. On an average 300 mg of vitamin A is secreted per day. Hence ICMR has recommended an additional allowance of 350 mg of retinol ie.a total of 950 mg per day.

Thiamine, riboflavin and Niacin

As the calorie and protein requirements increase during lactation, the requirements of these vitamins also increase correspondingly. The amount of these vitamins computed on the basis of increased energy allowance would be sufficient to cover the amount secreted in breast milk. Hence the levels are computed on the same basis as that of adults i.e. 0.5mg/1000k.cal, 0.6mg / 1000k.cal and 6.6mg / 1000k.cal of thiamine, riboflavin and niacin respectively.

Pyridoxine

ICMR has recommended an additional intake of 0.5 mg i.e., total intake of 2.5 mg/day, same as that during pregnancy.

Folic acid

The folate content of breast milk is about 2.5 mg . Based on this, ICMR has recommended an additional allowance of 50µg/day of free folate ie., a total of 150µg free folate/day.

Vitamin C (Ascorbic acid)

Well nourished Indian mother secretes about 20mg of Vitamin C per day during lactation. Considering this and the cooking losses averaging to 50 percent, ICMR has recommended an additional intake of 40mg/day ie. a total of 80mg of ascorbic acid per day.

Diet during lactation:

A lactating mother requires not only large quantities of body building and protective foods but also additional energy yielding foods to facilitate copious formation and secretion of breast milk. Besides adhering to the basic principles of meal planning the following guidelines need to be considered.

Large amount of fluids are essential for milk production. Therefore adequate fluids such as milk, fruit juice, milk based beverages and even water must be encouraged.

The choice of food is wide during lactation. No food need to be restricted except spicy and strong flavoured foods which might impart flavour to milk that may be repulsive to the baby and that may cause gastric distress to the mother.

Almost all medicines taken during lactation are absorbed into mothers blood and are secreted in the milk. Hence any medicine during lactation must be avoided or taken under strict medical supervision.

Since the nutrient needs are enhanced, the meal pattern may be changed to 5-7 meals a day by introducing in between snack between the meals.

When a mothers diet is inadequate, her milk yield is usually well maintained by drawing on her own reserve of nutrients and evidence of malnutrition is likely to appear in the mother before it does in her child. Many women in poor communities have a remarkable ability to breast feed their infants for long periods. This is probably due to repeated stimulation of the neurohumoral reflex by frequently putting the baby to the breast and letting it suckle at night.

Hence adequate diet during lactation will not only help the mother to maintain a sound nutritional status but also ensure good milk supply for a healthy infant.

A balanced vegetarian diet for a nursing mother doing sedentary work

S.No. Food group quantity in g

1. Cereal and millets 330

2. Pulses 90

3. Milk (ml) 500

4. Roots and Tubers 100

5. Green leafy vegetables 150

6. Other vegetables 100

7. Fruits 200

8. Sugar 20

9. Fats and Oils 30

For Non-veg substitute 30 g of pulse with 50 g of meat / fish / chicken / egg.

. Source : Dietary Guidelines for Indians - A manual, National

Institute of Nutrition, ICMR, Hyderabad, India, 1999.

Galactogogues

Galactogogues are foods that help to produce more milk. Garlic, milk, almonds are considered to increase milk production. Studies carried out on nursing mothers have revealed that extra amounts of body building foods like fish and mutton increase the secretion of breast milk. Lactating mothers are also given special preparations containing ajwain, fenugreek seeds, which supply iron, protein, calcium and B-complex vitamins.