Maternal & Child Health Links:
Research, Education, Extension & Technology
  Volume VI

This newsletter is written by and transmitted electronically from Karen L. Konzelmann, National Program Leader--Maternal and Child Health, Cooperative State Research, Education and Extension Service, USDA.  It is intended for Cooperative Extension System educators in the fields of nutrition, human health and nutrition research.

TABLE OF CONTENTS

Research News: Lean Body Mass of Women is Preserved During Lactation
Research Methods: Measurement of Potassium in a Total Body Potassium Counter
Lactation: New American Academy of Pediatrics Guidelines
Trends: Good News...Bad News
Teen Pregnancy: Latest Statistics
WIC Infant Feeding Study
Physical Activity, TV, and Fatness Among Children
Ten Ways You Can Prevent Infectious Diseases
Working Women Tracked in Federal Health Report
New Resources Available
Electronic Connections
Journal Articles Worth Noting
Subscribe Online for the electronic version of MCH LINKS

Research News: Lean Body Mass of Women is Preserved During Lactation

Lean body mass was preserved in well-nourished women who exclusively breast-fed their infants during the 1st six months postpartum according to a recent study conducted at the Children's Nutrition Research Center. The results of the work of Dr. Kathleen Motil, assistant professor of Pediatrics at Baylor College of Medicine, and others, suggests that the metabolic needs of milk protein production can be met solely by the maternal diet without impairing her own nutritional status.

Background: Because the quantity of protein retained during pregnancy is small compared with that required for lactation, maternal protein stores are rapidly depleted postpartum. Thus, after the first month of lactation, the source of milk protein must be derived from either diet or prepregnant body protein stores.  Previous studies have shown lactating women who consumed the recommended dietary protein allowance were associated with negative nitrogen balance during the period of lactation. These studies suggested that the lactating women supported their milk production at the expense of meeting their own metabolic needs. Few studies have examined the impact of the metabolic challenge imposed by lactation on the maintenance of lean body mass in well-nourished women.

Study Method: Thirty healthy women, of whom 10 were lactating, 10 were nonlactating, and 10 were nulliparous, were enrolled in the study. Their body composition was examined longitudinally at 6-week intervals between 6 and 24 weeks postpartum and at 52 weeks postpartum by clinical anthropometry and whole-body potassium (40K) counting. Dietary intakes were determined from 3-day food records during each 6-week period and were verified for accuracy with 24-hour urine collections tested for nitrogen excretion.  Milk production was measured by the test-weighing procedure during each 6-week period while the lactating women were breast-feeding exclusively.  After the test-weighing procedure, a 24 hour pooled milk sample was obtained for compositional analysis.  Each milk sample was analyzed for total nitrogen, nonprotein nitrogen, energy, lactose, and fat content. Protein nitrogen was calculated as the difference between total nitrogen and nonprotein nitrogen content.

Results: Lean body mass was maintained in women who exclusively breast-fed their infants during the first 6 months postpartum even though there was small, progressive loss of body weight throughout the period of lactation. The lactating women consumed approximately 55% more protein and 40% more energy than nonlactating women. The higher dietary protein intakes of the lactating women were sustained even as milk protein output declined by 32% (a normal fall), between 6 and 24 weeks postpartum. The amount of milk produced by the lactating women averaged 773 g/d and did not change significantly as lactation progressed. The amount of weight lost by the lactating women which was comprised entirely of body fat,  was only 1.5 kg over the 6 month period and occurred primarily from the thigh. Only two lactating and two nonlactating women reached their prepregnancy weight within this time period, supporting the concern that reproduction is an antecedent to maternal obesity in later life. The study was published in the Am J Clin Nutr 1998:67:292-300.

Research Methods: Measurement of Potassium in a Total Body Potassium Counter. During this procedure a study subject lies quietly for 15-20 minutes on a bed with gamma detectors above and below the surface. The detectors are sensitive to low levels of natural gamma radiation signals coming from the potassium in  the body. The potassium content of the body is proportional to the lean body mass at given ages, gender, and disease states. Therefore, lean body mass can be calculated from whole-body potassium. Body fat is calculated as the difference between body weight and lean body mass. Both components are expressed as a proportion of body weight.

Lactation: New American Academy of Pediatrics Guidelines

The American Academy of Pediatrics recently released new guidelines on breastfeeding and the use of human milk which reflect the latest scientific knowledge of the benefits and the mechanisms underlying the benefits.  The document outlines principles to guide the pediatrician and other health care providers in the initiation and maintenance of lactation. The following practices are among the recommendations:     

• Human milk is the preferred feeding for all infants including premature and sick newborns with rare exceptions
• Breastfeeding should begin as soon as possible after birth, usually within the first hour
• Newborns should be nursed whenever they show signs of hunger such as increased alertness, mouthing, or rooting
• No supplements such as water, formula, etc., should be given unless there is a medical reason
• Exclusive breastfeeding is ideal nutrition and sufficient to support growth and development
• In the first six months, water, juice and other foods are generally not necessary for infants fed human milk

The complete document is published in PEDIATRICS Vol.100, No.6 December 1997

Trends: Good News...Bad News

Good News...

• Prenatal Care Increasing - 82% in first trimester.
• Breastfeeding Rates Increasing - 60% upon hospital dismissal in 1995.
• Life Expectancy Increasing - 76.1 years, all racial groups combined.
• Immunization Rates Increasing - 74% of children ages 19-39 months.
• Infant Mortality Decreasing - 7.2 per 1,000 births, 1996 (7.6, 1995).
• Teen Pregnancy Decreasing - 54.7 births per 1,000 females 15-19 years old, 1996; 4% decrease since 1995.

Not Good News...

• Low Birth Weight Increasing - 7.4% - highest since 1975.
• Infant Mortality - still too high; 25 countries have lower rates than the U.S.
• Teen Pregnancy - still too high; 1996 rate is still higher than during 1976-1988.
• Child Abuse - more than 3 million children were reported to Child Protective Services for suspected abuse and neglect - 1 million confirmed cases, 1996.

References: National Center for Health Statistics, Pediatrics, December 1997, American Children: Key National Indicators of Well-Being, 1997.

Teen Pregnancy: Latest Statistics

The teenage population in the U.S. grew in 1996, but the decline in the teen birth rate resulted in a slight drop in the total number of births to teen mothers from 499,873 to 494,272 or 12.9% of the total of all births. Had the teen birth rate not declined from the 1991 level, there would have been at least an additional 67,000 births to teenage mothers in 1996.

As stated above, the preliminary data for 1996 indicate teenage childbearing fell 4% to 54.7 births per 1000 females 15 to 19 years of age. There was a 6% decrease among teens 15-17 years old.  This is the fifth consecutive year of decline with a total drop of 12% since 1991. The 1996 rate is still higher, however, than rates reported between 1976 and 1988.

The birth rate per 1000 for 15-19 years of age decreased as follows:

• White teenagers, 3% to 48.4
• Black teenagers, 5% to 91.7
• Black teen fertility rates have declined 21% since 1991
• Hispanic teenagers, 5% to 101.6
• Declines occurred in all 50 states and the District of Columbia

Reference: Annual Summary of Vital Statistics-1996 Pediatrics, Vol. 100, No 6.

WIC Infant Feeding Study

The WIC Infant Feeding Practices Study (WIC-IFPS) was a one-year longitudinal study which described infant feeding practices among a nationally representative sample of approximately 900 mothers who participated in WIC while they were pregnant. The study was designed to describe the changes in infant feeding practices over the first year of an infant's life and examine the factors that shaped the mothers' infant feeding decisions. Key findings regarding the mothers who chose to use infant formula as the feeding choice were as follows:

• More than 90% of formula fed WIC infants received iron fortified formula
• About 25% of WIC mothers add other foods or liquids into the bottle with the formula by the time their infants are 3 months old
• Large proportions of WIC infants are given cereal, fruits, and vegetables before they become 4 months old
• Cereal is often the first supplemental food introduced to the diets of WIC infants
• WIC infants who are cared for by someone other than their mothers are more likely than infants who are cared for by their mothers to receive cereals and fruits inappropriately early.
• Mothers who report receiving information from WIC about when to feed  supplemental foods are less likely to give cereal to their infants inappropriately early.
• Many WIC infants are given supplemental drinks too early. Substantial proportions of WIC infants are given some drinks that are not recommended for infants; i.e., sodas, tea, coffee, sweetened drinks.

Note: The U.S. Academy of Pediatrics Committee on Nutrition prefers supplementation to begin no earlier than four, but not later than six months of age. The study has implications for educators who work with new mothers, particularly ones with similar socio-economic backgrounds as those in the WIC program. Some of the findings are reflective of cultural and ethnic practices.

(USDA WIC Infant Feeding Practices Study Summary of Findings, Food & NutritionService, Office of Analysis and Evaluation, November, 1997.)

Physical Activity, TV, and Fatness Among Children

Data from the Third National Health and Nutrition Examination Survey, the most comprehensive of its kind, provide a link between the amount of time children spend watching television, their level of fatness, physical activity and body weight. The study involved 4,063 children aged 8 through 16 years. Mexican Americans and non-Hispanic blacks were over-sampled to produce reliable estimates for their groups.

Overall, 26% of U.S. children watched 4 or more hours of television per day and 67% watched at least 2 hours per day. Non-Hispanic black children had the highest rates of watching 4 or more hours of television per day (42%). The highest prevalence of watching 4 or more hours of television per day occurred in 11-13 year-old children.  Both the boys and girls who watched 4 or more hours of televison daily had greater body fat and a greater body mass index than those who watched less than 2 hours per day.

Twenty percent of U.S. children participated in 2 or fewer bouts of vigorous activity per week and the rate was higher in girls (26%) than in boys (17%). Eighty percent of the children reported performing 3 or more bouts of vigorous activity each week. This rate was lower in non-Hispanic black and Mexican American girls (69% and 73%, respectively). These data reconfirm that vigorous activity among ethnic minority children is lower than in non-Hispanic white children.

This study, and others, raise various issues related to the causes of  inactivity. In the case of television watching, it could be a consequence of being overweight, not the reverse. There is also some evidence that adolescents who watch more television eat higher-fat diets and that high-calorie food advertisements influence children's snack choices and consumption. More experimental trials and prospective risk-factor studies are needed to clarify the potential roles of television viewing and inactivity and its relationship to childhood obesity.

Reference: JAMA, March 25, 1998. Vol 279, No 12.

Ten Ways You Can Prevent Infectious Diseases

Infectious diseases are the third leading cause of death in the U.S. and the leading cause of death worldwide. In the last two decades more than 30 new, often virulent, diseases have been discovered.  These include Lyme disease, Legionnaire's disease, Ebola and AIDS. E.coli 0157:H7 was not identified until 1981 and has since been implicated in hundreds of deaths and sickened thousands in food-borne outbreaks. Recommended ways to help prevent the spread of infectious diseases include:

• Vaccinate all children, adults and pets
• Wash hands often, especially in cold and flu season
• Prepare food carefully and cook it thoroughly
• Use antibiotics exactly as the doctor directs
• Report an infection that does not heal to a doctor
• Avoid areas with lots of insects; use bug repellent
• Be cautious around all wild or unfamiliar animals
• Avoid unsafe, unprotected sex and intravenous drug use
• Ask about disease threats like hepatitis when you travel
• Allow yourself time to recover when sick

Reference: National Center for Infectious Diseases

Working Women Tracked in Federal Health Report

The U.S. Department of Health and Human Services recently released its first comprehensive report on the health and well-being of America's working women. The report entitled Women: Work and Health profiles statistics from more than 60 million women. Women now constitute nearly half of the U.S. work force.  Key findings include:

• Overall, women die from work-related injuries at a lower rate than men. Industries with the highest fatality rates are the same for men and women--mining, agriculture, construction and transportation.
• The number of work place homicides is higher among men than women, but proportionately they are greater among women, accounting for half of women's job-related deaths.
• For both men and women, job-related injuries most frequently affect the back.
• Prenatal education was provided by 9% of employers in 1992. Among larger work sites, those employing 750 or more workers, 40% of employers offered prenatal education.
• Currently employed women were more likely to have had a Pap test in the last 3 years than non-employed women.
• The employer's role in health insurance was significant. 73% of working women cited their employers as the source of insurance, whereas only 46% of women not in the work force cited the employer of a family member as the source of health insurance.

Reference: The Nations' Health, March 1998

New Resources Available

A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States.  Maternal & Child Health Technical Information Bulletin, published by National Center for Education in Maternal and Child Health, written by Ruth A. Lawrence, M.D. Single copies of this 38 page publication are available free from National Maternal and Child Health Clearinghouse, 2070 Chain Bridge Road, Suite 450, Vienna, VA  22182-2536.
 

The Nutrition Idea Book, a 300 page collection of 188 GEMs from the Journal of Nutrition Education.  It features sections on children, adolescents, elderly, adults, college students, professionals, work sites, and clinics.  Cost per copy is $18, including shipping and handling.  Checks and purchase orders accepted for 4 copies ($72) or more.  Checks must accompany orders for 1-3 copies.  Make checks and purchase orders payable to Society for Nutrition Education Foundation. Send orders to Guen Brown, GEMs, Route 10, Box 158-A, Morgantown, WV 26505.  Include your name, mailing address, street address (if different than mailing address), phone and fax numbers, and e-mail address.  For more information, contact Guen Brown: gbrown2@wvu.edu

Nutrition, Health & Child Development: Research Advances and Policy Recommendations - a joint publication from the Pan American Health Organization, the Tropical Metabolism Research Unit of the University of the West Indies and the World Bank.  The authors explore topics such as undernutrition, iron and iodine deficiencies, neonatal feeding, short-term food deprivation, parasitic infections, and psychosocial deprivation.  They also review results from early childhood interventions, including nutritional supplementation and psychological stimulation, as well as interventions in later childhood. The discounted price for MCHLINKS readers is $32.40 plus $8.00 shipping and handling.  To order, send a check or money order to: Pan American Health Organization, Sales and Distribution Center, Promo Code: 566E2, PO Box 27, Annapolis Junction, MD 20701-0027 USA. For further information contact Vivian E.    Sanchez at 202-337-7542.

Nutrition During Infancy - Principles and Practice, R.C. Tsang, S.H. Zlotkin, B.L. Nichols. J.W. Hansen (Eds.).  Published by Digital Educational Publishing, Inc. This book covers expert advice on managing growth faltering, meeting energy and protein needs, breastfeeding management, vitamins, lipids, etc.  A unique feature is the historical illustration and context in each chapter. The price is $95.00  plus shipping and handling. For ordering information, contact Digital Educational Publishing, Inc., 700 Walnut Street, Suite 450, Cincinnati, OH 45202. Toll free 1-888-679-2300; phone 513-345-6716; e-mail info@DEPinc.com

Upcoming Conference - Women in Africa and the African Diaspora: Health and Human Rights, Indianapolis, Indiana USA, October 22-27, 1998. The presentations will include recent trends in morbidity and mortality in women of African descent, socio-cultural factors which impact on the health of women of African descent, and the impact of changing focus of medical research.  Discussions will also focus on how dramatic changes in climatic conditions with resultant dislocations and food shortages,    changes in economic social policies and the escalation of ethnic politics and armed conflicts impact the health and human rights of women of African descent.  Conference contact: Professor Obioma Nnaemeka, Convenor, Second WAAD Conference, French and Women's Studies, Indiana University, 425 University Boulevard, Indianapolis, IN 46202 USA; Telephone: 317-278-2038, 317-274-0062 (message), FAX: 317-274-2347, e-mail: nnaemeka@iupui.edu

Electronic Connections

Journal Articles Worth Noting

1. Butte N, and Hopkinson JM. Body composition changes during lactation are      highly variable among women. J Nutr. 1998; 128:381S-385S. This is a review article in which the authors conclude that there are biological mechanisms that promote restoration of pre-pregnancy body mass.
2. Howard G, Wagenknecht LE, Burke GL, Diez-Roux A, Evans GW, McGovern P,  Nieto FJ, and Tell GS. Cigarette smoking and progression of atherosclerosis: The atherosclerosis risk in communities (ARIC) study.JAMA. 1998;279:119-124. Article reports a longitudinal assessment of the relationship between smoking exposure and a 3-year change in atherosclerosis.
3. Nichols BL, Dudley ML, Nichols VN, Putman M, Avery SE, Fraley JK,  Quaroni A, Shiner M, and Carrazza FR.  Effects of malnutrition on expression and activity of lactase in children. Gastroenterology. 1997; 112:742-751. Study concludes that malnutrition may limit the digestibility of milk sugar, lactose, while other carbohydrates such as   sugar and starch are more likely to be digested and absorbed.
4. Frisbie WP, Biegler M, deTurk P, Forbes D, and Pullum SG. Racial and ethnic differences in determinants of intrauterine growth retardation and other compromised birth outcomes. Am J Public Health. 1997;87:1977-1983. Authors detail study which finds the odds of compromised birth outcomes were much higher among African Americans than among Mexican Americans and non-Hispanic whites.

The purpose of this communication is to provide updates on relevant research and resources for education programming.  Please let me know if this meets your needs or if you have ideas for topics to include.  In order to facilitate sharing materials across the states, information about new materials will be included if details are forwarded to me.  A specific electronic mail address has been established by Baylor College of Medicine
for responses.  It is MCHLINKS@bcm.tmc.edu

The Cooperative State Research, Education, and Extension Service, USDA, is the Federal partner of the state and territory land grant universities in their research, education, and extension missions.  The USDA prohibits discrimination in its programs on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, marital or family status.  Mention of a  product, service, or curriculum does not constitute endorsement by USDA or CES unless the curriculum citation specifically says "recommended for use in all States and Territories".