Journal
AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 102, Issue 6, Pages 1468-1474Publisher
OXFORD UNIV PRESS
DOI: 10.3945/ajcn.114.105106
Keywords
antiretrovirals; B vitamins; breast milk; human milk; ultraperformance liquid chromatography tandem mass spectrometry
Categories
Funding
- Prevention Research Centers Special Interest Project of the CDC [SIP 13-01 U48-CCU409660-09, SIP 26-04 U48-DP000059-01, SIP 22-09 U48-DP001944-01]
- Bill & Melinda Gates Foundation [OPP53107, OPP1061055]
- National Institute of Allergy and Infectious Diseases
- University of North Carolina Center for AIDS Research [P30-AI50410]
- Carolina Population Center [R24 HD050924]
- NIH Fogarty AIDS International Training and Research Program [DHHS/NIH/FIC 2-D43 Tw01039-06, R24 Tw00798]
- NIH Fogarty AIDS International Training and Research Program (American Recovery and Reinvestment Act)
- intramural USDA-ARS Project [5306-51000-003-00D]
- Elizabeth Glaser Pediatric AIDS Foundation
- United Nations Children's Fund
- World Food Program
- Malawi Ministry of Health and Population
- Johnson Johnson
- US Agency for International Development
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Background: Little information is available on B vitamin concentrations in human milk or on how they are affected by maternal B vitamin deficiencies, antiretroviral therapy, or maternal supplementation. Objective: The objective was to evaluate the effects of antiretroviral therapy and/or lipid-based nutrient supplements (LNSs) on B vitamin concentrations in breast milk from HIV-infected women in Malawi. Design: Breast milk was collected from 537 women recruited within the Breastfeeding, Antiretrovirals, and Nutrition study at 2 or 6 wk and 24 wk postpartum. Women were assigned to receive antiretrovirals and LNSs, antiretrovirals only, LNSs only, or a control. Antiretrovirals and LNSs were given to the mothers from weeks 0 to 28. The antiretrovirals were zidovudine/lamivudine and nelfinavir or lopinavir/ritonavir. LNSs provided 93-118% of the Recommended Dietary Allowances of thiamin, riboflavin, niacin, pyridoxine, and vitamin B-12. Infants were exclusively breastfed. Results: LNSs increased milk concentrations of all vitamins except thiamin, whereas antiretrovirals lowered concentrations of nicotinamide, pyridoxal, and vitamin B-12. Although antiretrovirals alone had no significant effect on riboflavin concentrations, they negatively affected the LNS-induced increase in this vitamin. Thiamin was not influenced by the study interventions. Concentrations of all B vitamins were much lower than usually accepted values. Conclusions: All B vitamins were low in milk, and all but thiamin were increased by maternal supplementation with LNSs. Antiretrovirals alone decreased concentrations of some B vitamins in milk. When LNS was given in addition to antiretrovirals, the negative effect of antiretrovirals offset the positive effect of LNSs for all vitamins except thiamin.
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