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Title:   Author  item
                                            WILLIAMS, ANNE - University Of Californiaitem
                                            CHANTRY, CAROLINE - University Of Californiaitem
                                            YOUNG, SERA - Cornell Universityitem
                                            Allen, Lindsay

                                                         - *A*item
                                            ARNOLD, BENJAMIN - University Of Californiaitem
                                            COLFORD JR, JOHN - University Of Californiaitem
                                            DENTZ, HOLLY - University Of Californiaitem
                                            HAMPEL, DANIELA - University Of Californiaitem
                                            LIN, AUDRIE - University Of Californiaitem
                                            NULL, CLAIRE - University Of Californiaitem
                                            Shahab-Ferdows, Settiitem
                                            STEWART, CHRISTINE - University Of California
  Submitted to: Journal of Nutrition
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 5/7/2016
                                    Publication  Date: 4/13/2016
                                    Citation: Williams, A.M., Chantry, C.J., Young, S.L., Allen, L.H., Arnold, B.F., Colford Jr, J.M., Dentz, H.N., Hampel, D., Lin, A., Null, C.A., Shahab-Ferdows, S., Stewart, C. 2016. Vitamin B-12 concentrations in breast milk are low and are not associated with reported household hunger, recent animal source food or vitamin B-12 intake among women in rural Kenya. Journal of Nutrition. 146(5)1125-1131. doi: 10.3945/jn.115.228189.Interpretive Summary: Background: Breastmilk vitamin B-12 concentration may be inadequate in mothers living in regions where animal source food consumption is low or infrequent. Vitamin B-12 deficiency causes megaloblastic anemia and impairs growth and development in children.
Objective: To measure vitamin B-12 in breastmilk and examine its associations with a score for household hunger, and recent animal source food and vitamin B-12 intake. 
Methods: These analyses were conducted in a sub-study nested within a larger cluster-randomized trial assessing a water, sanitation, hygiene, and nutrition intervention in Kenya (clinicaltrials.gov identifier NCT01704105). We sampled 286 women 1-6 mo postpartum and performed a cross-sectional analysis. Mothers hand-expressed breastmilk 1-min after a feed started, following 90-min of observed non-breastfeeding. The Household Hunger Scale was used to measure hunger over the past mo, food intake in the last wk was measured using a food frequency questionnaire (FFQ), and vitamin B-12 intake was estimated using 24-h dietary recall. An animal source food score was constructed based on frequency of 10 items on the FFQ (range 0-70). Breastmilk vitamin B-12 concentration was measured using a solid-phase competitive chemiluminescent enzyme immunoassay. Breastmilk vitamin B-12 concentration was modeled with linear regression and generalized estimating equations were used to account for correlated observations at the cluster level.
Results: Median (Q1, Q3) vitamin B-12 intake was 1.5 (0.3, 9.7) 'g/d and 60% of women consumed <2.4'g/d, the estimated average requirement (EAR) during lactation. The median milk vitamin B-12 concentration was 113 (61, 199) pmol/L and 89% had concentrations <310 pmol/L, the estimated adequate level. Moderate or severe household hunger prevalence was 27%, and the animal source food score ranged from 0-30 item-days/week. Hunger, recent animal source food, and vitamin B-12 intakes were not associated with breastmilk vitamin B-12 concentrations, and maternal age was negatively associated with log breastmilk vitamin B-12 concentrations. 
Conclusion: Most of these lactating Kenyan women consumed less than the EAR of vitamin B-12 and had low breastmilk vitamin B-12 concentrations. We recommend interventions that improve vitamin B-12 intake among lactating women in Kenya to foster maternal health and child development
                                Technical Abstract: Background: Breastmilk vitamin B-12 concentration may be inadequate in mothers living in regions where animal source food consumption is low or infrequent. Vitamin B-12 deficiency causes megaloglastic anemia and impairs growth and development in children.
Objective: To measure vitamin B-12 in breastmilk and examine its associations with household hunger, recent animal source food and vitamin B-12 intake.
Methods: We performed a cross-sectional analysis of 286 women 1-6 mo postpartum sampled 8 from a cluster-randomized trial assessing a water, sanitation, hygiene, and nutrition intervention in Kenya (clinicaltrials.gov identifier NCT01704105). Mothers hand-expressed breastmilk 1-min into a feed, following 90-min of observed non-breastfeeding. The Household Hunger Scale was 11 used to measure hunger over the past mo, food intake in the last wk was measured using a food frequency questionnaire (FFQ), and vitamin B-12 intake was estimated using 24-h dietary recall. An animal source food score was based on frequency of 10 items on the FFQ (range 0-70). Breastmilk B-12 concentration was measured using a solid-phase competitive chemiluminescent enzyme immunoassay. Results: Median (Q1, Q3) B-12 intake was 1.5 (0.3, 9.7) μg/d and 60% of women consumed <2.4μg/d, the estimated average requirement (EAR) during lactation. Breastmilk vitamin B-12 concentration was 113 (61, 199) pmol/L and 89% had concentrations <310 pmol/L, the estimated adequate level. Moderate or severe household hunger prevalence was 27%, and the animal source food score ranged from 0-30 item-days/week. Hunger, recent animal source food, and vitamin B-12 intakes were not associated with breastmilk vitamin B-12 concentrations, and maternal age was negatively associated with log breastmilk B-12 concentrations.
Conclusion: Most women consumed less than the EAR of vitamin B-12 and had low breastmilk vitamin B-12 concentrations. We recommend interventions that improve vitamin B-12 intake among lactating women to foster maternal health and child development


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