Document ID: EPA-HQ-OW-2002-0033-0134
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2003-04-14T04:00Z

TABLE
OF
CONTENTS
Page
No.

14.
BREAST
MILK
INTAKE
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1
14.1.
BACKGROUND
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14.2.
KEY
STUDIES
ON
BREAST
MILK
INTAKE
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1
14.3.
RELEVANT
STUDIES
ON
BREAST
MILK
INTAKE
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14.4.
KEY
STUDIES
ON
LIPID
CONTENT
AND
FAT
INTAKE
FROM
BREAST
MILK
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5
14.5.
OTHER
FACTORS
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6
14.6.
RECOMMENDATIONS
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7
14.7
REFERENCES
FOR
CHAPTER
14
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8
LIST
OF
TABLES
Table
14­
1.
Daily
Intakes
of
Breast
Milk
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2
Table
14­
2.
Breast
Milk
Intake
for
Infants
Aged
1
to
6
Months
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2
Table
14­
3.
Breast
Milk
Intake
Among
Exclusively
Breast­
fed
Infants
During
the
First
4
Months
of
Life
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3
Table
14­
4.
Breast
Milk
Intake
During
a
24­
Hour
Period
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3
Table
14­
5.
Breast
Milk
Intake
Estimated
by
the
DARLING
Study
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4
Table
14­
6.
Milk
Intake
for
Bottle­
and
Breast­
fed
Infants
by
Age
Group
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4
Table
14­
7.
Milk
Intake
for
Boys
and
Girls
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4
Table
14­
8.
Intake
of
Breast
Milk
and
Formula
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5
Table
14­
9.
Lipid
Content
of
Human
Milk
and
Estimated
Lipid
Intake
Among
Exclusively
Breast­
fed
Infants
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6
Table
14­
10.
Predicted
Lipid
Intakes
for
Breast­
fed
Infants
Under
12
Months
of
Age
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6
Table
14­
11.
Number
of
Meals
Per
Day
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7
Table
14­
12.
Percentage
of
Mothers
Breast­
feeding
Newborn
Infants
in
the
Hospital
and
Infants
at
5
or
6
Months
of
Age
in
the
United
States
in
1989
,
by
Ethnic
Background
and
Selected
Demographic
a
Variables
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10
b
Table
14­
13.
Breast
Milk
Intake
Studies
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11
Table
14­
14.
Confidence
in
Breast
Milk
Intake
Recommendations
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13
Table
14­
15.
Breast
Milk
Intake
Rates
Derived
From
Key
Studies
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14
Table
14­
16.
Summary
of
Recommended
Breast
Milk
and
Lipid
Intake
Rates
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15
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
1
14.
BREAST
MILK
INTAKE
14.1.
BACKGROUND
Breast
milk
is
a
potential
source
of
exposure
to
toxic
The
available
studies
on
breast
milk
intake
are
substances
for
nursing
infants.
Lipid
soluble
chemical
summarized
in
the
following
sections.
Studies
on
breast
compounds
accumulate
in
body
fat
and
may
be
transferred
milk
intake
rates
have
been
classified
as
either
key
studies
to
breast­
fed
infants
in
the
lipid
portion
of
breast
milk.
or
relevant
studies
based
on
the
criteria
described
in
the
Because
nursing
infants
obtain
most
(
if
not
all)
of
their
Introduction
(
Volume
I,
Section
1.3.1).
Recommended
dietary
intake
from
breast
milk,
they
are
especially
intake
rates
are
based
on
the
results
of
key
studies,
but
vulnerable
to
exposures
to
these
compounds.
Estimating
relevant
studies
are
also
presented
to
provide
the
reader
the
magnitude
of
the
potential
dose
to
infants
from
breast
with
added
perspective
on
the
current
state
of
knowledge
milk
requires
information
on
the
quantity
of
breast
milk
pertaining
to
breast
milk
intake.
consumed
per
day
and
the
duration
(
months)
over
which
Relevant
data
on
lipid
content
and
fat
intake,
breast­
feeding
occurs.
Information
on
the
fat
content
of
breast­
feeding
duration
and
frequency,
and
the
estimated
breast
milk
is
also
needed
for
estimating
dose
from
breast
percentage
of
the
U.
S.
population
that
breast­
feeds
are
also
milk
residue
concentrations
that
have
been
indexed
to
lipid
presented.
content.
Several
studies
have
generated
data
on
breast
milk
intake.
Typically,
breast
milk
intake
has
been
measured
over
a
24­
hour
period
by
weighing
the
infant
before
and
after
each
feeding
without
changing
its
clothing
(
test
weighing).
The
sum
of
the
difference
between
the
measured
weights
over
the
24­
hour
period
is
assumed
to
be
equivalent
to
the
amount
of
breast
milk
consumed
daily.
Intakes
measured
using
this
procedure
are
often
corrected
for
evaporative
water
losses
(
insensible
water
losses)
between
infant
weighings
(
NAS,
1991).
Neville
et
al.
(
1988)
evaluated
the
validity
of
the
test
weight
approach
among
bottle­
fed
infants
by
comparing
the
weights
of
milk
taken
from
bottles
with
the
differences
between
the
infants'
weights
before
and
after
feeding.
When
test
weight
data
were
corrected
for
insensible
water
loss,
they
were
not
significantly
different
from
bottle
weights.
Conversions
between
weight
and
volume
of
breast
milk
consumed
are
made
using
the
density
of
human
milk
(
approximately
1.03
g/
mL)
(
NAS,
1991).
Recently,
techniques
for
measuring
breast
milk
intake
using
stable
isotopes
have
been
developed.
However,
few
data
based
on
this
new
technique
have
been
published
(
NAS,
1991).
Studies
among
nursing
mothers
in
industrialized
countries
have
shown
that
intakes
among
infants
average
approximately
750
to
800
g/
day
(
728
to
777
mL/
day)
during
the
first
4
to
5
months
of
life
with
a
range
of
450
to
1,200
g/
day
(
437
to
1,165
mL/
day)
(
NAS,
1991).
Similar
intakes
have
also
been
reported
for
developing
countries
(
NAS,
1991).
Infant
birth
weight
and
nursing
frequency
have
been
shown
to
influence
the
rate
of
intake
(
NAS,
1991).
Infants
who
are
larger
at
birth
and/
or
nurse
more
frequently
have
been
shown
to
have
higher
intake
rates.
Also,
breast
milk
production
among
nursing
mothers
has
been
reported
to
be
somewhat
higher
than
the
amount
actually
consumed
by
the
infant
(
NAS,
1991).

14.2.
KEY
STUDIES
ON
BREAST
MILK
INTAKE
Pao
et
al.
(
1980)
­
Milk
Intakes
and
Feeding
Patterns
of
Breast­
fed
Infants
­
Pao
et
al.
(
1980)
conducted
a
study
of
22
healthy
breast­
fed
infants
to
estimate
breast
milk
intake
rates.
Infants
were
categorized
as
completely
breast­
fed
or
partially
breast­
fed.
Breast
feeding
mothers
were
recruited
through
LaLeche
League
groups.
Except
for
one
black
infant,
all
other
infants
were
from
white
middleclass
families
in
southwestern
Ohio.
The
goal
of
the
study
was
to
enroll
infants
as
close
to
one
month
of
age
as
possible
and
to
obtain
records
near
one,
three,
six,
and
nine
months
of
age
(
Pao
et
al.,
1980).
However,
not
all
mother/
infant
pairs
participated
at
each
time
interval.
Data
were
collected
for
these
22
infants
using
the
test
weighing
method.
Records
were
collected
for
three
consecutive
24­
hour
periods
at
each
test
interval.
The
weight
of
breast
milk
was
converted
to
volume
by
assuming
a
density
of
1.03
g/
mL.
Daily
intake
rates
were
calculated
for
each
infant
based
on
the
mean
of
the
three
24­
hour
periods.
Mean
daily
breast
milk
intake
rates
for
the
infants
surveyed
at
each
time
interval
are
presented
in
Table
14­
1.
For
completely
breast­
fed
infants,
the
mean
intake
rates
were
600
mL/
day
at
1
month
of
age
and
833
mL/
day
at
3
months
of
age.
Partially
breast­
fed
infants
had
mean
intake
rates
of
485
mL/
day,
467
mL/
day,
395
mL/
day,
and
554
mL/
day
at
1,
3,
6,
and
9
months
of
age,
respectively.
Pao
et
al.
(
1980)
also
noted
that
intake
rates
for
boys
in
both
groups
were
slightly
higher
than
for
girls.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
2
August
1997
Table
14­
1.
Daily
Intakes
of
Breast
Milk
Age
Period
(
mL/
day)
(
mL/
day)
Number
of
Infants
Surveyed
at
Mean
Range
of
(
months)
of
Infants
(
mL/
day)
(
mL/
day)
(
mL/
day)
Each
Time
Intake
Daily
Intake
a
Completely
Breast­
fed
1
month
11
600
±
159
426
­
989
3
months
2
833
645
­
1,000
6
months
1
682
616
­
786
Partially
Breast­
fed
1
month
4
485
±
79
398
­
655
3
months
11
467
±
100
242
­
698
6
months
6
395
±
175
147
­
684
9
months
3
<
554
451
­
732
Data
expressed
as
mean
±
standard
deviation.
a
Source:
Pao
et
al.,
1980.

The
advantage
of
this
study
is
that
data
for
both
exclusively
and
partially
breast­
fed
infants
were
collected
for
multiple
time
periods.
Also,
data
for
individual
infants
were
collected
over
3
consecutive
days
which
would
account
for
some
individual
variability.
However,
the
number
of
infants
in
the
study
was
relatively
small
and
may
not
be
entirely
representative
of
the
U.
S.
population,
based
on
race
and
socioeconomic
status,
which
may
introduce
some
bias
in
the
results.
In
addition,
this
study
did
not
account
for
insensible
water
loss
which
may
underestimate
the
amount
of
breast
milk
ingested.
Dewey
and
Lönnerdal
(
1983)
­
Milk
and
Nutrient
Intakes
of
Breast­
fed
Infants
from
1
to
6
Months
­
Dewey
and
Lönnerdal
(
1983)
monitored
the
dietary
intake
of
20
breast­
fed
infants
between
the
ages
of
1
and
6
months.
Most
of
the
infants
in
the
study
were
exclusively
breast­
fed
(
five
were
given
some
formula,
and
several
were
given
small
amounts
of
solid
foods
after
3
months
of
age).
According
to
Dewey
and
Lönnerdal
(
1983),
the
mothers
were
all
well
educated
and
recruited
through
Lamaze
childbirth
classes
in
the
Davis
area
of
California.
Breast
milk
intake
volume
was
estimated
based
on
two
24­
hour
test
weighings
per
month.
Breast
milk
intake
rates
for
the
various
age
groups
are
presented
in
Table
14­
2.
Breast
milk
intake
averaged
673,
782,
and
896
mL/
day
at
1,
3,
and
6
months
of
age,
respectively.
The
advantage
of
this
study
is
that
it
evaluated
breastfed
infants
for
a
period
of
6
months
based
on
two
24­
hour
observations
per
infant
per
month.
Corrections
for
insensible
water
loss
apparently
were
not
made.
Also,
the
number
of
infants
in
the
study
was
relatively
small
and
may
not
be
representative
of
U.
S.
population,
based
on
race
and
socioeconomic
status.
Table
14­
2.
Breast
Milk
Intake
for
Infants
Aged
1
to
6
Months
Age
Number
Mean
SD
Range
a
1
16
673
192
341­
1,003
2
19
756
170
449­
1,055
3
16
782
172
492­
1,053
4
13
810
142
593­
1,045
5
11
805
117
554­
1,045
6
11
896
122
675­
1,096
Standard
deviation.
a
Source:
Dewey
and
Lönnerdal,
1983.

Butte
et
al.
(
1984)
­
Human
Milk
Intake
and
Growth
in
Exclusively
Breast­
fed
Infants
­
Breast
milk
intake
was
studied
in
exclusively
breast­
fed
infants
during
the
first
4
months
of
life
(
Butte
et
al.,
1984).
Breastfeeding
mothers
were
recruited
through
the
Baylor
Milk
Bank
Program
in
Texas.
Forty­
five
mother/
infant
pairs
participated
in
the
study.
However,
data
for
some
time
periods
(
i.
e.,
1,
2,
3,
or
4
months)
were
missing
for
some
mothers
as
a
result
of
illness
or
other
factors.
The
mothers
were
from
the
middleto
upper­
socioeconomic
stratum
and
had
a
mean
age
of
28.0
±
3.1
years.
A
total
of
41
mothers
were
white,
2
were
Hispanic,
1
was
Asian,
and
1
was
West
Indian.
Infant
growth
progressed
satisfactorily
over
the
course
of
the
study.
The
amount
of
milk
ingested
over
a
24­
hour
period
was
determined
using
the
test
weighing
procedure.
Test
weighing
occurred
over
a
24­
hour
period
for
most
participants,
but
intake
among
several
infants
was
studied
over
longer
periods
(
48
to
96
hours)
to
assess
individual
variation
in
intake.
The
study
did
not
indicate
whether
the
data
were
corrected
for
insensible
water
loss.
Mean
breast
milk
intake
ranged
from
723
g/
day
(
702
mL/
day)
at
3
months
to
751
g/
day
(
729
mL/
day)
at
1
month,
with
an
overall
mean
of
733
g/
day
(
712
mL/
day)
for
the
entire
study
period
(
Table
14­
3).
Intakes
were
also
calculated
on
the
basis
of
body
weight
(
Table
14­
3).
Based
on
the
results
of
test
weighings
conducted
over
48
to
96
hours,
the
mean
variation
in
individual
daily
intake
was
estimated
to
be
7.9
±
3.6
percent.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
3
Table
14­
3.
Breast
Milk
Intake
Among
Exclusively
Breast­
fed
Infants
During
the
First
4
Months
of
Life
Age
of
Intake
Intake
Weight
(
months)
Infants
(
g/
day)
(
g/
kg­
day)
(
kg)
Number
Breast
Milk
Breast
Milk
Body
a
a
b
1
37
751.0
±
130.0
159.0
±
24.0
4.7
2
40
725.0
±
131.0
129.0
±
19.0
5.6
3
37
723.0
±
114.0
117.0
±
20.0
6.2
4
41
740.0
±
128.0
111.0
±
17.0
6.7
Data
expressed
as
mean
±
standard
deviation.
a
Calculated
by
dividing
breast
milk
intake
(
g/
day)
by
breast
milk
intake
(
g/
kg­
b
day).
Source:
Butte
et
al.,
1984.

The
advantage
of
this
study
is
that
data
for
a
larger
number
of
exclusively
breast­
fed
infants
were
collected
than
were
collected
by
Pao
et
al.
(
1980).
However,
data
were
collected
over
a
shorter
time
period
(
i.
e.,
4
months
compared
to
6
months)
and
day­
to­
day
variability
was
not
characterized
for
all
infants.
In
addition,
the
population
studied
may
not
be
representative
of
the
U.
S.
population
based
on
race
and
socioeconomic
status.
Neville
et
al.
(
1988)
­
Studies
on
Human
Lactation
­
Neville
et
al.
(
1988)
studied
breast
milk
intake
among
13
infants
during
the
first
year
of
life.
The
mothers
were
all
multiparous,
nonsmoking,
Caucasian
women
of
middle­
to
upper­
socioeconomic
status
living
in
Denver,
Colorado
(
Neville
et
al.,
1988).
All
women
in
the
study
practiced
exclusive
breast­
feeding
for
at
least
5
months.
Solid
foods
were
introduced
at
mean
age
of
7
months.
Daily
milk
intake
was
estimated
by
the
test
weighing
method
with
corrections
for
insensible
weight
loss.
Data
were
collected
daily
from
birth
to
14
days,
weekly
from
weeks
3
through
8,
and
monthly
until
the
study
period
ended
at
1
year
after
inception.
The
estimated
breast
milk
intakes
for
this
study
are
listed
in
Table
14­
4.
Mean
breast
milk
intakes
were
770
g/
day
(
748
mL/
day),
734
g/
day
(
713
mL/
day),
766
g/
day
(
744
mL/
day),
and
403
g/
day
(
391
mL/
day)
at
1,
3,
6,
and
12
months
of
age,
respectively.
In
comparison
to
the
previously
described
studies,
Neville
et
al.
(
1988)
collected
data
on
numerous
days
over
a
relatively
long
time
period
(
12
months)
and
they
were
corrected
for
insensible
weight
loss.
However,
the
intake
rates
presented
in
Table
14­
4
are
estimated
based
on
intake
during
only
a
24­
hour
period.
Consequently,
these
intake
rates
are
based
on
short­
term
data
that
do
not
account
for
day­
to­
day
variability
among
individual
infants.
Also,
a
smaller
number
of
subjects
was
included
than
in
the
previous
studies,
and
the
population
studied
may
not
be
representative
of
the
U.
S.
population,
based
on
race
and
socioeconomic
status.

Table
14­
4.
Breast
Milk
Intake
During
a
24­
Hour
Period
Standard
Age
Number
Mean
Deviation
Range
(
days)
of
Infants
(
g/
day)
(
g/
day)
(
g/
day)

1
7
44
71
­
31­
149
2
10
182
86
44­
355
3
11
371
153
209­
688
4
11
451
176
164­
694
5
12
498
129
323­
736
6
10
508
167
315­
861
7
8
573
167
406­
842
8
9
581
159
410­
923
9
10
580
76
470­
720
10
10
589
132
366­
866
11
8
615
168
398­
934
14
10
653
154
416­
922
21
10
651
84
554­
786
28
13
770
179
495­
1144
35
12
668
117
465­
930
42
12
711
111
554­
896
49
10
709
115
559­
922
56
13
694
98
556­
859
90
12
734
114
613­
942
120
13
711
100
570­
847
150
13
838
134
688­
1173
180
13
766
121
508­
936
210
12
721
154
486­
963
240
10
622
210
288­
1002
270
12
618
220
223­
871
300
11
551
234
129­
894
330
9
554
240
120­
860
360
9
403
250
65­
770
a
Negative
value
due
to
insensible
water
loss
correction.
a
Source:
Neville
et
al.,
1988.

Dewey
et
al.
(
1991a;
1991b)
­
The
DARLING
Study
­
The
Davis
Area
Research
on
Lactation,
Infant
Nutrition
and
Growth
(
DARLING)
study
was
conducted
in
1986
to
evaluate
growth
patterns,
nutrient
intake,
morbidity,
and
activity
levels
in
infants
who
were
breast­
fed
for
at
least
the
first
12
months
of
life
(
Dewey
et
al.,
1991a;
1991b).
Seventy­
three
infants
aged
3
months
were
included
in
the
study.
The
number
of
infants
included
in
the
study
at
subsequent
time
intervals
was
somewhat
lower
as
a
result
of
attrition.
All
infants
in
the
study
were
healthy
and
of
normal
gestational
age
and
weight
at
birth,
and
did
not
consume
solid
foods
until
after
the
first
4
months
of
age.
The
mothers
were
highly
educated
and
of
"
relatively
high
socioeconomic
status"
from
the
Davis
area
of
California
(
Dewey
et
al.,
1991a;
1991b).
Breast
milk
intake
was
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
4
August
1997
estimated
by
weighing
the
infants
before
and
after
each
(
Table
14­
7).
Breast
milk
intake
was
estimated
to
be
656
feeding
and
correcting
for
insensible
water
loss.
Test
g/
day
(
637
mL/
day)
at
1
month
and
776
g/
day
(
753
mL/
day)
weighings
were
conducted
over
a
4­
day
period
every
3
at
3
months.
months.
The
results
of
the
study
indicate
that
breast
milk
intake
declines
over
the
first
12
months
of
life.
Mean
breast
milk
intake
was
estimated
to
be
812
g/
day
(
788
mL/
day)
at
3
months
and
448
g/
day
(
435
mL/
day)
at
12
months
(
Table
14­
5).
Based
on
the
estimated
intakes
at
3
months
of
age,
variability
between
individuals
(
coefficient
of
variation
(
CV)
=
16.3
percent)
was
higher
than
individual
day­
to­
day
variability
(
CV
=
5.4
percent)
for
the
infants
in
the
study
(
Dewey
et
al.,
1991a).

Table
14­
5.
Breast
Milk
Intake
Estimated
by
the
DARLING
Study
Age
Number
of
Mean
Intake
Standard
Deviation
(
months)
Infants
(
g/
day)
(
g/
day)

3
73
812
133
6
60
769
171
9
50
646
217
12
42
448
251
Source:
Dewey
et
al.
(
1991b).

The
advantages
of
this
study
are
that
data
were
collected
over
a
relatively
long­
time
(
4
days)
period
at
each
test
interval
which
would
account
for
some
day­
to­
day
infant
variability,
and
corrections
for
insensible
water
loss
were
made.
However,
the
population
studied
may
not
be
representative
of
the
U.
S.
population,
based
on
race
and
socioeconomic
status.

14.3.
RELEVANT
STUDIES
ON
BREAST
MILK
INTAKE
Hofvander
et
al.
(
1982)
­
The
Amount
of
Milk
Consumed
by
1­
to
3­
Month
Old
Breast­
or
Bottle­
Fed
Infants
­
Hofvander
et
al.
(
1982)
compared
milk
intake
among
breast­
fed
and
bottle­
fed
infants
at
ages
1,
2,
and
3
months
of
age.
Intake
of
breast
milk
and
breast
milk
substitutes
was
tabulated
for
25
Swedish
infants
in
each
age
group.
Daily
intake
among
breast­
fed
infants
was
estimated
using
the
test
weighing
method.
Test
weighings
were
conducted
over
a
24­
hour
time
period
at
each
time
interval.
Daily
milk
intake
among
bottle­
fed
infants
was
estimated
by
measuring
the
volumetric
differences
in
milk
contained
in
bottles
at
the
beginning
and
end
of
all
feeding
sessions
in
a
24­
hour
period.
The
mean
intake
rates
for
bottle­
fed
infants
were
slightly
higher
than
for
breast­
fed
infants
for
all
age
groups
(
Table
14­
6).
Also,
boys
consumed
breast
milk
or
breast
milk
substitutes
at
a
slightly
higher
rate
than
girls
Table
14­
6.
Milk
Intake
for
Bottle­
and
Breast­
fed
Infants
by
Age
Group
Age
Breast
Milk
Substitutes
Breast
Milk
(
months)
Mean
(
g/
day)
Mean
(
g/
day)
a
a
1
713
656
2
811
773
3
853
776
(
500­
1,000)
(
360­
860)

(
670­
1,180)
(
575­
985)

(
655­
1,065)
(
600­
930)

Range
given
in
parentheses.
a
Source:
Hofvander
et
al.,
1982.

Table
14­
7.
Milk
Intake
for
Boys
and
Girls
Boys
Girls
Age
(
g/
day)
N
(
g/
day)
N
Mean
Mean
Breast
milk
1
663
12
649
13
2
791
14
750
11
3
811
12
743
13
Breast
milk
substitute
1
753
10
687
15
2
863
13
753
12
3
862
13
843
12
Source:
Hofvander
et
al.,
1982.

This
study
was
conducted
among
a
small
number
of
Swedish
infants,
but
the
results
are
similar
to
those
summarized
previously
for
U.
S.
studies.
Insensible
water
losses
were
apparently
not
considered
in
this
study,
and
only
short­
term
data
were
collected.
Köhler
et
al.
(
1984)
­
Food
Intake
and
Growth
of
Infants
Between
Six
and
Twenty­
six
Weeks
of
Age
on
Breast
Milk,
Cow's
Milk,
Formula,
and
Soy
Formula
­
Köhler
et
al.
(
1984)
evaluated
breast
milk
and
formula
intake
among
normal
infants
between
the
ages
of
6
and
26
weeks.
The
study
included
25
fully
breast­
fed
and
34
formula­
fed
infants
from
suburban
communities
in
Sweden.
Intake
among
breast­
fed
infants
was
estimated
using
the
test
weighing
method
over
a
48­
hour
test
period.
Intake
among
formula­
fed
infants
was
estimated
by
feeding
infants
from
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
5
Table
14­
8.
Intake
of
Breast
Milk
and
Formula
Breast
Milk
Cow's
Formula
Soy
Formula
Age
(
wks)
N
Mean
(
g/
day)
SD
(
g/
day)
N
Mean
(
g/
day)
SD
(
g/
day)
N
Mean
(
g/
day)
SD
(
g/
day)

6
14
22
26
26
21
13
12
746
726
722
689
101
143
114
120
20
19
18
18
823
921
818
722
111
95
201
209
13
13
13
12
792
942
861
776
127
78
196
159
Source:
Köhler
et
al.,
1984.
bottles
with
known
volumes
of
formula
and
recording
the
the
length
of
time
that
an
infant
nurses.
Lipid
content
amount
consumed
over
a
48­
hour
period.
Table
14­
8
increases
from
the
beginning
to
the
end
of
a
single
nursing
presents
the
mean
breast
milk
and
formula
intake
rates
for
session
(
NAS,
1991).
The
lipid
portion
accounts
for
the
infants
studied.
Data
were
collected
for
both
cow's
approximately
4
percent
of
human
breast
milk
(
39
±
4.0
milk­
based
formula
and
soy­
based
formula.
The
results
g/
L)
(
NAS,
1991).
This
value
is
supported
by
various
indicated
that
the
daily
intake
for
bottle­
fed
infants
was
studies
that
evaluated
lipid
content
from
human
breast
milk.
greater
than
for
breast­
fed
infants.
Several
studies
also
estimated
the
quantity
of
lipid
The
advantages
of
this
study
are
that
it
compares
breast
consumed
by
breast­
feeding
infants.
These
values
are
milk
intake
to
formula
intake
and
that
test
weightings
were
appropriate
for
performing
exposure
assessments
for
conducted
over
2
consecutive
days
to
account
for
variability
nursing
infants
when
the
contaminant(
s)
have
residue
in
individual
intake.
Although
the
population
studied
was
concentrations
that
are
indexed
to
the
fat
portion
of
human
not
representative
of
the
U.
S.
population,
similar
intake
breast
milk.
rates
were
observed
in
the
studies
that
were
previously
summarized.
Axelsson
et
al.
(
1987)
­
Protein
and
Energy
Intake
During
Weaning
­
Axelsson
et
al.
(
1987)
measured
food
women
who
participated
in
a
study
of
breast
milk
intake
consumption
and
energy
intake
in
30
healthy
Swedish
among
exclusively
breast­
fed
infants.
The
study
was
infants
between
the
ages
of
4
and
6
months.
Both
formula­
conducted
with
over
40
women
during
a
4­
month
period.
fed
and
breast­
fed
infants
were
studied.
All
infants
were
fed
The
mean
lipid
content
of
breast
milk
at
various
infants'
supplemental
foods
(
i.
e.,
pureed
fruits
and
vegetables
after
ages
is
presented
in
Table
14­
9.
The
overall
lipid
content
4
months,
and
pureed
meats
and
fish
after
5
months).
Milk
for
the
4­
month
study
period
was
34.3
±
6.9
mg/
g
(
3.4
intake
among
breast­
fed
infants
was
estimated
by
weighing
percent).
Butte
et
al.
(
1984)
also
calculated
lipid
intakes
the
infants
before
and
after
each
feeding
over
a
2­
day
period
from
24­
hour
breast
milk
intakes
and
the
lipid
content
of
the
at
each
sampling
interval.
Breast
milk
intake
averaged
765
human
milk
samples.
Lipid
intake
was
estimated
to
range
mL/
day
at
4.5
months
of
age,
and
715
mL/
day
at
5.5
months
from
23.6
g/
day
(
3.8
g/
kg­
day)
to
28.0
g/
day
(
5.9
g/
kg­
day).
of
age.
The
number
of
women
included
in
this
study
was
small,
This
study
is
based
on
short­
term
data,
a
small
number
and
these
women
were
selected
primarily
from
middle­
to
of
infants,
and
may
not
be
representative
of
the
U.
S.
upper­
socioeconomic
classes.
Thus,
data
on
breast
milk
population.
However,
the
intake
rates
estimated
by
this
lipid
content
from
this
study
may
not
be
entirely
study
are
similar
to
those
generated
by
the
U.
S.
studies
that
representative
of
breast
milk
lipid
content
among
were
summarized
previously.

14.4.
KEY
STUDIES
ON
LIPID
CONTENT
AND
FAT
INTAKE
FROM
BREAST
MILK
Human
milk
contains
over
200
constituents
including
lipids,
various
proteins,
carbohydrates,
vitamins,
minerals,
and
trace
elements
as
well
as
enzymes
and
hormones
(
NAS,
1991).
The
lipid
content
of
breast
milk
varies
according
to
Butte
et
al.
(
1984)
­
Human
Milk
Intake
and
Growth
in
Exclusively
Breast­
fed
Infants
­
Butte
et
al.,
(
1984)
analyzed
the
lipid
content
of
breast
milk
samples
taken
from
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
6
August
1997
Table
14­
9.
Lipid
Content
of
Human
Milk
and
Estimated
Lipid
Intake
Among
Exclusively
Breast­
fed
Infants
Age
(
months)
Number
Lipid
Lipid
Lipid
Lipid
of
Content
Content
Intake
Intake
Observations
(
mg/
g)
(
percent)
(
g/
day)
(
g/
kg­
day)
a
b
a
a
1
37
36.2
±
7.5
3.6
28.0
±
8.5
5.9
±
1.7
2
40
34.4
±
6.8
3.4
25.2
±
7.1
4.4
±
1.2
3
37
32.2
±
7.8
3.2
23.6
±
7.2
3.8
±
1.2
4
41
34.8
±
10.8
3.5
25.6
±
8.6
3.8
±
1.3
Data
expressed
as
means
±
standard
deviations.
a
Percents
calculated
from
lipid
content
reported
in
mg/
g.
b
Source:
Butte,
et
al.,
1984.

the
U.
S.
population.
Also,
these
estimates
are
based
on
specified
(
i.
e.,
3
months
or
6
months).
Also,
because
intake
short­
term
data
and
day­
to­
day
variability
was
not
rates
are
indexed
to
the
lipid
portion
of
the
breast
milk,
they
characterized.
may
be
used
in
conjunction
with
residue
concentrations
Maxwell
and
Burmaster
(
1993)
­
A
Simulation
Model
to
Estimate
a
Distribution
of
Lipid
Intake
from
Breast
Milk
Intake
During
the
First
Year
of
Life
­
Maxwell
and
Burmaster
(
1993)
used
a
hypothetical
population
of
5,000
infants
between
birth
and
1
year
of
age
to
simulate
a
distribution
of
daily
lipid
intake
from
breast
milk.
The
hypothetical
population
represented
both
bottle­
fed
and
breast­
fed
infants
aged
1
to
365
days.
A
distribution
of
daily
lipid
intake
was
developed
based
on
data
in
Dewey
et
al.
(
1991b)
on
breast
milk
intake
for
infants
at
3,
6,
9,
and
12
months
and
breast
milk
lipid
content,
and
survey
data
in
Ryan
et
al.
(
1991)
on
the
percentage
of
breast­
fed
infants
under
the
age
of
12
months
(
i.
e.,
approximately
22
percent).
A
model
was
used
to
simulate
intake
among
1,113
of
the
5,000
infants
that
were
expected
to
be
breast­
fed.
The
results
of
the
model
indicated
that
lipid
intake
among
nursing
infants
under
12
months
of
age
can
be
characterized
by
a
normal
distribution
with
a
mean
of
26.8
g/
day
and
a
standard
deviation
of
7.4
g/
day
(
Table
14­
10).
The
model
assumes
that
nursing
infants
are
completely
breast­
fed
and
does
not
account
for
infants
who
are
breast­
fed
longer
than
1
year.
Based
on
data
collected
by
Dewey
et
al.
(
1991b),
Maxwell
and
Burmaster
(
1993)
estimated
the
lipid
content
of
breast
milk
to
be
36.7
g/
L
at
3
months
(
35.6
mg/
g
or
3.6%)
and
40.2
g/
L
(
39.0
mg/
g
or
3.9%)
at
12
months.
The
advantage
of
this
study
is
that
it
provides
a
"
snapshot"
of
daily
lipid
intake
from
breast
milk
for
breastfed
infants.
These
results
are,
however,
based
on
a
simulation
model
and
there
are
uncertainties
associated
with
the
assumptions
made.
The
estimated
mean
lipid
intake
rate
represents
the
average
daily
intake
for
nursing
infants
under
12
months
of
age.
These
data
are
useful
for
performing
exposure
assessments
when
the
age
of
the
infant
cannot
be
indexed
to
fat
content.

Table
14­
10.
Predicted
Lipid
Intakes
for
Breast­
fed
Infants
Under
12
Months
of
Age
Statistic
Value
Number
of
Observations
in
Simulation
1,113
Minimum
Lipid
Intake
1.0
g/
day
Maximum
Lipid
Intake
51.5
g/
day
Arithmetic
Mean
Lipid
Intake
26.8
g/
day
Standard
Deviation
Lipid
Intake
7.4
g/
day
Source:
Maxwell
and
Burmaster,
1993.

14.5.
OTHER
FACTORS
Other
factors
associated
with
breast
milk
intake
include:
the
frequency
of
breast­
feeding
sessions
per
day,
the
duration
of
breast­
feeding
per
event,
the
duration
of
breast­
feeding
during
childhood,
and
the
magnitude
and
nature
of
the
population
that
breast­
feeds.
Frequency
and
Duration
of
Feeding
­
Hofvander
et
al.
(
1982)
reported
on
the
frequency
of
feeding
among
25
bottle­
fed
and
25
breast­
fed
infants
at
ages
1,
2,
and
3
months.
The
mean
number
of
meals
for
these
age
groups
was
approximately
5
meals/
day
(
Table
14­
11).
Neville
et
al.
(
1988)
reported
slightly
higher
mean
feeding
frequencies.
The
mean
number
of
meals
per
day
for
exclusively
breast­
fed
infants
was
7.3
at
ages
2
to
5
months
and
8.2
at
ages
2
weeks
to
1
month.
Neville
et
al.
(
1988)
reported
that,
for
infants
between
the
ages
of
1
week
and
5
months,
the
average
duration
of
a
breast
feeding
session
is
16­
18
minutes.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
7
Table
14­
11.
Number
of
Meals
Per
Day
Age
(
months)
Bottle­
fed
Infants
Breast­
fed
(
meals/
day)
(
meals/
day)
a
a
1
5.4
(
4­
7)
5.8
(
5­
7)

2
4.8
(
4­
6)
5.3
(
5­
7)

3
4.7
(
3­
6)
5.1
(
4­
8)

Data
expressed
as
mean
with
range
in
parentheses.
a
Source:
Hofvander
et
al.,
1982.

Population
of
Nursing
Infants
and
Duration
of
Breast­
Feeding
During
Infancy
­
According
to
NAS
(
1991),
the
percentage
of
breast­
feeding
women
has
changed
dramatically
over
the
years.
Between
1936
and
1940,
approximately
77
percent
of
infants
were
breast
fed,
but
the
incidence
of
breast­
feeding
fell
to
approximately
22
percent
in
1972.
The
duration
of
breast­
feeding
also
dropped
from
about
4
months
in
the
early
1930s
to
2
months
in
the
late
1950s.
After
1972,
the
incidence
of
breast­
feeding
began
to
rise
again,
reaching
its
peak
at
approximately
61
percent
in
1982.
The
duration
of
breast­
feeding
also
increased
between
1972
and
1982.
Approximately
10
percent
of
the
mothers
who
initiated
breast­
feeding
continued
for
at
least
3
months
in
1972;
however,
in
1984,
37
percent
continued
breast­
feeding
beyond
3
months.
In
1989,
breast­
feeding
was
initiated
among
52.2
percent
of
newborn
infants,
and
40
percent
continued
for
3
months
or
longer
(
NAS,
1991).
Based
on
the
data
for
1989,
only
about
20
percent
of
infants
were
still
breast
fed
by
age
5
to
6
months
(
NAS,
1991).
Data
on
the
actual
length
of
time
that
infants
continue
to
breast­
feed
beyond
5
or
6
months
are
limited
(
NAS,
1991).
However,
Maxwell
and
Burmaster
(
1993)
estimated
that
approximately
22
percent
of
infants
under
1
year
of
age
are
breast­
fed.
This
estimate
is
based
on
a
reanalysis
of
survey
data
in
Ryan
et
al.
(
1991)
collected
by
Ross
Laboratories
(
Maxwell
and
Burmaster,
1993).
Studies
have
also
indicated
that
breast­
feeding
practices
may
differ
among
ethnic
and
socioeconomic
groups
and
among
regions
of
the
United
States.
The
percentages
of
mothers
who
breast
feed,
based
on
ethnic
background
and
demographic
variables,
are
presented
in
Table
14­
12
(
NAS,
1991).
Intake
Rates
Based
on
Nutritional
Status
­
Information
on
differences
in
the
quality
and
quantity
of
breast
milk
consumed
based
on
ethnic
or
socioeconomic
characteristics
of
the
population
is
limited.
Lönnerdal
et
al.
(
1976)
studied
breast
milk
volume
and
composition
(
nitrogen,
lactose,
proteins)
among
underprivileged
and
privileged
Ethiopian
mothers.
No
significant
differences
were
observed
between
the
data
for
these
two
groups;
and
similar
data
for
wellnourished
Swedish
mothers
were
observed.
Lönnerdal
et
al.
(
1976)
stated
that
these
results
indicate
that
breast
milk
quality
and
quantity
are
not
affected
by
maternal
malnutrition.
However,
Brown
et
al.
(
1986a;
1986b)
noted
that
the
lactational
capacity
and
energy
concentration
of
marginally­
nourished
women
in
Bangladesh
were
"
modestly
less
than
in
better
nourished
mothers."
Breast
milk
intake
rates
for
infants
of
marginally­
nourished
women
in
this
study
were
690
±
122
g/
day
at
3
months,
722
±
105
g/
day
at
6
months,
and
719
±
119
g/
day
at
9
months
of
age
(
Brown
et
al.,
1986a).
Brown
et
al.
(
1986a)
observed
that
breast
milk
from
women
with
larger
measurements
of
arm
circumference
and
triceps
skinfold
thickness
had
higher
concentrations
of
fat
and
energy
than
mothers
with
less
body
fat.
Positive
correlations
between
maternal
weight
and
milk
fat
concentrations
were
also
observed.
These
results
suggest
that
milk
composition
may
be
affected
by
maternal
nutritional
status.

14.6.
RECOMMENDATIONS
The
key
studies
described
in
this
section
were
used
in
selecting
recommended
values
for
breast
milk
intake,
fat
content
and
fat
intake,
and
other
related
factors.
Although
different
survey
designs,
testing
periods,
and
populations
were
utilized
by
the
key
and
relevant
studies
to
estimate
intake,
the
mean
and
standard
deviation
estimates
reported
in
these
studies
are
relatively
consistent.
There
are,
however,
limitations
with
the
data.
Data
are
not
available
for
infants
under
1
month
of
age.
This
subpopulation
may
be
of
particular
concern
since
a
larger
number
of
newborns
are
totally
breast
fed.
In
addition,
with
the
exception
of
Butte
(
1984),
data
were
not
presented
on
a
body
weight
basis.
This
is
particularly
important
since
intake
rates
may
be
higher
on
a
body
weight
basis
for
younger
infants.
Also,
the
data
used
to
derive
the
recommendations
are
over
10
years
old
and
the
sample
size
of
the
studies
was
small.
Other
subpopulations
of
concern
such
as
mothers
highly
committed
to
breast
feeding,
sometimes
for
periods
longer
than
1
year,
may
not
be
captured
by
the
studies
presented
in
this
chapter.
Further
research
is
needed
to
identify
these
subgroups
and
to
get
better
estimates
of
breast
milk
intake
rates.
The
general
designs
of
both
key
and
relevant
studies
and
their
limitations
are
summarized
in
Table
14­
13.
Table
14­
14
presents
the
confidence
rating
for
breast
milk
intake
recommendations.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
8
August
1997
Breast
Milk
Intake
­
The
breast
milk
intake
rates
for
nursing
infants
that
have
been
reported
in
the
key
studies
described
in
this
section
are
summarized
in
Table
14­
15.
Based
on
the
combined
results
of
these
studies,
742
mL/
day
is
recommended
to
represent
an
average
breast
milk
intake
rate,
and
1,033
mL/
day
represents
an
upper­
percentile
intake
rate
(
based
on
the
middle
range
of
the
mean
plus
2
standard
deviations)
for
infants
between
the
ages
of
1
and
6
months
of
age.
The
average
value
is
the
mean
of
the
average
intakes
at
1,
3,
and
6
months
from
the
key
studies
listed
in
Table
14­
15.
It
is
consistent
with
the
average
intake
rate
of
718
to
777
mL/
day
estimated
by
NAS
(
1991)
for
infants
during
the
first
4
to
5
months
of
life.
Intake
among
older
infants
is
somewhat
lower,
averaging
413
mL/
day
for
12­
month
olds
(
Neville
et
al.
1988;
Dewey
et
al.
1991a;
1991b).
When
a
time
weighted
average
is
calculated
for
the
12­
month
period,
average
breast
milk
intake
is
approximately
688
mL/
day,
and
upper­
percentile
intake
is
approximately
980
mL/
day.
Table
14­
16
summarizes
these
recommended
intake
rates.
Lipid
Content
and
Lipid
Intake
­
Recommended
lipid
intake
rates
are
based
on
data
from
Butte
et
al.
(
1984)
and
Maxwell
and
Burmaster
(
1993).
Butte
et
al.
(
1984)
estimated
that
average
lipid
intake
ranges
from
23.6
±
7.2
g/
day
(
22.9
±
7.0
mL/
day)
to
28.0
±
8.5
g/
day
(
27.2
±
8.3
mL/
day)
between
1
and
4
months
of
age.
These
intake
rates
are
consistent
with
those
observed
by
Burmaster
and
Maxwell
(
1993)
for
infants
under
1
year
of
age
[(
26.8
±
7.4
g/
day
(
26.0
±
7.2
mL/
day)].
Therefore,
the
recommended
breast
milk
lipid
intake
rate
for
infants
under
1
year
of
age
is
26.0
mL/
day
and
the
upper­
percentile
value
is
40.4
mL/
day
(
based
on
the
mean
plus
2
standard
deviations).
The
recommended
value
for
breast
milk
fat
content
is
4.0
percent
based
on
data
from
NAS
(
1991),
Butte
et
al.
(
1984),
and
Maxwell
and
Burmaster
(
1993).

14.7.
REFERENCES
FOR
CHAPTER
14
Axelsson,
I.;
Borulf,
S.;
Righard,
L.;
Räihä,
N.
(
1987)
Protein
and
energy
intake
during
weaning:
effects
and
growth.
Acta
Paediatr.
Scand.
76:
321­
327.
Brown,
K.
H.;
Akhtar,
N.
A.;
Robertson,
A.
D.;
Ahmed,
M.
G.
(
1986a)
Lactational
capacity
of
marginally
nourished
mothers:
relationships
between
maternal
nutritional
status
and
quantity
and
proximate
composition
of
milk.
Pediatrics.
78:
909­
919.
Brown,
K.
H.;
Robertson,
A.
D.;
Akhtar,
N.
A.
(
1986b)
Lactational
capacity
of
marginally
nourished
mothers:
infants'
milk
nutrient
consumption
and
patterns
of
growth.
Pediatrics.
78:
920­
927.
Butte,
N.
F.;
Garza,
C.;
Smith,
E.
O.;
Nichols,
B.
L.
(
1984)
Human
milk
intake
and
growth
in
exclusively
breastfed
infants.
Journal
of
Pediatrics.
104:
187­
195.
Dewey,
K.
G.;
Lönnerdal,
B.
(
1983)
Milk
and
nutrient
intake
of
breast­
fed
infants
from
1
to
6
months:
relation
to
growth
and
fatness.
Journal
of
Pediatric
Gastroenterology
and
Nutrition.
2:
497­
506.
Dewey,
K.
G.;
Heinig,
J.;
Nommsen,
L.
A.;
Lönnerdal,
B.
(
1991a)
Maternal
versus
infant
factors
related
to
breast
milk
intake
and
residual
volume:
the
DARLING
study.
Pediatrics.
87:
829­
837.
Dewey,
K.
G.;
Heinig,
J.;
Nommsen,
L.;
Lönnerdal,
B.
(
1991b)
Adequacy
of
energy
intake
among
breastfed
infants
in
the
DARLING
study:
relationships
to
growth,
velocity,
morbidity,
and
activity
levels.
The
Journal
of
Pediatrics.
119:
538­
547.
Hofvander,
Y.;
Hagman,
U.;
Hillervik,
C.;
Sjolin,
S.
(
1982)
The
amount
of
milk
consumed
by
1­
3
months
old
breast­
or
bottle­
fed
infants.
Acta
Paediatr.
Scand.
71:
953­
958.
Köhler,
L.;
Meeuwisse,
G.;
Mortensson,
W.
(
1984)
Food
intake
and
growth
of
infants
between
six
and
twenty­
six
weeks
of
age
on
breast
milk,
cow's
milk
formula,
and
soy
formula.
Acta
Paediatr.
Scand.
73:
40­
48.
Lönnerdal,
B.;
Forsum,
E.;
Gebre­
Medhim,
M.;
Hombraes,
L.
(
1976)
Breast
milk
composition
in
Ethiopian
and
Swedish
mothers:
lactose,
nitrogen,
and
protein
contents.
The
American
Journal
of
Clinical
Nutrition.
29:
1134­
1141.
Maxwell,
N.
I.;
Burmaster,
D.
E.
(
1993)
A
simulation
model
to
estimate
a
distribution
of
lipid
intake
from
breast
milk
during
the
first
year
of
life.
Journal
of
Exposure
Analysis
and
Environmental
Epidemiology.
3:
383­
406.
National
Academy
of
Sciences
(
NAS).
(
1991)
Nutrition
during
lactation.
Washington,
DC.
National
Academy
Press.
Neville,
M.
C.;
Keller,
R.;
Seacat,
J.;
Lutes,
V.;
Neifert,
M.;
et
al.
(
1988)
Studies
in
human
lactation:
milk
volumes
in
lactating
women
during
the
onset
of
lactation
and
full
lactation.
American
Journal
of
Clinical
Nutrition.
48:
1375­
1386.
Pao,
E.
M.;
Hines,
J.
M.;
Roche,
A.
F.
(
1980)
Milk
intakes
and
feeding
patterns
of
breast­
fed
infants.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
9
Journal
of
the
American
Dietetic
Association.
Ryan,
A.
S.;
Rush,
D.;
Krieger,
F.
W.;
Lewandowski,
G.
E.
77:
540­
545.
(
1991)
Recent
declines
in
breastfeeding
in
the
United
States,
1984­
1989.
Pediatrics.
88:
719­
727.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
10
August
1997
Table
14­
12.
Percentage
of
Mothers
Breast­
feeding
Newborn
Infants
in
the
Hospital
and
Infants
at
5
or
6
Months
of
Age
in
the
United
States
in
1989
,
by
Ethnic
Background
and
Selected
Demographic
Variables
a
b
Total
White
Black
Hispanicc
Category
Newborns
5­
6
Mo
Newborns
5­
6
Mo
Newborns
5­
6
Mo
Newborns
5­
6
Mo
Infants
Infants
Infants
Infants
All
mothers
52.2
19.6
58.5
22.7
23.0
7.0
48.4
15.0
Parity
Primiparous
52.6
16.6
58.3
18.9
23.1
5.9
49.9
13.2
Multiparous
51.7
22.7
58.7
26.8
23.0
7.9
47.2
16.5
Marital
status
Married
59.8
24.0
61.9
25.3
35.8
12.3
55.3
18.8
Unmarried
30.8
7.7
40.3
9.8
17.2
4.6
37.5
8.6
Maternal
age
<
20
yr
30.2
6.2
36.8
7.2
13.5
3.6
35.3
6.9
20­
24
yr
45.2
12.7
50.8
14.5
19.4
4.7
46.9
12.6
25­
29
yr
58.8
22.9
63.1
25.0
29.9
9.4
56.2
19.5
30­
34
yr
65.5
31.4
70.1
34.8
35.4
13.6
57.6
23.4
$
35
yr
66.5
36.2
71.9
40.5
35.6
14.3
53.9
24.4
Maternal
education
No
college
42.1
13.4
48.3
15.6
17.6
5.5
42.6
12.2
College
70.7
31.1
74.7
34.1
41.1
12.2
66.5
23.4
d
Family
income
<$
7,000
28.8
7.9
36.7
9.4
14.5
4.3
35.3
10.3
$
7,000­$
14,999
44.0
13.5
49.0
15.2
23.5
7.3
47.2
13.0
$
15,000­$
24,999
54.7
20.4
57.7
22.3
31.7
8.7
52.6
16.5
$
$
25,000
66.3
27.6
67.8
28.7
42.8
14.5
65.4
23.0
Maternal
employment
Full
time
50.8
10.2
54.8
10.8
30.6
6.9
50.4
9.5
Part
time
59.4
23.0
63.8
25.5
26.0
6.6
59.4
17.7
Not
employed
51.0
23.1
58.7
27.5
19.3
7.2
46.0
16.7
U.
S.
census
region
New
England
52.2
20.3
53.2
21.4
35.6
5.0
47.6
14.9
Middle
Atlantic
47.4
18.4
52.4
21.8
30.6
9.7
41.4
10.8
East
North
Central
47.6
18.1
53.2
20.7
21.0
7.2
46.2
12.6
West
North
Central
55.9
19.9
58.2
20.7
27.7
7.9
50.8
22.8
South
Atlantic
43.8
14.8
53.8
18.7
19.6
5.7
48.0
13.8
East
South
Central
37.9
12.4
45.1
15.0
14.2
3.7
23.5
5.0
West
South
Central
46.0
14.7
56.2
18.4
14.5
3.8
39.2
11.4
Mountain
70.2
30.4
74.9
33.0
31.5
11.0
53.9
18.2
Pacific
70.3
28.7
76.7
33.4
43.9
15.0
58.5
19.7
Mothers
were
surveyed
when
their
infants
were
6
months
of
age.
They
were
asked
to
recall
the
method
of
feeding
the
infant
when
in
the
a
hospital,
at
age
1
week,
at
months
1
through
5,
and
on
the
day
preceding
completion
of
the
survey.
Numbers
in
the
columns
labeled
"
5­
6
Mo
Infants"
are
an
average
of
the
5­
month
and
previous
day
responses.
Based
on
data
from
Ross
Laboratories.
b
Hispanic
is
not
exclusive
of
white
or
black.
c
College
includes
all
women
who
reported
completing
at
least
1
year
of
college.
d
Source:
NAS,
1991.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
11
Table
14­
13.
Breast
Milk
Intake
Studies
Study
Number
of
Individuals
Type
of
Feeding
Sampling
Time
and
Interval
Population
Studied
Comments
KEY
STUDIES
Butte
et
al.,
1984
45
Exclusively
breast­
fed
for
first
4
months
Most
infants
studied
over
1
day
only,
at
1,
2,
3,
4
months
some
studied
over
48
to
96
hours
to
study
individual
variability
Mid­
to
uppersocioeconomic
stratum
Estimated
breast
milk
intake;

corrected
for
insensible
water
loss
Dewey
et
al.,

1991a;
1991b
73
Breast­
fed
for
12
months;

exclusively
breast­
fed
for
at
least
first
4
months
Test
weighing
over
4­
day
period
every
3
months
for
1
year
Highly
educated,

highsocioeconomic
class
from
Davis
area
of
California
Estimated
breast
milk
intake;

corrected
for
insensible
water
loss
Dewey
and
Lönnerdal,
1983
20
Most
infants
exclusively
breast­
fed
Two
test
weighings
per
month
for
6
months
Mid
to
upper
class
from
Davis
area
of
California
Estimated
breast
milk
intake;
did
not
correct
for
insensible
water
loss
Neville
et
al.,
1988
13
Exclusively
breast­
fed
infants
Infants
studied
over
24­
hour
period
at
each
sampling
interval;

numerous
sampling
intervals
over
first
year
of
life
Nonsmoking
Caucasian
mothers;
middle­
to
uppersocioeconomic
status
Estimated
breast
milk
intake
and
lipid
intake;
corrected
for
insensible
water
loss;
estimated
frequency
and
duration
of
feeding
Pao
et
al.,
1980
22
Completely
or
partially
breast­
fed
infants
Three
consecutive
days
at
1,
3,

6,
and
9
months
White
middle
class
from
southeastern
Ohio
Estimated
breast
milk
intake;
did
not
correct
for
insensible
water
loss
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
12
August
1997
Table
14­
13.
Breast
Milk
Intake
Studies
(
continued)

Study
Number
of
Individuals
Type
of
Feeding
Sampling
Time
and
Interval
Population
Studied
Comments
RELEVANT
STUDIES
Axelsson
et
al.,
1987
30
Breast­
fed
infants
and
infants
fed
formula
with
two
different
energy
contents
Studied
over
2­
day
periods
at
4.5
and
5.5
months
of
age
Swedish
infants
Measured
intake
rates;
not
corrected
for
insensible
water
loss
Brown
et
al.,
1986a;

1986b
58,
60
Breast­
fed
infants
Studied
over
3
days
at
each
interval
Bangledeshi
infants;

marginally
nourished
mothers
Measured
milk
and
nutrient
intake
based
on
nutritional
status;
not
corrected
for
insensible
water
loss
Hofvander
et
al.,

1982
50
25
breast­
fed
and
25
formula­
fed
infants
Studied
24­
hour
period
at
1,
2,

and
3
months
Swedish
infants
Estimated
breast
milk
and
formula
intake;
no
corrections
for
insensible
water
loss
among
breast­
fed
infants;

estimated
frequency
of
feeding
Köhler
et
al.,
1984
59
25
fully
breast­
fed
and
34
formula­
fed
infants
Studied
over
48­
hour
periods
at
6,
14,
22,
and
26
weeks
of
age
Swedish
infants
Estimated
breast
milk
and
formula
intake
based
on
nutritional
status;
no
corrections
for
insensible
water
loss
among
breast­
fed
infants
Maxwell
and
Burmaster,
1993
1,113
Population
of
1,113
breastfed
infants
based
on
a
hypothetical
population
of
5,000
breast­
fed
and
bottlefed
infants
NA
NA
Simulated
distribution
of
breast
milk
intake
based
on
data
from
Dewey
1991a;
estimated
percent
of
breast­
fed
infants
under
12
months
of
age
NAS,
1991
NA
Breast­
fed
infants
NA
NA
Summarizes
current
state­
of­
knowledge
on
breast
milk
volume,
composition
and
breast­
feeding
populations
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
13
Table
14­
14.
Confidence
in
Breast
Milk
Intake
Recommendations
Considerations
Rationale
Rating
Study
Elements
C
Level
of
peer
review
All
key
studies
are
from
peer
review
literature.
High
C
Accessibility
Papers
are
widely
available
from
peer
review
journals.
High
C
Reproducibility
Methodology
used
was
clearly
presented.
High
C
Focus
on
factor
of
interest
The
focus
of
the
studies
was
on
estimating
breast
milk
intake.
High
C
Data
pertinent
to
U.
S.
Subpopulations
of
the
U.
S.
were
the
focus
of
all
the
key
studies.
High
C
Primary
data
All
the
studies
were
based
on
primary
data.
High
C
Currency
Studies
were
conducted
between
1980­
1986.
Although
incidence
of
breast
Medium
feeding
may
change
with
time,
breast
milk
intake
among
breastfed
infants
may
not.

C
Adequacy
of
data
collection
period
Infants
were
not
studied
long
enough
to
fully
characterize
day
to
day
Medium
variability.

C
Validity
of
approach
Methodology
uses
changes
in
body
weight
as
a
surrogate
for
total
ingestion.
Medium
This
is
the
best
methodology
there
is
to
estimate
breast
milk
ingestion.
Mothers
were
instructed
in
the
use
of
infant
scales
to
minimize
measurement
errors.
Three
out
of
the
5
studies
corrected
data
for
insensible
water
loss.

C
Study
size
The
sample
sizes
used
in
the
key
studies
were
fairly
small
(
range
13­
73).

C
Representativeness
of
the
population
Population
is
not
representative
of
the
U.
S.;
only
mid­
upper
class,
well
Low
nourished
mothers
were
studied.
Socioeconomic
factors
may
affect
the
incidence
of
breastfeeding.
Mother's
nourishment
may
affect
milk
production.

C
Characterization
of
variability
Not
very
well
characterized.
Infants
under
1
month
not
captured,
mothers
Low
committed
to
breast
feeding
over
1
year
not
captured.

C
Lack
of
bias
in
study
design
(
high
Bias
in
the
studies
was
not
characterized.
Three
out
of
5
studies
corrected
for
Low
rating
is
desirable)
insensible
water
loss.
Not
correcting
for
insensible
water
loss
may
underestimate
intake.
Mothers
selected
for
the
studies
were
volunteers;
therefore
response
rate
does
not
apply.
Population
studied
may
introduce
some
bias
in
the
results
(
see
above).

C
Measurement
error
All
mothers
were
well
educated
and
trained
in
the
use
of
the
scale
which
Medium
helped
minimize
measurement
error.

Other
Elements
C
Number
of
studies
There
are
5
key
studies.
High
C
Agreement
between
researchers
There
is
good
agreement
among
researchers.
High
Overall
Rating
Studies
were
well
designed.
Results
were
consistent.
Sample
size
was
fairly
Medium
low
and
not
representative
of
U.
S.
population
or
population
of
nursing
mothers.
Variability
cannot
be
characterized
due
to
limitations
in
data
collection
period.
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Page
Exposure
Factors
Handbook
14­
14
August
1997
Table
14­
15.
Breast
Milk
Intake
Rates
Derived
From
Key
Studies
Mean
(
mL/
day)
N
(
mean
plus
2
standard
Reference
Upper
Percentile
(
mL/
day)

deviations)

Age:
1
Month
600
729
747
673
weighted
avg
=
702
11
918
Pao
et
al.,
1980
37
981
Butte
et
al.,
1984
13
1,095
Neville
et
al.,
1988
16
1,057
Dewey
and
Lönnerdal,
1983
1,007a
Age:
3
Months
833
702
712
782
788
weighted
avg
=
759
2
­­­
Pao
et
al.,
1980
37
923
Butte
et
al.,
1984
12
934
Neville
et
al.,
1988
16
1,126
Dewey
and
Lönnerdal,
1983
73
1,046
Dewey
et
al.,
1991b
1,025a
Age:
6
Months
682
744
896
747
weighted
avg
=
765
1
­­­
Pao
et
al.,
1980
13
978
Neville
et
al.,
1988
11
1,140
Dewey
and
Lönnerdal,
1983
60
1,079
Dewey
et
al.,
1991b
1,059a
Age:
9
Months
600
627
avg
=
622
12
1,027
Neville
et
al.,
1988
50
1,049
Dewey
et
al.,
1991b
1,038
Age:
12
Months
391
435
weighted
avg
=
427
9
877
Neville
et
al.,
1988
42
923
Dewey
et
al.,
1991a;
1991b
900
12­
MONTH
TIME
WEIGHTED
AVERAGE
688
Range
900­
1,059
(
middle
of
the
range
980)

Middle
of
the
range.
a
Volume
II
­
Food
Ingestion
Factors
Chapter
14
­
Breast
Milk
Intake
Exposure
Factors
Handbook
Page
August
1997
14­
15
Table
14­
16.
Summary
of
Recommended
Breast
Milk
and
Lipid
Intake
Rates
Age
Mean
Upper
Percentile
Breast
Milk
1­
6
Months
742
mL/
day
1,033
mL/
day
12
Month
Average
688
mL/
day
980
mL/
day
Lipidsa
<
1
Year
26.0
mL/
day
40.4
mL/
day
The
recommended
value
for
the
lipid
content
of
breastmilk
is
4.0
percent.
a