Dietary intakes of 40 lactating women were measured by a 7-day record (7DR) and compared with results using a 1-day record (1DR), 3-day record (3DR), and a newly developed food frequency form. The estimated intakes of energy, protein, calcium, phosphorus, and iron were used in the comparison. The subjects ranged from 3 wk to 6 months postpartum and all were totally breast-feeding their infants at the time of the study. The 7DR was recorded by the subjects and random days were chosen to provide 1DR and 3DR. The food frequency form is a method developed to estimate nutrient intakes based on the consumption of 105 food items. Intraclass correlation coefficients used to compare methods indicated good, moderate, and poor agreement for 3DR/7DR, 1DR/7DR, and food frequency form/7DR comparisons, respectively. Regression analysis was used to assess further the agreement between 3DR and 7DR. This analysis indicated that the 3DR cannot provide good individual estimates of nutrient intakes, but can provide a reasonable estimate of the general quality of the diet. Intakes also were classified as high (greater than 1 1/3 Recommended Daily Allowance), medium (2/3 to 1 1/3 Recommended Daily Allowance), or low (less than 2/3 Recommended Daily Allowance), and Cohen's kappa was used to measure agreement between methods. None of the intakes was found to agree with the 7DR classification. Intraindividual variation was found to be greater than interindividual variation.

To determine whether the lean body mass of well-nourished women was mobilized to support milk protein output during lactation, the body composition of 10 lactating and 10 nonlactating women was examined longitudinally at 6-wk intervals between 6 and 24 wk postpartum and at 52 wk postpartum, and that of 10 nulliparous women was examined at equivalent intervals, by using clinical anthropometry and whole-body potassium counting. Milk production was determined at 6-wk intervals during the period of exclusive breast-feeding (6-24 wk postpartum) by the test-weighing procedure. Milk composition was determined by chemical analysis. Dietary intakes were determined at 6-wk intervals between 6 and 24 wk postpartum from 3-d food records with use of a nutrient database. Lean body mass was maintained in women who exclusively breast-fed their infants during the first 6 mo postpartum while consuming dietary protein in amounts that exceeded those of their nonlactating counterparts by 55%. The high protein intakes were sustained throughout lactation despite a progressive reduction by 32% of milk protein output. Lean body mass was preserved throughout lactation in well-nourished women, suggesting that the metabolic needs of milk protein production were met solely by higher protein intakes of the lactating women.

The partitioning of dietary and endogenous nutrients during lactation is not well understood. To examine associations between plasma hormone and substrate profiles and indices of either maternal body protein metabolism or lactational performance, we measured plasma insulin, cortisol, prolactin, thyroxine, triiodothyronine, individual amino acid, blood urea nitrogen, and prealbumin concentrations in lactating and nulliparous women in the postabsorptive state. We related these measurements to the subjects' nitrogen balance, urinary 3-methylhistidine excretion, [1-13C]leucine metabolism and milk production. Insulin concentrations showed significant positive relationships with nitrogen balance and prealbumin concentrations; cortisol levels showed a significant negative relationship with nitrogen balance and a significant positive relationship with leucine incorporation into protein. Thyroid hormone concentrations showed significant positive relationships with urinary 3-methylhistidine excretion, leucine incorporation into protein, and milk production. Proline concentrations were associated positively with nitrogen balance and negatively with leucine incorporation into protein, whereas glutamate-glutamine concentrations showed positive associations with leucine oxidation and milk nitrogen concentrations. We propose that insulin and cortisol modulate the channeling of nutrients between anabolic and anti-anabolic aspects of maternal body protein metabolism, whereas thyroid hormones and cortisol modulate nutrient partitioning toward milk production and visceral protein synthesis. We suggest that some nonessential amino acids (proline, glutamate-glutamine) may become limiting during lactation because of their unique contributions to milk protein synthesis.

Basal and postprandial metabolic rates were determined by indirect calorimetry in lactating, nonlactating postpartum, and nulliparous women who received a controlled diet of protein at 1.0 g.kg-1.d-1 and energy that approximated usual intake levels on the basis of diet records. Milk production was measured by the test-weighing procedure and by milk expression. Basal metabolic rates (BMRs) were similar among all groups of women. No relationships were detected between BMRs and postpartum time in lactating women. In contrast, postprandial metabolic rates (PMRs) increased (P less than 0.01) in lactating compared with nonlactating women. Milk nitrogen concentrations but not energy showed a linear relationship with PMR (r = 0.86, P less than 0.001). The energy cost of milk production was estimated to be 125% of the energy output in milk. Thus, increased energy needs during lactation are associated not only with milk production but also with elevated PMRs. This increase was met by an increase in dietary energy intakes of 50% above the intakes of nonlactating counterparts.