Objective: To investigate the extent to which breast milk is replaced by intake of other liquids or foods, and to estimate energy intake of infants defined as exclusively (EBF), predominantly (PBF) and partially breast-fed (PartBF). Design: Cross-sectional. Setting: Community-based study in urban Pelotas, Southern Brazil. Subjects: A total of 70 infants aged 4 months recruited at birth. Main outcome measures: Breast milk intake measured using a 'dose-to-the-mother' deuterium-oxide turnover method; feeding pattern and macronutrient intake assessed using a frequency questionnaire. Results: Adjusted mean breast milk intakes were not different between EBF and PBF (EBF, 806 g/day vs PBF, 778 g/day, P ¼ 0.59). The difference between EBF and PartBF was significant (PartBF, 603 g/day, P ¼ 0.004). Mean intakes of water from supplements were 10 g/day (EBF), 134 g/day (PBF) and 395 g/day (PartBF). Compared to EBF these differences were significant (EBF vs PBF, P ¼ 0.005; EBF vs PartBF, Po0.001). The energy intake of infants receiving cow or formula milk (BF þ CM/FM) in addition to breast milk tended to be 20% higher than the energy intake of EBF infants (EBF, 347 kJ/kg/day vs BF þ CM/FM, 418 kJ/kg/day, P ¼ 0.11). Conclusions: There was no evidence that breast milk was replaced by water, tea or juice in PBF compared to EBF infants. The energy intake in BF þ CM/FM infants tended to be 20% above the latest recommendations (1996) for breast-fed and 9% above those for formula-fed infants. If high intakes are maintained, this may result in obesity later in life. Sponsorship: International Atomic Energy Agency through RC 10981/R1.

The WHO has developed new growth curves based on breast-fed infants. Recommendations for energy intake have been adopted based on measurements of total energy expenditure. Data on human milk (HM) intake are needed to estimate the energy intake from this food source. However, objective HM data from around the world have not been available, because these measurements are difficult to obtain. Stable isotope methods have been developed to provide objective measurements over a 14-d period. A pooled analysis of 1115 data points of HM intake, obtained using the dose to the mother deuterium oxide turnover method, was undertaken in infants aged 0-24 mo from 12 countries across 5 continents. A hierarchical model was needed to estimate mean HM intake and its variance within and between countries given the complexity of the data. The overall mean HM intake was 0.78 (95% CI = 0.72, 0.84) kg/d, and the age-specific estimates indicated that intake increased over the first 3-4 mo and remained above 0.80 kg/d until 6-7 mo. The variability of intake increased in late infancy. Boys consumed 0.05 kg/d more than girls (P < 0.01). HM intake was strongly, inversely associated with non-HM water intake [r = -0.448 (95% CI -0.511 to -0.385); P < 0.0001]. These objective isotope values of HM intake improve our understanding of the magnitude and variability of HM intake within and across populations and help to estimate nutrient intakes in breast-fed infants.

The importance of exclusive breast-feeding in the first 6 mo of life is widely recognized, but most mothers still do not reach this goal. Several studies have shown that face-to-face lactation counseling is effective in increasing not only exclusive breast-feeding rates but also the total duration of breast-feeding. However, it is unclear whether counseling could increase breast milk intake. The purpose of this study was to evaluate the effect of lactation counseling on breast milk intake, assessed through the deuterium dilution method. This was a blind, randomized intervention trial of lactation counseling in a sample of 188 babies born in Pelotas, selected with the same criteria used for the WHO Multicentre Growth Reference Study (MGRS). The main outcomes were breastfeeding pattern and duration for all infants as well as breast milk intake for a subsample of 68 infants at the age of 4 mo. Mothers in the control group were almost twice as likely to stop breast-feeding by 4 mo as those in the intervention group (prevalence ratio 1.85; P ϭ 0.04). Cox regression confirmed that the velocity of weaning was twice as high in the control group. Breast milk and total water intakes did not differ between the groups. The deuterium dilution technique proved to be a practical means of assessing breast milk intake. Lactation counseling reduced early weaning, but breast milk intake at 4 mo was not affected. J. Nutr. 133: 205-210, 2003.Several authors have stressed the importance of breastfeeding and its advantages in terms of social, economic and health-related outcomes, particularly the reduction in morbidity and mortality caused by infectious diseases (1-10). Early introduction of other liquids or of complementary foods may reduce breast milk intake (11) and the protection afforded against several diseases (3,4,12). Thus, the WHO and UNICEF recommend that exclusive breast-feeding should be continued until the age of 6 mo (13).Despite the wide recognition of the importance of breast milk, rates of exclusive breast-feeding are still low in most countries, and the duration of any breast-feeding is also unsatisfactory in most of the world. Studies carried out in the last decade show that face-to-face counseling by trained health workers is effective not only for reducing the early introduction of liquids or solids, but also for increasing the duration of breast-feeding (1,12,14,15). It has also been argued that counseling could increase breast milk intake among breast-fed infants (16). However, in a comprehensive literature search, we did not identify any studies assessing breast milk intake in relation to the use of counseling.Isotopic methods have been developed in the last 20 y to measure breast milk intake. These have the advantage over test weighing for feeding frequency assessments because they do not interfere with normal patterns of behavior and are not time-consuming for the mothers involved (17-24).The method consists of the oral administration of a fixed dose of deuterium to the mother, and the fate of the d...