MATERIALS AND METHODSduring the first weeks after delivery (17,18). Hence, because of possibly insufficient carnitine synthesis, solely breast-fed infants may develop reduced serum carnitine levels during the first months of life.In the present study we measured carnitine concentrations from the serum of solely breast-fed infants and their lactating mothers during the first year after delivery. In addition, we measured carnitine levels in breast milk and calculated the intake of camitine during prolonged sole breast feeding.Subjects. The subjects of this study are a subgroup from a follow-up study of 200 infant-mother pairs (19). The study protocol was approved by the Ethical Committee of the Children's Hospital, University of Helsinki, and is in accordance with the Helsinki Declaration.We studied 37 infants, 24 girls and 13 boys, born to healthy, nonsmoking mothers without pregnancy complications. Three infants were delivered by cesarean section, the others through the vaginal route. All infants were born at term (37-42 wk of gestation) and their birth weights were appropriate for the gestational ages. All infants had normal Apgar scores of 7 to 10 at 1 min of age. The mean birth weight was 3369 g (range 2740-4040 g), and the mean birth length was 49.7 cm (range 47-51 cm).Feeding of infants. All 37 mothers were encouraged to feed their infants solely from the breasts. The number of solely breastfed infants was 31 at 2 months of age, 28 at 6 months, 7 at 9 months, and none at 12 months. The mean protein concentration of breast milk decreased from 13 to 8 g/liter whereas the mean fat concentration increased from 26 to 40 g/Iiter during lactation (19). All lactating mothers received supplementary iron and vitamins. Formula and solid food were started when there was not enough breast milk. The formula (Tutteli by Valio, Finnish Co-operative Dairy's Association, Helsinki, Finland) conformed to the FAOjWHO recommendations and contained 16 g/liter of protein (of which 60% whey), 35 g/liter fat (polyunsaturated/saturated ratio 0.33), and 73 g/liter lactose, corresponding to the lactose concentration of breast milk. The total carnitine concentration of the formula was 204 JLmol/liter. Beginning from the age of 3 months, the infants received solid food which consisted of fruits and vegetables. Cereals and meat were added at the age of 5 months. The formula was replaced with cow's milk at the age of 9 months.Follow-up. All infants were examined and their weight, length, and skinfold thickness measured every 1-2 months during the first year oflife at the Children's Hospital, University of Helsinki (19). Except for mild upper respiratory infections, otitis media, and diarrhea, the infants were healthy. After the age of 3 months the solely breast-fed infants grew slower and had more subcutaneous fat than the weaned infants (19).Blood and milk samples. A sample from mixed cord blood was taken at birth whereas the first blood sample from the mother was taken on the 3rd or 4th day after delivery. Peripheral venous samples of 5 ...