Maternal Vitamin A Nutriture and the Vitamin A Content of Human Milk

  • Marjorie J. Haskell
  • Kenneth H. Brown


Because of the many functions of vitamin A inhuman physiology, deficiency or excess of the vitamin inlactating women or their infants can adversely affecttheir health. Infants are born with low body stores of vitamin A, and rely on vitamin A inmilk to meet their needs. The vitamin A content of milkis related to maternal vitamin A status and maternaldietary vitamin A intake during lactation. Low-income lactating women in non-industrialized countrieshave lower milk vitamin A concentrations than lactatingwomen in industrialized countries. Supplementation oflactating women in non-industrialized countries with vitamin A or beta-carotene has resulted inincreased milk vitamin A concentrations. However, theoptimal timing and dose for sustaining adequate levelsof vitamin A in milk throughout the lactation period has not been determined. Furtherresearch is needed to understand factors affecting thetransfer of vitamin A to milk, and to evaluate variousstrategies for improving the vitamin A status of mothers and infants.



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  1. 1.
    J. A. Olson (1996). Vitamin A. In E. Ziegler (ed.), Present Knowledge in Nutrition, ILSI Press, Washington, D.C. pp. 109–119.Google Scholar
  2. 2.
    World Health Organization (1995). Global Prevalence of Vitamin A Deficiency, World Health Organization, Geneva.Google Scholar
  3. 3.
    M. W. Bloem, M. Wedel, and R. J. Egger (1990). Mild vitamin A deficiency and risk of respiratory tract disease and diarrhea in preschool and school children in northeastern Thailand. Am. J. Epidemiol. 131:332–339.PubMedGoogle Scholar
  4. 4.
    A. Sommer and K. West, Jr. (1996). Vitamin A deficiency. Health, Survival and Vision, Oxford University Press, Oxford.Google Scholar
  5. 5.
    A. Sommer, I. Tarwotjo, G. Hussaini, and D. Susanto (1983). Increased mortality in children with mild vitamin A deficiency. Lancet 2:585–588.PubMedGoogle Scholar
  6. 6.
    A. Sommer, J. Katz, and I. Tarwotjo (1984). Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency. Am. J. Clin. Nutr. 40:1090–1095.PubMedGoogle Scholar
  7. 7.
    G. H. Beaton, R. Martorell, K. A., B. Edmonston, G. McCabe, A. C. Ross, and B. Harvey (1993). Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. Nutrition Policy Discussion Paper No. 13 ACC/SCN.Google Scholar
  8. 8.
    J. Katz, S. K. Khatry, K. P. West, Jr., J. H. Humphrey, S. C. LeClerq, E. Kimbrough, P. R. Pohkrel, and A. Sommer (1995). Nightblindness is prevalent during pregnancy and lactation in rural Nepal. J. Nutr. 125:2122–2127.PubMedGoogle Scholar
  9. 9.
    S. de Pee, C. E. West, Muhilal, D. Karyadi, and J. G. A. J. Hautvast (1995). Lack of improvement in vitamin A status with increased consumption of dark-green leafy vegetables. Lancet 346:75–81.PubMedGoogle Scholar
  10. 10.
    E. Starbuck (1993). Night blindness during pregnancy as a risk marker for early infant death in Jumla, Nepal. Ph.D. Thesis, Johns Hopkins University.Google Scholar
  11. 11.
    P. Christian, K. P. West, Jr., S. K. Khatry, J. Katz, S. R. Shrestha, E. K. Pradhan, S. C. LeClerq, and R. P. Pokhrel (1998). Night blindness of pregnancy in rural Nepal—nutritional and health risks. Intl. J. Epid. 27:231–237.Google Scholar
  12. 12.
    K. J. West, S. Khatry, J. Katz, S. C. LeClerq, E. D. Pradhan, S. R. Shrestha, P. B. Connor, S. Dali, A. Adhikari, and R. P. Pokhrel (1997). Impact of weekly supplementation of women with vitamin A or beta-carotene on fetal, infant, and maternal mortality in Nepal. XVIII IVACG Meeting of the International Vitamin A Consultative Group, Cairo, Egypt. International Life Sciences Institute, Washington, D.C.Google Scholar
  13. 13.
    Z. A. Leitner, T. Moore, and I. M. Sharman (1975). Fatal self-medication with retinol and carrot juice. Proc. Nutr. Sci. 34:44A-45A.Google Scholar
  14. 14.
    H. K. Biesalski (1989). Comparative assessment of the toxicology of vitamin A and retinoids in man. Toxicology 57:117–161.PubMedGoogle Scholar
  15. 15.
    F. W. Rose (1986). Vitamin A congeners, Teratology 33:355.PubMedGoogle Scholar
  16. 16.
    World Health Organization (1997). Safe vitamin A dosage during pregnancy and lactation, World Health Organization.Google Scholar
  17. 17.
    J. Mills, J. Simpson, G. Cunningham, M. Conley, and G. Rhoads (1997). Vitamin A and birth defects. Am. J. Obstet. Gynecol., 177:31–36.PubMedGoogle Scholar
  18. 18.
    K. Rothman, L. Moore, M. Singer, U. S. Nguyen, S. Manino, and A. Milunsky (1995). Teratogenicity of high vitamin A intake. N. Engl. J. Med., 333:1369–1373.PubMedGoogle Scholar
  19. 19.
    Teratology Society Public Affairs Committee (1987). Teratology society position paper: Recommendations for vitamin A use during pregnancy Teratology 35:267–268.Google Scholar
  20. 20.
    A. Czeizel and M. Rockenbauer (1998). Prevention of congenital abnormalities by vitamin A. Int'l. J. Vit. Nutr. Res. 68:219–231.Google Scholar
  21. 21.
    S. de Pee, C. West, D. Permaesih, S. Martuti, Muhilal, and J. Hautvast (1998). Orange fruit is more effective than are dark-green, leafy vegetables in increasing serum concentrations of retinol and β-carotene in schoolchildren in Indonesia. Am. J. Clin. Nutr. 68:1058–1067.PubMedGoogle Scholar
  22. 22.
    N. W. Solomons and J. Bulux (1993). Plant sources of provitamin A and human nutriture. Nutr. Rev. 51:199–204.PubMedGoogle Scholar
  23. 23.
    K. M. Rigtrup, L. R. McEwen, H. M. Said, and D. E. Ong (1994). Retinyl ester hydrolytic activity is associated with human intestinal brush border membranes. Am. J. Clin. Nutr. 60:111–116.PubMedGoogle Scholar
  24. 24.
    V. Reddy and B. Sivakumar (1972). Studies on vitamin A absorption in children. Indian Pediatrics 9:307–310.PubMedGoogle Scholar
  25. 25.
    D. S. Goodman and W. S. Blaner (1984). Biosynthesis, absorption, and hepatic metabolism of retinol. In The Retinoids, Academic Press, Inc., New York, pp. 1–37.Google Scholar
  26. 26.
    J. A. Olson (1987). Recommended dietary intakes (RDI) of vitamin A in humans. Am. J. Clin. Nutr. 45:704–716.PubMedGoogle Scholar
  27. 27.
    S. Pereira and A. Begum (1973). Retention of a single oral massive dose of vitamin A. Clin. Sci. Mol. Med. 45:233–237.Google Scholar
  28. 28.
    J. Kusin, V. Reddy and B. Sivakumar (1974). Vitamin E supplements and the absorption of a massive dose of vitamin A. Am. J. Clin Nutr. 27:774–776.PubMedGoogle Scholar
  29. 29.
    H. E. Sauberlich, H. E. Hodges, D. L. Wallace, H. Kolder, J. E. Canham, J. Hood, N. Raica, Jr., L. K. Lowry (1974). Vitamin A metabolism and requirements in the human studied with the use of labeled retinol. Vit. Horm. 32:251–275.Google Scholar
  30. 30.
    J. W. Erdman, T. L. Bierer, and E. T. Gugger (1993). Absorption and transport of carotenoids. Ann. NY Acad. Sci. 691:76–85.PubMedGoogle Scholar
  31. 31.
    J. Bauernfeind (1971). Carotenoid vitamin A precursors and analogs in foods and feeds. J. Agr. Food Chem. 20:456–473.Google Scholar
  32. 32.
    X. D. Wang (1994). Review: Absorption and metabolism of β-carotene. J. Am. Coll. Nutr. 13:314–325.PubMedGoogle Scholar
  33. 33.
    T. van Vliet (1996). Absorption of β-carotene and other carotenoids in humans and animal models. Eur. J. Clin. Nutr. 50:S32–S37.Google Scholar
  34. 34.
    B. A. Underwood (1990). Methods for assessment of vitamin A status. J. Nutr. 120:1459–1463.PubMedGoogle Scholar
  35. 35.
    S. Pilch (1987). Analysis of vitamin A data from the health and nutrition examination surveys. J. Nutr. 117:636–640.PubMedGoogle Scholar
  36. 36.
    World Health Organization (1996). Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programmes. WHO/UNICEF, Geneva.Google Scholar
  37. 37.
    Z. Ajans, A. Sarrif, and M. Husbands (1965). Influence of vitamin A on human colostrum and early milk. Am. J. Clin. Nutr. 17:139–142.PubMedGoogle Scholar
  38. 38.
    J. C. Wallingford and B. A. Underwood (1986). Vitamin A deficiency in pregnancy, lactation, and the nursing child. In J. Bauernfeind (ed.), Vitamin A Deficiency and Its Control, Academic Press, New York, pp. 101–152.Google Scholar
  39. 39.
    A. Ross, M. Davila, and M. Cleary (1985). Fatty acids and retinyl esters of rat milk: Effects of diet and duration of lactation. J. Nutr. 115:1488–1497.PubMedGoogle Scholar
  40. 40.
    J. Tomlinson, G. E. Mitchell, N. W. Bradley, R. E. Tucker, J. A. Boling, G. T. Shelling (1974). Transfer of vitamin A from bovine liver to milk. J. Anim. Sci. 39:813.PubMedGoogle Scholar
  41. 41.
    S. Donoghue (1988). Vitamin A transport in plasma of ewes during late gestation and into milk during early lactation. J. Vit. Res. 58:3–11.Google Scholar
  42. 42.
    A. Vahlquist and S. Nilsson (1979). Mechanisms for vitamin A transfer from blood to milk in rhesus monkeys. J. Nutr. 109:1456–1463.PubMedGoogle Scholar
  43. 43.
    A. Ross (1982). Retinol esterification by mammary gland microsomes from the lactating rat. J. Lipid Res. 23:133–144.PubMedGoogle Scholar
  44. 44.
    M. Davila, L. Norris, M. Cleary, and A. Ross (1985). Vitamin A during lactation: Relationship of maternal diet to milk vitamin A content and to the vitamin A status of lactating rats and their pups. J. Nutr. 115:1033–1041.PubMedGoogle Scholar
  45. 45.
    A. C. Ross and E. Garder (1994). The function of vitamin A in cellular growth and differentiation, and its roles during pregnancy and lactation. Adv. Exp. Med. Biol. 352:187–208.PubMedGoogle Scholar
  46. 46.
    A. Pasatiempo and A. C. Ross (1990). Effects of food or nutrient restriction on milk vitamin A transfer and neonatal vitamin A stores in the rat. Brit. J. Nutr. 63:351–363.PubMedGoogle Scholar
  47. 47.
    K. Rasmussen and N. Warman (1983). Effect of maternal malnutrition during the reproductive cycle on growth and nutritional status of suckling rat pups. Am. J. Clin. Nutr. 38:77–83.PubMedGoogle Scholar
  48. 48.
    N. Warman and K. Rasmussen (1983). Effects of malnutrition during the reproductive cycle on nutritional status and lactational performance of rat dams. Nutr. Res. 3:527–545.Google Scholar
  49. 49.
    R. Stoltzfus and B. A. Underwood (1995). Breastmilk vitamin A as an indicator of the vitamin A status of women and infants. Bull World Health Org. 73:703–711.PubMedGoogle Scholar
  50. 50.
    M. Gebre-Medhin, A. Vahlquist, Y. Hofvander, L. Upsali, and B. Vahlquist (1976). Breast milk composition in Ethiopian and Swedish mothers. I. Vitamin A and β-carotene. Am. J. Clin. Nutr. 29:441–451.PubMedGoogle Scholar
  51. 51.
    B. Fredrikzon, O. Hernell, L. Blackburg, and T. Olivecrona (1978). Bile-salt stimulated lipase in human milk: Evidence of activity in vivo and of a role in the digestion of milk retinol esters. Pediatr. Res. 12:1048–1052.PubMedGoogle Scholar
  52. 52.
    L. Canfield, A. Giuliano, and E. Graver (1995). Carotenoids, Retinoids, and Vitamin A in Human Milk. In R. Jensen, (ed.), Handbook of Milk Composition, Academic Press, San Diego, California.Google Scholar
  53. 53.
    L. Canfield, A. Giuliano, E. Neilson, B. Blashil, E. Graver, and H. Yap (1998). Kinetics of the response of milk and serum β-carotene to daily β-carotene supplementation in healthy, lactating women. Am. J. Clin. Nutr. 67:276–283.PubMedGoogle Scholar
  54. 54.
    A. Rice, R. Stolzfus, A. de Francisco, J. Chakraborty, C. Kjolhede, and M. Wahed (1999). Maternal vitamin A or β-carotene supplementation in lactating Bangladeshi women benefits mothers and infants but does not prevent subclinical deficiency. J. Nutr. 129:356–365.PubMedGoogle Scholar
  55. 55.
    V. Newman (1993). Vitamin A and Breastfeeding: A Comparison of Data from Developed and Developing Countries, Wellstart International, San Diego, California.Google Scholar
  56. 56.
    B. A. Underwood (1994). Maternal vitamin A status and its importance in infancy and early childhood. Am. J. Clin. Nutr. 59:517S-524S.PubMedGoogle Scholar
  57. 57.
    R. Stoltzfus, M. Hakimi, K. W. Miller, K. M. Rasmussen, S. Dawiesah, J. P. Habicht, and M. J. Dibley (1993). High dose vitamin A supplementation of breast-feeding Indonesian mothers: Effects on the vitamin A status of mother and infant. J. Nutr. 123:666–675.PubMedGoogle Scholar
  58. 58.
    S. Roy, A. Islam, A. Molla, S. Akramuzzaman, F. Jahan, and G. Fuchs (1997). Impact of a single megadose of vitamin A at delivery on breastmilk of mothers and morbidity of their infants. Eur. J. Clin. Nutr. 51:302–307.PubMedGoogle Scholar
  59. 59.
    P. Venkatachalam, B. Belavady, and C. Gopalan (1962). Studies on vitamin A nutritional status of mothers and infants in poor communities in India. Trop. Pediatr. 61:262–268.Google Scholar
  60. 60.
    S. Kon and E. Mawson (1950). Human milk. Wartime studies of certain vitamins and constitutents. Med. Res. Council: Spec. Rep. Ser. No.269.Google Scholar
  61. 61.
    A. Sobel, A. Rosenberg, and B. Kramer (1950). Enrichment of milk vitamin A in normal lactating women. Am. J. Dis. Child. 80:932–943.Google Scholar
  62. 62.
    M. Hrubetz, J. J. Deul, and B. Hanley (1945). Studies on carotenoid metabolism. V. The effects of a high vitamin A intake on the composition of human milk. J. Nutr. 29:245–254.Google Scholar
  63. 63.
    Muhilal, A. Murdiana, I. Azis, S. Saidin, A. Basuni Jahari, and D. Karyadi (1988). Vitamin A-fortified monosodium glutamate and vitamin A status: a controlled field trial. Am. J. Clin. Nutr. 48:1265–1270.PubMedGoogle Scholar
  64. 64.
    G. Arroyave, J. R. Aguilar, M. Flores, and M. A. Guzman (1979). Evaluation of sugar fortification with vitamin A at the national level. Pan American Health Organization, Washington, D.C.Google Scholar
  65. 65.
    L. Villard and C. Bates (1987). Effect of vitamin A supplementation on plasma and breast milk vitamin A levels in poorly nourished Gambian women. Hum. Nut.: Clin. Nutr. 41C:47–58.Google Scholar
  66. 66.
    R. Tarjan, M. Kramer, K. Szoke, and K. Linder (1963). The effect of different factors on the composition of human milk and its variations. I. The effect of vitamin-rich foods on the composition of human milk. Nutr. Diet. 7:12–29.Google Scholar
  67. 67.
    S. Patton, L. Canfield, G. Huston, A. Ferris, and R. Jensen (1990). Carotenoids of human colostrum. Lipids 25:159–165.PubMedGoogle Scholar
  68. 68.
    Y. Kim, C. English, P. Reich, L. Gerber, and K. Simpson (1990). Vitamin A and carotenoids in human milk. J. Agr. Food Chem. 38:1930–1933.Google Scholar
  69. 69.
    L. Canfield, A. Giuliano, E. Neilson, H. H. Yap, E. J. Graver, H. A. Cui, and B. M. Blashil (1997). β-Carotene in breast milk and serum is increased after a single β-carotene dose. Am. J. Clin. Nutr. 66:52–61.PubMedGoogle Scholar
  70. 70.
    H. C. Furr, O. Amedee-Manesme, A. J. Clifford, R. H. Bergen III, A. D. Jones, D. P. Anderson, and J. A. Olson (1989). Vitamin A concentrations in liver determined by isotope dilution assay with tetradeuterated vitamin A and by biopsy in generally healthy adult humans. Am. J. Clin. Nutr. 49:713–716.PubMedGoogle Scholar
  71. 71.
    M. J. Haskell, G. J. Handelman, J. M. Peerson, A. D. Jones, A. Rabbi, M. A. Awal, M. A. Wahed, D. Mahalanabis, and K. H. Brown (1997). Assessment of vitamin A status by the deuterated retinol dilution technique and comparison with hepatic retinol concentration in Bangladeshi surgical patients. Am. J. Clin. Nutr. 66:67–74.PubMedGoogle Scholar
  72. 72.
    M. H. Green, J. B. Green, and K. C. Lewis (1987). Variation in retinol utilization rate with vitamin A status in the rat. J. Nutr. 117:694–703.PubMedGoogle Scholar
  73. 73.
    M. Haskell, R. Mazumder, J. M. Peerson, A. D. Jones, M. A. Wahed, D. Mahalanabis, and K. H. Brown (1999). Use of the deuterated retinol dilution (DRD) technique to assess total body vitamin A stores of adult volunteers consuming different levels of vitamin A. Am. J. Clin. Nutr. (in press).Google Scholar
  74. 74.
    S. Tanumihardjo, J. Cheng, D. Permaesih, Muherdiyantiningsih, E. Rustan, Muhilal, D. Karyadi, and J. A. Olson (1996). Refinement of the modified relative-dose response test as a method for assessing vitamin A status in a field setting: Experience with Indonesian children. Am. J. Clin. Nutr. 64:966–971.PubMedGoogle Scholar

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© Plenum Publishing Corporation 1999

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  • Marjorie J. Haskell
  • Kenneth H. Brown

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