- Click here for explanation of classification scheme.

To review the existing literature on lactation, diabetes and nutrition recommendations.

Inclusion criteria was not delineated.

Exclusion criteria was not delineated.

Recruitment:  Article search methods not described.

Design:  Narrative Review 

Blinding used (if applicable):  not applicable

Intervention (if applicable):  not applicable

Statistical Analysis -not applicable

 

Timing of Measurements-not applicable

Dependent Variables-not applicable

Independent Variables-not applicable

Control Variables-not applicable

 

Initial N: 25 references

Attrition (final N): 25

Age: Not applicable

Ethnicity:

Other relevant demographics:

Anthropometrics (e.g., were groups same or different on important measures)

Location: Not applicable

 

 Table 1. Definitions of dietary references intakes

	Definition
Recommended dietary allowance	The average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97% to 98%) healthy individuals in a particular life stage and gender group
Adequate intake	The recommended average daily intake based on observed or experimentally determined approximations or estimates of nutrient intake by a group of apparently healthy people who are assumed to be adequate (used when a recommended dietary allowance can not be determined)
Tolerable upper intake	The highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. As intake increases above the tolerable upper intake,the potential risk of adverse effects may increase.
Estimated average requirement	The average daily nutrient intake level estimated to meet the requirement of half of the healthy individuals in a particular life stage and gender group. In the case of energy, an estimated energy requirement is provided. It is the average dietary energy intake that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and level of physical activity, consistent with good health. In childrenand pregnant and lactating women, EER is taken to include the needs associated with the deposition of tissues or the secretion of milk at rates consistent with good health.

 

Table 2: Energy and micronutrients DRIs for Infants 0-12 months and for women during lactation

 

	DRIs for infants 0 to 12 months	DRIs for lactating women
Energy	Boys:470 to 570, 650, 750, 814 kcal/d at 0-3, 3-6, 9, and 12 mo, respectively	0-6 mo:EER+330kcal/d
	Girls:435 to 530, 595, 680, 770 kcal/d at 0-3, 3-6, 9, and 12 mo, respectively	7-12 mo:EER+400 kcal/d
Carbohydrates	AI, 0-6 mo:60 g/d; AI, 7-12 mo:95 g/d	RDA, 0-6 mo:210 g/d RDA, 7-12 mo.210 g/d
Protein	AI, 0-6 mo:1.52 g/kg/d or 9.1 g/d RDA, 7 - 12 mo:1.5 g/kg/d or 9.9 g/d	RDA,0-6 mo:1.1 g/kg/d or +25g/d RDA,7-12 mo:1.1 g/kg/d or +25 g/d
Fat	AI for fat, 0--6 moo:31 g/d AI for fat, 7-12 mo:30 g/d	Al for n-6:14 g/d of linoleic acid A1 for n-3:1.3 g/d of alpha linolenic acid

AI-Adequate intake;DRIs-dietary reference intakes; EER-estimated energy requirements;RDA-recommended dietary allowances

Other Findings: Gestational diabetes mellitus(Kjos et al.,1993)

Study 1

• 809 women, 404 elected to breast feed; 405 did not.
• Research Purpose -Examine the effect of 4 to 12 weeks of lactation on glucose tolerance (2-hour oral glucose test)and on fasting serum lipids (total cholesterol,HDL cholesterol, LDL cholesterol, and tryglycerides) in women with recent gestational diabetes.

• Glucose metabolism improved in the lactating group and differences were significant after adjusting for maternal age, BMI, and the use of insulin during pregnancy.

• Nursing had no effect on any of the lipid values.

• There was a two fold increase in postpartum diabetes in the nonlactating women.

• Diet-controlled diabetes occured in 1.6% (lactating women) and 3.9% (nonlactating women).

• Insulin treated diabetes occurred in 12.6% (lactating women) and 22% (nonlactating women).

• Other glucose parameters were better in lactating women.

• Therefore, it appeared that even a short duration of breast feeding has long-term effects on glucose parameters in women with gestational diabetes.

 Study 2

• Subjects were a group of 26 women with gestational diabetes (14 breastfeeding and 12 not breastfeeding) were studied at 3 months postpartum.
• each woman completed 75-g glucose tolerance test,a frequently sampled intravenous glucose tolerance test, and computed tomography scanning for adipose distribution and mass.
• Insulin sensitivity was not significantly different between the two groups nor was glucose effectiveness.
• Viseral fat and subcutaneous fat were similar between the two groups.
• Improved pancreatic beta-cell function was evident in women who were breastfeeding as measured by the disposition index (insulin sensitivity times acute insulin response to glucose).
• The benefits of breastfeeding in women with gestational diabetes may not be seen acutely, but may be seen long-term as evidenced by the report of Kjos et al.

 

 

 

 

• Dietary Reference Intakes - the mother's diet must supply the energy and micronutrients needed for the first year of life to successfully meet the infants'needs.
• Careful planning, education, and support are necessary to surmount obstacles to breastfeeding by women with diabetes
• The concept of breast feeding should be introduced early in the prenatal care of women with diabetes so that their misconceptions and other barriers can be addressed.
• Successful breastfeeding for women with type I diabetes requires the initiation of lactation to be coordinated with the delivery of the infant.
• Early maternal-infant separation delays breastfeeding and may compromise the initiation of lactation 
• Women with gestational diabetes should be encouraged to breast feed,because even a short duration of breastfeeding can have long-term beneficial effects on the future onset of diabetes.

1. Good review of DRI for lactating women.

2. The review of the Kjos et al. studies served as a 'point of emphasis' for this Narrative Review.