Dear all:

I'd have to go back to the details of so many supplementation studies to give you hard 
backup... I once reviewed the impact of supplementation programs for a World Bank 
review and I don't even know if I have a copy of what I wrote many years ago.  But the 
bottom line on malnourished women is that you need to be extremely malnourished for it 
to have any impact on supply.  Most of the supplementation studies showed little or no 
impact except in extreme conditions.  The malnutrition seen in Guatemala at the time of 
the INCAP studies was moderate and chronic, not the severe acute malnutrition seen 
sometimes in emergency conditions.  So, I think it would be very difficult to tease out an 
impact on breast mlk volume without a very tightly controlled study.

One of the imporant issues that I think is forgotten in women's nutrition  that IS very 
important for child care is energy levels and time use.  Many women in developing 
countries engage in physical labor that burns a lot of calories.  Pregnancy and lactation 
place an additional caloric burden on these mothers.  Where I think the importance of all 
of these traditional drinks and foods lies is in improving the mother's own nutritional 
status so that she has the energy to meet her daily tasks.  Energy expenditure studies 
are extremely difficult to conduct and I think that this, rather than "milk supply" may be 
the real benefit of ensuring these mothers get adequate nourishment.  For that reason, I 
don't think it matters how we pitch the concept of adequate nutrition to women -- I know 
there is a benefit even it may not really be the one that is perceived.

Best, Susan Burger

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