Dear Dia:
I'm still in training and not an IBCLC yet, but nutritional epidemiology is
a topic in which I have some expertise. I have a few comments about
abstracts of supplementation studies and how to evalute their conclusions.
First, studies presented at scientific meetings are often in a preliminary
state of analysis. The abstracts are often prepared and submitted before
the analyses are completed and do not contain adequate detail to evaluate
the validity, reliability and plausibility of the results. Often these
abstracts are presented with the intention to publish the results in a peer-
reviewed journal at a later point in time.
Second, one needs to evaluate whether or not the authors or funders of a
study will benefit financially from the study findings. If so, one might
question whether or not the findings were submitted to a forum that accepts
preliminaty results in order to gain publicity and boost sales immediately,
before a thorough analysis has been completed. One criteria to use in
judging the research is whether or not it is consistent with findings of
other groups, and in this case, there is other compatible research.
Third, while the specific study you cited seems plausible given some of the
other research on DHA, the abstract does not mention many of the conditions
that are important for recommendatiosn for public health or clinical
practice. At a minimum, one would need to know the diets of the
breastfeeding mothers. Were they strict vegetarians? lactovovegetarians?
omnivores? Did they have an adequate intake of DHA to begin with? There
could have been selection of mothers who had a low intake of DHA, in which
case, they would be most likely to benefit from the supplement. For
individual clients, I think the most important information we need to know
is who really needs additional DHA and in what quantity.
Finally, I think it is important to consider that one of the lessons from
supplementation studies is that FOODS that contain the particular item that
is included in the supplement actually contain additional nutrients hat
would be beneficial. Nutritional research still has not identified all of
the components of foods that influence our health. Hence, when adequate
food of sufficient variety and quality is available (and when cultural,
religious, food preferences, dietary allergies don't interfere) it is
always preferable to consume the food itself rather than the isola n
ted component in a supplement. Supplements can, however, be very useful
when access to particular foods or food groups is restricted.
I would not, on the basis of this one study, jump to recommending that all
lactating mothers go out and buy DHA supplements. I might, on the basis of
other studies that have similar findings, evalute foods rich in DHA and
recommend increasing their intake of these foods. Fish happens to be one
of these foods, but one has to be cautious about frequent consumption of
fish (e.g. tuna, swordfish) that are high in mercury (see previous posts on
this topic). If I encountered a mother who had a restricted intake of DHA,
I would summarize the literature and let her decide whether or not to take
DHA and other supplements. The Institute of Medicine published a solid
review entitled "Nutrition During Lactation" that has good advice for
lactating mothers with dietary restrictions. Unfortunately, it has not been
updated since the early 90s, so it is not much help on DHA or on calcium
supplements because so much recent research has been conducted on these
topics.
Susan Burger, PhD, MHS
Subj: DHA Supplementation of Breastfeeding Mothers Results in...
> Date: 4/30/01 7:16:36 AM Eastern Daylight Time
> From: AOL News
> BCC: DiaMichels
Hi folks,
The showed up in my email. I wonder if anyone has any comments on the last
line in particular.....
- Dia
>
Ø
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