Dear all:

Of the articles I could access:

Del Prado Martha et al  Contribution of dietary and newly formed arachidonic acid to 
human milk lipids in women eating a low-fat diet.  Am J Clin Nutr 2001;74:242-67.

Prentice AM, Roberts SB, Prentice A, et al.: "Dietary supplementation of lactation in 
Gambian women. Effect on breast milk volume and quality". Hum Nutr Clin Nutr 37C: 53-
64, 1983

Siber H, Hachey D, Schanler R, et al.  Manipulation of maternal diet to alter fatty acid 
composition of human milk intended for premature infants." Am J Clin Nutr 47: 810-814, 
1988 (not 1989 as was posted!)

None of the above came anywhere close to proving any functional impact of low fat 
content, imbalanced fatty acid ratios or lactose overload on an infant's behavior.

The Del Prado article basically showed that the fatty acid composition of the milk is 
influenced by fat stores, not intestinal absorption among women on a low fat diet.  This 
article would ONLY be relevant to women on low fat diets and says nothing about what 
happens to the infant with different fatty acid ratios.

The Prentice article is very familiar and was long ago discarded from my filing cabinet 
due to the issue of space in a small Manhattan apartment.  This article was among 
marginally malnourished women who were supplemented with biscuits and there was 
quite a bit of disturbance to the diet ordinarily consumed at home.  At lot of the impact 
was merely what we call income transfer.  Free food enabled these families to have more 
income because they didn't have to spend as much money buying or as much energy 
acquiring food.  I couldn't access the methods section, but I do have a vague memory of 
some methodology issues that could come into play if you were really trying to 
investigate lactose overload.  The results were no significant change in milk volume, nor 
in fat content.  There was a significant and small increase in lactose.  Now, what is not 
proven in this is whether the change in lactose was a "lactose overload". These women 
were likely offering the breast 20x day if they followed practices I know in other West 
African countries and switch nursing frequently.  There was no research done on an 
"increase in fussiness due to lactose overload".  So it would be a wild leap to extrapolate 
these results out to women in developed countries that highly schedule their infants to 
feed far less frequently than in many areas of Africa.

The Siber article shows what we already know, that the fatty acid composition changes 
with changes in maternal diet of the mother.  The sample size was ludicrously small -- 10 
infants.  Again, this article did not provide any evidence of "deficiency" or even 
"imbalances" and the impact on the infant --- it merely reported on "differences".  The 
functional impact of these findings was not established in this article.

The other two articles were not possible for me to access even an abstract from the 
internet.  By the title of the first --- it does not sound like it makes the leap to infant 
behavior.  By the title of the second --- it does not appear to be a true "trial" to 
determine what happens on a population basis when you implement an intervention.  If 
anyone has better luck than I in finding these articles, please let me know.  

Abakada AO, Hartmann PE: "Maternal Dietary Intake and Human Milk 
Composition." Breastfeeding Review 13: 43-45, 1988

Hatherly,Patricia A  The Manipulation Of Maternal Diet And Its Effect On The Infant With 
Particular Reference To Gastrointestinal Disturbance: A Series Of Case Studies. Journal of 
Australasian College of Nutritional & Environmental Medicine Vol. 13 No. 2; December 
1994: pp. 5-12

Still unconvinced about foremilk hindmilk imbalance as anything other than an unproven 
theory except for those who overpump to feed the freezer.

Susan Burger

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