Targeting Malnutrition: Isotopic Tools for Evaluating Nutrition Worldwide
Safeguarding Infants' Health During Breastfeeding

Why is IAEA measuring breast milk intake?

Poor complementary foods contribute to childhood malnutrition

The causes of childhood malnutrition are multiple. An important cause is the nutritional inadequacy of some complementary (weaning) foods. These foods are often prepared in unhygienic conditions, given to the child in dirty bottles, and may be nutritionally inadequate. To prevent or solve this problem, communities around the world are endeavouring to prepare nutritionally adequate complementary foods from locally available ingredients.

The conventional method for evaluating the nutritional quality of complementary foods is weight gain. Weight gain occurs when total nutrient intake from breastmilk plus complementary foods meets all needs, including those for growth. Inadequate growth results when the complementary food is nutritionally inferior, when complementary food displaces breastmilk intake, or both. To accurately judge the quality of the complementary food it is important to measure the amount of breastmilk intake.

Measuring breastmilk intake: conventional indicators and isotope techniques

The conventional method for measuring breast milk intake entails weighing the baby before and after each feeding. This is time-consuming, inaccurate and it interferes with the mother's normal activities. It can also not be used when the baby sleeps with the mother and is fed on demand many times during the night. A more practical and accurate method is to measure milk intake by isotope dilution using deuterium labelled water (2H2O).

IAEA initiatives to improve infant nutrition

Until recently, 2H sample analysis was limited to technically advanced laboratories. In a project just finished at the Gadhjah Mada University, Indonesia, done in collaboration between the IAEA, the USAID, US Department of Agriculture and Johns Hopkins University, a method for sample analysis was validated which is practical in developing countries as well as accurate (infrared spectroscopy). This method is much more cost-effective; equipment and analysis amount to only 10% of the former costs.

The infrared spectroscopy equipment is currently in use in a field project in Peru to measure breastmilk intake in the context of designing and evaluating nutritionally adequate complementary foods.

Using 2H2O to Measure Breastmilk Intake

  • 2H2O is administered by mouth to the mother

  • 2H enters the baby via breastmilk and mixes with all the water in the baby's body

  • The rate of 2H appearance in the baby, measured in spot urine or saliva collections, is proportional to breast milk intake
Advantages of 2H Labelled Water Method

  • gives integrated measurement of infant's milk intake over 10 -14 days

  • improves accuracy

  • is practical for measurements at home

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