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Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation^1,2,3,4,5

¹ From the Department of Pediatrics, Children's Nutrition Research Center, US Department of Agriculture, Agricultural Research Service, Baylor College of Medicine, Houston, TX.

² The contents of this publication do not necessarily reflect the views of policies of the US Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement from the US Government.

³ This work is a publication of the USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine (Houston, TX).

⁴ Supported by NIH grants RO1DK 55478 and HD 37857 and Baylor General Clinical Research Center grant MO1-RR-00188-34.

⁵ Address reprint requests and correspondence to MW Haymond, Children's Nutrition Research Center, 1100 Bates Street, Houston, TX 77030-2600. E-mail: mhaymond{at}bcm.tmc.edu.

Background: No evidence-based recommendations exist concerning what dietary macronutrient composition optimizes weight loss during lactation while maintaining milk production.

Objectives: The study was designed to test the following hypotheses: compared with a reduced-calorie, high-carbohydrate (H-CHO) diet, an isonitrogenous, isocaloric high-fat (H-F) diet will decrease milk production and carbohydrate oxidation, increase gluconeogenesis and hexoneogenesis, and not affect energy balance.

Design: Seven healthy lactating mothers and their infants were studied on 2 occasions in random order for 8 d separated by 1–2 wk. On one occasion, the subjects received the H-F (30% of energy as carbohydrate and 55% as fat) diet and on the other occasion received the H-CHO (60% of energy as carbohydrate and 25% as fat) diet. Milk production, infant intakes, and substrate and hormone concentrations were measured. Glucose rates of appearance, production, gluconeogenesis, glycogenolysis, and hexoneogenesis were measured by using stable-isotope gas chromatography–mass spectrometric techniques, and energy expenditure and substrate oxidation were measured by using indirect calorimetry.

Results: Milk volume, lactose, and protein concentrations were unaffected. Milk fat, energy, and infant intakes were higher (P < 0.05) during the H-F diet. Neither gluconeogenesis nor hexoneogenesis was different. During the H-F diet, energy expenditure and fat and protein oxidation rates were higher (P < 0.05), and the daily energy balance deficit was greater (P < 0.01).

Conclusions: Milk fat, energy output, and energy expenditure were higher during the H-F diet, which resulted in a greater negative energy balance. The lactating mothers adapted to a low carbohydrate intake by decreasing carbohydrate oxidation. Additional studies are warranted to determine whether a hypocaloric H-F diet might promote weight loss to a greater extent than the H-CHO diet while maintaining milk production.

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