CASE-REPORT - FAILURE-TO-THRIVE IN A BREAST-FED INFANT IS ASSOCIATED WITH MATERNAL DIETARY-PROTEIN AND ENERGY RESTRICTION

Objective: To determine whether failure to thrive in a breast-fed infa nt could be attributed to altered milk production or composition from a mother who consumed a self-imposed energy- and protein-restricted di et. Design: We evaluated the changes in growth and body composition, d ietary intakes, and milk production and composition in a mother-infant pair throughout the first postpartum year. Setting: The Children's Nu trition Research Center Metabolic Research Unit. Subjects: A breast-fe eding mother-infant pair. Measures of outcome: Body composition was me asured by total body electrical conductance, dietary intakes by food r ecords, milk production by the test weighing procedure, and milk compo sition by proximate analyses. Results: A marked decline in the infant' s linear and ponderal growth rates occurred when the mother consumed a n energy- (20 kcal.kg-1.d-1) and protein- (0.7 g.kg-1.d-1) restricted diet. The retardation in body weight gain was associated with an arres t of body fat, but not lean body mass, accretion. Maternal milk produc tion showed positive relationships with maternal dietary energy (p < 0 .01, r = 0.93) and protein (p < 0.05, r = 0.83) intakes. Milk composit ion reflected changes consistent with those of weaning rather than a s equela of the mother's diet. Conclusions: We concluded that failure to thrive in a breast-fed infant could be attributed to reduced milk pro duction in conjunction with maternal dietary energy- and protein-restr iction and that an assessment of maternal dietary intakes is essential in an evaluation of the breast-fed infant with failure to thrive.