ICMR BULLETIN VOL. 25-No.-8-AUGUST-1995.pdf

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Vol. 25, No. 8

August, 1995
LACTATION — CURRENT CONCEPTS AND CONCERNS

The importance of breast feeding in infant nutrition,
health and survival has long been recognized. The recog­
nition tliat lactation may have profound efifects on maternal
nutrition and fertility is of more recent origin. It is now well
established that over millennia, breast feeding has been the
major determinant of infant growth, health and survival
and the contraceptive effect of lactation has'been the
principal regulator of human fertility.
The first half of the present century witnessed a
profound decline in breast feeding in industrialized coun­
tries, so that in the sixties most women in these countries
were not breast feeding their infants; bottle feeding had
become the convenient norm and the symbol of sophisti­
cation. Luckily the tradition of universal prolonged lac­
tation remained essentially unaltered during this period in
developing countries like India.

Research studies carried out in the sixties and sev­
enties in developed and developing countries brought out
unique advantages of breast feeding and showed that
irrespective of the socio-economic status and standards of
environmental hygiene, breast feeding is the best for the
mother intuit dyad. There was a global movement to
promote breast feeding in areas where it had declined and
protect it in areas where it is still widely prevalent.

In India the traditional practice of near universal breast
feeding continues both in urban and in rural areas; however,

some recent data indicate that there has been a reduction
in the duration for which the infant is exclusively breast
fed. Early introduction of supplements to infants could
result in increased morbidity due to infections and conse­
quent growth faltering, as well as faster return of fertility
in the mother.

The present decade is witnessing marked changes in
the life-style, nutritional status, morbidity profile, fertility
pattern and contraceptives use in Indian women; some of
these may directly or indirectly have an impact on breast
feeding practices. There is increasing employment ofwomen
outside the home and consequent reduction in "demand
feeding” and earlier introduction of supplements to the
infant. Health education, appropriate contraceptive care
and food supplements to lactating women could result
in improvement in maternal nutritional status, more rapid
return of fertility and faster advent of the next pregnancy
if contraceptive care is not provided. With the advent of
the HTV epidemic, conflicting advice from different agen­
cies regarding breast feeding in seropositive women has
raised some doubts in the minds of both professionals and
the general public regarding the continued advocacy for
breast feeding in all segments of population.
Currently efforts are undenvay to provide clear
guidelines to medical and paramedical personnel on these
issues and inform and empower women so that they

Division of Publication & Information, ICM R, New Delhi - 11 0 029

understand the unique advantages of breast feeding and
therefore strive to achieve near universal practice ofbreast
feeding in spite of the pressures due to the rapidly changing
socio-economic milieu and life-styles. The present write up briefly reviews the current concepts and concerns on
lactation - nutrition - infection - fertility interactions and
the interventions required to sustain and support the ben­
eficial trends and remedial steps to minimize if not eliminate
adverse interactions.
Changing Trends in Lactation

Studies carried out in the fifties and sixties have shown
that both in urban and rural areas in India breast feeding
was nearly universal; there were no marked differences
between states or between different income groups. Two
major areas of concern were that colostrum feeding was
uncommon, and in rural areas there was a delay in. intro­
duction of supplements. Efforts were therefore directed to
inform women about the need to change these practices. In
the seventies the debate among professionals regarding the
energy needs for growth in infancy, led to conflicting advice
regarding the appropriate time for introduction of supple­
ments to breast fed infants, reaching the women especially
the urban middle income group. Studies carried out in both
the developed and developing countries have now clearly
shown that breast milk alone is sufficient to meet all the
nutrient, water and electrolyte needs of infants upto 6
months ofage irrespective ofmaternal nutritional status and
climatic conditions.
Data from the National Family Health Survey* indicate
that breast feeding is nearly universal with over 98 per cent
of infants being breast fed. There were no urban rural or
interstate diSerences regarding initiation of lactation. This
trend should be protected by emphasising the unique bene­
fits conferred by breast feeding to infants belonging to all
segments of the population.
Contrary to current recommendation that infants may
be exclusively breast fed upto 6 months and that there is
no need to introduce supplements and provide water earlier,
only 50 per cent of infants were exclusively breast fed even
in the 0-3 months age group; 22 per cent of infants received
water and 23 per cent milk or other fluids. In urban areas
only one third of infants were exclusively breast fed in the
0-3 months age group; in rural areas the figure was 55.4
per cent. There were substantial interstate dififerences also;
in Punjab only 3.3 per cent were exclusively breast fed at
0-3 months age, while 70.5 per cent were exclusively breast

74

fed in Andhra Pradesh. Too early introduction of supple­
ments is likely to result in increased morbidity due to
infections and hence should be discouraged.
It is essential that supplements preferably semisolids
are introduced to breast fed infants at 6 months of age so
that the nutrient requirement for growth is met; this message
is being given as a part of health education in all maternal
and child Health (MCH) programmes. In spite of this,
nearly a third of infents were not receiving additional
nutrients either as s^misotids or as other liquids even when
they were 6-9 months. 6f Age. Delay in introduction of
supplements was-reported jhore often (nearly 30%) in rural
than in urban (20%) areas. There were substantial differ­
ences between states; in Rajasthan only 9 per cent of those
in the 6-9 months age group received semisolid supplements
while nearly 70 per cent in Kerala were given semisolid
supplements. In all major states except West Bengal,
Kerala and Tamil Nadu, more than 50 per cent of infants
in the 6-9 months age did not receive semisolid supplements.
Delay in introduction of supplements will result in growth
retardation and hence the need for timely introduction of
supplements should be stressed as a part of MCH care
especially in rural areas in states where delay in introduc­
tion of supplements is reported.
It is, however, noteworthy that the practice of prolonged
breast feeding is still widely prevalent, 88 per cent of
children in the age group 12-15 months and 67 per cent
of children in the 20-23 months are breast fed. There were
marked interstate variations in breast feeding at 20-23
months with West Bengal (84%) and Tamil Nadu (36%)
at two ends of the spectrum.
The near universal initiation ofbreast feeding and the
long duration of lactation need to be protected and pro­
moted; efforts to reverse the tendency to introduce supple­
ments too early in infancy have to be vigorously continued
to ensure that infants do not unnecessarily get exposed to
the risk of infections.

Lactation and Maternal Nutrition

Diet surveys indicate that most lactating women
from the poorer segments of population subsist on diets
which provide 1,200-1,800 Kcal/day; there is no increase
in dietary intake during lactation. Successful prolonged
breast feeding for 18-24 months is the traditional practice
among the poorer segments of the Indian population. The
estimated calorie expenditure in milk secretion varies

between 400-700 Kcal/day. The net energy thus available
for a moderately active lactating mother is only 800-1100
Kcal/day2. Under normal circumstances such a large energy
deficit is likely to result in weight loss of about 1.5-2.0 kg/
month.

In spite ofcontinued low dietary intake, lactating women
lose only about 1-2 kg of weight during the first year of
lactation. With waning lactation, these women tend to
regain their body weight over the next year or two, provided
they do not become pregnant during this period2. Obviously
adaptive changes have been evolved over millennia to
ensure that lactation does not result in deterioration of
maternal nutritional status. It would appear that because
of these adaptive changes , the habitual dietary intake is
just sufficient to maintain body weight in non-lactating
women; and to prevent marked weight loss in spite of added
expenditure of about 500 Kcal/day during the first year of
lactation. It is also sufficient to cause a weight gain during
the later months of lactation when ene喏y loss in milk
production decreases. But with the cessation of lactation
it is again no more than adequate for maintenance of body
weight.
An important concept regarding energy utilisation is
that only a portion (maximum of 30-40%) of the total
energy is converted into ATP or similar high ene喏y com­
pounds and is available for physical work or anabolic
processes. It has been suggested that efficiency ofutilisation
might be higher when dietary intakes are lower. It is also
possible that efficiency of enei^y utilisation may be modi­
fied by physiological changes known to occur during lac­
tation .Ample data exist to indicate that plasma prolactin
levels are higher and remain at the elevated level tiifoughout
the period of lactation in undernourished women. It is
possible that elevated prolactin levels may have an anabolic
role and result in more efficient utilisation of available
nutrients by the mother. Obviously some ill understood but
sensitive adaptive changes occur in lactating women on
fixed energy intakes, so that the energy balance is main­
tained in spite of marked variations in energy expenditure.

Factors Associated with Deterioration of Maternal
Nutritional Status

Dual stress ofpregnancy and lactation
Among the traditional low income group of
women,prolonged lactation for 20-30 months is conumn;
contraceptive use is not widespread in these women. Under

these circumstances about a third of all pregnancies occur
in lactating women. Early advent of the next pregnancy
is more common in working women and in those who
introduce supplements to breast fed infants by the third
or fourth month of lactation. A substantial number of these
women continue to breast feed their infants during preg­
nancy and face the concurrent dual stress of pregnancy and
lactation. Diet surveys undertaken among women who had
conceived during lactation have shown that their food intake
is essentially similar to that ofnon-pregnant women. Women
who continued lactating during pregnancy had lower body
weights, delivered infants of lower birth weight3,4; the elder
sibling often showing growth retardation . These studies
have demonstrated that a short interpregnancy interval and
conception during lactation have an adverse effect on maternal
and infant nutrition, birth weight and infant survival. Ensuring
adequate contraceptive care at the appropriate time to
lactating women might therefore constitute an important
non-nutritional intervention for reducing the magnitude of
maternal and infant undemutrition among the poorer seg­
ments of the population in India .

Reduction in dietary intake
Studies from Gambia5 have demonstrated that a
further fall in dietary intake below the habitual level —
especially when coupled with increase in physical activity
as in the preharveist season — resulted in deterioration in
maternal nutritional status and lactational performance. In
India a situation akin to this might be present in drought
prone areas in the preharvest season or in women who are
participating in food for work programmes in periods of
drought. These situations and at risk women can readily
be identified by the local anganwadi worker or the auxiliary
nurse midwife (ANM). These identified "at risk” women
should be given adequate food supplements from the exiting
food supplementation programmes.

Women working outside home

Women*s participation in economically productive
activities outside the home is not a new phenomenon. Over
the last few decades, socio-economic pressures,increasing
urbanization and alterations in agricultural activities have
resulted in urban and rural women seeking employment
outside the home in nontraditional activities. Some recent
studies4,5 have shown that the dual stress of work in and
outside the home has had an adverse effect on maternal
nutri^onal status, reproductive performance, lactation and

75

infant health. It is, however, possible that employment
outside the home might benefit working women and her
family by increasing their purchasing power Women from
poorer segments ofthe population have to continue to work
outside the home in order to ensure that there is no further
deterioration in the purchasing power ofthe family. However,
imaginative intervention programmes if effectively imple­
mented might go a long way in reducing the physical work
done at home and at work and help in improvement of
maternal nutritional status. Non-nutritional strategies for
preventing deterioration in the nutritional status of lactating
women include facilities to reduce physical activity and
energy output such as provision ofbiogas plants and water
in the vicinity of the house.
Effect of Food Supplementation during Lactation
Lactating women had been considered a nutritionally
vulnerable group because of the obvious nutrient loss in
milk production; therefore they have been one of the target
groups for all food supplementation programmes in India.
Available data suggest that there is no substantial improve­
ment in maternal nutritional status even in carefully super­
vised food supplementation studies in which there was
substantial increase in maternal dietary intake5. Food
supplementation did not result in any increase in quantity
of milk secreted or improvement in quality of milk pro­
duced4,5. It has been suggested that the additional food
intake might have been utilized for reversal of adaptive
changes and hence there is no improvement in maternal
body weight. Weight gain is one of the parameters widely
used for evaluation ofthe food supplementation programmes.
Data from Gambia5 and elsewhere suggest that at least in
lactating women, weight gain may not follow improvement
in dietary intakes and so should not be used as a parameter
to evaluate the success of food supplementation4,6.
Studies from Gambia5 have shown that food supple­
mentation and improvement in maternal nutritional status
results in faster return of fertility in lactating women .
Studies in India have demonstrated that return of fertility
is more rapid in lactating women with higher body weight4,6.
These findings emphasizes the need for providing concur­
rent contraceptive care as a part of the programmes aimed
to improve maternal nutritional status to ensure that early
advent of the next pregnancy does not undo the benefits of
the food supplementation.

76

Impact of ongoing food supplementation programmes
Many developing countries including India have ini­
tiated massive food supplementation programmes aimed
at improvement of maternal and child nutritional status
among poorer segments of the population. %ry few of these
programmes have been formally evaluated. However, there
is an impression among professionals that by and large these
programmes have not produced any significant improve­
ment in maternal and child nutritional status. This might
be due to the fact that administrative bottlenecks and
logistic problems come in the way of food reaching the
target women. Even if this was achieved, food sharing and
food substitution are so common that the net increase in
dietary intake may be no more than 100-150 k cal/day.
There is also a growing awareness that unless coupled with
health care, increasing food intake alone might not result
in improved nutritional and health status of the individual.
The Integrated Child Development Scheme attempts to
achieve an integration of food supplementation, health care
and health education.
Many developing countries including India are facing
a resource crunch and therefore there might be a need for
better targeting of the existing programmes. Efforts may
have to be directed towards identifying individuals who
need the supplements most (such as women who are preg­
nant and lactating, those in whom fall in dietary intake or
increase in physical activity is occurring) and ensure that
they receive adequate food supplements through these food
supplementation programmes .

Effect of Maternal Nutrition on Lactation

Duration of lactation
Studies undertaken during the fifties in India showed
that undernourished rural women successfully initiate lac­
tation and continue to breast feed their offsprings for
periods up to 24 months. Several global studies and studies
from India have confirmed these observations. These data
suggpst that maternal undernutrition does not have any
adverse effect either on initiation of lactation or duration
of lactation4. Prolonged successful lactation appears to be
nature's protective evolutionaiy step to look after the nutritional
needs ofthe vulnerable young infant in communities where
poverty and undernutrition are common.

Volume of breast milk
Studies conducted at the National Institute ofNutrition
(NIN), Hyderabad, during the early sixties had shown that
undernourished Indian women secrete 500-800 ml milk/
day. More recent studies using electronic balances for
measurement of milk intake of infants have confirmed these
findings4. Report from the developed countries indicate that
milk intake of infants in these countries range 丘om 6001,000 ml/day but milk intake of infants born to undernour­
ished women was lower. The data suggest that quantity
of milk produced by undernourished women from devel­
oping countries is less than that of well nourished women
from developed countries7.
In recent years the concept that the infant modulates
maternal milk yield has gained wide acceptance. Infants of
undernourished women weigh less at birth and during
in自ncy compared to infants born to well nourished women.
The nutrient needs for these smaller infants are likely to
be lower and this may at least be one of the reasons for
the lower volume of milk ingested by these infants. Data
from some of the WHO collaborative studies (unpublished
data) have shown that when infants of similar birth weight
and body weight were investigated, there were no signifi­
cant differences in volumes of milk produced between
undernourished and well nourished mothers, supporting the
hypothesis that infant size is one of the determinants of the
volume of breast milk produced.
Composition of breast milk

Efforts to investigate the effect, if any, of maternal
nutritional status on composition of breast milk began in
the fifties. These studies showed that milk secreted by
undernourished women had a somewhat lower fat content,
protein levels were similar to those reported in well nour­
ished women. In spite of these differences in composition,
there were no significant differences in the calorie content
of milk secreted by undernourished and well nourished
women because in the former group the lactose content was
higher4. Subsequent studies in India and global studies have
confirmed these observations4,7. Most of the available data
suggest that food supplementation to undernourished women
does not have any significant impact on macro-nutrient
composition of breast milk4. Available data suggest that
the differences in the macro-nutrient composition of breast
milk in undernourished women do not have any impact
on infant growth and development. It is possible that nature
has ensured that the calorie content of breast milk remains

unaltered by maternal undemutrition, so that infant growth
is safeguarded. It is also possible that infants can adapt
and thrive even when the composition of their diet varies
substantially. In this context it is worth recalling that infant
food formulae in the forties and fifties had low fat, high
protein and high sugar content. Infants fed on these grew
well and have reached middle age without showing any
abnormalities attributable to their diet during infancy.
Studies on mineral and trace element content of breast
milk have shown that there are no significant differences
between milk secreted by well nourished and undernour­
ished mothers4. However, levels of almost all vitamins,
appear to be lower in milk secreted by undernourished
women4.
Majority of undernourished women from the
low income group in India show biochemical evidence of
vitamin deficiencies. It is therefore hardly surprising to note
that their breast milk contains lower concentration of these
vitamins. The nutritional consequences of this on breast
fed infants are still not clearly understood and need to be
investigated.Supplementation of vitamins to the lactating
women led to improvement in vitamin content of milk.

Infant Nutrition and Growth
It is now well accepted that breast feeding is the best
form of infant feeding for all segments of the population
in all countries. Breast milk provides appropriate nutrients
in adequate quantities to ensure optimal growth in early
infancy. Presence of anti-infective factors in breast milk
and the fact that breast milk reaches the infant without any
contamination ensures minimal morbidity due to infection
in breast fed infants. Available global and Indian data4
from all segments of the population suggest that up to 6
months ofage solely breast fed infants grow as well as those
who receive supplements. It would therefore appear that,
contrary to the earlier theoretical predictions based on
recommended dietary allowances during infancy, breast
milk alone might be sufficient to support the growth of
infants up to 6 months of age.

Appropriate time for introduction of supplements
Studies from India4,8 have shown that solely breast fed
infants grow well during the first three months of life; their
growth during this period is comparable to that observed
among infants born to well nourished mothers. Solely
breast fed infants from low incomegroups double their birth
weight by six months of age indicating that breast milk
alone is adequate to support infant growth in early infancy.

77

However, after six months, growth faltering is common8.
Delay in introduction of supplementary foods to infants
beyond six months of age results in growth retardation as
the infants do not get adequate nutrients to support growth.

It is essential that the current knowledge that breast
milk alone is sufficient to meet the nutritional needs of most
infants in the first six months of life is communicated to
the all medical and paramedical personnel so that they in
turn reassure women and counteract the existing tendency
for too early introduction of supplements and its adverse
consequences. Wherever possible, growth of infants should
be monitored by monthly weighing. In communities where
weighing is not possible, if a solely breast fed infant below
six months of age is not thriving, or is crying due to hunger
soon after breast feeds, the infant should be referred to the
Primary Health Centre (PHC) for examination and appro­
priate advice . In the absence of any of these problems all
women should be advised not to introduce supplements
prior to 6 months of age because under the existing con­
ditions of poor environmental sanitation such a practice is
associated with increased risk of morbidity due to infec­
tion4,8. Women should .also be made aware that too early
introduction of supplements will also result in faster return
of fertility.
Appropriate type of supplements

A variety of processed cereal-pulse based supplements
are available in the market. They are widely used by the
urban mothers belonging to middle and high income groups
because they are convenient and are affordable . These
segments of population should be informed about the need
to give the infant vegetables and fruits in addition to these
cereal pulse based supplements, so that the micronutrient
requirements of the infants are met.
Recipes for a large variety of low cost infant food
supplements prepared from locally available cereal, pulse,
sugar and jaggery have been published by several institu­
tions in India. However, community based studies have
shown that very few women are able to prepare these special
foods daily. Even when prepared these weaning foods
become heavily contaminated with bacteria and if fed a few
hours after preparation can cause diarrhoea4. It would
therefore appear that giving freshly cooked unseasoned rice
or wheat, pulse and vegetables from the family meal twice
a day might be the most feasible method of introducing
supplements to breast fed infants under the existing con­
ditions in India. It is important that between 6 and 12

78

months ofage the infant gets used to eating almost the whole
range of adult food when it is freshly cooked. Studies from
the NIN, Hyderabad, have shown that this practice was
associated with a tripling of birth weight by the first year,
relatively low morbidity due to infection and a reasonably
long interpregnancy interval even in the absence of contra­
ceptive care4*8.
Delay in introduction ofsupplements beyond six months
of age is associated with growth faltering and increased
susceptibility to infection due to undernutrition. It is
essential to ensure that health education messages advocat­
ing introduction of freshly cooked cereal, pulse and veg­
etable based semisolid supplements to infants by six months
of age, reach and are followed by urban and rural women
from low income groups in India .

HIV Infection and Breast Feeding
HTV infection has no adverse effect on lactation and
lactation has no adverse effect on the course and outcome
of HTV infection. Both HIV and antibodies to HIV are
present in breast milk; presence of antibodies to HTV may
provide some protection against transmission of HIV
infection through breast milk. Research studies indicate
that transmission of HTV through breast milk accounts for
1-3 per cent of all mother to infant transmissions, isolation
of HTV from breast milk and the reported instances of HIV
transmission through breast milk have led to the public
apprehension and debate about advantages of breast feed­
ing in the era of the HIV pandemic. The concern has been
heightened by the apparently conflicting recommendations
of the advisory panels on breast feeding in seropositive
women.

Breast feeding offers protection against a wide variety
of infection and hence is crucial for survival for the high
risk HIV infected neonates who might also be pre-term and
have low birth weight. There are no tests by which HIV
infected infants could be identified at birth. Unless all
infants born to seropositive mothers are breast fed , HIV
infected infants will be denied the benefit of breast feeding.
The advantages of breast feeding by far out weigh the
small potential risk of HIV infection through breast feed­
ing. Therefore, in the Indian context, breast feeding by the
biological mother is to be advocated in all infants born
to seropositive women.
In India very few of the infected mothers can be
detected because universal HIV testing is not possible.

Breast feeding is essential for infant survival and growth
especially among the poorer segments of the population,
because in&nt food formulae- are neither affordable nor
safe. Hence breast feeding by the biological mother should
continue irrespective of the HIV infection status of the
mother or infant, known or unknown. Promotion of breast
feeding by all mothers will therefore continue to be the
national policy9.
Lactation and Fertility

Lactation prolongs post partum amenorrhoea and pro­
vides some protection against pregnancy. Suckling-induced
endocrine changes result in relative infertility during lac­
tation. It is estimated that in India universal and prolonged
breast feeding prevents more pregnancies than all other
reversible contraceptives currently in use. However, it should
be clearly understood that lactation provides reliable and
effective protection against pregnancy only during the first
few months of lactation when the woman is. solely breast
feeding her offspring and is amenorrhocic. Increasing
duration of lactation beyond six months , introduction of
supplements to breast fed infants or return ofmenstruation
should all be taken as indications that lactating women
should seek contraceptive care to prevent too early advent
of an unwanted pregnancy3. This advice should be given
along with the health education message regarding the
appropriate time for introduction of supplements to the
breast fed infant, so that women understand the linkage
between the infant feeding practice, morbidity in infants
and return offertility and refrain from starting supplements
too early .
Effect of maternal nutritional status on lactational
infertility
Available data from developed and developing coun­
tries indicate that lactational amenorrhoea is shorter among
well nourished women from developed countries and among
the socio-economically better-off segments of the popula­
tion in developing countries. However, it has been suggested
that the shorter duration of lactational amenorrhoea might,
at least in part, be attributable to confounding variables
such as the earlier introduction ofsupplements and schedule
feeding among well nourished women, rather than a better
nutritional status per se. In the last decade, two studies3,5
have attempted to define the role of maternal nutritional
status on duration oflactational amenorrhoea. One ofthese
studies was undertaken among urban low income group

women with similar breast feeding practices who did not
receive any health and/or nutritional intervention. The
mean durations of lactation and lactational amenorrhoea
were significantly shorter in women whose body weights
were over 55 kg3. The other evidence came from studies
in Gambian women5; data from the study showed that
prolactin levels were higher and the duration of lactational
amenorrhoea was longer during the rainy season, when
calorie intakes were lower. Food supplementation to lac­
tating mothers resulted in a fall in prolactin levels and a
reduction in the duration oflactational amenorrhoea. Average
birth intervals were also shorter in women receiving supple­
ments5.

Obviously, under conditions of food scarcity and conse­
quent undernutrition, nature and evolution have ensured a
longer inter-birth interval so that the advent of the next
pregnancy does not cause further deterioration in both
maternal and infant nutritional status. Currently several
programmes aimed at improving maternal nutritional status
are underway It is essential to ensure that efforts to improve
maternal nutritional status are linked to programmes aimed
at providing contraceptive care , so that the advent of the
next pregnancy does not undo the benefits of food supple­
mentation. Contraceptives given to lactating women should
be carefully chosen so that they do not have any adverse
effect on lactation, the breast fed infant or the mother3.
SUMMARY
Surveys carried out in the country during the nineties
indicate that universal initiation of lactation and prolonged
breast feeding continue to be the rule in India both in urban
and rural areas. There is a tendency for too early introduc­
tion of supplements to breast fed infants especially in urban
areas; this practice may have adverse consequences such
as increased morbidity in breast fed infants and faster return
of fertility in the mother and hence need to be countered
through health education. Advent of the HIV epidemic has
provided one more reason to protect the existing practice
of universal and prolonged breast feeding.
Available data*suggest that lactation does not have an
adverse effect on maternal nutrition in undernourished
women subsisting on habitual low calorie diets. Chronic,
mild and moderate maternal undernutrition does not have
any adverse effect on initiation of lactation, duration of
lactation, quantity and quality of milk secreted and the
growth ofthe breast fed infant. However, further reduction
in dietaiy intake, advent ofthe next pregnancy or increase

79

in energy expenditure result in deterioratn. .1 in maternal
nutritional status and lactational performance. Food supple­
ments given to these women prevent these adverse conse­
quences.

2.

Prema, K., Madavapeddi, R. and Ramalakshmi, B. A. Changes
in anthropometric indices of nutritional status in lactating
women. Nutr Rep Intern 24: 893,1981.

3.

Ramachandran, P. Contraception during lactation. /CMR Bul­
letin 24: 67, 1994

Lactation provides reliable protection against preg­
nancy in the first few months when the infant is solely breast
fed; this effect is more marked in undernourished women.
Improvement in maternal nutritional status is associated
with faster return of fertility in lactating women; therefore
efforts to improve maternal nutritional status should always
be coupled with adequate provision for contraceptive care
so that the too early advent of the next pregnancy does
not result in deterioration in maternal nutritional status.

4.

Ramachandran, P. Lactation-nutrition fertility interaction. In:
Mbmen and Nutrition in India. Eds. C. Gopalan and S. Kaur.
Nutrition Foundation Of India, New Delhi. 1989.pl94

5.

Prentice, A.M. Whitehead, R.G., Roberts, S., Paul, A.,
Watkinson, M. and Watkinson, A. Dietary supplements of
Gambian nursing mothers and lactational performance. Lancet
U: 623, 1980.

6.

Ramachandran, P. Nutrition and its influence on the mother
child dyad. In: Nutrition and Population Links — Breast
Feeding, Family Planning and Child Health. Nutrition Policy
Discussion Paper No 11, ACC/SCN Symposium Report,
1992, p47.

7.

The Quantity and Quality of Breast Milk. Report of the WHO
collaborative study on breast feeding. Wjrid Health Organisation,
Geneva, 1985.

8.

Ramachandran, P. Weaning : Why, what and when: Indian
experience. In: Meaning ; Why, What and When. Eds. A.
Ballabriga and J. Rey. Raven Press, New York. 1987, pl87.

9.

Ramachandran, P. AIDS and the family. ICMR Bulletin 24:
115, 1994.

Early introduction of supplements to infants is likely
to result in faster return of fertility in lactating women.
Health education that solely breast fed infants grow and
thrive normally during the first six months and in them
the risk of infection is lower should be linked with advice
that once supplements are introduced all lactating women
should seek contraceptive care. Contraceptives should be
chosen with care so that they have no effect on lactation,
maternal or infant nutrition.
References:
1.

National Health and Family Survey ; India 1992- 93 (Intro­
ductory Repoit). International Institute of Population Studies,
Bombay, 1994,p80.

This write-up, published on the occasion of the Wbrid Breast
Feeding Week (August 1 to 7), has been contributed by
Dr. P. Ramachandran, Advisor Health, Planning Commis­
sion, New Delhi.

ABSTRACTS
Some Research Projects Completed Recently
The role of ellagic acid in chemical carcinogenesis.
The study was carried out on NMRI inbred mice to
evaluate the effect of ellagic acid (EA) on hepatic and
pulmonary phase I and phase II drug metabolizing enzymes
and antioxidant enzymes as also on lipid peroxidation in
the liver and lung. The role ofEA in modulating the binding
of chemical carcinogens, 3H-benzo(a)pyrene and “Cdethyl nitrosoamine with DNA in vivo and in vitro and its
effect on binding of 3H-benzo(a)pyrene and 14C-diethyl
nitrosoamine with DNA, mediated through peroxidative
cooxidation of the carcinogens in vitro were also studied.
The effects of EA feeding at doses of 3,6 and 12 pg/
ml drinking water for 8 weeks to male and female mice,
on phase I and phase II drug metabolising enzymes were
similar. EA did not change the activity of arylhydrocarbon

80

hydroxylase (AHH) in vivo and in vitro. Feeding of EA to
male mice for 8 weeks significantly decreased the hepatic
cytochrome P-450, cytochrome bs and cytochrome c-reductase; the strongest effect was found at the dose of 12 pg/
ml. On the other hand, AHH and cytochrome c-reductase
activities in lungs increased on EA feeding. Hepatic UDPglucoronyl transferase (UDPGT), glutathione-S-transferase
(GST) and reduced glutathione (GSH) were significantly
enhanced on EA feeding, and the effects appeared to
be EA dose dependent. However, in lungs UDPGT and
GSH levels were increased without any change in the GST
activity. GST inhibition curve, obtained at different con­
centrations of EA in the 10,000 g hepatic supernatant using
l-chloro-2, 4 dinitrobenzene (CDNB) as substrate sug­
gested two types of isoenzymes of GST (EA-binding and
EA-nonbinding). Kinetic studies revealed that EA inhibited

GST activity non-competitively with respect to CDNB as
a substrate.
EA feeding at a dose of 12 pg/ml inhibited the percent­
age inducibility of hepatic AHH by phenobarbitol from 25
to 6.5 per cent and the percentage inducibility of AHH by
methylcholanthrene was decreased from 173 to 154 per
cent. In the lungs, the percentage inducibility of AHH
remained unaltered.
Addition of EA to liver microsomes of mice resulted
in a steady increase in inhibition ofNADPH-dependent lipid
peroxidation upto 2mM concentration. The maximum of
70 percent inhibition ofascorbate-dq)endent lipid peroxidation
was achieved at ImM concentration ofEA. EA was found
to be a stronger antioxidant than the known strong antioxi­
dants like BHA, BHT, tocopherol and retinyl acetate. But
the alizarin, quercetin, myricetin and purourogallin were
found to be stronger inhibitors of in vitro lipid peroxidation
compared to EA. Feeding ofEA significantly increased the
levels of reduced glutathione and glutathione reductase in
the liver and lungs of male and female mice. However, there
were no changes in the activities of catalase and superoxide
dismutse. On the other hand, microsomes from liver and
lungs of EA fed animals showed significantly suppressed
NADPH- and ascorbate-dependent lipid peroxidation.

EA feeding at a dose of 12 pg/ml drinking water for
8 weeks to mice resulted in significant inhibition of 3Hbenzx)(a)pyrene binding to lung DNA. In 加 vitro studies
EA inhibited the binding of W^benzo^pyrene and 14CNDEA with DNA, mediated by NADPH, ascorbate and
linoleic acid-hematin systems.

It is thus concluded that EA not only act as an antioxi­
dant but also enhances the GSH-dependent protective
mechanisms. The overall consequences ofthese antioxidant
activities might be beneficial and account for the
anticarcinogenic activity of EA.

K.L. Khanduja
Department of Biophysics
Postgraduate Institute of Medical
Education and Research
Chandigarh.

2.

Majid, S., Khanduja, K.L., Gandhi, R.K., Kapur,, S. and
Shanna, R.R. Influence of ellagic acid on antioxidant defence
systems and lipid peroxidation in mice. Biochem Pharmacol
42: 1441, 1991.

3.

Khanduja, K.L. and Majid, S. Ellagic acid inhibits DNA
binding of benzo(a)pyrene activated by different modes. J Clin
Biochem Nutr 15: 1, 1993.

Production and immunological characterization of
antibodies against estradiol-albumin and estradiolalbumin-DNA conjugates and their possible role in the
pathogenesis of SLE.
The study was carried out to elucidate the possible role
of estradiol in conjugation with DNA, in the pathogenesis
of systemic lupus erythematosus (SLE). Commercially
available calf thymus DNA was purified by repeated ex­
traction with a mixture of chloroform and isoamyl alcohol.
In order to obtain small size DNA fragments, this DNA
was subjected to micrococcal nuclease digestion. DNA
fragments (average size 200 bp) were covalently linked to
bovine serum' albumin (BSA) and estradioLalbumin by
treatment with glutaraldehyde. The conjugates were sepa­
rated from free DNA by gel exclusion chromatograpy and
characterized by ultraviolet spectroscopy and thermal de­
naturation.

Antibodies were elicited in three rabbits immunized
with estradiol-BSA, estradiol-BSA-DNA and DNA-BSA
conjugates respectively; complexed with Freund's com­
plete/ incomplete adjuvants. The conjugates induced high
titre antibodies which were highly specific to their respec­
tive immunogens. These antibodies did not recognise native
DNA (B-fbrm), brominated DNA (Z-fbrm) or poly (de),
poly (rG). The estradiol-BSA-DNA conjugate showed
significant binding with sera from SLE patients known to
have a high level ofanti-native DNA antibodies. The results
indicated the recognition of the unique conformation of
estradiol-BSA-DNA conjugate by naturally occurring SLE
anti-DNA autoantibodies. The recognition of p-estradiol by
naturally occurring SLE autoantibodies was one of the
important findings of the study.
Asif Ali
Department of Biochemistry
Faculty of Medicine
Aligarh Muslim University
Aligarh.

Publications:
1.

Majid, S., Khanduja, K.L., Kapui; S. and ShaEa,, R.R.
Effect of feeding ellagic acid on glutathione-S-transferase
gtivity and reduced glutathione leveli in liver and lungs of
mice. J Clin Biochem Nutr 10: 119, 1991.

Publication:
Moinuddin and Ali, A. SLE and anti-DNA autoantibodies
binding estradiobalbumin-DNA conjugate. Lupus 3:43,1994.

81

ICMR NEWS
The following meetings of various technical groups/
committees of the Council were held:

diseases and impending epidemics; and (ii) Standardisation
for neutralising antibody for dengue at Salaya, Thailand
(July 17-19 and 21-23, 1995 respectively).

Meetings of the Project Review Committees held at
New Delhi:

Dr. V.P. Sharma, Director, Malaria Research Centre
(MRC), Delhi, participated in the Joint WHO/Thailand
International Assessment for Malaria at Bangkok (July 172 8, 1995).

Malaria, Filariasis and Kala-azar

August 8, 1995

Diarrhoeal Diseases

August 9, 1995

Participation of ICMR Scientists in Scientific Events:
Dr. G.V Satyavati, Director-General, ICMR, co-chaired
the meeting of the Joint Working Group of the Indo-US
Wccine Action Programme at New Delhi. She also par­
ticipated in the Workshop on Multidisciplinary perspectives
on introduction of new vaccines at New Delhi (July 17-20,
1995).

Dr. Kalyan Banerjee, Director, National Institute of
Virology, Pune, participated in the meetings on (i) Emerging

Dr. U.C. Hegde, Dy. Director, Institute for Research
in Reproduction, Bombay, participated in the VI Interna­
tional Congress of Reproductive Immunology at Washing­
ton D.C. (July 19-23, 1995).

Dr. Neena Valecha, Sr. Research Officer, MRC, Delhi,
participated in the Clinical Tropical Pharmacology Work­
shop on Chemotherapy of Malaria at Bangkok (July 31 August 11, 1995).
Dr. V.P. Sharma served as a Short-term WHO Con­
sultant on Disease Vector Control in Sri Lanka (August 32 8, 1995).

ICMR AIDED SYMPOSIA/SEMINARSAVORKSHOPS/COURSES/CONFERENCES
Symposium/SeminarAVorkshopZ
Course/Confercnce

Date & Place

Contact Address

International Symposium on Human Stones, Free
Radical and Trace Metals and VIH National
Conference of Urolithiasis Society of India 1995.

September 14-16,
1995;
(at Udaipur)

Dr. P.P. Singh, Organising Secretary, Department
of Biochemistry, R.N.T. Medical College, Udaipiu-.

National Seminar on Public Health Aspects of Fixed
Duration Treatment (FDT) in Leprosy.

September 22,1995;
(at Bombay)

Dr. C.R. Revankar, Organising Secretary, Bombay
Leprosy Project, Vidnyon Bhawan, SionChunabhatti, Bombay.

Symposium on Prevention and Control of Goitre
Endemism in Tribal Population through Education and
Mass Communication.

October 2-3, 1995:
(at Bhopal)

Dr. D.K. Belsare, Director, Institute for Natural
Resources and Human Environment, Bhopal.

Cytology Update -1995.

October 14-15, 1995;
(at Chandigarh)

Dr. A. Rajwanshi,- Organising Secretary of Update,
Department of Cytology and Gynaecologic
Pathology, Postgraduate Institute of Medical
Education and Research, Chandigarh.

XXVI Annual Conference of the Endocrine Society of
India.

December 1-3,1995;
(at Ahmedabad)

Dr. J.M. Bhatavdekar, Organising Secretary,
ESICON - 1995, Division of Molecular Endocrino­
logy, The Gujarat Cancer Society, Ahmedabad.

International Symposium on RadiomodiGers in Human
Health.

December 28-31,
1995;
(at Manipal)

Prof. P. Uma Devi, Convenor, ISRHH, Department
of Radiobiology, Kasturba Medical College,
Manipal.

82

COUNCIL'S TRAINING PROGRAMMES
Reproductive Biology

•

Orientation Course on Occupational Health for
Industrial Medical Officers (November 13-24,
1995).

•

Training Course on Air Pollution Monitoring and Risk
Assessment (December 13-19, 1995).

At the Institute for Research in Reproduction, Bombay:

•

Training Course on Techniques in Immunology, Cell
Biology and Molecular Biology (November2-25,1995).

•

Training Course on Techniques in Neuroendocrine Re­
search (February 6-10, 1996).

Medical Entomology

Endocrinology

At the Vector Control Research Centre,Pondicherry:

At the National Institute of Nutrition, Hyderabad:

•

•

Annual Training Course on Endocrinological Tech­
niques and their Application (August/September, 1995).

M.Sc. in Medical Entomology (From August 1995: for
2 years).

Laboratory Animal Technology
Nutrition

At the National Institute of Nutrition, Hyderabad:

•

Annual Training Course in Nutrition (December 1,
1995 - February 28, 1996).

At the Laboratory Animal Information Services Centre,
National Institute ofNutrition, Hyderabad:
•

Training Course for Laboratory Animal Supervisors
(September 4 - November 30, 1995).

Oncology

Haematology

At the Institute of Cytology and Preventive Oncology,
New Delhi:

At the Institute ofImmunohaematology, Bombay:

•

Workshop on Molecular Biology ofViruses and Cancer
alongwith Oligo DNA Synthesis and Polymerase Chain
Reaction (September 18-22, 1995).

•

Training Course in Blood Group Serology and Blood
Bank Methodology for Medical Officers (August 1 September 29, 1995).

•

Training Course in Blood Group Serology and Blood
Bank Methodology for Technicians (August 1-31,1995).

•

Training Course in Advanced Haematology and
Immunohaematology (September 11-29, 1995).

Occupational Health

At the National Institute of Occupational Health,
Ahmedabad:

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Nutritive Value of Indian Foods (1985), by C. Gopalan, B.V. Ramasastri and
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K.C. Pant and Y;G. Deosthale

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83

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