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Randomized Controlled Trial
. 2024 Oct 9;16(19):3425.
doi: 10.3390/nu16193425.

Impact of Maternal Moringa oleifera Leaf Supplementation on Milk and Serum Vitamin A and Carotenoid Concentrations in a Cohort of Breastfeeding Kenyan Women and Their Infants

Suzanna Labib Attia  1 , Silvia A Odhiambo  2   3 , Jerusha N Mogaka  3   4 , Raphael Ondondo  5 , Aric Schadler  1 , Kristen McQuerry  6 , George J Fuchs 3rd  1 , Janet E Williams  7 , Michelle K McGuire  8 , Carrie Waterman  9 , Kerry Schulze  10 , Patrick M Owuor  2   11
Affiliations
Randomized Controlled Trial

Impact of Maternal Moringa oleifera Leaf Supplementation on Milk and Serum Vitamin A and Carotenoid Concentrations in a Cohort of Breastfeeding Kenyan Women and Their Infants

Suzanna Labib Attia et al. Nutrients. .

Abstract

Background: Childhood vitamin A deficiency leads to increased morbidity and mortality. Human milk is the only source of vitamin A for exclusively breastfed infants. Dried Moringa oleifera leaf powder (moringa) is a good food source of provitamin A and other carotenoids. Its effect during lactation on human milk vitamin A and carotenoid content is unclear. Objectives: Our objective was to investigate the effect of maternal moringa consumption on human milk retinol and carotenoid concentrations and maternal and infant vitamin A status. Methods: We conducted a 3-month pilot single-blinded cluster-randomized controlled trial in breastfeeding mother-infant pairs (n = 50) in Kenya. Mothers received corn porridge with (20 g/d) or without moringa with complete breast expressions and maternal and infant serum collected at enrollment (infant <30 days old) and 3 months. Milk was analyzed for retinol and selected carotenoids; maternal/infant serum was analyzed for retinol binding protein (RBP). Results: 88% (n = 44) pairs completed milk and serum samples. Four mothers (9%) had vitamin A deficiency (RBP <0.07 µmol/L); 11 (25%) were vitamin A insufficient (VAI; RBP <1.05 µmol/L). Alpha-carotene concentration in milk was higher in the moringa than the control group at baseline (p = 0.024) and at exit (least squares means, LSM, 95%CI µg/mL 0.003, 0.003-0.004 moringa vs. 0.002, 0.001-0.003 control, n = 22/cluster; p = 0.014). In mothers with VAI, alpha-carotene was higher in the moringa group than controls at exit (LSM, 95%CI µg/mL 0.005, 0.003-0.009 moringa, n = 3, vs. 0.002, 0.000-0.004 control, n = 8, p = 0.027) with no difference at baseline. Milk carotenoids did not correlate with vitamin A status (serum RBP) in infants or mothers. Conclusions: Maternal moringa consumption did not impact concentration of milk vitamin A and resulted in limited increase in milk carotenoids in this cohort.

Keywords: carotenoids; human milk; maternal and child health; vitamin A.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
Figure 1
Figure 1
Box plots of milk retinol and select carotenoids according to maternal vitamin A status at baseline (Bsl) and exit with (green) and without (blue) maternal moringa supplementation. Median and IQR are presented. Open circles represent means. Vit A Suff: vitamin A sufficiency defined as retinol binding protein ≥1.05 µg/mL. Vit A Insuff: vitamin A insufficiency defined as serum retinol binding protein <1.05 µg/mL. (A) Retinol activity equivalents and retinol; (B) alpha-carotene and beta-carotene; (C) cis-beta-carotene and total beta-carotene; (D) alpha-cryptoxanthin and beta-cryptoxanthin; (E) lutein and lycopene; (F) cis-lycopene and total lycopene; (G) zeaxanthin and total reported carotenoids.
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