www.jped.com.br
ORIGINAL
ARTICLE
Effect
of
maternal
supplementation
with
vitamin
E
on
the
concentration
of
␣
-tocopherol
in
colostrum
夽
,
夽夽
Larisse
Rayanne
Miranda
de
Melo
a,
Heleni
Aires
Clemente
a,
Dalila
Fernandes
Bezerra
a,
Raquel
Costa
Silva
Dantas
a,
Héryka
Myrna
Maia
Ramalho
b,
Roberto
Dimenstein
a,∗aUniversidadeFederaldoRioGrandedoNorte(UFRN),DepartamentodeBioquímica,Natal,RN,Brazil bUniversidadePotiguar(UnP),DepartamentodeBiotecnologia,Natal,RN,Brazil
Received1October2015;accepted23March2016 Availableonline18June2016
KEYWORDS
Maternal
supplementation;
VitaminE;
Alpha-tocopherol;
Nutritionalneeds;
Newborn;
Humancolostrum
Abstract
Objective: ToevaluatetheeffectofmaternalsupplementationwithvitaminEonthe concen-trationof␣-tocopherolincolostrumanditssupplytothenewborn.
Method: Thisrandomizedclinicaltrialenrolled99healthyadult pregnantwomen;ofthese, 39wereassignedtothecontrolgroupand60tothesupplementedgroup.Afteranovernight fast,5mLofbloodand2mLofcolostrumwerecollected.Afterthefirstsampling(0hmilk),the supplementedgroupreceived400IUofsupplementaryvitaminE.Another2mLmilkaliquotwas collectedinbothgroups24haftersupplementation(24hmilk).Thesampleswereanalyzedby high-performanceliquidchromatography.The␣-tocopherolcontentprovidedbycolostrumwas calculatedbyconsideringadailyintakeof396mLofmilkandcomparingtheresultingvalueto therecommendeddailyintakeforinfantsaged0---6months(4mg/day).
Results: Theinitialmeanconcentrationof␣-tocopherolincolostrumwas1509.3±793.7g/dL in the controlgroup and1452.9±808.6g/dL in thesupplemented group. After 24h, the mean␣-tocopherolconcentrationwas1650.6±968.7g/dLinthecontrolgroup(p>0.05)and 2346.9±1203.2g/dLinthesupplementedgroup(p<0.001),increasingthevitaminEsupplyto thenewbornto9.3mg/day.Initially,18womeninthesupplementedgroupprovidedcolostrum ␣-tocopherolcontentsbelow4mg/day;aftersupplementation onlysixcontinuedtoprovide lessthantherecommendedamount.
夽
Pleasecitethisarticleas:MeloLR,ClementeHA,BezerraDF,DantasRC,RamalhoHM,DimensteinR.Effectofmaternalsupplementation withvitaminEontheconcentrationof␣-tocopherolincolostrum.JPediatr(RioJ).2017;93:40---6.
夽夽
StudycarriedoutatUniversidadeFederaldoRioGrandedoNorte(UFRN),Natal,RN,Brazil. ∗Correspondingauthor.
E-mail:[email protected](R.Dimenstein). http://dx.doi.org/10.1016/j.jped.2016.03.007
Conclusion: Maternal vitaminEsupplementation increasesthesupply ofthevitamintothe infantbyprovidingmorethantwicetheRecommendedDailyIntake.
©2016SociedadeBrasileiradePediatria.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/
4.0/).
PALAVRAS-CHAVE
Suplementac¸ão
materna;
VitaminaE;
Alfa-tocoferol; Requerimento nutricional; Recém-nascido;
Colostrohumano
Efeitodasuplementac¸ãomaternacomvitaminaEsobreaconcentrac¸ãode
␣-tocoferolnocolostro
Resumo
Objetivo: Avaliaroefeitodasuplementac¸ãomaternacomvitaminaEsobreaconcentrac¸ãode ␣-tocoferolnocolostroeofornecimentodestaparaorecém-nascido.
Método: Oestudoclínicorandomizadofoirealizadocom99parturientesadultasesaudáveis, sendo39alocadasnogrupocontrolee60nogruposuplementado.Apósjejumnoturno,foram coletadas 5mLdesanguee2mL decolostrodasparturientes.Apósaprimeiracoleta(leite 0h),ogruposuplementadorecebeusuplementac¸ãocom400UIdevitaminaE.Foirealizada novacoletade2mLdecolostro,emambososgrupos,24hapósasuplementac¸ão(leite24h). AsamostrasforamanalisadasporCromatografiaLíquida deAltaEficiência.Aquantidadede ␣-tocoferolfornecidapelocolostrofoiconsideradaparaumaingestãodiáriade396mLdeleite ecomparadacomaIngestãoDiáriaRecomendadaparacrianc¸asde0a6meses(4mg/dia). Resultados: Aconcentrac¸ãomédiainicialde␣-tocoferolnocolostrofoi1509,3±793,7g/dL nogrupocontrolee1452,9±808,6g/dLnogruposuplementado.Após24horasaconcentrac¸ão médiade␣-tocoferolnogrupocontrolefoi1650,6±968,7g/dL(p>0,05),jánogrupo suple-mentado aconcentrac¸ão média foi 2346,9±1203,2g/dL (p<0,001), aumentandoassim a ofertadevitaminaEparaorecém-nascidopara9,3mg/dia.Inicialmente18mulheresdogrupo suplementadoforneciam valores inferioresa4mg/diade␣-tocoferolem seucolostro, após suplementac¸ãoapenas6continuaramafornecerquantidadeinferioraorecomendado. Conclusão: Asuplementac¸ãomaternacomvitaminaEpromoveoaumentodofornecimentoda vitaminaparaorecém-nascido,fornecendomaisdoqueodobrodaIngestãoDiária Recomen-dada.
©2016SociedadeBrasileiradePediatria.PublicadoporElsevierEditoraLtda.Este ´eumartigo OpenAccesssobumalicenc¸aCCBY-NC-ND(http://creativecommons.org/licenses/by-nc-nd/4.
0/).
Introduction
VitaminEisthegenerictermusedtodescribeeight
differ-entmolecules:␣-,-,␥-,and␦-tocopheroland␣-,-,␥-,
and␦-tocotrienol.1 Among them,␣-tocopherolis theonly
isomerrelatedtonutritionalneedsofvitaminE.VitaminE isconsideredoneofthebestbiologicalantioxidantsdueto theprotection offeredtothe plasmamembrane and low-density lipoproteins against oxidation reactions and lipid peroxidation.2
Newborns are considered high-risk for vitamin E defi-ciency due to oxidative stress generated by postnatal transitionfromtheintrauterineenvironment,relativelylow in oxygen, tothe extrauterine one, significantly richerin oxygen.3Consideringthisvitamindeficiencyrisk,itis
rec-ommendedthatthe␣-tocopherolintakeduringthefirstsix monthsoftheinfant’slifebe4mg/day.4
It is knownthatthe placentaltransfer of␣-tocopherol fromthe mothertothe infantis limited, evenifthereis an increase in maternal intake of vitamin E.5 Thus, the
newborn may have low reserves of vitamin E, making it necessary that breast milk provide an adequate amount of vitamin E toensure the formation of vitamin reserves and reinforce the newborn’s defenses against oxidative stress.6
Insufficient intake of this nutrient at this stage of life (especiallyfromthe6thto8thweek)canaffectthe devel-opmentoftheimmuneandpulmonary systems.7 However,
ifregularbreastfeedingoccurs,nutritionaldeficiency symp-tomsaregenerallynotobservedinchildren.8
VenoussupplementationwithhighdosesofvitaminEin infantsincreasestheriskofsepsisandreduces supplemen-tationefficiencyinfightingsevereretinopathy.9Therefore,
maternalsupplementationtoimprovethenutritionalstatus oftheneonatethroughsatisfactoryamountsof␣-tocopherol providedby colostrumbecomesthesafestwaytoprevent possiblevitaminE deficiency,asitwillbe slowlyreleased duringthefeedings,contributingtotheformationofbody reserves,sinceplacentaltransferislimited.6
Thus,theaimofthisstudywastoinvestigatetheeffect ofmaternalsupplementationwithvitaminEonthe concen-tration of ␣-tocopherolin colostrum andconsequently on thesupplyofthisvitaminfortheneonate.
Methods
Ethicalconsiderations
ThestudywasapprovedbytheResearchEthicsCommittee
---REC daUniversidadeFederal do RioGrandedo Norte
Studypopulation
Forthe calculation ofthe requiredminimumsample size,
deductivepoweranalysiswasused,throughGPower®
soft-ware,version3(GPower®,Germany).Theparameterstaken
intoconsideration were:effectsize d=0.5,probabilityof
error ˛=0.05, power test ˇ=0.95, and a 95% confidence
interval. Using these parameters, the minimum required
sampleconsistedof22subjectsfor eachgroup.Atotalof
99adultand healthypregnantwomenparticipated inthis
study;39wereallocatedtothecontrolgroupand60tothe
supplementedgroup.
Sampling was carried out by convenience, comprising
pregnant, female volunteers aged 18---40 years, without
pathologies (diabetes, hypertension, cancer, diseases of
thegastrointestinaltract,liver,heartdiseases,infections,
syphilisand/orHIVpositive),whohaddeliveredafull-term,
singleinfantwithoutmalformationsanddidnotusevitamin
supplementsduringpregnancy.
Studydesign
The randomized clinical trial was carried out from
Jan-uary2012toMarch2013,attheMaternitySchool,inBrazil.
Womenthatmettheresearchcriteriawereinvitedto
partic-ipateinthestudyandsignedtheFreeandInformedConsent
(FIC).
Everymotherwhoacceptedtoparticipateinthestudy
wasallocated toa group, i.e., the control group (CG) or
the supplemented group (SG), by drawing lots, with the
latterreceivingcapsulescontaining400internationalunits
(IU) ofalpha-tocopherol. Randomization wasusedsothat
allwomenwouldhavethesamechance ofbeingsortedto
eitherofthetwogroups.
Blood(5mL) andcolostrum milk(2mL) werecollected
from each participant in the morning hours after an
overnightfast.Thecollectionofmilkoccurredintwostages,
thefirst(0h)attheinitialcontactwiththemotherandthe
second24hours(24h)afterthefirstcollection.The
moth-ersbelongingtothesupplementedgroupreceivedacapsule
containing400IUofalphatocopherol,respectively,afterthe
firstmilkcollection(0h).
Thedatarelatedtomaternalandneonatal
characteris-ticswereobtainedfromfiles.
Samplecollectionandpreparation
Bloodcollectedbyvenipuncture(5mL)bynursesondutyat
thematernitywereplacedinpolypropylenetubesprotected
fromlightandtransportedtothelaboratoryunder
refriger-ation;theywerethencentrifugedtoremoveof1000Lof
serum,thenstoredat−18◦C.
Colostrum was obtained by manual expression of one
breast,always at the end of the feeding toprevent
fluc-tuationsin fat and tocopherol content. The foremilk was
discardedand2mLwerecollectedattime0handanother
2mLsampleafter24h.Theseprocedureswereperformed
bythestudyauthorsthemselves.Asforthesupplemented
women, milk samples were collected 24h after
supple-mentation. The samples were collected in polypropylene
tubes protected from the light and transported under
refrigeration,thenweresenttothelaboratory;colostrum
sampleswereplacedinawaterbathat37◦Cfor15minand
homogenized and then a500L sample wasremoved and
storedat−18◦C.
Proceduresfortheanalysis
Thetechniqueusedforextractingthetocopherolinserum
was adapted from Ortega et al.10 To 2mL of serum, an
equalamount of95% ethanolwasadded,themixturewas stirred,and 2mL ofhexane wereadded forthree extrac-tion steps; each of the steps was stirredand centrifuged (10min,1073×g),andtheorganicphasecontaininghexane wasseparated,totaling6mL.
ThemethodologyadaptedfromRomeu-Nadaletal.11was
usedforthemilk.To0.5mLofcolostrumwasadded0.5mL of95%ethanol.Next,thetubewassubmittedtomechanical agitationfor1minandtheextractionprocesswasperformed intwostepswith2mLofhexane,resultingina4mL extrac-tionofthehexanephase.
Of the organic compounds obtained from both sam-ples, 2mL wereevaporated usingnitrogen, and thedried extractwasdissolvedin0.5mLofabsoluteethanolfor fur-ther analysisby HighPerformance Liquid Chromatography (HPLC).
The ␣-tocopherol concentrations were determined by HPLC in a Shimadzu® LC-20AT (Shimadzu®, USA) chro-matograph,equippedwitha20Lloopinjector,CBM 20A (Shimadzu®, USA) communicator, and coupled to a SPD-20A UV-VISdetector(Shimadzu®, USA),withUVdetection (max=292nm).
The chromatographic separation wascarried out in an LC Shim-Pack® CLC-ODS(Shimadzu®,USA) 4.6mm
×25cm reversed phase-column. The elution was isocratic with a mobilephase,consistingofmethanol/ultrapurewater (Milli-Q®,MilliporeSigma®,Merck,Germany)in97:3(v:v)witha 1.0mL/minflow.Thechromatogramswereintegratedusing theLCSolution®program(Shimadzu®,USA).
Theidentificationandquantificationofthe␣-tocopherol inthesampleswasestablishedbycomparisonofthepeak retentionareaobtainedinthechromatogramwiththearea oftherespectiveSIGMA®(Sigma®,Merck,Germany) alpha-tocopherolstandard.Theconcentrationofthestandardwas confirmedbythespecificextinctioncoefficientinabsolute ethanol,ε1%,1cm=75.8.
Confirmationofcapsuleconcentration
Toverifywhetherthecapsulescontained400IUofVitamin
E, theywereopened andthen analiquot of each capsule
wasweighed,whichwasplacedinapolypropylenetube
pro-tectedfromlightandaddedto1mLofHPLCgradeEthanol.
SIGMA® (Sigma®, Merck, Germany)␣-tocopherol was
simi-larlyproduced.
Theidentificationandquantificationofthe␣-tocopherol
in the capsules were established by comparing the peak
area obtained in the chromatogram with the area of the
respective alpha-tocopherolSIGMA® (Sigma®, Merck,
Ger-many)standard, aswellasthroughthespecific extinction
coefficientinabsoluteethanolof␣-tocopherolacetateε1%,
The capsules contained ␣-tocopherol at the
concen-trations stated on their labels, demonstrating the actual
amountprovidedbythecapsule.
Statisticalanalysis
Statistica7software(StatSoftInc.,USA)wasusedfor
sta-tistical analysis. Alpha-tocopherol values were expressed
as mean and standard deviation. To test the differences
between the means of parametric numerical data,
Stu-dent’s t-test was used in paired samples. Differences
were considered significant at p<0.05. The association
betweencontinuousvariables(concentrationofnutrientsin
milk andserum) was determinedby Pearson’s correlation
analysis.
Nutritionalneeds
Theamountof␣-tocopherolprovidedbycolostrumwas
con-sideredforadailyintakeof396mLofmilk,relatedtothe
averageproductionofmilkduringthefirstweekafter
deliv-eryofmothersthathadfull-termnewbornsandcompared
withthedietaryreferenceintake(DRI)forchildrenaged0---6
months,theequivalentto4mg/day.4,12
Results
Descriptionofthepopulation
Atotalof99womenparticipatedinthestudy,with39
allo-cated to the control group and 60 to the supplemented
group.
The mean age in yearswas24±6, most weremarried
orlivinginastableunion(65%),andthelevelofeducation
wasvaried:36%ofwomendidnotcompleteprimary
educa-tion,whereasonly0.9%attendedcollege/university.Family
incomeranged between 1and 4minimum wages(81.4%).
Themeannumberofresidentsinthehouseholdsofpregnant
womenwas5.4±1.6people,withaminimumvalueof2and
maximumof10.
Regardingobstetricvariables,53.1%of womenhadhad
anotherpregnancy;themaintypeofdeliverywascesarean
section (58.1%) with a mean of 39.1±1.4 weeks of
ges-tation. Mostwomen started the pregnancywith a normal
weight(51.2%); however,there wasatrend for increased
weightgaintotaling46.1%of womenwithoverweightand
obesityattheendofthepregnancy.
Concentrationsof␣-tocopherolinserum
The mothers had a mean concentration of ␣-tocopherol
inserumof1066.6±287.7mg/dLand1159.6±350mg/dL,
respectively in the CG and SG, with no significant
difference(p=0.41) between them. Overall, 6.1% of
par-ticipants (n=6) had serum levels indicating low levels
of ␣-tocopherol (ranging from 499.6 to 697.7mg/dL),
while 3.0% (n=3) had ␣-tocopherol deficiency
(lev-els<499.6mg/dL).13
Concentrationsof␣-tocopherolincolostrumand responsetosupplementation
The mothers had a mean concentration of ␣-tocopherol
in colostrum of 1509.3±793.7 and 1452.9±808.6mg/dL
respectively, in the CGand SG groups at time0h. It was
found that the concentrations of ␣-tocopherol were
sim-ilar in all groups, with no evidencethat the mean levels
in the groups at 0h were different (p=0.74). This fact
corroboratesthehomogeneity ofthegroups,showingthat
participants initially had similar ␣-tocopherol
concentra-tionsincolostrum.
After supplementation, the mean concentration of ␣
-tocopherol in the mothers’ colostrum was 1650.6±968.7
and2346.9±1203.2mg/dLintheCGandSGgroups,
respec-tively.
When comparingthe concentrations of␣-tocopherolin
colostrumattimes0hand24h,itwasobservedthatwomen
whodid notreceive supplementation(CG)showed similar
concentrations at both moments (p=0.33). However, the
mean␣-tocopherolconcentrationsinsupplementedwomen
increased the concentration of ␣-tocopherol secreted in
colostrumby61%(p<0.001).
Newborn’snutritionalneeds
Before supplementation, the CG and SG groups provided
amountsof␣-tocopherolrespectivelygreaterthan4mg/day
recommendedforchildrenaged0---6months(Table1).The
lowest value was0.66mg and thehighest was14.9mg of ␣-tocopherolfor396mLofcolostrum.
Inthecontrolgroup(CG),themean␣-tocopherolsupply remained unchanged, as this group received no supple-mentation, whereas the SG group, which received the supplementation,startedtoprovideonaverage3.6mg/day more␣-tocopherolfor396mLofcolostrum24hafter supple-mentation.
When individually analyzing the women in the control group, 33% (n=13) showed values below 4mg/day of ␣ -tocopherolintheircolostrumbeforethesupplementation, while 30% (n=18) of the supplemented group of women had the same amount of vitamin E. After supplemen-tation,only10%ofthewomen(n=6)showedvaluesbelow the 4mg of ␣-tocopherol for the newborn, while in the CG, 28% (n=11) of women stilldid not provide adequate amounts.
When assessing the␣-tocopherolconcentrations in the colostrumof supplementedwomenwhocouldnotprovide therecommendedvaluesintheirmilkevenafteringestion of400IU of vitamin E, itwas verifiedthat thesemothers
Table1 Supplyof␣-tocopherol(mg/day)fromcolostrum at0hand24h,accordingtotheexperimentalgroups.
Group [␣-TOH] colostrum0h
[␣-TOH] colostrum24h
p-value
CG 5.9mg/day 6.5mg/day 0.33 SG 5.7mg/day 9.3mg/day <0.001
hadin commonan initialconcentrationof␣-tocopherolin
colostrumlowerthan2mgfor396mL.
Discussion
The health ofpregnant women andnewborns depends on
adequate maternal nutrition. Nutrition during pregnancy
is, therefore, decisive for the gestational course and the
formationofreservesforlactation.Duringpregnancy,
symp-toms suchasnausea, vomiting, andheartburn maycause
areductioninfoodintake,especiallyconsideringthatfats
arenotwell tolerated.14 The reductionof thisintakecan
leadtoreducedconsumptionof␣-tocopheroland,thus,itis importanttoverifyifthemotherhasnutritionallyadequate plasmaconcentrationsofthisvitamin.
According to Sauberlich et al.,13 the concentration of
␣-tocopherol in serum must be greater than or equal to 697mg/dL. Based on these reference values, the study showedanaverageconcentrationconsideredtobe accept-ableregarding ␣-tocopherol parametersin serum. Similar concentrationswerefoundinthestudiesbyPapasetal.,15
Garciaetal.,16andDimensteinetal.17
Whenindividuallyanalyzing thebreastfeedingmothers, 6.1%ofthemhadlownutritionalstatusfor␣-tocopherol,a differentprevalencefromthatinthestudybydeLiraetal.18
carriedoutatthesamehospital,whichfoundapercentage of12%ofwomenwith␣-tocopheroldeficiency.This differ-encecan beexplainedbythe participationof adolescents inthesamplegroup.
The concentration of ␣-tocopherol in 0h colostrum of the twogroups was withinthe expectedwhen compared to studies carried out in Brazil by Dimenstein et al.,17
who found an average concentration of ␣-tocopherol of 1603.4±911mg/dL, and Campos et al.,19 who found
1313.9±798.7mg/dL. Studies in the United States20 and
Turkey21 showedsimilarresultstothoseinthiswork,with
␣-tocopherol values in colostrum of 1335.2±198.1 and 1326.6±68.9mg/dL,respectively.
RegardingtheeffectofusingvitaminEsupplementson the increase in ␣-tocopherol in breast milk, studies with humansarestillcontroversial.
Szlagatys-Sidorkiewiczetal.,22 inastudy conductedin
Poland, showed that the concentration of vitamin E in milkwasnothigherinwomenwhoreceivedrecommended vitaminsupplementsforpregnantandlactatingwomen com-pared to those who did not (p=0.332). Also in Poland, Martysiak-Zurowskaetal.23 obtainedsimilarresults,
show-ingnocorrelationbetweendietaryintakeofvitaminEand the use of supplements withthe concentration of alpha-tocopherolinbreastmilk.
However, a study in Canada found that there was a positive correlation between vitamin E found in milkand multivitamin supplementation reported by the research participants.24InastudyoftheBrazilianpopulation,Garcia
etal.25 observedthat24haftervitaminEsupplementation
there was a significant increase in the amount of alpha-tocopherolincolostrum(p=0.04).
Based on the established reference values for ␣ -tocopherol intake, the groups provided on average quantities >4mg/day, whereas the supplemented group showedanincreaseof61.5%.
However,nooneknowswithcertaintywhether4mg/day of␣-tocopherolissufficientatthisstageoflactation,since forthedeterminationof␣-tocopherolDRIforinfantsaged 0---6 months, only theaverage intake of thisnutrient was analyzed after two months of lactation.4 Thus, the first
monthoflifehasnotbeenaccountedfor,aphaseinwhich the newbornexperiencesan imbalanceof theantioxidant system due to the transitionto the extrauterine environ-ment,whichissignificantlyricherinoxygen.3
Inadditiontothis increasedrisk of oxidative stress, it isnecessarytotakeintoaccountcertainfactorsthatcause variations in nutrient intake from colostrum,such as dif-ferences in the milk intake volume and concentration of nutrientsduringearlylactation,factorsthatwerenot con-sideredtoestablishtheDRI,whichmayunderestimatethe neonate’srealneeds.
Studiesonthebenefitsof␣-tocopherolsupplementation innewbornsarestillscarce;however,ithasbeenreported that supplementation in the group of low birth weight infants has shown benefits that go beyond the reduction ofoxidativestress.Kitajimaetal.26foundthat
supplemen-tationwith␣-tocopherolcanimprovementaldevelopment of infants with low birth weight, especially regarding IQ performance at school age, indicating that ␣-tocopherol may be an essential nutrient for mental development in childhood.
ThisstudyisinaccordancewiththeresultsfoundbyChen etal.27that,whileassessingthelevelsofvitaminA,C,and
E inthemotherandchild, found thatnewborn’s levelsof ␣-tocopherolweredirectlyassociatedtomotor,behavioral development,anddevelopmentalquotient.
However,itisknownthatprematureinfantshaveahigher riskofdevelopingcomplicationsresultingfromintravenous supplementationwithvitaminE,suchasthedevelopmentof sepsisandnecrotizingenterocolitis.28 Facedwiththisrisk,
itwouldbesafertorecommendmaternalsupplementation of␣-tocopherol,withthevitaminbeingtransferredtothe infantthroughbreastmilk.Itisknownthatbreastmilkoffers severalbenefitstothenewborn,asitisanutritionally-rich foodandisfreefromimpurities,beingabletoreduce mor-bidityandmortalityandpromotehealthbenefitsinthelong term.29
Based on the results observed in the study, it was foundthatthemothersoftheassessedpopulationprovided tocopherol levels above the adequate intake (AI) before supplementation; however, such supply was increased by 61.5%aftersupplementation.
This increase in vitamin supply was also observed by Clement et al.30 in women supplemented with vitamin E
capsulesineithernaturalorsyntheticform;however,with better results than those who received RRR-␣-tocopherol capsules.
Inwomenwhose ␣-tocopherol concentrationsin breast milkwerelessthan4mg/day,anincreaseofvitaminEinmilk occurredaftersupplementationsimilarlytotheother moth-ers;however,duetothelowinitiallevelsofthevitamin,it failedtomeettheinfant’snutritionalneeds.
Maternal supplementation provides an increase in the supply of ␣-tocopherol,which bringsbenefits tothe new-born, contributing to the neonate’s motor and mental development,26,27 as well as strengthening the defenses
The study shows that supplementation with 400IU of ␣-tocopherol in the postpartum promotes an increase in ␣-tocopherol concentrationsin colostrum,a crucialphase for the neonate. Therefore, supplementation is recom-mended for women in the postpartum period, with a mega dose >400IU or dailysupplementationat doses that meet the DRI, in order to meet the needs of all the mothers.
Although supplementation provides an increase in ␣-tocopherollevels,factorsthatinterferewiththis supple-mentationhavenotbeeninvestigated,particularlyvitamin Eandfatintakeduringpregnancy,whichcanbeconsidered astudylimitation.Anotherfactortobetakeninto consid-erationisthat,becauseitisacross-sectionalstudy,itwas notpossibletoverifythepossibilityofmaintainingvitamin Elevelsduringotherstagesoflactation.
Funding
Conselho Nacional de Desenvolvimento Científico e
Tec-nológico---CNPQ.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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