Liu, Z., Diana, A., Slater, C., Preston, T. , Gibson, R. S., Houghton, L. and Duffull, S. B. (2019) Development of a nonlinear hierarchical model to describe the disposition of deuterium in mother-infant pairs to assess exclusive breastfeeding practice. Journal of Pharmacokinetics and Pharmacodynamics, 46(1), pp. 1-13. (doi: 10.1007/s10928-018-9613-x) (PMID:30430351) (PMCID:PMC6394541)
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Abstract
The World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months after birth. The deuterium oxide dose-to-the-mother (DTM) technique is used to distinguish EBF based on a cut-off (< 25 g/day) of water intake from sources other than breastmilk. This value is based on a theoretical threshold and has not been verified in field studies. The aim of this study was to estimate the water intake cut-off value that can be used to define EBF practice. One hundred and twenty-one healthy infants, aged 2.5-5.5 months who were deemed to be EBF were recruited. After administration of deuterium to the mothers, saliva was sampled from mother and infant pairs over a 14-day period. Validation of infant feeding practices was conducted via home observation over six non-consecutive days with caregiver recall. A fully Bayesian framework using a gradient-based Markov chain Monte Carlo approach implemented in Stan was used to estimate the cut-off of non-milk water intake of EBF infants. From the original data set, 113 infants were determined to be EBF and provided 1500 paired mother-infant observations. The deuterium saliva concentrations were best described by two linked 1-compartment models (mother and infant), with body weight as a covariate on the mother's volume of distribution and infant's body weight on infant's water clearance rate. The cut-off value was based on the 90th percentile of the posterior distribution of non-milk water intake and was 86.6 g/day. This cut-off value can be used in future field studies in other geographic regions to determine exclusivity of breast feeding practices in order to determine their potential public health needs.
| Item Type: | Articles |
|---|---|
| Additional Information: | This research is part of the ‘‘Developing biomarkers of exclusive breastfeeding practice’’ project, which is supported by Bill and Melinda Gates Foundation (Grant No. OPP1127870). |
| Keywords: | Bayesian, Breastfeeding, Deuterium-oxide turnover method, Human milk, MCMC, Pharmacokinetics, Stan |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Preston, Professor Tom |
| Authors: | Liu, Z., Diana, A., Slater, C., Preston, T., Gibson, R. S., Houghton, L., and Duffull, S. B. |
| College/School: | College of Science and Engineering > Scottish Universities Environmental Research Centre |
| Journal Name: | Journal of Pharmacokinetics and Pharmacodynamics |
| Publisher: | Springer |
| ISSN: | 1567-567X |
| ISSN (Online): | 1573-8744 |
| Published Online: | 14 November 2018 |
| Copyright Holders: | Copyright © 2018 The Authors |
| First Published: | First published in Journal of Pharmacokinetics and Pharmacodynamics 46(1):1-13 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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