1134 The American Journal of Clinical Nutrition 29: OCTOBER 1976, pp. 1134-1141. Printed in U.S.A.

Breast milk composition in Ethiopian and

Swedish mothers. II. Lactose, nitrogen, and
protein contents13
Bo L#{246}nnerdal,4 Ph.D., Elisabeih Forsum,5 Ph.D., Mehari Gebre-Medhin,6 M.D., M.P.H.
and LeijHarnbraeu.s,7 M .D.
ABSTRACT Breast milk from underprivileged and privileged Ethiopian mothers was collected at
different stages of lactation and analyzed for total nitrogen, nonprotein nitrogen, lactose, and
individual milk proteins (lactoferrin, is-lactalbumin, serum albumin, IgG and 1gM). These values
and the milk volume of one meal were compared to corresponding results from well-nourished
Swedish mothers. No significant differences between the levels of these constituents or the milk
volumes were found between the two groups of Ethiopian mothers. W hen comparison was made be-
tween breast milk from these two Ethiopian groups and the Swedish group, the former two showed
significantly higher values for the iron-binding protein lactoferrin. Am.J. C/in. Nutr. 29: 1134-
1141, 1976.
Human milk is the first food after birth for
the majority of children. In many countries,
especially the developing ones, it is the only
food up to the age of 4 to 6 months. Breast
milk is by nature extraordinarily well adapted
to the needs ofthe infant and its superiority in
feeding infants has been undisputed through-
out the years. The estimated requirements of
infants for proteins (1) and many other
nutrients are, therefore, based on the com-
position of breast milk. Breast-fed infants are
less liable to infections than bottle-fed infants
(2). In areas where nutritionally adequate
supplementary foods are scarce breast milk is
a valuable supplement during the second year
of life.
Concomitant with the increased availabil-
ity and use of artificial formulae a declining
trend in the frequency and duration of breast
feeding has been observed in most pants of the
world in recent years (3, 4). Although nutri-
tionally adequate for the maintenance of
growth these artificial substitutes lack some
of the unique features of human milk. Breast
milk, for example, contains substantial
amounts of secretory IgA (5) and the iron-
binding protein lactofennin (6) both of which
are known to enhance resistance to infection.
Breast milk also contains comparatively high
levels of the enzyme lysozyme (7), which is
capable of degrading bacterial cell wall, and
relatively lange amount of a B52-binding pro-
tein that has been shown to compete with
B12-removing microorganisms thereby acting
bacteniostatically (8). Another unique feature
is the pattern of essential amino acids and the
high content of nonprotein nitrogen (NPN)
(9).
It has been proposed that the quantity and
quality of breast milk are adversely affected
by maternal undernutrition but hitherto con-
ducted studies are inconclusive. Gopalan (10)
showed that the growth pattern of breast-fed
infants belonging to undernourished mothers
was satisfactory, suggesting adequate milk
production. These results have subsequently
been confirmed by other authors (Il, 12). In
From the Institute of Nutrition, University of Upp-
sala, Box 551, S-751 22 Uppsala, Sweden and the
Ethiopian Nutrition Institute, Addis Ababa.
2This paper is also listed as no. III in the series The
protein content of human milk published by the Insti-
tute of Nutrition, Uppsala.
Financial support was provided by the Swedish
International Development Authority (SIDA) and the
Swedish Medical Research Council (MFR) (project no.
B76- 19X-4722-Ol.
Assistant Professor of Nutrition. Assistant
Professor of Nutrition. 6 Director, Ethiopian Nutri-
tion Institute. Professor of Nutrition, Institute of
Nutrition, Uppsala.

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BREAST MI L K COMPOSI TI ON 1135
contrast, some investigators have shown re-
duced lactation performance in malnourished
women (13, 14). Of special interest are the
observations made by Deb and Cama (15)
and of Lindblad and Rahimtoola (16), indi-
cating impaired protein quality in the milk
from severely malnourished mothers.
The present study describes the protein
composition of milk from mothers belonging
to two different socioeconomic groups in
Ethiopia. The results obtained are compared
to normal data, reported earlier (17), which
are based on milk samples collected from
well-nourished Swedish mothers.
M aterial
Ethiopia
The Ethiopian mothers were all recruited from a
comprehensive study of the nutritional aspects of preg-
nancy and lactation directed by Ethiopian Nutrition
Institute (ENI). They represent two different socioeco-
nomic groups.
The nonprivileged group, comprising 78 mothers,
w as selected from a m unicipal antenatal clinic in the
Kirkos area of Addis Ababa. All the mothers were
illiterate and had a family income of less than Eth $100
(Eth $1.00 = US $0.50). This group consumes a
m onotonous diet with an average dietary protein and
energy intake less than 60% of that recommended by
FAO/W HO. Of the protein 97% is of plant origin. In
effect, this diet is inadequate in all respects except for
iron and thiamine (18).
The privileged group, comprising 26 mothers. were
recruited from an antenatal clinic for paying patients in
the D epartm ent of O bstetrics and G ynaecology, A ddis
Ababa University (formerly Haile Selassie University).
Both the mothers and their spouses in this group had
com pleted at least secondary school education and their
family income was generally above Eth $600 per month.
The dietary intake of energy and nutrients in this group
was ample (18).
The study was conducted during the period April to
S eptem ber 1973. Healthy, lactating mothers without
glucosuria or albuminuria, with normal blood pressure,
and having no clinical symptoms of acute or chronic
disease were selected consecutively from both clinics.
Further data related to dietary intake, hem atological,
and biochem ical characteristics in the third trimester of
pregnancy are presented elsew here (18, 19; M . G ebre-
M edhin et al., m anuscript in preparation).
Sweden
The Swedish group of mothers were all healthy and
socioeconomically and educationally privileged. In com-
mon with practically 100% of contemporary Swedish
m others they all gave birth to their babies in a hospital
and stayed in the w ard during S to 7 days after the
delivery.
M ethods
Milk collectioti
Ethiopia. Samples were collected in the morning at a
special clinic at ENI. Mothers were instructed not to
breast-feed their children after midnight prior to milk
collection. The milk samples were taken after overnight
fasting (for the purpose of blood collection). Both breasts
were emptied using an electric pump (Sister Majas
breast pump; Pump Egnell AB, Trollh#{228}ttan, Sweden), of
the type used in Sweden for many years. Pumping was
continued until milk no longer appeared in jets but
merely in a trickle or drop-wise. All samples were
collected by one person and, after registration of volume,
were placed in a deep freeze at -20 C within less than I
hr after collection. The samples were subsequently
transported in a frozen condition to Sweden by direct
flight in special containers with dry ice and stored at
-70 C.
Sweden. Milk samples from the second meal on the
4th and 5th day post partum were collected by a nurse
while the mother was still in the maternity ward. Mothers
whose children were 3 weeks old or older were visited in
their homes by a nurse. The day before the samples were
collected, the mother was instructed on how to weigh the
child before and after each feeding throughout 24 hr
starting early in the morning. On the sampling day. the
nurse visited the mother at the second meal of the day
when the infant was allowed to nurse on one breast while
the other was emptied by pumping. After mixing, a 20-mI
aliquot was taken for analysis and the rest of the milk
was offered to the child. In some instances samples were
kept in an ordinary refrigerator for up to I week before
being placed in a deep freeze at -70 C.
Further details regarding the clinical material and
sampling procedures in both the Ethiopian and Swedish
groups are found in the first of these series of investiga-
tions (20).
A nalvtical procedures
Methods for estimation of total nitrogen, NPN, lac-
toferrin, serum albumin, a-lactalbumin, lgG, 1gM, and
lactose are given in a companion paper. Information
regarding the statistical evaluation can also be found in
this paper (17).
R esults
The nitrogen distribution, lactose concen-
tration, and milk volume of the first meal of
the day for each period of lactation for
Ethiopian and Swedish mothers are shown in
Table 1 . The individual values of total nitno-
gen and nonprotein nitrogen obtained from
the Ethiopian mothers are compared with the
Swedish normal material in Figure 1. The
total nitrogen concentration decreases rapidly
during the first 20 days of lactation to reach
the level of mature milk. As shown in Table I
the nitrogen concentration in one of the

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To t al n i t r o g en #{149}non-pnviteged
0 pr i v i Le ge d
*non-priviteged
Non-protein nitrogen
A priviLeged
8
2 O
1.0
.. S#{ 149}
.. 8 #{149}
S.
2 I I t . , I . .
I I 3 6 L ONNERDAL ET AL .
FIG. I . Concentrations of total nitrogen and nonprotein nitrogen in milk from Ethiopian mothers belonging to two
socioeconomic groups compared to milk from well-nourished Swedish mothers. S olid line in the middle of striped
area = regression line for the Swedish material. S triped area = tolerance interval to the regression line.
T ABL E I
Nitrogen distribution, lactose concentration, and milk volume (first meal of the day)a
Months post
pa r t um
0-0.5 0.5 I .5 I .5 3.5 3.5 6.5 6.5
To t al n i t r o g en
(mg/mI)
Eth. nonprivileged
Eth.privileged
Swe. privileged
3.14 0.83
3.05 0.59
2.50 O.l7
2.89 0.59
1.93 0.24
1.77 0.33
1.97 0.29
1.61 0.21
1.69 0.30
1.48 0.17
1.74 0.30
NPN
(mg/mI)
Eth. nonprivileged
Eth. privileged
Sw e. p r i v i l eg ed
0.46 0.06
0.53 0.09
0.43 0.05
0.46 0.08
0.46 0.03
0.36 0.05
0.41 0.05
0.41 0.04
0.34 0.05
0.38 0.07
0.33 0.05
Lactose
( % w/v)
Eth. nonprivileged
Eth. privileged
Sw e. p r i v i l eg ed
6.46 0.89
5.93 0.58
7.42 0.51
6.60 0.63
7.02 0.56
7.43 0.48
7.64 0.16
7.33 0.47
7.49 0.31
7.64 0.35
7.78 0.48
Mi l k v ol ume
( ml )
Et h. nonpr i v i l e ge d
Et h. pr i v i l e ge d
Swe . pr i v i l e ge d
1 9 7 94
1 5 7 131
169 91
1 2 4 26
153 66
126 61
145 4 4
188 8 8
2 0 6 7 0
1 0 9 72
n Et h. nonpr i v i l e ge d
Et h. pr i v i l e ge d
Swe. privileged
S
15
3
I S
12
1 4
S
12
2 6
11
4 5
2 Val u es ar e m ean SD. Significantly higher than the corresponding value from Swedish mothers (0.001
< P < 0.01). cSignificantly higher than the corresponding value from Swedish mothers (0.01 < P < 0.05).
d5ignificantly higher than the corresponding value from Swedish mothers (P 0.001).
periods of lactation was significantly higher
in the two Ethiopian groups as compared to
the Swedish group. The nitrogen concentra-
tion in milk from nonpnivileged Ethiopian
mothers seems to increase after l70 days of
lactation (Fig. 1). This apparent increase is
not significant if the whole period from 20
days is considered. The concentrations of
nonprotein nitrogenous substances are more
constant throughout the lactation period.
The concentrations of the individual
human whey proteins are shown in Table 2.
The individual values obtained from the Ethi-
opian milks as well as the statistical represen-

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tation of the Swedish normal material are
shown i n Figures 2 to 5. The milk-specific
proteins a-lactalbumin and lactoferrin as well
as 1gM exhibit similar variations in concen-
TABLE 2
Concentrations of individual human whey proteins
tration with time as that of nitrogen. The
concentrations of the nonspecific milk pro-
teins, serum albumin and IgG, are fairly
constant throughout the lactation period.
aValues are mean SD. bsignificantly higher than the corresponding value from Swedish mothers (0.001
< P. < 0.01). cSignificantly higher than the corresponding value from Swedish mothers (P 0.001). dSig
nificantly higher than the corresponding value from Swedish mothers (0.01 < P < 0.05)
Lactose #{149} non-priviLeged
0 privaeged
i : : , : :
a non-privileged
A privileged
I - a
I a a
FIG. 2. Concentrations of lactose and a-lactalbumin in milk from Ethiopian mothers belonging to two socioeco-
nomic groups compared to milk from well-nourished Swedish mothers. S o lid lin e in the middle of s trip e d a re a =
regression line for the Swedish material. S trip e d a re a = tolerance interval to the regression line.
BREAST MI LK COMPOSI TI ON I 137
Monthspost
partum
0--0.5 0.5 .5

. 5 3 . 5 3 . 5 -6 . 5 6.5
Lactoferrin Eth. nonprivileged
Eth. privileged
S w e . p riv ile g e d
3.75 0.93
3.53 0.54
2.64 0.06
3.37 0.71
1.94 0.38
mg/nil
1.67 0.51 1.72 0.67
1.89 0.51
1.65 0.29 1.39 0.26
1.48 0.57
a -La c t a l-
bumin
Eth. nonprivileged
Eth. privileged
S w e . p riv ile g e d
3.70 0.31
3.62 0.59
3.58 0.28
3.72 #{216},35d
3.26 0.47
2.76 0.29 2.65 0.35
2.92 0.39
2.78 0.49 2.68 0.59
2.58 0.37
S e ru m
albumin
Eth. nonprivileged
Eth. privileged
S w e . p riv ile g e d
0.42 0.09
0.39 0.06
0.43 0.02
0.47 0. I I
0.41 0.07
0.36 0.07 0.36 0.08
0.38 0.06
0.39 0.04 0.38 0.04
0.34 0.07
1 g M Eth. nonprivileged
Eth. privileged
S w e . p riv ile g e d
0.087 0.070
0.156 # {2 1 6 }, # {2 1 6 }9 5 c
0.094 0.090d
0.045 0.025
0.027 0.023
0.029 0.0 1 3 0.030 0. 180
0.033 0.028
0.021 0.015 0.016 0.012
0.040 0.049
Ig G Eth. nonprivileged
Eth. privileged
S w e . p riv ile g e d
0.068 0.042
0.032 0.023
0.045 0.012
0.067 0.020
0.027 0.018
0.033 0.01 1 0.048 0.024
0.046 0.012
0.027 0.01 I 0.027 0.014
0.039 0.029

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I
L a c t o f e r r i n n o n - p r i v i L e g e d
apriviLeged
Serum atbumm #{149} non-priviLeged
. priviLeged
#{149} .
a
I
I #{149}1
I
I
# {1 4 9 }1
FIG. 3. Concentrations of lactolerrin and serum albumin in milk from Ethiopian mothers belonging to two socio-
economic groups compared to milk from well-nourished Swedish mothers. S olid line in the middle of striped area =
regression line for the Swedish material. S triped area = tolerance interval to the regression line.
IgG non-priviLeged
0 priViLeged
FIG. 4. Concentrations of immunoglobulin G in milk from Ethiopian mothers belonging to two socioeconomic
groups compared to milk from well-nourished Swedish mothers. S olid line in the middle of striped area = regression
line for the Swedish material. S triped area = tolerance interval to the regression line.
1138 LONNERDAL ET AL.
Figure 2 shows the concentrations of lactose together with serum albumin. Lactofennin
and one of the major human whey proteins, decreases rapidly during the first days of
a-bactalbumin. The concentration of lactose lactation to reach a constant level after about
increases with the time of lactation while that 20 days. A significantly higher concentration
of a-lactalbumin decreases. of lactoferrin was found in Ethiopian breast
The concentration of another major whey milk as compared to Swedish milk during the
protein, lactofennin, is shown in Figure 3 period 0.5 to 1.5 months (Table 2). This

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#{149} non-priviLeged
1 g M #{149} priviLeged
BREAST MI L K COMPOSI TI ON 1139
FIG. S. Concentrations of immunoglobulin M in milk from Ethiopian mothers belonging to two socioeconomic
groups compared to milk from well-nourished Swedish mothers. Solid line in the middle of striped area = regression
line the Swedish material. Striped area = tolerance interval to the regression line.
difference seems to be responsible for the
higher nitrogen concentration found in Ethi-
opian milk. However, this difference becomes
less pronounced as lactation proceeds. The
concentration of serum albumin is constant
throughout lactation and this is probably
explained by a passive transport of serum
albumin from the blood to the breast milk.
Figures 4 and 5 show the concentrations of
the immunoglobulins IgG and 1gM. The
concentration of 1gM was significantly higher
in the nonprivileged group of Ethiopian
mothers than in the Swedish group. In the
Ethiopian privileged group the IgG concen-
tration was higher than in the other groups.
Generally no significant differences in the
concentrations of individual proteins between
the two Ethiopian socioeconomic groups were
obtained, although they all were somewhat
higher in the privileged group (Table 2).
D iscussion
According to earlier studies little diurnal
variation in lactose (21) and protein (22)
contents have been found in breast milk.
Similanily the contents of different nitrogen
fractions as casein-N, albumin-N, NPN, and
amino acid-N (22) have been reported to
remain comparatively constant through the
day. These facts seem to justify the compani-
son of milk obtained from the second meal of
the day from Swedish mothers to milk
obtained from the first meal of the day from
Ethiopian mothers. However, no data are
available regarding diurnal variation of mdi-
vidual whey proteins. This is presently under
study and a minor reservation should be made
until complete information on this subject is
obtained.
The samples from the three groups differ
with respect to the stage of lactation in which
they were collected. In the privileged Ethiop-
ian group lactation was terminated after only
a few months and only samples from early
lactation were obtained (Table 1). Current
policy regarding maternity care does permit
mothers to stay away from work at the most 4
to 6 weeks after delivery. Employed mothers
are thus forced to replace breast milk with
artificial formulas at an early stage. In the
nonpnivileged group, on the other hand, few
samples could be obtained from early lacta-
tion since mothers traditionally stay indoors
during the first 6 to 8 weeks after delivery.
Most samples were collected after the second
month of lactation (Table I). This has to be
considered in the statistical comparisons

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1 1 4 0 L NNERDAL ET AL .
betw een the tw o E thiopian groups. M ilk
sam ples from the S w edish m others w ere
collected during the first 6.5 m onths of lacta-
tion m aking com parisons possible betw een
the S w edish m aterial and the tw o groups of
E thiopian m others.
It has been pointed out by M . G ebre-M ed-
hin et al. (20) that in this investigation the
m ilk volum es of the first m eal of the day
w ere not significantly different for S w edish
and E thiopian m others (Table 1). H ow ever,
this observation should be interpreted w ith
reservation. It is reasonable to assum e that
the use of a breast-pum p, w hich m ay have
m eant a greaten stress to the E thiopian
m others than to the S w edish ones, has led
to a reduction in m ilk yield in the previous
group. O n the other hand, the m ilk volum e
of the E thiopian m others m ay also have been
influenced in a positive direction as a num -
ber of these m others had to w ait several hours
after the usual nursing tim e before evacua-
tion of the breasts took place. This could pos-
sibly provide partial explanation for the fact
that the m ilk volum e in the group of non-
privileged E thiopian m others w as com parable
to that observed in their privileged E thio-
pian and S w edish counterparts.
A difference in lactofernin concentration of
breast m ilk from E thiopian and S w edish
m others is evident. The lactofennin concentra-
tion of the E thiopian sam ples is also m ark-
edly above that of breast m ilk from Japanese
m others reported by N agasaw a et al. (6). This
finding is of considerable interest and m ay be
connected to the very high iron content of the
Ethiopian diet. In the highland population
daily iron intakes of 300 to 500 m g are
com m on because of the consum ption of the
iron-rich cereal tefw hich is unique for E thi-
opia (23). H ow ever, m ost of the iron is in the
form of poorly absorbed com pounds (19, 24).
Lactoferrin is know n to act bacteniostatically
by retaining iron from iron-dem anding m i-
croorganism s (25), although the m echanism s
involved are not know n. Further investiga-
tions are required to elucidate the relationship
betw een iron intake and the lactofennin con-
tent of breast m ilk.
The high 1gM levels of the nonpnivileged
group could probably be explained by the
constant infections to w hich this group is
exposed. H ow ever, since accurate m ethods
are not currently available for determ ining
the concentrations of the m ajor breast m ilk
im m unoglobulins, secretory IgA and IgA , a
com plete evaluation of the im m uno-defensive
m echanism s involved cannot be perform ed.
No overall differences w ere found betw een
the E thiopian groups on the one hand and the
S w edish group on the other w ith respect to
the constituents analysed in the study. A s
m others from such different incom e groups
are know n to have m arkedly divergent die-
tary intakes, it is rem arkable that the present
investigation does not provide evidence that
undernutrition has any pronounced effects on
the quality of breast m ilk, at least in so far as
protein and lactose are concerned. Lindblad
and R ahim toola (16) studied the am ino acid
com position of breast m ilk from undernour-
ished m others from P akistan and E thiopia
(selected from the sam e low socioeconom ic
group as in this study). A m ong the P akistani
m others the am ino acid pattern w as changed
in a w ay that m ay indicate a change in protein
com position (16). This change w as not ob-
served in E thiopian m others (B . S . Lindblad,
personal com m unication). H ow ever, it is con-
ceivable that the P akistani m others w ere
under m ore severe nutritional stress than the
low socioeconom ic E thiopian group.
In conclusion, this report seem s to lend
support to the other studies that have show n
that the quality and quantity of breast m ilk
are not affected by m aternal m alnutrition.
H ow ever, published inform ation in this field
is lim ited and inconclusive. A fter all, it is the
ability of the child under the prevailing condi-
tions to optim ally utilize its m others m ilk that
is of im portance. In view of this, further
inform ation regarding the volum e of breast
m ilk produced, as w ell as the quantity con-
sum ed and utilized by the child is needed.
Furtherm ore, these param eters need to be
considered in relation to various ecological
conditions and determ inants of child health
and developm ent.
W e are very grateful to D rs. A nders V ahlquist, Y ngve
H ofvander, Francis K am w endo, S am R oss, and P rof. B o
V ahlquist for the arrangem ent and realization of this
joint study. The collaboration of the E N I M etabolic U nit
S taff, in particular, S isters lngrid Tesfatsion and A m sale
G ebre-Y ohannes and M iss B ent B org is gratefully
acknow ledged. W e also w ish to thank M rs. E w a Johans-
son for collecting the S w edish m aterial. For skillful

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BREAST MI L K COMPOSI TI ON 1 1 4 1
technical assistance we would like to express our grati-
tude to Mrs. Annika JUgare and Mrs. Maivor Sj#{246}strand.
The data program for the statistical evaluation was
developed by Drs. Hans Falk and Torgny Groth. Drs. B
Johansson and N. Harboe are thanked for gifts of
lactoferrin standards.
R eferences
I. FAO/W HO Ad Hoc Expert Committee. In: Energy
and Protein requirements. W orld Health Organiza-
tion. Technical report series. No 522, pp. 56-58.
WHO Ge n e v a , 1 9 7 3 .
2. MATA, 1. J., J. J. URRUTIA AND A. LEcIiTIG.
Infection and nutrition of children of a low socio-
economic rural community. Am. J. Clin. Nutr. 24:
249, 1971.
3. VAHLQUIST, B. Evolution of Breast Feeding in
Europe. J. Trop. Paediat. Environ. Child Health I:
11, 1975.
4. BERG, A. The Nutrition Factor, W ashington: The
Brookings Institution, 1973, p. 91.
5 . HANSON, L.-A., AND B. G. JOHANSSON. Immuno-
logical studies of milk. In: Milk proteins. New
York: Academic Press, 1970, pp. 45-123, vol. 1.
6. NAGASAWA, T., 1. KIVOSAWA AND K. KUW AI1ARA.
Amounts of lactoferrin in human colostrum and
milk. J. Dairy Sci. 12: 1651, 1972.
7. CHANDAN, R. C., R. M. PARR\ AND K. M. SHAHA-
RI. Lysozyme, lipase and nibonuclease in milk of
various species. J. Dairy Sci. 4: 606, 1968.
8. GULLBERG, R. Possible Influence of Vitamin B,,-
Binding Protein in Milk on the Intestinal Flora in
Breast-Fed Infants. Scand. J. Gastroenterol. 8: 497,
1973.
9. LONNERDAL, B., E. FORSUM AND L. HAMBRAEUS.
The protein content of human milk I. A transversal
study of Swedish normal material. Nutr. Rept..
Intern. 13: 125, 1976.
1 0 . GOPALAN, C. Protein intake of breast-fed poor In-
dian infants. J. Trop. Pediat. 2: 89, 1956.
11. GOPALAN, C., AND B. BELAVADY. Nutrition and
Lactation. Fed. Proc. 20 suppl. 7: 177, 1961.
12. VENKATACHALAM, P. 5. A Study of the Diet, Nutri-
tion and Health of the People of the Chimbut Area.
New Guinea; Monograph 4, Dept. Public Health,
Govt. of Papua, 1962.
13. KARMARKAR, M. G. , AND C. V. RAMAKRISHNAN.
Studies on human lactation. Acta Paediat. Scand.
49: 599, 1960.
14. SUKHATME, P. V., ANI) D. BASU. The present pattern
of production and availability of foods in Asia. In:
Proceedings of the First Asian Congress of Nutri-
tion. Hyderabad: Nutrition Soc. India, 1972, p. 19.
15. DEB, A. K., AND H. R. CAMA. Studies on human
lactation. Dietary nitrogen utilization during lacta-
tion and distribution of nitrogen in mothers milk.
Brit. J. Nutr. 16: 65, 1962.
16. LINDBLAD, B. S., ANt) R. J. RAHIMTOOLA. A pilot
study of the quality of human milk in a lower
socio-economic group in Karachi, Pakistan, Acta
Paediat. Scand. 63: 125, 1974.
17. LONNERDAL, B., E. FORSUM AND L. HAMBRAEUS.
A longitudinal study of the protein, nitrogen and
lactose contents of human milk from well-nourished
Swedish mothers. Am. J. Clin. Nutr. 29: 1 127, 1976.
18. GEBRE-MEDHIN, M., ANI) A. GOBEZIF. Dietary
intake in the third trimester of pregnancy and birth
weight of offspring among nonpnivileged and pnivi-
leged women. Am. J. Clin. Nutr. 28: 1322, 1975.
19. GEBRE-MEDHIN, M., A. KILLANDER, B. VAHLQUIST
AND E. W UHIB. Rarity of anemia of pregnancy in
Ethiopia. Scand. J. Haematol. 16: 168, 1976.
20. GEBRE-MEDIIIN, M., A. VAIJLQUIST, Y. H0FvANu-
ER, L. UPPSXLL ANt) B. VAHLQLIST. Breast milk
composition in Ethiopian and Swedish mothers. 1.
Vitamin A and fl-carotene. Am. J, Clin. Nutr. 29:
441, 1976.
21. MORRISON, S. D. Lactose. In: Human Milk; Yield
Proximate Principles and Inorganic Constituents,
Aberdeen: University Press, 1952, pp. 63-67.
22. MACY, I. G., B. Nisis, M. BROW N ANI) H. A.
HUNSCHER. Human milk studies. VII. Chemical
analysis of milk representative of the entire first and
last halves of the nursing period. Amer. J. Diseases
Childhood 42: 569, 1931.
23. ALMGXRD, G. High content of iron in tef, Eragrostis
Abyssinica Linn and some other crop species from
Ethiopia-a result of contamination. Ann. Agni.
CoIl. Sweden 29: 215, 1963.
24. HOFVANDER, Y. Hematological investigations in
Ethiopia with special reference to high iron intake.
Acta Med. Scand. Suppl. 494, 1968.
25. BULLEN, J . J., H. J. ROGERS AND L. LEIGH.
Iron-binding proteins in milk and resistance to
Eschenichia coli infection in infants. Bnit. Med. J.
1: 69, 1972.

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