Dietary Intervention to Increase Fruit and Vegetable Consumption in Breastfeeding Women: A Pilot Randomized Trial Measuring Inflammatory Markers in Breast Milk

Published:September 10, 2018DOI:



      Diets rich in fruits and vegetables (F/V) can reduce the inflammatory profile of circulating cytokines and potentially decrease the risk of breast cancer. However, the extent to which a diet rich in F/V alters cytokine levels in breast tissue remains largely unknown. Breast milk provides a means of assessing concentrations of secreted cytokines in the breast microenvironment and is a potential tool for studying the effects of diet on inflammation in breast tissue and breast cancer risk.


      The aim of this pilot randomized trial was to test the feasibility of increasing F/V intake in breastfeeding women and of measuring changes in markers of inflammation in breast milk.

      Design and intervention

      Participants randomized to the intervention (n=5) were provided weekly boxes of F/V, along with dietary counseling, to increase consumption of F/V to 8 to 10 daily servings for 12 consecutive weeks. Controls (n=5) were directed to the US Department of Agriculture’s “ChooseMyPlate” diet for pregnancy and breastfeeding.


      Ten breastfeeding women consuming fewer than five servings of F/V per day, as estimated by the National Institutes of Health “All-Day” Fruit and Vegetable Screener (F/V Screener), were recruited through flyers and a lactation consultant between February and May 2016 in the Western Massachusetts area.

      Main outcome measures

      Baseline demographic and F/V intake data were collected during enrollment. At week 1 and week 13 (final) home visits, participants provided milk samples and anthropometric measurements were recorded. Participants completed F/V screeners at baseline and at study end. Adiponectin, leptin, C-reactive protein, and 11 additional cytokines were measured in breast milk collected at weeks 1 and 13.

      Statistical analyses

      F/V consumption at baseline and after the final visit, and between controls and intervention groups, was compared with dependent and independent t tests, respectively. Differences between cytokine levels at weeks 1 and 13 were assessed with a mixed-effects repeated-measures model.


      All women in the intervention increased F/V intake and were consuming more servings than controls by week 13; daily serving of F/V at baseline and final visit: controls=1.6 and 2.0, diet=2.6 and 9.9. Most cytokines were detected in the majority of milk samples: 12 were detected in 90% to 100% of samples, one was detected in 75% of samples, and one was detected in 7.5% of samples; coefficients of variation were below 14% for 11 of the cytokines.


      These preliminary findings indicate that it is feasible to significantly increase F/V intake in breastfeeding women and provide support for conducting a larger diet intervention study in breastfeeding women, in which longer-term benefits of the intervention are assessed.


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      A. R. Essa is a clinical research coordinator, Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston; at the time of the study, she was study coordinator, Department of Veterinary and Animal Sciences, University of Massachusetts Amherst.


      E. P. Browne is a research fellow, Department of Veterinary and Animal Sciences, University of Massachusetts Amherst, Life Sciences Laboratories, Amherst.


      E. C. Punska is research technician, Department of Veterinary and Animal Sciences, University of Massachusetts Amherst, Life Sciences Laboratories, Amherst.


      K. Perkins is a physician assistant student, Massachusetts College of Pharmacy and Health Sciences, Boston; at the time of the study, she was an undergraduate student, University of Massachusetts, Amherst.


      E. Boudreau is dining hall assistant manager, University of Massachusetts Amherst.


      H. Wiggins is a nutrition educator, University of New England, Biddeford, ME; at the time of the study, she was a graduate student and teaching assistant, Department of Nutrition, University of Massachusetts Amherst.


      D. L. Anderton is distinguished professor and department chair, Department of Sociology, University of South Carolina, Columbia.


      L. Sibeko is an assistant professor, Department of Nutrition, University of Massachusetts, Amherst.


      S. R. Sturgeon is a professor, Department of Public Health and Health Sciences, University of Massachusetts, Amherst.


      K. F. Arcaro is a professor, Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst.