The MiLC Study: Moringa in Lactation and Early Childhood

Exclusive breastfeeding (EBF) for the first six months of life is estimated to save over 800,000 child deaths under 5 years. In low- and middle-income countries with high rates of child undernutrition, the importance of EBF increases further. Despite this, there are limited proven medications or foods to increase milk volume. We investigated the benefits of a nutrient-dense potential galactagogue, the powdered leaf of the Moringa oleifera (moringa), in a pilot randomized controlled trial of moringa leaf powder supplementation in 50 mother-infant pairs in Western Kenya. We found that mothers consuming 20g of moringa daily for three months had double the volume of breast milk compared to controls, with no dilution of protein and fat content. In addition, infants of mothers consuming moringa had increased growth-related hormone insulin-like growth factor-1 (IGF-1) and hemoglobin over controls. Our overall objective is to evaluate the effect of moringa on mothers of undernourished infants on milk volume, milk composition, EBF rates, and maternal and infant health. We hypothesize that moringa supplementation to mothers of undernourished infants increases milk volume, enhances milk nutrients, and improves select markers of maternal and infant health. These changes are driven by maternal hormonal regulation of lactation, longer duration of EBF, and increased concentration of nutrient delivery to mothers directly and to infants via breastmilk. Design: We will perform a cluster-randomized single- blinded controlled trial. Mothers of undernourished infants in Western Kenya will either receive 20g moringa leaf powder in corn porridge or corn porridge alone daily for six months with follow-up visits every 3 months for two years. Milk, serum, and urine samples, dietary variables, and a survey of perceptions of breastfeeding at baseline and periodically throughout the study will be collected. We will perform anthropometrics and collect information on medical diagnoses and feeding practices at each visit. Aims: 1: Determine the impact of maternal moringa consumption on milk volume and infant milk consumption and investigate mechanisms driving these effects. 2: Quantify the impact of maternal moringa supplementation on duration of EBF and concentrations of selected nutrients in human milk. 3: Assess the effect of moringa supplementation on selected indicators of maternal and infant health. Primary outcomes: Comparing between groups, we will examine increases in milk volume, prevalence and duration of EBF, and infant growth via changes in IGF-1. Significance: This trial investigates the role of moringa in lactation and early childhood. This innovative study intersects with the NICHD Pediatric Growth and Nutrition Branch priority on understanding how human milk “affects the health of the infant and lactating parent” and will define the role of moringa in enhancing lactation and supporting maternal and child health in vulnerable populations.