Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial

Suzanna L. Attia; Patrick M. Owuor; Silvia A. Odhiambo; Jerusha N. Mogaka; Raphael Ondondo; Irma Castro Navarro; Aric Schadler; Kristen McQuerry; George J. Fuchs; Janet E. Williams; Katlyn N. Scarrow; Mark A. McGuire; Michelle K. McGuire; Carrie Waterman

doi:10.1016/j.cdnut.2025.107568

Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial

Suzanna L. Attia
, Patrick M. Owuor
, Silvia A. Odhiambo
, Jerusha N. Mogaka
, Raphael Ondondo
, Irma Castro Navarro
, Aric Schadler
, Kristen McQuerry
, George J. Fuchs
, Janet E. Williams
, Katlyn N. Scarrow
, Mark A. McGuire
, Michelle K. McGuire
, Carrie Waterman

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Feeding of human milk enhances infant health and survival over alternative feeding methods, but early cessation often occurs due to perceived or real insufficient milk supply. Moringa oleifera leaves are nutrient dense and may increase milk output. Objectives: We investigated the impact of maternal dried moringa leaf powder supplementation (moringa) on milk composition and output and infant and maternal health. Methods: Breastfeeding mother–infant pairs (n = 50) living in Kisumu County, Kenya, were cluster-randomized by location to consume moringa powder (20 g/d) in corn porridge (the moringa group) or corn porridge alone (the control group) for 3 mo. Milk and maternal/infant blood were collected and 24-h expressed milk volume evaluated at baseline and 3 mo. Maternal and infant anthropometrics were measured monthly. Milk lipid and protein concentrations and maternal and/or infant serum retinol-binding protein, ferritin/soluble transferrin receptor, and insulin-like growth factor (IGF)-1 concentrations were measured. Results: Nearly, all dyads (n = 45, 90%) completed the study. Baseline characteristics were similar between groups. At 3 mo, mothers in the moringa group (mean: 947 mL; 95% CI: 794, 1113 mL) expressed twice as much milk as controls (mean: 618 mL; 95% CI: 486, 763 mL; P = 0.003). Infant serum IGF-1 concentration was greater in the moringa group (mean: 25.2 ng/mL; 95% CI: 21.0, 29.5 ng/mL) than that in the control group (mean: 17.8 ng/mL; 95% CI: 13.6, 22.0 ng/mL; P = 0.017). There was no effect of moringa on total milk lipid and protein concentrations, fatty acids, or infant growth. Conclusions: In this population, 3 mo of maternal moringa consumption was associated with increased expressed milk output and higher circulating infant IGF-1 without impacting infant growth. Additional studies are needed to understand the mechanisms driving these effects and their influence on long-term health. This trial was registered at clinicaltrials.gov as NCT04587271 (https://clinicaltrials.gov/ct2/show/NCT04587271).

Original language	English
Article number	107568
Number of pages	15
Journal	Current Developments in Nutrition
Volume	9
Issue number	11
DOIs	https://doi.org/10.1016/j.cdnut.2025.107568
State	Published - Nov 2025

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Funding

RBP, ferritin, and sTFR were corrected for inflammation according to the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) study, which supports the use of serum RBP for vitamin A status and serum ferritin and sTFR for population measures of iron status alongside the need for correction of these for inflammation, except for RBP in women of reproductive age [29,30]. Codes for use in Statistical Package for the Social Sciences (SPSS; IBM Corp, 2021) provided on request by the BRINDA study team by direct correspondence were used to correct the measures of vitamin A and iron stores for inflammation. Corrected measures were compared with uncorrected measures.This study was supported by NIH BIRCWH K12DA035150, University of Kentucky Department of Pediatrics (to SLA), and NIH 1K01TW009987-01 (to CW). Publication supported by NIH R01 HD114728 (to SLA). The use of REDCap University of Kentucky was supported by the University of Kentucky NIH CTSA UL1TR001998. MKM and JEW are funded in part by NIH P20GM152304, and MKM and MAM by the Idaho Agriculture Experiment Station. The supporting sources had no role in the design or interpretation of the data nor restrictions on publication.CW reports financial support was provided by John E Fogarty International Center. PO reports a relationship with Pamoja Community Based Organization that includes board membership. This study was supported by NIH BIRCWH K12DA035150, University of Kentucky Department of Pediatrics (to SLA ), and NIH 1K01TW009987-01 (to CW). Publication supported by NIH R01 HD114728 (to SLA). The use of REDCap University of Kentucky was supported by the University of Kentucky NIH CTSA UL1TR001998. MKM and JEW are funded in part by NIH P20GM152304, and MKM and MAM by the Idaho Agriculture Experiment Station. The supporting sources had no role in the design or interpretation of the data nor restrictions on publication.

Funders	Funder number
Idaho Agriculture Experiment Station
Fogarty International Center
National Institutes of Health (NIH)	K12DA035150, R01 HD114728, 1K01TW009987-01
University of Kentucky	UL1TR001998, P20GM152304

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being

Keywords

Moringa oleifera
dietary intervention
human milk
insulin-like growth factor 1
iron
malnutrition
maternal and child health
vitamin A

ASJC Scopus subject areas

Medicine (miscellaneous)
Food Science
Nutrition and Dietetics

Access to Document

10.1016/j.cdnut.2025.107568

Cite this

Attia, S. L., Owuor, P. M., Odhiambo, S. A., Mogaka, J. N., Ondondo, R., Navarro, I. C., Schadler, A., McQuerry, K., Fuchs, G. J., Williams, J. E., Scarrow, K. N., McGuire, M. A., McGuire, M. K., & Waterman, C. (2025). Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial. Current Developments in Nutrition, 9(11), Article 107568. https://doi.org/10.1016/j.cdnut.2025.107568

@article{ff3bef7fd8d2464db001b92e44bf4df9,

title = "Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial",

abstract = "Background: Feeding of human milk enhances infant health and survival over alternative feeding methods, but early cessation often occurs due to perceived or real insufficient milk supply. Moringa oleifera leaves are nutrient dense and may increase milk output. Objectives: We investigated the impact of maternal dried moringa leaf powder supplementation (moringa) on milk composition and output and infant and maternal health. Methods: Breastfeeding mother–infant pairs (n = 50) living in Kisumu County, Kenya, were cluster-randomized by location to consume moringa powder (20 g/d) in corn porridge (the moringa group) or corn porridge alone (the control group) for 3 mo. Milk and maternal/infant blood were collected and 24-h expressed milk volume evaluated at baseline and 3 mo. Maternal and infant anthropometrics were measured monthly. Milk lipid and protein concentrations and maternal and/or infant serum retinol-binding protein, ferritin/soluble transferrin receptor, and insulin-like growth factor (IGF)-1 concentrations were measured. Results: Nearly, all dyads (n = 45, 90\%) completed the study. Baseline characteristics were similar between groups. At 3 mo, mothers in the moringa group (mean: 947 mL; 95\% CI: 794, 1113 mL) expressed twice as much milk as controls (mean: 618 mL; 95\% CI: 486, 763 mL; P = 0.003). Infant serum IGF-1 concentration was greater in the moringa group (mean: 25.2 ng/mL; 95\% CI: 21.0, 29.5 ng/mL) than that in the control group (mean: 17.8 ng/mL; 95\% CI: 13.6, 22.0 ng/mL; P = 0.017). There was no effect of moringa on total milk lipid and protein concentrations, fatty acids, or infant growth. Conclusions: In this population, 3 mo of maternal moringa consumption was associated with increased expressed milk output and higher circulating infant IGF-1 without impacting infant growth. Additional studies are needed to understand the mechanisms driving these effects and their influence on long-term health. This trial was registered at clinicaltrials.gov as NCT04587271 (https://clinicaltrials.gov/ct2/show/NCT04587271).",

keywords = "Moringa oleifera, dietary intervention, human milk, insulin-like growth factor 1, iron, malnutrition, maternal and child health, vitamin A",

author = "Attia, \{Suzanna L.\} and Owuor, \{Patrick M.\} and Odhiambo, \{Silvia A.\} and Mogaka, \{Jerusha N.\} and Raphael Ondondo and Navarro, \{Irma Castro\} and Aric Schadler and Kristen McQuerry and Fuchs, \{George J.\} and Williams, \{Janet E.\} and Scarrow, \{Katlyn N.\} and McGuire, \{Mark A.\} and McGuire, \{Michelle K.\} and Carrie Waterman",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = nov,

doi = "10.1016/j.cdnut.2025.107568",

language = "English",

volume = "9",

number = "11",

}

Attia, SL, Owuor, PM, Odhiambo, SA, Mogaka, JN, Ondondo, R, Navarro, IC, Schadler, A, McQuerry, K, Fuchs, GJ, Williams, JE, Scarrow, KN, McGuire, MA, McGuire, MK & Waterman, C 2025, 'Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial', Current Developments in Nutrition, vol. 9, no. 11, 107568. https://doi.org/10.1016/j.cdnut.2025.107568

Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial. / Attia, Suzanna L.; Owuor, Patrick M.; Odhiambo, Silvia A. et al.
In: Current Developments in Nutrition, Vol. 9, No. 11, 107568, 11.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output

T2 - A Pilot Single-Blinded Cluster-Randomized Trial

AU - Attia, Suzanna L.

AU - Owuor, Patrick M.

AU - Odhiambo, Silvia A.

AU - Mogaka, Jerusha N.

AU - Ondondo, Raphael

AU - Navarro, Irma Castro

AU - Schadler, Aric

AU - McQuerry, Kristen

AU - Fuchs, George J.

AU - Williams, Janet E.

AU - Scarrow, Katlyn N.

AU - McGuire, Mark A.

AU - McGuire, Michelle K.

AU - Waterman, Carrie

PY - 2025/11

Y1 - 2025/11

N2 - Background: Feeding of human milk enhances infant health and survival over alternative feeding methods, but early cessation often occurs due to perceived or real insufficient milk supply. Moringa oleifera leaves are nutrient dense and may increase milk output. Objectives: We investigated the impact of maternal dried moringa leaf powder supplementation (moringa) on milk composition and output and infant and maternal health. Methods: Breastfeeding mother–infant pairs (n = 50) living in Kisumu County, Kenya, were cluster-randomized by location to consume moringa powder (20 g/d) in corn porridge (the moringa group) or corn porridge alone (the control group) for 3 mo. Milk and maternal/infant blood were collected and 24-h expressed milk volume evaluated at baseline and 3 mo. Maternal and infant anthropometrics were measured monthly. Milk lipid and protein concentrations and maternal and/or infant serum retinol-binding protein, ferritin/soluble transferrin receptor, and insulin-like growth factor (IGF)-1 concentrations were measured. Results: Nearly, all dyads (n = 45, 90%) completed the study. Baseline characteristics were similar between groups. At 3 mo, mothers in the moringa group (mean: 947 mL; 95% CI: 794, 1113 mL) expressed twice as much milk as controls (mean: 618 mL; 95% CI: 486, 763 mL; P = 0.003). Infant serum IGF-1 concentration was greater in the moringa group (mean: 25.2 ng/mL; 95% CI: 21.0, 29.5 ng/mL) than that in the control group (mean: 17.8 ng/mL; 95% CI: 13.6, 22.0 ng/mL; P = 0.017). There was no effect of moringa on total milk lipid and protein concentrations, fatty acids, or infant growth. Conclusions: In this population, 3 mo of maternal moringa consumption was associated with increased expressed milk output and higher circulating infant IGF-1 without impacting infant growth. Additional studies are needed to understand the mechanisms driving these effects and their influence on long-term health. This trial was registered at clinicaltrials.gov as NCT04587271 (https://clinicaltrials.gov/ct2/show/NCT04587271).

AB - Background: Feeding of human milk enhances infant health and survival over alternative feeding methods, but early cessation often occurs due to perceived or real insufficient milk supply. Moringa oleifera leaves are nutrient dense and may increase milk output. Objectives: We investigated the impact of maternal dried moringa leaf powder supplementation (moringa) on milk composition and output and infant and maternal health. Methods: Breastfeeding mother–infant pairs (n = 50) living in Kisumu County, Kenya, were cluster-randomized by location to consume moringa powder (20 g/d) in corn porridge (the moringa group) or corn porridge alone (the control group) for 3 mo. Milk and maternal/infant blood were collected and 24-h expressed milk volume evaluated at baseline and 3 mo. Maternal and infant anthropometrics were measured monthly. Milk lipid and protein concentrations and maternal and/or infant serum retinol-binding protein, ferritin/soluble transferrin receptor, and insulin-like growth factor (IGF)-1 concentrations were measured. Results: Nearly, all dyads (n = 45, 90%) completed the study. Baseline characteristics were similar between groups. At 3 mo, mothers in the moringa group (mean: 947 mL; 95% CI: 794, 1113 mL) expressed twice as much milk as controls (mean: 618 mL; 95% CI: 486, 763 mL; P = 0.003). Infant serum IGF-1 concentration was greater in the moringa group (mean: 25.2 ng/mL; 95% CI: 21.0, 29.5 ng/mL) than that in the control group (mean: 17.8 ng/mL; 95% CI: 13.6, 22.0 ng/mL; P = 0.017). There was no effect of moringa on total milk lipid and protein concentrations, fatty acids, or infant growth. Conclusions: In this population, 3 mo of maternal moringa consumption was associated with increased expressed milk output and higher circulating infant IGF-1 without impacting infant growth. Additional studies are needed to understand the mechanisms driving these effects and their influence on long-term health. This trial was registered at clinicaltrials.gov as NCT04587271 (https://clinicaltrials.gov/ct2/show/NCT04587271).

KW - Moringa oleifera

KW - dietary intervention

KW - human milk

KW - insulin-like growth factor 1

KW - iron

KW - malnutrition

KW - maternal and child health

KW - vitamin A

UR - https://www.scopus.com/pages/publications/105020875777

UR - https://www.scopus.com/pages/publications/105020875777#tab=citedBy

U2 - 10.1016/j.cdnut.2025.107568

DO - 10.1016/j.cdnut.2025.107568

M3 - Article

AN - SCOPUS:105020875777

VL - 9

JO - Current Developments in Nutrition

JF - Current Developments in Nutrition

IS - 11

M1 - 107568

ER -

Effect of Maternal Moringa oleifera Leaf Supplementation on Maternal and Infant Nutritional Status and Human Milk Output: A Pilot Single-Blinded Cluster-Randomized Trial

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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