Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: a randomized controlled trial in rural Ethiopia

Impact of complementary feeding on infant gut microbiome, metabolites and early development

Introducing complementary foods is critical for promoting infant health and development. During the weaning period, the dietary patterns provide essential nutrients and facilitate the development of a diverse gut microbiome, which plays significant roles in the regulation of immune, metabolic, and neurological functions. This study enrolled 200 families to assess the impact of complementary feeding on infant growth and health outcomes. Data included detailed records of feeding practices, infant growth measurements, health assessments, and fecal samples and breast milk collected between weeks 12 and 32 postpartum. The gut microbiome was analyzed using 16S rRNA sequencing, while metabolites such as human milk oligosaccharides (HMOs), monosaccharides, and short-chain fatty acids (SCFAs) were measured using chromatography-mass spectrometry. Results revealed a high prevalence of breastfeeding, with complementary food introduced at around 16 weeks. Significant alterations in the infant gut microbiome were observed, particularly in the genera Lactobacillus, Akkermansia, and Staphylococcus. Additionally, the levels of HMOs, monosaccharides, and SCFAs were found to be influenced by the introduction of complementary foods. Significant correlations emerged between complementary feeding practices, gut microbiome diversity, specific bacterial genera (e.g., Streptococcus, Lactobacillus, Bifidobacterium, and Clostridioides), and key metabolites (such as lacto-N-tetraose, lacto-N-neotetraose, mannose, and butyric acid). This study offers valuable insights into the complex interactions between complementary feeding, gut microbiome development, and metabolite profiles during early infant growth. Future research with larger cohorts and targeted dietary interventions is recommended to further elucidate the underlying mechanisms.

Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis

Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle-Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α-linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets.

Impact of polyunsaturated fatty acids during and pregnancy and lactation: A comprehensive review

BACKGROUND

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are relevant polyunsaturated fatty acids (PUFA) derived from alpha-linolenic acid (ALA) and linoleic acid (LA), respectively. These are important in pregnancy and lactation periods because of their benefits to the developing fetus and infant. Currently, the high prevalence of gestational obesity has led to a revision of PUFAs recommendations in these periods, due to changes in the lipid profile of women marked by a higher consumption of n-6 PUFA.

OBJECTIVE

This review aims to present an updated compilation of evidence on DHA and ARA during gestation and lactation.

METHODS

The literature review was performed in different databases, PubMed, Scopus, Web of Science, Scielo, ISI, and Ovid MedLine, highlighting the importance of DHA and ARA for newborn development.

RESULTS

An adequate intake of n-3 PUFA, especially DHA, in the mother during pregnancy and the postnatal period is important for the normal development of the child's brain. Maternal DHA supplementation increases DHA levels in mothers, but its direct link to infant neurodevelopment remains unclear. Obesity generates changes in the FA profile of pregnant women, causing an imbalance of n-3 and n-6 PUFA. An adequate level of DHA benefits children's cognitive function. However, a potential connection exists to the infants' inflammatory profile.

CONCLUSION

During gestation and lactation periods, an adequate DHA intake and n-6/ n-3 PUFA ratio (especially for obese women) are important for the optimal growth and brain development of the child.

Postpartum dietary intake, depression and the concentration of docosahexaenoic acid in mature breast milk in Wuhan, China

Background: Docosahexaenoic acid (DHA, C22:6) is an important fatty acid in breast milk and is essential for infantile growth and cognitive development. However, the factors that affect the DHA concentration in breast milk have not been completely clarified. Objective: This study aimed to characterize the composition of breast milk fatty acids and to identify maternal factors associated with breast milk DHA concentration in postpartum women in Wuhan, China. Methods: In this cross-sectional study, we analyzed milk fatty acids in 115 lactating women at 30-120 days postpartum using GC-MS. Maternal sociodemographic, health and other information were collected using a self-reported questionnaire. Maternal dietary intake information was collected through a 24-hour dietary recall method. Postpartum depression status was identified using the Edinburgh Postnatal Depression Scale (EPDS). Results: The mean DHA proportion in breast milk was 0.49%. The multivariate regression model showed that the milk DHA proportion was positively associated with maternal aquatic product intake (β = 0.183, 95%CI: 0.052, 0.314) and DHA supplement use (β = 0.146, 95%CI: 0.108, 0.185), and negatively associated with postpartum depression status (β = -0.122, 95%CI: -0.243, -0.002) after adjustment for several maternal and infant factors. Conclusion: Increasing maternal aquatic product intake and DHA supplement use and improving postpartum depression status may increase DHA concentration in breast milk in lactating women.

Breastmilk PUFA strongly associated with maternal dietary intake but not anthropometric parameters and breastmilk carotenoids

BACKGROUND

Long chain polyunsaturated fatty acids (PUFA) and the optimal n-6/n-3 fatty acids ratio are essential for proper neurodevelopment in infancy. This study aimed to evaluate the association between breastmilk fatty acid intake and maternal dietary intake, anthropometrics and breastmilk carotenoid levels.

METHODS

This observational, prospective study included 44 women in the first, third, and sixth month of lactation. At each study visit, maternal anthropometric measures were assessed and breastmilk samples were collected and assessed for fatty acids and carotenoids. At the third and sixth month, maternal diet was evaluated by three-day foods record.

RESULTS

Mean breastmilk docosahexaenoic (DHA) was 0.58%, 0.47%, and 0.49%, respectively at the 1, 3, and 6 month (p ≤ 0.05). Mean DHA intake were higher in month 3 compared to 6: 357 vs. 169 mg/day. Pre-pregnancy BMI was associated with SFA, PUFA, and n-6 PUFA at 1 month, whereas current BMI to SFA at months 1 and 3. DHA was correlated with lycopene, total carotenoids at 1 month and total carotenoids at month 3, whereas n-3 PUFA to lycopene at 1 month. DHA, n-3 PUFA, n-6 PUFA and saturated (SFA) levels were associated with its dietary intake both at months 3 and 6, AA/DHA and LA/ALA ratios only at month 3.

CONCLUSIONS

Maternal intake of PUFA and n-6/n-3 ratios were a good predictor of its breastmilk composition, whereas pre-pregnancy and current BMI, as well as breastmilk carotenoids had a limited influence.

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

OBJECTIVE

In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia.

SOURCE OF INFORMATION

A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021.

STUDY ELIGIBILITY CRITERIA

Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included.

STUDY APPRAISAL AND SYNTHESIS

All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study.

RESULTS

Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention.

CONCLUSION

Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia.

PROTOCOL REGISTRATION NUMBER

PROSPERO, CRD42020155519.