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Ranque CL, Stroble C, Amicucci MJ, Tu D, Diana A, Rahmannia S, Suryanto AH, Gibson RS, Sheng Y, Tena J, Houghton LA, Lebrilla CB. Examination of Carbohydrate Products in Feces Reveals Potential Biomarkers Distinguishing Exclusive and Nonexclusive Breastfeeding Practices in Infants. J Nutr 2020; 150:1051-1057. [PMID: 32055824 PMCID: PMC7198307 DOI: 10.1093/jn/nxaa028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The stable isotope deuterium dose-to-mother (DTM) technique to estimate nonbreast milk water intake demonstrates that maternal self-report methods of infant feeding overestimate the true prevalence of exclusively breastfeeding practices. OBJECTIVE We aimed to determine potential monosaccharide and oligosaccharide markers that distinguish between exclusively breastfed (EBF) versus nonexclusively breastfed (non-EBF) infants utilizing LC-MS-based methods. METHODS Data for the analysis were collected as part of a larger, longitudinal study of 192 breastfed Indonesian infants aged 2 mo and followed up at 5 mo. Feces samples were collected from infants aged 2 mo (n = 188) and 5 mo (n = 184). EBF and non-EBF strata at each time point were determined via the DTM technique. Feces samples were analyzed to determine monosaccharide content using ultra-high-performance LC-triple quadrupole MS (UHPLC-QqQ MS). Relative abundances of fecal oligosaccharides were determined using nano-LC-Chip-quadrupole time-of-flight MS (nano-LC-Chip-Q-ToF MS). RESULTS At age 2 mo, monosaccharide analysis showed the abundance of fructose and mannose were significantly higher (+377% and +388%, respectively) in non-EBF compared with EBF infants (P <0.0001). Fructose and mannose also showed good discrimination with areas under the curve (AUC) of 0.86 and 0.82, respectively. Oligosaccharide analysis showed that a 6-hexose (Hex6) isomer had good discrimination (AUC = 0.80) between EBF and non-EBF groups at 5 mo. CONCLUSION Carbohydrate products, particularly fecal mono- and oligosaccharides, differed between EBF and non-EBF infants aged under 6 mo and can be used as potential biomarkers to distinguish EBF versus non-EBF feeding practices.
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Affiliation(s)
| | - Carol Stroble
- Department of Chemistry, University of California, Davis, CA, USA
| | | | - Diane Tu
- Department of Chemistry, University of California, Davis, CA, USA
| | - Aly Diana
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand,Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Sofa Rahmannia
- Nutrition Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia,Faculty of Medicine, Universitas Pasundan, Bandung, Indonesia
| | | | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Ying Sheng
- Department of Chemistry, University of California, Davis, CA, USA
| | - Jennyfer Tena
- Department of Chemistry, University of California, Davis, CA, USA
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Carlito B Lebrilla
- Department of Chemistry, University of California, Davis, CA, USA,Address correspondence to CBL (e-mail: )
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Addison R, Hill L, Bode L, Robertson B, Choudhury B, Young D, Wright C, Relton C, Garcia AL, Tappin DM. Development of a biochemical marker to detect current breast milk intake. MATERNAL & CHILD NUTRITION 2020; 16:e12859. [PMID: 31216094 PMCID: PMC7038895 DOI: 10.1111/mcn.12859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023]
Abstract
The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breastfed, nine exclusively formula fed, and 11 mixed breast/formula fed. High-performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect "any breastfeeding" only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N-acetylglucosamine (GlcNAc) measured as GlcNH2 after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2[%]) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment, the GlcNH2/Man ratio with a cut-off of 1.5 correctly identified all those receiving "any breast milk," while excluding exclusively formula fed infants. The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.
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Affiliation(s)
- Ruth Addison
- NHS Ayrshire & Arran Primary Care Trust, Rainbow House Paediatric UnitAyrshire Central HospitalIrvineUK
| | - Lauren Hill
- General PaediatricsPinderfields General HospitalWakefieldUK
| | - Lars Bode
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence (LRF MOMI CORE)University of CaliforniaSan DiegoCalifornia
| | - Bianca Robertson
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence (LRF MOMI CORE)University of CaliforniaSan DiegoCalifornia
| | - Biswa Choudhury
- Glycoanalytical Core, Glycobiology Research and Training CenterUniversity of CaliforniaSan DiegoCalifornia
| | - David Young
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUK
| | - Charlotte Wright
- Section of Child Health, School of MedicineGlasgow UniversityGlasgowUK
| | - Clare Relton
- ScHARRUniversity of SheffieldSheffieldUK
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Ada L. Garcia
- Human Nutrition, School of Medicine, Dentistry and NursingGlasgow UniversityGlasgowUK
| | - David M. Tappin
- Section of Child Health, School of MedicineGlasgow UniversityGlasgowUK
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