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Babiszewska-Aksamit M, Żelaźniewicz A, Apanasewicz A, Piosek M, Winczowska P, Barbarska O, Ziomkiewicz A. Breast size in lactating women and the content of macronutrients in human milk. Am J Hum Biol 2024; 36:e24055. [PMID: 38420902 DOI: 10.1002/ajhb.24055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Although the primary function of a woman's breast is milk synthesis, only a few studies have evaluated the relationship between breast size and human milk composition, showing equivocal results. This study aims to test if breast size during fully established lactation is related to energy density and content of macronutrients in human milk. MATERIALS AND METHODS Mothers of healthy, born-on-term infants at stage III of lactogenesis (N = 137) provided breast milk samples. Milk composition was analyzed using midinfrared transmission spectroscopy. The breast size index was calculated by dividing the breast by the circumference below the breast. RESULTS Stepwise forward linear regression showed a negative association between breast size index and lactose concentration in breast milk (β = -.242, p = .003). The final model, which includes breast size index, feeding frequency, and maternal energy intake together explained around 13% of the variance in breast milk lactose content (R2 adj = .126, p < .001). No statistically significant relationship was found between breast size index and milk's energy density, protein, and fat content. CONCLUSION This is the first study that shows a negative relationship between breast size during fully established lactation and lactose concentration in milk in a large sample size. No relationship between other macronutrients and breast size indicates that large breast size is not necessary for adequate milk production; however, it may contribute to an altered lactose concentration.
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Affiliation(s)
- Magdalena Babiszewska-Aksamit
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Wroclaw, Poland
- Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
| | | | - Anna Apanasewicz
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Wroclaw, Poland
| | | | - Patrycja Winczowska
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Wroclaw, Poland
| | - Olga Barbarska
- School of Medical & Health Sciences, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Anna Ziomkiewicz
- Laboratory of Anthropology, Jagiellonian University, Institute of Zoology and Biomedical Research, Poland
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Juncker HG, Naninck EFG, Schipper L, Lucassen PJ, van Goudoever JB, de Rooij SR, Korosi A. Maternal stress in the postpartum period is associated with altered human milk fatty acid composition. Clin Nutr 2022; 41:2517-2528. [PMID: 36223713 DOI: 10.1016/j.clnu.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Maternal stress in the postpartum period affects not only the mother, but also her newborn child who is at increased risk for a wide range of disorders later in life. The mechanisms underlying transmission of maternal stress to the child remain elusive. Human milk (HM) is a potential candidate and is an important source of fatty acid (FA), which are crucial for child (neuro)development. This study aims to investigate whether maternal psychological and biological stress influences HM FA composition over the first month postpartum. METHODS The Amsterdam Mother's Milk study is a prospective cohort study. We included lactating women who delivered at term with a large range of stress levels: a high stress (HS) group, women whose child was hospitalized for a minimum of 2 days (n=23) and a control (CTL) group, women who gave birth to a healthy child (n=73). HM was collected three times a day at postpartum days 10, 17 and 24. Perceived psychological stress was measured using multiple validated questionnaires, while biological stress measures were based on cortisol in hair, saliva and HM. HM FAs were analyzed by gas-chromatography and compared between groups. RESULTS Maternal perceived stress scores were significantly higher in the HS group (p < 0.01), whereas cortisol measurements did not differ between groups. The absolute concentrations of total FA in HM (p=0.023), including the total amount of poly unsaturated fatty acids (PUFAs) (p=0.022) and omega-6 PUFAs (p=0.018), were lower in the HS group compared to the CTL group. Relative values of FAs did not differ between groups. CONCLUSION Maternal stress in the first month postpartum was associated with overall lower levels of FA in HM. This possibly indicates a route of transmission of maternal stress signals to the infant. Future research should investigate if these stress-induced changes in HM FAs have consequences for child development.
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Affiliation(s)
- H G Juncker
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam Reproduction and Development Institute, Amsterdam, the Netherlands
| | - E F G Naninck
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam Reproduction and Development Institute, Amsterdam, the Netherlands
| | - L Schipper
- Danone Nutricia Research, Utrecht, the Netherlands
| | - P J Lucassen
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - J B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam Reproduction and Development Institute, Amsterdam, the Netherlands
| | - S R de Rooij
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - A Korosi
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands.
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Geddes DT, Gridneva Z, Perrella SL, Mitoulas LR, Kent JC, Stinson LF, Lai CT, Sakalidis V, Twigger AJ, Hartmann PE. 25 Years of Research in Human Lactation: From Discovery to Translation. Nutrients 2021; 13:3071. [PMID: 34578947 PMCID: PMC8465002 DOI: 10.3390/nu13093071] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
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Affiliation(s)
- Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Sharon Lisa Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Leon Robert Mitoulas
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
- Medela, AG, Lättichstrasse 4b, 6340 Baar, Switzerland
| | - Jacqueline Coral Kent
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Lisa Faye Stinson
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Vanessa Sakalidis
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | | | - Peter Edwin Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
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Psychosocial stress and cortisol stress reactivity predict breast milk composition. Sci Rep 2021; 11:11576. [PMID: 34078999 PMCID: PMC8172899 DOI: 10.1038/s41598-021-90980-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
We studied a sample of 146 Polish, exclusively breastfeeding mothers and their healthy born on time infants to explore the effect of perinatal psychosocial stress on breast milk composition. Maternal perinatal stress was assessed using Recent Life Changes Questionnaire summarizing stressful events from the previous six months. Stress reactivity was determined by administering the cold pressor test and measuring cortisol in saliva samples taken during the test. Breast milk sample was taken to measure energy, protein, fat, lactose, and fatty acid content. Analyses revealed that stress reactivity was positively associated with milk fat and long-chain unsaturated fatty acids and negatively associated with milk lactose. Perinatal psychosocial stress negatively affected energy density, fat as well as medium-chain and long-chain saturated fatty acids in milk. These results, together with previous studies, advocate monitoring maternal psychological status during the peripartum to promote breastfeeding and healthy infant nutrition.
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Maternal Distress and Social Support Are Linked to Human Milk Immune Properties. Nutrients 2021; 13:nu13061857. [PMID: 34072410 PMCID: PMC8226629 DOI: 10.3390/nu13061857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022] Open
Abstract
Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized that this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy five-month-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using the Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (β = -0.23, p = 0.028) and SIgA (β = -0.30, p = 0.004), while social support was positively associated with milk IgG (β = 0.25, p = 0.017). Neither anxiety nor social support were related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological wellbeing and social support may affect milk immune properties.
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Leghi GE, Lai CT, Narayanan A, Netting MJ, Dymock M, Rea A, Wlodek ME, Geddes DT, Muhlhausler BS. Daily variation of macronutrient concentrations in mature human milk over 3 weeks. Sci Rep 2021; 11:10224. [PMID: 33986316 PMCID: PMC8119942 DOI: 10.1038/s41598-021-89460-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
Human milk (HM) composition is known to be highly variable, both between individuals and across the duration of lactation. It is less clear, however, to what extent fat, lactose and protein concentrations in HM change daily over shorter time periods in mature HM, and no studies have evaluated this to date. The aim of this study was to systematically assess and compare HM macronutrient concentrations in samples collected at different times of day, from left and right breasts and daily across a 3-week period in the same woman. Fifteen lactating women (1.6–4.9 months postpartum) collected daily pre-feed HM samples from both breasts each morning for 21 consecutive days and completed intensive sampling once a week (morning, afternoon and evening samples) during this period. Concentrations of fat, protein and lactose in HM did not differ according to time of day, day of week or breast used for collection. The results of this study suggest that pre-feed samples collected at any point across a 3-week period and from either the left or right breast provide comparable measures of fat, protein and lactose concentrations in mature HM, in pragmatic studies where women are collecting their own HM samples. Clinical trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12619000606189).
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Affiliation(s)
- Gabriela E Leghi
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia
| | - Ching T Lai
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Ardra Narayanan
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Merryn J Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Michael Dymock
- Centre for Applied Statistics, University of Western Australia, Perth, Australia
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Perth, Australia
| | - Mary E Wlodek
- Department of Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Beverly S Muhlhausler
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, Australia.
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7
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Tie WJ, Kent JC, Tat Lai C, Rea A, Hepworth AR, Murray K, Geddes DT. Reproducibility of the creamatocrit technique for the measurement of fat content in human milk. Food Chem 2021; 356:129708. [PMID: 33845253 DOI: 10.1016/j.foodchem.2021.129708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/24/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Quantification of human milk (HM) fat is important for determining the energy intake of infants. The simplest and most rapid method is the creamatocrit method. However, the reliability of the creamatocrit has not been comprehensively investigated. The aims of this study were to test the inter- and-intra-rater reliability of: 1) HM sampling after hand- or-machine mixing methods and 2) HM fat measurement by the creamatocrit method. Inter-and-intra rater HM sampling after hand- or-machine mixing methods had high intraclass correlation coefficient (>0.91). Inter-rater reliability of measurement of HM with low fat (<2%) resulted in high variability (median coefficient of variations (CVs) > 15%). Intra- and inter-rater reliability of measurement of HM with higher fat (>3.5%) had low variability (median CVs < 10%). As the greatest variation in the creamatocrit method occurred during the measurement of HM samples with low fat, duplicate readings are necessary to reduce discrepancies in every HM fat determination.
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Affiliation(s)
- Wan Jun Tie
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia.
| | - Jacqueline Coral Kent
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia.
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia.
| | - Alethea Rea
- Faculty of Engineering and Mathematical Sciences, Mathematics and Statistics, The University of Western Australia, Perth, Western Australia, Australia; College of Science, Health, Engineering and Education, Academic Operations, Information Technology, Mathematics and Statistics, Murdoch University, Perth, Western Australia, Australia.
| | - Anna Rachel Hepworth
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia.
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
| | - Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia.
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8
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Pundir S, Gridneva Z, Pillai A, Thorstensen EB, Wall CR, Geddes DT, Cameron-Smith D. Human Milk Glucocorticoid Levels Are Associated With Infant Adiposity and Head Circumference Over the First Year of Life. Front Nutr 2020; 7:166. [PMID: 33015131 PMCID: PMC7516011 DOI: 10.3389/fnut.2020.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
Human milk (HM) is a complex and dynamic biological fluid, which contains appreciable concentrations of the glucocorticoids, cortisol and cortisone. Experimental studies in non-human primates suggest the HM glucocorticoids' impact on infant growth and body composition. In this current study, analysis is made of the relationships between HM glucocorticoid concentrations and the infant growth and development over the first year of life. HM was collected by lactating healthy women (n = 18), using a standardized protocol, at 2, 5, 9, and 12 months after childbirth. Cortisol and cortisone concentrations in the HM were measured using liquid chromatography mass spectrometry. Infant weight, length and head circumference were measured by standard protocols and percentage fat mass (% FM) determined by whole body bioimpedance. Cortisol and cortisone concentrations were unaltered over the analyzed lactation period (2–12 months), and were altered by infant sex. Although, HM cortisol was positively associated with infant percentage fat mass (% FM) (p = 0.008) and cortisone positively associated with infant head circumference (p = 0.01). For the first 12 months of life, the concentration of HM glucocorticoids levels was positively associated with infant adiposity (%FM) and head circumference. This preliminary evidence provides insight to a possible relationship between ingested HM glucocorticoids and infant body composition. Further studies are required to determine the mechanisms regulating HM glucocorticoids.
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Affiliation(s)
- Shikha Pundir
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Perth, WA, Australia
| | - Avinesh Pillai
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Eric B Thorstensen
- School of Molecular Sciences, The University of Western Australia, Perth, WA, Australia
| | - Clare R Wall
- Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, WA, Australia
| | - David Cameron-Smith
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
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Perrin MT, Belfort MB, Hagadorn JI, McGrath JM, Taylor SN, Tosi LM, Brownell EA. The Nutritional Composition and Energy Content of Donor Human Milk: A Systematic Review. Adv Nutr 2020; 11:960-970. [PMID: 32119744 PMCID: PMC7360450 DOI: 10.1093/advances/nmaa014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/17/2019] [Accepted: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
The American Academy of Pediatrics recommends donor human milk (DHM) as the preferred feeding strategy for preterm infants when the milk of the mother is unavailable, based on conclusive evidence of lower rates of necrotizing enterocolitis with DHM feedings compared with preterm infant formula. The nutritional composition of DHM may differ from maternal milk for many reasons including differences in maternal characteristics, milk collection methods, and the impact of donor milk banking practices. The purpose of this systematic review is to examine the literature regarding research on the fat, protein, carbohydrate, vitamin, and mineral composition of DHM obtained through nonprofit milk banks or commercial entities. PubMed, CINAHL, and Scopus databases were searched for articles published between 1985 and 30 April, 2019. In total, 164 abstracts were screened independently by 2 investigators, and 14 studies met all inclusion criteria. Studies were predominantly small (<50 samples) and measured macronutrients. Few studies assessed vitamins and minerals. Information bias was prevalent due to the use of a variety of analytical methods which influence accuracy and cross-study comparisons. Other sources of information bias included missing information regarding methods for protein and calorie assessment. Despite these limitations, existing research suggests the potential for 2-fold and greater differences in the fat, protein, and energy composition of DHM, with mean values for energy and fat often below clinical reference values expected for human milk. Further research is warranted regarding the nutritional composition of DHM, with a prioritization on measuring macronutrients and micronutrients using established reference methods.
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Affiliation(s)
- Maryanne T Perrin
- Department of Nutrition, The University of North Carolina Greensboro, Greensboro, NC, USA
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - James I Hagadorn
- Connecticut Human Milk Research Center, Connecticut Children's Medical Center, Division of Neonatology, Connecticut Children's, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jacqueline M McGrath
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Lauren M Tosi
- Connecticut Human Milk Research Center, Connecticut Children's Medical Center, Division of Neonatology, Connecticut Children's, Hartford, CT, USA
| | - Elizabeth A Brownell
- Connecticut Human Milk Research Center, Connecticut Children's Medical Center, Division of Neonatology, Connecticut Children's, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Leghi GE, Netting MJ, Middleton PF, Wlodek ME, Geddes DT, Muhlhausler BS. The impact of maternal obesity on human milk macronutrient composition: A systematic review and meta-analysis. Nutrients 2020; 12:nu12040934. [PMID: 32230952 PMCID: PMC7231188 DOI: 10.3390/nu12040934] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
Maternal obesity has been associated with changes in the macronutrient concentration of human milk (HM), which have the potential to promote weight gain and increase the long-term risk of obesity in the infant. This article aimed to provide a synthesis of studies evaluating the effects of maternal overweight and obesity on the concentrations of macronutrients in HM. EMBASE, MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, and ProQuest databases were searched for relevant articles. Two authors conducted screening, data extraction, and quality assessment independently. A total of 31 studies (5078 lactating women) were included in the qualitative synthesis and nine studies (872 lactating women) in the quantitative synthesis. Overall, maternal body mass index (BMI) and adiposity measurements were associated with higher HM fat and lactose concentrations at different stages of lactation, whereas protein concentration in HM did not appear to differ between overweight and/or obese and normal weight women. However, given the considerable variability in the results between studies and low quality of many of the included studies, further research is needed to establish the impact of maternal overweight and obesity on HM composition. This is particularly relevant considering potential implications of higher HM fat concentration on both growth and fat deposition during the first few months of infancy and long-term risk of obesity.
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Affiliation(s)
- Gabriela E. Leghi
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA 5064, Australia;
| | - Merryn J. Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (M.J.N.); (P.F.M.)
- Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Philippa F. Middleton
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (M.J.N.); (P.F.M.)
| | - Mary E. Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, WA 6009, Australia;
| | - Beverly S. Muhlhausler
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA 5064, Australia;
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-8-8305-0697
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Di Benedetto MG, Bottanelli C, Cattaneo A, Pariante CM, Borsini A. Nutritional and immunological factors in breast milk: A role in the intergenerational transmission from maternal psychopathology to child development. Brain Behav Immun 2020; 85:57-68. [PMID: 31129231 DOI: 10.1016/j.bbi.2019.05.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/15/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022] Open
Abstract
Perinatal psychopathologies affect more than 25% of women during and after their gestational period. These psychiatric disorders can potentially determine important biological variations in their organisms, affecting many different physiological and metabolic pathways. Of relevance, any of these changes occurring in the mother can alter the normal composition of breast milk, particularly the concentration of nutritional and inflammatory components, which play a role in child brain functioning and development. Indeed, there is evidence showing that changes in milk composition can contribute to cognitive impairments and alterations in mental abilities in children. This review aims to shed light on the unique intergenerational role played by breast milk composition, from maternal psychopathologies to child development.
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Affiliation(s)
- Maria Grazia Di Benedetto
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK.
| | - Chiara Bottanelli
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK.
| | - Annamaria Cattaneo
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
| | - Carmine Maria Pariante
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
| | - Alessandra Borsini
- Section of Stress, Psychiatry and Immunology & Perinatal Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK.
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Manta-Vogli PD, Schulpis KH, Dotsikas Y, Loukas YL. Nutrition and medical support during pregnancy and lactation in women with inborn errors of intermediary metabolism disorders (IEMDs). J Pediatr Endocrinol Metab 2020; 33:5-20. [PMID: 31804959 DOI: 10.1515/jpem-2019-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022]
Abstract
The establishment of expanded newborn screening (NBS) not only results in the early diagnosis and treatment of neonates with inborn errors of intermediary metabolism disorders (IEMDs) but also helps the affected females to reach the reproductive age under medical and dietetic support, as well as to give birth to normal infants. In this review, we aimed to focus on laboratory investigation tests, dietetic management and medical support for most known IEMD pregnant and lactating women, such as those suffering from aminoacidopathies, carbohydrate metabolic diseases and fatty acid (FAO) oxidation disorders.
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Affiliation(s)
- Penelope D Manta-Vogli
- Department of Clinical Nutrition and Dietetics, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Yannis Dotsikas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274696, Fax: +30 210 7274039
| | - Yannis L Loukas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274224, Fax: +30 211 1826131
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Carbohydrates in Human Milk and Body Composition of Term Infants during the First 12 Months of Lactation. Nutrients 2019; 11:nu11071472. [PMID: 31261649 PMCID: PMC6683013 DOI: 10.3390/nu11071472] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 02/01/2023] Open
Abstract
Human milk (HM) carbohydrates may affect infant appetite regulation, breastfeeding patterns, and body composition (BC). We investigated relationships between concentrations/calculated daily intakes (CDI) of HM carbohydrates in first year postpartum and maternal/term infant BC, as well as breastfeeding parameters. BC of dyads (n = 20) was determined at 2, 5, 9, and/or 12 months postpartum using ultrasound skinfolds (infants) and bioelectrical impedance spectroscopy (infants/mothers). Breastfeeding frequency, 24-h milk intake and total carbohydrates (TCH) and lactose were measured to calculate HM oligosaccharides (HMO) concentration and CDI of carbohydrates. Statistical analysis used linear regression/mixed effects models; results were adjusted for multiple comparisons. Higher TCH concentrations were associated with greater infant length, weight, fat-free mass (FFM), and FFM index (FFMI), and decreased fat mass (FM), FM index (FMI), %FM and FM/FFM ratio. Higher HMO concentrations were associated with greater infant FFM and FFMI, and decreased FMI, %FM, and FM/FFM ratio. Higher TCH CDI were associated with greater FM, FMI, %FM, and FM/FFM ratio, and decreased infant FFMI. Higher lactose CDI were associated with greater FM, FMI, %FM, and FM/FFM, ratio and decreased FFMI. Concentrations and intakes of HM carbohydrates differentially influence development of infant BC in the first 12 months postpartum, and may potentially influence risk of later obesity via modulation of BC.
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Zielinska MA, Hamulka J, Wesolowska A. Carotenoid Content in Breastmilk in the 3rd and 6th Month of Lactation and Its Associations with Maternal Dietary Intake and Anthropometric Characteristics. Nutrients 2019; 11:E193. [PMID: 30669320 PMCID: PMC6356523 DOI: 10.3390/nu11010193] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 12/18/2022] Open
Abstract
Carotenoids are diet-dependent milk components that are important for the visual and cognitive development of an infant. This study determined β-carotene, lycopene and lutein + zeaxanthin in breastmilk and its associations with dietary intake from healthy Polish mothers in the first six months of lactation. Concentrations of carotenoids in breastmilk were measured by HPLC (high-performance liquid chromatography) (first, third, sixth month of lactation) and dietary intake was assessed based on a three-day dietary record (third and sixth month of lactation). The average age of participants (n = 53) was 31.4 ± 3.8 years. The breastmilk concentrations of carotenoids were not changed over the progress of lactation. Lycopene was a carotenoid with the highest content in breastmilk (first month 112.2 (95% CI 106.1⁻118.3)-sixth month 110.1 (103.9⁻116.3) nmol/L) and maternal diet (third month 7897.3 (5465.2⁻10329.5) and sixth month 7255.8 (5037.5⁻9474.1) µg/day). There was a positive correlation between carotenoids in breastmilk and dietary intake (lycopene r = 0.374, r = 0.338; lutein + zeaxanthin r = 0.711, r = 0.726, 3rd and 6th month, respectively) and an inverse correlation with maternal BMI in the third month of lactation (β-carotene: r = -0.248, lycopene: r = -0.286, lutein + zeaxanthin: r = -0.355). Adjusted multivariate regression models confirmed an association between lutein + zeaxanthin intake and its concentration in breastmilk (third month: β = 0.730 (0.516⁻0.943); 6th: β = 0.644 (0.448⁻0.840)). Due to the positive associations between dietary intake and breastmilk concentrations, breastfeeding mothers should have a diet that is abundant in carotenoids.
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Affiliation(s)
- Monika A Zielinska
- Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159 Nowoursynowska St., 02-776 Warsaw, Poland.
| | - Jadwiga Hamulka
- Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159 Nowoursynowska St., 02-776 Warsaw, Poland.
| | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Neonatology, Faculty of Health Sciences, Medical University of Warsaw, 63A Zwirki i Wigury St., 02-091 Warsaw, Poland.
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15
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Bzikowska-Jura A, Czerwonogrodzka-Senczyna A, Olędzka G, Szostak-Węgierek D, Weker H, Wesołowska A. Maternal Nutrition and Body Composition During Breastfeeding: Association with Human Milk Composition. Nutrients 2018; 10:E1379. [PMID: 30262786 PMCID: PMC6213543 DOI: 10.3390/nu10101379] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
The composition of human milk is dynamic and can vary according to many maternal factors, such as diet and nutritional status. This study investigated the association of maternal nutrition and body composition with human milk composition. All measurements and analyses were done at three time points: during the first (n = 40), third (n = 22), and sixth (n = 15) month of lactation. Human milk was analyzed using the Miris human milk analyzer (HMA), body composition was measured with bioelectrical bioimpedance (BIA) using a Maltron BioScan 920-II, and the assessment of women's nutrition was based on a three-day dietary record. The correlation coefficient (Pearson's r) did not show a significant statistical relationship between human milk composition and nutrients in women's diet at three time points. For women in the third month postpartum, we observed moderate to strong significant correlations (r ranged from 0.47 to 0.64) between total protein content in milk and the majority of body composition measures as follows: positive correlations: % fat mass (r = 0.60; p = 0.003), fat-free mass expressed in kg (r = 0.63; p = 0.001), and muscle mass (r = 0.47; p = 0.027); and negative correlation: % total body water (r = -0.60; p = 0.003). The variance in milk fat content was related to the body mass index (BMI), with a significant positive correlation in the first month postpartum (r = 0.33; p = 0.048). These findings suggest that it is not diet, but rather the maternal body composition that may be associated with the nutritional value of human milk.
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Affiliation(s)
- Agnieszka Bzikowska-Jura
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Aneta Czerwonogrodzka-Senczyna
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Gabriela Olędzka
- Department of Medical Biology, Faculty of Health Science, Medical University of Warsaw, Nowogrodzka Str. 73, 02-018 Warsaw, Poland.
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Halina Weker
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Aleksandra Wesołowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Faculty of Health Science, Department of Neonatology, Medical University of Warsaw, Zwirki i Wigury Str. 63A, 02-091 Warsaw, Poland.
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16
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Human Milk Casein and Whey Protein and Infant Body Composition over the First 12 Months of Lactation. Nutrients 2018; 10:nu10091332. [PMID: 30235880 PMCID: PMC6164442 DOI: 10.3390/nu10091332] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 12/30/2022] Open
Abstract
Human milk (HM) influences infant feeding patterns and body composition (BC). This small proof-of concept longitudinal study investigated relationships between infant/maternal BC and HM casein, whey and total protein during the first 12 months of lactation. BC of breastfeeding dyads (n = 20) was measured at 2 (n = 15), 5 (n = 20), 9 (n = 19), and/or 12 (n = 18) months postpartum with ultrasound skinfolds (infants) and bioimpedance spectroscopy (infants/mothers). Proteins concentrations and 24-h milk intake were measured and calculated daily intakes (CDI) determined. Higher maternal weight, body mass index, fat-free mass, fat-free mass index, and fat mass index were associated with higher concentration of whey protein (p ≤ 0.034, n = 20). There were no associations between infant BC and concentrations of all proteins, and CDI of whey and total protein. Higher CDI of casein were associated with lower infant fat-free mass (p = 0.003, n = 18) and higher fat mass (p < 0.001), fat mass index (p = 0.001, n = 18), and % fat mass (p < 0.001, n = 18) measured with ultrasound skinfolds. These results show a differential effect of HM casein on development of infant BC during the first year of life, suggesting that there is a potential to improve outcome for the infant through interventions, such as continuation of breastfeeding during the first 12 months of life and beyond, which may facilitate favourable developmental programming that could reduce risk of non-communicable diseases later in life.
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Tie WJ, Gardner H, Lai CT, Hepworth AR, Al‐Tamimi Y, Paech MJ, Hartmann PE, Geddes DT. Changes in milk composition associated with pethidine-PCEA usage after Caesarean section. MATERNAL & CHILD NUTRITION 2017; 13:e12275. [PMID: 27040350 PMCID: PMC6865999 DOI: 10.1111/mcn.12275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/27/2015] [Accepted: 11/29/2015] [Indexed: 12/01/2022]
Abstract
The effect of pethidine as patient-controlled epidural analgesia (PCEA) on specific biochemical components in breast milk in relation to the timing of secretory activation is not well investigated. The aim of this study was to compare biochemical timing of secretory activation between women who had a vaginal (V) or Caesarean birth with pethidine-PCEA (CBP). Several milk samples were collected daily from 36 mothers (17 V, 19 CBP) for the first 265 h post-partum. Protein and lactose concentrations and Na+ and K+ ion levels were measured. Samples were assigned to three time periods: 0-72, >72-165 and >165-265 h post-partum for statistical analyses. Data were analyzed using linear mixed effect models. In the first 72 h post-partum, the mean difference in lactose concentration was 5 gL-1 higher in group V (P < 0.05). From >72-165 h post-partum, protein and Na+ concentrations were lower in group V (P = 0.05, P = 0.02), and K+ levels were higher in group V (P < 0.001). From >165-265 h post-partum, there were no significant differences between the groups. Biochemically, secretory activation had occurred by 72 h post-partum in both groups. There were greater variations in measured biochemical components observed within group CBP initially. However, by 165 h post-partum, there were no differences in the biochemical components between the groups. This suggests that effects of pethidine-PCEA are diminished by 72 h post-partum and undetected by 165 h.
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Affiliation(s)
- Wan Jun Tie
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Hazel Gardner
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Ching Tat Lai
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Anna Rachel Hepworth
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Michael James Paech
- School of Medicine and PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Peter Edwin Hartmann
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Donna Tracy Geddes
- School of Chemistry and BiochemistryUniversity of Western AustraliaPerthWestern AustraliaAustralia
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18
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Abstract
Human milk analyzers can measure macronutrient content in native breast milk to tailor adequate supplementation with fortifiers. This article reviews all studies using milk analyzers, including (i) evaluation of devices, (ii) the impact of different conditions on the macronutrient analysis of human milk, and (iii) clinical trials to improve growth. Results lack consistency, potentially due to systematic errors in the validation of the device, or pre-analytical sample preparation errors like homogenization. It is crucial to introduce good laboratory and clinical practice when using these devices; otherwise a non-validated clinical usage can severely affect growth outcomes of infants.
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19
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Pundir S, Wall CR, Mitchell CJ, Thorstensen EB, Lai CT, Geddes DT, Cameron-Smith D. Variation of Human Milk Glucocorticoids over 24 hour Period. J Mammary Gland Biol Neoplasia 2017; 22:85-92. [PMID: 28144768 DOI: 10.1007/s10911-017-9375-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/20/2017] [Indexed: 01/09/2023] Open
Abstract
Human milk (HM) contains a complex array of hormones, including members of the glucocorticoid family. The predominant glucocorticoids, cortisol and cortisone may influence the growth and behaviour of the breastfed infant. However, little is understood of the factors regulating the levels of these hormones within HM. The aim of the study was to examine HM cortisol and cortisone concentration, measured in samples collected at each feed during a 24 hour period. Twenty three exclusively breastfeeding mothers collected milk, prior to and after each breastfeeding session over 24 hour period at 3.2(1.60) months. HM cortisol and cortisone levels were measured using high pressure liquid chromatography mass spectroscopy. Cortisone was the predominant glucocorticoid (3.40 ng/ml), and cortisol was detected in all samples (1.62 ng/ml). A positive correlation was found between cortisone and cortisol (r = 0.61, y = 1.93 ± 0.24, p < 0.0001). Cortisol and cortisone concentrations were significantly higher in feeds in the morning (2.97 ng/ml and 4.88 ng/ml), compared to afternoon (1.20 ng/ml and 3.54 ng/ml), evening (0.69 ng/ml and 2.13 ng/ml) and night (1.59 and 3.27 ng/ml). No difference was found between glucocorticoids level of the milk expressed for collection either before or immediately after the breastfeed, or between milk collected from the left or right breast. This study shows that HM glucocorticoid concentrations exhibit a 24 hour pattern, with highest peak levels in the early morning, reflecting the circadian pattern as previously reported in plasma. Thus, HM glucocorticoid concentrations are likely to reflect those in the maternal circulation.
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Affiliation(s)
- Shikha Pundir
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Clare R Wall
- Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Cameron J Mitchell
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Eric B Thorstensen
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Ching T Lai
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - David Cameron-Smith
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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20
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Abstract
There are wide variations in the macronutrient values adopted by neonatal intensive care units and industry to fortify milk in efforts to achieve recommended intakes for preterm infants. Contributing to this is the variation in macronutrient composition of preterm milk between and within mothers and the variable quality of milk analyses used to determine the macronutrient content of milk. We conducted a systematic review of the literature using articles published in English between 1959 and 2013 that reported the concentrations of one or more macronutrients or energy content in human preterm milk, sampled over a representative 24-h period. Searched medical databases included Ovid Medline, Scopus, CINAHL and the Cochrane Library. Results are presented as mean values and ranges for each macronutrient during weeks 1-8 of lactation, and preferred mean values (g/100 ml) for colostrum (week 1) and mature milk (weeks 2-8; protein: 1·27, fat: 3·46, lactose: 6·15 and carbohydrate: 7·34), using data from studies employing the highest-quality analyses. Industry-directed fortification practices using these mean values fail to meet protein targets for infants weighing <1000 g when the fortified milk is fed <170-190 ml/kg per d, and the protein:energy ratio of the fortified milk is inadequate. This study aimed to provide additional information to industry in order to guide their future formulation of breast milk fortifiers. Quality macronutrient analyses of adequately sampled preterm breast milk would improve our understanding of the level of fortification needed to meet recommended protein and energy intakes and growth targets, as well as support standardised reporting of nutritional outcomes.
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Cannon AM, Kakulas F, Hepworth AR, Lai CT, Hartmann PE, Geddes DT. The Effects of Leptin on Breastfeeding Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12340-55. [PMID: 26437426 PMCID: PMC4626972 DOI: 10.3390/ijerph121012340] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/07/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
Abstract
Breastfed infants have a reduced risk of becoming overweight and/or obese later in life. This protective effect has been partly attributed to leptin present in breastmilk. This study investigated 24-h variations of skim milk leptin and its relationship with breastmilk macronutrients and infant breastfeeding patterns. Exclusive breastfeeding mothers of term singletons (n = 19; age 10 ± 5 weeks) collected pre- and post-feed breastmilk samples for every breastfeed over a 24-h period and test-weighed their infants to determine milk intake at every breastfeed over a 24-h period. Samples (n = 454) were analysed for leptin, protein, lactose and fat content. Skim milk leptin concentration did not change with feeding (p = 0.184). However, larger feed volumes (>105 g) were associated with a decrease in post-feed leptin levels (p = 0.009). There was no relationship between the change in leptin levels and change in protein (p = 0.313) or lactose levels (p = 0.587) between pre- and post-feed milk, but there was a trend for a positive association with changes in milk fat content (p = 0.056). Leptin concentration significantly increased at night (p < 0.001) indicating a possible 24-h pattern. Leptin dose (ng) was not associated with the time between feeds (p = 0.232). Further research should include analysis of whole breastmilk and other breastmilk fractions to extend these findings.
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Affiliation(s)
- Anna M Cannon
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Western Australia 6009, Australia.
| | - Foteini Kakulas
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Western Australia 6009, Australia.
| | - Anna R Hepworth
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Western Australia 6009, Australia.
| | - Ching Tat Lai
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Western Australia 6009, Australia.
| | - Peter E Hartmann
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Western Australia 6009, Australia.
| | - Donna T Geddes
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Western Australia 6009, Australia.
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Quinn EA, Diki Bista K, Childs G. Milk at altitude: Human milk macronutrient composition in a high-altitude adapted population of tibetans. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 159:233-43. [DOI: 10.1002/ajpa.22871] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 09/04/2015] [Accepted: 09/06/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Elizabeth A. Quinn
- Department of Anthropology; Washington University in St. Louis; St. Louis Missouri 63130
| | | | - Geoff Childs
- Department of Anthropology; Washington University in St. Louis; St. Louis Missouri 63130
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Twigger AJ, Hepworth AR, Lai CT, Chetwynd E, Stuebe AM, Blancafort P, Hartmann PE, Geddes DT, Kakulas F. Gene expression in breastmilk cells is associated with maternal and infant characteristics. Sci Rep 2015; 5:12933. [PMID: 26255679 PMCID: PMC4542700 DOI: 10.1038/srep12933] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/15/2015] [Indexed: 01/11/2023] Open
Abstract
Breastmilk is a rich source of cells with a heterogeneous composition comprising early-stage stem cells, progenitors and more differentiated cells. The gene expression profiles of these cells and their associations with characteristics of the breastfeeding mother and infant are poorly understood. This study investigated factors associated with the cellular dynamics of breastmilk and explored variations amongst women. Genes representing different breastmilk cell populations including mammary epithelial and myoepithelial cells, progenitors, and multi-lineage stem cells showed great variation in expression. Stem cell markers ESRRB and CK5, myoepithelial marker CK14, and lactocyte marker α-lactalbumin were amongst the genes most highly expressed across all samples tested. Genes exerting similar functions, such as either stem cell regulation or milk production, were found to be closely associated. Infant gestational age at delivery and changes in maternal bra cup size between pre-pregnancy and postpartum lactation were associated with expression of genes controlling stemness as well as milk synthesis. Additional correlations were found between genes and dyad characteristics, which may explain abnormalities related to low breastmilk supply or preterm birth. Our findings highlight the heterogeneity of breastmilk cell content and its changes associated with characteristics of the breastfeeding dyad that may reflect changing infant needs.
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Affiliation(s)
- Alecia-Jane Twigger
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Anna R Hepworth
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Ching Tat Lai
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Ellen Chetwynd
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, School of Medicine, University of North Carolina, 3010 Old Clinic Building, CB 7615, Chapel Hill, NC 27599, USA
| | - Alison M Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, School of Medicine, University of North Carolina, 3010 Old Clinic Building, CB 7615, Chapel Hill, NC 27599, USA
| | - Pilar Blancafort
- 1] Department of Pharmacology, School of Medicine, University of North Carolina, 120 Mason Farm Road, Chapel Hill, NC 27599, USA [2] Cancer Epigenetics group, the Harry Perkins Institute of Medical Research, and School of Anatomy, Physiology and human Biology, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Peter E Hartmann
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Donna T Geddes
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Foteini Kakulas
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
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24
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Broadhurst M, Beddis K, Black J, Henderson H, Nair A, Wheeler T. Effect of gestation length on the levels of five innate defence proteins in human milk. Early Hum Dev 2015; 91:7-11. [PMID: 25460250 DOI: 10.1016/j.earlhumdev.2014.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/03/2014] [Accepted: 11/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human milk contains a range of host defence proteins that appear to contribute to health and wellbeing, but their variability in abundance among individuals has not been very well characterised. Milk from mothers of premature infants has altered composition, but the effect of gestation length on the host-defence properties of milk is not known. A study was therefore undertaken to determine the variability and effect of gestation length on the abundance of five host-defence proteins in milk; lactoferrin, secretory IgA, IgG, secretory component, and complement C3. METHODS Milk was obtained from 30 mothers at their second and fifth week of lactation. These were from three groups of ten mothers having had very premature (V; 28-32 weeks gestation), premature (P; 33-36 weeks) or full term deliveries (T; 37-41 weeks). The concentration of each of the five proteins was measured in each milk sample by either ELISA or quantitative western blotting. RESULTS The concentration of IgG, and complement C3 ranged 22- and 17-fold respectively between mothers, while lactoferrin, secretory IgA, and secretory component ranged 7-, 9-, and 4-fold, respectively. The V group had significantly lower concentrations of four of the five proteins, the exception being IgG. Levels of these four proteins also decreased between weeks 2 and 5 of lactation in the P and T groups. Significant correlation was found between the concentrations of the host defence proteins within individual mothers, indicating some degree of co-ordinate regulation. CONCLUSIONS Mothers vary widely in the levels of host defence proteins in milk. Very short gestation length results in decreased abundance of host-defence proteins in milk. This may have functional implications for very premature infants.
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Affiliation(s)
| | - Keryn Beddis
- AgResearch, Ruakura Research Centre, Hamilton, New Zealand
| | - Janet Black
- Neonatal Unit, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand
| | | | - Arun Nair
- Neonatal Unit, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand
| | - Thomas Wheeler
- AgResearch, Ruakura Research Centre, Hamilton, New Zealand.
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Zonneveld MI, Brisson AR, van Herwijnen MJC, Tan S, van de Lest CHA, Redegeld FA, Garssen J, Wauben MHM, Nolte-'t Hoen ENM. Recovery of extracellular vesicles from human breast milk is influenced by sample collection and vesicle isolation procedures. J Extracell Vesicles 2014; 3:24215. [PMID: 25206958 PMCID: PMC4139932 DOI: 10.3402/jev.v3.24215] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 12/18/2022] Open
Abstract
Extracellular vesicles (EV) in breast milk carry immune relevant proteins and could play an important role in the instruction of the neonatal immune system. To further analyze these EV and to elucidate their function it is important that native populations of EV can be recovered from (stored) breast milk samples in a reproducible fashion. However, the impact of isolation and storage procedures on recovery of breast milk EV has remained underexposed. Here, we aimed to define parameters important for EV recovery from fresh and stored breast milk. To compare various protocols across different donors, breast milk was spiked with a well-defined murine EV population. We found that centrifugation of EV down into density gradients largely improved density-based separation and isolation of EV, compared to floatation up into gradients after high-force pelleting of EV. Using cryo-electron microscopy, we identified different subpopulations of human breast milk EV and a not previously described population of lipid tubules. Additionally, the impact of cold storage on breast milk EV was investigated. We determined that storing unprocessed breast milk at −80°C or 4°C caused death of cells present in breast milk, leading to contamination of the breast milk EV population with storage-induced EV. Here, an alternative method is proposed to store breast milk samples for EV analysis at later time points. The proposed adaptations to the breast milk storage and EV isolation procedures can be applied for EV-based biomarker profiling of breast milk and functional analysis of the role of breast milk EV in the development of the neonatal immune system.
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Affiliation(s)
- Marijke I Zonneveld
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands ; Department of Biochemistry & Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Alain R Brisson
- Imagerie Moléculaire et NanoBioTechnologie, UMR-CBMN CNRS-University of Bordeaux, Pessac, France
| | - Martijn J C van Herwijnen
- Department of Biochemistry & Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sisareuth Tan
- Imagerie Moléculaire et NanoBioTechnologie, UMR-CBMN CNRS-University of Bordeaux, Pessac, France
| | - Chris H A van de Lest
- Department of Biochemistry & Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Frank A Redegeld
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands ; Nutricia Research Centre for Specialized Nutrition, Utrecht, The Netherlands
| | - Marca H M Wauben
- Department of Biochemistry & Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Esther N M Nolte-'t Hoen
- Department of Biochemistry & Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Timby N, Domellöf E, Hernell O, Lönnerdal B, Domellöf M. Neurodevelopment, nutrition, and growth until 12 mo of age in infants fed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial. Am J Clin Nutr 2014; 99:860-8. [PMID: 24500150 DOI: 10.3945/ajcn.113.064295] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies have indicated that differences in the composition of human milk and infant formula yield benefits in cognitive development and early growth for breastfed infants. OBJECTIVE The objective was to test the hypothesis that feeding an infant formula with reduced energy and protein densities and supplemented with bovine milk fat globule membrane (MFGM) reduces differences in cognitive development and early growth between formula-fed and breastfed infants. DESIGN In a prospective, double-blind, randomized controlled trial, 160 infants <2 mo of age were randomly assigned to be fed an MFGM-supplemented, low-energy, low-protein experimental formula (EF) or a standard formula (SF) until 6 mo of age. The energy and protein contents of the EF and SF were 60 and 66 kcal/100 mL and 1.20 and 1.27 g/100 mL, respectively. A breastfed reference (BFR) group consisted of 80 infants. RESULTS At 12 mo of age, the cognitive score (mean ± SD) on testing with the Bayley Scales of Infant and Toddler Development, Third Edition, was significantly higher in the EF group than in the SF group (105.8 ± 9.2 compared with 101.8 ± 8.0; P = 0.008) but was not significantly different from that in the BFR group (106.4 ± 9.5; P = 0.73). The EF group ingested larger volumes of formula than did the SF group (864 ± 174 compared with 797 ± 165 mL/d; P = 0.022), fully compensating for the lower energy density. No significant differences in linear growth, weight gain, body mass index, percentage body fat, or head circumference were found between the EF and SF groups. CONCLUSIONS MFGM supplementation to infant formula narrows the gap in cognitive development between breastfed and formula-fed infants. Between 2 and 6 mo of age, formula-fed term infants have the capacity to upregulate their ingested volumes when the energy density of formula is reduced from 66 to 60 kcal/100 mL.
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Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences, Pediatrics (NT, OH, and MD) and the Department of Psychology (ED), Umeå University, Umeå, Sweden, and the Department of Nutrition, University of California, Davis, Davis, CA (BL)
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Smilowitz JT, O’Sullivan A, Barile D, German JB, Lönnerdal B, Slupsky CM. The human milk metabolome reveals diverse oligosaccharide profiles. J Nutr 2013; 143:1709-18. [PMID: 24027187 PMCID: PMC4083237 DOI: 10.3945/jn.113.178772] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/15/2013] [Accepted: 08/26/2013] [Indexed: 12/22/2022] Open
Abstract
Breast milk delivers nutrition and protection to the developing infant. There has been considerable research on the high-molecular-weight milk components; however, low-molecular-weight metabolites have received less attention. To determine the effect of maternal phenotype and diet on the human milk metabolome, milk collected at day 90 postpartum from 52 healthy women was analyzed by using proton nuclear magnetic resonance spectroscopy. Sixty-five milk metabolites were quantified (mono-, di-, and oligosaccharides; amino acids and derivatives; energy metabolites; fatty acids and associated metabolites; vitamins, nucleotides, and derivatives; and others). The biological variation, represented as the percentage CV of each metabolite, varied widely (4-120%), with several metabolites having low variation (<20%), including lactose, urea, glutamate, myo-inositol, and creatinine. Principal components analysis identified 2 clear groups of participants who were differentiable on the basis of milk oligosaccharide concentration and who were classified as secretors or nonsecretors of fucosyltransferase 2 (FUT2) gene products according to the concentration of 2'-fucosyllactose, lactodifucotetraose, and lacto-N-fucopentaose I. Exploration of the interrelations between the milk sugars by using Spearman rank correlations revealed significant positive and negative associations, including positive correlations between fucose and products of the FUT2 gene and negative correlations between fucose and products of the fucosyltransferase 3 (FUT3) gene. The total concentration of milk oligosaccharides was conserved among participants (%CV = 18%), suggesting tight regulation of total oligosaccharide production; however, concentrations of specific oligosaccharides varied widely between participants (%CV = 30.4-84.3%). The variability in certain milk metabolites suggests possible roles in infant or infant gut microbial development. This trial was registered at clinicaltrials.gov as NCT01817127.
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Affiliation(s)
- Jennifer T. Smilowitz
- Departments of Food Science and Technology
- Foods for Health Institute, University of California, Davis, Davis, CA
| | - Aifric O’Sullivan
- Departments of Food Science and Technology
- Nutrition, and
- Foods for Health Institute, University of California, Davis, Davis, CA
| | - Daniela Barile
- Departments of Food Science and Technology
- Foods for Health Institute, University of California, Davis, Davis, CA
| | - J. Bruce German
- Departments of Food Science and Technology
- Foods for Health Institute, University of California, Davis, Davis, CA
| | - Bo Lönnerdal
- Nutrition, and
- Foods for Health Institute, University of California, Davis, Davis, CA
| | - Carolyn M. Slupsky
- Departments of Food Science and Technology
- Nutrition, and
- Foods for Health Institute, University of California, Davis, Davis, CA
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