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Talebiyan S, Belfort MB. Human Milk Fortification for Very Preterm Infants: Toward Optimal Nutrient Delivery, Neonatal Intensive Care Unit Growth, and Long-Term Outcomes. Clin Perinatol 2023; 50:625-641. [PMID: 37536768 DOI: 10.1016/j.clp.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Human milk is the preferred diet for very preterm infants due to short-term and long-term benefits for health and neurodevelopment. Fortification of human milk is required to deliver sufficient nutrients to attain recommended growth targets during the neonatal hospitalization. Intrinsic variability in human milk composition poses a challenge in clinical practice because some infants fail to meet recommended nutrient intakes even with existing approaches of standard (fixed-dose) and adjustable fortification. Individually targeted fortification is an emerging strategy to minimize nutrition delivery gaps through application of point-of-care human milk analysis and has potential to improve growth and related outcomes.
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Affiliation(s)
- Saharnaz Talebiyan
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Avenue BL-341, Boston, MA 02115, USA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Avenue BL-341, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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2
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Karbasi S, Binabaj MM, Khorasanchi Z, Bideh M, Zarban A, Bahrami A. Association between adherence to a low carbohydrate dietary (LCD) pattern with breast milk characteristics and oxidative markers in infants' urine: a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:40. [PMID: 37149671 PMCID: PMC10163718 DOI: 10.1186/s41043-023-00381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Breast milk (BM) is a dynamic fluid that varies over time and between women. The variations in BM components are most likely associated with maternal diet quality. This study aimed to assess adherence to a low carbohydrate dietary (LCD) pattern with oxidative stress markers of BM characteristics and infants' urine. MATERIALS AND METHODS In this cross-sectional study 350 breastfeeding mothers and their infants were recruited. BM samples were collected from mothers, and urine specimens were obtained from each infant. To evaluate LCD scores, subjects were divided into 10 deciles according to the percent of energy obtained from carbohydrates, proteins, and fats. Determination of total antioxidant activity was conducted using the ferric reducing antioxidant power (FRAP), 2, 2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Ellman's assay. Biochemical assays of samples including calcium, total protein, and triglyceride level were also performed using commercial kits. RESULTS Participants with the greatest LCD pattern adherence were placed into the last quartile (Q4), and those with the minimum LCD were in the first quartile (Q1). Individuals in the highest LCD quartile had significantly higher levels of milk FRAP, thiol, and protein, as well as infant urinary FRAP and lower milk MDA levels than those in the lowest quartile. Multivariate linear regression analyses indicated that higher score of the LCD pattern was associated with a higher level of milk thiol, protein, and lower level of milk MDA (p < 0.05). CONCLUSION Our findings show that adherence to a LCD, as defined by a low level of carbohydrates in daily food intake, is linked with improved BM quality and markers of oxidative stress in infant urine.
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Affiliation(s)
- Samira Karbasi
- Department of Molecular Medicine, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Moradi Binabaj
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra Khorasanchi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Milad Bideh
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Asghar Zarban
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
- Clinical Biochemistry Department, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
| | - Afsane Bahrami
- Clinical Research Development Unit of Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
- Clinical Research Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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3
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He G, Li G, Jiang Y, Hua J, Chu X, Xiong L, Gong J, Xiao G, Ye X. Macronutrient content and fatty acid composition and their positional distribution in human breast milk from Zhejiang Province, China in different lactation periods. Food Sci Nutr 2021; 9:6746-6761. [PMID: 34925804 PMCID: PMC8645764 DOI: 10.1002/fsn3.2626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
Lactational changes in macronutrient content, lipid profile, fatty acid composition, and positional distribution of human breast milk were investigated in this study. A total of 378 milk samples of six different lactation periods, including 0‒5, 6‒14, 15‒30, 31‒90, 91‒180, and 181‒360 days, were collected cross-sectionally from healthy lactating women in Zhejiang, China. As lactation progressed from 0‒5 to 15‒30 days, the lipid content and the percentages of C10:0, C12:0, C14:0, C18:2n-6, and C18:3n-3 increased significantly, while the protein concentration and the proportions of phospholipids, cholesterols, C16:0, C18:1n-9, C24:1n-9, C20:4n-6, C22:4n-6, C22:5n-3, and C22:6n-3 decreased notably. When lactation was further extended to 181‒360 days, the protein content continued to decrease, and the percentages of C12:0 and C14:0 continued to increase, whereas the levels of other tested nutrients remained stable. Although the triacylglycerol positional distributions of some fatty acids underwent significant lactational variations, C14:0, C16:0, C24:1n-9, C22:4n-6, C22:5n-3, and C22:6n-3 were located mainly at the sn-2 position, while C18:1n-9, C18:2n-6, and C18:3n-3 were primarily distributed at the sn-1,3 positions. Compared with human breast milk reported in Western countries, samples in our study demonstrated higher percentages of C18:2n-6, C18:3n-3, C20:4n-6, and C22:6n-3, but lower proportions of C12:0, C14:0, and C18:1n-9. The results from this study indicated a nutritional composition different from that of the Western countries and may provide useful data for the development of infant formulas closer to Chinese breast milk in terms of the fatty acid composition and its specified positional distribution on triglyceride structure.
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Affiliation(s)
- Guanghua He
- Department of Food Science and NutritionZhejiang UniversityHangzhouChina
- School of Biological and Chemical EngineeringZhejiang University of Science and TechnologyHangzhouChina
| | - Guipu Li
- Beingmate (Hangzhou) Food Research Institute Co., LtdHangzhouChina
| | - Yanxi Jiang
- Beingmate (Hangzhou) Food Research Institute Co., LtdHangzhouChina
| | - Jiacai Hua
- Beingmate (Hangzhou) Food Research Institute Co., LtdHangzhouChina
| | - Xiaojun Chu
- Beingmate (Hangzhou) Food Research Institute Co., LtdHangzhouChina
| | - Lina Xiong
- Beingmate (Hangzhou) Food Research Institute Co., LtdHangzhouChina
| | - Jinyan Gong
- School of Biological and Chemical EngineeringZhejiang University of Science and TechnologyHangzhouChina
| | - Gongnian Xiao
- School of Biological and Chemical EngineeringZhejiang University of Science and TechnologyHangzhouChina
| | - Xingqian Ye
- Department of Food Science and NutritionZhejiang UniversityHangzhouChina
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4
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Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics 2021; 148:peds.2021-054272. [PMID: 34635582 DOI: 10.1542/peds.2021-054272] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Provision of mother's own milk for hospitalized very low birth weight (VLBW) (≤1500 g) infants in the NICU provides short- and long-term health benefits. Mother's own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Every mother should receive information about the critical importance of mother's own milk to the health of a VLBW infant. Pasteurized human donor milk is recommended when mother's own milk is not available or sufficient. Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother's own milk by providing institutional supports for early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding, when appropriate. Promotion of human milk and breastfeeding for VLBW infants requires multidisciplinary and system-wide adoption of lactation support practices.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa M Stellwagen
- University of California Health Milk Bank, San Diego, California.,Department of Pediatrics, University of California, San Diego, Health, San Diego, California
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,New York City Health + Hospitals/Elmhurst
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenda B Poindexter
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia
| | - Karen M Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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5
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Fusch S, Fusch G, Yousuf EI, Rochow M, So HY, Fusch C, Rochow N. Individualized Target Fortification of Breast Milk: Optimizing Macronutrient Content Using Different Fortifiers and Approaches. Front Nutr 2021; 8:652641. [PMID: 34621769 PMCID: PMC8490648 DOI: 10.3389/fnut.2021.652641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Native breast milk composition displays significant inter- and intra-individual variation which persists after standard fortification with fixed doses and challenges target fortification. This study aims to analyze the macronutrient composition of different commercially available fortifiers and the effect of different fortification strategies on nutritional intake of preterm infants. Methods: In 103 preterm infants, native breast milk samples were collected from 24-h feeding batches (n = 3,338) and fat, protein and carbohydrate contents were analyzed. Nutrient content was compared for breast milk that had undergone either (i) standard fortification, (ii) targeted fortification, (iii) selective batching according to breast milk composition, or (iv) partial lyophilization. For (i) eight commercially available standard fortifiers were tested. Targeted fortification (ii) involved the addition of single component modulars of either protein, fat or carbohydrates to standard fortified breast milk. Using a mathematical growth model, the combined effect of protein, fat and carbohydrate intake on growth was assessed. The best composition of standard fortifiers as the initial step for target fortification was explored assuming three clinical scenarios for milk analysis. Results: Macronutrient content was highly variable between native breast milk samples, and this variation was still present after standard fortification, however at elevated macronutrient levels. Standard fortification, breast milk batching, as well as partial lyophilization of human milk resulted in deficient and imbalanced enteral intakes in a significant proportion of infants. Target fortification reduced this variation in a, respectively, higher percentage of samples. The effect size was dependent on the number of measurements per week. The optimum composition of standard fortifiers was dependent on the clinical scenario (measurement frequency) for target fortification. Conclusions: To provide precise and accurate intakes of macronutrients, breast milk should be target fortified. Standard fortified breast milk can result in excess above recommended intakes of some macronutrients which limits the efficiency of target fortification. Standard fortifiers with improved composition are needed for target fortification.
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Affiliation(s)
- Stephanie Fusch
- Department of Pediatrics, University Medicine Greifswald, Greifswald, Germany.,Department of Pediatrics, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Hon Yiu So
- Department of Mathematics and Statistics, Oakland University, Rochester, MI, United States
| | - Christoph Fusch
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Niels Rochow
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, General Hospital, Paracelsus Medical University, Nuremberg, Germany.,Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
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6
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Parschat K, Melsaether C, Jäpelt KR, Jennewein S. Clinical Evaluation of 16-Week Supplementation with 5HMO-Mix in Healthy-Term Human Infants to Determine Tolerability, Safety, and Effect on Growth. Nutrients 2021; 13:nu13082871. [PMID: 34445031 PMCID: PMC8401119 DOI: 10.3390/nu13082871] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022] Open
Abstract
Human milk oligosaccharides (HMOs) are complex sugars that occur naturally in human breast milk and provide many beneficial functions. Most formula products lack HMOs or contain only the most abundant HMO, 2′-fucosyllactose; however, benefits of HMOs come from multiple sugars. We therefore developed a mixture of five HMOs (5HMO-Mix) mimicking the natural concentrations of the top five HMOs (5.75 g/L total, comprising 52% 2′-fucosyllactose, 13% 3-fucosyllactose, 26% lacto-N-tetraose, 4% 3′-sialyllactose, and 5% 6′-sialyllactose) representing the groups of neutral, neutral-fucosylated, and sialylated HMOs. We conducted the first multicenter, randomized, controlled, parallel-group clinical study assessing the safety, tolerability, and effect on growth of formula containing the 5HMO-Mix in healthy infants. We enrolled 341 subjects aged ≤14 days; 225 were randomized into groups fed either with infant formula containing 5HMO-Mix (5HMO-Mix) or infant formula without HMOs (IF) for 4 months, with the others exclusively breastfed. There were no differences in weight, length, or head circumference gain between the two formula groups. The 5HMO-Mix was well tolerated, with 5HMO-Mix and breastfed infants producing softer stools at a higher stool frequency than the control formula group. Adverse events were equivalent in all groups. We conclude that the 5HMO-Mix at 5.75 g/L in infant formula is safe and well tolerated by healthy term infants during the first months of life.
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Affiliation(s)
- Katja Parschat
- Chr. Hansen HMO GmbH, 53619 Rheinbreitbach, Germany
- Correspondence: ; Tel.: +49-2224-98810400
| | | | | | - Stefan Jennewein
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), 52074 Aachen, Germany;
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7
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Schinkel ER, Nelson ER, Young BE, Bernstein RM, Taylor SN, Hay WW, Brown LD, Brown KJ, Prenni J. Concentrating human milk: an innovative point-of-care device designed to increase human milk feeding options for preterm infants. J Perinatol 2021; 41:582-589. [PMID: 33060780 PMCID: PMC9848740 DOI: 10.1038/s41372-020-00820-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether a point-of-care osmotic device concentrates important human milk (HM) nutrients to support feeding neonates requiring high-nutrient, low-volume feedings. STUDY DESIGN Raw and pasteurized HM samples were concentrated to determine the effects of time and temperature on concentration. Concentrated samples were compared with matched baseline samples to measure changes in selected nutrient concentrations. Furthermore, changes in concentration of certain bioactive components of raw milk samples were measured. RESULT The device significantly increased the concentrations of the majority of the measured nutrient and bioactive levels (p < 0.05). Increasing temperature of HM from 4 to 37 °C increased the concentration rate >30%. In all cases, the concentration rate of pasteurized HM was greater than that of raw HM. CONCLUSIONS The osmotic concentration of HM is a promising option for neonatal nutrition. Further studies are needed to establish an evidence base for the practical applications of this point-of-care device.
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Affiliation(s)
| | | | - Bridget E. Young
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry
| | - Robin M. Bernstein
- Department of Anthropology and Institute of Behavioral Science, University of Colorado, Boulder
| | | | | | | | - Kitty J. Brown
- Center for Proteomics and Metabolomics at Colorado State University
| | - Jessica Prenni
- Center for Proteomics and Metabolomics at Colorado State University
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8
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Leghi GE, Middleton PF, Netting MJ, Wlodek ME, Geddes DT, Muhlhausler BS. A Systematic Review of Collection and Analysis of Human Milk for Macronutrient Composition. J Nutr 2020; 150:1652-1670. [PMID: 32240307 DOI: 10.1093/jn/nxaa059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND As human milk (HM) composition varies by time and across even a single feed, methods of sample collection can significantly affect the results of compositional analyses and complicate comparisons between studies. OBJECTIVE The aim was to compare the results obtained for HM macronutrient composition between studies utilizing different sampling methodologies. The results will be used as a basis to identify the most reliable HM sampling approach. METHODS EMBASE, MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, and ProQuest databases were searched for relevant articles. Observational and interventional studies were included, and at least 2 authors screened studies and undertook data extraction. Quality assessment was conducted using the Newcastle-Ottawa scale and previously published pragmatic score. RESULTS A total of 5301 publications were identified from our search, of which 101 studies were included (n = 5049 breastfeeding women). Methods used for HM collection were divided into 3 categories: collection of milk from all feeds over 24 h (32 studies, n = 1309 participants), collection at one time point (62 studies, n = 3432 participants), and "other methods" (7 studies, n = 308 participants). Fat and protein concentrations varied between collection methods within lactation stage, but there were no obvious differences in lactose concentrations. There was substantial variability between studies in other factors potentially impacting HM composition, including stage of lactation, gestational age, and analytical method, which complicated direct comparison of methods. CONCLUSIONS This review describes the first systematic evaluation of sampling methodologies used in studies reporting HM composition and highlights the wide range of collection methods applied in the field. This information provides an important basis for developing recommendations for best practices for HM collection for compositional analysis, which will ultimately allow combination of information from different studies and thus strengthen the body of evidence relating to contemporary HM composition. This trial was registered at PROSPERO as CRD42017072563, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017072563.
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Affiliation(s)
- Gabriela E Leghi
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia.,Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Philippa F Middleton
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Merryn J Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Discipline of Pediatrics, The University of Adelaide, Adelaide, Australia
| | - Mary E Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Beverly S Muhlhausler
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia.,Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, Australia
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9
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Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: A double-blind randomized controlled trial. Clin Nutr 2020; 40:54-63. [PMID: 32446787 DOI: 10.1016/j.clnu.2020.04.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS In preterm infants, natural variation of breast milk composition makes it difficult to achieve recommended macronutrient intakes with standard fortification. Evidence suggests that nutritional deficiency induces poor postnatal growth. This study investigates impacts of target fortification on preterm growth and metabolism by adjusting breast milk macronutrients. METHODS This study was conducted as a single-centre, double-blind, randomized controlled trial for infants <30 gestational weeks. The control group received standard fortification and the intervention group received standard plus target fortification adding modular protein, lipids, and carbohydrates. Breast milk content was measured 3x/week using a validated near-infrared bedside spectrometer (NIRS). Modulars were added to achieve recommended values. To assess total nutrient intake, all 2810 native breast milk samples were analyzed - protein and fat using bedside-NIRS, lactose using tandem mass spectrometry (UPLC-MS/MS). Body composition was measured using air displacement plethysmography. Primary outcome was weight gain during the first 21 days of intervention. RESULTS Baseline characteristics, morbidities, and total fluid intake were not different between groups (intervention n = 52, control n = 51). The intervention group infants had higher macronutrient intakes, weight gain (21.2 ± 2.5 vs 19.3 ± 2.4 g/kg/d, mean difference: 1.9 g/kg/d, 95% CI: 0.9 - 2.9), and body weight. Infants in the intervention group from mothers with below-average breast milk protein content showed greatest impact on weight at 36 weeks (2580 ± 280 g vs 2210 ± 300 g), length, head circumference, fat, and fat-free mass. Also, feeding intolerance was less frequent, blood urea was higher, and triglycerides were lower. CONCLUSIONS This study provides evidence that target fortification of breast milk with low macronutrient content enhances the quality of nutrition and growth and is feasible in clinical routine.
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10
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Bahreynian M, Feizi A, Kelishadi R. Is fatty acid composition of breast milk different in various populations? A systematic review and meta-analysis. Int J Food Sci Nutr 2020; 71:909-920. [PMID: 32253956 DOI: 10.1080/09637486.2020.1746958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This systematic review and meta-analysis aims to systematically review the fatty acid (FA) composition of breast milk in different populations. We systematically searched the Medline via PubMed, Scopus and Clarivate till July 2019. We initially retrieved 433 articles. Having removed duplicates, with initial searching of title and abstracts, 317 papers were excluded and 80 remained. A meta-analysis of 80 cross-sectional, cohort studies, including 8793 subjects, was conducted. Meta-regression analysis indicated that factors including maternal age (p-values of SFA: 0.03, omega-3: 0.01, trans fats:<0.001, total fatty acids: 0.02), year of conducting study (p-values of SFA: <0.001, MUFA: 0.02, omega-6: 0.04,trans fats: 0.04) and sample size (p-values of SFA: 0.03, PUFA: 0.01, omega-6: 0.01, omega-3:<0.001) contributed to the heterogeneity of meta-analysis. This study indicates the large variation of FA content in maternal milk across different populations. Special concern is necessary for both the quality and total amount of fat intake of pregnant and lactating mothers.
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Affiliation(s)
- Maryam Bahreynian
- Department of Nutrition, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Harris T, Gardner F, Podany A, Kelleher SL, Doheny KK. Increased early enteral zinc intake improves weight gain in hospitalised preterm infants. Acta Paediatr 2019; 108:1978-1984. [PMID: 31033040 DOI: 10.1111/apa.14828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 12/22/2022]
Abstract
AIM To test the hypothesis that enteral zinc intake is associated with improved preterm infant growth during neonatal intensive care unit (NICU) hospitalisation. METHODS This prospective cohort study enrolled 105 preterm infants at a tertiary referral centre. Enteral zinc intake was calculated at day of life 14, and growth was measured as change in weight, length and head circumference from birth to discharge. Nonparametric tests assessed the contribution of breast milk vs formula and enteral zinc intake on weight, length and head circumference growth. Partial correlations evaluated the impact of baseline health status and caloric intake on growth. Multiple regression analysis was then completed to determine the unique contribution of zinc intake to weight gain and head circumference growth. RESULTS Total enteral zinc intake was positively associated with weight gain (r = 0.4, p < 0.01) and head circumference growth (r = 0.3, p < 0.01) during NICU hospitalisation. Further, multiple regression analysis showed higher zinc intake is linked to weight gain during NICU hospitalisation after accounting for postmenstrual age at birth. CONCLUSION Increased early enteral zinc intake is linked to weight gain during NICU hospitalisation, highlighting the importance of enteral zinc intake in early infant nutrition.
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Affiliation(s)
- Tracey Harris
- Division of Neonatal‐Perinatal Medicine Penn State Health Children's Hospital Hershey PA USA
| | - Fumiyuki Gardner
- Division of Neonatal‐Perinatal Medicine Penn State Health Children's Hospital Hershey PA USA
| | - Abigail Podany
- Department of Surgery Penn State Health Milton S. Hershey Medical Center Hershey PA USA
| | - Shannon L. Kelleher
- Department of Biomedical and Nutritional Sciences University of Massachusetts Lowell Lowell MA USA
| | - Kim K. Doheny
- Division of Neonatal‐Perinatal Medicine Penn State Health Children's Hospital Hershey PA USA
- Department of Neural and Behavioral Sciences Penn State College of Medicine Hershey PA USA
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12
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Knake LA, King BC, Gollins LA, Hurst NM, Hagan J, Ford SL, Hair AB. Optimizing the Use of Human Milk Cream Supplement in Very Preterm Infants: Growth and Cost Outcomes. Nutr Clin Pract 2019; 35:689-696. [PMID: 31642112 DOI: 10.1002/ncp.10423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An exclusive human milk-based diet has been shown to decrease necrotizing enterocolitis and improve outcomes for infants ≤1250 g birth weight. Studies have shown that infants who received an exclusive human milk diet with a donor-human milk-derived cream supplement (cream) had improved weight and length velocity when the cream was added to mother's own milk or donor-human milk when energy was <20 kcal/oz using a human milk analyzer. Our objective was to compare growth and cost outcomes of infants ≤1250 g birth weight fed with an exclusive human milk diet, with and without human milk cream, without the use of a human milk analyzer. METHODS Two cohorts of human milk-fed premature infants were compared from birth to 34 weeks postmenstrual age. Group 1 (2010-2011) received a donor-human milk fortifier, whereas Group 2 (2015-2016) received donor-human milk fortifier plus the commercial cream supplement, if weight gain was <15 g/kg/d. RESULTS There was no difference in growth between the 2 groups for weight (P = 0.32) or head circumference (P = 0.90). Length velocity was greater for Group 1 (P = 0.03). The mean dose of donor-human milk fortifier was lower in Group 2 (P < 0.001). Group 2 saved an average of $2318 per patient on the cost of human milk products (P < 0.01). CONCLUSIONS Infants receiving a human milk diet with cream supplementation for growth faltering achieve appropriate growth in a cost-effective feeding strategy.
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Affiliation(s)
- Lindsey A Knake
- Department of Pediatrics, Section of Neonatology, Vanderbilt University, Nashville, Tennessee, USA.,Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Brian C King
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Laura A Gollins
- Clinical Nutrition Services, Texas Children's Hospital, Houston, Texas, USA
| | - Nancy M Hurst
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Joseph Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Steven L Ford
- Department of Pediatrics, Division of Neonatology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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13
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Kwan C, Fusch G, Rochow N, Fusch C. Milk analysis using milk analyzers in a standardized setting (MAMAS) study: A multicentre quality initiative. Clin Nutr 2019; 39:2121-2128. [PMID: 31526612 DOI: 10.1016/j.clnu.2019.08.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/08/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Human milk analyzers are increasingly used to rapidly measure the macronutrient content in breast milk for individual target fortification, to reduce the risk of postnatal growth restriction. However, many milk analyzers are used without calibration, validation or quality assurance. AIMS To investigate measurement quality between different human milk analyzers, to test whether accuracy and precision of devices can be improved by establishing individual calibration curves, and to assess long-term stability of measurements, following good clinical laboratory practice (GCLP). METHODS Sets of identical breast milk samples were sent to 13 participating centres in North America and Europe, for a total of 15 devices. The study included 3 sets of samples: A) initial assessment of the device's performance consisting of 10 calibration samples with random replicates; B) long term stability and quality control consisting of 2 batches of samples to be measured every time before the device is used, over 6 months; C) ring trial consisting of 2 samples to be measured monthly. The devices tested were Unity SpectraStar (n = 5) and MIRIS Human Milk Analyzer (n = 10). RESULTS There are significant variations in accuracy and precision between different milk analyzers' fat, protein and lactose measurements. However, the accuracy of measurements can be improved by establishing individual correction algorithms. Repeated measurements are more robust when coming from a larger batch volume. Long term stability also varies between devices. CONCLUSION The variations in measurements between devices are clinically significant and would impact both daily dietary prescriptions, and the outcomes of clinical studies assessing the effect of targeted adjustment of nutrient intake in preterm babies. This study shows that it is crucial to follow GCLP when using milk analyzers to ensure proper measurement of macronutrients, similar to what is required of other medical devices.
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Affiliation(s)
- Celia Kwan
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Niels Rochow
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Christoph Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Nuremberg, Germany.
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14
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Miller JD, Young SL, Boateng GO, Oiye S, Owino V. Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya. MATERNAL AND CHILD NUTRITION 2019; 15:e12862. [PMID: 31222968 DOI: 10.1111/mcn.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 12/28/2022]
Abstract
Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food-insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother-infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose-to-the-mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide-measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed-effects model of quantity of breast milk intake across time, deuterium oxide-measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one-point increase in food insecurity score was associated with a 5.6 (±2.2)-g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, Illinois
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, Illinois
| | | | - Shadrack Oiye
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Victor Owino
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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15
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Păduraru L, Zonda GI, Avasiloaiei AL, Moscalu M, Dimitriu DC, Stamatin M. Influence of refrigeration or freezing on human milk macronutrients and energy content in early lactation: Results from a tertiary centre survey. Paediatr Child Health 2019; 24:250-257. [PMID: 31239814 PMCID: PMC6587407 DOI: 10.1093/pch/pxy164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/30/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neonates with severe conditions that cannot be breastfed should receive fresh or preserved expressed human milk in addition to parenteral nutrition. OBJECTIVE To identify the time during lactation when the macronutrients provide maximum energy and evaluate the effect of refrigeration and freezing. METHODS We analyzed the composition of fresh milk, refrigerated at +4°C and frozen at -20°C, expressed by mothers of 60 preterm and 30 term infants from a level III maternity, in colostrum, transitional, and mature milk. RESULTS In fresh milk, the protein level constantly decreases during lactation, with a significant difference after 3 weeks of lactation. Preterm milk of day 21 and day 30 had significantly lower protein than term milk (1.27 versus 1.43 g/dL, P=0.015 and 1.13 versus 1.28 g/dL, P=0.001). Refrigeration for 72 hours of term milk decreased protein content less than freezing. Preterm colostrum has significantly less protein after 48 hours of refrigeration or freezing. Preterm milk from day 60 lost carbohydrates if refrigerated 72 hours or frozen for 2 months. Lipids in preterm colostrum decrease after 8 weeks of freezing. Refrigeration for up to 72 hours did not change significantly the energy value of colostrum or transitional milk. Freezing preterm milk more than 2 weeks leads to significant loss of energy. CONCLUSIONS Milk frozen for more than 2 weeks contains less protein and energy than milk refrigerated for up to 72 hours. In the absence of milk bank access, in common settings, short-term refrigeration is preferable to long-term freezing.
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Affiliation(s)
- Luminița Păduraru
- Department of Mother and Child Care, Division of Neonatology, “Grigore T. Popa” University of Medicine and Pharmacy Iași, Iași, România
| | - Gabriela Ildikó Zonda
- Department of Mother and Child Care, Division of Neonatology, “Grigore T. Popa” University of Medicine and Pharmacy Iași, Iași, România
| | - Andreea-Luciana Avasiloaiei
- Department of Mother and Child Care, Division of Neonatology, “Grigore T. Popa” University of Medicine and Pharmacy Iași, Iași, România
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Division of Informatics and Medical Statistics, “Grigore T. Popa” University of Medicine and Pharmacy Iași, Iași, România
| | - Daniela Cristina Dimitriu
- Department of Morphological Sciences 2, Division of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy Iași, Iași, România
| | - Maria Stamatin
- Department of Mother and Child Care, Division of Neonatology, “Grigore T. Popa” University of Medicine and Pharmacy Iași, Iași, România
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16
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Fusch C. Avoiding Postnatal Growth Retardation by Individualized Fortification of Breast Milk: Implications for Somatic and Neurodevelopmental Outcomes. Breastfeed Med 2019; 14:S15-S17. [PMID: 30985203 PMCID: PMC6486660 DOI: 10.1089/bfm.2019.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Christoph Fusch
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
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17
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Sane F, Scuotto A, Pierrat V, Kacet N, Hober D, Romond MB. Diabetes progression and alterations in gut bacterial translocation: prevention by diet supplementation with human milk in NOD mice. J Nutr Biochem 2018; 62:108-122. [PMID: 30292969 DOI: 10.1016/j.jnutbio.2018.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/19/2018] [Accepted: 08/29/2018] [Indexed: 12/19/2022]
Abstract
Impaired intestinal barrier function occurs before type 1 diabetes (T1D) onset with a possible contribution of microbial translocation. Breastfeeding is associated with enhanced mucosal intestinal integrity and T1D protection. Our aim was to study the potential of human milk (HM) to prevent diabetes onset and modulate the translocation of gut bacteria susceptible to breastfeeding or associated to diabetes onset. We show that HM intake can prevent T1D in nonobese diabetic mice independently of bifidobacteria colonization. Prior to diabetes onset, HM mice harbored splenic bacterial counts and plasma lipopolysaccharides level similar to control mice but exhibited a reduced expansion of Anaerotruncus sp. in pancreas and Lactobacillus johnsonii and Barnesiella in Peyer's patches (PP). Surprisingly, pancreas and PP bacterial expansion did not correlate with their own gut localization but with ileal Escherichia coli and cecal HM-susceptible bacteria (the promoted L. murinus and Bacteroides vulgatus, and the repressed B. fragilis and E. coli), respectively. Besides, higher colonic B. vulgatus counts induced by HM intake were associated with low islet infiltration and pancreatic E. coli expansion. On another hand, splenic dendritic cells (DCs) were identified as negative covariate of PP Barnesiella, suggesting a possible HM contribution to preserving splenic DCs through the reduction of Barnesiella translocation. Fecal B. vulgatus also negatively correlated with PP Barnesiella expansion, indicating that the mouse coprophagic behavior likely added to HM effect. Our findings provide evidence that HM has a multilevel impact and cooperates with some gut bacteria for controlling bacterial translocation at the earliest stage of insulitis.
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Affiliation(s)
- Famara Sane
- Université Lille et CHU de Lille Laboratoire de Virologie EA3610, F-59037 Lille, France
| | | | - Véronique Pierrat
- CHRU Lille, Hôpital Jeanne de Flandres, Lactarium Régional, Lille 59133, France
| | - Nadine Kacet
- CHRU Lille, Hôpital Jeanne de Flandres, Lactarium Régional, Lille 59133, France
| | - Didier Hober
- Université Lille et CHU de Lille Laboratoire de Virologie EA3610, F-59037 Lille, France
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18
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Butts CA, Hedderley DI, Herath TD, Paturi G, Glyn-Jones S, Wiens F, Stahl B, Gopal P. Human Milk Composition and Dietary Intakes of Breastfeeding Women of Different Ethnicity from the Manawatu-Wanganui Region of New Zealand. Nutrients 2018; 10:nu10091231. [PMID: 30181524 PMCID: PMC6164561 DOI: 10.3390/nu10091231] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 01/12/2023] Open
Abstract
Human milk is nutrient rich, complex in its composition, and is key to a baby’s health through its role in nutrition, gastrointestinal tract and immune development. Seventy-eight mothers (19–42 years of age) of Asian, Māori, Pacific Island, or of European ethnicity living in Manawatu-Wanganui, New Zealand (NZ) completed the study. The women provided three breast milk samples over a one-week period (6–8 weeks postpartum), completed a three-day food diary and provided information regarding their pregnancy and lactation experiences. The breast milk samples were analyzed for protein, fat, fatty acid profile, ash, selected minerals (calcium, magnesium, selenium, zinc), and carbohydrates. Breast milk nutrient profiles showed no significant differences between the mothers of different ethnicities in their macronutrient (protein, fat, carbohydrate, and moisture) content. The breast milk of Asian mothers contained significantly higher levels of polyunsaturated fatty acids (PUFAs), omega-3 (n-3) and omega-6 (n-6) fatty acids, docosahexaenoic acid (DHA), and linoleic acids. Arachidonic acid was significantly lower in the breast milk of Māori and Pacific Island women. Dietary intakes of protein, total energy, saturated and polyunsaturated fat, calcium, phosphorus, zinc, iodine, vitamin A equivalents, and folate differed between the ethnic groups, as well as the number of serves of dairy foods, chicken, and legumes. No strong correlations between dietary nutrients and breast milk components were found.
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Affiliation(s)
- Christine A Butts
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Duncan I Hedderley
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Thanuja D Herath
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Gunaranjan Paturi
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 92169, Auckland 1142, New Zealand.
| | - Sarah Glyn-Jones
- Danone Nutricia NZ Limited, 56-58 Aintree Avenue, Mangere, Auckland 2022, New Zealand.
| | - Frank Wiens
- Danone Nutricia Research, Upsalalaan 12, 3584 CT Utrecht, The Netherlands.
| | - Bernd Stahl
- Danone Nutricia Research, Upsalalaan 12, 3584 CT Utrecht, The Netherlands.
| | - Pramod Gopal
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
- Riddet Institute, Massey University, Palmerston North 4442, New Zealand.
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19
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Erick M. Breast milk is conditionally perfect. Med Hypotheses 2017; 111:82-89. [PMID: 29407004 DOI: 10.1016/j.mehy.2017.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/24/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023]
Abstract
Breast milk is the universal preferred nutrition for the newborn human infant. New mother have been encouraged to exclusively breastfeed by health care professionals and consumer-advocacy forums for years, citing "breast milk is the perfect food". The benefits are numerous and include psychological, convenience, economical, ecological and nutritionally superior. Human milk is a composite of nutritional choices of the mother, commencing in the pre-conceptual era. Events influencing the eventual nutritional profile of breast milk for the neonate start with pre-conceptual dietary habits through pregnancy and finally to postpartum. Food choices do affect the nutritional profile of human breast milk. It is not known who coined the phrase "breast milk is the perfect food" but it is widely prevalent in the literature. While breast milk is highly nutritive, containing important immunological and growth factors, scientific investigation reveals a few short-falls. Overall, human breast milk has been found to be low in certain nutrients in developed countries: vitamin D, iodine, iron, and vitamin K. Additional nutrient deficiencies have been documented in resource-poor countries: vitamin A, vitamin B 12, zinc, and vitamin B 1/thiamin. Given these findings, isn't it more accurate to describe breast milk as "conditionally perfect"? Correcting the impression that breast milk is an inherently, automatically comprehensive enriched product would encourage women who plan to breastfeed an opportunity to concentrate on dietary improvement to optimizes nutrient benefits ultimately to the neonate. The more immediate result would improve pre-conceptual nutritional status. Here, we explore the nutritional status of groups of young women; some of whom will become pregnant and eventually produce breast milk. We will review the available literature profiling vitamin, mineral, protein and caloric content of breast milk. We highlight pre-existing situations needing correction to optimize conception and fetal development. While alternative forms of infant nutrition carry standard product labels of nutrient adequacy, this information does not apply universally to all breast milk. Infant formulas are fortified with various amounts of vitamins, minerals, supplemental protein concentrates, nucleic factors, omega 3 fatty acids and any important new nutritional finding. Infant formulas are manufactured to be consistent in composition and are monitored closely for quality. Not true for human breast milk. Any nutrient deficiency existing in pregnancy will ultimately be carried forward via lactation. It is a biological impossibility for a lactating woman to transfer nutrients via breast milk she does not have!
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Affiliation(s)
- Miriam Erick
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA 02115, USA.
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