Fatty acid composition of the milk of well-nourished Sudanese women

Is fatty acid composition of breast milk different in various populations? A systematic review and meta-analysis

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.

Arachidonic Acid in Human Milk

Breastfeeding is universally recommended as the optimal choice of infant feeding and consequently human milk has been extensively investigated to unravel its unique nutrient profile. The human milk lipid composition is unique and supplies specifically long-chain polyunsaturated fatty acids (LC-PUFAs), in particular, arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3). Arachidonic acid (ARA) is the most predominant long-chain polyunsaturated fatty acid in human milk, albeit at low concentrations as compared to other fatty acids. It occurs predominantly in the triglyceride form and to a lesser extent as milk fat globule membrane phospholipids. Human milk ARA levels are modulated by dietary intake as demonstrated by animal and human studies and consequently vary dependent on dietary habits among mothers and regions across the globe. ARA serves as a precursor to eicosanoids and endocannabinoids that also occur in human milk. A review of scientific and clinical studies reveals that ARA plays an important role in physiological development and its related functions during early life nutrition. Therefore, ARA is an important nutrient during infancy and childhood and, as such, appropriate attention is required regarding its nutritional status and presence in the infant diet. Data are emerging indicating considerable genetic variation in encoding for desaturases and other essential fatty acid metabolic enzymes that may influence the ARA level as well as other LC-PUFAs. Human milk from well-nourished mothers has adequate levels of both ARA and DHA to support nutritional and developmental needs of infants. In case breastfeeding is not possible and infant formula is being fed, experts recommend that both ARA and DHA are added at levels present in human milk.

Influence of maternal and socioeconomic factors on breast milk fatty acid composition in urban, low-income families

The lipid composition of breast milk may have a significant impact on early infant growth and cognitive development. Comprehensive breast milk data is lacking from low‐income populations in the Indian subcontinent impeding assessment of deficiencies and limiting development of maternal nutritional interventions. A single breast milk specimen was collected within 6 weeks postpartum from two low‐income maternal cohorts of exclusively breastfed infants, from Dhaka, Bangladesh (n = 683) and Kolkata, India (n = 372) and assayed for percentage composition of 26 fatty acids. Mature milk (>15 days) in Dhaka (n = 99) compared to Kolkata (n = 372) was higher in total saturated fatty acid (SFA; mean 48% vs. 44%) and disproportionately lower in ω3‐polyunsaturated fatty acid (PUFA), hence the ω6‐ and ω3‐PUFA ratio in Dhaka were almost double the value in Kolkata. In both sites, after adjusting for days of lactation, increased maternal education was associated with decreased SFA and PUFA, and increasing birth order or total pregnancies was associated with decreasing ω6‐PUFA or ω3‐PUFA by a factor of 0.95 for each birth and pregnancy. In Dhaka, household prosperity was associated with decreased SFA and PUFA and increased ω6‐ and ω3‐PUFA. Maternal height was associated with increased SFA and PUFA in Kolkata (1% increase per 1 cm), but body mass index showed no independent association with either ratio in either cohort. In summary, the socioeconomic factors of maternal education and household prosperity were associated with breast milk composition, although prosperity may only be important in higher cost of living communities. Associated maternal biological factors were height and infant birth order, but not adiposity. Further study is needed to elucidate the underlying mechanisms of these effects.

Human breast milk: A review on its composition and bioactivity

Breast milk is the perfect nutrition for infants, a result of millions of years of evolution, finely attuning it to the requirements of the infant. Breast milk contains many complex proteins, lipids and carbohydrates, the concentrations of which alter dramatically over a single feed, as well as over lactation, to reflect the infant's needs. In addition to providing a source of nutrition for infants, breast milk contains a myriad of biologically active components. These molecules possess diverse roles, both guiding the development of the infants immune system and intestinal microbiota. Orchestrating the development of the microbiota are the human milk oligosaccharides, the synthesis of which are determined by the maternal genotype. In this review, we discuss the composition of breast milk and the factors that affect it during the course of breast feeding. Understanding the components of breast milk and their functions will allow for the improvement of clinical practices, infant feeding and our understanding of immune responses to infection and vaccination in infants.

Milk of northern Sudanese mothers whose traditional diet is high in carbohydrate contains low docosahexaenoic acid

AIM

  The suckling neonates and infants are reliant primarily on the mother for optimal supply of docosahexaenoic acid (DHA). The richest source of preformed DHA is cold-water oily fish. Although there is paucity of data, existing evidence suggest women with restricted access to these foods have low or marginal DHA status. The aim of the study was to investigate milk fatty acids of Sudanese mothers whose traditional diet is high in carbohydrate and low in fat and gain some insight into the provision of DHA to the suckling offspring.

METHODS

Colostrum (n =26), transitional (n=20) and mature (n=14) milk samples were obtained from Northern Sudanese women (NSW) recruited prior to delivery from Ibrahim Malik and Khartoum Teaching Hospitals.

RESULTS

  The arachidonic acid content of the colostrum (0.87±0.28%) and transitional (0.89± 0.29%) and mature (0.48±0.12%) milk of the NSW were broadly comparable with published international values. In contrast, the DHA level (colostrum 0.13±0.07%, transitional 0.13±0.06% and mature milk 0.06±0.05%) was very low.

CONCLUSION

  The study reveals breast milk of NSW, whose traditional diet is almost devoid of fish and fish products, is unlikely to provide sufficient DHA to support optimal postnatal neuro-visual development.

The influence of Iraqi mothers' socioeconomic status on their milk-lipid content

OBJECTIVE

To investigate the lipid content and fatty acid (FA) composition, especially n(3) long-chain polyunsaturated fatty acids (n(3) LCPUFAs) of mature breast-milk of Iraqi mothers and their relation to the socioeconomic status of the mothers.

DESIGN

A collection of mature breast-milk of mothers with three different socioeconomic status (lactation period 5+/-1 month).

SETTING

Mosul province (in the north of Iraq).

SUBJECTS

Mature breast-milk samples were obtained from a group of 20- to 35-year-old mothers with different socioeconomic status: high urban (HU, n=25), low urban (LU, n=15) and typical suburban (SU, n=25).

PROCEDURE

Mature-milk samples were collected from each lactating mother. The lipid components of each sample, namely triglycerides (TGs), cholesterol (C) and phospholipids (PLs) were determined enzymatically. After their separation and esterification, FAs were determined as FA methyl esters by capillary gas chromatography.

RESULTS

The percentages of n(3) LCPUFAs were 0.48+/-0.025, 0.37+/-0.029 and 0.38+/-0.018% for HU, LU and SU mothers, respectively. The amount of TGs, the major component of milk lipid, was 5.64+/-0.24, 5.21+/-1.61 and 3.21+/-0.92 g/100 ml for HU, SU and LU mothers, respectively. The milk-lipid content varied with the socioeconomic status.

CONCLUSION

The socioeconomic status of lactating mothers affected the lipid content and FA composition, especially the level of n(3) LCPUFAs (the very important structural constituents of the retina, brain and other nervous tissues). Mature breast-milk for the studied groups was low in n(3) LCPUFAs compared with that of mothers from developed countries and that recommended by WHO for optimum infant nutrition.

SPONSORSHIP

Supported by grants from Department of Chemistry, University of Mosul. The analysis of FA methyl ester samples was performed at the National Centre for Scientific Research, France.

Trans fatty acids and conjugated linoleic acids in the milk of urban women and nomadic Fulani of northern Nigeria

BACKGROUND

Trans fatty acids (TFAs) and conjugated linoleic acids (CLAs) are present in dairy products and human milk and can have detrimental and beneficial effects in humans. The content of TFAs and CLAs in milk is determined largely by the diet of the mother.

METHODS

We compared the proportions of TFAs and CLAs in the milk of rural Fulani in northern Nigeria who consume dairy products to that of women living in an urban center who consume little in the way of dairy products. Lactating Fulani women (n=41) and women residing in the city of Jos, Nigeria (n=41) were recruited into the study. We predicted that the milk of the Fulani pastoralists would contain higher amounts of TFAs and CLAs compared to their urban counterparts.

RESULTS

The mean total TFA proportions for the Fulani and urban women were 0.22% and 0.34%, respectively, and were not significantly different. The percentages of CLAs in milk fat were not different between rural and urban women (0.16% vs 0.14%). These TFA and CLA values were 4- to 10-fold lower than for milk of women elsewhere in the world.

CONCLUSIONS

The percentages of TFAs and CLAs in milk were not different between rural and urban dwellers in northern Nigeria whose diets differ greatly in the amounts of dairy products they contain. However, the fact that the percentages of TFAs and CLAs in the milk of Nigerian women were much lower than the percentages reported from other parts of the world may have implications for the long-term growth and development of infants in the northern Nigeria and elsewhere in the Western Sahel.

Influences of maternal dietary intake and suckling on breast milk lipid and fatty acid composition in low-income women from Brasilia, Brazil

Diet has a strong effect, while suckling stimulus is believed not to influence breast milk fatty acids. The effect of dietary pattern and suckling on the fatty acid composition of Brazilian women's breast milk was studied. A cross-sectional study was conducted with low-income women living in the central region of Brazil, where dietary DHA is not readily available. Fore and hind milk fatty acids were collected from 77 women on day 15+/-1 postpartum, and information on maternal characteristics and dietary habit was taken. The effect of suckling stimulus was measured by the changes between fore and hind milk. The mean body mass index (BMI) of volunteers was 23.7+/-3.2 kg/m(2), and the milk lipid concentration was 4.8+/-1.2 g/dl. A mixture of traditional and western type of dietary habit, high in fat and sugar was observed. The fatty acids of the subject's milk were 41.93+/-1.42% saturated, 33.31+/-1.67% monounsaturated and 25.03+/-5.23% polyunsaturated (wt/wt). The DHA level in the milk was 0.34+/-0.19%, similar to the values found in milk of many western societies. DHA and 18:3n-3 levels increased from fore to hind milk (p<0.05). Correlation existed mostly between dietary components and milk 16:0 and oleic acid (18:0). An analysis of classes of fatty acids in milk showed oleic acid (18:0) to present a negative correlation with all milk fatty acid classes. The results suggest that breast milk fatty acids of Brazilian women reflect a western maternal dietary pattern and are influenced by the suckling.

Isomeric fatty acids: evaluating status and implications for maternal and child health

"Isomeric fatty acids" is a term that refers to the trans- and positional isomers formed during hydrogenation of naturally occurring oils. The purposes of this paper are as follows: (i) to summarize potential exposure of infants to isomeric fatty acids by reviewing estimates of isomeric fatty acids in the maternal diet, in human milk, and in infant formula/infant foods, and (ii) to evaluate the evidence for adverse effects of isomeric fatty acids on infant development with respect to growth and essential fatty acid status. Estimates of the intake of trans-fatty acids vary widely both within and across populations. Current estimates of trans-fatty acids in the North American population are 4-11% of total fatty acids or 3-13 g/(person x d), whereas in Mediterranean countries in which olive oil is the primary fat and in Far Eastern countries in which little commercially hydrogenated fat is consumed, per capita consumption of trans-fatty acids is <1-2 g/d. The trans-fatty acid content of human milk reflects the cross-cultural variation in the maternal diet, with trans-fatty acids in human milk samples ranging from 6 to 7% in North America to <0.5% in Hong Kong. Trans-fatty acids are transferred from the maternal diet through the placenta to the developing fetus or through milk to the breast-fed infant. In some studies, plasma trans-fatty acids are inversely related to birth weight and head circumference. The hypothesis that dietary trans-fatty acids could inhibit biosynthesis of long-chain polyunsaturated fatty acids with 20 and 22 carbon atoms and thus affect infant development is supported by studies demonstrating an inverse correlation of plasma trans-fatty acids with n-3 and n-6 longchain polyunsaturated fatty acids in infants. However, no such relationship has been observed in human milk. A definitive answer concerning a potentially adverse effect of dietary trans-fatty acids on infant development awaits future studies.

Lipids in human milk

I have reviewed recent (March 1995-December 1997) papers on human milk lipids including many on fatty acid (FA) composition. The effects of maternal diets on the profiles are apparent. However, more data on the composition of milk lipids are needed. It is noteworthy that so few papers on milk FA composition have reported analyses using high-resolution gas-liquid chromatography columns. Two of these were on milk from women in North America. The diets in North America are varied and the number of analyses few. We do not have a reliable data base showing the ranges of biologically important acids. Except for the gangliosides, few new data on the other lipids appeared during this period.