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Mohr AE, Senkus KE, McDermid JM, Berger PK, Perrin MT, Handu D. Human Milk Nutrient Composition Data is Critically Lacking in the United States and Canada: Results from a Systematic Scoping Review of 2017-2022. Adv Nutr 2023; 14:1617-1632. [PMID: 37758059 PMCID: PMC10721511 DOI: 10.1016/j.advnut.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
Characterization of the nutrients in human milk is important to understand the dietary and developmental requirements of infants. The objective of this review was to summarize the state-of-the-science on the nutrient composition of human milk in the United States and Canada published from 2017 to 2022. Four databases were searched for randomized controlled studies and others given the scoping nature of this review. We limited type to mature milk collected 21 d postpartum and beyond from lactating individuals in the United States and Canada who gave birth at 37-wk gestation or later (full-term). Outcomes of interest included traditional macro- and micronutrients, including human milk oligosaccharides (HMOs), and milk volume. The publication date range was selected as January 1, 2017, to the day the literature search was performed. A total of 32 articles were included in the scoping review from primarily longitudinal cohort or cross-sectional designs. The most prevalent sample collection method was full-breast expression (n = 20) with most studies (n = 26) collecting samples from a single timepoint. Carbohydrates (HMOs [n = 12], glucose [n = 8], and lactose [n = 6]) and protein (n = 5) were the most frequently assessed nutrients in this body of work, with consensus among studies that glucose is present in limited concentrations compared to lactose (24-64 mg/dL compared with 6-7 g/dL) and that HMOs are influenced by temporality and secretor status. Included studies displayed an overall level of heterogeneity and sparsity paralleling previous reports and nutrient data in the USDA FoodData Central system. Much of the data extracted from retained articles generally provided analysis of a specific nutrient or group of nutrients. Moreover, many studies did not use the preferred analytical methods as outlined by the Human Milk Composition Initiative to increase measurement confidence. Up-to-date nutrient composition data of human milk is still greatly needed as it is paramount for the management of infant feeding, assessment of infant and maternal nutritional and health needs, and as a reference for infant formula development.
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Affiliation(s)
- Alex E Mohr
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Katelyn E Senkus
- Department of Human Nutrition, The University of Alabama, Tuscaloosa, AL, United States
| | | | - Paige K Berger
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, United States
| | - Deepa Handu
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL, United States.
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Böckmann KA, Bernhard W, Minarski M, Shunova A, Wiechers C, Poets CF, Franz AR. Choline supplementation for preterm infants: metabolism of four Deuterium-labeled choline compounds. Eur J Nutr 2023; 62:1195-1205. [PMID: 36460779 PMCID: PMC10030424 DOI: 10.1007/s00394-022-03059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Supply of choline is not guaranteed in current preterm infant nutrition. Choline serves in parenchyma formation by membrane phosphatidylcholine (PC), plasma transport of poly-unsaturated fatty acids (PUFA) via PC, and methylation processes via betaine. PUFA-PC concentrations are high in brain, liver and lung, and deficiency may result in developmental disorders. We compared different deuterated (D9-) choline components for kinetics of D9-choline, D9-betaine and D9-PC. METHODS Prospective study (1/2021-12/2021) in 32 enterally fed preterm infants (28 0/7-32 0/7 weeks gestation). Patients were randomized to receive enterally a single dose of 2.7 mg/kg D9-choline-equivalent as D9-choline chloride, D9-phosphoryl-choline, D9-glycerophosphorylcholine (D9-GPC) or D9-1-palmitoyl-2-oleoyl-PC(D9-POPC), followed by blood sampling at 1 + 24 h or 12 + 60 h after administration. Plasma concentrations were analyzed by tandem mass spectrometry. Results are expressed as median (25th/75th percentile). RESULTS At 1 h, plasma D9-choline was 1.8 (0.9/2.2) µmol/L, 1.3 (0.9/1.5) µmol/L and 1.2 (0.7/1.4) µmol/L for D9-choline chloride, D9-GPC and D9-phosphoryl-choline, respectively. D9-POPC did not result in plasma D9-choline. Plasma D9-betaine was maximal at 12 h, with lowest concentrations after D9-POPC. Maximum plasma D9-PC values at 12 h were the highest after D9-POPC (14.4 (9.1/18.9) µmol/L), compared to the other components (D9-choline chloride: 8.1 [5.6/9.9] µmol/L; D9-GPC: 8.4 (6.2/10.3) µmol/L; D9-phosphoryl-choline: 9.8 (8.6/14.5) µmol/L). Predominance of D9-PC comprising linoleic, rather than oleic acid, indicated fatty-acyl remodeling of administered D9-POPC prior to systemic delivery. CONCLUSION D9-Choline chloride, D9-GPC and D9-phosphoryl-choline equally increased plasma D9-choline and D9-betaine. D9-POPC shifted metabolism from D9-betaine to D9-PC. Combined supplementation of GPC and (PO) PC may be best suited to optimize choline supply in preterm infants. Due to fatty acid remodeling of (PO) PC during its assimilation, PUFA co-supplementation with (PO) PC may increase PUFA-delivery to critical organs. This study was registered (22.01.2020) at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502. STUDY REGISTRATION This study was registered at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502.
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Affiliation(s)
- Katrin A Böckmann
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany.
| | - Wolfgang Bernhard
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Michaela Minarski
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Anna Shunova
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Cornelia Wiechers
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Axel R Franz
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
- Center for Pediatric Clinical Studies, Eberhard Karls University, Tübingen, Germany
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Yang MT, Lan QY, Liang X, Mao YY, Cai XK, Tian F, Liu ZY, Li X, Zhao YR, Zhu HL. Lactational Changes of Phospholipids Content and Composition in Chinese Breast Milk. Nutrients 2022; 14:nu14081539. [PMID: 35458100 PMCID: PMC9030290 DOI: 10.3390/nu14081539] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Phospholipids are pivotal polar lipids in human milk and essential for infants’ growth and development, especially in the brain and cognitive development. Its content and composition are affected by multiple factors and there exist discrepancies in different studies. In this study, we determined five major phospholipids classes (phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, phosphatidylcholine, and sphingomyelin) in 2270 human milk samples collected from 0 to 400 days postpartum in six regions of China. The high-performance liquid chromatography coupled with an evaporative light scattering detector (HPLC-ELSD) was performed to quantify the phospholipids. Total phospholipid median (IQR) content was in a range between 170.38 ± 96.52 mg/L to 195.69 ± 81.80 mg/L during lactation and was higher concentrated in colostrum milk and later stage of lactation (after 200 days postpartum) compared with that in the samples collected between 10 to 45 days postpartum. Variations in five major sub-class phospholipids content were also observed across lactation stages (phosphatidylethanolamine: 52.61 ± 29.05 to 59.95 ± 41.74 mg/L; phosphatidylinositol: 17.65 ± 10.68 to 20.38 ± 8.55 mg/L; phosphatidylserine: 15.98 ± 9.02 to 22.77 ± 11.17 mg/L; phosphatidylcholine: 34.13 ± 25.33 to 48.64 ± 19.73 mg/L; sphingomyelin: 41.35 ± 20.31 to 54.79 ± 35.26 mg/L). Phosphatidylethanolamine (29.18–32.52%), phosphatidylcholine (19.90–25.04%) and sphingomyelin (22.39–29.17%) were the dominant sub-class phospholipids in Chinese breast milk during the whole lactation period. These results updated phospholipids data in Chinese human milk and could provide evidence for better development of secure and effective human milk surrogates for infants without access to breast milk.
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Affiliation(s)
- Meng-Tao Yang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (M.-T.Y.); (Q.-Y.L.); (Z.-Y.L.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
| | - Qiu-Ye Lan
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (M.-T.Y.); (Q.-Y.L.); (Z.-Y.L.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
| | - Xue Liang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 102401, China;
| | - Ying-Yi Mao
- Abbott Nutrition Research & Development Center, Abbott Ltd., Shanghai 200233, China; (Y.-Y.M.); (X.-K.C.); (F.T.); (X.L.)
| | - Xiao-Kun Cai
- Abbott Nutrition Research & Development Center, Abbott Ltd., Shanghai 200233, China; (Y.-Y.M.); (X.-K.C.); (F.T.); (X.L.)
| | - Fang Tian
- Abbott Nutrition Research & Development Center, Abbott Ltd., Shanghai 200233, China; (Y.-Y.M.); (X.-K.C.); (F.T.); (X.L.)
| | - Zhao-Yan Liu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (M.-T.Y.); (Q.-Y.L.); (Z.-Y.L.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
| | - Xiang Li
- Abbott Nutrition Research & Development Center, Abbott Ltd., Shanghai 200233, China; (Y.-Y.M.); (X.-K.C.); (F.T.); (X.L.)
| | - Yan-Rong Zhao
- Abbott Nutrition Research & Development Center, Abbott Ltd., Shanghai 200233, China; (Y.-Y.M.); (X.-K.C.); (F.T.); (X.L.)
- Correspondence: (Y.-R.Z.); (H.-L.Z.); Tel.: +86-21-2082-2472 (Y.-R.Z.); +86-20-8733-1811 (H.-L.Z.)
| | - Hui-Lian Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (M.-T.Y.); (Q.-Y.L.); (Z.-Y.L.)
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
- Correspondence: (Y.-R.Z.); (H.-L.Z.); Tel.: +86-21-2082-2472 (Y.-R.Z.); +86-20-8733-1811 (H.-L.Z.)
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Nascimento MB, Martins LC, Draghi PF, Fonseca FL. Evaluation of Human Milk Quality during its Distribution Flow at Neonatal Assistance Units. CURRENT NUTRITION & FOOD SCIENCE 2021. [DOI: 10.2174/1573401316999200918161010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Premature babies have physiological vulnerabilities that influence their absorption
and digestion capacity, compromising their clinical condition. Human milk from human
milk banks has contributed enormously to providing these newborns with complete nutrition.
Objective:
To evaluate the quality of human milk collected at the Human Milk Bank during its distribution
in neonatal units.
Methods:
A cross-sectional study, with a quantitative approach, was carried out in a maternity hospital
with Human Milk Bank. After the pasteurization of milk and its consequent release to these
units, a new test was carried out for the analysis of acid titration, caloric and microbiological content.
Results:
Human Milk showed a decrease of approximately 20% in caloric content and a reduction
in acidity. Approximately 12.3% of the samples were contaminated by fecal coliforms.
Conclusion:
There is a need for a second moment of evaluation of human milk, after the flow, or
to rethink the new ways of preserving the initial quality of human milk.
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Affiliation(s)
- Maria B.G. Nascimento
- Department of Health Sciences, Faculdade de Medicina do ABC, Universidade Federal de Campina Grande, Brazil
| | - Lourdes C. Martins
- Nucleus of Studies in Environmental Epidemiology, Laboratory of Experimental Atmospheric Pollution, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia F. Draghi
- Clinical Laboratory of FMABC, Faculdade de Medicina do ABC, Universidade Federal de Campina Grande, Campina Grande, Paraiba, Brazil
| | - Fernando L.A. Fonseca
- Laboratory Research in Public Health, Clinical Analysis Laboratory, Faculdade de Medicina do ABC, Universidade Federal de Campina Grande, Campina Grande, Paraiba, Brazil
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Hampel D, Shahab-Ferdows S, Nguyen N, Kac G, Allen LH. High-Throughput Analysis of Water-Soluble Forms of Choline and Related Metabolites in Human Milk by UPLC-MS/MS and Its Application. Front Nutr 2021; 7:604570. [PMID: 33614690 PMCID: PMC7892616 DOI: 10.3389/fnut.2020.604570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Choline and related metabolites are key factors in many metabolic processes, and insufficient supply can adversely affect reproduction and fetal development. Choline status is mainly regulated by intake, and human milk is the only choline source for exclusively breastfed infants. Further, maternal status, genotype, and phenotype, as well as infant outcomes, have been related to milk choline concentrations. In order to enable the rapid assessment of choline intake for exclusively breastfed infants and to further investigate the associations between milk choline and maternal and infant status and other outcomes, we have developed a simplified method for the simultaneous analysis of human milk choline, glycerophosphocholine, phosphocholine, and the less abundant related metabolites betaine, carnitine, creatinine, dimethylglycine (DMG), methionine, and trimethylamine N-oxide (TMAO) using ultraperformance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS). These analytes have milk concentrations ranging over 3 orders of magnitude. Unlike other recently described LC-based methods, our approach does not require an ion-pairing reagent or high concentrations of solvent modifiers for successful analyte separation and thus avoid signal loss and potential permanent contamination. Milk samples (10 μl) were diluted (1:80) in water : methanol (1:4, v:v) and filtered prior to analysis with an optimized gradient of 0.1% propionic acidaq and acetonitrile, allowing efficient separation and removal of contaminants. Recovery rates ranged from 108.0 to 130.9% (inter-day variation: 3.3–9.6%), and matrix effects (MEs) from 54.1 to 114.3%. MEs were greater for carnitine, creatinine, and TMAO at lower dilution (1:40, p < 0.035 for all), indicating concentration-dependent ion suppression. Milk from Brazilian women (2–8, 28–50, and 88–119 days postpartum, ntotal = 53) revealed increasing concentration throughout lactation for glycerophosphocholine, DMG, and methionine, while carnitine decreased. Choline and phosphocholine were negatively correlated consistently at all three collection time intervals. The method is suitable for rapid analysis of human milk water-soluble forms of choline as well as previously not captured related metabolites with minimal sample volumes and preparation.
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Affiliation(s)
- Daniela Hampel
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Setareh Shahab-Ferdows
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States
| | - Ngoc Nguyen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Gilberto Kac
- Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Lindsay H Allen
- United States Department of Agriculture/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA, United States.,Department of Nutrition, University of California, Davis, Davis, CA, United States
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Torrez Lamberti MF, DeBose-Scarlett E, Garret T, Parker LA, Neu J, Lorca GL. Metabolomic Profile of Personalized Donor Human Milk. Molecules 2020; 25:E5783. [PMID: 33302441 PMCID: PMC7763631 DOI: 10.3390/molecules25245783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022] Open
Abstract
Human milk could be considered an active and complex mixture of beneficial bacteria and bioactive compounds. Since pasteurization drastically reduces the microbial content, we recently demonstrated that pasteurized donor human milk (DHM) could be inoculated with different percentages (10% and 30%) of mother's own milk (MOM) to restore the unique live microbiota, resulting in personalized milk (RM10 and RM30, respectively). Pasteurization affects not only the survival of the microbiota but also the concentration of proteins and metabolites, in this study, we performed a comparative metabolomic analysis of the RM10, RM30, MOM and DHM samples to evaluate the impact of microbial restoration on metabolite profiles, where metabolite profiles clustered into four well-defined groups. Comparative analyses of DHM and MOM metabolomes determined that over one thousand features were significantly different. In addition, significant changes in the metabolite concentrations were observed in MOM and RM30 samples after four hours of incubation, while the concentration of metabolites in DHM remained constant, indicating that these changes are related to the microbial expansion. In summary, our analyses indicate that the metabolite profiles of DHM are significantly different from that of MOM, and the profile of MOM may be partially restored in DHM through microbial expansion.
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Affiliation(s)
- Monica F. Torrez Lamberti
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA; (M.F.T.L.); (E.D.-S.)
| | - Evon DeBose-Scarlett
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA; (M.F.T.L.); (E.D.-S.)
| | - Timothy Garret
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Leslie Ann Parker
- College of Nursing, University of Florida, Gainesville, FL 32611, USA;
| | - Josef Neu
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL 32611, USA;
| | - Graciela L. Lorca
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA; (M.F.T.L.); (E.D.-S.)
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Gianni ML, Morniroli D, Bettinelli ME, Mosca F. Human Milk and Lactation. Nutrients 2020; 12:nu12040899. [PMID: 32224879 PMCID: PMC7230226 DOI: 10.3390/nu12040899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
Human milk is uniquely tailored to meet infants’ specific nutritional requirements [...]
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Affiliation(s)
- Maria Lorella Gianni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, Via Commenda 12, 20122 Milan, Italy; (D.M.); (F.M.)
- Department of Clinical Science and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-0255-032-483
| | - Daniela Morniroli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, Via Commenda 12, 20122 Milan, Italy; (D.M.); (F.M.)
| | - Maria Enrica Bettinelli
- Department of Clinical Science and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy;
| | - Fabio Mosca
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, Via Commenda 12, 20122 Milan, Italy; (D.M.); (F.M.)
- Department of Clinical Science and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy;
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