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Hashemi Javaheri FS, Karbin K, Senobari MA, Hakim HG, Hashemi M. The association between maternal body mass index and breast milk composition: a systematic review. Nutr Rev 2024:nuad174. [PMID: 38273741 DOI: 10.1093/nutrit/nuad174] [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: 01/27/2024] Open
Abstract
CONTEXT Breast milk composition is influenced by many factors, ranging from maternal nutritional status to infant sex. Previous studies have explored the relationship between maternal body mass index (BMI) and breast milk composition; however, the findings have been inconsistent and controversial. OBJECTIVE To systematically review the evidence on the association of maternal weight and BMI with breast milk composition. DATA SOURCES The PubMed and Scopus databases were searched up to May 3, 2023, using the following search strategy: ("maternal weight" OR "maternal BMI" OR "mother's weight" OR "mother's BMI") AND ("maternal milk" OR "human milk" OR "breast milk"). DATA EXTRACTION A total of 83 publications, involving data from more than 11 310 lactating women, were identified. All extracted data were compiled, compared, and critically analyzed. DATA ANALYSIS Overall, maternal BMI was associated with higher levels of leptin and insulin, and the ratio of omega-6 to omega-3 polyunsaturated fatty acids in breast milk. However, no conclusive associations were found between maternal BMI and the levels of energy, macronutrients, micronutrients, and other components of breast milk. CONCLUSIONS This systematic review provides robust evidence supporting a positive correlation between maternal BMI and breast milk concentrations of leptin, insulin, and the omega-6 to omega-3 polyunsaturated fatty acid ratio. Nevertheless, disparities in findings are noticeable for other constituents of breast milk. To comprehensively grasp the influence of maternal weight and BMI on breast milk composition, further research endeavors are imperative. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023458667.
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Affiliation(s)
- Fatemeh Sadat Hashemi Javaheri
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Karim Karbin
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mohammad Amin Senobari
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hakime Ghadiri Hakim
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hashemi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Kulesza-Brończyk B, Bień A, Sobieraj P, Orczyk-Pawiłowicz M, Lis-Kuberka J, Czosnykowska-Łukacka M, Bzikowska-Jura A. Factors affecting total protein and lactoferrin in human milk. Sci Rep 2023; 13:22434. [PMID: 38104179 PMCID: PMC10725433 DOI: 10.1038/s41598-023-50124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023] Open
Abstract
The aim of this study was to investigate factors affecting total, true protein and lactoferrin (Lf) concentrations in human milk (HM) and to evaluate the changes in protein concentrations over the course of lactation (first to sixth month postpartum). HM samples were collected from exclusively breastfeeding mothers during six time periods (1-6 months postpartum); 198 breast milk samples were collected in total. The concentrations of total and true protein in HM were determined using the MIRIS human milk analyzer (HMA). The assessment of HM protein content was also performed in skim HM samples and quantified by bicinchoninic methods with the Bicinchoninic Acid Protein Assay Kit. In turn, Lf content in skim HM samples was determined by the enzyme-linked immunosorbent assay (ELISA) in accordance with a slightly modified procedure. In the first month of lactation total protein concentration was negatively correlated with maternal pre-pregnancy BMI (r = - 0.397; p = 0.022), whereas in the third month postpartum, positive correlation with maternal age was found (r = 0.399; p = 0.021). Considering Lf concentration, in the first month of lactation, it was positively correlated with baby's birth weight (r = 0.514; p = 0.002). In the next months (from second to sixth) no relationships between Lf concentration and maternal and infants' factors were observed. The concentration of protein and Lf in HM changes dynamically throughout lactation. Maternal and infant characteristics may impact the HM protein and Lf content, especially in the first month postpartum.
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Affiliation(s)
- Bożena Kulesza-Brończyk
- Department of Obstetrics, Gynecology and Maternity Care, Faculty of Health Sciences, Medical University of Bialystok, Białystok, Poland
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland.
| | - Piotr Sobieraj
- Department of Internal Medicine, Hypertension and Vascular Diseases, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Orczyk-Pawiłowicz
- Division of Chemistry and Immunochemistry, Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Wrocław, Poland
| | - Jolanta Lis-Kuberka
- Division of Chemistry and Immunochemistry, Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Wrocław, Poland
| | | | - Agnieszka Bzikowska-Jura
- Department of Medical Biology, Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Medical University of Warsaw, Warsaw, Poland
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Nurani N, Wibowo T, Susilowati R, Hastuti J, Haksari EL, Julia M, Van Weissenbruch M. Changes in Mature Human Milk Macronutrient Composition over 45 years in an Urban Population in Indonesia. J Hum Lact 2023; 39:648-655. [PMID: 37712570 DOI: 10.1177/08903344231195326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND With improvement in a population's welfare, its food consumption patterns may change, including those of nursing mothers. This, in turn, could influence their human milk composition. RESEARCH AIM To investigate the secular trend in macronutrient composition of mature human milk from mothers of healthy, full-term infants in urban populations in Indonesia from 1974 and 2019. METHOD We compared the macronutrient composition of mature human milk of healthy full-term infants from 1974 and 2019. The data from 2019 used the Human Milk Analyzer MIRIS to quantify the milk's carbohydrate, fat, and protein content, while the historical data used methods available at that time, that is, methods described by Benedict, Gerber and Kjeldahl, respectively. RESULTS There were no significant differences in carbohydrate, protein and fat content across categories of maternal nutritional status in the respective periods. However, the fat content of human milk from 2019 was significantly higher than that of 1974 (4.7 g/dl, SD = 1.7 g/dl vs. 3.3 g/dl, SD = 1.1 g/dl; p < 0.001), while its carbohydrate content was significantly lower (6.2 g/dl, SD = 2.1 g/dl vs. 7.1 g/dl, SD = 0.2 g/dl; p < 0.001). There was no difference in the protein content between the two periods (1.4 g/dl, SD = 0.5 g/dl vs. 1.6 g/dl, SD = 0.3 g/dl; p = 0.491). CONCLUSION The mature human milk from 2019 has a higher fat and total energy content but lower carbohydrate content than those observed 4 decades ago. The protein content remained the same.
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Affiliation(s)
- Neti Nurani
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Tunjung Wibowo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Rina Susilowati
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Janatin Hastuti
- Department of Health Nutrition. Lab. of Bioanthropology & Palaeoanthropology, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ekawaty Lutfia Haksari
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mirjam Van Weissenbruch
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Han SM, Derraik JGB, Vickers MH, Devaraj S, Huang F, Pang WW, Godfrey KM, Chan SY, Thakkar SK, Cutfield WS. A nutritional supplement taken during preconception and pregnancy influences human milk macronutrients in women with overweight/obesity and gestational diabetes mellitus. Front Nutr 2023; 10:1282376. [PMID: 37915619 PMCID: PMC10616264 DOI: 10.3389/fnut.2023.1282376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Rational Maternal overweight/obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of their offspring developing overweight/obesity or type 2 diabetes later in life. However, the impacts of maternal overweight/obesity and dysglycemia on human milk (HM) macronutrient composition are not well understood. Objective Through a double-blind randomised controlled trial, we investigated the effects of maternal supplementation from preconception throughout pregnancy until birth on HM macronutrient concentrations, in association with maternal and infant factors including maternal pre-pregnancy body mass index (BMI) and GDM status. In addition, we aimed to characterise longitudinal changes in HM macronutrients. Methods The control supplement contained calcium, iodine, iron, β-carotene, and folic acid. The intervention supplement additionally contained zinc, vitamins B2, B6, B12, and D3, probiotics, and myo-inositol. HM samples were collected across seven time points from 1 week to 12 months from Singapore and/or New Zealand. HM macronutrient concentrations were measured using a MIRIS Human Milk Analyser. Potential differences in HM macronutrient concentrations were assessed using linear mixed models with a repeated measures design. Results Overall, HM macronutrient concentrations were similar between control and intervention groups. Among the control group, overweight/obesity and GDM were associated with higher HM fat and energy concentrations over the first 3 months. Such associations were not observed among the intervention group. Of note, mothers with GDM in the intervention group had lower HM fat by 10% (p = 0.049) and energy by 6% (p = 0.029) than mothers with GDM in the control group. Longitudinal changes in HM macronutrient concentrations over 12 months of lactation in New Zealand showed that HM fat and energy decreased in the first 6 months then increased until 12 months. HM lactose gradually decreased from 1 week to 12 months while crude protein decreased from 1 week to 6 months then remained relatively constant until 12 months of lactation. Conclusion Maternal overweight/obesity or GDM were associated with increased HM fat and energy levels. We speculate the intervention taken during preconception and pregnancy altered the impact of maternal BMI or GDM status on HM macronutrient composition. Further studies are required to identify the mechanisms underlying altered HM macronutrient concentration in the intervention group and to determine any long-term effects on offspring health. Clinical trial registration ClinicalTrials.gov, NCT02509988, Universal Trial Number U1111-1171-8056. Registered on 16 July 2015. This is an academic-led study by the EpiGen Global Research Consortium.
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Affiliation(s)
- Soo Min Han
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - José G. B. Derraik
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mark H. Vickers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Surabhi Devaraj
- Nestlé Research, Société des Produits Nestlé S.A., Singapore, Singapore
| | - Fang Huang
- Nestlé Research, Société des Produits Nestlé S.A., Beijing, China
| | - Wei Wei Pang
- Global Centre for Asian Women’s Health, Dean’s Office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sagar K. Thakkar
- Nestlé Research, Société des Produits Nestlé S.A., Singapore, Singapore
| | - Wayne S. Cutfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- A Better Start—National Science Challenge, The University of Auckland, Auckland, New Zealand
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Wati LR, Sargowo D, Nurseta T, Zuhriyah L. The Role of Protein Intake on the Total Milk Protein in Lead-Exposed Lactating Mothers. Nutrients 2023; 15:nu15112584. [PMID: 37299547 DOI: 10.3390/nu15112584] [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: 04/15/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Protein is an essential macronutrient for the growth and development of infants. Protein levels in lactating mothers are dynamic and influenced by various factors, particularly the environment and maternal characteristics. Therefore, this study aimed to evaluate the complex correlation between maternal blood lead levels (BLLs), maternal diet, and total milk protein. The Kruskal-Wallis test was used to compare total milk protein in the three groups of lead exposure, while Spearman's correlation was used to assess the correlation between maternal diet, BLLs, and total milk protein. The multivariate analysis used multiple linear regression. The results showed that the median of maternal BLLs and total milk protein were 3.3 µg/dL and 1.07 g/dL, respectively. Maternal protein intake and current BMI had a positive correlation with total milk protein, while BLLs had a negative correlation. BLLs ≥ 5 μg/dL had the most significant impact on reducing the total milk protein (p = 0.032). However, increasing maternal protein intake can effectively maintain total milk protein levels in mothers with BLLs under 5 μg/dL (p < 0.001). It is crucial to measure BLLs in lactating mothers residing in areas exposed to lead because high maternal protein intake can only maintain total milk protein levels when the BLLs are <5 μg/dL.
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Affiliation(s)
- Linda Ratna Wati
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Brawijaya, Malang 65145, East Java, Indonesia
- Department of Midwifery, Faculty of Medicine, Universitas Brawijaya, Malang 65145, East Java, Indonesia
| | - Djanggan Sargowo
- Department of Cardiology, Faculty of Medicine, Universitas Brawijaya, Universitas Brawijaya Hospital, Malang 65145, East Java, Indonesia
| | - Tatit Nurseta
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Brawijaya, Malang 65145, East Java, Indonesia
| | - Lilik Zuhriyah
- Department of Public Health, Faculty of Medicine, Universitas Brawijaya, Malang 65145, East Java, Indonesia
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Maternal Diet Influences Human Milk Protein Concentration and Adipose Tissue Marker. Nutrients 2023; 15:nu15020433. [PMID: 36678304 PMCID: PMC9866185 DOI: 10.3390/nu15020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
(1) Background: Adequate protein intake plays an essential role in growth and neurodevelopment, especially in preterm infants. We investigated the effects of maternal diet and body mass index (BMI) on human milk (HM) composition. (2) Methods: HM samples were obtained from 136 lactating mothers (BMI: 18.0−36.7 kg/m2), of which 93% gave birth to preterm infants. Macronutrient content in HM was measured by mid-infrared transmission spectroscopy. Leptin and adiponectin were analyzed using appropriate ELISAs. Maternal diet was determined by 24-h recall. (3) Results: Significant positive associations were found between protein, fat, carbohydrate and energy intake, and levels of corresponding macronutrients in HM, especially in protein concentrations (p < 0.001). An increased protein intake was positively correlated with adiponectin (p < 0.001) and leptin (p = 0.035) in HM. Maternal BMI was positively associated with a higher protein level in HM (p < 0.05), as well as with a higher dietary protein intake (p < 0.05). (4) Conclusions: Knowledge of maternal diet and BMI impacting HM composition is essential to optimize the feeding of newborn infants. This is especially relevant in the nutritional management of preterm infants; it can be utilized in approaches to improve growth rates and the appropriate development of infants and to prevent obesity.
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Okman E, Beser E, Kucukoglu Keser M, Sari FN, Alyamac Dizdar E. The Relationship of Adolescent Motherhood to the Macronutrient Content of Breast Milk. Breastfeed Med 2022; 17:764-767. [PMID: 35985000 DOI: 10.1089/bfm.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Breast milk is the best nutrient for newborns due to its rich dietary content, immunological factors, ease of accessibility, and affordability. Given the fact that adolescent birth rate in Turkey is high, this study examines the effects of adolescent motherhood with regard to macronutrient contents in breast milk. Study Design: We collected colostrum samples from mothers staying at our hospital. Gestational ages were ≥37 weeks. Demographic characteristics of the patients were registered. The MIRIS (Mid-Infrared Human Milk Analyzer) device was operated to analyze breast milk, adopting a spectroscopy method for measurements. Protein, fat, carbohydrate, and energy levels of the hindmilk samples were measured; thus, study groups were compared. Results: The study included 224 mothers, of whom 49 were adolescents and 125 were adults. Maternal weight and maternal body mass index, weight gain during pregnancy, mode of delivery and gestational age, as well as birth weight and gender of the infants were similar. As breast milk contents were compared, we found out that fat content levels in the colostrum of adolescent mothers were significantly higher, with respect to the other group. Protein and carbohydrate levels were lower in adolescents, even if they were not statistically significant. There was no difference between the groups in terms of energy levels. Conclusion: Adolescent motherhood may have negative influences on infant welfare. However, in terms of breast milk content quality, adult mothers are not superior to adolescents.
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Affiliation(s)
- Esin Okman
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Esra Beser
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Merve Kucukoglu Keser
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatma Nur Sari
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Evrim Alyamac Dizdar
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Ramiro-Cortijo D, Gila-Diaz A, Herranz Carrillo G, Cañas S, Gil-Ramírez A, Ruvira S, Martin-Cabrejas MA, Arribas SM. Influence of Neonatal Sex on Breast Milk Protein and Antioxidant Content in Spanish Women in the First Month of Lactation. Antioxidants (Basel) 2022; 11:antiox11081472. [PMID: 36009190 PMCID: PMC9405477 DOI: 10.3390/antiox11081472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Breast milk (BM) is the best food for newborns. Male sex is associated with a higher risk of fetal programming, prematurity, and adverse postnatal outcome, being that BM is an important health determinant. BM composition is dynamic and modified by several factors, including lactation period, prematurity, maternal nutritional status, and others. This study was designed to evaluate the influence of sex on BM composition during the first month of lactation, focused on macronutrients and antioxidants. Forty-eight breastfeeding women and their fifty-five newborns were recruited at the Hospital Clínico San Carlos (Madrid, Spain). Clinical sociodemographic data and anthropometric parameters were collected. BM samples were obtained at days 7, 14, and 28 of lactation to assess fat (Mojonnier method), protein (Bradford method), and biomarkers of oxidative status: total antioxidant capacity (ABTS and FRAP methods), thiol groups, reduced glutathione, superoxide dismutase and catalase activities, lipid peroxidation, and protein oxidation (spectrophotometric methods). Linear mixed models with random effects adjusted by maternal anthropometry, neonatal Z-scores at birth, and gestational age were used to assess the main effects of sex, lactation period, and their interaction. BM from mothers with male neonates exhibited significantly higher protein, ABTS, FRAP, and GSH levels, while catalase showed the opposite trend. No differences between sexes were observed in SOD, total thiols, and oxidative damage biomarkers. Most changes were observed on day 7 of lactation. Adjusted models demonstrated a significant association between male sex and proteins (β = 2.70 ± 1.20; p-Value = 0.048). In addition, total antioxidant capacity by ABTS (β = 0.11 ± 0.06) and GSH (β = 1.82 ± 0.94) showed a positive trend near significance (p-Value = 0.056; p-Value = 0.064, respectively). In conclusion, transitional milk showed sex differences in composition with higher protein and GSH levels in males. This may represent an advantage in the immediate perinatal period, which may help to counteract the worse adaptation of males to adverse intrauterine environments and prematurity.
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Affiliation(s)
- David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, 2, 28029 Madrid, Spain; (D.R.-C.); (A.G.-D.); (S.R.)
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
| | - Andrea Gila-Diaz
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, 2, 28029 Madrid, Spain; (D.R.-C.); (A.G.-D.); (S.R.)
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
| | - Gloria Herranz Carrillo
- Division of Neonatology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martin Lagos s/n, 28040 Madrid, Spain;
| | - Silvia Cañas
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
- Department of Agricultural Chemistry and Food Science, Faculty of Science, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
- Institute of Food Science Research, CIAL (UAM-CSIC), Universidad Autonoma de Madrid, C/Nicolás Cabrera, 9, 28049 Madrid, Spain
| | - Alicia Gil-Ramírez
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
- Department of Agricultural Chemistry and Food Science, Faculty of Science, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
- Institute of Food Science Research, CIAL (UAM-CSIC), Universidad Autonoma de Madrid, C/Nicolás Cabrera, 9, 28049 Madrid, Spain
| | - Santiago Ruvira
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, 2, 28029 Madrid, Spain; (D.R.-C.); (A.G.-D.); (S.R.)
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
- PhD Programme in Pharmacology and Physiology, Doctoral School, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - María A. Martin-Cabrejas
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
- Department of Agricultural Chemistry and Food Science, Faculty of Science, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
- Institute of Food Science Research, CIAL (UAM-CSIC), Universidad Autonoma de Madrid, C/Nicolás Cabrera, 9, 28049 Madrid, Spain
| | - Silvia M. Arribas
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, 2, 28029 Madrid, Spain; (D.R.-C.); (A.G.-D.); (S.R.)
- Food, Oxidative Stress and Cardiovascular Health (FOSCH) Research Group, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; (S.C.); (A.G.-R.); (M.A.M.-C.)
- Correspondence:
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Maternal dietary intake, nutritional status and macronutrient composition of human breast milk: systematic review. Br J Nutr 2022; 127:1796-1820. [PMID: 34294167 DOI: 10.1017/s0007114521002786] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Human breast milk (BM) is the best source of nutrition in early life, particularly during the first 6 months. Nevertheless, human BM composition is variable, and more insight in the exact factors contributing to this variability is warranted. In this review, we explored the impact of maternal dietary intake and nutritional status (e.g. anthropometric measures, BMI, bioimpedance) on human milk macronutrient composition. PubMed, Scopus and Cochrane were systematically searched till November 2019. In total, 4946 publications underwent title-abstract screening; 101 publications underwent full-text screening. Eventually, fifty publications were included in this review, investigating either associations between maternal dietary intake (n 29) and/or maternal nutritional status (n 29), and macronutrient composition of human BM. Reported energy composition ranged from 213 to 301 kJ/100 ml, and 67 % and 54 % of the studies reported associations between with maternal nutritional intake and status, respectively. Protein content ranged from 0·8 to 3·3 g/100 ml, and four studies suggested a negative association with nutritional status. Fat content ranged from 2·1 to 9·8 g/100 ml, and 68 % of the studies reported positive associations with nutritional status. Carbohydrate content ranged from 5·8 to 7·5 g/100 ml, and 67 % of the included studies did not report an association between intake and status. Literature investigating associations of maternal dietary intake and nutrition status with BM composition of macronutrients and energy content is diversified, both in terms of used methodology and results. Further studies using well-defined and standard parameters are essential to aid the formulation of scientific recommendations.
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Thum C, Wall C, Day L, Szeto IMY, Li F, Yan Y, Barnett MPG. Changes in Human Milk Fat Globule Composition Throughout Lactation: A Review. Front Nutr 2022; 9:835856. [PMID: 35634409 PMCID: PMC9137899 DOI: 10.3389/fnut.2022.835856] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/22/2022] [Indexed: 01/19/2023] Open
Abstract
There has been a growing interest in understanding how the relative levels of human milk fat globule (MFG) components change over the course of lactation, how they differ between populations, and implications of these changes for the health of the infant. In this article, we describe studies published over the last 30 years which have investigated components of the MFG in term milk, focusing on changes over the course of lactation and highlighting infant and maternal factors that may influence these changes. We then consider how the potential health benefits of some of the milk fat globule membrane (MFGM) components and derived ingredients relate to compositional and functional aspects and how these change throughout lactation. The results show that the concentrations of phospholipids, gangliosides, cholesterol, fatty acids and proteins vary throughout lactation, and such changes are likely to reflect the changing requirements of the growing infant. There is a lack of consistent trends for changes in phospholipids and gangliosides across lactation which may reflect different methodological approaches. Other factors such as maternal diet and geographical location have been shown to influence human MFGM composition. The majority of research on the health benefits of MFGM have been conducted using MFGM ingredients derived from bovine milk, and using animal models which have clearly demonstrated the role of the MFGM in supporting cognitive and immune health of infants at different stages of growth and development.
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Affiliation(s)
- Caroline Thum
- AgResearch Ltd, Te Ohu Rangahau Kai, Palmerston North, New Zealand
- *Correspondence: Caroline Thum
| | - Clare Wall
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Li Day
- AgResearch Ltd, Te Ohu Rangahau Kai, Palmerston North, New Zealand
| | - Ignatius M. Y. Szeto
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group, Co., Ltd, Beijing, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd, Hohhot, China
| | - Fang Li
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group, Co., Ltd, Beijing, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd, Hohhot, China
| | - Yalu Yan
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group, Co., Ltd, Beijing, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd, Hohhot, China
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11
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Maternal Factors Affecting the Macronutrient Composition of Transitional Human Milk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063308. [PMID: 35328998 PMCID: PMC8955619 DOI: 10.3390/ijerph19063308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 12/17/2022]
Abstract
This study investigated the influence of selected maternal factors on the macronutrient composition and energy of human milk (HM). The study enrolled 159 breastfeeding mothers from five postpartum care centers in Seoul, Korea. Their gestational weeks were 37−42 weeks, they had no complications before and after childbirth, and were at 7−14 days postpartum. They provided data using structured questionnaires on general characteristics, stress, sleep quality, spousal support, and dietary intake. Breastfeeding assessment (LATCH) was investigated by qualified nurses, and each mother provided one sample of HM. The HM composition was analyzed using the Miris® HM analyzer. The relationships between variables were analyzed using Pearson’s correlation analysis, and a linear regression analysis was performed to verify the main variables. It was found that maternal dietary intake was related to HM composition as the %energy from carbohydrates (β = 0.86, p < 0.01) and %energy from fat (β = 0.77, p < 0.05) showed positive relationships with HM energy. The LATCH score was positively related to HM energy (β = 0.17, p < 0.05). In contrast, postpartum stress, sleep quality, and spousal support were not associated with HM macronutrient composition. In conclusion, HM macronutrients and energy content were associated with maternal dietary intake and LATCH scores, but not with postpartum stress, sleep quality, and spousal support.
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12
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Zeynali L, Nourizadeh R, Khalili AF, Hosseini M, Khalili A, Hakimi S. Effect of Vaginal Delivery on Lactose Content of Human Milk. Curr Pediatr Rev 2022; 18:138-143. [PMID: 34872478 DOI: 10.2174/1573396317666211206123648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/13/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The macronutrients of human milk are considered essential nutritional sources in the first few months of a newborn's life. The present study aimed to investigate the effect of delivery mode on the macronutrients of human milk. METHODS This retrospective cohort study was conducted on 102 women who gave birth by cesarean section or vaginal delivery between September 2019 and November 2019. The participants were requested to provide their milk samples on day 15 ± 1 after childbirth. RESULTS There were no significant differences between the two groups (cesarean and vaginal delivery) regarding the sociodemographic characteristics and intake of fat, carbohydrate, protein, and energy. The lactose level was significantly higher in women who gave birth by vaginal delivery (adjusted mean difference, 1.2 (95 % CI 0.02- 1.82)). For other macronutrients, there were no statistically significant differences between the two groups. CONCLUSION The vaginal delivery might influence the mature milk lactose level.
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Affiliation(s)
- Leila Zeynali
- Students Research Committee, Tabriz University of Medical Science, Tabriz, Iran
| | - Roghaiyeh Nourizadeh
- Faculty of Nursing and Midwifery, Midwifery Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Azizeh Farshbaf Khalili
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Assef Khalili
- Department of Basic Sciences, Faculty of Allied Medical Science, Tabriz University of Medical Science, Tabriz Iran
| | - Sevil Hakimi
- Faculty of Nursing and Midwifery, Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Science, Tabriz, Iran
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13
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Çınar N, Karakaya Suzan Ö, Kaya Ö, Karataş H, Duken ME. Investigation of the Effect of Human Milk Expression Techniques on Milk Content: A Systematic Review. J Trop Pediatr 2021; 67:6490899. [PMID: 34971400 DOI: 10.1093/tropej/fmab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND If the mother and infant cannot meet after birth, it is recommended to express milk and give it to the infant. There was evidence indicating that there might be decrease in essential nutrient values in human milk content depending on the expression technique in literature. The goal of this systematic review was to investigate the effect of human milk expression techniques on the macronutrient milk content and establish an evidence base for future studies. METHODS Studies investigating the effect of human milk expression techniques on milk content were reviewed without year limitations. A literature review was conducted in six electronic databases (MEDLINE, Web of Science, PubMed, ScienceDirect, CINAHL and Cochrane) until 30 May 2021, using the keywords of breast milk expression techniques, milk content and breast milk pumping. RESULTS From 258 articles initially screened, we included 6 articles in the systematic review. The fat, protein and lactose content of human milk was analyzed in the studies reviewed. It was concluded that there was no significant effect on the protein (9.7-9.8 g/dl and 2.1-2.1 g/dl, respectively) and lactose (6.50-6.53% and 6.1-6.1 g/dl, respectively) content of milk. However, the fat (58.30, 48.81g/l; 2.6-2.2 g/dl) content was affected. CONCLUSIONS This study investigated the effect of milk expression techniques on the macronutrient content of human milk, and it was concluded that there was no significant effect on the protein and carbohydrate content of milk. However, the fat content was affected. Limitation of this study is that some factors that might affect the content of human milk were not standardized sufficiently in the included studies.
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Affiliation(s)
- Nursan Çınar
- Faculty of Health Sciences, Department of Nursing, Esentepe Campus, Sakarya University, Serdivan, Sakarya 54187, Turkey
| | - Özge Karakaya Suzan
- Faculty of Health Sciences, Department of Nursing, Esentepe Campus, Sakarya University, Serdivan, Sakarya 54187, Turkey
| | - Özge Kaya
- Istanbul Yeni Yuzyil University, Health Care Vocational School, Department of Anesthesia, Topkapi Campus, Zeytinburnu, Istanbul 34010, Turkey
| | - Hülya Karataş
- Faculty of Health Sciences, Department of Nursing, Harran University, Urfa 63300, Turkey
| | - Mehmet Emin Duken
- Faculty of Health Sciences, Department of Nursing, Harran University, Urfa 63300, Turkey
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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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15
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Cheema AS, Stinson LF, Rea A, Lai CT, Payne MS, Murray K, Geddes DT, Gridneva Z. Human Milk Lactose, Insulin, and Glucose Relative to Infant Body Composition during Exclusive Breastfeeding. Nutrients 2021; 13:nu13113724. [PMID: 34835980 PMCID: PMC8625960 DOI: 10.3390/nu13113724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
Human milk (HM) components may influence infant growth and development. This study aimed to investigate relationships between infant body composition (BC) and HM lactose, insulin, and glucose (concentrations and calculated daily intakes (CDI)) as well as 24-h milk intake and maternal BC at 3 months postpartum. HM samples were collected at 2 months postpartum. Infant and maternal BC was assessed with bioimpedance spectroscopy. Statistical analysis used linear regression accounting for infant birth weight. 24-h milk intake and CDI of lactose were positively associated with infant anthropometry, lean body mass and adiposity. Higher maternal BC measures were associated with lower infant anthropometry, z-scores, lean body mass, and adiposity. Maternal characteristics including BC and age were associated with concentrations and CDI of HM components, and 24-h milk intake. In conclusion, 24-h intake of HM and lactose as well as maternal adiposity are related to development of infant BC.
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Affiliation(s)
- Ali S. Cheema
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.S.C.); (L.F.S.); (C.T.L.); (D.T.G.)
| | - Lisa F. Stinson
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.S.C.); (L.F.S.); (C.T.L.); (D.T.G.)
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Murdoch, WA 6150, Australia;
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.S.C.); (L.F.S.); (C.T.L.); (D.T.G.)
| | - Matthew S. Payne
- Division of Obstetrics and Gynaecology, UWA Medical School, The University of Western Australia, Crawley, WA 6009, Australia;
- Women and Infants Research Foundation, Subiaco, WA 6008, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.S.C.); (L.F.S.); (C.T.L.); (D.T.G.)
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.S.C.); (L.F.S.); (C.T.L.); (D.T.G.)
- Correspondence: ; Tel.: +61-8-6488-4467
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16
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Prevalence and associated factors of breastmilk aflatoxin M1 levels in mothers from Banke, Nepal. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Do Maternal Factors and Milk Expression Patterns Affect the Composition of Donor Human Milk? Nutrients 2021; 13:nu13072425. [PMID: 34371935 PMCID: PMC8308884 DOI: 10.3390/nu13072425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
A primary role of Human Milk Banks (HMBs) is to provide human milk (HM) for preterm infants and to support the mothers of these infants as they establish their own milk supply. A better understanding of the variation in the energy and macronutrients contents of donor human milk (DHM) potentiates targeted nutrition for preterm babies. Therefore, the aim of this study was to assess the variability of energy and macronutrients content in DHM and to investigate the impact of maternal factors and feeding practices on the nutritional value of DHM. The study involved 49 donors registered in the HMB in the Holy Family Hospital in Warsaw, Poland. Samples from each donor were pooled within a maximum of two weeks. The composition of DHM, including energy content, protein, fat, and carbohydrate concentrations, was analyzed using the Miris Human Milk Analyzer. The analyses were performed before the pasteurization process. The mean time of milk donation to HMB was 13.2 ± 6.0 weeks. There were no significant differences in energy and macronutrients contents of DHM in the beginning and at the end of milk donation to HMB, however, HM fat concentration was positively correlated with afternoon feedings (r = 0.289, p = 0.044). The method of feeding (breastfeeding vs. feeding only expressed milk) also did not impact the nutritional value of DHM. Future research for the DHM should include a further cross-sectional observational study with the collection of detailed donor information and characteristics of milk expression and feeding practices to further evaluate the pooling processes and the effect on DHM composition.
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18
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van Sadelhoff JHJ, Siziba LP, Buchenauer L, Mank M, Wiertsema SP, Hogenkamp A, Stahl B, Garssen J, Rothenbacher D, Genuneit J. Free and Total Amino Acids in Human Milk in Relation to Maternal and Infant Characteristics and Infant Health Outcomes: The Ulm SPATZ Health Study. Nutrients 2021; 13:nu13062009. [PMID: 34200908 PMCID: PMC8230437 DOI: 10.3390/nu13062009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 12/25/2022] Open
Abstract
Free amino acids (FAAs) are important regulators of key pathways necessary for growth, development, and immunity. Data on FAAs in human milk (HM) and their roles in infant development are limited. We investigated the levels of FAAs and total amino acids (TAA, i.e., the sum of conjugated amino acids and FAAs) in HM in relation to infant and maternal characteristics and immunological conditions. FAA and TAA levels in HM sampled at 6 weeks (n = 671) and 6 months (n = 441) of lactation were determined using high-performance liquid chromatography. Child growth was ascertained at 4–5 weeks and at 6–7 months of age. Child allergy and lower respiratory tract infections were assessed in the first years of life. Associations of amino acid (AA) levels in HM with child growth and health outcomes were determined by Spearman correlation and modified Poisson regression, respectively. Free glutamine, glutamate, and serine in 6-week HM positively correlated with infant weight gain in the first 4–5 weeks of age. Maternal pre-pregnancy weight and body mass index (BMI) were negatively correlated with free glutamine and asparagine in 6-week and 6-month HM and positively correlated with the sum of TAAs in 6-month HM, but significance was lost following confounder adjustment. Free glutamine was lower in 6-month HM of mothers with an allergy (either active or non-active). No consistent associations were found between FAAs in HM and child health outcomes. However, potential negative associations were observed between specific FAAs and the risk of food allergy. These results suggest that specific FAAs play a role in infant growth. Moreover, these findings warrant further investigations into the relation of FAAs in HM with infant health outcomes and maternal allergy.
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Affiliation(s)
- Joris H. J. van Sadelhoff
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands; (A.H.); (J.G.)
- Correspondence: ; Tel.: +31-625-699-571
| | - Linda P. Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (L.P.S.); (L.B.); (J.G.)
| | - Lisa Buchenauer
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (L.P.S.); (L.B.); (J.G.)
| | - Marko Mank
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (S.P.W.); (B.S.)
| | - Selma P. Wiertsema
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (S.P.W.); (B.S.)
| | - Astrid Hogenkamp
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands; (A.H.); (J.G.)
| | - Bernd Stahl
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (S.P.W.); (B.S.)
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands; (A.H.); (J.G.)
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (S.P.W.); (B.S.)
| | | | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (L.P.S.); (L.B.); (J.G.)
- Institute of Epidemiology and Medical Biometry, Ulm University, 89079 Ulm, Germany;
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19
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Leghi GE, Lai CT, Narayanan A, Netting MJ, Dymock M, Rea A, Wlodek ME, Geddes DT, Muhlhausler BS. Daily variation of macronutrient concentrations in mature human milk over 3 weeks. Sci Rep 2021; 11:10224. [PMID: 33986316 PMCID: PMC8119942 DOI: 10.1038/s41598-021-89460-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
Human milk (HM) composition is known to be highly variable, both between individuals and across the duration of lactation. It is less clear, however, to what extent fat, lactose and protein concentrations in HM change daily over shorter time periods in mature HM, and no studies have evaluated this to date. The aim of this study was to systematically assess and compare HM macronutrient concentrations in samples collected at different times of day, from left and right breasts and daily across a 3-week period in the same woman. Fifteen lactating women (1.6–4.9 months postpartum) collected daily pre-feed HM samples from both breasts each morning for 21 consecutive days and completed intensive sampling once a week (morning, afternoon and evening samples) during this period. Concentrations of fat, protein and lactose in HM did not differ according to time of day, day of week or breast used for collection. The results of this study suggest that pre-feed samples collected at any point across a 3-week period and from either the left or right breast provide comparable measures of fat, protein and lactose concentrations in mature HM, in pragmatic studies where women are collecting their own HM samples. Clinical trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12619000606189).
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Affiliation(s)
- Gabriela E Leghi
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia
| | - Ching T Lai
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Ardra Narayanan
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Merryn J Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Michael Dymock
- Centre for Applied Statistics, University of Western Australia, Perth, Australia
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Perth, Australia
| | - Mary E Wlodek
- Department of Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Beverly S Muhlhausler
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, Australia.
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20
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Picó C, Reis F, Egas C, Mathias P, Matafome P. Lactation as a programming window for metabolic syndrome. Eur J Clin Invest 2021; 51:e13482. [PMID: 33350459 DOI: 10.1111/eci.13482] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
The concept of developmental origins of health and disease (DOHaD) was initially supported by the low birth weight and higher risk of developing cardiovascular disease in adult life, caused by nutrition restriction during foetal development. However, other programming windows have been recognized in the last years, namely lactation, infancy, adolescence and even preconception. Although the concept has been developed in order to study the impact of foetal calorie restriction in adult life, it is now recognized that maternal overweight during programming windows is also harmful to the offspring. This article explores and summarizes the current knowledge about the impact of maternal obesity and obesogenic diets during lactation in the metabolic programming towards the development of metabolic syndrome in the adult life. The impact of maternal obesity and obesogenic diets in milk quality is discussed, including the alterations in specific micro and macronutrients, as well as the impact of such alterations in the development of metabolic syndrome-associated features in the newborn, such as insulin resistance and adiposity. Moreover, the impact of milk quality and formula feeding in infants' gut microbiota, immune system maturation and in the nutrient-sensing mechanisms, namely those related to gut hormones and leptin, are also discussed under the current knowledge.
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Affiliation(s)
- Catalina Picó
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics and Obesity), University of the Balearic Islands, Palma (Mallorca), Spain.,Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma (Mallorca), Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Palma (Mallorca), Spain
| | - Flávio Reis
- Faculty of Medicine, Institute of Pharmacology & Experimental Therapeutics and Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Conceição Egas
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Center of Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | | | - Paulo Matafome
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Faculty of Medicine, Institute of Physiology and Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Department of Complementary Sciences, Instituto Politécnico de Coimbra, Coimbra Health School (ESTeSC), Coimbra, Portugal
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21
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Daniel AI, Shama S, Ismail S, Bourdon C, Kiss A, Mwangome M, Bandsma RHJ, O'Connor DL. Maternal BMI is positively associated with human milk fat: a systematic review and meta-regression analysis. Am J Clin Nutr 2021; 113:1009-1022. [PMID: 33675341 PMCID: PMC8023843 DOI: 10.1093/ajcn/nqaa410] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lack of robust estimates of human-milk nutrient composition and influential maternal factors, such as body composition, are barriers to informing nutrition policies and programs. OBJECTIVE The objective was to understand the relation between maternal BMI and human-milk energy, fat, and/or total protein. METHODS Four electronic databases (MEDLINE, Embase, CINAHL, and Web of Science) were searched. Outcomes assessed were human-milk energy (kcal/L), fat (g/L), and total protein (g/L) from mothers 1 to 6 mo postpartum. Studies with data on maternal BMI or weight and height that quantified human-milk energy, fat, or protein between 1 and 6 mo postpartum were eligible. Random-effects meta-regression weighted by the inverse of the study-level SE was completed for each of the 3 outcomes. The certainty of evidence for each outcome was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS A total of 11,373 titles and abstracts were identified, and after full-text screening, 69 articles of 66 studies were included. Meta-regression results showed a positive association between maternal BMI and human-milk fat (β: 0.56 g/L; 95% CI: 0.034, 1.1; P = 0.04; I2 = 93.7%, n = 63 datapoints). There was no significant association between maternal BMI and human-milk energy (β: 3.9 kcal/L; 95% CI: -1.6, 9.5; P = 0.16, I2 = 93.3%, n = 40 datapoints) or total protein (β: 0.13 g/L; 95% CI: -0.16, 0.41; P = 0.37, I2 = 99.1%, n = 40 datapoints). The certainty of evidence for human-milk energy was low and the certainty of evidence for fat and total protein was very low. CONCLUSIONS Meta-regression analysis of available literature suggested an association between maternal BMI and human-milk fat between 1 and 6 mo postpartum. Future studies are needed to confirm the relation between maternal BMI; variation in human-milk energy, fat, and protein content; and the implications for child growth and development. This review is registered with International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018098808) at https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Shama
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Ismail
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Martha Mwangome
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Program, Kilifi, Kenya
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Deborah L O'Connor
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Nguyen MTT, Kim J, Seo N, Lee AH, Kim YK, Jung JA, Li D, To XHM, Huynh KTN, Van Le T, Israr B, Nazir A, Seo JA, Lee D, An HJ, Kim J. Comprehensive analysis of fatty acids in human milk of four Asian countries. J Dairy Sci 2021; 104:6496-6507. [PMID: 33685684 DOI: 10.3168/jds.2020-18184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Human milk lipids provide not only energy but also indispensable bioactive components such as essential fatty acids. To establish the recommended daily intake value and guidelines for infant formula, a reference library of fatty acid composition has been generated from 4 Asian countries (South Korea, China, Vietnam, and Pakistan). Regardless of country, palmitic acid (C16:0), linoleic acid (C18:1), and linolenic acid (C18:2) were the 3 most abundant fatty acids in human milk and account for more than 75% of total fatty acids (total FA). However, there were several considerable differences between fatty acids, particularly n-3 and n-6 (omega-3 and omega-6) groups. Chinese mothers' milk had a high concentration of linoleic acid at 24.38 ± 10.02% of total FA, which may be due to maternal diet. Among the 4 countries, Pakistani mothers' milk contained a high amount of saturated fatty acid (56.83 ± 5.96% of total FA), and consequently, polyunsaturated fatty acids, including n-3 and n-6, were significantly lower than in other countries. It is noteworthy that docosahexaenoic acid (DHA) in Pakistani mothers' milk was 44.8 ± 33.3 mg/L, which is only 25 to 30% of the levels in the other 3 countries, suggesting the need for DHA supplementation for infants in Pakistan. Moreover, the ratio of n-6 to n-3 was also remarkably high in Pakistani mothers' milk (15.21 ± 4.96), being 1.4- to 1.7-fold higher than in other countries. The average DHA:ARA ratio in Asian human milk was 1.01 ± 0.79. Korean mothers' milk showed a high DHA:ARA ratio, with a value of 1.30 ± 0.98, but Pakistani mothers' milk had a significantly lower value (0.42 ± 0.12). The fatty acid compositions and anthropometric data of mother (body mass index, age) did not show any correlation. The obtained data might provide information about human milk compositions in the Asian region that could benefit from setting up recommended nutrient intake and infant formula for Asian babies.
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Affiliation(s)
- My Tuyen T Nguyen
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea; College of Agriculture, Can Tho University, Can Tho, 900000, Vietnam
| | - Jieun Kim
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea
| | - Nari Seo
- Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon 34134, Korea
| | - A Hyun Lee
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea
| | - Yong-Ki Kim
- Maeil Asia Human Milk Research Center, Maeil Dairies Co. Ltd., 63 Jinwiseo-ro, Jinwi-myeon, Pyeongtaek, Gyeonggi-do 17706, Korea
| | - Ji A Jung
- Maeil Asia Human Milk Research Center, Maeil Dairies Co. Ltd., 63 Jinwiseo-ro, Jinwi-myeon, Pyeongtaek, Gyeonggi-do 17706, Korea
| | - Dan Li
- College of Food Science and Engineering, Changchun University, Changchun 130022, China
| | - Xuan Hong M To
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Khanh Trang N Huynh
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Thanh Van Le
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Beenish Israr
- Faculty of Food, Nutrition, and Home Science, University of Agriculture, Faisalabad 38000, Pakistan
| | - Anum Nazir
- Faculty of Food, Nutrition, and Home Science, University of Agriculture, Faisalabad 38000, Pakistan
| | - Jung-A Seo
- Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon 34134, Korea
| | - Daum Lee
- Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon 34134, Korea
| | - Hyun Joo An
- Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon 34134, Korea
| | - Jaehan Kim
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea.
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23
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Ward E, Yang N, Muhlhausler BS, Leghi GE, Netting MJ, Elmes MJ, Langley-Evans SC. Acute changes to breast milk composition following consumption of high-fat and high-sugar meals. MATERNAL AND CHILD NUTRITION 2021; 17:e13168. [PMID: 33660402 PMCID: PMC8189213 DOI: 10.1111/mcn.13168] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/25/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Breast milk composition is influenced by habitual diet, yet little is known about the short-term effects of changes in maternal diet on breast milk macronutrient concentrations. Our aim was to determine the acute effect of increased consumption of sugar/fat on breast milk protein, lactose and lipids. Exclusively breastfeeding women (n = 9) were provided with a control, higher fat (+28 g fat) and higher sugar (+66 g sugar) diet over three separate days at least 1 week apart. Hourly breast milk samples were collected concurrently for the analysis of triglycerides, cholesterol, protein, and lactose concentrations. Breast milk triglycerides increased significantly following both the higher fat and sugar diet with a greater response to the higher sugar compared to control diet (mean differences of 3.05 g/dL ± 0.39 and 13.8 g/dL ± 0.39 in higher fat and sugar diets, respectively [P < 0.001]). Breast milk cholesterol concentrations increased most in response to the higher sugar diet (0.07 g/dL ± 0.005) compared to the control (0.04 g/dL) and the higher fat diet (0.05 g/dL) P < 0.005. Breast milk triglyceride and lactose concentrations increased (P < 0.001, P = 0.006), whereas protein decreased (p = 0.05) in response to the higher fat diet compared to the control. Independent of diet, there were significant variations in breast milk composition over the day; triglycerides and cholesterol concentrations were higher at end of day (P < 0.001), whereas protein and lactose concentrations peaked at Hour 10 (of 12) (P < 0.001). In conclusion, controlled short-term feeding to increase daily sugar/fat consumption altered breast milk triglycerides, cholesterol, protein and lactose. The variations observed in breast milk protein and lactose across the 12 h period is suggestive of a circadian rhythm.
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Affiliation(s)
- Ellen Ward
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - Ni Yang
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - Beverly S Muhlhausler
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, South Australia, Australia.,School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gabriela E Leghi
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Merryn J Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew J Elmes
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK
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24
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Protein levels and protease activity in milk from mothers of pre-term infants: A prospective longitudinal study of human milk macronutrient composition. Clin Nutr 2021; 40:3567-3577. [PMID: 33419616 DOI: 10.1016/j.clnu.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/01/2020] [Accepted: 12/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS The composition and enzymology of human milk changes throughout the lactation period, and differ for mothers who give birth prematurely compared to those who deliver at full-term. Understanding the composition of milk from mothers of very low birth weight premature infants is of great significance, and the objective of this study was to evaluate the composition, protein profile and plasmin activity of milk from mothers who delivered infants at different gestational ages. METHODS Samples of human milk were donated by women (n = 74) in the Cork, Ireland, area who gave birth to full-term (>37 weeks gestation, FT), pre-term (32-37 weeks, PT) and very pre-term (≤32 weeks, VPT) infants. FT milk was collected at 1, 3, 6 and 10 weeks post-partum (PP), while PT and VPT milk was collected weekly until the FT due date of the infant and subsequently followed the FT protocol. RESULTS Gestational age did not significantly affect lactose or fat content or total energy content of milk. However, protein content, and levels of some individual proteins, were significantly affected by both gestational age at birth and duration of lactation, with significantly higher protein levels in PT or VPT milk samples at 0-7 days and 1-2 months, respectively. Plasmin activity was significantly higher in VPT milk, indicating differences in proteolytic processing in milk. CONCLUSION Compositional differences between the milk of mothers of term and pre-term infants were greatest in terms of the protein profile, which showed both qualitative and quantitative differences, as well as difference in proteolytic activity.
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25
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Khor GL, Tan SS, Stoutjesdijk E, Ng KWT, Khouw I, Bragt M, Schaafsma A, Dijck-Brouwer DAJ, Muskiet FAJ. Temporal Changes in Breast Milk Fatty Acids Contents: A Case Study of Malay Breastfeeding Women. Nutrients 2020; 13:nu13010101. [PMID: 33396781 PMCID: PMC7824650 DOI: 10.3390/nu13010101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 12/21/2022] Open
Abstract
The composition of human breast milk changes in the first two months of life, adapting itself to the evolving needs of the growing new-born. Lipids in milk are a source of energy, essential fatty acids (FA), fat-soluble vitamins, and vital bioactive components. Information on breast milk FA of Malaysian lactating women is scarce. Based on convenience sampling, a total of 20 Malay breastfeeding women who fulfilled the inclusion criteria were recruited. Breast milk was collected three times from each subject at consecutive intervals of 2–3 weeks apart. A total of 60 breast milk samples were collected and classified into “transitional milk” (n = 8), “early milk” (n = 26) and “mature milk” (n = 26). All milk samples were air freighted to University of Groningen, Netherlands for analysis. The dominant breast milk FA were oleic acid, constituting 33% of total fatty acids, followed by palmitic acid (26%). Both these FA and the essential FA, linoleic acid (10%) and alpha-linolenic acid (0.4%), showed no significant changes from transitional to mature milk. Breast milk ratio of n-6:n-3 polyunsaturated fatty acids (PUFA) was comparatively high, exceeding 10 throughout the lactation period, suggesting a healthier balance of PUFA intake is needed in pregnancy and at postpartum.
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Affiliation(s)
- Geok Lin Khor
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia; (S.S.T.); (K.W.T.N.)
- Correspondence:
| | - Seok Shin Tan
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia; (S.S.T.); (K.W.T.N.)
| | - Eline Stoutjesdijk
- Laboratory Medicine, University Medical Center Groningen and University of Groningen, 9713 GZ Groningen, The Netherlands; (E.S.); (D.A.J.D.-B.); (F.A.J.M.)
| | - Kock Wai Tony Ng
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia; (S.S.T.); (K.W.T.N.)
| | - Ilse Khouw
- FrieslandCampina, 3800 BN Amersfoort, The Netherlands; (I.K.); (M.B.); (A.S.)
| | - Marjolijn Bragt
- FrieslandCampina, 3800 BN Amersfoort, The Netherlands; (I.K.); (M.B.); (A.S.)
| | - Anne Schaafsma
- FrieslandCampina, 3800 BN Amersfoort, The Netherlands; (I.K.); (M.B.); (A.S.)
| | - D. A. Janneke Dijck-Brouwer
- Laboratory Medicine, University Medical Center Groningen and University of Groningen, 9713 GZ Groningen, The Netherlands; (E.S.); (D.A.J.D.-B.); (F.A.J.M.)
| | - Frits A. J. Muskiet
- Laboratory Medicine, University Medical Center Groningen and University of Groningen, 9713 GZ Groningen, The Netherlands; (E.S.); (D.A.J.D.-B.); (F.A.J.M.)
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26
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de Fluiter KS, Kerkhof GF, van Beijsterveldt IALP, Breij LM, van de Heijning BJM, Abrahamse-Berkeveld M, Hokken-Koelega ACS. Longitudinal human milk macronutrients, body composition and infant appetite during early life. Clin Nutr 2020; 40:3401-3408. [PMID: 33309161 DOI: 10.1016/j.clnu.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/15/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Breastfeeding is the gold standard infant feeding. Data on macronutrients in relation to longitudinal body composition and appetite are very scarce. The aim of this study was to investigate longitudinal human milk macronutrients at 1 and 3 months in association with body composition and appetite during early life in healthy, term-born infants. We hypothesized that infants receiving higher caloric human milk would have more body fat mass and satiate earlier. METHODS In 133 exclusively breastfed infants (Sophia Pluto Cohort), human milk samples at 1 and 3 months were analyzed for macronutrients (fat, protein, carbohydrate) by MIRIS Human Milk Analyzer, with appetite assessment by Baby Eating Behavior Questionnaires. Fat mass (FM) and fat-free mass (FFM) were measured by PEA POD and DXA, and abdominal FM by ultrasound. RESULTS Milk samples showed large differences in macronutrients, particularly in fat content. Protein and energy content decreased significantly from 1 to 3 months. Fat and carbohydrate content tended to decrease (p = 0.066 and 0.081). Fat (g/100 ml) and energy (kcal/100 ml) content at 3 months were associated with FM% at 6 months (β 0.387 and 0.040, resp.) and gain in FM% from 1 to 6 months (β 0.088 and 0.009, resp.), but not with FM% at 2 years. Carbohydrate content at 3 months tended to associate with visceral FM at 2 years (β 0.290, p = 0.06). Infants receiving higher caloric milk were earlier satiated and finished feeding faster. CONCLUSIONS Our longitudinal data show decreasing milk protein and energy content from age 1 to 3 months, while fat and carbohydrate tended to decrease. Macronutrient composition, particularly fat content, differed considerably between mothers. Milk fat and energy content at 3 months associated with gain in FM% from age 1 to 6 months, indicating that higher fat and energy content associate with higher gain in FM% during the critical window for adiposity programming. As infants receiving higher caloric breastfeeding were earlier satiated, this self-regulatory mechanism might prevent intake of excessive macronutrients. ONLINE TRIAL REGISTRY NTR, NL7833.
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Affiliation(s)
- Kirsten S de Fluiter
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Gerthe F Kerkhof
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Inge A L P van Beijsterveldt
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Laura M Breij
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | | | - Anita C S Hokken-Koelega
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands; Dutch Growth Research Foundation, Rotterdam, the Netherlands
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27
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Ongprasert K, Ruangsuriya J, Malasao R, Sapbamrer R, Suppansan P, Ayood P, Kittisakmontri K, Siviroj P. Macronutrient, immunoglobulin a and total antioxidant capacity profiles of human milk from 1 to 24 months: a cross-sectional study in Thailand. Int Breastfeed J 2020; 15:90. [PMID: 33126900 PMCID: PMC7602312 DOI: 10.1186/s13006-020-00333-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 10/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background An extended duration of breastfeeding of up to two years is encouraged by many health authorities, but information regarding the composition of milk after one year postpartum is limited. The goal of this study was to determine the association between the duration of lactation and macronutrient contents, immunoglobulin A (IgA) levels and total antioxidant capacity (TAC) in human milk (HM), from 1 to 24 months postpartum. Methods Cross-sectional milk samples were collected between January and April 2019 from mothers with healthy full-term children who had been lactating for 1 to 24 months. The HM was biochemically analyzed for protein and carbohydrate contents by colorimetric assays. The fat content was determined by capillary centrifugation, and the energy content was calculated from the results of centrifugation assays. IgA levels and TAC were determined by ELISA and a Trolox equivalent antioxidant capacity (TEAC) assay, respectively. Pearson’s correlation coefficient and Spearman’s rank correlation coefficient were used to determine associations between months of lactation and milk composition, and multiple regression analysis was used to assess associations between months of lactation and milk composition adjusted for relevant covariates. Differences were considered significant at p < 0.05. Results One hundred eighty-four milk samples were analyzed. The month of lactation was positively associated with the fat concentration (B = 0.31, SE = 0.09, p = 0.001), energy content (B = 3.11, SE = 0.92, p = 0.001), and IgA (B = 4.17, SE = 1.08, p < 0.001) but negatively associated with the carbohydrate concentration (B = − 0.22, SE = 0.01, p = 0.04). No association was observed between the month of lactation and the protein concentration or TAC after adjustment for maternal age, maternal BMI, birth order, and breastfeeding frequency. Conclusion The duration of lactation was found to be positively associated with the fat, energy, and IgA content in HM for up to two years postpartum, and negatively associated with carbohydrate concentration. More prospective cohort studies are needed to obtain evidence-based knowledge regarding the changes in HM composition throughout the course of lactation.
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Affiliation(s)
- Krongporn Ongprasert
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Jetsada Ruangsuriya
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rungnapa Malasao
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pikul Suppansan
- Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pisittawoot Ayood
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kulnipa Kittisakmontri
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Samuel TM, Zhou Q, Giuffrida F, Munblit D, Verhasselt V, Thakkar SK. Nutritional and Non-nutritional Composition of Human Milk Is Modulated by Maternal, Infant, and Methodological Factors. Front Nutr 2020; 7:576133. [PMID: 33117843 PMCID: PMC7557356 DOI: 10.3389/fnut.2020.576133] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
Human milk (HM) is dynamic and shows a high inter- and intra-individual variability. To characterize HM with precision, it is necessary to understand the factors that modulate its composition. The objective of this narrative review is to summarize the maternal, infant and methodological factors that affect HM composition. We searched SCOPUS and PubMed databases for articles related to factors that are known to or could potentially influence HM composition and volume across lactation periods. Our comprehensive review encompasses various maternal-, infant-related, and methodological factors that modulate aspects of HM composition including macro- and micronutrients, vitamins and minerals, as well as volume. The most profound changes were observed in HM lipids and lipophiles. Evidence exists for many of the infant-related factors known to affect the nutritive and non-nutritive components of HM (e.g., birth weight, gestational age, infant age/stage of lactation). In contrast, less is known with respect to maternal factors; where there is either limited research or conflicting evidence (e.g., maternal lifestyle, obstetric history, medical conditions), except for the mother's diet, for which there is a relatively well-established understanding. Equally, although many of the methodological factors (e.g., HM sampling, handling and analytics) are known to impact HM composition, few studies have investigated this as a primary outcome, making it an important area of future research in HM. Here we propose a systematic capture of numerous maternal- and infant-related characteristics to facilitate associative comparisons of HM data within and across studies. Additionally, it would be prudent to standardize the methodological aspects known to affect HM composition in analytics, not only for HM lipids and lipophiles, but also for those nutrients whose variability is yet less well-understood. Defining the factors determining HM composition with accuracy will open perspectives for maternal intervention to optimize milk composition for specific needs of infants.
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Affiliation(s)
| | | | | | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
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29
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Bzikowska-Jura A, Sobieraj P, Szostak-Węgierek D, Wesołowska A. Impact of Infant and Maternal Factors on Energy and Macronutrient Composition of Human Milk. Nutrients 2020; 12:E2591. [PMID: 32858897 PMCID: PMC7551856 DOI: 10.3390/nu12092591] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
The present study investigates the influence of selected infant and maternal factors on the energy and macronutrient composition of mature human milk (HM). The study enrolled 77 mothers at 4-8 weeks postpartum. Each mother provided 1 sample of HM. Each extracted HM sample was formed by mixing four subsamples of HM, each of which were obtained in one predefined 6-h periods of the day. Among maternal factors, the analysis included: anthropometric data before and after pregnancy; weight gain in pregnancy; body composition, assessed using the Maltron BioScan 920-II to analyze bioimpedance; and dietary intake, assessed with three-day dietary records. Among the neonatal factors, birth weight and length, number of daily feedings and type of delivery were included. The composition of HM, including energy content, protein, fat and carbohydrate concentrations, was analyzed using the Miris human milk analyzer. Pearson's and Spearman's correlation coefficients and multivariable logistic regression models were used to analyze the association between the selected maternal and infant factors and HM milk composition. It was found that total protein content of HM was correlated with pre-pregnancy BMI (Spearman rho = 0.238; p = 0.037), current lean body mass (Spearman rho = -0.293, p = 0.01) and total water content (Spearman rho = -0.315, p = 0.005). Carbohydrates were the only macronutrients whose composition was significantly affected by the infant factors. It was reported that higher carbohydrate content was associated with male sex (OR = 4.52, p = 0.049). Our results show that maternal and infant factors, especially maternal pre-pregnancy and current nutritional status and infant sex, interact and affect HM composition, suggesting that macronutrient and energy content in HM may be determined in pregnancy and may have unique compositional profile for every mother-infant dyad.
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Affiliation(s)
- Agnieszka Bzikowska-Jura
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland
| | - Piotr Sobieraj
- Deparment of Internal Medicine, Hypertension and Vascular Diseases, Faculty of Medicine, Medical University of Warsaw, Banacha Str 1a, 02-097 Warsaw, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland
| | - Aleksandra Wesołowska
- Department of Neonatology, Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Faculty of Health Science, Medical University of Warsaw, Zwirki i Wigury Str. 63A, 02-091 Warsaw, Poland
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Beser Ozmen E, Okman E, Sari FN, Kucukoglu Keser M, Dizdar EA, Tayman C, Oguz SS. Comparison of the Macronutrient Content of Colostrum: Locals with Refugees. Breastfeed Med 2020; 15:453-457. [PMID: 32466681 DOI: 10.1089/bfm.2020.0085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Breast milk (BM) is considered the ideal and natural way of feeding for all infants. Although previous studies evaluated the factors influencing the content of BM, data concerning the effect of being a refugee on macronutrient contents of BM are rather inadequate. Therefore, we aimed to compare the macronutrient content of colostrum samples of Turkish and Syrian mothers. Materials and Methods: BM from lactating mothers who delivered term newborns was collected within the first 48 hours of lactation. Milk protein, fat, carbohydrate, and energy levels were measured by using a mid-infrared human milk analyzer. Demographic characteristics of the mothers and the infants were recorded. Results: Colostrum samples of 180 lactating mothers (Turkish: 96, Syrian: 84) were obtained. There were no significant differences between the groups in terms of body mass index of the mothers, mode of delivery, and infant gender. However, Syrian mothers gained less weight during pregnancy compared with Turkish mothers (p = 0.029). The median protein, fat, and energy levels of colostrum samples were found to be significantly higher in Turkish mothers than in Syrian mothers (p = 0.001, p = 0.017, p < 0.001, respectively). Cesarean delivery and being a Syrian refugee were independently associated with lower protein content of colostrum in logistic regression analysis. Conclusion: Lactating mothers who delivered their babies through vaginal route were found to be advantageous in terms of colostral protein content. Also, an association between being a refugee and lower protein content of colostrum was remarkable.
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Affiliation(s)
- Esra Beser Ozmen
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Esin Okman
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatma Nur Sari
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Merve Kucukoglu Keser
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Evrim Alyamac Dizdar
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Cuneyt Tayman
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serife Suna Oguz
- Neonatal Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Leghi GE, Netting MJ, Middleton PF, Wlodek ME, Geddes DT, Muhlhausler BS. The impact of maternal obesity on human milk macronutrient composition: A systematic review and meta-analysis. Nutrients 2020; 12:nu12040934. [PMID: 32230952 PMCID: PMC7231188 DOI: 10.3390/nu12040934] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
Maternal obesity has been associated with changes in the macronutrient concentration of human milk (HM), which have the potential to promote weight gain and increase the long-term risk of obesity in the infant. This article aimed to provide a synthesis of studies evaluating the effects of maternal overweight and obesity on the concentrations of macronutrients in HM. EMBASE, MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, and ProQuest databases were searched for relevant articles. Two authors conducted screening, data extraction, and quality assessment independently. A total of 31 studies (5078 lactating women) were included in the qualitative synthesis and nine studies (872 lactating women) in the quantitative synthesis. Overall, maternal body mass index (BMI) and adiposity measurements were associated with higher HM fat and lactose concentrations at different stages of lactation, whereas protein concentration in HM did not appear to differ between overweight and/or obese and normal weight women. However, given the considerable variability in the results between studies and low quality of many of the included studies, further research is needed to establish the impact of maternal overweight and obesity on HM composition. This is particularly relevant considering potential implications of higher HM fat concentration on both growth and fat deposition during the first few months of infancy and long-term risk of obesity.
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Affiliation(s)
- Gabriela E. Leghi
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA 5064, Australia;
| | - Merryn J. Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (M.J.N.); (P.F.M.)
- Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Philippa F. Middleton
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (M.J.N.); (P.F.M.)
| | - Mary E. Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, WA 6009, Australia;
| | - Beverly S. Muhlhausler
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA 5064, Australia;
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-8-8305-0697
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Rigourd V, Lopera I, Cata F, Benoit G, Jacquemet B, Lapillonne A. Role of Daily Milk Volume and Period of Lactation in Nutrient Content of Human Milk: Results from a Prospective Study. Nutrients 2020; 12:nu12020421. [PMID: 32041195 PMCID: PMC7071293 DOI: 10.3390/nu12020421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 01/31/2023] Open
Abstract
Most studies assessing the macronutrient content of human milk are published retrospectively using analyzers that fail to determine sodium content and do not take into account the role of volume in milk composition. We aimed to describe macronutrient content and sodium content in human milk over time, observe any associations between them, and determine the factors associated with the evolution of milk composition. A prospective, longitudinal, monocentric study was undertaken. Contents of protein, fat, and lactose of 102 milk samples from 40 mothers were determined using a human milk analyzer and that of sodium with a flame spectrophotometer. Milk volumes along with clinical data were recorded. Protein content in the fourth quartile of volume was significantly lower than that in the first three, suggesting the existence of a volume threshold for protein content at approximately 445 mL. After multivariate analysis, it was found that maternal age, average volume, and lactation period remained significantly associated with protein content, maternal age remained significantly associated with fat content, and only average volume with sodium content. In consideration of previous findings along with our data, we suggest that extra care should be taken with fortification for feeding preterm infants when the mother’s milk volume is greater than 400–450 mL.
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Affiliation(s)
- Virginie Rigourd
- Neonatal Department, Necker Enfants Malades Hospital, 75015 Paris, France; (V.R.); (I.L.)
- Milk Bank Ile de France, Necker Enfants Malades Hospital, 75015 Paris, France;
| | - Isabel Lopera
- Neonatal Department, Necker Enfants Malades Hospital, 75015 Paris, France; (V.R.); (I.L.)
| | - Florina Cata
- Neonatal Unit, Centre Hospitalier de Remiremont, 88200 Remiremont, France;
| | - Guy Benoit
- Pharmacology Trousseau Hospital, 75015 Paris, France;
| | - Benedicte Jacquemet
- Milk Bank Ile de France, Necker Enfants Malades Hospital, 75015 Paris, France;
| | - Alexandre Lapillonne
- Neonatal Department, Necker Enfants Malades Hospital, 75015 Paris, France; (V.R.); (I.L.)
- EHU 7328 PACT, Imagine Institute, Paris Descartes University, 75015 Paris, France
- Correspondence:
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Manta-Vogli PD, Schulpis KH, Dotsikas Y, Loukas YL. Nutrition and medical support during pregnancy and lactation in women with inborn errors of intermediary metabolism disorders (IEMDs). J Pediatr Endocrinol Metab 2020; 33:5-20. [PMID: 31804959 DOI: 10.1515/jpem-2019-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022]
Abstract
The establishment of expanded newborn screening (NBS) not only results in the early diagnosis and treatment of neonates with inborn errors of intermediary metabolism disorders (IEMDs) but also helps the affected females to reach the reproductive age under medical and dietetic support, as well as to give birth to normal infants. In this review, we aimed to focus on laboratory investigation tests, dietetic management and medical support for most known IEMD pregnant and lactating women, such as those suffering from aminoacidopathies, carbohydrate metabolic diseases and fatty acid (FAO) oxidation disorders.
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Affiliation(s)
- Penelope D Manta-Vogli
- Department of Clinical Nutrition and Dietetics, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Yannis Dotsikas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274696, Fax: +30 210 7274039
| | - Yannis L Loukas
- Laboratory of Pharm. Analysis, Department of Pharmacy, National and Kapodestrian University of Athens, Panepistimiopolis Zographou, GR-157 71, Athens, Greece, Phone: +30 210 7274224, Fax: +30 211 1826131
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Sahin S, Ozdemir T, Katipoglu N, Akcan AB, Kaynak Turkmen M. Comparison of Changes in Breast Milk Macronutrient Content During the First Month in Preterm and Term Infants. Breastfeed Med 2020; 15:56-62. [PMID: 31765240 DOI: 10.1089/bfm.2019.0141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose: This study aims to achieve a better understanding of the trend of maternal milk macronutrient levels by analyzing protein, lipid, carbohydrate, and energy content of the breast milk and investigate the possible confounders of macronutrient content during the first 4 weeks of lactation to meet the specific needs of babies, guide optimum fortification of maternal milk. Patients and Methods: Breast milk from 39 mothers who had delivered preterm infants and 21 mothers of term infants were collected longitudinally for the first 4 weeks of lactation. Fresh milk samples were obtained on day 3, 7, 14, and 28 of lactation. The samples are analyzed using mid-infrared milk analyzer (MIRIS Human Milk Analyzer, HMA; Miris AB, Uppsala, Sweden). Results: Colostral milk protein concentrations of mothers of both preterm and term infants were significantly higher and the protein content of the samples decreased in time, according to the week of lactation during the study period. In contrast, fat, carbohydrate, and energy content were lowest in the colostral milk in both groups. When preterm and term milks were compared, fat and carbohydrate levels on 28th day and energy levels on 14th and 28th days were significantly higher in term milks, whereas no difference in protein contents were observed between the two groups on each time period. Mode of delivery was found to have statistically significant correlation with protein content of the milk. Conclusion: This longitudinal study revealed significant changes in analyzed macronutrient contents of mother's milk over the first 4 week period.
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Affiliation(s)
- Suzan Sahin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Tuba Ozdemir
- Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Nagehan Katipoglu
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Abdullah Barıs Akcan
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Munevver Kaynak Turkmen
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Pérez-Escamilla R, Buccini GS, Segura-Pérez S, Piwoz E. Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months? Adv Nutr 2019; 10:931-943. [PMID: 31147672 PMCID: PMC6855974 DOI: 10.1093/advances/nmz039] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence indicating that exclusive breastfeeding for 6 mo compared with <6 mo increases the risk of developing food allergies. Mild to moderate maternal undernutrition may reduce amounts of some nutrients in breast milk but does not directly diminish milk volume. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. All newborns should have their growth, hydration status, and development carefully monitored. In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account.
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Affiliation(s)
| | | | | | - Ellen Piwoz
- Bill & Melinda Gates Foundation, Seattle, WA
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Tanriverdi S, Koroglu O, Uygur Ö, Yalaz M, Kultursay N. Evaluation of macronutrient content of fresh and frozen human milk over 6 months. J Matern Fetal Neonatal Med 2019; 34:1875-1882. [PMID: 31394940 DOI: 10.1080/14767058.2019.1651269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM In this study; we aimed to see the time-dependent changes in the macronutrient content of early frozen breast milk and also to compare it with fresh breast milk in the first 6 months. MATERIALS AND METHOD We evaluated the milk samples of 43 mothers who delivered at term. Milk samples after the first 15 days following delivery were expressed and collected dividing into seven aliquots to be stored frozen at -20 °C. Every month freshly collected new milk samples were analyzed together with one aliquot of the stored samples, up to 6 months. The energy, protein, lipid, and carbohydrate contents of samples were analyzed by Miris Human Milk Analyzer. RESULTS In the first 3 months, fresh milk had higher caloric and lipid content when compared to frozen samples. The protein content of fresh milk decreased after 2 months and became lower than frozen samples. The energy and lipid content of frozen milk decreased over time but protein and carbohydrate contents stayed stable. Carbohydrate content of fresh and frozen samples did not show major changes. CONCLUSION It may be more suitable to consume the frozen milk that was collected in the early weeks of delivery within first 2 months.
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Affiliation(s)
- Sema Tanriverdi
- Department of Pediatrics, Division of Neonatology, Manisa Celal Bayar University Medical School, Uncubozkoy, Yunusemre, Manisa, Turkey
| | - Ozge Koroglu
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Ege Üniversitesi, Izmir, Turkey
| | - Özgün Uygur
- Department of Pediatrics, Division of Neonatology, SBU Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Yalaz
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Ege Üniversitesi, Izmir, Turkey
| | - Nilgun Kultursay
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Ege Üniversitesi, Izmir, Turkey
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Macronutrient composition in human milk from mothers of preterm and term neonates is highly variable during the lactation period. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Impact of Maternal Diet on Human Milk Composition Among Lactating Women in Latvia. ACTA ACUST UNITED AC 2019; 55:medicina55050173. [PMID: 31137596 PMCID: PMC6572110 DOI: 10.3390/medicina55050173] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/24/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
Abstract
Background and objectives: Many studies indicate that the maternal diet is an important factor affecting human milk composition. Human milk composition among lactating women in Latvia, as well as the maternal diet during lactation, has not been sufficiently studied. The aim of this research was to assess dietary habits and macronutrient intake among lactating women in Latvia and to examine the effect of diet on human milk composition. Materials and Methods: Research was conducted between November 2016 and December 2017. Mature human milk samples (n = 61) along with a 72h food diary, a food frequency questionnaire (FFQ), and a questionnaire about maternal and infant characteristics were obtained from voluntary women who were recruited via an invitation published in a social media member group for nursing mothers. Fat content in human milk was determined by LVS ISO 2446:2008, protein content was determined by LVS EN ISO 8968-1:2014, lactose was determined by ISO 22662:2007, and the fatty acid profile was analyzed using gas chromatography. Dietary data were evaluated using the Finnish food composition database Fineli, release 19 (3 March 2018). Results: Median values for fat, protein, and lactose in mature human milk were 4.40%, 1.08%, and 6.52%, respectively. Predominant fatty acids in human milk were oleic acid (C18:1 n9c), palmitic acid (C16:0), and linoleic acid (C18:2 n6c) at 34.60%, 24.00%, and 11.00% of total fatty acids, respectively. The trans elaidic acid (C18:1 n9t) level was <0.10% in all human milk samples. Significant, positive associations (p < 0.05) were found between maternal dietary intake of linoleic, α-linolenic, docosahexaenoic, total cis-monounsaturated, total cis-polyunsaturated, and total n-6 and n-3 polyunsaturated fatty acids, the ratio of n-6/n-3, and the level of these fatty acids in human milk. Total energy and carbohydrate intake among participants were lower, but total fat, saturated fat, and sugar intake were higher than recommended. Protein, linoleic acid, and α-linolenic acid intake were adequate, but docosahexaenoic acid intake was noticeably lower than recommended. Women should be supported with information regarding their nutritional needs during lactation and the possible impact of diet on human milk composition. Conclusion: Macronutrient (fat, protein, and lactose) content in human milk is not affected by maternal diet. Conversely, the human milk fatty acid profile is affected by the immediate diet consumed by the mother. Habitual dietary habits can also impact the fatty acid profile of human milk.
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Corbitt M, Paredes Ruvalcaba N, Fujita M. Variation in breast milk macronutrient contents by maternal anemia and hemoglobin concentration in northern Kenya. Am J Hum Biol 2019; 31:e23238. [PMID: 30908793 DOI: 10.1002/ajhb.23238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/23/2019] [Accepted: 03/09/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study explored differing levels of macronutrients in breast milk in relation to maternal anemia and hemoglobin. METHODS Archived milk specimens and data from a cross-sectional sample of 208 breastfeeding mothers in northern Kenya, originally collected in 2006, were analyzed; data included milk fat, maternal hemoglobin concentration, and anemia status (anemia defined as hemoglobin <12 g/dL). Total protein and lactose were measured and energy was calculated. To explore the association between milk outcomes (fat, protein, lactose, and energy) and anemia, regression models were constructed with and without adjustment for maternal age, parity, and time (days) postpartum. The same models were constructed using hemoglobin as a continuous predictor in lieu of dichotomous anemia to explore the role of hemoglobin levels and anemia severity in predicting milk outcomes. RESULTS The group comparison indicated significantly higher milk protein and lower milk fat for anemic mothers relative to nonanemic counterparts. After adjustment for maternal age, parity, and time postpartum, maternal anemia was associated with significantly higher milk protein (P = 0.001) and significantly lower milk fat (P = 0.025). Hemoglobin had a significant inverse relationship with milk protein (P = 0.017) and a marginally significant positive relationship with milk fat (P = 0.060) after adjusting for the maternal variables. Neither anemia nor hemoglobin was significant in predicting lactose or milk energy. CONCLUSIONS Maternal anemia and hemoglobin concentration may be associated with complex changes in milk macronutrients. Future research should clarify the impact of maternal anemia on a range of breast milk components while accounting for other maternal characteristics.
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Affiliation(s)
- Mary Corbitt
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
| | - Masako Fujita
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
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Fujita M, Ruvalcaba NP, Wander K, Corbitt M, Brindle E. Buffered or impaired: Maternal anemia, inflammation and breast milk macronutrients in northern Kenya. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 168:329-339. [PMID: 30575959 PMCID: PMC6352968 DOI: 10.1002/ajpa.23752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/25/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Maternal anemia has adverse consequences for the mother-infant dyad. To evaluate whether and how milk nutrient content may change in ways that could "buffer" infants against the conditions underlying maternal anemia, this study assessed associations between milk macronutrients and maternal iron-deficiency anemia (IDA), non-iron-deficiency anemia (NIDA), and inflammation. METHODS A secondary analysis of cross-sectional data and milk from northern Kenya was conducted (n = 204). The combination of hemoglobin and transferrin receptor defined IDA/NIDA. Elevated serum C-reactive protein defined acute inflammation. The effects of IDA, NIDA, and inflammation on milk macronutrients were evaluated in regression models. RESULTS IDA (β = 0.077, p = .022) and NIDA (β = 0.083, p = .100) predicted higher total protein (ln). IDA (β = -0.293, p = .002), NIDA (β = -0.313, p = .047), and inflammation (β = -0.269, p = .007) each predicted lower fat (ln); however, anemia accompanying inflammation predicted higher fat (β = 0.655, p = .007 for IDA and β = 0.468, p = .092 for NIDA). NIDA predicted higher lactose (β = 1.020, p = .003). CONCLUSIONS Milk macronutrient content both increases and decreases in the presence of maternal anemia and inflammation, suggesting a more complicated and dynamic change than simple impairment of nutrient delivery during maternal stress. Maternal fat delivery to milk may be impaired under anemia. Mothers may buffer infant nutrition against adverse conditions or poor maternal health by elevating milk protein (mothers with IDA/NIDA), lactose (mothers with NIDA), or fat (mothers with anemia and inflammation). This study demonstrates the foundational importance of maternal micronutrient health and inflammation or infection for advancing the ecological understanding of human milk nutrient variation.
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Affiliation(s)
- Masako Fujita
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Katherine Wander
- Department of Anthropology, Binghamton University (SUNY)
- Laboratory for Anthropometry and Biomarkers, Binghamton University (SUNY)
| | - Mary Corbitt
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington
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Bzikowska-Jura A, Czerwonogrodzka-Senczyna A, Olędzka G, Szostak-Węgierek D, Weker H, Wesołowska A. Maternal Nutrition and Body Composition During Breastfeeding: Association with Human Milk Composition. Nutrients 2018; 10:E1379. [PMID: 30262786 PMCID: PMC6213543 DOI: 10.3390/nu10101379] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
The composition of human milk is dynamic and can vary according to many maternal factors, such as diet and nutritional status. This study investigated the association of maternal nutrition and body composition with human milk composition. All measurements and analyses were done at three time points: during the first (n = 40), third (n = 22), and sixth (n = 15) month of lactation. Human milk was analyzed using the Miris human milk analyzer (HMA), body composition was measured with bioelectrical bioimpedance (BIA) using a Maltron BioScan 920-II, and the assessment of women's nutrition was based on a three-day dietary record. The correlation coefficient (Pearson's r) did not show a significant statistical relationship between human milk composition and nutrients in women's diet at three time points. For women in the third month postpartum, we observed moderate to strong significant correlations (r ranged from 0.47 to 0.64) between total protein content in milk and the majority of body composition measures as follows: positive correlations: % fat mass (r = 0.60; p = 0.003), fat-free mass expressed in kg (r = 0.63; p = 0.001), and muscle mass (r = 0.47; p = 0.027); and negative correlation: % total body water (r = -0.60; p = 0.003). The variance in milk fat content was related to the body mass index (BMI), with a significant positive correlation in the first month postpartum (r = 0.33; p = 0.048). These findings suggest that it is not diet, but rather the maternal body composition that may be associated with the nutritional value of human milk.
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Affiliation(s)
- Agnieszka Bzikowska-Jura
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Aneta Czerwonogrodzka-Senczyna
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Gabriela Olędzka
- Department of Medical Biology, Faculty of Health Science, Medical University of Warsaw, Nowogrodzka Str. 73, 02-018 Warsaw, Poland.
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Halina Weker
- Department of Clinical Dietetics, Faculty of Health Science, Medical University of Warsaw, E Ciolka Str. 27, 01-445 Warsaw, Poland.
| | - Aleksandra Wesołowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Faculty of Health Science, Department of Neonatology, Medical University of Warsaw, Zwirki i Wigury Str. 63A, 02-091 Warsaw, Poland.
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Human Milk Casein and Whey Protein and Infant Body Composition over the First 12 Months of Lactation. Nutrients 2018; 10:nu10091332. [PMID: 30235880 PMCID: PMC6164442 DOI: 10.3390/nu10091332] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 12/30/2022] Open
Abstract
Human milk (HM) influences infant feeding patterns and body composition (BC). This small proof-of concept longitudinal study investigated relationships between infant/maternal BC and HM casein, whey and total protein during the first 12 months of lactation. BC of breastfeeding dyads (n = 20) was measured at 2 (n = 15), 5 (n = 20), 9 (n = 19), and/or 12 (n = 18) months postpartum with ultrasound skinfolds (infants) and bioimpedance spectroscopy (infants/mothers). Proteins concentrations and 24-h milk intake were measured and calculated daily intakes (CDI) determined. Higher maternal weight, body mass index, fat-free mass, fat-free mass index, and fat mass index were associated with higher concentration of whey protein (p ≤ 0.034, n = 20). There were no associations between infant BC and concentrations of all proteins, and CDI of whey and total protein. Higher CDI of casein were associated with lower infant fat-free mass (p = 0.003, n = 18) and higher fat mass (p < 0.001), fat mass index (p = 0.001, n = 18), and % fat mass (p < 0.001, n = 18) measured with ultrasound skinfolds. These results show a differential effect of HM casein on development of infant BC during the first year of life, suggesting that there is a potential to improve outcome for the infant through interventions, such as continuation of breastfeeding during the first 12 months of life and beyond, which may facilitate favourable developmental programming that could reduce risk of non-communicable diseases later in life.
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Osteopontin Levels in Human Milk Vary Across Countries and Within Lactation Period: Data From a Multicenter Study. J Pediatr Gastroenterol Nutr 2018; 67:250-256. [PMID: 29668569 DOI: 10.1097/mpg.0000000000002004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Osteopontin (OPN) is a multifunctional protein expressed in many cell types, tissues and body fluids with the highest concentrations found in milk; significantly higher in human than in bovine milk. Intervention studies have indicated beneficial effects of supplementing infant formula with bovine OPN. In this multicenter study, we determined the OPN content in human milk samples from 629 Chinese, Danish, Japanese and Korean mothers. METHODS At each study site, milk samples were collected and analyzed for OPN and protein concentration using ELISA and infrared spectroscopy, respectively. RESULTS A total of 829 milk samples from 629 women were included. When delivering the first sample, mean maternal age was 31.4 years (SD 4.0), and median infant age was 13.4 weeks (interquartile range 4.6-17.9). The median OPN concentration varied across sites; from 99.7 mg/L in Danish, 185.0 mg/L in Japanese, 216.2 mg/L in Korean to 266.2 mg/L in Chinese mothers (P < 0.001), corresponding to 1.3%, 2.4%, 1.8% and 2.7% of the total protein content (OPN/protein%) (P < 0.05), respectively. Based on 75 Chinese and 33 Japanese mothers delivering more than 1 sample, multilevel (mixed model) linear regression analysis showed a decrease in OPN concentration with infant age (β = (-11.3), 95% confidence interval (CI) = (-13.9) to (-8.8) and β = (-2.1), 95% CI = (-3.2) to (-0.9), respectively). CONCLUSIONS In this large multicenter study, we observed statistically significant differences in the OPN concentration and the OPN/protein% in human milk samples between countries. Based on mothers delivering more than 1 sample, a significant decrease within the lactation period was observed.
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Jans G, Devlieger R, De Preter V, Ameye L, Roelens K, Lannoo M, Van der Schueren B, Verhaeghe J, Matthys C. Bariatric Surgery Does Not Appear to Affect Women's Breast-Milk Composition. J Nutr 2018; 148:1096-1102. [PMID: 29901782 DOI: 10.1093/jn/nxy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 04/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background The breast-milk composition in the first 6 wk postpartum of women who have undergone bariatric surgery (BS) is unknown. Objective The aim of this study was to examine 1) the breast-milk macronutrient and vitamin A composition in women who had and who had not undergone BS and 2) the impact of maternal diet on the breast-milk composition. We hypothesized that the milk of women who had undergone BS would be less energy dense and have a lower vitamin A concentration than that of other women. Methods A multicenter prospective substudy was conducted at 2 university hospitals. Breast-milk samples were collected from 24 normal-weight [NW; mean ± SD body mass index (BMI; kg/m2): 21.5 ± 1.7; mean ± SD age: 29 ± 6 y], 39 overweight (OW; BMI: 26.9 ± 1.5; aged 29 ± 5 y), and 12 obese women (BMI: 35.0 ± 5.7; aged 29 ± 5 y) as well as from 11 women who had undergone BS (BMI: 28.0 ± 4.4; aged 30 ± 4 y) from day 3 until week 6 of lactation. Milk energy and macronutrients (Human Milk Analyzer; Miris) and vitamin A concentrations (iCheck Fluoro; BioAnalyt) were determined at the end of each week. Maternal diet (food-frequency questionnaire) and physical activity (Kaiser Physical Activity Survey) were measured during the third trimester of pregnancy and on day 3 or 4 and during week 6 of lactation. Statistical analyses include 1-factor ANOVA, Spearman and Pearson correlations, and multiple linear regression. Results In all women, a weekly increase in milk energy, total fat, and total carbohydrates was seen, whereas a weekly decrease in proteins and vitamin A was found during the first 2 wk of lactation, followed by a stable concentration of all nutrients. At week 4, milk protein concentrations were higher in women who had undergone BS (14 g/L) compared with NW (8 g/L; P = 0.005) and OW (9 g/L; P = 0.019) women. At week 5, milk carbohydrate concentrations were higher in women who had undergone BS (74 g/L) compared with NW women (68 g/L; P = 0.042). Conclusions Breast milk of women who have undergone BS appears to be adequate in energy, macronutrients, and vitamin A during the first 6 wk of lactation. This supports the conclusion that breast feeding should not be discouraged in this group of women. This trial was registered at http://www.clinicaltrials.gov as NCT02515214.
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Affiliation(s)
- Goele Jans
- Departments of Development and Regeneration, KU Leuven, Leuven, Belgium.,Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium
| | - Roland Devlieger
- Departments of Development and Regeneration, KU Leuven, Leuven, Belgium.,Departments of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Vicky De Preter
- Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium
| | - Lieveke Ameye
- Departments of Development and Regeneration, KU Leuven, Leuven, Belgium.,Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Matthias Lannoo
- Departments of Development and Regeneration and Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium.,Departments of Obstetrics and Gynecology Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Departments of Development and Regeneration and Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium.,Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Departments of Development and Regeneration, KU Leuven, Leuven, Belgium.,Departments of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Departments of Development and Regeneration and Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium.,Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Abstract
The aim of this study was to determine the fatty acid (FA) composition of breast milk, and its association with mothers' FA intake. Milk samples were obtained from 238 healthy lactating women who volunteered to participate in the Human Milk Micronutrients Analysis Research. Dietary intake during lactation was assessed using a 3-d food record, and fat content and FA composition of the breast milk samples were analysed by IR spectrometry using MilkoScan FT2 and GC flame ionisation detector, respectively. The fat content was 3·31 (sd 1·41) g/100 ml breast milk. The concentrations of arachidonic acid (20 : 4 n-6), EPA (20 : 5 n-3) and DHA (22 : 6 n-3) in breast milk were 0·48 (sd 0·13), 0·15 (sd 0·12) and 0·67 (sd 0·47) % of total FA, respectively. Fat content and FA composition of breast milk were associated with maternal age, BMI, supplement use and infant age. Dietary intakes of EPA, DHA, n-3 FA, n-6 FA, SFA and PUFA were positively correlated with the corresponding FA in the milk samples. FA levels in breast milk and maternal diet are highly correlated. Further studies are warranted to explore factors that may be associated with changes in FA composition in human milk.
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Abstract
Animal studies show that the lactation period contributes to metabolic programming of the offspring and that oral leptin and insulin show bioactivity. Stage of lactation, duration of gestation, maternal body composition, and maternal diet seem to influence the concentrations of small molecules in human milk. Variability of small molecule concentrations seems higher in preterm milk than in term milk. Insulin in human milk shows concentrations similar to plasma. Leptin concentration is lower in milk than in plasma and reflects maternal body mass index. Early in lactation, leptin could contribute to mediating the association between maternal and infant body composition.
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Affiliation(s)
- Hans Demmelmair
- Division of Metabolism and Nutritional Medicine, Dr. von Hauner Childrens Hospital, University of Munich Medical Center, Lindwurmstrasse 4, 80337 München, Germany.
| | - Berthold Koletzko
- Division of Metabolism and Nutritional Medicine, Dr. von Hauner Childrens Hospital, University of Munich Medical Center, Lindwurmstrasse 4, 80337 München, Germany
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Abstract
Human milk analyzers can measure macronutrient content in native breast milk to tailor adequate supplementation with fortifiers. This article reviews all studies using milk analyzers, including (i) evaluation of devices, (ii) the impact of different conditions on the macronutrient analysis of human milk, and (iii) clinical trials to improve growth. Results lack consistency, potentially due to systematic errors in the validation of the device, or pre-analytical sample preparation errors like homogenization. It is crucial to introduce good laboratory and clinical practice when using these devices; otherwise a non-validated clinical usage can severely affect growth outcomes of infants.
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Kim H, Jung BM, Lee BN, Kim YJ, Jung JA, Chang N. Retinol, α-tocopherol, and selected minerals in breast milk of lactating women with full-term infants in South Korea. Nutr Res Pract 2017; 11:64-69. [PMID: 28194267 PMCID: PMC5300949 DOI: 10.4162/nrp.2017.11.1.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study was performed to measure fat-soluble vitamins and minerals in breast milk of Korean lactating mothers who exclusively breastfed their babies. SUBJECTS/METHODS Breast milk samples were collected from 334 mothers. Concentrations of retinol and α-tocopherol were analyzed by high performance liquid chromatography ultraviolet spectrometry while concentrations of minerals were measured by inductively coupled plasma optical emission spectrometry. RESULTS Retinol and α-tocopherol contents of breast milk were 39.58 ± 19.64 µg/dL and 0.23 ± 0.13 mg/dL, respectively. Average sodium, potassium, calcium, phosphorus, and magnesium levels in breast milk were 11.11 ± 5.16, 38.56 ± 9.01, 27.87 ± 6.10, 13.56 ± 3.30, and 3.05 ± 0.65 mg/dL, respectively. Contents of trace elements such as iron, zinc, copper, and manganese were 40.26 ± 46.21, 98.40 ± 62.47, 24.09 ± 9.03, and 0.90 ± 1.63 µg/dL, respectively. Fat-soluble vitamin concentration was positively correlated with total fat in milk samples, but no significant differences were observed in levels of retinol, α-tocopherol, or minerals based on whether or not lactating women were taking dietary supplements. CONCLUSIONS Micronutrient contents of breast milk samples from Korean lactating women were comparable to those of other nations. Retinol and α-tocopherol levels were correlated and also with total fat in breast milk.
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Affiliation(s)
- Hyesook Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Byung-Mun Jung
- Maeil Asia Human Milk Research Center, Maeil Dairies Co., Ltd, 50, Jongno-1-gil, Jongno-Gu, Seoul 03142, Korea
| | - Bum-Noh Lee
- Maeil Asia Human Milk Research Center, Maeil Dairies Co., Ltd, 50, Jongno-1-gil, Jongno-Gu, Seoul 03142, Korea
| | - Yun-Je Kim
- Maeil Asia Human Milk Research Center, Maeil Dairies Co., Ltd, 50, Jongno-1-gil, Jongno-Gu, Seoul 03142, Korea
| | - Ji A Jung
- Maeil Asia Human Milk Research Center, Maeil Dairies Co., Ltd, 50, Jongno-1-gil, Jongno-Gu, Seoul 03142, Korea
| | - Namsoo Chang
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
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50
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Hahn WH, Song JH, Song S, Kang NM. Do gender and birth height of infant affect calorie of human milk? An association study between human milk macronutrient and various birth factors. J Matern Fetal Neonatal Med 2016; 30:1608-1612. [PMID: 27482600 DOI: 10.1080/14767058.2016.1219989] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to analyze the macronutrient of human milk (HM) and to find out the various maternal-infantile factors that can affect HM composition. METHODS 478 HM samples were collected from healthy and exclusively breast-feeding mothers who delivered healthy term neonates within 3 months. Macronutrient of the samples was analyzed and the birth data were collected. RESULTS In multivariate logistic regression analysis, various maternal-infantile factors were found to be associated with HM composition changes; higher fat: cesarean section (OR = 2.47, p < 0.001) and birth height (OR = 0.84, p = 0.004); higher protein: postpartum age (OR = 0.89, p < 0.001); higher carbohydrate: vaginal delivery (OR = 0.50, p = 0.005) and female infant (OR = 0.56, p = 0.012); higher calorie: postpartum age (OR = 0.95, p = 0.003), female infant (OR = 0.33, p = 0.017), and birth height (OR = 0.74, p < 0.001). Female infant (OR = 0.36, p = 0.029), birth height (OR = 0.73, p = 0.001), and postpartum age (OR = 0.95, p = 0.005) were found as independent risk factors for higher HM calorie. CONCLUSION Various maternal-infantile factors were found to affect HM composition. Interestingly, delivery mode, gender of infant, and birth height were associated with changes in HM macronutrient as well as postpartum age.
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Affiliation(s)
- Won-Ho Hahn
- a Department of Pediatrics , School of Medicine, Soon Chun Hyang University, Seoul Hospital , Seoul , Republic of Korea
| | - Joon-Hwan Song
- b Department of Pediatrics , School of Medicine, Soon Chun Hyang University, Cheonan Hospital , Cheonan , Republic of Korea
| | - Seunghyun Song
- c Faculty of Art and Philosophy and Faculty of Political and Social Sciences , Ghent University , Belgium , and
| | - Nam Mi Kang
- d Department of Nursing, Konkuk University , Chungju , Republic of Korea
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