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Siziba LP, Baier C, Pütz E, Ascherl R, Wendt T, Thome UH, Gebauer C, Genuneit J. A descriptive analysis of human milk dispensed by the Leipzig Donor Human Milk Bank for neonates between 2012 and 2019. Front Nutr 2023; 10:1233109. [PMID: 38035356 PMCID: PMC10684730 DOI: 10.3389/fnut.2023.1233109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Human milk banking has become an important aspect of Nutritional medicine. It is not just about the provision of mother's own milk (MOM) or donor human milk (DHM) in the hospital, but also a strategy to encourage breastfeeding in the clinical setting and beyond. Objective To describe the feeding patterns of hospitalised infants including human milk dispensed by the Leipzig Donor Human Milk Bank (LMB). Design A descriptive analysis of daily data on milk feeds dispensed by LMB for hospitalised infants distinguishing between MOM or DHM, either fresh or frozen, and raw/pasteurised milk from 2012-2019. Results We included 2,562 infants with median hospitalisation of 23 days, for whom human milk was dispensed on median 76% of those days and other nutrition on the remaining days. Raw MOM and raw DHM comprised 52% and 8% of the dispensed milk, respectively. Dispensing exclusive DHM instead of MOM for at least one full day was required for 55% of the infants, mostly at the beginning but also later during hospitalisation. Exclusive raw DHM was dispensed on at least 1 day for 37% of the infants, in different birthweight strata <1,000 g: 10%, 1,000-1500 g: 11%, 1,500-2500 g: 13% and > 2,500 g: 3%. At discharge, MOM was dispensed for more than 60% of the infants. Conclusion During an infant's hospital stay, LMB dispenses various human milk feeds with interspersed DHM resulting in complex intra-individual and time-variant feeding patterns. LMB dispenses raw MOM and especially raw DHM with the intention to retain the properties of human milk unlike a diet containing pasteurised DHM and/or formula. Although raw DHM comprises a small percentage of all dispensed milk, raw DHM is dispensed for a substantial portion of infants. Our results document that dispensing raw DHM, is possible in routine settings.
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Affiliation(s)
- Linda P. Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Caroline Baier
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Pütz
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Rudolf Ascherl
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Thomas Wendt
- Data Integration Centre, University of Leipzig Medical Centre, Leipzig, Germany
| | - Ulrich H. Thome
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Corinna Gebauer
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
- German Center for Child and Youth Health (DZKJ), Leipzig, Germany
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Ordnung M, Mank M, Stahl B, Kurz D, Marosvölgyi T, Decsi T, Rothenbacher D, Genuneit J, Siziba LP. Potential sex differences in human milk fatty acids and their association with atopic dermatitis: Results of the Ulm SPATZ health study. Pediatr Allergy Immunol 2023; 34:e13992. [PMID: 37492919 DOI: 10.1111/pai.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Polyunsaturated fatty acids (PUFAs) in human milk are essential in immune system maturation and might play a role in the development of allergic conditions, such as atopic dermatitis (AD) in infants. Immune system responses are modulated by sex, but data on the sex-specific associations with PUFAs are limited. We therefore explored sex-specific differences in human milk PUFAs and their association with AD up to 2 years. METHODS PUFAs were measured in human milk samples from the Ulm SPATZ Health Study at 6 weeks (n = 512) and 6 months (n = 367). Associations with AD up to 2 years were evaluated using crude and multivariable logistic regression. Interactions between infant sex and PUFAs were explored by including the product term. RESULTS No significant associations were observed with 6-week data. At 6 months, the median relative proportion of docosahexaenoic acid (DHA) was significantly higher in milk for female than male infants (p = .001). Female infants whose milk was lower in quintile proportions of alpha-linolenic acid (ALA) at 6 months had lower odds of AD compared to males [first vs. fifth quintile OR (95% confidence interval): 0.13 (0.02, 0.66), p = .02]. This interaction was not significant when correcting for multiple testing (α threshold: p = .004). No other statistically significant associations were observed. CONCLUSION Individual quintile PUFA proportions in human milk were not associated with AD, overall and in a sex-specific manner. More comprehensive and statistically powered longitudinal studies are needed to determine whether potential sex differences in human milk, if any, could be of clinical relevance for infants including the investigation of mediating factors.
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Affiliation(s)
- Madeleine Ordnung
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Marko Mank
- Danone Nutricia Research, Utrecht, The Netherlands
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Deborah Kurz
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Tamas Marosvölgyi
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Tamas Decsi
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- German Center for Child and Youth Health (DZKJ), Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
- German Center for Child and Youth Health (DZKJ), Germany
| | - Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
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3
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Cheung KY, Petrou L, Helfer B, Porubayeva E, Dolgikh E, Ali S, Ali I, Archibald-Durham L, Brockway MM, Bugaeva P, Chooniedass R, Comberiati P, Cortés-Macías E, D'Elios S, Feketea G, Hsu P, Kana MA, Kriulina T, Kunii Y, Madaki C, Omer R, Peroni D, Prokofiev J, Simpson MR, Shimojo N, Siziba LP, Genuneit J, Thakor S, Waris M, Yuan Q, Zaman S, Young BE, Bugos B, Greenhawt M, Levin ME, Zheng J, Boyle RJ, Munblit D. Health and nutrition claims for infant formula: international cross sectional survey. BMJ 2023; 380:e071075. [PMID: 36792145 PMCID: PMC9930154 DOI: 10.1136/bmj-2022-071075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims. DESIGN International cross sectional survey. SETTING Public facing and healthcare professional facing company owned or company managed formula industry websites providing information about products marketed for healthy infants delivered at full term in 15 countries: Australia, Canada, Germany, India, Italy, Japan, Nigeria, Norway, Pakistan, Russia, Saudi Arabia, South Africa, Spain, the United Kingdom, and the United States in 2020-22. MAIN OUTCOME MEASURES Number and type of claims made for each product and ingredient. References cited were reviewed and risk of bias was assessed for registered clinical trials using the Cochrane risk of bias tool, and for systematic reviews using the Risk Of Bias in Systematic reviews tool. RESULTS 757 infant formula products were identified, each with a median of two claims (range from 1 (Australia) to 4 (US)), and 31 types of claims across all products. Of 608 products with ≥1 claims, the most common claim types were "helps/supports development of brain and/or eyes and/or nervous system" (323 (53%) products, 13 ingredients), "strengthens/supports a healthy immune system" (239 (39%) products, 12 ingredients), and "helps/supports growth and development" (224 (37%) products, 20 ingredients). 41 groups of ingredients were associated with ≥1claims, but many claims were made without reference to a specific ingredient (307 (50%) products). The most common groups of ingredients cited in claims were long chain polyunsaturated fatty acids (278 (46%) products, 9 different claims); prebiotics, probiotics, or synbiotics (225 (37%) products, 19 claims); and hydrolysed protein (120 (20%) products, 9 claims). 161/608 (26%) products with ≥1 claims provided a scientific reference to support the claim-266 unique references were cited for 24 different claim types for 161 products. The reference types most frequently cited were clinical trials (50%, 134/266) and reviews (20%, 52/266). 28% (38/134) of referenced clinical trials were registered, 14% (19/134) prospectively. 58 claims referred to 32 registered clinical trials, of which 51 claims (27 trials) related to a randomised comparison. 46 of 51 claims (90%) referenced registered clinical trial outcomes at high risk of bias, and all cited systematic reviews and pooled analyses, carried a high risk of bias. CONCLUSIONS Most infant formula products had at least one health and nutrition claim. Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence.
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Affiliation(s)
- Ka Yan Cheung
- Faculty of Medicine, Imperial College London, London, UK
| | - Loukia Petrou
- Faculty of Medicine, Imperial College London, London, UK
| | - Bartosz Helfer
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
- Meta Research Centre, University of Wroclaw, Wroclaw, Poland
| | - Erika Porubayeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Elena Dolgikh
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Sana Ali
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Insaf Ali
- College of Medicine, King Faisal University, Kingdom Saudi Arabia
| | - Lindsay Archibald-Durham
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Polina Bugaeva
- Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Rishma Chooniedass
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Winnipeg, BC, Canada
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Erika Cortés-Macías
- Institute of Agrochemistry and Food Technology (IATA-CSIC), National Research Council, 46980 Valencia, Spain
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Gavriela Feketea
- Department of Pediatrics, Pediatric Allergy Outpatient Clinic, "Karamandaneio," Children Hospital, Patras, Greece
- Department of Pharmacology, "luliu Hatieganu" University of Medicine and Pharmacy, 400337, Cluj-Napoca, Romania
| | - Peter Hsu
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Musa Abubakar Kana
- Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
| | - Tatiana Kriulina
- Department of Paediatrics and Paediatric Rheumatology, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yuzuka Kunii
- Centre for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Comfort Madaki
- Kaduna Infant Development (KID) Birth Cohort Study Project, Kaduna, Nigeria
| | - Rihab Omer
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | | - Melanie Rae Simpson
- Department of Public Health and General Practice, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim, Norway
| | - Naoki Shimojo
- Centre for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sohini Thakor
- Faculty of Medicine, Imperial College London, London, UK
| | - Marium Waris
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Quan Yuan
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sadia Zaman
- Faculty of Medicine, Imperial College London, London, UK
| | - Bridget E Young
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brighid Bugos
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Jonathan Zheng
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
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4
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Siziba LP, Huhn S, Pütz E, Baier C, Peter RS, Gebauer C, Griffin S, Wedekind S, Shenker N, Genuneit J. Diversity and trends of human milk banking: a scoping review from 1946 to 2021. Arch Dis Child Fetal Neonatal Ed 2022; 108:210-216. [PMID: 36207059 DOI: 10.1136/archdischild-2022-324499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The provision of donor human milk (DHM) through human milk banks is now widely practised globally. The study aimed to describe the current state, identify major topics and map out the emerging trends in human milk banking. METHODS PubMed was systematically searched for publications related to DHM, with the last update on 14 May 2021, for papers published between 1946 and 2021. Titles and abstracts were screened and indexed into 8 main and 39 subcategories. A top-up search was done in April 2022, but these results have not been incorporated. RESULTS A total of 1083 publications were identified, and more than a third (41%) were either observational or interventional studies. Predominant topics were milk type and milk composition. Almost half (49%) of the publications in the last decade were funded through government/research councils, and industry funding started shortly after links between formula and necrotising enterocolitis were published. Literature from high-income countries was six times more than publications from low-income or middle-income countries (LMICs). CONCLUSION The diversity and trends of publications included in this scoping review ranged from descriptive studies comparing biological and compositional differences of mother's own milk, DHM and/or formula. Very few studies have investigated associations of different milk types with infant outcomes. Evidence on breastfeeding and recipient psychological health outcomes is limited. Further research should identify the appropriateness of different funding sources. Future collaborations between academics, clinicians and milk banks in LMICs should be fostered to bridge the gap that exists between DHM and access.
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Affiliation(s)
- Linda P Siziba
- Medical Faculty, Department of Pediatrics, Pediatric Epidemiology, Leipzig University, Leipzig, Germany
| | - Sebastian Huhn
- Medical Faculty, Department of Pediatrics, Pediatric Epidemiology, Leipzig University, Leipzig, Germany
| | - Elisabeth Pütz
- Medical Faculty, Department of Pediatrics, Pediatric Epidemiology, Leipzig University, Leipzig, Germany
| | - Caroline Baier
- Medical Faculty, Department of Pediatrics, Pediatric Epidemiology, Leipzig University, Leipzig, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Corinna Gebauer
- Department of Pediatrics, Division of Neonatology, University of Leipzig Medical Centre, Leipzig, Germany
| | - Samantha Griffin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sophie Wedekind
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalie Shenker
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jon Genuneit
- Medical Faculty, Department of Pediatrics, Pediatric Epidemiology, Leipzig University, Leipzig, Germany.,German Center for Child and Youth Health (DZKJ), Leipzig, Germany
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5
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Zhang K, Siziba LP, Suo NJ, Rothenbacher D, Genuneit J. Breastfeeding duration is positively associated with decreased smoking relapse in the postpartum period. Midwifery 2022; 108:103289. [DOI: 10.1016/j.midw.2022.103289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
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Siziba LP, Mank M, Stahl B, Kurz D, Gonsalves J, Blijenberg B, Rothenbacher D, Genuneit J. Human milk oligosaccharide profiles and child atopic dermatitis up to 2 years of age: The Ulm SPATZ Health Study. Pediatr Allergy Immunol 2022; 33:e13740. [PMID: 35212042 DOI: 10.1111/pai.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human milk oligosaccharides (HMOs) have several biological functions. Yet, very few studies have investigated the effect of HMOs on the development of allergies and even fewer on their specific associations with atopic dermatitis (AD) during early childhood. OBJECTIVE This study investigated whether individual HMO concentrations, measured at two time points of lactation, were associated with reported diagnosis of AD in children up to two years of age. METHOD Outcome data were available for HMOs measured in human milk samples collected at 6 weeks (n = 534) and 6 months (n = 356) of lactation. Associations of HMOs with AD, ascertained from parents and pediatricians at ages one and two years, were assessed in crude and adjusted logistic regression models. RESULTS Few associations were statistically significant at the conventional level (p < .05), for example, 6-week Lacto-N-neotetraose with 2-year AD [OR 95%CI: 0.82 (0.66, 1.00)] and 6-month 3'-sialyllactose among non-secretor mothers with 1-year AD [2.59 (1.53, 6.81)]. Importantly, accounting for multiple testing, these and all further associations were not statistically significant (all p > .0031, which is the threshold for statistical significance after correction for multiple testing). CONCLUSION Our findings suggest that the intake of different levels (or even absence) of the individual HMOs measured at 6 weeks and 6 months of lactation, in the current study, is not significantly associated with the development of AD in early childhood. Given the exploratory nature of our study and the limited sample size, these results should be interpreted with caution. The specific HMOs for which we show plausible associations at conventional level may warrant further research and investigation.
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Affiliation(s)
- Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Marko Mank
- Danone Nutricia Research, Utrecht, The Netherlands
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, The Netherlands.,Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Deborah Kurz
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | | | | | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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7
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Röhrl DV, Brandstetter S, Siziba LP, Rothenbacher D, Gaertner VD, Harner S, Köninger A, Apfelbacher C, Melter M, Genuneit J, Kabesch M. Food allergy in infants assessed in two German birth cohorts 10 years after the EuroPrevall Study. Pediatr Allergy Immunol 2022; 33:e13689. [PMID: 34716935 DOI: 10.1111/pai.13689] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of food allergies (FA) in children increased rapidly at the turn of the century. The EuroPrevall study identified Germany as a country with very high prevalence of FA at that time. Using two large German birth cohorts, we provide an update of the status quo 10 years later. METHODS KUNO Kids and Ulm SPATZ Health studies are two ongoing prospective birth cohorts. Information on FA was obtained by questionnaires at birth and after 6, 12, and 24 months. Univariable and multivariable logistic regression analyses were performed to investigate risk factors during pregnancy, birth, and early childhood. RESULTS In 1139 and 1006 children from KUNO Kids and SPATZ, the point prevalence of parent-reported FA symptoms at the ages of 1 and 2 years was 13.2% (95% CI: 11.2-15.2) and 13.9% (95% CI: 11.5-17.2) in KUNO Kids. Doctor's diagnosed FA at 1 and 2 years was 2.4% (95% CI: 1.6-3.4) and 2.7% (95% CI: 1.2-4.3) in KUNO Kids and 2.3% (95% CI: 1.3-3.6) and 3% (95% CI: 2.0-4.5) in SPATZ. Cow's milk and citrus fruits were most frequently suspected by parents to cause FA symptoms. Atopy in the child was associated with a higher frequency of FA at any time, whereas atopy in first-degree relatives was only associated with FA at year 1. Smoke exposure during pregnancy was a risk for FA at age 2. CONCLUSION The prevalence of food allergy seems to have plateaued in the last 10 years in Germany. FA is often suspected by parents but only rarely diagnosed by oral food challenge. Risk factor analysis may help to establish personalized health approaches.
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Affiliation(s)
- Daniela V Röhrl
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
| | - Susanne Brandstetter
- Science and Innovation Campus Regensburg (WECARE) of the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany.,University Children's Hospital Regensburg (KUNO) of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
| | - Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Vincent D Gaertner
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
| | - Susanne Harner
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
| | - Angela Köninger
- Science and Innovation Campus Regensburg (WECARE) of the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany.,Department of Obstetrics and Gynecology of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
| | - Christian Apfelbacher
- Science and Innovation Campus Regensburg (WECARE) of the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Magdeburg, Germany
| | - Michael Melter
- Science and Innovation Campus Regensburg (WECARE) of the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany.,University Children's Hospital Regensburg (KUNO) of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), of the University of Regensburg and the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany.,Science and Innovation Campus Regensburg (WECARE) of the Order of St. John at the St. Hedwig Hospital, Regensburg, Germany
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8
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Siziba LP, Mank M, Stahl B, Kurz D, Gonsalves J, Blijenberg B, Rothenbacher D, Genuneit J. Associations of Human Milk Oligosaccharides With Otitis Media and Lower and Upper Respiratory Tract Infections up to 2 Years: The Ulm SPATZ Health Study. Front Nutr 2021; 8:761129. [PMID: 34760912 PMCID: PMC8572796 DOI: 10.3389/fnut.2021.761129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Human milk oligosaccharides (HMOs) support and concurrently shape the neonatal immune system through various mechanisms. Thereby, they may contribute to lower incidence of infections in infants. However, there is limited evidence on the role of individual HMOs in the risk of otitis media (OM), as well as lower and upper respiratory tract infections (LRTI and URTI, respectively) in children up to 2 years. Objective: To investigate whether individual HMO concentrations measured at 6 weeks of lactation were associated with risk of OM, LRTI or URTI up to 2 years in breastfed infants. Associations with OM, LRTI and URTI were determined for the most prominent human milk oligosaccharides including 13 neutral, partly isomeric structures (trioses up to hexaoses), two acidic trioses, and lactose. Design: HMO measurements and physician reported data on infections were available from human milk samples collected at 6 weeks postpartum (n = 667). Associations of HMOs with infections were assessed in crude and adjusted models using modified Poisson regression. Results: Absolute concentrations (median [min, max], in g/L) of 2′-fucosyllactose (2′-FL) tended (p = 0.04) to be lower, while lacto-N-tetraose (LNT) was higher in the milk for infants with OM in the 1st year of life (p = 0.0046). In the milk of secretor mothers, LNT was significantly higher in the milk for infants with OM (RR [95% CI]: 0.98 [0.15, 2.60]) compared to infants without OM (RR [95% CI]: 0.76 [0.14, 2.90]) at 1 year (p = 0.0019). No statistically significant milk group differences and associations were observed for OM, LRTI, and URTI (p > 0.0031). Conclusion: Our findings suggest that neither prominent neutral individual HMOs (ranging from 2′-FL to LNDFHs) nor acidic human milk sialyllactoses or lactose are significantly associated with a reduced or increased risk of infections in infants up to 2 years of age. Further research is needed to determine whether specific HMOs could potentially reduce the incidence or alleviate the course of distinct infections in early life.
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Affiliation(s)
- Linda P Siziba
- Department of Pediatrics, Pediatric Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Marko Mank
- Danone Nutricia Research, Utrecht, Netherlands
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, Netherlands.,Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Deborah Kurz
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | | | | | - Jon Genuneit
- Department of Pediatrics, Pediatric Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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9
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Siziba LP, Brenner H, Amitay EL, Koenig W, Rothenbacher D, Genuneit J. Potential sex differences in human milk leptin and their association with asthma and wheeze phenotypes: Results of the Ulm Birth Cohorts. Pediatr Allergy Immunol 2021; 32:1663-1672. [PMID: 34173262 DOI: 10.1111/pai.13586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND The hormone leptin has been suggested to play a role in the respiratory and immune systems. Evidence on sex-specific concentrations of leptin in human milk and sex-specific associations with the development of asthma and wheeze has been put forward but is still scarce. OBJECTIVE To investigate whether male and female infants receive different levels of leptin through human milk and whether leptin is implicated in the development of asthma and wheeze in a sex-dependent manner using data from the two Ulm Birth Cohort studies. METHODS Leptin data were available from human milk samples collected at 6 weeks (Ulm Birth Cohort Study [UBCS, n = 678; Ulm SPATZ Health Study, n = 587]), and, in SPATZ only, at 6 months (n = 377) and 12 months (n = 66) of lactation. Sex-specific associations with doctor-diagnosed asthma and wheeze phenotypes were assessed in crude and adjusted models using logistic regression. Adjustments were made for maternal allergy, exclusive breastfeeding, infant age at the time of milk sampling, and child BMI z-score. RESULTS At 6 weeks, leptin levels (median [min, max], in ng/L) were higher in the milk for girls (197 [0.100, 4120]) than in milk for boys (159 [1.02, 3280], p = .045) in UBCS. No significant sex differences were observed in SPATZ (p = .152). There were no significant associations of leptin with asthma or wheeze in both studies, even in a sex-dependent manner (p > .05). CONCLUSION It remains unclear whether male and female infants receive different levels of leptin through human milk. However, leptin in human milk may not be associated with history and development of asthma and wheeze in a sex-specific manner.
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Affiliation(s)
- Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Efrat L Amitay
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Siziba LP, Mank M, Stahl B, Gonsalves J, Blijenberg B, Rothenbacher D, Genuneit J. Human Milk Oligosaccharide Profiles over 12 Months of Lactation: The Ulm SPATZ Health Study. Nutrients 2021; 13:nu13061973. [PMID: 34201331 PMCID: PMC8228739 DOI: 10.3390/nu13061973] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
Human milk oligosaccharides (HMOs) have specific dose-dependent effects on child health outcomes. The HMO profile differs across mothers and is largely dependent on gene expression of specific transferase enzymes in the lactocytes. This study investigated the trajectories of absolute HMO concentrations at three time points during lactation, using a more accurate, robust, and extensively validated method for HMO quantification. We analyzed human milk sampled at 6 weeks (n = 682), 6 months (n = 448), and 12 months (n = 73) of lactation in a birth cohort study conducted in south Germany, using label-free targeted liquid chromatography mass spectrometry (LC-MS2). We assessed trajectories of HMO concentrations over time and used linear mixed models to explore the effect of secretor status and milk group on these trajectories. Generalized linear model-based analysis was used to examine associations between HMOs measured at 6 weeks of lactation and maternal characteristics. Results: Overall, 74%, 18%, 7%, and 1% of human milk samples were attributed to milk groups I, II, III, and IV, respectively. Most HMO concentrations declined over lactation, but some increased. Cross-sectionally, HMOs presented high variations within milk groups and secretor groups. The trajectories of HMO concentrations during lactation were largely attributed to the milk group and secretor status. None of the other maternal characteristics were associated with the HMO concentrations. The observed changes in the HMO concentrations at different time points during lactation and variations of HMOs between milk groups warrant further investigation of their potential impact on child health outcomes. These results will aid in the evaluation and determination of adequate nutrient intakes, as well as further (or future) investigation of the dose-dependent impact of these biological components on infant and child health outcomes.
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Affiliation(s)
- Linda P. Siziba
- Pediatric Epidemiology, Department of Paediatrics, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Correspondence: ; Tel.: +49-34-1972-4181
| | - Marko Mank
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (B.S.); (J.G.); (B.B.)
| | - Bernd Stahl
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (B.S.); (J.G.); (B.B.)
- Department of Chemical Biology & Drug Discovery, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - John Gonsalves
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (B.S.); (J.G.); (B.B.)
| | - Bernadet Blijenberg
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.M.); (B.S.); (J.G.); (B.B.)
| | | | - Jon Genuneit
- Pediatric Epidemiology, Department of Paediatrics, Medical Faculty, Leipzig University, 04103 Leipzig, Germany;
- Institute of Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany;
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12
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Pretorius CE, Asare H, Kruger HS, Genuneit J, Siziba LP, Ricci C. Exclusive Breastfeeding, Child Mortality, and Economic Cost in Sub-Saharan Africa. Pediatrics 2021; 147:peds.2020-030643. [PMID: 33622796 DOI: 10.1542/peds.2020-030643] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa remains the region with the highest under-5 mortality (U5M) rates globally. Emerging evidence revealed that exclusive breastfeeding (EBF) rates are significantly associated with a decreased risk for child mortality. Our aim with this study is to fill the gap of knowledge regarding the economic impact of EBF practices in relation to U5M in sub-Saharan African countries. METHODS Data were gathered from the World Bank's database during the period 2000-2018. A meta-analytical approach was used to evaluate heterogeneity of country estimates and to perform an estimate of the prevalence of EBF and economic cost by country. The association between estimates of U5M and EBF prevalence was estimated and used to perform the total cumulative nonhealth gross domestic product loss (TCNHGDPL) attributable to U5M in 2018 and 2030. RESULTS The prevalence of EBF increased by 1%, and U5M reduced significantly by 3.4 per 1000 children each year during 2000-2018. A U5M reduction of 5.6 per 1000 children could be expected if EBF prevalence improved by 10%. The TCNHGDPL in sub-Saharan Africa had a total value higher than $29 billion in 2018. The cost of U5M is estimated to increase to ∼$42 billion in 2030. CONCLUSIONS If EBF prevalence improve by 10%, the related TCNHGDPL was estimated to be $27 billion in 2018 and $41 billion in 2030, therefore saving ∼$1 billion. Sub-Saharan Africa should imperatively prioritize and invest in essential approaches toward EBF implementation.
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Affiliation(s)
- Cianté E Pretorius
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; and
| | - Hannah Asare
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; and
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; and
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Leipzig University, Leipzig, Germany
| | - Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Leipzig University, Leipzig, Germany
| | - Cristian Ricci
- Pediatric Epidemiology, Department of Pediatrics, Leipzig University, Leipzig, Germany
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13
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Siziba LP, Chimhashu T, Siro SS, Ngounda JO, Jacobs A, Malan L, Smuts CM, Baumgartner J. Breast milk and erythrocyte fatty acid composition of lactating women residing in a peri‑urban South African township. Prostaglandins Leukot Essent Fatty Acids 2020; 156:102027. [PMID: 31740198 DOI: 10.1016/j.plefa.2019.102027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Data on breast milk fatty acid (FA) composition in South African lactating women in relation to their FA status, as well as on potential compositional changes within feed, are limited. The aim of this study was to assess the FA composition of breast milk sampled at three time points within feed, and to determine associations with red blood cell (RBC) total phospholipid FA levels in lactating South African mothers of 2-4-month-old breastfed infants. FA composition (% total FAs) was analyzed in RBC total phospholipids, and in fore-, mid-feed and hind-milk samples of lactating mothers (n = 100) of Black African descent living in a peri‑urban township. The mean age of the lactating women was 27.8 ± 6.8 years. Geometric mean (95% CI) breast milk SFA, MUFA and PUFA contents were 37.7 (37.3,38.1), 28.5 (27.9, 28.8), and 23.5 (23.2, 24.5)%, respectively. Breast milk DHA and AA contents were 0.25 (0.24, 3.71) and 0.81 (0.79, 0.83)%, respectively, in fore-, mid- and hind-milk combined. Maternal RBC EPA, DHA and AA levels were 0.37 (0.34, 0.40), 3.8 (3.6, 4.0) and 15.4 (14.8, 16.1)%, respectively. Women who reported to consume fish often (n = 3) had significantly higher RBC EPA levels than women who consumed fish sometimes (n = 56), never (n = 14) or rarely (n = 19). Breast milk DHA positively correlated with maternal RBC DHA, while no correlations were found between breast milk AA and maternal RBC AA. Breast milk ALA and DHA contents were significantly higher in mid-feed [ALA= 0.8 (0.2, 0.2), DHA=0.3 (0.2, 0.3)] and hind-milk [ALA=0.8 (0.8, 0.9), DHA=0.3 (0.3, 0.3)] than foremilk [ALA=0.8 (0.7, 0.9), DHA=0.2 (0.2, 0.3)]. In contrast, LA and AA contents remained constant within feed. In this sample of peri‑urban South African lactating mothers, breast milk was low in DHA and high in AA compared to global means. Breast milk DHA was associated with maternal RBC status, while breast milk AA was not. We further showed that breast milk ALA and DHA increased, while LA and AA remained unchanged within feed. This suggests that n-3 PUFA maybe preferentially transferred to breast milk within feed through biomagnification.
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Affiliation(s)
- Linda P Siziba
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa.
| | - Tsitsi Chimhashu
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa; Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, Netherlands
| | - Sicelosethu S Siro
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Jennifer Osei Ngounda
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Adriaan Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa; Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland
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14
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Siziba LP, Lorenz L, Stahl B, Mank M, Marosvölgyi T, Decsi T, Rothenbacher D, Genuneit J. Changes in Human Milk Fatty Acid Composition During Lactation: The Ulm SPATZ Health Study. Nutrients 2019; 11:nu11122842. [PMID: 31756908 PMCID: PMC6949892 DOI: 10.3390/nu11122842] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/21/2022] Open
Abstract
The lipid fraction of human milk provides the infant with the fatty acids that are necessary for optimal growth and development. The aim of this study was to investigate the fatty acid composition of human milk at three time points during lactation and its change over time using appropriate statistical methods. Human milk samples from breastfeeding mothers at 6 weeks (n = 706), 6 months (n = 483), and 12 months (n = 81 with all three time points) were analyzed. Centered log-ratio (clr) transformation was applied to the fatty acid data. Principal component analysis (PCA) and generalized linear model-based repeated measure analysis were used to assess changes over time. The total lipid content was significantly higher at 6 months (β = 0.199, p < 0.029) and 12 months of lactation (β = 0.421, p < 0.001). The constituents of C20:3n-6 and C20:3n-3 were lower at 6 months (p < 0.001). Four distinct sub-compositional fatty acid groups were only identified at 12 months of lactation. The inclusion of small fatty acids of small constituent size in the analysis resulted in a shift in the balance between fatty acid constituents. Human milk fatty acid composition during prolonged lactation is different from that of human milk during a short duration of lactation. Our findings support the hypothesis that a combination of multiple fatty acids is important in fatty acid profiling beyond the presentation of individual fatty acids. Furthermore, the high variability of small fatty acids warrants attention because a compositional analysis may show more pronounced changes.
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Affiliation(s)
- Linda P. Siziba
- Pediatric Epidemiology, Department of Pediatrics, University Medicine Leipzig, 04103 Leipzig, Germany;
| | - Leonie Lorenz
- Institute of Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany; (L.L.); (D.R.)
| | - Bernd Stahl
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (B.S.); (M.M.)
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 Utrecht, The Netherlands
| | - Marko Mank
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands; (B.S.); (M.M.)
| | - Tamas Marosvölgyi
- Department of Paediatrics, Medical School, University of Pécs, 7623 Pécs, Hungary; (T.M.); (T.D.)
| | - Tamas Decsi
- Department of Paediatrics, Medical School, University of Pécs, 7623 Pécs, Hungary; (T.M.); (T.D.)
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany; (L.L.); (D.R.)
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, University Medicine Leipzig, 04103 Leipzig, Germany;
- Institute of Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany; (L.L.); (D.R.)
- Correspondence: ; Tel.: +49-731-500-31067; Fax: +49-731-5012-31067
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15
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Siziba LP, Baumgartner J, Rothman M, Matsungo TM, Faber M, Smuts CM. Efficacy of novel small-quantity lipid-based nutrient supplements in improving long-chain polyunsaturated fatty acid status of South African infants: a randomised controlled trial. Eur J Clin Nutr 2019; 74:193-202. [PMID: 31371795 DOI: 10.1038/s41430-019-0482-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to investigate the efficacy of small-quantity lipid-based nutrient supplements (SQ-LNS) containing essential fatty acids (EFAs) with or without long-chain polyunsaturated fatty acids (LCPUFAs) in improving LCPUFA status in South African infants fed complementary food. SUBJECTS/METHODS Six-month-old infants (n = 750) were randomised to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNSs contained micronutrients and EFAs. SQ-LNS-plus additionally contained the LCPUFAs arachidonic acid (AA) and docosahexaenoic acid (DHA), lysine, phytase and other nutrients. Plasma total phospholipid FA composition (% of total FAs) was measured at baseline (n = 353) and at 12 months (n = 293). RESULTS At baseline, geometric mean (95% CI) plasma DHA and AA were 4.1 (4.0-4.3) and 11.5 (11.2-11.8)% respectively, with significantly higher plasma DHA and AA in breastfed than non-breastfed infants. Infants receiving the SQ-LNS-plus had significantly higher plasma DHA (4.52 (4.3-4.9)) at 12 months than the controls (3.8 (3.6-4.0)), with a higher effect size in infants who no longer received breast milk (β = 1.148 (95% CI = 0.597, 1.699)) than in infants who were still breastfeeding (β = 0.544 (95% CI = 0.179, 0.909)). There was no effect of either of the two SQ-LNSs on plasma AA. Consequently, infants receiving the SQ-LNS-plus had a significantly lower plasma n-6 to n-3 PUFA ratio at 12 months than control infants did. CONCLUSIONS Our study suggests that the provision of SQ-LNS-plus is efficacious in improving plasma DHA status. Particularly, infants who are no longer breastfed may benefit most from LCPUFA-enriched SQ-LNS.
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Affiliation(s)
- Linda P Siziba
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520, Potchefstroom, South Africa
| | - Marinel Rothman
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520, Potchefstroom, South Africa
| | - Tonderayi M Matsungo
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520, Potchefstroom, South Africa
| | - Mieke Faber
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520, Potchefstroom, South Africa.
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16
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Siziba LP, Baumgartner J, Ricci C, Jacobs A, Rothman M, Matsungo TM, Covic N, Faber M, Smuts CM. Associations of plasma total phospholipid fatty acid patterns with feeding practices, growth, and psychomotor development in 6-month-old South African infants. Matern Child Nutr 2019; 15:e12763. [PMID: 30489019 PMCID: PMC7199032 DOI: 10.1111/mcn.12763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/14/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess plasma fatty acid (FA) patterns of 6-month-old South African infants and to determine their association with feeding practices, growth, and psychomotor development. Plasma total phospholipid FA composition (% of total FAs) of 6-month-old infants (n = 353) from a peri-urban township was analysed, and principal component and factor analysis were performed to identify plasma FA patterns. Feeding practices, anthropometric measurements, and psychomotor development scores were determined. Four major plasma phospholipid FA patterns were identified: A plant-based C18 FA, a high n-6 long-chain polyunsaturated fatty acids (LCPUFA), a C16:1 and long-chain saturated fatty acid (SFA), and a high n-3 and low n-6 LCPUFA pattern. Formula feeding was associated with higher, whereas breastfeeding was associated with lower scores for the plant-based C18 FA and C16:1 and long-chain SFA patterns. On the other hand, breastfeeding, the consumption of cow's milk, and the consumption of semisolid foods were associated with higher scores, whereas formula feeding was associated with lower scores for the high n-6 LCPUFA pattern. Breastfeeding and the consumption of semisolids were also associated with higher high n-3 and low n-6 LCPUFA pattern scores. The C16:1 and long-chain SFA and high n-3 and low n-6 LCPUFA patterns were positively associated with psychomotor development scores. In 6-month-old South African infants, we identified distinct plasma FA patterns that presumably represent the FA quality of their diet and that are associated with psychomotor development. Our results suggest that breast milk is an important source of n-6 LCPUFAs and formula-fed infants may be at risk of inadequate LCPUFA intake.
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Affiliation(s)
- Linda P. Siziba
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Jeannine Baumgartner
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Cristian Ricci
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Adriaan Jacobs
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Marinel Rothman
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | | | - Namukolo Covic
- Poverty, Health and Nutrition DivisionInternational Food Policy Research InstituteWashingtonDCUSA
| | - Mieke Faber
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
- Non‐Communicable Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Cornelius M. Smuts
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
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