Dietary Patterns During Lactation and Human Milk Composition and Quantity: A NESR Systematic Review

Abstract Objectives To inform the Dietary Guidelines for Americans, 2020–2025, the USDA and HHS identified important public health questions to be examined by the 2020 Dietary Guidelines Advisory Committee. The Committee conducted a systematic review with support from the USDA's Nutrition Evidence Systematic Review (NESR) team to answer the question: What is the relationship between dietary patterns consumed during lactation and human milk composition and quantity? Methods The Committee developed protocols to describe how they would use NESR's SR methodology to examine the evidence related to dietary patterns (DP) during lactation and human milk (HM). NESR librarians conducted a literature search and NESR analysts dual-screened the results using pre-defined inclusion and exclusion criteria to identify articles published between 2000 and 2019. NESR analysts extracted data from and assessed the risk of bias of included studies. The Committee synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. Results This systematic review included 7 articles. Three articles from 2 cross-sectional studies examined DP and HM, while 4 articles from 3 randomized controlled trials examined diets based on macronutrient distributions and HM. The body of evidence was limited by small sample sizes, risk of bias concerns, heterogeneous methods, and study populations with limited racial/ethnic and socioeconomic diversity. Conclusions Limited evidence suggests that maternal consumption of diets higher in fat (>35% fat) and lower in carbohydrate during lactation is related to higher total fat in HM collected in the maternal postprandial period. Limited evidence suggests that certain maternal DP during lactation, including diets based on macronutrient distributions, are related to the relative proportions of saturated fat and monounsaturated fatty acids in HM, and of polyunsaturated fatty acids in HM collected in the maternal postprandial period. Insufficient or no evidence was available to assess the association between DP during lactation and HM quantity, as well as total protein, water- and fat-soluble vitamins, minerals, human milk oligosaccharides, and bioactive proteins in HM. Funding Sources USDA, Food and Nutrition Service, Center for Nutrition Policy and Promotion.

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Dietary Patterns during Lactation and Human Milk Composition and Quantity: A Systematic Review

10.52570/nesr.dgac2020.sr0203 ◽

2020 ◽

Author(s):

Sharon Donovan ◽

Kathryn Dewey ◽

Rachel Novotny ◽

Jamie Stang ◽

Elsie Taveras ◽

...

Keyword(s):

Systematic Review ◽

Human Milk ◽

Dietary Patterns ◽

Milk Composition

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Dietary Patterns of Breastfeeding Mothers and Human Milk Composition: Data from the Italian MEDIDIET Study

Nutrients ◽

10.3390/nu13051722 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1722

Author(s):

Francesca Bravi ◽

Matteo Di Maso ◽

Simone R. B. M. Eussen ◽

Carlo Agostoni ◽

Guglielmo Salvatori ◽

...

Keyword(s):

Fatty Acids ◽

Human Milk ◽

Dietary Patterns ◽

Maternal Nutrition ◽

Dietary Habits ◽

Maternal Diet ◽

Principal Component ◽

Milk Composition ◽

Principal Component Factor Analysis

(1) Background: Several studies have reported associations between maternal diet in terms of single foods or nutrients and human milk compounds, while the overall role of maternal diet and related dietary patterns has rarely been investigated. (2) Methods: Between 2012 and 2014, we enrolled 300 healthy Italian mothers, who exclusively breastfed their infant. During a hospital visit at 6 weeks postpartum, a sample of freshly expressed foremilk was collected and information on maternal dietary habits in the postpartum period was obtained through an interviewer-administered food frequency questionnaire. We applied principal component factor analysis to selected nutrients in order to identify maternal dietary patterns, and assessed correlations in human milk macronutrients and fatty acids across levels of dietary patterns. (3) Results: Five dietary patterns were identified, named “Vitamins, minerals and fibre”, “Proteins and fatty acids with legs”, “Fatty acids with fins”, “Fatty acids with leaves”, “Starch and vegetable proteins”. These dietary patterns were correlated with some milk components, namely fatty acids, and in particular ω-3 and its subcomponents. (4) Conclusions: This study showed that overall maternal dietary habits during breastfeeding may influence human milk composition, suggesting the importance of adequate maternal nutrition during lactation not only for the mother herself but also to provide the infant with milk containing adequate amount and quality of nutrients for a balanced nutrition.

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Lack of Evidence for Additional Protein-Energy in Enteral Nutrition for Very Low Birth Weight Preterm Infants: A Systematic Review (P11-086-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-086-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Lisa Moloney ◽

Mary Rozga ◽

Tanis Fenton ◽

Sharon Groh-Wargo

Keyword(s):

Enteral Nutrition ◽

Human Milk ◽

Preterm Infants ◽

Low Birthweight ◽

Infant Nutrition ◽

Small Sample ◽

Risk Of Bias ◽

Control Group ◽

Limited Evidence ◽

Protein Energy

Abstract Objectives To investigate the evidence for the effect of protein and energy via enteral nutrition on identified outcomes in very low birthweight preterm infants. Methods A literature search was conducted using EMBASE, CINAHL, Cochrane Central and PubMed databases for the period of January 1980-November 2017 for all peer-reviewed articles examining preterm infant nutrition. A multidisciplinary volunteer expert Workgroup and staff screened articles according to defined inclusion criteria (randomized controlled trials, enteral fed preterm infants with birthweight < 1500 gm, economically developed nations). Studies that evaluated the effect of adding protein-energy in enteral feeding, compared to a control group, were included. Data was extracted and risk of bias was evaluated using the Academy's Quality Criteria Checklist and Cochrane's Risk of Bias Tool. Data was summarized and conclusion statements were developed and graded for each identified outcome using the GRADE framework and Academy methodology. Results The search identified in 25,264 articles, and five articles were included. Two included studies had low risk of bias. The remaining studies had bias in the following Cochrane domains: selection (2), performance (2), and attrition (1). Eight conclusion statements were developed, five were graded as limited evidence, and three were graded as having fair evidence. Protein-energy fortification was found to have a significant positive effect on weight gain (SMD (95%CI): 1.24 (0.26,2.22)) in human milk fed VLBW preterm infants, however, no evidence of effect was found in formula or mixed fed infants. Limited evidence suggests a significant effect on fat free mass (MD (95% CI): 179 g (28.5, 386.5)) after 30 days, but no effect on fat mass. No significant effect was found on necrotizing enterocolitis, anemia, length, head circumference, or days to full feeds. Conclusions Evidence was lacking regarding the effect of protein-energy fortification on identified outcomes in VLBW preterm infants. Available evidence was low in quality due to small sample sizes and heterogeneity in study populations (formula fed, human milk fed), interventions (amount of protein) and reporting of methods (protein prescription vs actual intake) and outcomes. Funding Sources Academy of Nutrition and Dietetics.

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Omega 3 Fatty Acids in Enteral Nutrition for Very Low Birth Weight Preterm Infants: A Systematic Review (P11-085-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-085-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Lisa Moloney ◽

Mary Rozga ◽

Kathleen Gura ◽

Camilia Martin

Keyword(s):

Systematic Review ◽

Fatty Acids ◽

Enteral Nutrition ◽

Human Milk ◽

Preterm Infant ◽

Preterm Infants ◽

Visual Development ◽

Risk Of Bias ◽

Omega 3 Fatty Acids ◽

Omega 3

Abstract Objectives To investigate the evidence for the effect of omega 3 fatty acids via enteral nutrition on identified outcomes in the very low birthweight preterm infant population. Methods A literature search was conducted in EMBASE, CINAHL, Cochrane Central, PubMed databases for the period of January 1980-November 2017 for all peer-reviewed articles examining preterm infant nutrition. A multidisciplinary volunteer expert Workgroup and staff screened articles according to defined inclusion criteria (randomized controlled trials, enteral fed preterm infants < 1500 gm, economically developed nations). Data was extracted and risk of bias was evaluated for each included article using the Academy's Quality Criteria Checklist and Cochrane's Risk of Bias Tool. Data was summarized and conclusion statements were developed and graded for each identified outcome using the GRADE framework and Academy methodology. Results The search identified in 25,264 articles, and six studies published in 13 articles were included. Two included studies had low risk of bias. Remaining studies had bias in the following Cochrane domains: attrition (2), detection (3), selection (2), performance (2), and reporting (1). Eleven conclusion statements were developed, 4 were graded as good, 2 as fair, 5 as limited. Though evidence quality describing the effect of 64mg of omega 3s daily on mortality and retinopathy of prematurity was good, there were no significant effects reported [RR (95% CI) was 1.31 (0.88 to 1.96) and 0.96 (0.61, 1.50), respectively]. Similarly, there were no significant effects found for type of fat intake by VLBW infants on bronchopulmonary disease, atopy, necrotizing enterocolitis, anthropometrics, neuro- or visual development or gastrointestinal health. Conclusions This systematic review revealed high heterogeneity amongst interventions, including in feeding types (formula, formula or human milk, or human milk), mode of supplementation, and amount and composition of supplement (DHA, EPA, ARA, MCT). Funding Sources Academy of Nutrition and Dietetics.

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Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes

Medicina ◽

10.3390/medicina57060573 ◽

2021 ◽

Vol 57 (6) ◽

pp. 573

Author(s):

João Miguel Santos ◽

Joana F. Pereira ◽

Andréa Marques ◽

Diana B. Sequeira ◽

Shimon Friedman

Keyword(s):

Systematic Review ◽

Root Canal ◽

Small Sample ◽

Risk Of Bias ◽

Root Canal Treatment ◽

Cochrane Library ◽

Posterior Teeth ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Irreversible Pulpitis

Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as ‘high’ or ‘serious’, ‘fair’, and ‘low’ for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

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Quality of life in primary sclerosing cholangitis: a systematic review

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01739-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Elena Marcus ◽

Paddy Stone ◽

Anna-Maria Krooupa ◽

Douglas Thorburn ◽

Bella Vivat

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Clinical Research ◽

Disease Progression ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Small Sample ◽

Limited Evidence ◽

Research Studies

Abstract Background Primary sclerosing cholangitis (PSC) is a rare bile duct and liver disease which can considerably impact quality of life (QoL). As part of a project developing a measure of QoL for people with PSC, we conducted a systematic review with four review questions. The first of these questions overlaps with a recently published systematic review, so this paper reports on the last three of our initial four questions: (A) How does QoL in PSC compare with other groups?, (B) Which attributes/factors are associated with impaired QoL in PSC?, (C) Which interventions are effective in improving QoL in people with PSC?. Methods We systematically searched five databases from inception to 1 November 2020 and assessed the methodological quality of included studies using standard checklists. Results We identified 28 studies: 17 for (A), ten for (B), and nine for (C). Limited evidence was found for all review questions, with few studies included in each comparison, and small sample sizes. The limited evidence available indicated poorer QoL for people with PSC compared with healthy controls, but findings were mixed for comparisons with the general population. QoL outcomes in PSC were comparable to other chronic conditions. Itch, pain, jaundice, severity of inflammatory bowel disease, liver cirrhosis, and large-duct PSC were all associated with impaired QoL. No associations were found between QoL and PSC severity measured with surrogate markers of disease progression or one of three prognostic scoring systems. No interventions were found to improve QoL outcomes. Conclusion The limited findings from included studies suggest that markers of disease progression used in clinical trials may not reflect the experiences of people with PSC. This highlights the importance for clinical research studies to assess QoL alongside clinical and laboratory-based outcomes. A valid and responsive PSC-specific measure of QoL, to adequately capture all issues of importance to people with PSC, would therefore be helpful for clinical research studies.

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P–394 Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: a systematic review and meta-analysis

Human Reproduction ◽

10.1093/humrep/deab130.393 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

M P Rimmer ◽

N Black ◽

S Keay ◽

S Quenby ◽

B. H.A Wattar

Keyword(s):

Systematic Review ◽

Embryo Transfer ◽

Meta Analysis ◽

Small Sample ◽

Risk Of Bias ◽

Population Characteristics ◽

Implantation Failure ◽

Randomised Trials ◽

Recurrent Implantation Failure ◽

History Of

Abstract Study question What is the effectiveness of IV Intralipid (IVI) in improving pregnancy rates in women undergoing IVF with history of Recurrent implantation failure (RIF) to improve reproductive outcomes. Summary answer The evidence to support the use of IVI at the time of embryo transfer in women with RIF is limited. More RCTs are needed. What is known already: Optimising the implantation process following embryo transfer remains a clinical challenge with 10% of couples undergoing IVF affected by (RIF). Immunotherapy could help to optimise endometrial receptivity and increase the chances for successful conception in women with history of RIF. Intra-venous Intralipid (IVI), a fat-based emulsion of soybean oil, glycerine, phospholipids, egg, and polyunsaturated fatty acids, has been evaluated in several trials as a potential intervention to downregulate the uNK cells and macrophages as well as inhibit the pro-inflammatory mediators including T1 helper cells. Evidence synthesis is needed to evaluate the effectiveness of this intervention. Study design, size, duration We performed this systematic review using a prospectively registered protocol (CRD42019148517) and reported in accordance with the PRISMA guidelines. Participants/materials, setting, methods: We searched MEDLINE, EMBASE and CENTRAL for any randomised trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analysed data using a random effect model and reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI). Main results and the role of chance We included five randomised trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, RR 1.55, 95%CI 1.16–2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95%CI 1.42–2.35, I2 0%) post treatment compared to no intervention. Limitations, reasons for caution Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics. Wider implications of the findings: Our meta-analysis offers an overview on the value of IVI to help women affected by RIF. Given the limitations and the quality of included trials, adopting the use of IVI a-la-carte to couples undergoing IVF remains immature. IVI should not be offered until larger RCTs demonstrate a persistent benefit. Trial registration number CRD42019148517

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Human Milk Composition and Dietary Intakes of Breastfeeding Women of Different Ethnicity from the Manawatu-Wanganui Region of New Zealand

Nutrients ◽

10.3390/nu10091231 ◽

2018 ◽

Vol 10 (9) ◽

pp. 1231 ◽

Cited By ~ 21

Author(s):

Christine Butts ◽

Duncan Hedderley ◽

Thanuja Herath ◽

Gunaranjan Paturi ◽

Sarah Glyn-Jones ◽

...

Keyword(s):

Fatty Acids ◽

New Zealand ◽

Breast Milk ◽

Human Milk ◽

Milk Composition ◽

Pacific Island ◽

Dietary Intakes ◽

Omega 3 ◽

Food Diary ◽

Milk Samples

Human milk is nutrient rich, complex in its composition, and is key to a baby’s health through its role in nutrition, gastrointestinal tract and immune development. Seventy-eight mothers (19–42 years of age) of Asian, Māori, Pacific Island, or of European ethnicity living in Manawatu-Wanganui, New Zealand (NZ) completed the study. The women provided three breast milk samples over a one-week period (6–8 weeks postpartum), completed a three-day food diary and provided information regarding their pregnancy and lactation experiences. The breast milk samples were analyzed for protein, fat, fatty acid profile, ash, selected minerals (calcium, magnesium, selenium, zinc), and carbohydrates. Breast milk nutrient profiles showed no significant differences between the mothers of different ethnicities in their macronutrient (protein, fat, carbohydrate, and moisture) content. The breast milk of Asian mothers contained significantly higher levels of polyunsaturated fatty acids (PUFAs), omega-3 (n-3) and omega-6 (n-6) fatty acids, docosahexaenoic acid (DHA), and linoleic acids. Arachidonic acid was significantly lower in the breast milk of Māori and Pacific Island women. Dietary intakes of protein, total energy, saturated and polyunsaturated fat, calcium, phosphorus, zinc, iodine, vitamin A equivalents, and folate differed between the ethnic groups, as well as the number of serves of dairy foods, chicken, and legumes. No strong correlations between dietary nutrients and breast milk components were found.

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“Effect of the intervention with omega-3 fatty acids on nutritional and clinical aspects in patients with breast cancer receiving medical treatment”

10.1101/2021.02.08.21251389 ◽

2021 ◽

Author(s):

Palma-Gutierrez Edgardo ◽

Espinoza-Rado Erika ◽

Zafra-Tanaka Jessica Hanae

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Fatty Acids ◽

Medical Treatment ◽

Muscle Protein ◽

Data Extraction ◽

Risk Of Bias ◽

Clinical Aspects ◽

Omega 3 Fatty Acids ◽

Omega 3

ABSTRACTBackgroundIt is known that cancer can cause loss of body weight and muscle protein wasting, which leads to a state of malnutrition, which in turn worsens the prognosis and health of the cancer patient. It has been suggested that the promoting mechanism of this state is systemic inflammation, for which reason several clinical trials have used omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as adjuvants to antineoplastic treatment, mainly due to its anti-inflammatory effects. However, few systematic reviews and meta-analyzes have analyzed the effects of omega-3s in patients with breast cancer.ObjectiveThe aim of this study is to assess the effect of the supplementation with omega-3 fatty acids on nutritional and clinical outcomes in patients with breast cancer receiving medical treatment.MethodsA systematic review will be conducted, starting with a search in PubMed, CENTRAL and EMBASE using search terms related to omega-3 fatty acids and breast cancer. We will include only randomized controlled trials that assess the effects of omega-3 in patients with breast cancer receiving medical treatment.. Data will be extracted in a spread sheet. Study selection and data extraction will be conducted by two reviewers independently and the Cochrane Risk of Bias Tool for RCT will be used for assessment of risk of bias. Discrepancies will be reviewed with a third reviewer.ConclusionThis systematic review aims to provide an analysis on the outcomes of the usage of the intervention with omega-3 fatty acids on nutritional and clinical aspects in patients with breast cancer receiving medical treatment.

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Infant milk-feeding practices and childhood leukemia: a systematic review

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy306 ◽

2019 ◽

Vol 109 (Supplement_1) ◽

pp. 757S-771S ◽

Cited By ~ 3

Author(s):

Darcy Güngör ◽

Perrine Nadaud ◽

Carol Dreibelbis ◽

Concetta C LaPergola ◽

Yat Ping Wong ◽

...

Keyword(s):

Systematic Review ◽

Human Milk ◽

Systematic Reviews ◽

Childhood Leukemia ◽

Lymphoblastic Leukemia ◽

Surveillance Systems ◽

Limited Evidence ◽

Cancer Data ◽

Review Team ◽

Milk Feeding

ABSTRACTBackgroundDuring the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations.ObjectivesThe aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) feeding a lower versus higher intensity of human milk to mixed-fed infants with acute childhood leukemia, generally, and acute lymphoblastic leukemia, specifically.MethodsThe Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980 to March 2016, dual-screened the results using predetermined criteria, extracted data from and assessed risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence.ResultsWe included 24 articles from case-control or retrospective studies. Limited evidence suggests that never feeding human milk versus 1) ever feeding human milk and 2) feeding human milk for durations ≥6 mo are associated with a slightly higher risk of acute childhood leukemia, whereas evidence comparing never feeding human milk with feeding human milk for durations <6 mo is mixed. Limited evidence suggests that, among infants fed human milk, a shorter versus longer duration of human milk feeding is associated with a slightly higher risk of acute childhood leukemia. None of the included articles examined exclusive human milk feeding or the intensity of human milk fed to mixed-fed infants.ConclusionsFeeding human milk for short durations or not at all may be associated with slightly higher acute childhood leukemia risk. The evidence could be strengthened with access to broadly generalizable prospective samples; therefore, we recommend linking surveillance systems that collect infant feeding and childhood cancer data.

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