Impact of Infant and Maternal Factors on Energy and Macronutrient Composition of Human Milk

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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Longitudinal Analysis of Macronutrient Composition in Preterm and Term Human Milk: A Prospective Cohort Study

Nutrients ◽

10.3390/nu11071525 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1525 ◽

Cited By ~ 8

Author(s):

Fischer Fumeaux ◽

Garcia-Rodenas ◽

De Castro ◽

Courtet-Compondu ◽

Thakkar ◽

...

Keyword(s):

Human Milk ◽

Energy Content ◽

Male Gender ◽

Total Protein Content ◽

Macronutrient Composition ◽

Very Preterm Infants ◽

Very Preterm ◽

Longitudinal Measurements ◽

Potential Factors ◽

Over Time

Background: Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants. As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM). Addressing HM composition and variations is essential to optimize HM fortification strategies for these vulnerable infants. Aims: To analyze and compare macronutrient composition in HM of mothers lactating very preterm (PT) (28 0/7 to 32 6/7 weeks of gestational age, GA) and term (T) infants (37 0/7 to 41 6/7 weeks of GA) over time, both at similar postnatal and postmenstrual ages, and to investigate other potential factors of variations. Methods: Milk samples from 27 mothers of the PT infants and 34 mothers of the T infants were collected longitudinally at 12 points in time during four months for the PT HM and eight points in time during two months for the T HM. Macronutrient composition (proteins, fat, and lactose) and energy were measured using a mid-infrared milk analyzer, corrected by bicinchoninic acid (BCA) assay for total protein content. Results: Analysis of 500 HM samples revealed large inter- and intra-subject variations in both groups. Proteins decreased from birth to four months in the PT and the T HM without significant differences at any postnatal time point, while it was lower around term equivalent age in PT HM. Lactose content remained stable and comparable over time. The PT HM contained significantly more fat and tended to be more caloric in the first two weeks of lactation, while the T HM revealed higher fat and higher energy content later during lactation (three to eight weeks). In both groups, male gender was associated with more fat and energy content. The gender association was stronger in the PT group, and it remained significant after adjustments. Conclusion: Longitudinal measurements of macronutrients compositions of the PT and the T HM showed only small differences at similar postnatal stages in our population. However, numerous differences exist at similar postmenstrual ages. Male gender seems to be associated with a higher content in fat, especially in the PT HM. This study provides original information on macronutrient composition and variations of HM, which is important to consider for the optimization of nutrition and growth of PT infants.

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Sexually Dimorphic Associations between Maternal Factors and Human Milk Hormonal Concentrations

Nutrients ◽

10.3390/nu12010152 ◽

2020 ◽

Vol 12 (1) ◽

pp. 152 ◽

Cited By ~ 5

Author(s):

Laura Galante ◽

Hanna Lagström ◽

Mark H. Vickers ◽

Clare M. Reynolds ◽

Samuli Rautava ◽

...

Keyword(s):

Growth Factor ◽

Human Milk ◽

Maternal Education ◽

Milk Composition ◽

Sexually Dimorphic ◽

Insulin Like Growth Factor ◽

Maternal Factors ◽

Infant Outcomes ◽

Healthy Development ◽

Future Work

While human milk composition is characterised by marked dynamicity, we are far from having a clear picture of what factors drive this variation. Hormones in human milk are known to vary according to specific maternal phenotypes, but limited evidence shows the infant also has a role in determining milk composition. The present study aimed to investigate the interplay between maternal and infant characteristics in relation to human milk hormonal profile. In total, 501 human milk samples from mothers recruited in the Finnish STEPS cohort study (Steps to the healthy development) were analysed. Pre-pregnancy and pregnancy maternal data, socioeconomic status and infant characteristics at birth were collated. Leptin, adiponectin, insulin-like growth factor-1 and cyclic Glycine-Proline in milk were measured. Multivariate analysis of variance (MANOVA) and linear regression were utilised for statistical analysis. Sex-specific interactions with maternal factors were observed, as the infant sex mediated associations between gestational diabetes and milk adiponectin (p = 0.031), birth-mode and total protein (p = 0.003), maternal education and insulin-like growth factor-1: cyclic Glycine-Proline ratio (p = 0.035). Our results suggest that changes in human milk composition are associated with interactions between maternal and infant characteristics and pathophysiological factors. Future work should expand on these findings and further explore the link between hormonal profiles in human milk and infant outcomes.

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Maternal Nutrition and Body Composition During Breastfeeding: Association with Human Milk Composition

Nutrients ◽

10.3390/nu10101379 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1379 ◽

Cited By ~ 25

Author(s):

Agnieszka Bzikowska-Jura ◽

Aneta Czerwonogrodzka-Senczyna ◽

Gabriela Olędzka ◽

Dorota Szostak-Węgierek ◽

Halina Weker ◽

...

Keyword(s):

Body Composition ◽

Human Milk ◽

Milk Fat ◽

Maternal Nutrition ◽

Milk Composition ◽

The Body ◽

Fat Free Mass ◽

Total Protein Content ◽

Time Points ◽

Dietary Record

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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Energy and nitrogen metabolism of lactating rabbits

British Journal Of Nutrition ◽

10.1079/bjn19830059 ◽

1983 ◽

Vol 49 (3) ◽

pp. 507-516 ◽

Cited By ~ 26

Author(s):

G. G. Partridge ◽

M. F. Fullera ◽

J. D. Pullar

Keyword(s):

Energy Content ◽

High Protein Diet ◽

Milk Composition ◽

The Body ◽

Metabolizable Energy ◽

High Protein ◽

Body Tissue ◽

Energy Output ◽

Before And After ◽

Energy Retention

1. Twelve crossbred does (New Zealand White × California) were offered a diet of high protein and metabolizable energy content (249 g/kg dry matter (DM) and 13·6 MJ/kg DM respectively) throughout a 32 d lactation at one of four feeding levels (240, 280, 320 or 360 g/d). Each feeding level was replicated three times.2. Milk output was measured by weighing the does before and after their one daily suckling period.3. The lactation was divided into four consecutive 8-d periods. Each doe was placed in a direct calorimeter for 48 h around the mid-point of each of these periods and measurements of energy exchange were made. Nitrogen balance was also measured throughout the study period.4. Milk samples were taken from a parallel group of animals and the estimates of milk composition were applied to the main group of does.5. From the second period of lactation onwards nearly all does mobilized body tissue to support milk energy secretion, although there was no loss of weight. Multiple regression analyses were used to examine the apparent efficiency with which metabolizable energy and body-tissue energy were utilized for milk production. Overall, the relationship was described by the equation:Period of lactation … 2 3 4Milk E = 0.735 me intake – 0·938Body ER –296 –280 –276(se 0-020) (se 0-039)where Milk E is the milk energy output, ME intake is the metabolizable energy intake and Body ER is the body energy retention, all expressed in kJ/kg body-weight0·75 per d.All does appeared to be in positive N balance throughout lactation on this high-protein diet.

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Development of macronutrient composition of very preterm human milk

British Journal Of Nutrition ◽

10.1017/s0007114598001743 ◽

1998 ◽

Vol 80 (1) ◽

pp. 35-40 ◽

Cited By ~ 16

Author(s):

Yolande G. H. Maas ◽

Jeanet Gerritsen ◽

Augustinus A. M. Hart ◽

Mijna Hadders-Algra ◽

Jan M. Ruijter ◽

...

Keyword(s):

Human Milk ◽

Nutritional Value ◽

Milk Composition ◽

Macronutrient Composition ◽

Total N ◽

Very Preterm ◽

Carbohydrate Concentration ◽

Lactose Concentration ◽

Gestational Age At Delivery ◽

The Moment

The effects of gestational age at delivery (GA), postnatal age (PNA) and post-menstrual age (PMA=PNA+GA, an indicator of autonomous developmental processes not affected by the moment of birth) on macronutrient composition of very preterm milk were studied. Total N, fat, lactose and carbohydrate concentrations, energy density and 24 h volume were determined in 282 24 h milk samples collected at weekly intervals (days 7–55 of lactation) from seventy-nine women delivering their babies between 25 and 29 weeks of gestation. GA related differences were found for carbohydrate concentration only: carbohydrate concentration was lower with increasing GA. PNA was related to a decrease in total N and an increase in lactose concentration. PMA was not related to milk composition. Our data indicate that PNA strongly influences the development of the composition of very preterm human milk, while GA affects carbohydrate content with a negligible effect on the nutritional value of the milk. We conclude that in accordance with current opinion in paediatrics, human milk is the best source of nutrients even for very preterm (< 30 weeks GA) infants.

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Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

10.20944/preprints202004.0043.v1 ◽

2020 ◽

Author(s):

Karel Allegaert ◽

anne smits

Keyword(s):

Human Milk ◽

Clinical Research ◽

Healthy Volunteers ◽

Observational Studies ◽

Milk Composition ◽

Short Term ◽

Macronutrient Composition ◽

Lactating Women ◽

Pbpk Models ◽

Religious Fasting

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting, nor fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in 6 papers and one abstract related to religious fasting (n=129 women) and observational studies in lactating women (n=23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18-25h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate, with almost no changes in macronutrients during acute fasting. We therefor conclude that neither short term fasting nor fluid abstention (18-25h) affect human milk macronutrient composition, so that women can be reassured when this topic were raised during consulting. Besides the nutritional relevance, this also matters as clinical research samples – especially to estimate analgo-sedative exposure by lactation - are commonly collected after maternal procedural sedation, associated with maternal fasting and physiology-based pharmacokinetic (PBPK) models assume stable human milk composition.

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Variation in fat, lactose and protein in human milk over 24h and throughout the first year of lactation

British Journal Of Nutrition ◽

10.1079/bjn2002579 ◽

2002 ◽

Vol 88 (1) ◽

pp. 29-37 ◽

Cited By ~ 151

Author(s):

Leon R. Mitoulas ◽

Jacqueline C. Kent ◽

David B. Cox ◽

Robyn A. Owens ◽

Jillian L. Sherriff ◽

...

Keyword(s):

Growth Rate ◽

Human Milk ◽

Energy Content ◽

Accurate Determination ◽

Milk Composition ◽

First Year ◽

Left And Right ◽

Daily Milk Production ◽

Daily Milk

Fat in human milk is extremely variable and can represent up to 50 % of infant energy intake. To accurately determine milk composition and infant intake at 1 (n 17), 2 (n 17), 4 (n 17), 6 (n 15), 9 (n 6) and 12 (n 5) months of lactation, samples of fore- and hind-milk were collected from each breast at each feed over 24 h periods from an initial group of seventeen women. The content of fat in milk varied over 24 h, with a mean CV of 47·6 (SE 2·1) % (N 76) AND 46·7 (se 1·7) % (n 76) for left and right breasts respectively. The 24 h amounts of fat, lactose and protein in milk differed between women (P=0·0001), but were consistent between left and right breasts. Daily milk production differed between breasts (P=0·0001) and women (P=0·0001). Accordingly, amounts of fat (P=0·0008), lactose (P=0·0385) and protein (P=0·0173) delivered to the infant over 24 h also differed between breasts and women (P=0·0001). The energy content of milk and the amount of energy delivered to the infant over 24 h were the same between breasts, but differed between women (P=0·0001). The growth rate of a group of only six infants in the present study was not related to either the concentrations or amounts of fat, lactose, protein and energy in milk over the first 6 months of life. These results show the individuality of milk composition and suggest that only a rigorous sampling routine that takes into account all levels of variation will allow the accurate determination of infant intake of fat, lactose, protein and energy.

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Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance

Children ◽

10.3390/children7060060 ◽

2020 ◽

Vol 7 (6) ◽

pp. 60

Author(s):

Karel Allegaert ◽

Anne Smits

Keyword(s):

Human Milk ◽

Clinical Research ◽

Healthy Volunteers ◽

Observational Studies ◽

Milk Composition ◽

Short Term ◽

Macronutrient Composition ◽

Lactating Women ◽

Pbpk Models ◽

Religious Fasting

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on ‘human milk composition’ and screened title, abstract and full paper on ‘fasting’ or ‘abstention’ and ‘macronutrient composition’ (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in six papers and one abstract related to religious fasting (n = 129 women) and observational studies in lactating women (n = 23, healthy volunteers, fasting). These data reflect two different ‘fasting’ patterns: an acute (18–25 h) model in 71 (healthy volunteers, Yom Kippur/Ninth of Av) women and a chronic repetitive fasting (Ramadan) model in 81 women. Changes were most related to electrolytes and were moderate and mainly in the chronic repetitive fasting model, with no clinical significant changes in macronutrients during acute fasting. We therefore conclude that neither short-term fasting nor fluid abstention (18–25 h) affect human milk macronutrient composition, so that women can be reassured when this topic was raised during consulting. Besides the nutritional relevance, this also matters, as clinical research samples—especially estimating analgo-sedative exposure by lactation—are commonly collected after maternal procedural sedation and maternal fasting. Based on these results, it is reasonable to assume stable human milk composition when such data are used in physiology-based pharmacokinetic (PBPK) models.

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Macronutrient, immunoglobulin a and total antioxidant capacity profiles of human milk from 1 to 24 months: a cross-sectional study in Thailand

International Breastfeeding Journal ◽

10.1186/s13006-020-00333-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Krongporn Ongprasert ◽

Jetsada Ruangsuriya ◽

Rungnapa Malasao ◽

Ratana Sapbamrer ◽

Pikul Suppansan ◽

...

Keyword(s):

Human Milk ◽

Antioxidant Capacity ◽

Total Antioxidant Capacity ◽

Energy Content ◽

Immunoglobulin A ◽

Milk Composition ◽

Cross Sectional ◽

Milk Samples ◽

Carbohydrate Concentration ◽

Total Antioxidant

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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Macronutrient, immunoglobulin A and total antioxidant capacity profiles of human milk: cross-sectional surveys at ages 6, 12, 18 and 24 months.

10.21203/rs.2.19567/v5 ◽

2020 ◽

Author(s):

krongporn ongprasert ◽

Jetsada Ruangsuriya ◽

Rungnapa Malasao ◽

Ratana Sapbamrer ◽

Pikul Suppansan ◽

...

Keyword(s):

Human Milk ◽

Antioxidant Capacity ◽

Correlation Coefficient ◽

Total Antioxidant Capacity ◽

Energy Content ◽

Immunoglobulin A ◽

Milk Composition ◽

Milk Samples ◽

Carbohydrate Concentration ◽

Total Antioxidant

Abstract Background: A longer 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 associations of macronutrient contents, immunoglobulin A (IgA) levels, and the total antioxidant capacity (TAC) in human milk (HM) with the month of lactation from 1 to 24 months postpartum.Methods: Milk samples were collected from mothers with healthy full-term children who had been lactating from 1 to 24 months from January 2019 to April 2019. 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 the 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 milk composition and the month of lactation, and multiple regression analysis was used to assess the association between covariates and milk composition. 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 and TAC after adjustment for maternal age, maternal BMI, birth order, and breastfeeding frequency.Conclusions: Based on our results, fat, energy, and IgA contents in HM were positively associated with the month of lactation, and a slight but significant negative association was detected for the carbohydrate concentration up to two years postpartum.

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