Human milk fatty acid composition from nine countries varies most in DHA

Dynamic changes at high-protein dietary pattern of major fatty acids in healthy lactating women: A systematic review and meta-analysis

BACKGROUND

Fatty acids (FAs) in human milk are important nutrients for infants. They play important roles in energy supply, nervous system development, and metabolic function maintenance. However, how the composition of major milk FAs change with lactation stages remains controversial.

OBJECTIVES

To systematically review the concentration range of major FAs in human milk at various lactation stages.

METHODS

A total of 12 papers involving 50 sets of data with 3507 participants were reviewed according to the PRISMA checklist and flow diagram. The inclusion criteria was the literatures had the FAs contents in breast milk of healthy lactation mothers at three lactation stages and the dietary patterns could be calculated. The exclusion criteria were: the studies were duplicates, were unrelated to dietary patterns or breast milk composition, and/or the study populations were unhealthy. We searched PubMed, the China National Knowledge Infrastructure, WanFang, and Web of science. Agency for Health Care Research and Quality (AHRQ) was used to assess the bias of studies. The mean values of polyunsaturated fatty acids (PUFAs) including docosahexaenoic acid (DHA), arachidonic acid (AA), eicosapentaenoic acid (EPA), α-linolenic acid (ALA), linoleic acid (LA), monounsaturated fatty acids (MUFAs), and saturated fatty acids (SFAs, including lauric acid and palmitic acid), in human milk at three lactation stages (colostrum 1-7 d, transitional milk 8-14 d, mature milk 15 d-3 mo) of healthy lactating women were investigated in terms of the high protein dietary pattern. Publication biases were evaluated by Egger's test.

RESULTS

According to the percentage in total fat of colostrum, transitional milk, and mature milk (% wt/wt), respectively, the results showed that PUFA (25.72%, 24.92%, and 22.69%), AA (0.85%, 0.76%, and 0.59%), DHA (0.53%, 0.47%, and 0.39%), EPA (0.15%, 0.10%, and 0.10%), and MUFA (37.39%, 37.21%, and 36.14%) contents in breast milk decreased with lactation, while another two PUFA forms, LA (17.47%, 17.82%, and 17.48%), and ALA (1.09%, 1.39%, and 1.24%) arrived at a peak in the transitional milk and then decreased in the mature milk, SFA (37.46%, 38.64%, and 40.52%), and lauric acid contents (2.78%, 4.91%, and 4.97%) increased with the lactation stages.

CONCLUSION

These findings could shed light on the dynamic change progress of major FA metabolism, potentially enhancing the knowledge of lactation biology, and improving infant feeding practices to meet their needs.

Plasma Sphingomyelins and Carnitine Esters of Infants Consuming Whole Goat or Cow Milk-Based Infant Formulas or Human Milk

BACKGROUND

Infant formulas are typically manufactured using skimmed milk, whey proteins, and vegetable oils, which excludes milk fat globule membranes (MFGM). MFGM contains polar lipids, including sphingomyelin (SM).

OBJECTIVE

The objective of this study was comparison of infant plasma SM and acylcarnitine species between infants who are breastfed or receiving infant formulas with different fat sources.

METHODS

In this explorative study, we focused on SM and acylcarnitine species concentrations measured in plasma samples from the TIGGA study (ACTRN12608000047392), where infants were randomly assigned to receive either a cow milk-based infant formula (CIF) with vegetable oils only or a goat milk-based infant formula (GIF) with a goat milk fat (including MFGM) and vegetable oil mixture to the age ≥4 mo. Breastfed infants were followed as a reference group. Using tandem mass spectrometry, SM species in the study formulas and SM and acylcarnitine species in plasma samples collected at the age of 4 mo were analyzed.

RESULTS

Total SM concentrations (∼42 μmol/L) and patterns of SM species were similar in both formulas. The total plasma SM concentrations were not different between the formula groups but were 15 % (CIF) and 21% (GIF) lower in the formula groups than in the breastfed group. Between the formula groups, differences in SM species were statistically significant but small. Total carnitine and major (acyl) carnitine species were not different between the groups.

CONCLUSIONS

The higher total SM concentration in breastfed than in formula-fed infants might be related to a higher SM content in human milk, differences in cholesterol metabolism, dietary fatty acid intake, or other factors not yet identified. SM and acylcarnitine species composition in plasma is not closely related to the formula fatty acid composition. This trial was registered at Australian New Zealand Clinical Trials Registry as ACTRN12608000047392.

Dietary intake of different ratios of ARA/DHA in early stages and its impact on infant development

Long-chain polyunsaturated fatty acids (LC-PUFAs), arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3) are essential in the development of infants. ARA and DHA from breast milk or infant formula are the main sources of access for infants to meet their physiological and metabolic needs. The ratio of ARA to DHA in breast milk varies among regions and different lactation stages. Different ratios of ARA and DHA mainly from algal oil, animal fat, fish oil, and microbial oil, are added to infant formula in different regions and infant age ranges. Supplementing with appropriate ratios of ARA and DHA during infancy promotes brain, neural, visual, and other development aspects. In this review, we first introduced the current intake status of ARA and DHA in different locations, lactation stages, and age ranges in breast milk and infant formula. Finally, we discussed the effect of different ratios of ARA and DHA on infant development. This review provided a comprehensive research basis for the nutritional research of infants who consume different ratios of ARA and DHA.

Optimizing ARA and DHA in infant formula: A systematic review of global trends, regional disparities, and considerations for precision nutrition

In the context of precision nutrition, the addition of ARA and DHA in infant formula needs to consider more factors. This study conducted a comprehensive literature review, including 112 relevant Chinese and English articles, to summarize and analyze the global levels of ARA, DHA, and the ARA/DHA ratio in breast milk. The data were correlated with local aquatic products intake and children's IQ. The results indicated that the average level of DHA in breast milk across regions is lower than that of ARA. Variations in DHA content were identified as a primary factor influencing ARA/DHA ratio fluctuations. Breast milk ARA and DHA levels decrease with prolonged lactation periods but increase over the past 22 years. Correlation analysis revealed a significant positive relationship between aquatic products intake and breast milk DHA levels (r = 0.64, p < 0.05). Breast milk DHA levels also showed a significant positive correlation with children's IQ (r = 0.67, p < 0.01). Stable breast milk ARA content did not exhibit significant correlations with aquatic products intake or children's IQ (r = 0, p > 0.05). Among 22 infant formula products available in China, only 5 had ARA levels within the range of breast milk. Most formula products had higher ARA levels than DHA, resulting in ARA/DHA ratios generally exceeding 1. The temporal and spatial variability in breast milk ARA and DHA levels may lead to diverse health outcomes in infants. Therefore, the addition of ARA and DHA in infant formula should consider this variability, including the molecular forms and positional isomerism of the added ARA and DHA. Additionally, considering the impact of different cognitive development tests and infant's gene expression on formula assessment results, there is a need to establish a more comprehensive infant health assessment system to guide the addition of ARA and DHA in formula.

Targeting Peroxisome Proliferator-Activated Receptor-β/δ, Reactive Oxygen Species and Redox Signaling with Phytocompounds for Cancer Therapy

Significance: Peroxisome proliferator-activated receptors (PPARs) have a moderately preserved amino-terminal domain, an extremely preserved DNA-binding domain, an integral hinge region, and a distinct ligand-binding domain that are frequently encountered with the other nuclear receptors. PPAR-β/δ is among the three nuclear receptor superfamily members in the PPAR group. Recent Advances: Emerging studies provide an insight on natural compounds that have gained increasing attention as potential anticancer agents due to their ability to target multiple pathways involved in cancer development and progression. Critical Issues: Modulation of PPAR-β/δ activity has been suggested as a potential therapeutic strategy for cancer management. This review focuses on the ability of bioactive phytocompounds to impact reactive oxygen species (ROS) and redox signaling by targeting PPAR-β/δ for cancer therapy. The rise of ROS in cancer cells may play an important part in the initiation and progression of cancer. However, excessive levels of ROS stress can also be toxic to the cells and cancer cells with increased oxidative stress are likely to be more vulnerable to damage by further ROS insults induced by exogenous agents, such as phytocompounds and therapeutic agents. Therefore, redox modulation is a way to selectively kill cancer cells without causing significant toxicity to normal cells. However, use of antioxidants together with cancer drugs may risk the effect of treatment as both act through opposite mechanisms. Future Directions: It is advisable to employ more thorough and detailed methodologies to undertake mechanistic explorations of numerous phytocompounds. Moreover, conducting additional clinical studies is recommended to establish optimal dosages, efficacy, and the impact of different phytochemicals on PPAR-β/δ.

Development and large-scale production of human milk fat analog by fermentation of microalgae

Background

Human milk contains a complex mixture of triacylglycerols (TAG), making it challenging to recreate using common ingredients.

Objective

The study aimed to develop an innovative fermentation technique to produce essential human milk TAG, effectively tackling a significant hurdle in infant nutrition.

Method

An in-depth analysis of the literature has been conducted to identify the specific TAG to be targeted. We used a microalgal oil production platform and a two-step procedure to modify its fatty acid and TAG composition. The palmitic acid (16:0) content has been increased by classical strain improvement techniques, followed by a step involving the expression of a lysophosphatidic acid acyltransferase (LPAAT) sequence capable of esterifying 16:0 specifically at the internal position (sn-2 palmitate) of TAG. Once the strain was stabilized, the fermentation was scaled up in a 50-L reactor to yield several kilograms of biomass. Subsequently, the oil was extracted and refined using standard oil processing conditions. Liquid chromatography-mass spectrometry was employed to monitor the TAG profile and the region specificity of 16:0 at the internal position (sn-2 palmitate) of TAG.

Results

The initial strain had a 16:0 level of 25% of total fatty acids, which was increased to 30% by classical strain improvement. Simultaneously, the oleic acid level decreased from 61% to 57% of total fatty acids. Upon expression of an exogenous LPAAT gene, the level of the 16:0 esterified in the internal position of the TAG (sn-2 palmitate) increased by a factor of 10, to reach 73% of total palmitic acid. Consequently, the concentration of oleic acid in the internal position decreased from 81% to 22% of total fatty acids, with TAG analysis confirming that the primary TAG species in the oil was 1,3-dioleoyl-2-palmitoyl-glycerol (OPO). The 50-L-scale fermentation trial confirmed the strain's ability to produce oil with a yield of >150 g of oil per liter of fermentation broth in a timeframe of 5 days, rendering the process scalable for larger-scale industrialization.

Conclusion

We have demonstrated the feasibility of producing a suitable TAG composition that can be effectively integrated into the formulations of infant nutrition in combination with other fats and oils to meet the infant feeding requirements.

Characterization of gelatin-based wound dressing biomaterials containing increasing coconut oil concentrations

This study determined the influence and ideal ratios of various coconut oil (CO) amounts in gelatin (G) based-films as wound dressings since there are limited comparative studies to evaluate the sole effect of increasing CO on protein-based biomaterials. Homogenous films at G:CO ratio of 4:0,4:2,4:3,4:4 (w:w) corresponding to CO-0, CO-2, CO-3, CO-4, respectively, were obtained using solution casting. SEM showed CO caused rougher surfaces decreasing mechanical strength. However, no pores were observed in CO-4 due to bigger clusters of oil improving stretchability compared to CO-3; and durability since aging of CO-4 was >10% lower than CO-0 in aqueous media. FTIR showed triglycerides' band only in CO films with increasing amplitude. Moreover, amide-I of CO-2 was involved in more hydrogen bonding, therefore, CO-2 had the highest melt-like transition temperatures (Tmax) at ∼163 °C while others' were at ∼133 °C; and had more ideal mechanical properties among CO films. XTT showed that increased CO improved 3T3 cell viability as CO-0 significantly decreased viability at 10,50,75,100 μg/mL (p < 0.05), whereas CO-2 and CO-3 within 5-75 μg/mL and CO-4 within 5-100 μg/mL range increased viability ≥100% suggesting proliferation. All CO samples at 25 μg/mL stimulated 3T3 cell migration in Scratch Assay indicating wound healing. CO amounts mainly improved thermal and healing properties of gelatin-based biomaterial. CO-2 was more thermally stable and CO-4 had better influence on cell viability and wound healing than CO-0. Therefore, increased CO ratios, specifically 4:2 and 4:4, G:CO (w:w), in gelatin-based films can be ideal candidates for wound dressing materials.

Erucic Acid: A Possible Therapeutic Agent for Neurodegenerative Diseases

Neurodegenerative disorders are among the most common life-threatening disorders among the elderly worldwide and are marked by neuronal death in the brain and spinal cord. Several studies have demonstrated the beneficial role of dietary fatty acids in different brain disorders. This is due to their neurotrophic, antioxidant, and anti-inflammatory properties. Furthermore, extensive evidence shows that an unbalanced intake of certain dietary fatty acids increases the risk of neuropsychiatric diseases. Several research has been done on erucic acid, an ingestible omega-9 fatty acid that is found in Lorenzo's oil. Erucic acid was previously thought to be a natural toxin because of its negative effects on heart muscle function and hepatic steatosis, but it has been discovered that erucic acid is regularly consumed in Asian countries through the consumption of cruciferous vegetables like mustard and rapeseed oil with no evidence of cardiac harm. Erucic acid can also be transformed into nervonic acid, a crucial element of myelin. Therefore, erucic acid may have remyelinating effects, which may be crucial for treating different demyelinating conditions. Also, erucic acid exerts antioxidant and anti-inflammatory effects, suggesting its possible therapeutic role in different neurodegenerative disorders. Considering the fruitful effects of this compound, this article reviews the probable role of erucic acid as a pharmacological agent for treating and managing different neurodegenerative disorders.

Quantitative Analysis of Nervonic and Erucic Acids in Human Milk: Comparison with Infant Formula with Different Fat Sources and Nutritional Stages

This study aims to quantitatively analyze nervonic (C24:1 n-9) and erucic (C22:1 n-9) acids in human milk (HM) collected from Korean mothers, along with the infant formulas (IFs) with different fat sources and nutritional stages. The content of nervonic and erucic acids in HM from Korean mothers were 2.13 and 2.81 mg/100 g, accounting for 0.06 and 0.08% of the total fatty acids (FAs), respectively. These acids in IFs based on fat from plant-oil formula were higher than those in IFs based on cow milk formula. The composition of erucic acid in IFs based on cow milk formula and plant-oil formula increased with the nutritional stages, while nervonic acid only increased in IFs based on the plant-oil formula.

Characterization of GM3 Gangliosides in Human Milk throughout Lactation: Insights from the Analysis with the Use of Reversed-Phase Liquid Chromatography Coupled to Quadrupole Time-Of-Flight Mass Spectrometry

Gangliosides are complex lipids found in human milk that play important structural and biological functions. In this study, we utilized reversed-phase liquid chromatography coupled to quadrupole time-of-flight mass spectrometry to evaluate the molecular distribution of GM3 in human milk samples collected at distinct lactation stages, ranging from colostrum to advanced lactation samples. Throughout lactation, GM3 d40:1 emerged as the most abundant GM3 species, except in colostrum, where GM3 d42:2 prevailed. The relative content of GM3 species containing very long N-fatty acyl (N-FA) substituents with >22 carbon atoms decreased, while the content of GM3 species containing 14:0, 18:0, 18:1, and 20:0 N-FA substituents increased in the later months of lactation. These findings highlight the divergence of GM3 profiles across the lactation period. Moreover, considerable interindividual variance was observed among the analyzed samples. The assessment of the GM3 profiles contributes to our understanding of the dynamic composition of human milk.

Impact of Maternal Fish Consumption on Serum Docosahexaenoic Acid (DHA) Levels in Breastfed Infants: A Cross-Sectional Study of a Randomized Clinical Trial in Japan

Docosahexaenoic acid (DHA), an essential n-3 long-chain polyunsaturated fatty acid (LCPUFA) abundant in fish, is crucial for infant brain development. We investigated the associations between maternal dietary habits, infant feeding patterns, and serum levels of DHA and other LCPUFAs in infants aged 5-6 months in Japan, where fish consumption is high. This cross-sectional study used serum samples from 268 infants enrolled in a randomized clinical trial. The frequency of mothers' consumption of 38 food items and infant feeding patterns were prospectively surveyed. Cow's milk formula (CMF) supplemented with 15.9% linolenic acid, 1.6% α-linolenic acid, 0.40% DHA, and 0.27% arachidonic acid was used. Significant positive associations with infants' serum DHA levels were found for "Blue-back fish" (rho = 0.24; p = 0.0001) and "White fish" (rho = 0.25, p = 0.0001). The combined variable "Blue-White fish" was found to be significantly associated with higher serum DHA levels in infants (rho = 0.29, p < 0.0001). Predominantly breastfed infants had significantly higher serum DHA levels than those fed more CMF (rho = 0.32, p < 0.0001). After multivariate analysis, "Blue-White fish" and "Feeding patterns" remained significantly and independently associated with serum DHA levels. These findings suggest that frequent consumption of "Blue-back fish" and/or "White fish" by lactating mothers, along with prioritizing breastfeeding over DHA-supplemented CMF, might effectively increase infants' serum DHA levels.

Growth and adiposity in newborns study (GAINS): The influence of prenatal DHA supplementation protocol

BACKGROUND

Obesity and central fat mass (FM) accrual drive disease development and are related to greater morbidity and mortality. Excessive gestational weight gain (GWG) increases fetal fat accretion resulting in greater offspring FM across the lifespan. Studies associate greater maternal docosahexaenoic acid (DHA) levels with lower offspring FM and lower visceral adipose tissue during childhood, however, most U.S. pregnant women do not consume an adequate amount of DHA. We will determine if prenatal DHA supplementation is protective for body composition changes during infancy and toddlerhood in offspring exposed to excessive GWG.

METHODS AND DESIGN

Infants born to women who participated in the Assessment of DHA on Reducing Early Preterm Birth randomized controlled trial (ADORE; NCT02626299) will be invited to participate. Women were randomized to either a high 1000 mg or low 200 mg daily prenatal DHA supplement starting in the first trimester of pregnancy. Offspring body composition and adipose tissue distribution will be measured at 2 weeks, 6 months, 12 months, and 24 months using dual energy x-ray absorptiometry. Maternal GWG will be categorized as excessive or not excessive based on clinical guidelines.

DISCUSSION

Effective strategies to prevent obesity development are lacking. Exposures during the prenatal period are important in the establishment of the offspring phenotype. However, it is largely unknown which exposures can be successfully targeted to have a meaningful impact. This study will determine if prenatal DHA supplementation modifies the relationship between maternal weight gain and offspring FM and FM distribution at 24 months of age.

ETHICS AND DISSEMINATION

The University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00140895). The results of the trial will be disseminated at conferences and in peer reviewed publications.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03310983.

The Programming Effect of Plant-Based DHA, Along with Equivalent AA, on Immune System and Oral Tolerance Development in Six-Week Allergy Prone BALB/c Pups

BACKGROUND

Docosahexaenoic acid (DHA) and arachidonic acid (AA) on oral tolerance (OT) development in allergy-prone infants is less known.

OBJECTIVES

We aim to determine the effects of early life DHA supplementation (1% of total fat, from novel canola oil), along with AA, on OT toward ovalbumin (ova, egg protein) in allergy-prone BALB/c pups at 6-wk.

METHODS

Breastfeeding dams (n ≥ 10/diet) were fed DHA+AA (1% DHA, 1% AA wt/wt of total fat) or control (0% DHA, 0% AA) suckling period diet (SPD) during which pups consumed dam's milk. At 3-wk, pups from each SPD group were assigned to either the control or DHA+AA weaning diet. For OT, pups from each diet group were either orally fed ova or placebo daily from 21-25 d. Systemic immunization to ova was induced through intraperitoneal injections before euthanizing 6-wk pups. Ova-specific immunoglobulin (ova-Ig) and splenocytes ex-vivo cytokine response to different stimuli were analyzed using a 3-factor analysis of variance.

RESULTS

OT-induced suppression was seen in ova-stimulated splenocyte ex-vivo response, where ova-tolerized pups showed significantly lower total immunoglobulin (Ig)G, IgG1, interleukin (IL)-2 and IL-6 production than sucrose (placebo) pups. DHA+AA SPD was associated with 3 times lower plasma concentrations of ova-IgE (P = 0.03) than controls. DHA+AA weaning diet resulted in lower T helper type-2 cytokines (IL-4 and IL-6) with ova stimulation than controls, which may benefit OT. DHA+AA SPD resulted in significantly higher T cell cytokine response [IL-2, interferon-gamma, (IFNγ) and IL-1β] to anti-CD3/CD28 stimulation than controls. The splenocytes stimulated with lipopolysaccharide produced lower inflammatory cytokines (IFNγ, tumor necrosis factor-alpha, IL-6, and C-X-C motif ligand 1), which may be because of lower CD11b+CD68+ splenocytes proportion in pups from DHA+AA SPD than control (all P < 0.05).

CONCLUSIONS

DHA and AA in early life may influence OT in allergy-prone BALB/c mouse offspring, as they effectively promote T helper type-1 immune responses.

Comparison of glycerophospholipid and sphingolipid in mature milk from different sampled regions in the Chinese human milk project (CHMP) study

Milk phospholipids (PLs) are critical components of infant growth. This study aimed to discover PL in mature human milk (HM) from China (n = 201) and mainly assessed the effect caused by sampled regions. The average total PL concentration was quantified from 3.65 to 11.25 mg per g of lipid, and the major PL class identified was sphingomyelin (SM, 38.06-47.62 %), followed by phosphatidylcholine (PC, 29.61-34.39 %), and phosphatidylethanolamine (PE, 10.54-24.46 %). In addition, the 36:2 (18:0/18:2), 38:6 (16:0/22:6), 40:1 (d18:1/22:0), and 42:2 (d18:1/24:1) were the most abundant molecular species identified in glycerophospholipid and SM molecular species respectively. Some PL molecular species were strongly related with region of sampling, like lysophosphatidylinositol 18:1 was only detected in Beijing. In conclusion, those findings showed that the PL molecular species and concentration of HM had significant regional diversity, and it will give the Chinese human milk database more accurate PL data.

Higher Availability of Long-Chain Monounsaturated Fatty Acids in Preterm than in Full-Term Human Milk

While the role of n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFAs) in the maturation of the infantile nervous system is extensively studied and relatively well-characterized, data on the potential developmental importance of the n-9 long-chain monounsaturated fatty acid (LCMUFA), nervonic acid (NA, C24:1n-9) are scarce and ambiguous. Therefore, the aim of the present study was to reanalyze our available data on the contribution of NA and its LCMUFA precursors, gondoic acid (C20:1n-9) and erucic acid (EA, C22:1n-9) to the fatty acid composition of human milk (HM) during the first month of lactation in mothers of both preterm (PT) and full-term (FT) infants. HM samples were obtained daily during the first week of lactation, and then on the 14th, 21st, and 28th days. Values of the LCMUFAs, C20:1n-9, EA, and NA were significantly higher in colostrum than in transient and mature HM. Consequently, there were highly significant inverse associations between LCMUFA values and the duration of lactation. Moreover, C20:1n-9, EA, and NA values were monotonously, considerably, and at many timepoints significantly higher in PT than in FT HM samples. By the 28th day of lactation, summarized LCMUFA values in PT HM samples declined to the level measured in FT HM samples on the first day of lactation; however, EA and NA values were still significantly higher in PT than in FT HM on the 28th day. Significantly higher availability of LCMUFAs in PT than in FT HM underpins the potential biological role of this hitherto somewhat neglected group of fatty acids.

Temporal evolution of fatty acid content in human milk of lactating mothers from the Philippines

Fatty acids (FA) play a key role in infant growth and development. The aim of this study was to study the temporal evolution of FA from 3 or 4 weeks to 4 months postpartum in human milk (HM) from Filipino mothers. Mid-morning HM samples (n = 41) were collected after full expression from a single breast and FA were assessed using gas-liquid chromatography coupled to flame ionization detector. The total FA content remained relatively constant over the study period. The most abundant FA in HM were oleic acid (OA), palmitic acid (PA) and linoleic acid (LA), a trend similarly reported in HM from European and Chinese mothers. The former two were unchanged over the course of lactation while there was a slight increase in LA content over time. Similarly, the saturated fatty acid (SFA) and monounsaturated FA (MUFA) contents did not vary over the first four months of lactation. The SFA content was much higher than that reported in HM from Europe and China, mainly driven by PA, lauric and myristic acids. The MUFA content on the other hand, while comparable to that reported in HM from Chinese populations was lower than that reported in Europe. There was a small increase in the polyunsaturated FA (PUFA) content over the study duration. The levels of essential FA, linoleic acid (LA) and α-linolenic acid (ALA) were found to be much lower than that reported in other populations. The concentrations of arachidonic acid (AA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) remained stable over the study duration. AA and DHA in HM from Filipino mothers were comparable to global averages, however in case of the latter the concentration was found to be lower than in previous reports. DHA is of great clinical significance as it plays a key role in infant growth and development. In our study, we observed a wide inter- and intra-individual variability in the levels of DHA in HM, presumably reflecting diverse intakes of DHA rich foods and bioconversion in vivo. Personalized recommendations may help achieve recommended levels of DHA amongst population with levels below global averages. This may help achieve HM sufficiency and therefore be linked to clinical benefits for the mother and the baby. SUMMARY: This study details the temporal evolution of human milk (HM) fatty acids (FA) in Filipino mothers up to four months postpartum. The total FA content remained relatively constant over the study period. The most abundant FA were oleic, palmitic and linoleic acids. HM from Filipino mothers had relatively higher saturated FA content driven by palmitic, lauric and myristic acids, while the levels of essential FA, linoleic and α-linoleic acids were lower compared to other populations. Similarly, the concentration of monounsaturated FA were also lower than that reported in HM from European mothers. Arachidonic acid and docosahexaenoic acid (DHA) concentrations were comparable to global averages however the HM DHA levels were seen to have decreased when compared to previous reports from the Philippines. Additionally, a wide variability was seen in HM DHA levels suggesting a need for strategies such as personalized recommendations in order to ensure HM DHA sufficiency.

Interaction between maternal dietary fat intake, breast milk omega-3 fatty acids and infant growth during the first year of life

BACKGROUND

Long chain fatty acids (LCFA) of human milk (HM) might be associated with different patterns of weight gain in infancy. This study aims to examine the interaction between maternal dietary fat intake, breast milk content of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) with infant growth during the first year of life.

METHODS

This longitudinal study was conducted among 215 Iranian mother-infant pairs. The infants were followed up from birth to 12 months of age. Trained healthcare providers measured infant anthropometrics including weight, length and head circumference at birth, 2, 4, 6 and 12 months of age. Breast hind milk samples were collected in the morning through hand expression between 6 and 12 weeks postpartum. Maternal dietary intake was assessed using a 3-day dietary record. Linear mixed effects models were performed to determine the interaction between maternal dietary fat intake, the breast milk content of EPA and DHA with infant growth. Further adjustments were applied for potential confounders.

RESULTS

Mean and standard deviation (SD) of maternal age and body mass index were 29.70 (5.24) years and 24.47 (4.42) kg/m² , respectively. Mean (SD) of infant birth weight was 3177.50 (413.20) g, and 50% were boys. An inverse interaction existed between maternal dietary fat intake and breast milk EPA with infant 4-month weight (β: -366.2, P-value: 0.01). We found a significant association of maternal dietary fat intake and infant 6-month weight (β: 22.5, P-value: 0.04). An inverse interaction was documented between maternal dietary fat intake and breast milk DHA with infant weight at 12-month of age (β: -95.3, P-value: 0.02). We found a significant association between maternal dietary fat intake and infant length at 12-month (β: 0.06, P-value: 0.02).

CONCLUSION

We found an inverse interaction between maternal dietary fat intake and breast milk omega-3 fatty acids with infant weight at 4 and 12 months of age. Although longer follow-up of growth indices is recommended, these findings suggest functional relevance of HM composition to infant growth.

Could dietary erucic acid lower risk of brain tumors? An epidemiological look to Chinese population with implications for prevention and treatment

Erucic acid, an omega-9 monounsaturated fatty acid present in Brassicaceae plants (rapeseed and mustard oils) is highly consumed by the Chinese population and according to several global survey studies, its highest levels are encountered in the Chinese women's milk. Erucic acid is an activating ligand of the transcription factor PPARδ and an inhibitor of the transcriptional activity of PPARγ, which drive tumorigenesis of glioblastomas and medulloblastomas. In this theoretical review, we propose that erucic acid in diet may associate with the risk of brain tumors. High grade brain tumors including medulloblastomas in children and glioblastomas in adults have devastating consequences for human health and the latter tumors are practically incurable. CONCORD-3 epidemiological study recently published in 2021 revealed a low ratio of medulloblastomas in the pediatric age group and also a low ratio of glioblastomas in adults in the Chinese population. It is certain that such profound differences can not be attributed to a single genetic factor or a single nurture pattern. It is very likely that multiple hereditary, nutritional and environmental factors are responsible for these lower ratios; yet here we propose that erucic acid may be one of the contributing factors. If future epidemiological studies and animal models show antitumor activity of erucic acid regarding brain neoplasias, it can be utilized as a preventive strategy for populations possessing very high risks to develop brain tumors such as those harbouring hereditary syndromes increasing the vulnerability to develop such malignancies.

Breastmilk PUFA strongly associated with maternal dietary intake but not anthropometric parameters and breastmilk carotenoids

BACKGROUND

Long chain polyunsaturated fatty acids (PUFA) and the optimal n-6/n-3 fatty acids ratio are essential for proper neurodevelopment in infancy. This study aimed to evaluate the association between breastmilk fatty acid intake and maternal dietary intake, anthropometrics and breastmilk carotenoid levels.

METHODS

This observational, prospective study included 44 women in the first, third, and sixth month of lactation. At each study visit, maternal anthropometric measures were assessed and breastmilk samples were collected and assessed for fatty acids and carotenoids. At the third and sixth month, maternal diet was evaluated by three-day foods record.

RESULTS

Mean breastmilk docosahexaenoic (DHA) was 0.58%, 0.47%, and 0.49%, respectively at the 1, 3, and 6 month (p ≤ 0.05). Mean DHA intake were higher in month 3 compared to 6: 357 vs. 169 mg/day. Pre-pregnancy BMI was associated with SFA, PUFA, and n-6 PUFA at 1 month, whereas current BMI to SFA at months 1 and 3. DHA was correlated with lycopene, total carotenoids at 1 month and total carotenoids at month 3, whereas n-3 PUFA to lycopene at 1 month. DHA, n-3 PUFA, n-6 PUFA and saturated (SFA) levels were associated with its dietary intake both at months 3 and 6, AA/DHA and LA/ALA ratios only at month 3.

CONCLUSIONS

Maternal intake of PUFA and n-6/n-3 ratios were a good predictor of its breastmilk composition, whereas pre-pregnancy and current BMI, as well as breastmilk carotenoids had a limited influence.

Associations of Region and Lactation Stage with Odd-Chain Fatty Acid Profile in Triglycerides of Breast Milk in China

Odd-chain fatty acids (OCFAs), with potential value for growing infants, have been reported in breast milk. The association of location and lactation stage with the profile and content of OCFAs in breast milk was studied. We analyzed 1487 breast milk samples collected from 12 areas in China, and 102 infant formulas from different brands were purchased from the local supermarket. The content of sn-2 C15:0 significantly decreased from the colostrum to the mature stage, while that of C17:0 was not significantly increased by the lactation stage (p > 0.05). The content of C15:0 and C17:0 significantly decreased dramatically after the colostrum period, while the content of C13:0 was highest in the mature stage. The level of C15:0 and C17:0 in human milk from Gansu and Xinjiang was significantly higher than that from other areas. Similar trends were observed on the level of sn-2 C15:0 and C17:0, whereas the content of sn-2 C11:0 and C13:0 was significantly higher in breast milk from Shandong. Based on the PDS-LA analysis, the difference among infant formulas, each stage of human milk and human milk from different locations were different. Research is needed to determine if there are health benefits associated with OCFAs.

Predictors of Human Milk Fatty Acids and Associations with Infant Growth in a Norwegian Birth Cohort

Triglyceride-bound fatty acids constitute the majority of lipids in human milk and may affect infant growth. We describe the composition of fatty acids in human milk, identify predictors, and investigate associations between fatty acids and infant growth using data from the Norwegian Human Milk Study birth cohort. In a subset of participants (n = 789, 30% of cohort), oversampled for overweight and obesity, we analyzed milk concentrations of detectable fatty acids. We modelled percent composition of fatty acids in relation to maternal body mass index, pregnancy weight gain, parity, smoking, delivery mode, gestational age, fish intake, and cod liver oil intake. We assessed the relation between fatty acids and infant growth from 0 to 6 months. Of the factors tested, excess pregnancy weight gain was positively associated with monounsaturated fatty acids and inversely associated with stearic acid. Multiparity was negatively associated with monounsaturated fatty acids and n-3 fatty acids while positively associated with stearic acid. Gestational age was inversely associated with myristic acid. Medium-chain saturated fatty acids were inversely associated with infant growth, and mono-unsaturated fatty acids, particularly oleic acid, were associated with an increased odds of rapid growth. Notably, excessive maternal weight gain was associated with cis-vaccenic acid, which was further associated with a threefold increased risk of rapid infant growth (OR = 2.9, 95% CI 1.2–6.6), suggesting that monounsaturated fatty acids in milk may play a role in the intergenerational transmission of obesity.

Human Milk Lipid Profiles around the World: A Systematic Review and Meta-Analysis

Reported breast milk lipid concentrations may vary with geographical region, postnatal age, and year of sample collection. In this review, we summarized data on the concentrations of total fat, total phospholipids, cholesterol, and fatty acids in human milk worldwide and their variation according to lactation stage, study area, and sample collection year. A systematic literature search was performed using the PubMed, Embase, Web of Science, and Medline databases for English-language papers and Wanfang and China National Knowledge Infrastructure databases for Chinese-language papers. A total of 186 studies evaluating the human milk lipid profiles were included. According to random-effects models based on worldwide data, the summarized means (95% CIs) as percentages of total fat were 42.2% (41.1%, 43.3%) for SFAs, 36.6% (35.6%, 37.5%) for MUFAs, and 21.0% (19.3%, 22.7%) for PUFAs. However, the study heterogeneity was high for most types of fatty acids (I2 > 99%). Human milk from Western countries had higher concentrations of MUFAs and 18:1n-9 (ω-9), but lower concentrations of PUFAs, 18:2n-6, 20:4n-6, 18:3n-3, 20:5n-3, 22:6n-3, and total n-6 PUFA compared with those from non-Western countries (P < 0.001-0.011). Significant lactation stage differences were observed for total fat and some individual fatty acids. The concentrations of SFAs and 16:0 were significantly negatively correlated with sampling year (P < 0.001-0.028). In contrast, a significant positive correlation between the concentrations of 18:2n-6 and 18:3n-3 and sampling year was observed (P < 0.001-0.035). Our results suggest that the pooling of data on human milk lipid profiles in different studies should be done with caution due to the high between-study heterogeneity. The concentration of lipids, including total fat, cholesterol, and specific fatty acids, differs in human milk according to lactation stage, geographical region, and year of sample collection.

Comprehensive Analysis of Lipid Composition in Human Foremilk and Hindmilk

Precision nutrition, also referred to as personalized nutrition, focuses on the individual to determine the individual's most effective eating plan to prevent or treat disease. A precision nutrition for infants requires the determination of the profile of human milk. We compared the lipid profiles of the foremilk (i.e., the initial milk of a breastfeed) and hindmilk (the last milk) of six Japanese subjects and evaluated whether a human milk lipid profile is useful for precision nutrition even though the fat concentration fluctuates during lactation. We detected and quantified 527 species with a lipidome analysis by liquid chromatography-tandem mass spectrometry. The fat concentration in hindmilk (120.6 ± 66.7 μmol/mL) was significantly higher than that in foremilk (68.6 ± 33.3 μmol/mL). While the total carbon number of fatty acids in triglyceride (TG) was highest in C52 for all subjects, the second or third number differed among the subjects. Both the distribution of total carbon number of fatty acids included in TG and the distribution of fatty acids in TG classified by the number of double bonds were almost the same in the foremilk and hindmilk in each subject. The lipids levels containing docosahexaenoic acid and arachidonic acid in total lipids of the foremilk and the hindmilk were almost the same in each subject. Among the sphingolipids and glycerophospholipids, the level of sphingomyelin was the highest in four subjects' milk, and phosphatidylcholine was the highest in the other two subjects' milk. The order of their major species was the same in each foremilk and hindmilk. A clustering heatmap revealed the differences between foremilk and hindmilk in the same subject were smaller than the differences among individuals. Our analyses indicate that a human-milk lipid profile reflects individual characteristics and is a worthwhile focus for precision nutrition.

Human Milk Lipids Induce Important Metabolic and Epigenetic Changes in Neonates

Lipids are a major source of energy during the fetal/neonatal period. Most are received from the mother, transplacentally during the intrauterine period or via maternal milk after birth. However, in addition to the known nutritional roles, lipids are now known to bind a variety of cellular receptors to regulate specific patterns in metabolism and gene expression. The expression of these receptors is regulated by various genetic and environmental stimuli, and ligation can activate positive-feedback loops in the expression and the activity of downstream signaling pathways. The authors summarize the role of lipid ligands, cognate receptors, epigenetic regulation, and downstream signaling.

Changes in Human Milk Fat Globule Composition Throughout Lactation: A Review

There has been a growing interest in understanding how the relative levels of human milk fat globule (MFG) components change over the course of lactation, how they differ between populations, and implications of these changes for the health of the infant. In this article, we describe studies published over the last 30 years which have investigated components of the MFG in term milk, focusing on changes over the course of lactation and highlighting infant and maternal factors that may influence these changes. We then consider how the potential health benefits of some of the milk fat globule membrane (MFGM) components and derived ingredients relate to compositional and functional aspects and how these change throughout lactation. The results show that the concentrations of phospholipids, gangliosides, cholesterol, fatty acids and proteins vary throughout lactation, and such changes are likely to reflect the changing requirements of the growing infant. There is a lack of consistent trends for changes in phospholipids and gangliosides across lactation which may reflect different methodological approaches. Other factors such as maternal diet and geographical location have been shown to influence human MFGM composition. The majority of research on the health benefits of MFGM have been conducted using MFGM ingredients derived from bovine milk, and using animal models which have clearly demonstrated the role of the MFGM in supporting cognitive and immune health of infants at different stages of growth and development.

Human milk fatty acid composition and its association with maternal blood and adipose tissue fatty acid content in a cohort of women from Europe

Purpose

Human milk (HM) composition is influenced by factors, like maternal diet and body stores, among other factors. For evaluating the influence of maternal fatty acid (FA) status on milk FA composition, the correlation between FA content in HM and in maternal plasma, erythrocytes, and adipose tissue was investigated.

Methods

223 European women who delivered at term, provided HM samples over first four months of lactation. Venous blood and adipose tissue (only from mothers who consented and underwent a C-section delivery) were sampled at delivery. FAs were assessed in plasma, erythrocytes, adipose tissue, and HM. Evolution of HM FAs over lactation and correlations between FA content in milk and tissues and between mother’s blood and cord blood were established.

Results

During lactation, arachidonic acid (ARA) and docosahexaenoic acid (DHA) significantly decreased, while linoleic acid (LA), alpha-linolenic acid (ALA), and eicosapentaenoic acid (EPA) remained stable. Positive correlations were observed between HM and adipose tissue for palmitic, stearic, oleic, and polyunsaturated fatty acids (PUFAs). Correlations were found between milk and plasma for oleic, LA, ARA, ALA, DHA, monounsaturated fatty acids (MUFAs), and PUFAs. No correlation was observed between erythrocytes and HM FAs. LA and ALA were more concentrated in maternal blood than in infant blood, contrary to ARA and DHA, supporting that biomagnification of LCPUFAs may have occurred during pregnancy.

Conclusions

These data show that maternal adipose tissue rather than erythrocytes may serve as reservoir of PUFAs and LCPUFAs for human milk. Plasma also supplies PUFAs and LCPUFAs to maternal milk. If both, adipose tissue and plasma PUFAs, are reflection of dietary intake, it is necessary to provide PUFAs and LCPUFAs during pregnancy or even before conception and lactation to ensure availability for mothers and enough supply for the infant via HM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02788-6.

Erucic acid exposure during the first year of life-Scenarios with precise food-based dietary guidelines

Recently, the European Food Safety Authority (EFSA) issued a tolerable daily intake (TDI) for erucic acid, which is mainly found in rapeseed oil. Infants may be exposed to erucic acid from rapeseed oil indirectly through maternal consumption via breastmilk or the fat component in formula, and directly as a part of complementary feeding (CF). To check the safety of infant nutrition, scenarios for erucic acid exposure were calculated based on the daily food amounts of the German dietary guidelines. Information on erucic acid concentrations in foods was obtained from European studies for breastmilk, from EFSA samples for formula powder, and from a representative analysis of rapeseed oil samples in the German retail market. 6 scenarios were calculated for the early milk feeding phase (4 formula feeding, 2 breastfeeding) and 8 scenarios for the later CF phase (5 CF +formula feeding, 3 CF +breastfeeding). Out of the 14 scenarios, only 3 resulted in exposures that were definitively below the TDI (range 4.4.-6.0 mg/kg bodyweight; BW). Assuming either high consumption or high concentration led to high exceedances (range 7.5-26.2 mg/kg BW), especially in case of the new EU limits for formula or vegetable oils (33.6 and 43.2 mg/kg BW, respectively). In our scenarios, high erucic acid exposures occurred during a particularly sensitive developmental period. To definitively weigh the potential risks from erucic acid in infants against nutritional benefits of the dietary recommendations, reliable, timely data on erucic acid in breast milk and formula are needed, similar to those from rapeseed oil in Germany.

Cohort profile: Japanese human milk study, a prospective birth cohort: baseline data for lactating women, infants and human milk macronutrients

PURPOSE

The Japanese Human Milk Study, a longitudinal prospective cohort study, was set up to clarify how maternal health, nutritional status, lifestyle and sociodemographic and economic factors affect breastfeeding practices and human milk composition. This would eventually determine factors affecting the growth and development of infants and children.

PARTICIPANTS

A total of 1210 Japanese lactating women who satisfied the inclusion criteria, were invited across the country at various participating sites, between 2014 and 2019. Finally a total of 1122 women were enrolled in this study.

FINDINGS TO DATE

Among 1122 eligible participants, mean age at delivery was 31.2 (SD 4.4) years and mean prepregnancy BMI was 20.8 (SD 2.7). Among these women, 35% were previously nulliparous and 77.7% had college, university or higher education. The mean gestational period was 39.0 (SD 1.3) weeks. Caesarean section was reported among 11.9%; mean infant birth weight was 3082 (SD 360) g. Of the infants, 53.7% were male. Overall, our participants appeared to be healthier than the general population in Japan. Analyses of the 1079 eligible human milk samples obtained at the first and second months postpartum showed the following composition: carbohydrate, 8.13 (SD 0.32) g/100 mL; fat, 3.77 (SD 1.29) g/100 mL; and crude protein, 1.20 (SD 0.23) g/100 mL. We also analysed osteopontin, fatty acid, vitamin D and phospholipid levels in limited subcohorts of the samples.

FUTURE PLANS

Follow-up surveys will be conducted to obtain milk samples every 2 months for 12 months and to investigate mother and child health until the children reach 5 years of age. These will be completed in 2024. We plan to longitudinally analyse the composition of macronutrients and various bioactive factors in human milk and investigate the lifestyle and environmental factors that influence breastfeeding practices, maternal and child health, and child development.

TRIAL REGISTRATION NUMBER

UMIN000015494; pre-results.

Total Fatty Acid and Polar Lipid Species Composition of Human Milk

Human milk lipids are essential for infant health. However, little is known about the relationship between total milk fatty acid (FA) composition and polar lipid species composition. Therefore, we aimed to characterize the relationship between the FA and polar lipid species composition in human milk, with a focus on differences between milk with higher or lower milk fat content. From the Norwegian Human Milk Study (HUMIS, 2002–2009), a subset of 664 milk samples were analyzed for FA and polar lipid composition. Milk samples did not differ in major FA, phosphatidylcholine, or sphingomyelin species percentages between the highest and lowest quartiles of total FA concentration. However, milk in the highest FA quartile had a lower phospholipid-to-total-FA ratio and a lower sphingomyelin-to-phosphatidylcholine ratio than the lowest quartile. The only FAs associated with total phosphatidylcholine or sphingomyelin were behenic and tridecanoic acids, respectively. Milk FA and phosphatidylcholine and sphingomyelin species containing these FAs showed modest correlations. Associations of arachidonic and docosahexaenoic acids with percentages of phosphatidylcholine species carrying these FAs support the conclusion that the availability of these FAs limits the synthesis of phospholipid species containing them.

Macronutrient content and fatty acid composition and their positional distribution in human breast milk from Zhejiang Province, China in different lactation periods

Lactational changes in macronutrient content, lipid profile, fatty acid composition, and positional distribution of human breast milk were investigated in this study. A total of 378 milk samples of six different lactation periods, including 0‒5, 6‒14, 15‒30, 31‒90, 91‒180, and 181‒360 days, were collected cross-sectionally from healthy lactating women in Zhejiang, China. As lactation progressed from 0‒5 to 15‒30 days, the lipid content and the percentages of C10:0, C12:0, C14:0, C18:2n-6, and C18:3n-3 increased significantly, while the protein concentration and the proportions of phospholipids, cholesterols, C16:0, C18:1n-9, C24:1n-9, C20:4n-6, C22:4n-6, C22:5n-3, and C22:6n-3 decreased notably. When lactation was further extended to 181‒360 days, the protein content continued to decrease, and the percentages of C12:0 and C14:0 continued to increase, whereas the levels of other tested nutrients remained stable. Although the triacylglycerol positional distributions of some fatty acids underwent significant lactational variations, C14:0, C16:0, C24:1n-9, C22:4n-6, C22:5n-3, and C22:6n-3 were located mainly at the sn-2 position, while C18:1n-9, C18:2n-6, and C18:3n-3 were primarily distributed at the sn-1,3 positions. Compared with human breast milk reported in Western countries, samples in our study demonstrated higher percentages of C18:2n-6, C18:3n-3, C20:4n-6, and C22:6n-3, but lower proportions of C12:0, C14:0, and C18:1n-9. The results from this study indicated a nutritional composition different from that of the Western countries and may provide useful data for the development of infant formulas closer to Chinese breast milk in terms of the fatty acid composition and its specified positional distribution on triglyceride structure.

Long Chain Polyunsaturated Fatty Acids Docosahexaenoic Acid and Arachidonic Acid Supplementation in the Suckling and the Post-weaning Diet Influences the Immune System Development of T Helper Type-2 Bias Brown Norway Rat Offspring

Background: Dietary long chain polyunsaturated fatty acids (LCPUFA) such as arachidonic acid (ARA) and docosahexaenoic acid (DHA) play an important role in the development of the infant immune system. The role of LCPUFA in the T helper type 2 (Th2) biased immune system is unknown. We aimed to understand the effect of feeding LCPUFA during suckling and post-weaning on immune system development in Th2 bias Brown Norway rat offspring.

Methods: Brown Norway dams were randomly assigned to nutritionally adequate maternal diet throughout the suckling period (0–3 weeks), namely, control diet (0% ARA, 0% DHA; n= 8) or ARA + DHA (0.45% ARA, 0.8% DHA; n = 10). At 3 weeks, offspring from each maternal diet group were randomized to either a control (0% ARA, 0% DHA; n = 19) or ARA+DHA post-weaning (0.5% ARA, 0.5% DHA; n = 18) diet. At 8 weeks, offspring were killed, and tissues were collected for immune cell function and fatty acid composition analyses.

Results: ARA + DHA maternal diet resulted in higher (p < 0.05) DHA composition in breast milk (4×) without changing ARA levels. This resulted in more mature adaptive immune cells in spleen [T regulatory (Treg) cells and B cells], mesenteric lymph nodes (MLN, lower CD45RA+), and Peyer's patches (PP; higher IgG+, B cells) in the ARA+DHA group offspring at 8 weeks. ARA+DHA post-weaning diet (3–8 weeks) resulted in 2 × higher DHA in splenocyte phospholipids compared to control. This also resulted in higher Th1 cytokines, ~50% higher TNF-α and IFNγ, by PMAi stimulated splenocytes ex vivo, with no differences in Th2 cytokines (IL-4, IL-13, and IL-10) compared to controls.

Conclusion: Feeding dams a diet higher in DHA during the suckling period resulted in adaptive immune cell maturation in offspring at 8 weeks. Providing ARA and DHA during the post-weaning period in a Th2 biased Brown Norway offspring model may support Th1 biased immune response development, which could be associated with a lower risk of developing atopic diseases.

Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes.

Perinatal Polyunsaturated Fatty Acid Status and Obesity Risk

High obesity rates in almost all regions of the world prompt an urgent need for effective obesity prevention. Very good scientific evidence from cell culture and rodent studies show that the availability of essential polyunsaturated fatty acids (PUFA) and their long-chain polyunsaturated derivatives, namely, arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid, influence adipogenesis; for this reason, early life status may influence later obesity risk. The respective PUFA effects could be mediated via their eicosanoid derivatives, their influence on cell membrane properties, the browning of white adipose tissue, changes to the offspring gut microbiome, their influence on developing regulatory circuits, and gene expression during critical periods. Randomized clinical trials and observational studies show divergent findings in humans, with mostly null findings but also the positive and negative effects of an increased n-3 to n-6 PUFA ratio on BMI and fat mass development. Hence, animal study findings cannot be directly extrapolated to humans. Even though the mechanistic data basis for the effects of n-3 PUFA on obesity risk appears promising, no recommendations for humans can be derived at present.

Health benefits of docosahexaenoic acid and its bioavailability: A review

Docosahexaenoic acid (DHA) is the predominant omega-3 long-chain polyunsaturated fatty acid found in human brain and eyes. There are a number of studies in the literature showing the health benefits of DHA. It is critical throughout all life stages from the need for fetal development, the prevention of preterm birth, and the prevention of cardiovascular disease to the improvements in the cognitive function and the eye health of adults and elderly. These benefits might be related to the modulation of gut microbiota by DHA. In addition, there are some discrepancies in the literature regarding certain health benefits of DHA, and this review is intended to explore and understand these discrepancies. Besides the variations in the DHA contents of different supplement sources, bioavailability is crucial for the efficacy of DHA supplements, which depends on several factors. For example, DHA in phospholipid and triglyceride forms are more readily to be absorbed by the body than that in ethyl ester form. In addition, dietary lipids in meals and emulsification of DHA oil can increase the bioavailability of DHA. Estrogens stimulated the biosynthesis of DHA, whereas testosterone stimulus induced a decrease in DHA. The roles of DHA through human lifespan, the sources, and its recommended daily intake in different countries are also discussed to provide a better understanding of the importance of this review.

Association between dietary fatty acid patterns based on principal component analysis and fatty acid compositions of serum and breast milk in lactating mothers in Nanjing, China

This study aimed to comprehensively analyze dietary fatty acids (FAs) to evaluate their association with FA compositions of maternal serum and breast milk and assess their effects on mothers and infants. Overall, 121 healthy lactating Chinese mothers at 30-50 days of postpartum were enrolled and instructed to complete a Food Frequency Questionnaire, together with venous blood and breast milk sample collections. Dietary FA patterns were derived by principal component analysis with varimax rotation. Serum and breast milk FA compositions were detected using capillary gas chromatography and presented as relative concentrations (weight percentage of total FAs, %). Daily energy intake, absolute intake of most nutrients, and percentage of energy intake provided by these nutrients significantly varied among the different dietary FA patterns. There were significant differences in serum polyunsaturated fatty acid (PUFA) levels (P = 0.011); in monounsaturated fatty acid and PUFA proportions in breast milk with respect to four patterns (P = 0.002 and P = 0.026, respectively); and in n-6 PUFA, n-3 PUFA, linoleic acid, γ-linolenic acid, α-linolenic acid, and docosahexaenoic acid levels in breast milk (P = 0.027, P = 0.007, P = 0.048, P = 0.034, P = 0.020, and P = 0.002, respectively). Furthermore, maternal weight retention and length-for-age z scores, weight-for-age z scores and head circumference-for-age z scores of infants with respect to the four patterns exhibited significant differences (P = 0.038, P = 0.030, P = 0.034, and P<0.001, respectively). The results demonstrated the effect of dietary FA patterns on FA compositions of serum and breast milk, and patterns mainly characterized by LC-PUFA may have potentially beneficial effects on maternal postpartum recovery and infant growth.

Relationship between traditional maternal diet pattern and breastmilk composition of rural lactating women during the first month postpartum in Shigatse, Tibet

Maternal nutrition can influence the composition of human breastmilk by altering the components that are sensitive to maternal diet pattern. Traditional Tibetan maternal diet pattern among native rural lactating women possesses distinct characteristics due to its unique geographical environment and dietary habits. This study investigated maternal diet pattern and human breastmilk composition of Tibetan lactating women through different lactation stages during the first month postpartum in Shigatse. The results indicated that Tibetan maternal diet profile was apparently monotonous, mainly sufficient in Zanba, buttered tea, red meat, and fatty soup, yet insufficient in white meat, eggs, leafy vegetables, and fruits, leading to imperfect maternal nutritional intakes with high-level carbohydrates and deficient proteins. Distinctions of maternal diet profiles in various degrees can be discovered upon different lactation stages, which brings multiple influences to the composition of human milk. There was significantly weak-to-medium correlation of protein contents between maternal diet intakes and human milk, while other macronutrients correlated insignificantly. Micronutrient constituents in human milk, involving functional unsaturated fatty acids and free essential amino acids, were also impacted by maternal diet intakes through different lactation stages. These results show that more systematic and profound research is requisite for the clarification and development of Tibetan maternal diet to offer more enhanced and individualized nutritional recommendations for Tibetan lactating women and infants.

Bacterial Diversity of Breast Milk in Healthy Spanish Women: Evolution from Birth to Five Years Postpartum

The objective of this work was to characterize the microbiota of breast milk in healthy Spanish mothers and to investigate the effects of lactation time on its diversity. A total of ninety-nine human milk samples were collected from healthy Spanish women and were assessed by means of next-generation sequencing of 16S rRNA amplicons and by qPCR. Firmicutes was the most abundant phylum, followed by Bacteroidetes, Actinobacteria, and Proteobacteria. Accordingly, Streptococcus was the most abundant genus. Lactation time showed a strong influence in milk microbiota, positively correlating with Actinobacteria and Bacteroidetes, while Firmicutes was relatively constant over lactation. 16S rRNA amplicon sequencing showed that the highest alpha-diversity was found in samples of prolonged lactation, along with wider differences between individuals. As for milk nutrients, calcium, magnesium, and selenium levels were potentially associated with Streptococcus and Staphylococcus abundance. Additionally, Proteobacteria was positively correlated with docosahexaenoic acid (DHA) levels in breast milk, and Staphylococcus with conjugated linoleic acid. Conversely, Streptococcus and trans-palmitoleic acid showed a negative association. Other factors such as maternal body mass index or diet also showed an influence on the structure of these microbial communities. Overall, human milk in Spanish mothers appeared to be a complex niche shaped by host factors and by its own nutrients, increasing in diversity over time.

Evaluation of the changes in human milk lipid composition and conformational state with Raman spectroscopy during a breastfeed

Human milk fat forms the main energy source for breastfed infants, and is highly variable in terms of concentration and composition. Understanding the changes in human milk lipid composition and conformational state during a breastfeed can provide insight into lipid synthesis and secretion in the mammary gland. Therefore, the aim of this study was to evaluate human milk fatty acid length, degree of unsaturation (lipid composition) and lipid phase (lipid conformational state) at different stages during a single breastfeed (fore-, bulk- and hindmilk). A total of 48 samples from 16 lactating subjects were investigated with confocal Raman spectroscopy. We did not observe any significant changes in lipid composition between fore-, bulk and hindmilk. A new finding from this study is that lipid conformational state at room temperature changed significantly during a breastfeed, from almost crystalline to almost liquid. This observation suggests that lipid synthesis in the mammary gland changes during a single breastfeed.

Chinese Breast Milk Fat Composition and Its Associated Dietary Factors: A Pilot Study on Lactating Mothers in Beijing

Regional differences were found in breast milk composition. This study intended to profile the composition of fatty acid (FA) and triacylglycerol (TAG) in Chinese breast milk and to explore its association with maternal diet. Breast milk samples and data of 52 lactating women at 60–90 days postpartum were collected. The FA composition was measured using gas chromatography–flame ionization detection (GC-FID), and the TAG profile was detected by an ultra-performance liquid chromatography system, coupled with accurate-mass quadrupole time-of-flight mass spectrometer. A semi-quantitative food intake frequency questionnaire and a one-time 24-h dietary recall were used to evaluate the previous month's and the short-term dietary intake, including dietary patterns, food groups, and nutrients. Oleic–palmitic–linoleic (OPL) is the most predominant TAG within the Chinese human milk, followed by oleic–palmitic–oleic (OPO), with an average OPL-to-OPO ratio of 1.35. Linoleic acid (LA) and oleic acid (OA) accounted for 23.9 and 32.0% of the total FAs, respectively. Among the food groups consumed during the preceding month, LA content was positively associated with the consumption of soybeans and soybean products (r = 0.311, p = 0.030), whereas a negative correlation was identified with seafood consumption (r = −0.302, p = 0.030). Negative correlations were found between the OA content and the consumption of soybeans and soybean products (r = −0.363, p = 0.009), livestock and poultry meat (r = −0.375, p = 0.006), nuts (r = −0.305, p = 0.028), as well as cooking oil (r = −0.445, p = 0.001). No significant associations were identified between the LA and OA contents and the dietary patterns. This study confirmed a high OPL level in Chinese breast milk and revealed associations of FAs with maternal dietary intake.

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

(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.

Milk Phospholipid Profiling Among Japanese Women with Differing Docosahexaenoic Acid Levels

To characterize the milk phospholipids (PLs) profile using phosphorus-31 nuclear magnetic resonance (³¹P-NMR) and to investigate the effect of elevated milk docosahexaenoic acid (DHA) levels on PLs profiles in Japanese mothers.

Methods

Milk samples from eligible patients with high and low DHA from a former cross-sectional study (n = 20; n = 10 for each group) were included. Fifteen milk PLs were analyzed using ³¹P-NMR, and the profiles were compared group-wise using Mann-Whitney U-test. The P value of <0.05 was considered statistically significant.

Results

The median DHA content in milk was 1.13% and 0.29% for the high and low milk DHA groups, respectively. Twelve PLs, excluding lysophosphatidylserine, cardiolipin, and phosphatidylglycerol, were detected in all participants with 100% positive results. The median concentrations and proportions of total PLs, sphingophospholipids, and glycerophospholipids were comparable between groups. The proportions of choline-containing glycerophospholipid were significantly higher in the high milk DHA group than that in the low milk DHA group (24.09% [median, interquartile range: 23.08%-26.38%] and 21.41% [20.74%-22.84%], P = 0.019). Although the proportions of phosphatidylinositol were significantly lower in the high milk DHA group than that in the low milk DHA group (6.62% [5.75%-6.72%] versus 7.63% [7.11%-8.16%], P = 0.002), while that of phosphatidylcholine (21.90% [18.51%-23.22%] versus 19.78% [18.17%-20.26%], P = 0.059) and alkyl-acyl phosphatidylcholine (0.60% [0.40%-0.74%] versus 0.33% [0.14%-0.51%], P = 0.059) were higher in the former than that in the latter.

Conclusions

Our results were comparable to that of the previous literature. Large variations in the milk DHA might affect the composition of choline-containing glycerophospholipids in Japanese mothers. However, possible confounders were not excluded in the study populations.

Randomized Controlled Trial of Early Docosahexaenoic Acid and Arachidonic Acid Enteral Supplementation in Very Low Birth Weight Infants

OBJECTIVE

To determine feasibility of providing a concentrated emulsified long-chain polyunsaturated fatty acids (LCPUFA) supplement to very low birth weight infants, and to evaluate blood LCPUFA concentrations at 2 and 8 weeks of study supplementation.

STUDY DESIGN

This prospective, randomized, double-blind, placebo-controlled trial randomized infants to receive (1) LCPUFA-120 (a supplement of 40 mg/kg/day docosahexaenoic acid [DHA] and 80 mg/kg/day arachidonic acid [ARA]; DHA:ARA at 1:2 ratio), (2) LCPUFA-360 (a supplement of 120 mg/kg/day DHA and 240 mg/kg/day ARA), or (3) sunflower oil (placebo control). Infants received supplement daily for 8 weeks or until discharge, whichever came first. Whole blood LCPUFA levels (wt%; g/100 g) were measured at baseline, 2 weeks, and 8 weeks.

RESULTS

Infants were 28 weeks of gestation (IQR, 27-30 weeks of gestation) and weighed 1040 g (IQR, 910-1245 g). At 2 weeks, the change in blood DHA (wt%) from baseline differed significantly among groups (sunflower oil, n = 6; -0.63 [IQR, -0.96 to -0.55]; LCPUFA-120: n = 12; -0.14 [IQR, -0.72 to -0.26]; LCPUFA-360, n = 12; 0.46 [IQR, 0.17-0.81]; P = .002 across groups). Change in blood ARA (wt%) also differed by group (sunflower oil: -2.2 [IQR, -3.9 to -1.7]; LCPUFA-120: 0.1 [IQR, -2.1 to 1.1] vs LCPUFA-360: 2.9 IQR, 1.5 to 4.5]; P = .0002). Change from baseline to 8 weeks significantly differed between groups for DHA (P = .02) and ARA (P = .003).

CONCLUSIONS

Enteral LCPUFA supplementation supported higher blood DHA by 2 weeks. LCPUFA supplementation at 360 mg of combined DHA and ARA is likely necessary to reduce declines as well as allow increases in whole blood concentrations in the first 8 weeks of life.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT03192839.

Milk fat globule membrane in infant nutrition: a dairy industry perspective

This review provides an overview of the composition, structure, and biological activities of milk fat globule membrane (MFGM) compounds with focus on the future application of this compound as a food ingredient. MFGM is a particular component of mammalian milks and is comprised of a tri-layer of polar lipids, glycolipids and proteins. In recent years, MFGM has been extensively studied for the purpose of enhancing the efficacy of infant nutrition formula. For example, infant formulas supplemented with bovine MFGM have shown promising results with regard to neurodevelopment and defense against infections. Components of MFGM have been shown to present several health benefits as the proteins of the membrane have shown antiviral activity and a reduction in the incidence of diarrhea. Moreover, the presence of sphingomyelin, a phospholipid, implies beneficial effects on human health such as enhanced neuronal development in infants and the protection of neonates from bacterial infections. The development of a lipid that is similar to human milk fat would represent a significant advance for the infant formula industry and would offer high technology formulas for those infants that depend on infant formula. The complexity of the structure of MFGM and its nutritional and technological properties is critically examined in this review with a focus on issues relevant to the dairy industry.