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Nagel E, Elgersma KM, Gallagher TT, Johnson KE, Demerath E, Gale CA. Importance of human milk for infants in the clinical setting: Updates and mechanistic links. Nutr Clin Pract 2023; 38 Suppl 2:S39-S55. [PMID: 37721461 PMCID: PMC10513735 DOI: 10.1002/ncp.11037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Human milk (HM) is the optimal source of nutrition for infants and has been implicated in multiple aspects of infant health. Although much of the existing literature has focused on the individual components that drive its nutrition content, examining HM as a biological system is needed for meaningful advancement of the field. Investigation of the nonnutritive bioactive components of HM and the maternal, infant, and environmental factors which affect these bioactives is important to better understand the importance of HM provision to infants. This information may inform care of clinical populations or infants who are critically ill, hospitalized, or who have chronic diseases and may benefit most from receiving HM. METHODS In this narrative review, we reviewed literature examining maternal and infant influences on HM composition with a focus on studies published in the last 10 years that were applicable to clinical populations. RESULTS We found multiple studies examining HM components implicated in infant immune and gut health and neurodevelopment. Additional work is needed to understand how donor milk and formula may be used in situations of inadequate maternal HM. Furthermore, a better understanding of how maternal factors such as maternal genetics and metabolic health influence milk composition is needed. CONCLUSION In this review, we affirm the importance of HM for all infants, especially clinical populations. An understanding of how HM composition is modulated by maternal and environmental factors is important to progress the field forward with respect to mechanistic links between HM biology and infant health outcomes.
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Affiliation(s)
- Emily Nagel
- School of Public Health, University of Minnesota-Twin Cities, Minnesota, USA
| | | | | | - Kelsey E Johnson
- Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, Minnesota, USA
| | - Ellen Demerath
- School of Public Health, University of Minnesota-Twin Cities, Minnesota, USA
| | - Cheryl A. Gale
- Department of Pediatrics, University of Minnesota-Twin Cities, Minnesota, USA
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Zhou Z, Liu Y, Yan T, Tu S, Guo H, Zhou J, Ye Z, Zhang Z, Li K, Zhao P, Zuo G, Han B. Multi-point analysis of absorbance for detection of lactose in breast milk using back-propagation neural network. J Food Compost Anal 2023. [DOI: 10.1016/j.jfca.2023.105305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Karbasi S, Mohamadian M, Naseri M, Yahya Hanafi-Bojd M, Khorasanchi Z, Morovatdar N, Zarban A, Bahrami A, Ferns GA. The association of maternal food quality score (FQS) with breast milk nutrient content and antioxidant content of infant urine: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:126. [PMID: 36829155 PMCID: PMC9951474 DOI: 10.1186/s12884-023-05400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/20/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Breast milk (BM) is a complex fluid with a variable composition within women over time and between women in the population. The BM compositional differences are likely to be partly due to maternal dietary patterns. This study aimed to evaluate food quality score (FQS) in lactating mothers and its association with quality indicators of BM and antioxidant content of infant urine. METHODS This cross-sectional study was undertaken in 350 lactating women aged 20 to 35 years. Data on dietary intake was collected using a validated food frequency questionnaire (FFQ) containing 65 food items. The FQS was calculated by integrating the scores obtained from healthy and unhealthy food groups. Subjects were categorized according to FQS adherence, with the greatest adherence being allocated to the third tertile and those with the lowest FQS in the first tertile. Antioxidant activity of the BM and infant urine samples was assessed using the Ferric reducing antioxidant power (FRAP), 2, 2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Ellman's assay. The total content of BM protein, calcium, and triglyceride was measured using standard biochemical kits. RESULTS BM from mothers from the third tertile of FQS contained significantly higher DPPH, thiol, calcium, and protein levels compared to BM from those in the lowest tertile (p˂0.05). Infant urinary DPPH and FRAP was also significantly higher in the highest tertile vs. the lowest tertile (p˂0.05). CONCLUSION High maternal adherence to the FQS was associated with a high BM quality and antioxidant content of infant urine.
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Affiliation(s)
- Samira Karbasi
- grid.411701.20000 0004 0417 4622Department of Molecular Medicine, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Malihe Mohamadian
- grid.411701.20000 0004 0417 4622Cellular and Molecular Research Center, Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohsen Naseri
- grid.411701.20000 0004 0417 4622Cellular and Molecular Research Center, Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Yahya Hanafi-Bojd
- grid.411701.20000 0004 0417 4622Cellular and Molecular Research Center, Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran ,grid.411701.20000 0004 0417 4622Department of Pharmaceutics and Pharmaceutical Nanotechnology. School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Khorasanchi
- grid.411583.a0000 0001 2198 6209Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- grid.411583.a0000 0001 2198 6209Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asghar Zarban
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran. .,Clinical Biochemistry Department, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
| | - Afsane Bahrami
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. .,Clinical Research Development Unit of Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Gordon A. Ferns
- grid.414601.60000 0000 8853 076XBrighton and Sussex Medical School, Division of Medical Education, Falmer, Brighton, BN1 9PH Sussex UK
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Maternal Adherence to a Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern and the Relationship to Breast Milk Nutrient Content. Matern Child Health J 2023; 27:385-394. [PMID: 36607482 DOI: 10.1007/s10995-022-03552-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Maternal lifestyle factors, such as diet and nutritional status are likely to affect the composition of breast milk (BM). This study aimed to investigate the association between adherence to a Dietary Approaches to Stop Hypertension (DASH) dietary pattern (DP) and BM nutrient content. METHOD A total of 700 milk samples were obtained from 350 lactating women. The dietary intakes of the women in the study were estimated using a validated food frequency questionnaire, which included 65 food items. The total antioxidant activity (TAC) of BM samples was evaluated using the Ferric reducing antioxidant power (FRAP), 2,2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARS), and Ellman's assay. Also using commercially available kits, the total protein, calcium, and triglyceride contents in milk were determined. RESULTS Individuals in the 3rd tertile of adherence to the DASH diet (highest adherence) consumed more dietary fiber, fruits, vegetables, nuts, legumes, and seeds, low-fat dairy, whole grain, less red and processed meat, sweetened beverages, and sodium than those in the first tertile (lowest adherence). Subjects in the 3rd tertile of DASH DP had higher values of milk DPPH and calcium compared to those in the first tertile (P < 0.05). Milk MDA and triglyceride were significantly lower in the 3rd tertile of DASH diet versus the first tertile (P < 0.05). CONCLUSION Our study showed that high adherence to the DASH DP was associated with higher BM DPPH and calcium levels and lower amounts of BM MDA and triglyceride. The adherence to the healthy DPs such as the DASH can improve the quality of BM in lactating women.
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Effect of Different Dietary Patterns on Macronutrient Composition in Human Breast Milk: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15030485. [PMID: 36771192 PMCID: PMC9919556 DOI: 10.3390/nu15030485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
The aim of this meta-analysis was to systematically review the relationships between lactation diet and the composition of mature breast milk through screening multiple databases and gray literatures, with priority given to quantitative articles published in Chinese and English. We identified 27 cross-sectional studies that included 4355 lactating women. According to these data, dietary patterns were categorized into four patterns based on the fat and protein energy supplying ratio, including rational-fat and rational-protein dietary (RR), high-fat and high-protein dietary (HH), rational-fat and high-protein dietary (RH), and high-fat and rational-protein dietary (HR). The results showed the fat content in mature milk was increased with increments of fat intake, while both the protein and lactose contents in mature milk did not increase with their intakes for lactating mothers. Among these four dietary patterns, the energy ratio of macronutrients in human milk at the RR was the closest to the estimated energy ratio for infants aged 0-6 M. In conclusion, our study represents that the rational dietary pattern should be advocated, and the irrational dietary patterns, especially high-fat and high-protein dietary patterns, should be avoided during lactation stage.
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Bottin JH, Eussen SRBM, Igbinijesu AJ, Mank M, Koyembi JCJ, Nyasenu YT, Ngaya G, Mad-Bondo D, Kongoma JB, Stahl B, Sansonetti PJ, Bourdet-Sicard R, Moya-Alvarez V. Food Insecurity and Maternal Diet Influence Human Milk Composition between the Infant's Birth and 6 Months after Birth in Central-Africa. Nutrients 2022; 14:4015. [PMID: 36235668 PMCID: PMC9573613 DOI: 10.3390/nu14194015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Although the World Health Organization (WHO) and UNICEF recommend that infants should be exclusively breastfed for the first 6 months of life, evidence is scarce on how the mother’s undernourishment status at delivery and maternal dietary factors influence human milk (HM) composition during the first 6 months of life in regions with high food insecurity. The maternal undernourishment status at delivery, maternal diet, and HM nutrients were assessed among 46 women and their 48 vaginally born infants in Bangui at 1, 4, 11, 18, and 25 weeks after birth through 24-h recalls and food consumption questionnaires from December 2017 to June 2019 in the context of the "Mother-to-Infant TransmIssion of microbiota in Central-Africa" (MITICA) study. High food insecurity indexes during the follow-up were significantly associated with them having lower levels of many of the human milk oligosaccharides (HMOs) that were measured and with lower levels of retinol (aß-coef = −0.2, p value = 0.04), fatty acids (aß-coef = −7.2, p value = 0.03), and amino acids (aß-coef = −2121.0, p value < 0.001). On the contrary, women from food-insecure households displayed significantly higher levels of lactose in their HM (aß-coef = 3.3, p value = 0.02). In parallel, the consumption of meat, poultry, and fish was associated with higher HM levels of many of the HMOs that were measured, total amino acids (aß-coef = 5484.4, p value < 0.001), and with lower HM levels of lactose (aß-coef = −15.6, p value = 0.01). Food insecurity and maternal diet had a meaningful effect on HM composition with a possible impact being an infant undernourishment risk. Our results plead for consistent actions on food security as an effective manner to influence the nutritional content of HM and thereby, potentially improve infant survival and healthy growth.
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Affiliation(s)
| | | | | | - Marko Mank
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands or
| | | | - Yawo Tufa Nyasenu
- Laboratoire d’Analyses Médicales, Institut Pasteur de Bangui, Bangui BP923, Central African Republic
- Laboratoire de Biologie Moléculaire et d’Immunologie, Université de Lomé, Lomé P.O. Box 1396, Togo
| | - Gilles Ngaya
- Laboratoire d’Analyses Médicales, Institut Pasteur de Bangui, Bangui BP923, Central African Republic
| | - Daniel Mad-Bondo
- Direction du Service de Santé de la Gendarmerie, Sis Camp Henri IZAMO, Bangui BP790, Central African Republic
| | - Jean-Bertrand Kongoma
- Direction du Service de Santé de la Gendarmerie, Sis Camp Henri IZAMO, Bangui BP790, Central African Republic
| | - Bernd Stahl
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands or
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Philippe J. Sansonetti
- Chaire de Microbiologie et Maladies Infectieuses, Collège de France, 75005 Paris, France
- Unité de Pathogénie Microbienne Moléculaire, INSERM U1202, Department of Cell Biology and Infection, Institut Pasteur, 75015 Paris, France
| | | | - Violeta Moya-Alvarez
- Unité de Pathogénie Microbienne Moléculaire, INSERM U1202, Department of Cell Biology and Infection, Institut Pasteur, 75015 Paris, France
- Epidemiology of Emergent Diseases Unit, Global Health Department, Institut Pasteur, 75015 Paris, France
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Mexitalia M, Ardian RY, Pratiwi R, Panunggal B. Correlation of maternal dietary intake with breast milk composition and infant growth. Nutr Health 2022:2601060221129118. [PMID: 36164676 DOI: 10.1177/02601060221129118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Maternal dietary intake during the period of lactation has an impact on infants growth. Macronutrients in breast milk are affected by several factors such as maternal dietary intake and maternal nutritional status. This study aims to prove the association between maternal protein and fat intake with the composition of breast milk and growth of infants (age 0-6 months). Methods: Prospective study was conducted for 6 months in 41 mother-infant pairs who were exclusively breastfed, and visited to hospitals or health centres. The mothers age is <40 years old with normal and single pregnancy. The breast milk was collected and analyzed using Human Milk Analyzer. Results: There was a negative correlation between maternal protein intake and breast milk composition at 3 months old infants (p = 0.042), between fat intake with HAZ score at 2 weeks (p = 0.048), and between protein intake with HAZ score at 3 months (p = 0.049). Finally, there was a significant increase in WAZ and HAZ score in all sample groups. Although the maternal protein intake of our subjects were only at 83% of Indonesian's RDA average, the protein composition of breast milk and the growth of the infants was sufficient. Conclusion: There is correlation between maternal dietary intake with the composition of breastmilk and infant growth. Even though the calories and protein intake of the mother is lower than the RDA, the breast milk is still sufficient for the growth of infants aged 0-6 months who are exclusively breastfed.
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Affiliation(s)
- Maria Mexitalia
- Department of Pediatrics, 95450Faculty of Medicine, Diponegoro University/Dr Kariadi Hospital, Indonesia
| | - Rendy Yoga Ardian
- Department of Pediatrics, 95450Faculty of Medicine, Diponegoro University/Dr Kariadi Hospital, Indonesia
| | - Rina Pratiwi
- Department of Pediatrics, 95450Faculty of Medicine, Diponegoro University/Dr Kariadi Hospital, Indonesia
| | - Binar Panunggal
- Department of Nutrition Science, 95450Faculty of Medicine, Diponegoro University, Indonesia
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Di Maso M, Bravi F, Ferraroni M, Agostoni C, Eussen SRBM, Decsi T, Quitadamo PA, Tonetto P, Peila C, Profeti C, Salvatori G, Kazmierska I, Decarli A, Vacca E, Bertino E, Stahl B, Moro GE. Adherence to Mediterranean Diet of Breastfeeding Mothers and Fatty Acids Composition of Their Human Milk: Results From the Italian MEDIDIET Study. Front Nutr 2022; 9:891376. [PMID: 35719165 PMCID: PMC9201754 DOI: 10.3389/fnut.2022.891376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsThe content of fatty acids (FA) in human milk may be influenced by maternal nutrition. We evaluated the role of a Mediterranean diet in influencing the content of FA in human milk among 282 breastfeeding mothers participating in the MEDIDIET study.Materials and MethodsMediterranean Diet Score (MDS), a composite index, was used to evaluate adherence to the Mediterranean diet. It includes 9 components (i.e., vegetables, fruit, cereals, legumes, monounsaturated to saturated FA ratio – MUFA/SFA, fish, dairy products, meat, and alcohol) and therefore potentially ranges from 0 (no adherence) to 9 (complete adherence) points. None of the mothers obtained the highest score due to the low alcohol consumption in the study population. Mothers were categorized in approximate tertiles of adherence: 0–3 (34.4%), 4 (26.2%), and 5–8 points (39.4%). The mean content of FA across categories of MDS was compared using ANOVA and test for trend.ResultsA high adherence of breastfeeding mothers to the Mediterranean diet was associated with lower content of SFA in human milk (42.58 ± 4.36 for MDS = 0–3, 42.58 ± 4.89 for MDS = 4, and 40.92 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend = 0.02). Conversely, a high adherence was associated with higher content of MUFA in human milk (43.27 ± 4.27 for MDS = 0–3, 43.27 ± 4.47 for MDS = 4, and 45.24 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), ω-3 FA (1.07 ± 0.25 for MDS = 0–3, 1.22 ± 0.49 for MDS = 4, and 1.31 ± 0.51% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), and the major types of ω-3 FA (i.e., α-linolenic acid – ALA, eicosapentaenoic acid – EPA, docosahexaenoic acid – DHA, docosapentaenoic acid – DPA). These associations were mainly driven by the adherence to the vegetables, MUFA/SFA, fish, and dairy products components of the Mediterranean diet.ConclusionA high adherence to the Mediterranean diet was associated with human milk showing a lower content of SFA and higher content of MUFA and ω-3 FA, including DHA. The Mediterranean diet may contribute in human milk production with higher content of specific FA which is directly involved in infant’s neural and visual development, as reported by previous studies.
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Affiliation(s)
- Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Monica Ferraroni,
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Tamás Decsi
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Pasqua A. Quitadamo
- Neonatology and Neonatal Intensive Care Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paola Tonetto
- Neonatal Intensive Care Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Chiara Peila
- Neonatal Intensive Care Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Claudio Profeti
- Azienda Ospedaliera Universitaria Meyer di Firenze, Florence, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Iwona Kazmierska
- Neonatal Intensive Care Unit, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | - Adriano Decarli
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
| | | | - Enrico Bertino
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, Università degli Studi di Torino, Turin, Italy
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, Netherlands
- Department of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Guido E. Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy
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