Differences in preterm and term milk fatty acid compositions may be caused by the different hormonal milieu of early parturition

Associations of maternal diet with nutritional and chemical exposure markers in human milk from the LACTACOL cohort of preterm infants

PURPOSE

Maternal diet may impact human milk composition. Our objective was to characterize the association between maternal diet and the presence of nutritional and chemical exposure markers of human milk in the context of prematurity.

METHODS

One hundred and three mothers of preterm infants, recruited in the west of France near the Atlantic coast, completed a food frequency questionnaire to assess daily food intake. Milk was sampled up to discharge for analysis of Fatty Acids (FAs), Human Milk Oligosaccharides (HMOs) and Persistent Organic Pollutants (POPs).

RESULTS

Four dietary patterns were identified by principal component analysis coupled with hierarchical clustering. The pattern "Snack Eater" with the highest n-6:n-3 ratio in terms of polyunsaturated FA intake showed the lowest levels of n-3 FAs (e.g., DocosaHexaenoic Acid (DHA), p = 0.037) and POPs in milk. The highest level of dibenzodioxin was observed among the "Omnivores" pattern (p = 0.027). Butter intake was associated with FAs in milk, mainly saturated (e.g., 15:0, β = 59.2, 95%CI [30.0-88.5]) and some POPs (e.g., PCB138, β = 53.3, 95%CI [10.9-95.6]), but not with HMO. Fish intake was associated with POPs in milk.

CONCLUSION

Maternal diet may be associated with the FAs and POPs composition of milk in mothers of preterm infants, as it is for full-term infants. To improve the nutritional composition of human milk, it would be advisable to avoid the "Snack-eater" pattern and to favour the consumption of nutrient-rich foods. Butter consumption has been identified as a major contributor of pollutants and saturated fatty acids, and should therefore be given particular attention.

Trans isomeric fatty acids in human milk and their role in infant health and development

It is well known that long chain polyunsaturated fatty acids (LCPUFAs) play an important role in neurodevelopment in the perinatal life. The most important source of these fatty acids is the diet, however, they can also be formed in the human body from their shorter chain precursors, the essential fatty acids. Since the WHO recommends exclusive breastfeeding for the first six months after birth, the exclusive source of these fatty acids for breastfed infants is human milk, which can be influenced by the mother's diet. Unsaturated fatty acids can have either cis or trans configuration double bond in their chain with distinct physiological effects. Cis isomeric unsaturated fatty acids have several beneficial effects, while trans isomers are mostly detrimental, because of their similar structure to saturated fatty acids. Trans fatty acids (TFAs) can be further subdivided into industrial (iTFA) and ruminant-derived trans fatty acids (rTFA). However, the physiological effects of these two TFA subgroups may differ. In adults, dietary intake of iTFA has been linked to atherosclerosis, insulin resistance, obesity, chronic inflammation, and increased development of certain cancers, among other diseases. However, iTFAs can have a negative impact on health not only in adulthood but in childhood too. Results from previous studies have shown that iTFAs have a significant negative effect on LCPUFA levels in the blood of newborns and infants. In addition, iTFAs can affect the growth and development of infants, and animal studies suggest that they might even have lasting negative effects later in life. Since the only source of TFAs in the human body is the diet, the TFA content of breast milk may determine the TFA supply of breastfed infants and thus affect the levels of LCPUFAs important for neurodevelopment and the health of infants. In this review, we aim to provide an overview of the TFA content in human milk available in the literature and their potential effects on infant health and development.

Maternal training during lactation modifies breast milk fatty acid composition and male offspring glucose homeostasis in rat

The perinatal exposome can modify offspring metabolism and health later in life. Within this concept, maternal exercise during gestation has been reported modifying offspring glucose sensing and homeostasis, while the impact of such exercise during lactation is little-known. We thus aimed at evaluating short- and long-term effects of it on offspring pancreatic function, assuming a link with changes in breast milk composition. Fifteen-week-old primiparous female Wistar rats exercised during lactation at a constant submaximal intensity (TR) or remained sedentary (CT). Male offspring were studied at weaning and at 7 months of age for growth, pancreas weight, glycemia and insulin responses. Milk protein content was determined by the bicinchoninic acid assay (BCA colorimetric method), and lipid content and fatty acid composition by gas chromatography. Mature milk from TR rats contained significantly less saturated (-7 %) and more monounsaturated (+18 %) and polyunsaturated (PUFA +12 %) fatty acids compared to CT rats, with no difference in total lipid and protein concentrations. In offspring from TR vs CT mothers, fasting glycemia was lower, pancreas weight was higher with a lower insulin content (-37 %) at weaning. Such outcomes were correlated with milk PUFA levels and indices of desaturase or elongase activities. These effects were no longer present at 7 months, whereas a more efficient muscle insulin sensitivity was observed. Maternal training during lactation led to a specific milk phenotype that was associated with a short-term impact on glucose homeostasis and pancreatic function of the male offspring.

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 profile across lactational stages after term and preterm delivery: A pooled data analysis

BACKGROUND

Lipids in human milk (HM) provide the majority of energy for developing infants, as well as crucial essential fatty acids (FA). The FA composition of HM is highly variable and influenced by multiple factors. We sought to increase understanding of the variation in HMFA profiles and their development over the course of lactation, and after term and preterm delivery, using a pooled data analysis.

OBJECTIVE

To review the literature and perform a pooled data analysis to qualitatively describe an extensive FA profile (36 FAs) in term and preterm colostrum, transitional - and mature milk up to 60 days postpartum.

DESIGN

A Medline search was conducted for HMFA profile data following term or preterm delivery. The search was confined to English language papers published between January 1980 and August 2018. Studies reporting original data, extensive FA profiles in HM from healthy mothers were included. Weighted least squares (WLS) means were calculated from the pooled data using random or fixed effect models.

RESULTS

Our pooled data analysis included data from 55 studies worldwide, for a total of 4374 term milk samples and 1017 preterm milk samples, providing WLS means for 36 FAs. Patterns in both term and preterm milk were apparent throughout lactation for some FAs: The most abundant FAs (palmitic, linoleic and oleic acid) remained stable over time, whereas several long-chain polyunsaturated FAs (including ARA and DHA) seemed to decrease and short- and medium-chain FAs increased over time.

CONCLUSIONS

High heterogeneity between individual studies was observed for the reported levels of some FAs, whereas other FAs were remarkably consistent between studies. Our pooled data suggests that specific FA categories fluctuate according to distinct patterns over the course of lactation; many of these patterns are comparable between term and preterm milk.

Total and sn-2 fatty acid profile of breast milk from women delivering preterm infants under the influence of maternal characteristics

Data on the total fatty acid (FA) profile and position-specific triacylglycerides (TAGs) in preterm infants' maternal milk are essential for establishing the recommended requirement of FA in preterm infants in China. We aimed to determine the composition and positional distribution of FAs in preterm infants' maternal milk in China and further investigate the effect of maternal background on the FA composition. Breast milk samples (4, 11, 30, 60, and 90 (all ±3) days post-partum) were collected from 59 healthy women delivering preterm infants. The total and sn-2 milk FA composition was determined using gas chromatography. The multivariate statistical analysis showed significant differences in the FA profiles of milk with different lactation times, gestational ages and maternal ages. In particular, the content of linoleic and linolenic acid (ALA) was much higher, whereas the content of docosahexaenoic (DHA) and arachidonic acid were lower in the preterm milk from the Wuxi district than that from America and countries in Europe. The content of sn-2 polyunsaturated FAs (ALA: p = 0.013 and DHA: p = 0.003) were lower in the preterm colostrum from women aged over 30 years. Overall, these results suggest that the European and American standards of preterm formula may not be suitable for Chinese preterm infants, and polyunsaturated FA fortification in the maternal diet or preterm formula is needed for women with advanced age.

Influence of prednisolone on parameters of de novo lipogenesis and indices for stearoyl-CoA- and Δ6- desaturase activity in healthy males: A Post-hoc analysis of a randomized, placebo-controlled, double-blind trial

Glucocorticoid treatment decreases liver insulin sensitivity and may modify fatty acid metabolism. We investigated the influence of oral prednisolone on indices for de novo lipogenesis (DNLi), stearoyl-CoA desaturase (SCDi) and Δ6-desaturase (D6Di) activity in healthy males. In addition, we explored whether the changes may be associated with prednisolone-induced changes in glucose and lipid metabolism and insulin sensitivity. Thirty-two healthy young males (mean ± SD age 22 ± 3 years, BMI 22.4 ± 1.7 kg/m²) were allocated to receive prednisolone 7.5 mg/day (PRED7.5; n = 12), prednisolone 30 mg/day (PRED30; n = 12), or placebo (n = 8) in a randomized double-blind fashion for 2 weeks. Fatty acid compositions of plasma cholesteryl esters (CE), phospholipids (PL) and triglycerides (TG) were measured at baseline and on day 14. DNLi, SCDi and D6Di were estimated from product/precursor ratios in CE, with DNLi primary deriving from 16:1ω7/18:2ω6, SCDi from 16:1ω7/16:0 and D6Di from 22:6ω3/20:5ω3. Ratios were also assessed in PL and TG. In CE, PRED30 increased DNLi by 51.2 [95%CI 14.8; 87.6]%, increased SCDi by 48.6 [18.7; 78.5]%, and decreased D6Di by 57.7 [-91.8; -23.5]% (p ≤ 0.01 for all, compared to placebo). The prednisolone-induced increases in DNLi and SCDi were positively correlated with insulin sensitivity (r = 0.35 and 0.50, respectively). Similar results were found in PL and TG. Prednisolone dose-dependently increases DNLi and SCDi and decreases D6Di in plasma CE, PL and TG in healthy males after 2 weeks. The observed unfavorable effects on fatty acid metabolism were related to the induction of glucocorticoid-induced insulin resistance.

Fatty acids profile in preterm Colostrum of Tunisian women. Association with selected maternal characteristics

Fatty acids (FA), especially arachidonic (AA, 20:4ω6) and docosahexaenoic (DHA, 22:6ω3) acids are critical for the health and development of infants. Colostrum FA composition has been examined in 101 lactating Tunisian women delivering prematurely using gas chromatography. Among polyunsaturated FA, linoleic acid predominated whereas each of the other polyunsaturated FA accounted for 1% or less of total FA. Colostrum AA and DHA contents were lower in women aged above 34 years compared to those less than 34 years. Preeclampsia was associated with lower DHA (0.40±0.22 vs. 0.53±0.27; p=0.018), but higher AA (1.14±0.44 vs. 0.93±0.30; p<0.006) and AA:DHA ratio (4.31±4.04 vs. 2.29±2.79; p<0.001). In multivariate analysis, colostrum DHA correlated with plasma DHA (β, 0.417; p=0.002), maternal age (β, -0.290; p=0.028) and preeclampsia (β, -0.270; p=0.042). Preterm colostrum FA profile in Tunisian women is comparable to those of other populations. Colostrum AA and DHA levels are altered in aged and pre-eclamptic women.

Gestational age dependent changes of the fetal brain, liver and adipose tissue fatty acid compositions in a population with high fish intakes

INTRODUCTION

There are no data on the intrauterine fatty acid (FA) compositions of brain, liver and adipose tissue of infants born to women with high fish intakes.

SUBJECTS AND METHODS

We analyzed the brain (n=18), liver (n=14) and adipose tissue (n=11) FA compositions of 20 stillborn infants with different gestational ages (range 8-38 weeks) born to Tanzanian women with low linoleic acid (LA) intakes and high intakes of docosahexaenoic (DHA) and arachidonic (AA) acids from local fish.

RESULTS AND DISCUSSION

With advancing gestation, brain saturated-FA (SAFA; in g/100g FA), polyunsaturated-FA (PUFA), DHA, 20:3ω6, 22:4ω6 and 22:5ω6 increased, while monounsaturated-FA (MUFA), 20:3ω9, 22:3ω9 and AA decreased. Decreasing brain AA might be caused by increasing AA-metabolism to 20:3ω6, 22:4ω6 and 22:5ω6. In the liver, SAFA, PUFA and LA increased, while MUFA decreased with gestation. The steep increase of (mostly de novo synthesized) SAFA in adipose tissue coincided with relative decreases of MUFA, PUFA, DHA, LA and AA with advancing gestation. Compared to Western infants, the currently studied African infants had higher DHA, lower AA, and a higher DHA/AA-ratio in brain and adipose tissue, while the LA content of adipose tissue was lower.

CONCLUSION

The low LA and high DHA and AA intakes by the mothers of these infants might support optimal α-linolenic (ALA) vs. LA competition for Δ5D and Δ6D-activities and DHA vs. AA antagonism. Conversely, the Western diet, characterized by high LA and lower DHA and AA intakes, might disturb these evolutionary conserved mechanisms aiming at an optimal ω3/ω6-balance.

Fatty acid compositions of preterm and term colostrum, transitional and mature milks in a sub-Saharan population with high fish intakes

BACKGROUND

There are no data on the fatty acid (FA) compositions of preterm and term milks for sub-Saharan African populations with advancing lactation. However, it is generally acknowledged that our ancestors evolved in sub-Saharan East-Africa, where they inhabited the land-water ecosystems.

METHODS

We compared the FA-compositions of preterm (28-36 weeks) and term (37-42) colostrum (2-5 day), transitional (6-15) and mature (16-56) milks in rural African women with stable dietary habits and lifelong high freshwater fish intakes.

RESULTS

From colostrum to mature milk: the median docosahexaenoic acid (DHA) content decreased from 1.11 to 0.75; and arachidonic acid (AA) from 0.93 to 0.69 g% in preterm milk. In term milk, DHA decreased from 0.81 to 0.53 and AA from 1.08 to 0.55 g%. Medium-chain saturated-FA (MCSAFA) increased from 16.9 to 33.7, and 7.92-29.0 g%, while mono-unsaturated FA (MUFA) decreased from 32.5 to 22.6, and 40.0-26.5 g%, in preterm and term milk, respectively. Consistent with the literature, preterm colostrum contained higher DHA and MCSAFA, and lower MUFA compared to term colostrum. These differences vanished rapidly with advancing lactation. MUFA and MCSAFA were inversely related.

CONCLUSIONS

The presently found DHA in preterm colostrum and mature milks and AA in premature mature milk proved the highest reported in the literature so far, as derived from analysis with capillary GC-columns. We confirmed the much higher MCSAFA and lower MUFA contents in milk of rural African, compared to Westernized women. The milk FA composition of this traditional population might show us the FA composition on which our species evolved and consequently to which our genome has become adapted to optimally support (infant) health.