Fatty acid composition of human milk in Spain

Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis

Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle-Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α-linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets.

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.

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.

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.

Preparation of Human Milk Fat Substitutes: A Review

Human milk is generally regarded as the best choice for infant feeding. Human milk fat (HMF) is one of the most complex natural lipids, with a unique fatty acid composition and distribution and complex lipid composition. Lipid intake in infants not only affects their energy intake but also affects their metabolic mode and overall development. Infant formula is the best substitute for human milk when breastfeeding is not possible. As the main energy source in infant formula, human milk fat substitutes (HMFSs) should have a composition similar to that of HMF in order to meet the nutritional needs of infant growth and development. At present, HMFS preparation mainly focuses on the simulation of fatty acid composition, the application of structured lipids and the addition of milk fat globule membrane (MFGM) supplements. This paper first reviews the composition and structure of HMF, and then the preparation development of structured lipids and MFGM supplements are summarized. Additionally, the evaluation and regulation of HMFSs in infant formula are also presented.

The Triad Mother-Breast Milk-Infant as Predictor of Future Health: A Narrative Review

The benefits of human milk for both mother and infant are widely acknowledged. Human milk could represent a link between maternal and offspring health. The triad mother-breast milk-infant is an interconnected system in which maternal diet and lifestyle might have effects on infant's health outcome. This link could be in part explained by epigenetics, even if the underlining mechanisms have not been fully clarified yet. The aim of this paper is to update the association between maternal diet and human milk, pointing out how maternal diet and lifestyle could be associated with breast-milk composition, hence with offspring's health outcome.

Is fatty acid composition of breast milk different in various populations? A systematic review and meta-analysis

This systematic review and meta-analysis aims to systematically review the fatty acid (FA) composition of breast milk in different populations. We systematically searched the Medline via PubMed, Scopus and Clarivate till July 2019. We initially retrieved 433 articles. Having removed duplicates, with initial searching of title and abstracts, 317 papers were excluded and 80 remained. A meta-analysis of 80 cross-sectional, cohort studies, including 8793 subjects, was conducted. Meta-regression analysis indicated that factors including maternal age (p-values of SFA: 0.03, omega-3: 0.01, trans fats:<0.001, total fatty acids: 0.02), year of conducting study (p-values of SFA: <0.001, MUFA: 0.02, omega-6: 0.04,trans fats: 0.04) and sample size (p-values of SFA: 0.03, PUFA: 0.01, omega-6: 0.01, omega-3:<0.001) contributed to the heterogeneity of meta-analysis. This study indicates the large variation of FA content in maternal milk across different populations. Special concern is necessary for both the quality and total amount of fat intake of pregnant and lactating mothers.

The Concentration of Omega-3 Fatty Acids in Human Milk Is Related to Their Habitual but Not Current Intake

This study determined fatty acid (FA) concentrations in maternal milk and investigated the association between omega-3 fatty acid levels and their maternal current dietary intake (based on three-day dietary records) and habitual dietary intake (based on intake frequency of food products). Tested material comprised 32 samples of human milk, coming from exclusively breastfeeding women during their first month of lactation. Milk fatty acids were analyzed as fatty acid methyl ester (FAME) by gas chromatography using a Hewlett-Packard 6890 gas chromatograph with MS detector 5972A. We did not observe any correlation between current dietary intake of omega-3 FAs and their concentrations in human milk. However, we observed that the habitual intake of fatty fish affected omega-3 FA concentrations in human milk. Kendall’s rank correlation coefficients were 0.25 (p = 0.049) for DHA, 0.27 (p = 0.03) for EPA, and 0.28 (p = 0.02) for ALA. Beef consumption was negatively correlated with DHA concentrations in human milk (r = −0.25; p = 0.046). These findings suggest that current omega-3 FA intake does not translate directly into their concentration in human milk. On the contrary, their habitual intake seems to markedly influence their milk concentration.

Impact of Maternal Diet on Human Milk Composition Among Lactating Women in Latvia

Background and objectives: Many studies indicate that the maternal diet is an important factor affecting human milk composition. Human milk composition among lactating women in Latvia, as well as the maternal diet during lactation, has not been sufficiently studied. The aim of this research was to assess dietary habits and macronutrient intake among lactating women in Latvia and to examine the effect of diet on human milk composition. Materials and Methods: Research was conducted between November 2016 and December 2017. Mature human milk samples (n = 61) along with a 72h food diary, a food frequency questionnaire (FFQ), and a questionnaire about maternal and infant characteristics were obtained from voluntary women who were recruited via an invitation published in a social media member group for nursing mothers. Fat content in human milk was determined by LVS ISO 2446:2008, protein content was determined by LVS EN ISO 8968-1:2014, lactose was determined by ISO 22662:2007, and the fatty acid profile was analyzed using gas chromatography. Dietary data were evaluated using the Finnish food composition database Fineli, release 19 (3 March 2018). Results: Median values for fat, protein, and lactose in mature human milk were 4.40%, 1.08%, and 6.52%, respectively. Predominant fatty acids in human milk were oleic acid (C18:1 n9c), palmitic acid (C16:0), and linoleic acid (C18:2 n6c) at 34.60%, 24.00%, and 11.00% of total fatty acids, respectively. The trans elaidic acid (C18:1 n9t) level was <0.10% in all human milk samples. Significant, positive associations (p < 0.05) were found between maternal dietary intake of linoleic, α-linolenic, docosahexaenoic, total cis-monounsaturated, total cis-polyunsaturated, and total n-6 and n-3 polyunsaturated fatty acids, the ratio of n-6/n-3, and the level of these fatty acids in human milk. Total energy and carbohydrate intake among participants were lower, but total fat, saturated fat, and sugar intake were higher than recommended. Protein, linoleic acid, and α-linolenic acid intake were adequate, but docosahexaenoic acid intake was noticeably lower than recommended. Women should be supported with information regarding their nutritional needs during lactation and the possible impact of diet on human milk composition. Conclusion: Macronutrient (fat, protein, and lactose) content in human milk is not affected by maternal diet. Conversely, the human milk fatty acid profile is affected by the immediate diet consumed by the mother. Habitual dietary habits can also impact the fatty acid profile of human milk.

Fatty acid composition of breast milk in Galicia (NW Spain): A cross-country comparison

Based on the premise that the fatty acid composition of human milk can be substantially altered by diet, the current study investigated the fatty acid profile (fattyacidome) of breast milk in Galicia, a small region located in the north-west of Spain and characterized by the Southern European Atlantic Diet (SEAD). A cross-country comparison was also performed to assess worldwide variety and diet impact, reviewing the profiles reported various European, North and South American, Asian and African countries and Australia. Galician human milk appeared similar to the rest of Europe, with some particular features related to the SEAD (dairy, pork, beef and sunflower and olive oils), such as relatively high levels of linoleic acid and lower α-linolenic acid. The results also showed the existence of woman-specific profiles and significant changes over lactation in some fatty acids. Worldwide, the fatty acid profiles were similar, with the clear exception of Asiatic breast milk. The impact of fatty acids on infant health warrants further investigation.

Changes in fatty acid composition of human milk over lactation stages and relationship with dietary intake in Chinese women

Breast milk samples and 24-hour food records were obtained from lactating mothers on day 1 (colostrum), day 14 (transitional milk) and day 42 (mature milk) from Hangzhou (n = 202), Lanzhou (n = 133) and Beijing (n = 142), China. Fatty acid methyl esters were prepared by standard methods, separated and quantified by gas chromatography. We aimed to investigate the fatty acid composition (% of total fatty acid) in human milk of three lactating stages from three regions in China and the relationship with maternal dietary intake during lactation. Present results showed that the fatty acid composition of breast milk varied with lactating period and geographical regions in China. In all the milk samples, the total saturated fatty acid (SFA) remained stable. However, C10:0 and C12:0 increased over the lactation period, total monounsaturated fatty acid (MUFA) significantly increased from colostrum (34.50%) to transitional milk (37.06%), and total polyunsaturated fatty acid (PUFA) showed its highest percentage in colostrum (29.58%). In particular, C22:6n-3 and C22:5n-3 were lowest in mature milk (0.38% and 0.41%, respectively), and C18:3n-3 (1.83%) was lowest in colostrum. There were significant differences among the three regions in total MUFA and PUFA in breast milk. The Hangzhou samples had the lowest C18:1n-9 and highest C22:6n-3. Additionally, C22:6n-3, total PUFA and n-3 PUFA were lowest in the Lanzhou samples. Different dietary habits were largely the drivers behind the different fatty acid profiles among the three regions.

Breast milk fatty acid composition and fatty acid intake of lactating mothers in South Korea

The aim of this study was to determine the fatty acid (FA) composition of breast milk, and its association with mothers' FA intake. Milk samples were obtained from 238 healthy lactating women who volunteered to participate in the Human Milk Micronutrients Analysis Research. Dietary intake during lactation was assessed using a 3-d food record, and fat content and FA composition of the breast milk samples were analysed by IR spectrometry using MilkoScan FT2 and GC flame ionisation detector, respectively. The fat content was 3·31 (sd 1·41) g/100 ml breast milk. The concentrations of arachidonic acid (20 : 4 n-6), EPA (20 : 5 n-3) and DHA (22 : 6 n-3) in breast milk were 0·48 (sd 0·13), 0·15 (sd 0·12) and 0·67 (sd 0·47) % of total FA, respectively. Fat content and FA composition of breast milk were associated with maternal age, BMI, supplement use and infant age. Dietary intakes of EPA, DHA, n-3 FA, n-6 FA, SFA and PUFA were positively correlated with the corresponding FA in the milk samples. FA levels in breast milk and maternal diet are highly correlated. Further studies are warranted to explore factors that may be associated with changes in FA composition in human milk.

Impact of maternal nutrition on breast-milk composition: a systematic review

BACKGROUND

It is widely reported that maternal diet influences the nutritional composition of breast milk. The amount of variability in human milk attributable to diet remains mostly unknown. Most original studies that reported a dietary influence on breast-milk composition did not assess diet directly, did not quantify its association with milk composition, or both.

OBJECTIVE

To gather the quantitative evidence on this issue, we carried out a systematic PubMed and Medline search of articles published up to January 2015 and filtered the retrieved articles according to predefined criteria.

DESIGN

Only studies that provided quantitative information on both maternal diet and milk data, measured in individual healthy mothers of healthy term infants and based on an original observational or experimental design, were included. Exclusion criteria were a focus on supplements, transfer of toxic metals or other contaminants from diet to milk, or on marginally nourished women.

RESULTS

Thirty-six publications-including data on 1977 lactating women-that matched our criteria were identified. Seventeen studies investigated dietary effects on fatty acids in breast milk. The rest included studies that focused on a diverse spectrum of other nutritional properties of breast milk. The largest evidence, in terms of number of articles, for any link between maternal diet and a nutritive property of breast milk came from 3 studies that supported the link between fish consumption and high docosahexaenoic acid in breast milk and 2 studies that reported a positive correlation between dietary vitamin C and milk concentrations of this vitamin.

CONCLUSIONS

The available information on this topic is scarce and diversified. Most of the evidence currently used in clinical practice to make recommendations is limited to studies that only reported indirect associations.

Comparison of free fatty acid content of human milk from Taiwanese mothers and infant formula

OBJECTIVE

Few studies on the free fatty acid (FFA) content of milk from non-Caucasian mothers have been published. We compared the FFA concentrations in human milk (HM) from Taiwanese mothers of preterm (PTHM) and full-term infants (FTHM) and in infant formula (IF).

MATERIALS AND METHODS

Thirty-eight HM samples were collected from 23 healthy lactating mothers and 15 mothers who gave birth prematurely (range 29-35 weeks, mean 33 weeks). The regular formula and preterm infant formula (PTIF) for three brands of powdered IF were also evaluated. Milk samples were extracted and methylated for analysis by gas chromatography/mass spectrometry (GC/MS).

RESULTS

Reference values for individual FFAs in breast milk from Taiwanese mothers were determined. The mean total FFAs were significantly higher in IF (21,554 μmol/L) and PTIF (19,836 μmol/L) than in FTHM (8,540 μmol/L) and PTHM (9,259 μmol/L) (p < 0.05). Saturated FAs were predominant in all types of milk (43.1% for FTHM, 42.8% for PTHM, 45.5% for IF and 45.3% for PTIF). Monounsaturated FAs were significantly higher in IF and PTIF (42.6% and 43.9%) than in FTHM and PTHM (37.7% and 39.5%), and polyunsaturated FAs in FTHM and PTHM (20% and 18.2%) were higher than in IF and PTIF (11.9% and 10.9%). HM had a more desirable linoleic acid/α-linolenic acid ratio than IF. No significant differences in individual FFAs in FTHM were observed among three lactating periods.

CONCLUSION

FFA levels in HM from Taiwanese mothers are in agreement with results for different geographically distinct populations. Nevertheless, the FFA content in IF did not meet well with HM, particularly, the excess additives of saturated and monounsaturated FAs, and the shortage of polyunsaturated FAs. The effect of variations in FFA content in IF on future unfavorable outcomes such as obesity, atopic syndrome, and less optimal infant neurodevelopment should be further investigated.

Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation

Scientific literature is increasingly reporting on dietary deficiencies in many populations of some nutrients critical for foetal and infant brain development and function.

PURPOSE

To highlight the potential benefits of maternal supplementation with docosahexaenoic acid (DHA) and other important complimentary nutrients, including vitamin D, folic acid and iodine during pregnancy and/or breast feeding for foetal and/or infant brain development and/or function.

METHODS

English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies were obtained through searches on MEDLINE and the Cochrane Register of Controlled Trials from January 2000 through to February 2012 and reference lists of retrieved articles. Reports were selected if they included benefits and harms of maternal supplementation of DHA, vitamin D, folic acid or iodine supplementation during pregnancy and/or lactation.

RESULTS

Maternal DHA intake during pregnancy and/or lactation can prolong high risk pregnancies, increase birth weight, head circumference and birth length, and can enhance visual acuity, hand and eye co-ordination, attention, problem solving and information processing. Vitamin D helps maintain pregnancy and promotes normal skeletal and brain development. Folic acid is necessary for normal foetal spine, brain and skull development. Iodine is essential for thyroid hormone production necessary for normal brain and nervous system development during gestation that impacts childhood function.

CONCLUSION

Maternal supplementation within recommended safe intakes in populations with dietary deficiencies may prevent many brain and central nervous system malfunctions and even enhance brain development and function in their offspring.

Breast milk fat concentration and fatty acid pattern during the first six months in exclusively breastfeeding Greek women

PURPOSE

To determine fat and fatty acid (FA) profile of Greek mother's milk during the first 6 months of exclusive breastfeeding and to examine their correlation with dietary and other maternal characteristics.

METHODS

Milk samples and dietary records were obtained by mothers at 1st (n = 64), 3rd (n = 39), and 6th (n = 24) month postpartum. Fatty acid methylesters were separated and quantified by gas chromatography (GC/FID) and fat concentration by the creamatocrit method.

RESULTS

At the 3 time points, milk fat concentration ranged between 26.3 and 30.2 g/l (p > 0.05). Milk's FA composition was expressed as weight percentage (% wt/wt of all FAs detected with a C6 to C22 chain length). Maternal macronutrient and FA dietary intake, as well as the FAs' profile in maternal milk, remained constant over the 6 months. Saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) represented approx. 46, 35, and 18 % of all FAs, while ω6 and ω3 PUFA were 17.4 and 0.8 %, respectively. Body weight gain during pregnancy was positively related to breast milk's concentration in SFA (p < 0.01) and negatively to milk's concentration in MUFA (p < 0.01). Age and parity were also independent factors affecting the FA profile in maternal milk. A strong positive effect was found during the first month postpartum, between mother's PUFA intake and the concentration of PUFA, ω3 fatty acids, docosahexaenoic and linoleic acid (LA) in the milk, while MUFA intake was strongly correlated with the concentration of PUFA, ω6 fatty acids, and LA.

CONCLUSION

This study is among few in literature to determine FA profile of breast milk in European populations and verified certain dietary factors that influence this profile. Maternal PUFA and MUFA intake were found to be important factors affecting breast milk's FA profile.

Fatty acid composition of Taiwanese human milk

BACKGROUND

The purpose of this study was to analyze quantitatively the fatty acid composition of the milk of Taiwanese women.

METHODS

Two hundred and sixty-nine human milk specimens were obtained from 240 Taiwanese mothers, aged 19-41 years, and subjected to chromatographic analysis.

RESULTS

Milk specimens were pooled by the mothers' districts of residence and lactation stages, at 0-11 days, 22-45 days, 46-65 days and 66-297 days after delivery. The fatty acid composition was expressed as weight percentage of all fatty acids detected with C8-C24 chain length. More than 80% of the fatty acids were composed of lauric, myristic, palmitic, stearic, oleic and linoleic acids. The amount of saturated fatty acid was 36.7%. With regard to essential fatty acids, the amount of linoleic acid (LA) was 22% and that of linolenic acid (ALA) was 1.8%, both levels being higher than in human milk from Western countries. However, the ratio of LA/ALA remained at 13:1 for the whole duration of lactation. It has been reported that mothers with high fish consumption have a high content of docosahexaenoic acid and eicosapentaenoic acid in their milk, and we found this phenomenon occurring in our study. The percentage of docosahexaenoic acid and eicosapentaenoic acid in Taiwanese human milk was 0.79% and 0.17%, respectively.

CONCLUSION

Fatty acid composition in human milk varies during lactation. With regard to essential fatty acids, the amount of LA was 22% and that of ALA was 1.8%, both levels being higher than in human milk from Western and other Asian countries.

Lipid content and fatty acids composition of mature human milk in rural North China

To determine the lipid content and fatty acid (FA) composition of breast milk from fifty-two lactating women between ninth and twelfth lactation weeks in rural North China. The mothers were questioned on their dietary habits. Total milk lipids extracts were transmethylated and analysed using GLC to determine FA contents. The mean lipid content was 40·21 (sd 1·43) g/l. SFA constituted 35·92 % of the total FA. Medium-chain and long-chain SFA presented levels of 10·91 and 25·01 %, respectively. MUFA and PUFA constituted 32·59 and 19·97 % of the total FA, respectively. Oleic, linoleic and α-linolenic acid (ALA) presented contents of 31·26, 17·73 and 1·03 %, respectively. Arachidonic acid had a content of 0·30 %, while DHA content was 0·19 %. Not any form of trans FA were found in human milk samples. A maternal diet transition is proceeding in China. Further investigation on the analysis of human milk FA composition is needed to upgrade the human milk database in China.

Trans fatty acids and fatty acid composition of mature breast milk in turkish women and their association with maternal diet's

The aim of this study was to determine the fatty acid composition and trans fatty acid and fatty acid contents of breast milk in Turkish women and to find the effect of breastfeeding mothers' diet on trans fatty acid and fatty acid composition. Mature milk samples obtained from 50 Turkish nursing women were analyzed. Total milk lipids extracts were transmethylated and analyzed by using gas liquid chromatography to determine fatty acids contents. A questionnaire was applied to observe eating habits and 3 days dietary records from mothers were obtained. Daily dietary intake of total energy and nutrients were estimated by using nutrient database. The mean total trans fatty acids contents was 2.13 +/- 1.03%. The major sources of trans fatty acids in mothers' diets were margarines-butter (37.0%), bakery products and confectionery (29.6%). Mothers who had high level of trans isomers in their milk consumed significantly higher amounts of these products. Saturated fatty acids, polyunsaturated fatty acids and monounsaturated fatty acids of human milk constituted 40.7 +/- 4.7%, 26.9 +/- 4.2% and 30.8 +/- 0.6% of the total fatty acids, respectively. The levels of fatty acids in human milk may reflect the current diet of the mother as well as the diet consumed early in pregnancy. Margarines, bakery products and confectionery are a major source of trans fatty acids in maternal diet in Turkey.

Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide

Concentrations of the long-chain polyunsaturated fatty acids (LCPUFAs) docosahexaenoic acid (DHA, 22:6n-3) and arachidonic acid (AA, 20:4n-6) in human breast milk are important indicators of infant formula DHA and AA concentrations, and recent evidence suggests that neural maturation of breastfed infants is linked to breast-milk LCPUFA concentrations. We report a descriptive meta-analysis that considered 106 studies of human breast milk culled to include only studies that used modern analysis methods capable of making accurate estimates of fatty acid (FA) profiles and criteria related to the completeness of reporting. The final analysis included 65 studies of 2474 women. The mean (+/-SD) concentration of DHA in breast milk (by wt) is 0.32 +/- 0.22% (range: 0.06-1.4%) and that of AA is 0.47 +/- 0.13% (range: 0.24-1.0%), which indicates that the DHA concentration in breast milk is lower than and more variable than that of AA. The highest DHA concentrations were primarily in coastal populations and were associated with marine food consumption. The correlation between breast-milk DHA and AA concentrations was significant but low (r = 0.25, P = 0.02), which indicates that the mean ratio of DHA to AA in regional breast milk varies widely. This comprehensive analysis of breast-milk DHA and AA indicates a broad range of these nutrients worldwide and serves as a guide for infant feeding.

Fatty acid composition of milk of refugee Karen and urban Korean mothers. Is the level of DHA in breast milk of Western women compromised by high intake of saturated fat and linoleic acid?

BACKGROUND

Lower proportions of docosahexaenoic acid (DHA) and total n-3 metabolites have been reported in breast milk of European, Australian and North American women compared with milk of mothers from non-Western countries. This difference is not always explained by intakes of marine products.

OBJECTIVE

We investigated the possibility that the relative composition of DHA and total n-3 metabolites in breast milk of non-Western mothers with low fat intakes is higher than the levels commonly reported in their Western counterparts.

SUBJECTS

Mature milk of refugee Karen women from two different camps in Thailand (n=26 and n=53), and transition milk from urban Korean mothers (n=12) in Seoul was collected. In common with their respective community, the mothers have low fat intake, which is predominately of plant origin.

RESULTS

The percentage levels of DHA and n-3 metabolites in the milk of the Karen mothers were 0.52 +/- 0.14 and 0.85 +/- 0.24 (camp 1) and 0.54 +/- 0.22 and 0.92 +/- 0.42 (camp 2). In the Korean milk, DHA was 0.96 +/- 0.21 and total n-3 metabolites 1.51 +/- 0.3.

CONCLUSION

We postulate that the levels of DHA and total n-3 metabolites may be compromised in breast milk of mothers on the Western high fat diet. This calls into question the use of DHA composition of such milk as a reference for the formulation of milk designed, for infant feed or, to test the function of DHA in neuro-visual development.

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

Many published studies of breast milk FA composition are limited to populations from one or two countries. We aimed to examine the degree to which FA compositions vary across a number of diverse populations. Because diet and maternal adipose stores influence breast milk FA composition, differences in FA composition between groups most likely reflect habitual dietary differences. Approximately 50 breast milk samples (full breast expression) were collected from women in Australia, Canada, Chile, China, Japan, Mexico, Philippines, the United Kingdom, and the United States. The proportion of saturated FA was relatively constant among countries, with the exception of the Philippines, where levels of lauric and myristic acids were elevated (means greater than two times the mean of most other countries). Monounsaturated FA also varied little, with the exception of low levels of oleic acid in the Philippines and high levels of erucic acid in China. Although arachidonic acid (C20:4n-6) levels were similar among all countries (means ranging from 0.36 wt % to 0.49 wt %), mean DHA (C22:6n-3) levels ranged from 0.17 to 0.99 wt %, with the highest levels in Japanese milk and the lowest levels in Canadian and U.S. samples. The results of this study demonstrate that the proportion of saturated and monounsaturated FA are relatively constant across a large number of countries, whereas the level of some of the PUFA, especially DHA, are highly variable.

Influences of maternal dietary intake and suckling on breast milk lipid and fatty acid composition in low-income women from Brasilia, Brazil

Diet has a strong effect, while suckling stimulus is believed not to influence breast milk fatty acids. The effect of dietary pattern and suckling on the fatty acid composition of Brazilian women's breast milk was studied. A cross-sectional study was conducted with low-income women living in the central region of Brazil, where dietary DHA is not readily available. Fore and hind milk fatty acids were collected from 77 women on day 15+/-1 postpartum, and information on maternal characteristics and dietary habit was taken. The effect of suckling stimulus was measured by the changes between fore and hind milk. The mean body mass index (BMI) of volunteers was 23.7+/-3.2 kg/m(2), and the milk lipid concentration was 4.8+/-1.2 g/dl. A mixture of traditional and western type of dietary habit, high in fat and sugar was observed. The fatty acids of the subject's milk were 41.93+/-1.42% saturated, 33.31+/-1.67% monounsaturated and 25.03+/-5.23% polyunsaturated (wt/wt). The DHA level in the milk was 0.34+/-0.19%, similar to the values found in milk of many western societies. DHA and 18:3n-3 levels increased from fore to hind milk (p<0.05). Correlation existed mostly between dietary components and milk 16:0 and oleic acid (18:0). An analysis of classes of fatty acids in milk showed oleic acid (18:0) to present a negative correlation with all milk fatty acid classes. The results suggest that breast milk fatty acids of Brazilian women reflect a western maternal dietary pattern and are influenced by the suckling.

Triacylglycerol markers of mature human milk

OBJECTIVES

To determine which triacylglycerol (TAG) species in mature human milk are less affected by external factors and may thus be considered as TAG markers, as well as to determine which species are most influenced by these external conditions. Furthermore, we examine the correlation between the TAG markers and their fatty acids (FAs).

SETTING AND SUBJECTS

Six healthy women from Barcelona (Catalonia, Spain).

DESIGN AND INTERVENTIONS

In order to obtain the maximum variability of sampling conditions, 40 mature human milk samples were collected from different mothers, on different days, at different times of the day, and from different breasts during and after both the baby's and mother's meal. TAG and FA profiles were determined and correlated. The TAG composition was determined by high-performance liquid chromatography with an evaporative light-scattering detector, and also with atmospheric pressure chemical ionisation mass spectrometry. FAs compositions were determined by gas chromatography.

RESULTS

The results were analysed using the SPSS statistical package and proved to be more variable than might have been found in a more restrictive sample design. Nevertheless, despite these conditions, some TAG species were found in relatively constant levels in mature human milk, and could thus be considered as markers of the mature milk TAG profile. TAG species that we can classify in this group were: LaMO, CaPO, LaCaO, LaPCa, LaOL, MPLn, LLO, LaOO, MPL, and MOL. The names do not indicate the location of fatty acids in the glycerol molecule. On the other hand, concentrations of other TAG species vary considerably between samples and consequently these may be understood to be especially affected by the external factors. TAGs like PaLS, MPO, PaOO, PPP, MPS, SPP, LOO, PPO, MOS, SSP, POL, and SOS are in this second group. Correlation between the TAG markers and their FAs was examined by Pearson's test and a significant correlation was found for some FAs.

CONCLUSIONS

The TAG species present in mature human milk are affected in different ways by external factors such as dietary intake, nutritional status, length of lactation, time of the day, etc. Some TAGs may be considered as markers of mature human milk as they are relatively constant under a wide range of sampling conditions and do not depend on the factors mentioned.

SPONSORSHIP

This study was supported by the Fundació Mestres Jané.

Can perinatal supplementation of long-chain polyunsaturated fatty acids prevent diabetes mellitus?

It is suggested that the negative correlation between breast-feeding and insulin resistance and diabetes mellitus can be related to the presence of significant amounts of long-chain polyunsaturated fatty acids in the human breast milk. Based on this, it is proposed that provision of adequate amounts of long chain polyunsaturated fatty acids during the critical periods of brain growth and development can prevent or postpone the development diabetes mellitus.

Fatty acid and sn-2 fatty acid composition in human milk from Granada (Spain) and in infant formulas

OBJECTIVE

To investigate differences in fatty acid and sn-2 fatty acid composition in colostrum, transitional and mature human milk, and in term infant formulas.

SETTING

Departament de Nutrició i Bromatologia, University of Barcelona, Spain and University Hospital of Granada, Spain.

SUBJECTS

One-hundred and twenty mothers and 11 available types of infant formulas for term infants.

DESIGN

We analysed the fatty acid composition of colostrum (n=40), transitional milk (n=40), mature milk (n=40) and 11 infant formulas. We also analysed the fatty acid composition at sn-2 position in colostrum (n=12), transitional milk (n=12), mature milk (n=12), and the 11 infant formulas.

RESULTS

Human milk in Spain had low saturated fatty acids, high monounsaturated fatty acids and high linolenic acid. Infant formulas and mature human milk had similar fatty acid composition. In mature milk, palmitic acid was preferentially esterified at the sn-2 position (86.25%), and oleic and linoleic acids were predominantly esterified at the sn-1,3 positions (12.22 and 22.27%, respectively, in the sn-2 position). In infant formulas, palmitic acid was preferentially esterified at the sn-1,3 positions and oleic and linoleic acids had higher percentages at the sn-2 position than they do in human milk.

CONCLUSION

Fatty acid composition of human milk in Spain seems to reflect the Mediterranean dietary habits of mothers. Infant formulas resemble the fatty acid profile of human milk, but the distribution of fatty acids at the sn-2 position is markedly different.

Physiological aspects of human milk lipids

Human milk from healthy and well-nourished mothers is the preferred form of feeding for all healthy newborn infants. The nutrient supply with human milk supports normal growth and development of the infant. Here the general characteristics of human milk lipids and recent knowledge on lactational physiology, composition and functional aspects of human milk lipids are discussed. Lipids in human milk represent the main source of energy for the breastfed baby and supply essential nutrients such as fat-soluble vitamins and polyunsaturated fatty acids (PUFA). The essential fatty acids linoleic and alpha-linolenic acids (LA and ALA) are precursors of long-chain polyunsaturated fatty acids (LC-PUFA), including arachidonic (20:4n-6) and docosahexaenoic (22:6n-3) acids (AA and DHA). LC-PUFA serve as indispensable structural components of cellular membranes and are deposited to a considerable extent in the growing brain and the retina during perinatal development. The supply of preformed LC-PUFA with human milk lipids has been related to functional outcomes of the recipient infants such as visual acuity and development of cognitive functions during the first year of life. Recent stable isotope studies indicate that the major portion of milk PUFA is not derived directly from the maternal diet, but stems from endogenous body stores. Thus, not only the woman's current but also her long-term dietary intake is of marked relevance for milk fat composition.

The influence of dietary palmitic acid triacylglyceride position on the fatty acid, calcium and magnesium contents of at term newborn faeces

The distribution of long-chain saturated fatty acids in triglycerides is different in infant formulas to that in human milk. In human milk, palmitic acid is predominantly esterified in the sn-2 position (beta-position) of the triglycerides, whereas in infant formulas, it is esterified mainly in the sn-1,3 positions (alpha,alpha'-positions). The specific distribution of the fatty acids in the triglyceride plays a key role in lipid digestion and absorption. We studied fatty-acid, calcium and magnesium composition in the faeces of three groups of at term newborn infants fed different diets: Group A (n=12) was fed from birth to 2 months with human milk (66% palmitic acid in beta-position), Group B (n=12) was fed with formula alpha (19% palmitic acid esterified in beta-position) for 2 months, and Group C (n=12) was fed with formula alpha during the first month and with formula beta (44.5% palmitic acid in beta-position) during the second month. Samples were taken at the end of the first month (t0) and at the end of the second month (t1). Groups A and C presented significantly lower contents of palmitic acid in faeces at t1 than at t0, whereas in Group B, amounts remained similar. Faecal calcium in Groups A and C decreased in the second month (t1), although the fall was no statistically significant. In Group B, calcium amounts showed no change. We found that infant formula beta when compared with infant formula alpha reduced significantly the contents of total fatty acids and palmitic acid in faeces. We conclude that palmitic acid in beta-position is, therefore, beneficial for term infants.

Maternal dietary PUFAs intake and human milk content relationships during the first month of lactation

Maternal dietary fatty acids (FFAs) intake and corresponding human milk composition relationships have been assessed throughout the first month of lactation in 34 lactating women consecutively enrolled. All mothers were on their habitual diet. Food records (95 items) were administered to the mothers, six-times during the first month of lactation (1 day after delivery, 4, 7, 14, 21, and 28 days after colostrum appearance) and referred to maternal dietary intake of the day before. Milk collected on day 1 was considered as colostrum, day 4 and 7 samples as transitional milk, and day 14, 21 and 28 samples as mature milk. Five gas chromatographic analyses were performed on each sample. Statistics were made using Friedman's and Pearson's test. Maternal dietary saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs) were significantly related to the corresponding milk pattern in the phase of transitional milk (P<0.01), while total polyunsaturated (PUFAs) content was significantly related only to the mature milk (P<0.01); in this phase about 42% of the variations occurring in PUFAs milk content can be related to variation of maternal PUFAs dietary intake. The results in the present study provide evidence of the relationships between maternal diet and milk composition. The degree of correlation between maternal diet and PUFAs milk content increases throughout milk maturational process and reaches significance only in mature milk. This would imply that advancing lactation, milk PUFAs provision sources gradually shift from adipose tissue catabolism to maternal diet.

Long-chain polyunsaturated fatty acids

Long-chain polyunsaturated fatty acids (LC-PUFA) are essential for normal development. Fetal accretion of LC-PUFA occurs during the last trimester of gestation; therefore, premature infants are born with minimal LC-PUFA reserves. Recent studies indicate that the newborn can synthesize LC-PUFA from essential fatty acid precursors; however, the extent of de novo synthesis remains to be established. Postnatally, human milk provides LC-PUFA to the newborn. Maternal LC-PUFA reserves depend upon diet and can be improved by supplementation of docosahexaenoic acid and arachidonic acid during pregnancy and lactation. This in turn affects fetal LC-PUFA accretion and postnatal provision through mother's milk. Supplementation of formula-fed preterm or full-term infants with docosahexaenoic acid and arachidonic acid leads to plasma and red blood cell LC-PUFA levels similar to those of breast-fed infants. The higher blood and presumably tissue levels of LC-PUFA following supplementation lead, however, to only temporary functional benefits.

Lipids in human milk

I have reviewed recent (March 1995-December 1997) papers on human milk lipids including many on fatty acid (FA) composition. The effects of maternal diets on the profiles are apparent. However, more data on the composition of milk lipids are needed. It is noteworthy that so few papers on milk FA composition have reported analyses using high-resolution gas-liquid chromatography columns. Two of these were on milk from women in North America. The diets in North America are varied and the number of analyses few. We do not have a reliable data base showing the ranges of biologically important acids. Except for the gangliosides, few new data on the other lipids appeared during this period.

Fatty acid composition of human milk in Kuwaiti mothers

Kuwaiti diet is exceptionally rich in fat, carbohydrates and proteins. In addition, subjects in Kuwait are exposed to extreme heat and sun light. Fatty acid profiles of human milk obtained from 19 full breast feeding Kuwaiti mothers were analyzed. Dietary patterns for individual mothers were determined by 24 h dietary recall and food frequency questionnaire. The fatty acid content of human milk was affected by the diet consumed by the lactating mother. The content of long chain polyunsaturated fatty acids (LCP) in human milk lipids did not correlate with their parent fatty acids like linoleic and alpha-linolenic acids. However the human milk LCP were related to the of content of LCP in the maternal diet. Mothers reporting a high fish consumption showed significant amounts of C22:6, omega 3 and C20:5, omega 3 fatty acids. As a general conclusion, breast milk produced by a well nourished mother is better suited to meet the lipid requirements of infants.

Polyunsaturated fatty acids in human milk and their role in early infant development

The lipid fraction of human milk represents the main source of energy for the newborn infant and supplies essential nutrients such as fat-soluble vitamins and polyunsaturated fatty acids (PUFA). The essential fatty acids linoleic and alpha-linolenic acids are precursors of long-chain polyunsaturated fatty acids (LC-PUFA), such as arachidonic (C20:4 n-6) and docosahexaenoic (C22:6 n-3) acids, present in human milk in considerable amounts. LC-PUFA are indispensable structural components of all cellular membranes, and they are incorporated in relatively large amounts during early growth of the brain and the retina. Moreover, some LC-PUFA are precursors of eicosanoids, molecules with potent biological activity that modulates various cellular and tissue processes. The supply of long-chain fatty acids has been associated with functional outcomes of the recipient infants such as visual acuity and development of cognitive functions during the first year of life. Here we discuss the PUFA composition of human milk, factors which determine and modulate milk PUFA content, and possible effects of milk LC-PUFA on infant growth and development.

n-3 and n-6 fatty acid enrichment by dietary fish oil and phospholipid sources in brain cortical areas and nonneural tissues of formula-fed piglets

Sufficient availability of both n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA) is required for optimal structural and functional development in infancy. The question has been raised as to whether infant formulae would benefit from enrichment with 20 and 22 carbon fatty acids. To address this issue, we determined the effect of fish oil and phospholipid (LCPUFA) sources on the fatty acid composition of brain cortical areas and nonneural tissues of newborn piglets fed artificially for 2 wk. They were fed sow milk, a control formula, or the formula enriched with n-3 fatty acids from a low-20:5n-3 fish oil added at a high or a low concentration, or the formula enriched with n-3 and n-6 fatty acids from either egg yolk- or pig brain-phospholipids. Both the fish oil- and the phospholipid-enriched formula produced significantly higher plasma phospholipid 22:6n-3 concentrations than did the control formula. The 22:6n-3 levels in the brain, hepatic, and intestinal phospholipids were significantly correlated with plasma values, whereas cardiac 22:6n-3 content appeared to follow a saturable dose-response. Feeding sow milk resulted in a much higher 20:4n-6 content in nonneural tissues than did feeding formula. Supplementation with egg phospholipid increased the 20:4n-6 content in the heart, red blood cells, plasma, and intestine in comparison to the control formula, while pig brain phospholipids exerted this effect in the heart only. The addition of 4.5% fish oil in the formula was associated with a decline in 20:4n-6 in the cortex, cerebellum, heart, liver, and plasma phospholipids, whereas using this source at 1.5% limited the decline to the cerebellum, liver, and plasma. Whatever the dietary treatment, the phosphatidylethanolamine 20:4n-6 level was 10-20% higher in the brain temporal lobe than in the parietal, frontal, and occipital lobes in the temporal lobe by administering the formula enriched with egg or brain phospholipids. In conclusion, feeding egg phospholipids to neonatal pigs increased both the 22:6n-3 content in the brain and the 20:4n-6 content in the temporal lobe cortex. This source also increased the 22:6n-3 levels in nonneural tissues with only minor alterations of 20:4n-6. These data support the notion that infant formulae should be supplemented with both 22:6n-3 and 20:4n-6 rather than with 22:6n-3 alone.

Fatty acid composition of plasma and erythrocytes in term infants fed human milk and formulae with and without docosahexaenoic and arachidonic acids from egg yolk lecithin

Human milk contains small but nutritionally significant amounts of long-chain polyunsaturated fatty acids (LCP), such as arachidonic (AA, 20:4n-6) and docosahexaenoic (DHA, 22:6n-3) acids, which are not present in most infant formulae. In the present study, the fatty acid composition of plasma and erythrocytes was determined at birth and again at 7 days, 1 and 3 months in 49 healthy full-term infants (37-42 week's gestation). One group of infants was fed exclusively with human milk (n=16) and the others were randomly assigned to a standard term formula (F) (n=15) or the same formula with egg yolk lecithin providing DHA (0.15%) and AA (0.30%) (LCP-F) (n=18). Plasma and erythrocyte LCP values of the three dietary groups did not differ at 7 days of age, but the contents of DHA and AA in plasma and erythrocytes at 1 and 3 months were significantly lower (P<0.05) in infants fed non supplemented formula than in infants fed breast milk and supplemented formula. There were no differences in plasma or erythrocyte AA or DHA concentrations between the group fed breast milk and the group fed supplemented formula during the period studied.