Longitudinal Changes in Crude Protein and Amino Acids in Human Milk in Chinese Population: A Systematic Review

Maternal BMI During Lactation Is Associated with Major Protein Compositions in Early Mature Milk

OBJECTIVES

The present study identified multiple proteins in early mature milk and explored the correlation between protein compositions in HM and maternal BMI during lactation.

METHODS

A total of 70 mothers giving birth to single-term infants from four representative cites were enrolled in this research. Milk samples were collected between 9 and 11 a.m. to avoid the influence of circadian rhythms. The concentration of total protein in the milk samples was determined using the Bradford method, and the concentrations of α-lactalbumin, lactoferrin, osteopontin, αs-1 casein, β-casein, and κ-casein, butyrophilin, periodic acid Schiff 6/7, fatty acid-binding protein, and xanthine oxidoreductase in the milk samples were measured through a previously published method using ultra-performance liquid chromatography coupled with mass spectrometry. A semi-structured questionnaire investigation and body measurements were carried out by trained investigators to collect the information of subjects.

RESULTS

In the univariate models, the concentrations of TP (r = 0.306), α-La (r = 0.260), LF (r = 0.371), OPN (r = 0.286), and αS1-CN (r = 0.324) were all positively and significantly correlated with maternal BMI. In the models' adjusted covariates, the concentrations of TP (Lg β = 7.4 × 10-3), LF (Lg β = 19.2 × 10-3), αS1-CN (Lg β = 8.2 × 10-3) and the proportion of LF (β = 0.20%) were positively correlated with continuous maternal BMI changes. TP concentrations in the HM of obese mothers were higher than in the other three groups (Lg β: 66.7 × 10-3~140.5 × 10-3), α-La concentrations were higher than in the underweight and normal groups (Lg β: 94.4 × 10-3~145.7 × 10-3), and OPN concentrations were higher than in the overweight groups (Lg β = 103.6 × 10-3). The concentrations of LF (Lg β: -298.2 × 10-3~-191.0 × 10-3), OPN (Lg β: -248.9 × 10-3~-145.3 × 10-3), and αS1-CN (Lg β: -160.7 × 10-3~-108.3 × 10-3) in the HM of underweight mothers were lower than those in the other three groups. β-CN concentrations were lower than normal (Lg β = -125.1 × 10-3) and obese groups (Lg β = -165.7 × 10-3), κ-CN concentrations were lower than the overweight (Lg β = -132.5 × 10-3) and obese groups (Lg β = -147.9 × 10-3), and the proportion of LF was lower than that of the overweight (β = -2.80%) and obese groups (β = -2.52%). The proportion of LF in normal mothers was lower than that in the overweight group (β = -1.15%). No statistically significant associations between four MFGM proteins and maternal BMI were determined as the equation models could not be fitted (p for F-test < 0.05).

CONCLUSIONS

Obese mothers had higher concentrations of multiple protein components than other groups, while underweight mothers had lower concentrations. The association between BMI and protein compositions may be more pronounced for certain protein types.

Amino acid requirements of the infant: the amino acid composition of human breast milk

The recommended amino acid requirements of the infant are based on the amino acid composition of mature human breast milk. The amino acid composition of breast milk is usually determined following either acid or alkaline (for tryptophan) hydrolysis. For accuracy, however, the known effect of hydrolysis time on amino acid composition should be accounted for. Also, ideally the amino acid composition of breast milk should be given in units of digested (assumed to be absorbed) amino acids. A review of the literature is presented which gives mean total amino acid concentrations in mature human milk (n = 26 studies), mean hydrolysis correction factors (n = 3 studies) and mean true ileal amino acid digestibility coefficients (n = 3 studies, suckling piglet). There were differences between the estimates of amino acid concentration corrected for hydrolysis time and digestibility, and current FAO (2013) recommendations that were not corrected for these factors. The values based on the published literature up until 2023 (mg/g true protein) corrected for hydrolysis time and digestibility gave higher values (more than 16% higher) for leucine, lysine and threonine, and considerably higher values (greater than 30%) for histidine and tryptophan. Current recommendations may need revision.

Longitudinal Changes in Human Milk Minerals and Vitamins in the Chinese Population: A Scoping Review

This scoping review aims to investigate longitudinal changes in minerals and vitamins concentrations in human milk among the Chinese population. Following the PRISMA-ScR guidelines, a comprehensive and systematic literature search was conducted using both English and Chinese databases. Data were extracted and categorized into six defined lactation stages. We found that the concentration of most minerals decreased throughout the lactation period, although calcium (Ca) and magnesium (Mg) fluctuated slightly across lactation periods. Fat-soluble vitamins also showed a decline throughout the lactation period, while water-soluble vitamins exhibited an increasing trend. However, folic acid, biotin, and pantothenic acid demonstrated a downward trend. Overall, this review has identified the longitudinal changes in minerals and vitamins concentrations in human milk among the Chinese population. In order to conduct a more in-depth examination of maternal characteristics and nutritional factors of the composition of human milk, it is recommended to utilize standardized protocols for the collection and analysis of human milk samples.

An Accurate Estimate of the Amino Acid Content of Human Milk Collected from Chinese Women Adjusted for Differences in Amino Acid Digestibility

BACKGROUND

The amino acid (AA) composition of human milk is used to define the AA requirements of the infant. Thus, it is important that estimates of composition be as complete and accurate as possible. When determining AA composition using standard hydrolysis methods, some AAs are progressively destroyed while others are incompletely released. For accuracy, AA composition needs to be determined using multiple hydrolysis times. The true ileal digestibility of AAs also needs to be taken into consideration.

OBJECTIVE

The objective was to bring together AA compositional (determined using multiple hydrolysis intervals) and digestibility data determined using the piglet to give an estimate of the absorbed AA profile of human milk with reference in particular to Asian females.

METHODS

Mature milk was collected from Chinese females. AA analysis using multiple hydrolysis intervals and a nonlinear regression model was used to accurately estimate AA composition. Human milk, as well as a protein-free diet, were fed to piglets (n = 6), and ileal digesta were collected (piglet age, 21 d) to determine the true ileal AA digestibility of AAs in human milk.

RESULTS

True ileal AA digestibility coefficients ranged from (mean ± standard error of the mean) 0.61 ± 0.081 for tyrosine to 1.01 ± 0.030 for tryptophan, with a digestibility for total nitrogen of 0.90 ± 0.013. Convergence criteria were met for the modeling for each AA, and the model had a level of significance of P < 0.0001 for each AA. The amount of available AAs (total AA content as per the model prediction multiplied by the true ileal AA digestibility coefficient determined in the piglet) are reported.

CONCLUSIONS

An estimate of the absorbed AA profile of mature milk collected from Chinese females is provided. For the first time, data is presented for cysteine.

The Association of Formula Protein Content and Growth in Early Infancy: A Systematic Review and Meta-Analysis

This systematic review aimed to examine differences in growth outcomes between breastfed infants and infants fed with formula with different protein/energy ratios during the first six months of life. We conducted a systematic review in the PubMed, Web of Science, and Springer databases. Twenty clinical trials qualified for inclusion. We extracted data about the growth outcomes of infants who were exclusive breastfed or exclusively infant formula fed in the first six months and used a meta-analysis to pool the finding data. We categorized study formulas into four groups according to their protein content: <1.8, 1.8−2.0, 2.1−2.2, and >2.2 g/100 kcal. In the first month of life, growth was not different between formula- and breastfed infants. During 2−3 months of life, growth was faster in infants who consumed formulas with protein contents higher than 2.0 g/100 kcal. After 3 months, formula-fed infants grew faster than breastfed infants. Our meta-analysis indicated that the growth outcomes of infants fed with infant formula with a relatively low protein/energy ratios, compared with that a relatively high protein/energy ratio, were close to those of breastfed infants.

Dynamic Changes in Human Milk Oligosaccharides in Chinese Population: A Systematic Review and Meta-Analysis

The aim of this systematic review was to summarize concentrations of human milk oligosaccharides (HMOs) in the Chinese population. We searched articles originally published in both Chinese and English. When compiling data, lactation was categorized into five stages. We found that 6′-sialyllactose, lacto-N-tetraose, and lacto-N-neotetraose decreased over lactation. Conversely, 3′-fucosyllactose increased over lactation. Our study represents the first systematic review to summarize HMO concentrations in Chinese population. Our findings not only provide data on HMO profiles in Chinese population but suggest future directions in the study of the metabolism of HMOs.

Longitudinal Changes in the Concentration of Major Human Milk Proteins in the First Six Months of Lactation and Their Effects on Infant Growth

Our knowledge related to human milk proteins is still limited. The present study determined the changes in multiple human milk proteins during the first six months of lactation, investigated the influencing factors of milk proteins, and explored the impact of milk proteins on infant growth. A total of 105 lactating women and their full-term infants from China were prospectively surveyed in this research. Milk samples were collected at 1–5 days, 8–14 days, 1 month, and 6 months postpartum. Concentrations of total protein and α-lactalbumin were measured in all milk samples, and concentrations of lactoferrin, osteopontin, total casein, β-casein, α_s−1 casein, and κ-casein were measured in milk from 51 individuals using ultra performance liquid chromatography coupled with mass spectrometry. The concentration of measured proteins in the milk decreased during the first six months of postpartum (p-trend < 0.001). Maternal age, mode of delivery, maternal education, and income impacted the longitudinal changes in milk proteins (p-interaction < 0.05). Concentrations of α_s−1 casein in milk were inversely associated with the weight-for-age Z-scores of the infants (1 m: r −0.29, p 0.038; 6 m: r −0.33, p 0.020). In conclusion, the concentration of proteins in milk decreased over the first six months postpartum, potentially influenced by maternal demographic and delivery factors. Milk protein composition may influence infant weights.