Fatty acid profile comparisons in human milk sampled from the same mothers at the sixth week and the sixth month of lactation

EFSA Panel on Food Additives and Flavourings (FAF), Castle L, Andreassen M, Aquilina G, Bastos ML, Boon P, Fallico B, FitzGerald R, Frutos Fernandez MJ, Grasl‐Kraupp B, Gundert‐Remy U, Gürtler R, Houdeau E, Kurek M, Louro H, Passamonti S, Wölfle D, Dusemund B, Turck D, Barmaz S, Tard A, Rincon AM. Re-evaluation of citric acid esters of mono- and diglycerides of fatty acids (E 472c) as a food additive in foods for infants below 16 weeks of age and follow-up of its re-evaluation

Citric acid esters of mono- and diglycerides of fatty acids (E 472c) was re-evaluated in 2020 by the Food Additives and Flavourings Panel (FAF Panel) along with acetic acid, lactic acid, tartaric acid, mono- and diacetyltartaric acid, mixed acetic and tartaric acid esters of mono- and diglycerides of fatty acids (E 472a,b,d,e,f). As a follow-up to this assessment, the FAF Panel was requested to assess the safety of citric acid esters of mono- and diglycerides of fatty acids (E 472c) for its use as food additive in food for infants below 16 weeks of age belonging to food categories (FCs) 13.1.1 (Infant formulae as defined by Directive 2006/141/EC) and 13.1.5.1 (Dietary foods for infants for special medical purposes and special formulae for infants). In addition, the FAF Panel was requested to address the recommendation of the re-evaluation of E 472c as a food additive to update the EU specifications in Commission Regulation (EU) No 231/2012. For this, a call for data was published to allow interested partied to provide the requested information for a risk assessment. The Panel concluded that the technical data provided by the interested business operators support an amendment of the EU specifications for E 472c. Regarding the safety of the use of E 472c in food for infants below 16 weeks of age, the Panel concluded that there is no safety concern from its use at the reported use levels and at the maximum permitted levels in food for infants below 16 weeks of age (FCs 13.1.1 and 13.1.5.1).

Impact of polyunsaturated fatty acids during and pregnancy and lactation: A comprehensive review

BACKGROUND

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are relevant polyunsaturated fatty acids (PUFA) derived from alpha-linolenic acid (ALA) and linoleic acid (LA), respectively. These are important in pregnancy and lactation periods because of their benefits to the developing fetus and infant. Currently, the high prevalence of gestational obesity has led to a revision of PUFAs recommendations in these periods, due to changes in the lipid profile of women marked by a higher consumption of n-6 PUFA.

OBJECTIVE

This review aims to present an updated compilation of evidence on DHA and ARA during gestation and lactation.

METHODS

The literature review was performed in different databases, PubMed, Scopus, Web of Science, Scielo, ISI, and Ovid MedLine, highlighting the importance of DHA and ARA for newborn development.

RESULTS

An adequate intake of n-3 PUFA, especially DHA, in the mother during pregnancy and the postnatal period is important for the normal development of the child's brain. Maternal DHA supplementation increases DHA levels in mothers, but its direct link to infant neurodevelopment remains unclear. Obesity generates changes in the FA profile of pregnant women, causing an imbalance of n-3 and n-6 PUFA. An adequate level of DHA benefits children's cognitive function. However, a potential connection exists to the infants' inflammatory profile.

CONCLUSION

During gestation and lactation periods, an adequate DHA intake and n-6/ n-3 PUFA ratio (especially for obese women) are important for the optimal growth and brain development of the child.

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.

The Impact of Linoleic Acid on Infant Health in the Absence or Presence of DHA in Infant Formulas

Both linoleic acid (LA) and α-linolenic acid (ALA) are essential dietary fatty acids, and a balanced dietary supply of these is of the utmost importance for health. In many countries across the globe, the LA level and LA/ALA ratio in breast milk (BM) are high. For infant formula (IF), the maximum LA level set by authorities (e.g., Codex or China) is 1400 mg LA/100 kcal ≈ 28% of total fatty acid (FA) ≈ 12.6% of energy. The aims of this study are: (1) to provide an overview of polyunsaturated fatty acid (PUFA) levels in BM across the world, and (2) to determine the health impact of different LA levels and LA/ALA ratios in IF by reviewing the published literature in the context of the current regulatory framework. The lipid composition of BM from mothers living in 31 different countries was determined based on a literature review. This review also includes data from infant studies (intervention/cohort) on nutritional needs regarding LA and ALA, safety, and biological effects. The impact of various LA/ALA ratios in IF on DHA status was assessed within the context of the current worldwide regulatory framework including China and the EU. Country averages of LA and ALA in BM range from 8.5-26.9% FA and 0.3-2.65% FA, respectively. The average BM LA level across the world, including mainland China, is below the maximum 28% FA, and no toxicological or long-term safety data are available on LA levels > 28% FA. Although recommended IF LA/ALA ratios range from 5:1 to 15:1, ratios closer to 5:1 seem to promote a higher endogenous synthesis of DHA. However, even those infants fed IF with more optimal LA/ALA ratios do not reach the DHA levels observed in breastfed infants, and the levels of DHA present are not sufficient to have positive effects on vision. Current evidence suggests that there is no benefit to going beyond the maximum LA level of 28% FA in IF. To achieve the DHA levels found in BM, the addition of DHA to IF is necessary, which is in line with regulations in China and the EU. Virtually all intervention studies investigating LA levels and safety were conducted in Western countries in the absence of added DHA. Therefore, well-designed intervention trials in infants across the globe are required to obtain clarity about optimal and safe levels of LA and LA/ALA ratios in IF.

Human milk nutritional composition across lactational stages in Central Africa

The African region encompasses the highest undernutrition burden with the highest neonatal and infant mortality rates globally. Under these circumstances, breastfeeding is one of the most effective ways to ensure child health and development. However, evidence on human milk (HM) composition from African women is scarce. This is of special concern, as we have no reference data from HM composition in the context of food insecurity in Africa. Furthermore, data on the evolution of HM across lactational stages in this setting lack as well. In the MITICA study, we conducted a cohort study among 48 Central-African women and their 50 infants to analyze the emergence of gut dysbiosis in infants and describe the mother-infant transmission of microbiota between birth and 6 months of age. In this context, we assessed nutritional components in HM of 48 lactating women in Central Africa through five sampling times from week 1 after birth until week 25. Unexpectedly, HM-type III (Secretor + and Lewis genes -) was predominant in HM from Central African women, and some nutrients differed significantly among HM-types. While lactose concentration increased across lactation periods, fatty acid concentration did not vary significantly. The overall median level of 16 detected individual human milk oligosaccharides (HMOs; core structures as well as fucosylated and sialylated ones) decreased from 7.3 g/l at week 1 to 3.5 g/l at week 25. The median levels of total amino acids in HM dropped from 12.8 mg/ml at week 1 to 7.4 mg/ml at week 25. In contrast, specific free amino acids increased between months 1 and 3 of lactation, e.g., free glutamic acid, glutamine, aspartic acid, and serine. In conclusion, HM-type distribution and certain nutrients differed from Western mother HM.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Food Insecurity and Maternal Diet Influence Human Milk Composition between the Infant's Birth and 6 Months after Birth in Central-Africa

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.

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.

Trans Fatty Acids Content in Whole-Day Diets Intended for Pregnant and Breastfeeding Women in Gynaecological and Obstetric Wards: Findings from the Study under the “Mum’s Diet” Pilot Program in Poland

Trans fatty acids (TFAs) have been proven to have an adverse effect on human health by interfering with n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) synthesis. LC-PUFA n-3 are necessary for the development and maturation of the nervous system and retina during the prenatal period and infancy. TFAs are not synthesized de novo in the human body. Their presence in body fluids arises from the diet. The aim of our study was to determine the content of TFAs in individual meals and in a whole-day hospital diet intended for pregnant and breastfeeding women. Samples were collected from six different hospitals in Poland which voluntarily applied to the “Mum’s Diet” Pilot Program. The content of fatty acids, including TFAs, was determined by gas chromatography coupled with mass spectrometry (GC-MS). The TFAs content in the whole-day hospital diets ranged from 3.86 to 8.37% of all fatty acids (% wt/wt). Food products served for elevenses and afternoon snacks contributed the highest amounts of TFAs. These mainly included dairy products containing TFAs of natural origins. The estimated average intake of TFAs with the hospital diet was 0.72 g/person/day (range: 0.34–1.16 g/person/day) and did not exceed the maximum level of 1% of dietary energy recommended by the World Health Organization.

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

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

The Role of Ionic Liquid Interaction in the Separation of Fatty Acid Methyl Esters—Polyunsaturated Geometric Isomers in GC–MS

Knowledge of the type and level of saturated and unsaturated fatty acids in food and clinical matrices is of practical importance, but the wide variety of fatty acids makes analyses very complex. The discrimination of the geometric isomers of fatty acid needs proper and effective separation conditions. The efficiency of three different stationary phases was evaluated by GC–MS methods in the separation of fatty acids in their methyl ester forms. Significant differences were observed in the efficiencies of polysiloxane-based (non-polar HP-5MS and medium/high polarity DB-225MS) and ionic liquid-based (SLB-IL111) columns. Baseline separation of the geometric isomers of linoleic acid methyl ester was obtained by the extremely polar SLB-IL111 column, showing a preference over the other two columns. The optimization of the experimental conditions (response linearity, limit of detection, limit of quantification, system suitability, intraday and interday repeatability and accuracy) showed the separation power of the ionic liquid interaction in the analyses by using short (25–30 m long) columns. By deducting the general principles of the interaction, predictions can be made for the separation of other isomers. The results facilitate the precise identification of various types of fatty acids in real samples for nutritional information.

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.

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.

Changes in Human Milk Fatty Acid Composition During Lactation: The Ulm SPATZ Health Study

The lipid fraction of human milk provides the infant with the fatty acids that are necessary for optimal growth and development. The aim of this study was to investigate the fatty acid composition of human milk at three time points during lactation and its change over time using appropriate statistical methods. Human milk samples from breastfeeding mothers at 6 weeks (n = 706), 6 months (n = 483), and 12 months (n = 81 with all three time points) were analyzed. Centered log-ratio (clr) transformation was applied to the fatty acid data. Principal component analysis (PCA) and generalized linear model-based repeated measure analysis were used to assess changes over time. The total lipid content was significantly higher at 6 months (β = 0.199, p < 0.029) and 12 months of lactation (β = 0.421, p < 0.001). The constituents of C20:3n-6 and C20:3n-3 were lower at 6 months (p < 0.001). Four distinct sub-compositional fatty acid groups were only identified at 12 months of lactation. The inclusion of small fatty acids of small constituent size in the analysis resulted in a shift in the balance between fatty acid constituents. Human milk fatty acid composition during prolonged lactation is different from that of human milk during a short duration of lactation. Our findings support the hypothesis that a combination of multiple fatty acids is important in fatty acid profiling beyond the presentation of individual fatty acids. Furthermore, the high variability of small fatty acids warrants attention because a compositional analysis may show more pronounced changes.

Association of maternal allergy with human milk soluble CD14 and fatty acids, and early childhood atopic dermatitis

BACKGROUND

This study aimed to investigate whether maternal allergy is associated with soluble CD14 (sCD14) and fatty acid composition in different stages of lactation and the onset of atopic dermatitis (AD) in early childhood.

METHODS

In total, 443 mother-child groups (445 children) were enrolled in the Prediction of Allergies in Taiwanese Children birth cohort study. Colostrum and mature milk at 2 months postpartum (2-month HM) were collected from lactating mothers. Information regarding parental allergy histories and physician-diagnosed atopic diseases was obtained using age-specific questionnaires (0-2 years). We compared sCD14 levels and the composition of 30 fatty acids in the colostrum and 2-month HM, respectively, between allergic and non-allergic mothers and between children with and without AD by the age of 2 years.

RESULTS

In total, 185 (41.8%) mothers presented with allergies, and 154 (34.6%) children had physician-diagnosed AD by the age of 2 years. Both in the colostrum and 2-month HM of 289 lactating mothers, sCD14 levels were significantly lower in allergic mothers whose children presented with AD compared with children who did not (P = 0.015 and 0.044, respectively). Among the children with AD who were born to non-allergic mothers, sCD14 levels were lower. However, the result was not statistically significant (P = 0.376 and 0.264, respectively). Our data revealed the lack of associations between fatty acid composition and AD (P > 0.05).

CONCLUSION

Decreased sCD14 levels in the colostrum and 2-month HM were associated with AD at 2 years of age, particularly among children born to mothers with allergies.

Human milk enriched with human milk lyophilisate for feeding very low birth weight preterm infants: A preclinical experimental study focusing on fatty acid profile

BACKGROUND

Human milk, with essential nutrients and long chain polyunsaturated fatty acids (LC-PUFAs) such as the omega 3 and 6 fatty acids is important for development of the central nervous system and the retina in very low birth weight infants (<1,500 g). However, breast milk may not be sufficient to meet these needs. The possibility of supplementing breast milk with a lyophilisate of human milk was explored in this study. The objectives of this study were to determine the total lipid content and the lipid profile of the Human Milk on Baseline (HMB) and that of the Concentrates with the Human Milk + lyophilisate (with lyophilisate of milk in the immediate period (HMCI), at 3 months (HMC3m), and at 6 months (HMC6m) of storage).

METHODS

Fifty donors from the Human Milk Bank of Children's Hospital provided consent, and donated milk samples. Macronutrient (including total lipids) quantification was performed using the MIRIS® Human Milk Analyzer, and the fatty acid profile was determined by gas chromatography (CG-FID, SHIMADZU®).

RESULTS

There was a higher lipid concentration in HMCI relative to HMB. The concentrations of the main fatty acids (% of total) were as follows: palmitic acid (C16:0) HMB, 22.30%; HMCI, 21.46%; HMC3m, 21.54%; and HMC6m, 21.95% (p<0.01); oleic acid (C18:1n-9) HMB, 30.41%; HMCI, 30.47%; HMC3m, 30.55%; and HMC6m, 29.79% (p = 0.46); linoleic acid (C18:2n-6) HMB, 19.62%; HMCI, 19.88%; HMC3m, 19.49%; and HMC6m, 19.45% (p = 0.58); arachidonic acid (C20:4n-6) HMB, 0.35%; HMCI, 0.16%; HMC3m, 0.13%; and HMC6m, 0.15% (p<0.01); α-linolenic acid (C18:3n-3) HMB,1.32%; HMCI, 1.37%; HMC3m, 1.34%; and 1.34% HMC6m (p = 0.14); docosahexaenoic acid (C22:6n-3) HMB, 0.10%; HMCI, 0.06%; HMC3m, 0.05%; and HMC6m, 0.06% (p<0.01). There were no significant changes in the lipid profile when stored. There was no evidence of peroxidation during storage.

CONCLUSIONS

Freeze-dried human milk fortified with a human milk concentrate brings potential benefits to newborns, mainly by preserving the essential nutrients present only in breast milk; however, further clinical studies are required to evaluate the safety and efficacy of the concentrate as a standard nutritional food option for very low birth weight infants.

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.

New approach shows no association between maternal milk fatty acid composition and childhood wheeze or asthma

BACKGROUND

Previous observational studies have implied breastmilk fatty acid composition may play a role in the development of atopic eczema or atopic sensitization in breastfed infants and toddlers. However, studies investigating associations with wheeze and asthma in later childhood are scarce and did not account for inherent correlation of compositional data. Our aim was to explore the association of maternal milk fatty acid composition with childhood wheezing phenotypes and asthma up to age 13 years using a new statistical approach.

METHODS

Breastmilk was collected 6 weeks and 6 months postdelivery in the Ulm Birth Cohort Study (n=720 and n=454, respectively). Concentrations of 28 fatty acids were measured by high-resolution capillary gas-liquid chromatography. To control for constant-sum constraint, concentration data were transformed using the centered log ratio method. Compositional biplots and correlation matrices were used to group centered log ratio transformed fatty acids. Adjusted risk ratios with parent-reported wheezing phenotypes and doctor-diagnosed asthma were computed using a modified Poisson regression.

RESULTS

We observed no straightforward evidence of associations between overall breastmilk fatty acid composition and specific wheeze phenotypes or doctor-diagnosed asthma.

CONCLUSION

Using appropriate statistical methodology, we report null associations. These findings may partly be attributable to several cohort-specific factors associated with breastfeeding and breastmilk collection. Further studies could improve on ours by analyzing samples of breastmilk and formula and by including all children for whom these are exclusively or together the major source of fatty acids in the first months of life.

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.

Influence of maternal and socioeconomic factors on breast milk fatty acid composition in urban, low-income families

The lipid composition of breast milk may have a significant impact on early infant growth and cognitive development. Comprehensive breast milk data is lacking from low‐income populations in the Indian subcontinent impeding assessment of deficiencies and limiting development of maternal nutritional interventions. A single breast milk specimen was collected within 6 weeks postpartum from two low‐income maternal cohorts of exclusively breastfed infants, from Dhaka, Bangladesh (n = 683) and Kolkata, India (n = 372) and assayed for percentage composition of 26 fatty acids. Mature milk (>15 days) in Dhaka (n = 99) compared to Kolkata (n = 372) was higher in total saturated fatty acid (SFA; mean 48% vs. 44%) and disproportionately lower in ω3‐polyunsaturated fatty acid (PUFA), hence the ω6‐ and ω3‐PUFA ratio in Dhaka were almost double the value in Kolkata. In both sites, after adjusting for days of lactation, increased maternal education was associated with decreased SFA and PUFA, and increasing birth order or total pregnancies was associated with decreasing ω6‐PUFA or ω3‐PUFA by a factor of 0.95 for each birth and pregnancy. In Dhaka, household prosperity was associated with decreased SFA and PUFA and increased ω6‐ and ω3‐PUFA. Maternal height was associated with increased SFA and PUFA in Kolkata (1% increase per 1 cm), but body mass index showed no independent association with either ratio in either cohort. In summary, the socioeconomic factors of maternal education and household prosperity were associated with breast milk composition, although prosperity may only be important in higher cost of living communities. Associated maternal biological factors were height and infant birth order, but not adiposity. Further study is needed to elucidate the underlying mechanisms of these effects.

Review of Infant Feeding: Key Features of Breast Milk and Infant Formula

Mothers' own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. Although breastfeeding is highly recommended, breastfeeding may not always be possible, suitable or solely adequate. Infant formula is an industrially produced substitute for infant consumption. Infant formula attempts to mimic the nutritional composition of breast milk as closely as possible, and is based on cow's milk or soymilk. A number of alternatives to cow's milk-based formula also exist. In this article, we review the nutritional information of breast milk and infant formulas for better understanding of the importance of breastfeeding and the uses of infant formula from birth to 12 months of age when a substitute form of nutrition is required.

Are odorant constituents of herbal tea transferred into human milk?

The present study investigates aroma transfer from commercial nursing tea, consumed in the maternal diet, into human milk by correlating sensory assessments with quantitative analytical data. The target terpenes were quantified in milk (expressed before and after tea consumption) and tea samples via gas chromatography–mass spectrometry (GC-MS) using stable isotope dilution assays (volunteer donors n = 5). Sensory analyses were carried out on different milk samples from a single donor, sampled before (blank) and at different times after tea ingestion. Quantitative analysis revealed that no significant odorant transfer into milk was observed after lactating women drank the tea. The comparative sensorial analysis of milk samples expressed before and after tea consumption confirmed that tea ingestion had no significant influence on the odor profile of human milk.

Breast milk fatty acid profile in relation to infant growth and body composition: results from the INFAT study

BACKGROUND

There is some evidence that the n-6/n-3 long-chain polyunsaturated fatty acids (LCPUFAs) ratio in early nutrition, and thus in breast milk, could influence infant body composition.

METHODS

In an open-label randomized controlled trial (RCT), 208 healthy pregnant women were allocated to a dietary intervention (supplementation with 1,200 mg n-3 LCPUFAs per day and instructions to reduce arachidonic acid (AA) intake) from the 15th wk of gestation until 4 mo of lactation or to follow their habitual diet. Breast milk LCPUFAs at 6 wk and 4 mo postpartum were related to infant body composition assessed by skinfold thickness (SFT) measurements and ultrasonography during the first year of life.

RESULTS

Dietary intervention significantly reduced breast milk n-6/n-3 LCPUFAs ratio. In the whole sample, early breast milk docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and n-3 LCPUFAs at 6 wk postpartum were positively related to the sum of four SFT measurements at age 1. Breast milk AA and n-6 LCPUFAs at 6 wk postpartum were negatively associated with weight, BMI, and lean body mass (LBM) up to 4 mo postpartum.

CONCLUSION

Breast milk n-3 LCPUFAs appear to stimulate fat mass growth over the first year of life, whereas AA seems to be involved in the regulation of overall growth, especially in the early postpartum period.

trans Isomeric fatty acids are inversely related to the availability of long-chain PUFAs in the perinatal period

We summarize data on the potential interaction of trans isomeric fatty acids [trans fatty acids (TFAs)] with the availability of long-chain polyunsaturated fatty acids (LC-PUFAs) in the perinatal period. Today, TFA intakes in pregnant and lactating women can be estimated to be ∼1% of energy in the majority of the population. The significant inverse associations seen between TFAs and LC-PUFAs in pregnant women in 3 different European populations investigated in a recent study raise doubts about the nutritional adequacy of high TFA intakes during pregnancy. In a recent study on the TFA content of human milk in a sizable group of mothers at the sixth week of lactation, both arachidonic and docosahexaenoic acids correlated significantly inversely to 18-carbon TFAs but not to 16-carbon TFAs, and at the sixth month of lactation arachidonic acid correlated significantly inversely to 18-carbon TFAs but not to 16-carbon TFAs. Similarly, significant inverse correlations were seen between 18-carbon TFAs and arachidonic and docosahexaenoic acids in both artery and vein wall lipids in a sizable group of healthy term infants. The TFA data obtained in umbilical blood vessel wall lipids were related to the neurologic condition of healthy children at 18 mo of age: children with minimal neurologic dysfunction at age 18 mo had significantly higher cord blood vein wall trans octadecadienoic acid values than did neurologically normal children. Total TFA values as well as total 18-carbon TFA values in umbilical vein wall lipids were significantly inversely associated with neurologic optimality score. Contradictory data renders it impossible to draw firm conclusions on the role of TFAs in modifying fetal growth; however, TFA exposure may be a confounding parameter in studies that investigate the relation between fetal fatty acid supply and intrauterine growth.

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.

Breast milk fatty acid composition differs between overweight and normal weight women: the STEPS Study

OBJECTIVE

We studied differences in breast milk fatty acid (FA) composition between overweight and normal weight women and the effect of FA composition on children's cholesterol concentrations at 13 months and growth from birth to 13 months.

METHODS

Samples were collected from lactating women (n = 100) participating in STEPS study at infant's age of 3 months, and FA composition was analyzed with gas chromatography. Diet of mother was studied with Index of Diet Quality at third trimester of pregnancy and with food frequency questionnaire on sampling day. The children's weights and heights were collected from hospital records at birth and during study visits at 13 months.

RESULTS

Overweight women's breast milk compared to normal weight women's breast milk contained higher amount of saturated FAs (46.3 vs. 43.6 %, P = 0.012), lower amount of n-3FAs (2.2 vs. 2.7 %, P = 0.010), lower ratio of unsaturated to saturated FAs (1.1 vs. 1.3, P = 0.008), and higher ratio of n-6 to n-3 FAs (5.7 vs. 4.9, P = 0.031) than those of normal weight women even after adjusting for maternal diet (P < 0.05 for all). Normal weight women adhered more to dietary recommendations during pregnancy, whereas no differences were found in diet at sampling 3 months postpartum. The children's weight gains correlated with saturated FAs (R = 0.22, P = 0.04) and the ratio of unsaturated to saturated FAs (R = -0.23, P = 0.038) in milk; however, effects diminished after adjusting for total duration of breastfeeding. Milk FA composition was not associated with children's cholesterol concentrations at 13 months.

CONCLUSIONS

Breast milk FA composition differed between overweight and normal weight women.

Inverse association between trans isomeric and long-chain polyunsaturated fatty acids in pregnant women and their newborns: data from three European countries

BACKGROUND

trans unsaturated fatty acids are thought to interfere with essential fatty acid metabolism. To extend our knowledge of this phenomenon, we investigated the relationship between trans isomeric and long-chain polyunsaturated fatty acids (LCPUFA) in mothers during pregnancy and in their infants at birth.

METHODS

Fatty acid composition of erythrocyte phosphatidylcholine (PC) and phosphatidylethanolamine (PE) was determined in Spanish (n = 120), German (n = 78) and Hungarian (n = 43) women at the 20th and 30th week of gestation, at delivery and in their newborns.

RESULTS

At the 20th week of gestation, the sum of trans fatty acids in PE was significantly (p < 0.01) lower in Hungarian [0.73 (0.51), % wt/wt, median (IQR)] than in Spanish [1.42 (1.36)] and German [1.30 (1.21)] women. Docosahexaenoic acid (DHA) values in PE were significantly (p < 0.01) higher in Hungarian [5.65 (2.09)] than in Spanish [4.37 (2.60)] or German [4.39 (3.3.2)] women. The sum of trans fatty acids significantly inversely correlated to DHA in PCs in Spanish (r = -0.37, p < 0.001), German (n = -0.77, p < 0.001) and Hungarian (r = -0.35, p < 0.05) women, and in PEs in Spanish (r = -0.67, p < 0.001) and German (r = -0.71, p < 0.001), but not in Hungarian (r = -0.02) women. Significant inverse correlations were seen between trans fatty acids and DHA in PEs at the 30th week of gestation (n = 241, r = -0.52, p < 0.001), at delivery (n = 241, r = -0.40, p < 0.001) and in cord lipids (n = 218, r = -0.28, p < 0.001).

CONCLUSION

Because humans cannot synthesize trans isomeric fatty acids, the data obtained in the present study support the concept that high maternal trans isomeric fatty acid intake may interfere with the availability of LCPUFA both for the mother and the fetus.

Genetic variants in the FADS gene cluster are associated with arachidonic acid concentrations of human breast milk at 1.5 and 6 mo postpartum and influence the course of milk dodecanoic, tetracosenoic, and trans-9-octadecenoic acid concentrations over the duration of lactation

BACKGROUND

Breastfeeding is considered an optimal nutritional source of n-6 (omega-6) and n-3 (omega-3) fatty acids (FAs) for the proper visual and cognitive development of newborn children. In addition to maternal nutrition as an important regulator of FA concentrations, first results exist on an association of breast-milk FAs with single nucleotide polymorphisms (SNPs) in the FADS gene cluster, which encodes the rate-limiting enzymes in the elongation-desaturation pathway of long-chain polyunsaturated fatty acids (LC-PUFAs).

OBJECTIVE

We analyzed the influence of FADS SNPs on breast-milk FA concentrations and their time course during lactation in the Ulm Birth Cohort study, which comprised 772 nursing mothers at 1.5 mo after giving birth, and in a subset of 463 mothers who were still breastfeeding at 6 mo postpartum.

DESIGN

We conducted linear regression analysis of 8 FADS SNPs with FA concentrations at both time points separately and assessed the genotype effect over time in a longitudinal analysis by using a generalized estimating equation regression model.

RESULTS

We observed significant associations of FADS genotypes with arachidonic acid (AA) concentrations and the 20:4n-6/20:3n-6 ratio at both time points but no association of FADS SNPs with the time course of AA concentrations. A longitudinal analysis of FAs other than LC-PUFAs by genotype over time showed associations for dodecanoic acid, cis-15-tetracosenoic acid, and trans-9-octadecenoic acid.

CONCLUSIONS

Maternal FADS genotypes are associated with breast-milk AA concentrations and might therefore influence the supply of this FA for children. Furthermore, our data indicate an interrelation between the LC-PUFA pathway and saturated and monounsaturated FAs.