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Stinson LF, George A, Gridneva Z, Jin X, Lai CT, Geddes DT. Effects of Different Thawing and Warming Processes on Human Milk Composition. J Nutr 2024; 154:314-324. [PMID: 38042352 DOI: 10.1016/j.tjnut.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023] Open
Abstract
The composition of human milk is influenced by storage and processing practices. The effects of thawing and warming practices on human milk composition remain poorly studied despite their prevalence in home, research, and donor milk bank settings. This review comprehensively examines the impact of different thawing and warming methods on nutritional and bioactive human milk components. While some components such as carbohydrates and minerals remain stable under most typical thawing and warming conditions, others, such as fat, immune proteins, bacterial and human cells, and peptide amine hormones, are sensitive to warming. This review has identified that the data on the effects of milk thawing and warming is limited and often contradictory. Given that numerous important components of milk are diminished during cold storage, it is important that thawing and warming practices do not lead to further loss of or alterations to beneficial milk components. Further work in this field will facilitate greater standardization of thawing methods among researchers and underpin recommendations for thawing and warming of expressed milk for parents.
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Affiliation(s)
- Lisa F Stinson
- School of Molecular Sciences, The University of Western Australia, Perth, Australia.
| | - Alexandra George
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Xuehua Jin
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
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Balcells-Esponera C, Borràs-Novell C, López-Abad M, Cubells Serra I, Basseda Puig A, Izquierdo Renau M, Herranz Barbero A, Iglesias-Platas I. Bioactive peptides in preterm human milk: Impact of maternal characteristics and their association to neonatal outcomes. Biofactors 2024; 50:135-144. [PMID: 37584623 DOI: 10.1002/biof.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/29/2023] [Indexed: 08/17/2023]
Abstract
Human milk adipokines in term babies seem partially determined by maternal factors and affect infant's development. We aimed to describe bioactive peptide concentration in very preterm human milk and associations to maternal characteristics and postnatal growth. Mothers delivering ≤32 weeks of gestation and their infant/s were recruited. At 4 weeks of lactation, an aliquot of 24-h-pooled milk was collected for exclusively breastfeeding dyads. Insulin, leptin, adiponectin, and milk fat globule epidermal growth factor-8 (MFG-E8) were measured by enzyme-linked immunoabsorbent assay in skimmed milk. One hundred mothers (28.8 ± 2.3 weeks at delivery) provided a milk sample. Milk insulin was related to gestational age, pre-pregnancy body mass index (BMI), and galactagogue treatment (final model: adjusted R2 : 0.330, p < 0.0001; adjusted β coefficients: galactagogue treatment: 0.348, p 0.001; pre-pregnancy BMI: 0.274, p 0.009; gestational age: -0.290, p 0.007). Adiponectin was higher in mothers with gestational diabetes (30.7 ± 6.5 vs. 24.8 ± 8 ng/mL, p 0.044). Leptin was associated with pre-pregnancy BMI (Spearman's ρ: 0.648, p < 0.0001) and MFG-E8 to presence of labor and multiple pregnancy (final linear regression model, R2 : 0.073, p 0.028, adjusted β coefficients: presence of labor -0.229, p 0.050; twins: -0.192, p 0.099). Milk adiponectin was associated with a greater decrease in length z-scores from birth to 28 days (Pearson's r: -0.225, p 0.032) and to discharge (Pearson's r: -0.290, p 0.003). Milk MFG-E8 was lower in milk of mothers whose babies experienced late-onset sepsis (13.3 ± 5.8 vs. 16.8 ± 6.3 μg/mL, p 0.023). Adipokines levels in preterm human milk are partially related to maternal metabolic status. Milk peptide concentration associates with early neonatal growth trajectories.
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Affiliation(s)
- Carla Balcells-Esponera
- Neonatology Department, BCNatal-Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Borràs-Novell
- Neonatology Department, BCNatal-Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Miriam López-Abad
- Neonatology Department, BCNatal-Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Montserrat Izquierdo Renau
- Neonatology Department, BCNatal-Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Ana Herranz Barbero
- Neonatology Department, BCNatal-Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Iglesias-Platas
- Neonatology Department, BCNatal-Centre de Medicina Maternofetal i Neonatologia de Barcelona, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospital Trust, Norwich, UK
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Vass RA, Mikó É, Gál C, Kőszegi T, Vass CI, Bokor S, Molnár D, Funke S, Kovács K, Bódis J, Ertl T. The Effect of Holder Pasteurization and Different Variants on Breast Milk Antioxidants. Antioxidants (Basel) 2023; 12:1857. [PMID: 37891936 PMCID: PMC10604438 DOI: 10.3390/antiox12101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND After birth, breast milk (BM) is a known essential source of antioxidants for infants. We analyzed the non-enzymatic total antioxidant capacity (TAC), oxygen radical absorbance capacity (ORAC), and glutathione, calcium, transferrin, and total protein levels of human breast milk before and after Holder pasteurization (HoP). METHODS The collected donor BM samples were pasteurized with HoP. RESULTS HoP decreased TAC (-12.6%), ORAC (-12.1%), transferrin (-98.3%), and total protein (-21.4%) levels; HoP did not influence the glutathione concentration, and it increased the total calcium (+25.5%) concentration. Mothers who gave birth via Cesarean section had significantly lower TAC in their BM. TAC and glutathione levels were elevated in the BM of mothers over the age of 30. BM produced in the summer had higher glutathione and calcium levels compared to BM produced in the winter. The glutathione concentration in term milk samples was significantly higher in the first two months of lactation compared to the period between the third and sixth months. The transferrin level of BM for female infants was significantly higher than the BM for boys, and mothers with a BMI above 30 had increased transferrin in their samples. CONCLUSIONS Antioxidant levels in human milk are influenced by numerous factors. Environmental and maternal factors, the postpartum age at breast milk collection, and Holder pasteurization of the milk influence the antioxidant intake of the infant.
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Affiliation(s)
- Réka Anna Vass
- Department of Obstetrics and Gynecology, Medical School University of Pécs, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Obstetrics and Gynecology, Magyar Imre Hospital, 8400 Ajka, Hungary
| | - Éva Mikó
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Department of Microbiology, Medical School University of Pécs, 7624 Pécs, Hungary
| | - Csenge Gál
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Tamás Kőszegi
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Department of Laboratory Medicine, Medical School University of Pécs, 7624 Pécs, Hungary
| | - Csaba I Vass
- Obstetrics and Gynecology, Magyar Imre Hospital, 8400 Ajka, Hungary
| | - Szilvia Bokor
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Department of Pediatrics, Medical School University of Pécs, 7624 Pécs, Hungary
| | - Dénes Molnár
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- Department of Pediatrics, Medical School University of Pécs, 7624 Pécs, Hungary
| | - Simone Funke
- Department of Obstetrics and Gynecology, Medical School University of Pécs, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Kálmán Kovács
- Department of Obstetrics and Gynecology, Medical School University of Pécs, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - József Bódis
- Department of Obstetrics and Gynecology, Medical School University of Pécs, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
- HUN-REN-PTE Human Reproduction Research Group, 7624 Pécs, Hungary
| | - Tibor Ertl
- Department of Obstetrics and Gynecology, Medical School University of Pécs, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
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Gates A, Hair AB, Salas AA, Thompson AB, Stansfield BK. Nutrient Composition of Donor Human Milk and Comparisons to Preterm Human Milk. J Nutr 2023; 153:2622-2630. [PMID: 37517552 DOI: 10.1016/j.tjnut.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Human milk is the preferred diet for very low birth weight (VLBW, <1500 g) infants. When mother's own milk is unable to meet the needs of VLBW infants, donor human milk (DHM) is the preferred alternative. Unfortunately, the composition of DHM remains elusive and no comparative studies between preterm human milk and DHM have been performed previously. OBJECTIVES We aimed to analyze the nutrient content of commercial pooled DHM and compare nutrient content in DHM with that of early and mature preterm human milk. METHODS We analyzed nutrient content in 15 DHM samples provided from 7 commercial milk banks including calories, carbohydrate, fat, protein, sodium, chloride, potassium, zinc, calcium, phosphorus, magnesium, and vitamin D and compared each nutrient to early (7 d of life) and mature (28 d of life) preterm human milk samples (n = 28-36 per nutrient, gestational age = 28 ± 3 wk). Protein-to-energy ratio and carbohydrate-to-nonprotein energy ratio were calculated for each sample and compared. RESULTS Mean values for all macro- and micronutrients in DHM are reported. In comparison to early or mature preterm human milk, DHM had significantly lower protein, sodium, chloride, potassium, and zinc content. Calorie, carbohydrate, calcium, phosphorus, magnesium, and vitamin D content did not differ statistically between DHM and early or mature preterm human milk. Fat content was modestly lower in early but not mature human milk when compared with DHM. CONCLUSIONS We provide mean values for several macro- and micronutrients for DHM and identify key differences between DHM and preterm human milk, which may be considered when designing human milk-based feeding plans. This study was registered at clinicaltrials.gov as NCT05742815.
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Affiliation(s)
- Amy Gates
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Amy B Hair
- Department of Pediatrics, College of Medicine, Baylor University, Houston, TX
| | - Ariel A Salas
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Amy B Thompson
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Brian K Stansfield
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA.
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Suwaydi MA, Lai CT, Rea A, Gridneva Z, Perrella SL, Wlodek ME, Geddes DT. Circadian Variation in Human Milk Hormones and Macronutrients. Nutrients 2023; 15:3729. [PMID: 37686759 PMCID: PMC10490050 DOI: 10.3390/nu15173729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
There is an inadequate understanding of the daily variations in hormones and macronutrients in human milk (HM), and sample collection protocols vary considerably from study to study. To investigate changes in these milk components across 24 h, 22 lactating women collected small milk samples before and after each breastfeed or expression from each breast. Test weighing was used to determine the volume of HM consumed in each feed. The concentrations of leptin, adiponectin, insulin, fat, and glucose were measured, and the intakes were calculated. A linear mixed model was fitted to assess within-feed and circadian variation in HM feed volume and concentration, and intakes of several components. The average infant intake of HM was 879 g/24 h. Significantly higher pre-feed concentrations were found for adiponectin and glucose and lower post-feed concentrations were found for insulin and fat. Significant circadian rhythms were displayed for leptin, adiponectin, insulin, glucose (both concentration and intake), fat concentration, and milk volume. These findings demonstrate the necessity for setting up standardised and rigorous sampling procedures that consider both within-feed and circadian variations in HM components to gain a more precise understanding of the impacts of these components on infant health, growth and development.
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Affiliation(s)
- Majed A. Suwaydi
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia (C.T.L.); (Z.G.); (S.L.P.); (M.E.W.)
- School of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia (C.T.L.); (Z.G.); (S.L.P.); (M.E.W.)
| | - Alethea Rea
- Mathematics and Statistics, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia;
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia (C.T.L.); (Z.G.); (S.L.P.); (M.E.W.)
| | - Sharon L. Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia (C.T.L.); (Z.G.); (S.L.P.); (M.E.W.)
| | - Mary E. Wlodek
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia (C.T.L.); (Z.G.); (S.L.P.); (M.E.W.)
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia (C.T.L.); (Z.G.); (S.L.P.); (M.E.W.)
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Velumula PK, Elbakoush F, Elfadeel H, Lulic-Botica M, Natarajan G, Bajaj M. Comparative Growth Outcomes in Preterm Infants Fed Either Mother's Own Milk or Donor Human Milk. Breastfeed Med 2023; 18:300-306. [PMID: 36971613 DOI: 10.1089/bfm.2022.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Objective: To compare growth velocity (GV) in preterm infants fed mother's own milk (MOM) fortified with human milk-based fortifier (HMBF) to those who received donor human milk (DHM) fortified with HMBF. Study Design: A retrospective study of preterm infants with birth weight <1,250 g receiving an exclusive human milk diet. Maternal and infant charts were reviewed for feeding, growth, and short-term neonatal morbidities. Results: On regression analysis, after adjusting (gestational age, multiple births, antenatal steroids, and small for gestational age), no significant difference was observed between the two groups in GV from birth to 32 weeks postmenstrual age (β-coefficient 0.83, 95% confidence interval [CI]: -0.47 to 2.14, p = 0.21), GV from the day of regaining of birth weight to discharge (β-coefficient -0.015, 95% CI: -1.08 to 1.05, p = 0.98). The rate of Grade 3 and 4 intraventricular hemorrhage was significantly higher in the DHM group (19.6% compared to 5.5% in MOM, p = 0.03). Conclusion: At our institution, there was no difference in GV of preterm infants fed HMBF-fortified MOM versus HMBF-fortified DBM.
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Affiliation(s)
| | - Faesal Elbakoush
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
- Department of Pediatrics, Hutzel Women's Hospital/Detroit Medical Center, Detroit, Michigan, USA
| | - Hiba Elfadeel
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
- Department of Pediatrics, Hutzel Women's Hospital/Detroit Medical Center, Detroit, Michigan, USA
| | - Mirjana Lulic-Botica
- Department of Pediatrics, Hutzel Women's Hospital/Detroit Medical Center, Detroit, Michigan, USA
- Department of Pharmacy, Wayne State University, Detroit, Michigan, USA
| | - Girija Natarajan
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
- Department of Pediatrics, Hutzel Women's Hospital/Detroit Medical Center, Detroit, Michigan, USA
- Department of Pediatrics, Central Michigan University, Detroit, Michigan, USA
| | - Monika Bajaj
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
- Department of Pediatrics, Hutzel Women's Hospital/Detroit Medical Center, Detroit, Michigan, USA
- Department of Pediatrics, Central Michigan University, Detroit, Michigan, USA
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7
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Insulin, Testosterone, and Albumin in Term and Preterm Breast Milk, Donor Milk, and Infant Formula. Nutrients 2023; 15:nu15061476. [PMID: 36986206 PMCID: PMC10051190 DOI: 10.3390/nu15061476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Background: Infants have three options for feeding: their own mother’s breast milk, donor milk, or infant formula. Insulin, testosterone, total protein, and albumin levels were measured in breast milk samples from the first 6 months of lactation, in donor milk samples, and in different infant formulas. Methods: Mothers who gave birth to term (n = 19) or preterm (n = 19) infants were recruited to collect breast milk samples during the first 6 months of lactation. The Breast Milk Collection Center (Unified Health Institution, Pécs, Hungary) provided 96 donor milk (DM) samples for analysis in our study. Insulin, testosterone, total protein, and albumin levels were measured in breast milk, donor milk, and infant formulas. Results: During the first 2 months of lactation, the concentration of insulin was lower (−27.4%) while the testosterone concentration was higher (+20.8%) compared to the period between the 3rd and 6th months only in the preterm breast milk samples. The infant formulas examined did not contain insulin or testosterone. Holder pasteurization (HoP) did not influence the level of testosterone in human milk, although HoP decreased the insulin (−53.6%) and albumin (−38.6%) concentrations. Conclusions: Diet impacts the hormone intake of infants, underlining the importance of breastfeeding and the possible supplementation of formula-fed infants.
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Dilemmas in initiation of very preterm infant enteral feeds-when, what, how? J Perinatol 2023; 43:108-113. [PMID: 36447040 DOI: 10.1038/s41372-022-01564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
With limited clinical evidence available to guide common nutritional decisions, significant variation exists in approaches to enteral feeding for very preterm infants, specifically when feedings are initiated, what is fed, and the method used for feedings. Preclinical studies have highlighted the benefits associated with avoiding nil per os and providing early-stage mother's own milk or colostrum. However, these recommended approaches are often mutually exclusive due to the delays in lactation associated with very preterm delivery, resulting in uncertainty regarding which approach should be prioritized. Few studies have evaluated feeding frequency in preterm infants, with limited generalizability to extremely preterm infants. Therefore, even evidence-based approaches to very preterm infant feed initiation can differ. Future research is needed to identify optimal strategies for enteral nutrition in very preterm infants, but, until then, evidence-informed approaches may vary depending on each neonatal intensive care unit's assessment of risk and benefit.
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Nesfatin-1 in Human Milk and Its Association with Infant Anthropometry. Nutrients 2022; 15:nu15010176. [PMID: 36615833 PMCID: PMC9824050 DOI: 10.3390/nu15010176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Breastfed infants have different growth patterns to formula-fed infants and are less likely to develop obesity later in life. Nesfatin-1 is an anorexigenic adipokine that was discovered in human milk more than a decade ago, and its role in infant appetite regulation is not clear. Our aim was to describe nesfatin-1 levels in human milk collected 3-4 months postpartum, associations with infant anthropometry, and factors (maternal pre-pregnancy body mass index (mBMI), high weight gain during pregnancy, milk fat, and energy content) possibly influencing nesfatin-1 levels. We hypothesized that nesfatin-1 levels in mother's milk would differ for infants that were large (high weight-for-age Z-score (WAZ)) or small (low WAZ) at the time of milk sample collection. We used enzyme-linked immunosorbent assay to detect the nesfatin-1 concentration in milk samples from mothers to high WAZ (n = 50) and low WAZ (n = 50) infants. We investigated associations between nesfatin-1 levels and infant anthropometry at 3-4 months of age and growth since birth, using linear regression adjusted for mBMI, birth weight, infant sex, and exclusivity of breastfeeding. We found no difference in nesfatin-1 levels between the two groups and no association with infant anthropometry, even after adjusting for potential confounders. However, high nesfatin-1 levels were correlated with low mBMI. Future research should investigate serum nesfatin-1 level in both mothers, infants and associations with growth in breastfed children.
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Marousez L, Tran L, Micours E, De Lamballerie M, Gottrand F, Pierrat V, Eberlé D, Ley D, Lesage J. Metabolic hormones in human breast milk are preserved by high hydrostatic pressure processing but reduced by Holder pasteurization. Food Chem 2022; 377:131957. [PMID: 34990954 DOI: 10.1016/j.foodchem.2021.131957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 11/04/2022]
Abstract
In human milk banks (HMBs), donor milk (DM) is commonly sterilized by Holder pasteurization (HoP). High hydrostatic pressure (HHP) processing is an innovative, alternative method for DM sterilization. We evaluated the impact of HHP processing on the concentration of seven metabolic milk hormones. Eight samples of raw DM were aliquoted. One aliquot was sterilized by HoP (62 °C for 30 min), and another was processed by HHP (350 MPa at 38 °C). Compared with raw DM, HoP milk displayed reduced concentrations of insulin, nesfatin-1, cortisol, leptin, apelin and GLP-1, though adiponectin levels were unchanged. HHP processing maintained the levels of insulin, nesfatin-1, cortisol and leptin at their initial levels in raw DM, reduced apelin and adiponectin levels, but increased GLP-1 level. Sterilization of DM by HHP thus preserves the main metabolic hormones in human milk, underlining the interest of this method for use in HMBs.
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Affiliation(s)
- Lucie Marousez
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Léa Tran
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Edwina Micours
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | | | - Frédéric Gottrand
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Division of Gastroenterology Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, F-59000 Lille, France
| | - Véronique Pierrat
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Delphine Eberlé
- Univ. Lille, Inserm, UMR1011 - Nuclear Receptors, Metabolic and Cardiovascular Diseases, Institut Pasteur de Lille, F-59000 Lille, France
| | - Delphine Ley
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Division of Gastroenterology Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, F-59000 Lille, France
| | - Jean Lesage
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France.
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11
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Mank E, van Toledo L, Heijboer AC, van den Akker CHP, van Goudoever JB. Insulin Concentration in Human Milk in the First Ten Days Postpartum: Course and Associated Factors. J Pediatr Gastroenterol Nutr 2021; 73:e115-e119. [PMID: 34183615 DOI: 10.1097/mpg.0000000000003214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND OBJECTIVES Human milk (HM) is better tolerated than formula in preterm infants. Insulin, which is naturally present in HM but not in formula, has been suggested as a key factor for feeding tolerance, as it appears to stimulate intestinal maturation. Its precise concentrations during the early postnatal period, however, remains unknown. The objective of this study was to assess the natural timecourse of the HM insulin concentration during the first ten days postpartum. The effect of preterm delivery, maternal obesity, and diurnal rhythm were also assessed. METHOD HM was collected from 31 non-diabetic mothers (21 preterm [gestational age (GA) < 37 weeks]; 10 at-term [GA ≥ 37 weeks]) on ≥ 4 time-points per day during the first five days, and once on the tenth day postpartum. RESULTS The HM insulin concentration declined rapidly within the first three days postpartum (day 1: 516 [312-1058] pmol/L; day 3: 157 [87-299] pmol/L), after which the concentration remained relatively stable. The insulin concentrations were higher in HM from obese mothers than from non-obese mothers (P < 0.001). Preterm delivery did not significantly affect HM insulin concentrations when adjusted for maternal pre-pregnancy body mass index category (P = 0.270). Diurnal rhythm was characterized by an insulin concentration decline throughout the night (P = 0.001), followed by an increase in the morning (P = 0.001). CONCLUSION The HM insulin concentration declines rapidly in the first three days postpartum, follows a diurnal rhythm, and is higher in obese mothers compared to non-obese mothers. HM insulin concentrations are not affected by preterm delivery.
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Affiliation(s)
- Elise Mank
- Department of Pediatrics-Neonatology, Emma Children's Hospital
| | | | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Suwaydi MA, Gridneva Z, Perrella SL, Wlodek ME, Lai CT, Geddes DT. Human Milk Metabolic Hormones: Analytical Methods and Current Understanding. Int J Mol Sci 2021; 22:ijms22168708. [PMID: 34445437 PMCID: PMC8395916 DOI: 10.3390/ijms22168708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023] Open
Abstract
Human milk (HM) contains a wide array of peptide hormones including leptin and adiponectin, which are involved in the regulation of infant growth and development. These essential hormones might play an important role in the regulation of metabolic reprogramming of the new-born infant. However, HM hormone studies are sparse and heterogeneous in regard to the study design, sample collection, preparation and analysis methods. This review discussed the limitations of HM hormone analysis highlighting the gaps in pre-analytical and analytical stages. The methods used to quantify HM metabolic hormones (leptin, adiponectin, ghrelin, insulin, obestatin, resistin and apelin) can be classified as immunoassay, immunosensor and chromatography. Immunoassay methods (ELISA and RIA) have been predominantly used in the measurement of these HM hormones. The relative validity parameters of HM hormones analysis are often overlooked in publications, despite the complexity and differences of HM matrix when compared to that of plasma and urine. Therefore, appropriate reports of validation parameters of methodology and instrumentation are crucial for accurate measurements and therefore better understanding of the HM metabolic hormones and their influences on infant outcomes.
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Affiliation(s)
- Majed A. Suwaydi
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan 54142, Saudi Arabia
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
- Correspondence: ; Tel.: +61-8-6488-4467
| | - Sharon L. Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
| | - Mary E. Wlodek
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
- Population Health, Murdoch Children’s Research Institute (MCRI), Parkville, VIC 3052, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
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13
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Colaizy TT. Effects of milk banking procedures on nutritional and bioactive components of donor human milk. Semin Perinatol 2021; 45:151382. [PMID: 33632557 DOI: 10.1016/j.semperi.2020.151382] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pasteurized donor human milk is in wide use for preterm infants in neonatal intensive care units when maternal milk is unavailable. Pasteurization of donor milk is required to prevent bacterial contamination, and multiple methods are used in the non-profit and commercial milk banking industries. Pasteurization results in changes in the nutrient and bioactive components in donor milk compared to unpasteurized human milk, and these changes vary by the type of pasteurization process. Other milk bank practices including freezing of milk, pooling of milk from multiple donors and use of pre-processing macronutrient analysis also affect the nutritional composition of donor milk. This review compiles evidence regarding three common pasteurization techniques for donor milk: Holder pasteurization, vat pasteurization, and retort pasteurization and their effects on the nutritional content and bioactive factors in human milk. It also includes review of literature investigating the impact of freezing and storage, and best practices for multi-donor milk pooling.
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Affiliation(s)
- Tarah T Colaizy
- Professor of Pediatrics, University of Iowa, 8809 JPP, UIHC, 200 Hawkins Drive, Iowa City, IA 52242, United States.
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14
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Vass RA, Kiss G, Bell EF, Roghair RD, Miseta A, Bódis J, Funke S, Ertl T. Breast Milk for Term and Preterm Infants-Own Mother's Milk or Donor Milk? Nutrients 2021; 13:nu13020424. [PMID: 33525560 PMCID: PMC7912320 DOI: 10.3390/nu13020424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/23/2023] Open
Abstract
Hormones are important biological regulators, controlling development and physiological processes throughout life. We investigated pituitary hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and total protein levels during the first 6 months of lactation. Breast milk samples were collected every fourth week of lactation from mothers who gave birth to preterm (n = 14) or term (n = 16) infants. Donor milk is suggested when own mother’s milk is not available; therefore, we collected breast milk samples before and after Holder pasteurization (HoP) from the Breast Milk Collection Center of Pécs, Hungary. Three infant formulas prepared in the Neonatal Intensive Care Unit of the University of Pécs were tested at three different time points. Our aim was to examine the hormone content of own mother’s milk and donor milk. There were no significant changes over time in the concentrations of any hormone. Preterm milk had higher PRL (28.2 ± 2.5 vs. 19.3 ± 2.3 ng/mL) and LH (36.3 ± 8.8 vs. 15.9 ± 4.1 mIU/L) concentrations than term milk during the first 6 months of lactation. Total protein and FSH concentrations did not differ between preterm and term breast milk. Holder pasteurization decreased the PRL concentration (30.4 ± 1.8 vs. 14.4 ± 0.6 ng/mL) and did not affect gonadotropin levels of donor milk. Infant formulas have higher total protein content than breast milk but do not contain detectable levels of pituitary hormones. Differences were detected in the content of pituitary hormones produced for preterm and term infants. Divergence between feeding options offers opportunities for improvement of nutritional guidelines for both hospital and home feeding practices.
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Affiliation(s)
- Réka A. Vass
- Department of Obstetrics and Gynecology, University of Pécs Medical School, 7624 Pécs, Hungary; (J.B.); (S.F.); (T.E.)
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, 7624 Pécs, Hungary
- Correspondence: ; Tel.: +36-30-253-2000
| | - Gabriella Kiss
- Department of Laboratory Medicine, University of Pécs Medical School, 7624 Pécs, Hungary; (G.K.); (A.M.)
| | - Edward F. Bell
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA; (E.F.B.); (R.D.R.)
| | - Robert D. Roghair
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA; (E.F.B.); (R.D.R.)
| | - Attila Miseta
- Department of Laboratory Medicine, University of Pécs Medical School, 7624 Pécs, Hungary; (G.K.); (A.M.)
| | - József Bódis
- Department of Obstetrics and Gynecology, University of Pécs Medical School, 7624 Pécs, Hungary; (J.B.); (S.F.); (T.E.)
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, 7624 Pécs, Hungary
| | - Simone Funke
- Department of Obstetrics and Gynecology, University of Pécs Medical School, 7624 Pécs, Hungary; (J.B.); (S.F.); (T.E.)
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, 7624 Pécs, Hungary
| | - Tibor Ertl
- Department of Obstetrics and Gynecology, University of Pécs Medical School, 7624 Pécs, Hungary; (J.B.); (S.F.); (T.E.)
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, 7624 Pécs, Hungary
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15
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Bramer S, Boyle R, Weaver G, Shenker N. Use of donor human milk in nonhospitalized infants: An infant growth study. MATERNAL AND CHILD NUTRITION 2021; 17:e13128. [PMID: 33404169 PMCID: PMC7988867 DOI: 10.1111/mcn.13128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
When mother's own milk (MOM) is unavailable or insufficient, donor human milk (DHM) is recommended as the next best alternative for low birthweight infants. DHM use for healthy, term infants is increasing, but evidence for growth and tolerability is limited. This retrospective study evaluated growth in term infants in the community who received DHM from a UK milk bank. Mothers of infants receiving DHM between 2017 and 2019 were contacted (n = 49), and 31 (63.2%) agreed to participate. Fourteen infants received DHM as a supplement to other feeds (MOM and/or infant formula) and 17 were exclusively fed DHM where breastfeeding was impossible (range: 3–6 weeks). Growth was assessed by deriving z‐scores using the WHO standard for infant growth and compared with 200 exclusively breastfed infants. Multivariate regression analysis revealed no feeding method‐specific association between z‐score and age, nor between weight and age, suggesting that z‐scores and growth velocity were not affected by feeding exclusive MOM, supplemental DHM or exclusive DHM. DHM was well‐tolerated with no adverse events that led to early cessation. After receiving supplemental DHM group, 63% of infants whose mothers had no physical barrier to breastfeeding (5/8 infants) were exclusively breastfed. This novel study reports adequate growth outcomes of healthy nonhospitalized infants receiving DHM, either as the sole milk source or supplement. Prospective studies are needed to confirm whether DHM is a suitable feeding alternative for term infants in the community, optimal durations, as well as the impact of DHM availability on breastfeeding rates and maternal mental health. DHM recipients were compared with the who infant growth standard (World Health Organization, 2020) by deriving z‐scores. The WHO Anthro Macro (World Health Organization, 2011 ) was used to calculate weight‐for‐age, length‐for‐age and head circumference‐for‐age z‐scores; z‐scores are the standard deviation of an infant's anthropometric measurements when compared with the WHO standard for infant growth and are gender and age specific.
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Affiliation(s)
- Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, UK
| | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, UK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK
| | - Natalie Shenker
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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16
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Torrez Lamberti MF, DeBose-Scarlett E, Garret T, Parker LA, Neu J, Lorca GL. Metabolomic Profile of Personalized Donor Human Milk. Molecules 2020; 25:E5783. [PMID: 33302441 PMCID: PMC7763631 DOI: 10.3390/molecules25245783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022] Open
Abstract
Human milk could be considered an active and complex mixture of beneficial bacteria and bioactive compounds. Since pasteurization drastically reduces the microbial content, we recently demonstrated that pasteurized donor human milk (DHM) could be inoculated with different percentages (10% and 30%) of mother's own milk (MOM) to restore the unique live microbiota, resulting in personalized milk (RM10 and RM30, respectively). Pasteurization affects not only the survival of the microbiota but also the concentration of proteins and metabolites, in this study, we performed a comparative metabolomic analysis of the RM10, RM30, MOM and DHM samples to evaluate the impact of microbial restoration on metabolite profiles, where metabolite profiles clustered into four well-defined groups. Comparative analyses of DHM and MOM metabolomes determined that over one thousand features were significantly different. In addition, significant changes in the metabolite concentrations were observed in MOM and RM30 samples after four hours of incubation, while the concentration of metabolites in DHM remained constant, indicating that these changes are related to the microbial expansion. In summary, our analyses indicate that the metabolite profiles of DHM are significantly different from that of MOM, and the profile of MOM may be partially restored in DHM through microbial expansion.
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Affiliation(s)
- Monica F. Torrez Lamberti
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA; (M.F.T.L.); (E.D.-S.)
| | - Evon DeBose-Scarlett
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA; (M.F.T.L.); (E.D.-S.)
| | - Timothy Garret
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Leslie Ann Parker
- College of Nursing, University of Florida, Gainesville, FL 32611, USA;
| | - Josef Neu
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL 32611, USA;
| | - Graciela L. Lorca
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA; (M.F.T.L.); (E.D.-S.)
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17
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Young BE, Murphy K, Borman LL, Heinrich R, Krebs NF. Milk Bank Pooling Practices Impact Concentrations and Variability of Bioactive Components of Donor Human Milk. Front Nutr 2020; 7:579115. [PMID: 33123548 PMCID: PMC7573550 DOI: 10.3389/fnut.2020.579115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Donor human milk (DHM) bank practices, such as pasteurization and pooling according to postpartum age of milk donations and number of donors included in a pool may impact the resulting concentration of bioactive components of DHM. Aims: We determined the impact of Holder pasteurization, postpartum milk age, and pool donor number (number of donors included in a pool) on resulting concentrations of total immunoglobulin A (IgA; which provides immune protection to the recipient infant) and insulin (an important hormone for gut maturation).We also documented inter-relationships between these bioactive components and macronutrients in DHM pools. Methods: Pre and post-pasteurization aliquots of 128 DHM samples were obtained from the Rocky Mountain Children's Foundation Mother's Milk Bank (a member of the Human Milk Banking Association of North America, HMBANA). Macronutrients were measured via mid-infrared spectroscopy. Total IgA was measured via customized immunoassay in skim milk and insulin was measured via chemiluminescent immunoassay. Results: Mean post-pasteurization total IgA concentration was 0.23 ± 0.10 (range: 0.04-0.65) mg/mL a 17.9% decrease due to pasteurization (n = 126). Mean post-pasteurization DHM insulin concentration was 7.0 ± 4.6 (range: 3-40) μU/mL, a decrease of 13.6% due to pasteurization (n = 128). The average DHM pool postpartum milk age was not associated with total IgA or insulin concentrations, but pool donor number was associated with bioactive components. Pools with only one donor had lower total IgA and lower insulin concentrations than pools with at least 2 donors (p < 0.05). Increasing the number of donors in a pool decreased the variability in total IgA and insulin concentrations (p < 0.04). Conclusion: Increasing the number of donors included in DHM pools may help optimize bioactive components in DHM received by premature infants. These results help inform milk banking practices to decrease compositional variability in produced DHM pools.
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Affiliation(s)
- Bridget E Young
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Katherine Murphy
- Department of Pediatrics Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Laraine L Borman
- Mothers' Milk Bank, Rocky Mountain Children's Health Foundation, Arvada, CO, United States
| | - Rebecca Heinrich
- Mothers' Milk Bank, Rocky Mountain Children's Health Foundation, Arvada, CO, United States
| | - Nancy F Krebs
- Department of Pediatrics - Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
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18
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Vass RA, Bell EF, Colaizy TT, Schmelzel ML, Johnson KJ, Walker JR, Ertl T, Roghair RD. Hormone levels in preterm and donor human milk before and after Holder pasteurization. Pediatr Res 2020; 88:612-617. [PMID: 32000260 DOI: 10.1038/s41390-020-0789-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND After birth, breastfeeding is the exclusive source of hormonal signaling between mother and infant. Hospitalized infants often receive donor milk when their own mother's milk is unavailable. METHODS The presence of insulin, leptin, cortisol, progesterone, and testosterone was examined in samples from milk bank donors and mothers of preterm infants. We further investigated the effect of Holder pasteurization (HoP) on hormone levels. RESULTS Comparing nonpasteurized samples, leptin levels were nearly threefold higher in milk from mothers of preterm infants versus donated milk, and regardless of milk source, leptin levels were significantly decreased by HoP. Insulin concentrations were also decreased by HoP, and among mothers of preterm infants, obesity was associated with significantly higher content of leptin and insulin. While combined use of donor milk and HoP was associated with cortisol levels nearly threefold higher than those in nonpasteurized own mother's milk, progesterone and testosterone content did not differ by source or pasteurization. CONCLUSIONS The hormonal composition of breast milk is impacted by HoP and maternal obesity. Compared to nonpasteurized maternal milk, use of pasteurized donor milk dramatically decreases the intake of leptin while increasing the intake of cortisol. Further research is necessary to define optimal breast milk processing practices.
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Affiliation(s)
- Réka A Vass
- Departments of Neonatology and Obstetrics & Gynecology, University of Pécs Medical School, Pécs, Hungary.,MTA-PTE Human Reproduction Scientific Research Group, Pécs, Hungary
| | - Edward F Bell
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Tarah T Colaizy
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mendi L Schmelzel
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Karen J Johnson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jacky R Walker
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Tibor Ertl
- Departments of Neonatology and Obstetrics & Gynecology, University of Pécs Medical School, Pécs, Hungary.,MTA-PTE Human Reproduction Scientific Research Group, Pécs, Hungary
| | - Robert D Roghair
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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19
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Chang FY, Fang LJ, Chang CS, Wu TZ. The Effect of Processing Donor Milk on Its Nutrient and Energy Content. Breastfeed Med 2020; 15:576-582. [PMID: 32598161 DOI: 10.1089/bfm.2020.0076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: The pasteurization is a mandatory step to inactivate pathogenic microorganisms of bank milk. For storage, freezing and thawing are necessary. The concentration of macronutrients and energy of bank milk could be influenced by these procedures which are routinely used in human milk bank. Research Aim: The aim of this study is to analyze the effect of bank milk processing (pasteurization and freezing/thawing) on the macronutrients (fat, protein, and carbohydrate) concentration and energy content. Materials and Methods: The samples of donor milk were collected and studied before/after pasteurization and after frozen for 3 months. Total 100 samples of bank milk were tested using an infrared analyzer. The measurements of fat, protein, carbohydrate, and energy were statistically analyzed by SPSS. Results: There was a prominent reduction of fat mean concentration following pasteurization and frozen (20.5% and 6.5%, respectively). The processing did not cause significant changes in protein content, but there were significant increase after pasteurization and decrease after frozen in carbohydrate (p < 0.05). Overall (postpasteurization and frozen storage), a 9.6% decrease was observed for energy content. Conclusion: This study revealed that the processing of bank milk (including Holder Pasteurization and frozen storage) decreased fat and energy content of human milk significantly, and this could not meet the specific needs of preterm infants.
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Affiliation(s)
- Fang-Yuan Chang
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
| | - Li-Jung Fang
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
| | - Chao-Sheng Chang
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Tsung-Zu Wu
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
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20
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Mann S, Curone G, Chandler TL, Sipka A, Cha J, Bhawal R, Zhang S. Heat treatment of bovine colostrum: II. Effects on calf serum immunoglobulin, insulin, and IGF-I concentrations, and the serum proteome. J Dairy Sci 2020; 103:9384-9406. [PMID: 32828503 DOI: 10.3168/jds.2020-18619] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Abstract
In-depth analysis of colostrum components has identified hundreds of proteins, but data are sparse regarding their systemic uptake in the newborn calf. Moreover, heat treatment may influence these colostral components and their absorption. Our objectives were to describe the serum proteome of newborn calves before and after colostrum feeding and the possible effects of colostral heat treatment. Newborn Holstein heifer calves (n = 22) were randomized within pair and fed heat-treated (n = 11; 60°C, 60 min) or raw (n = 11) colostrum at 8.5% of birth body weight by esophageal feeder within 1 h of birth. After the single colostrum feeding, calves were not fed until after the 8-h time point, when milk was offered free-choice. Blood samples were taken immediately before feeding (0 h), as well as 4, 8, and 24 h after feeding. Whole blood packed cell volume (%), serum Brix percentage, and plasma glucose concentrations were determined for all time points. Plasma insulin and insulin-like growth factor-I concentrations were determined by radioimmunoassay for selected time points. Serum IgA and IgG were measured by radial immunodiffusion at 24 h. The serum proteome was analyzed using nano-scale reverse-phase chromatography and tandem mass spectrometry (nano LC-MS/MS) in 0- and 8-h samples. For proteomics analysis, ratios of results for 8-h to 0-h samples were analyzed with false discovery rate adjustment. For all other outcomes, repeated-measures ANOVA was performed with the fixed effects of group, time, and their interaction, and random effect of pair. Serum Brix percentage and glucose concentrations increased over time and were independent of colostrum treatment. Serum IgG and IgA concentrations at 24 h did not differ between groups. Nano LC-MS/MS identified a total of 663 unique proteins in serum, of which 261 increased in abundance, whereas 67 decreased in abundance after feeding in both groups. Among serum proteins that increased in abundance and that were previously identified in colostrum, many belonged to those involved in immune response, coagulation, the classical complement pathway, or the antimicrobial peptide class of cathelicidins. Serum proteins that decreased in abundance and that were identified in colostrum belonged to the alternative complement pathway and the membrane attack complex. Thirty-eight proteins differed in calves that were fed heat-treated colostrum compared with those fed raw colostrum. Decreased abundances in calves fed heat-treated colostrum included several enzymes involved in glycolysis or glycogenolysis, whereas the incretin gastric inhibitory polypeptide and serum insulin were increased in this group. Our findings point to important innate immune defense pathways associated with colostrum ingestion in newborn calves. Furthermore, calves fed heat-treated colostrum showed differences in serum proteins and enzymes associated with carbohydrate metabolism.
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Affiliation(s)
- S Mann
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
| | - G Curone
- Department of Veterinary Medicine, University of Milano, 26900, Lodi, Italy
| | - T L Chandler
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - A Sipka
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - J Cha
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY 14853
| | - R Bhawal
- Proteomics and Metabolomics Facility, Institute of Biotechnology, Cornell University, Ithaca, NY 14853
| | - S Zhang
- Proteomics and Metabolomics Facility, Institute of Biotechnology, Cornell University, Ithaca, NY 14853
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21
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Mann S, Curone G, Chandler TL, Moroni P, Cha J, Bhawal R, Zhang S. Heat treatment of bovine colostrum: I. Effects on bacterial and somatic cell counts, immunoglobulin, insulin, and IGF-I concentrations, as well as the colostrum proteome. J Dairy Sci 2020; 103:9368-9383. [PMID: 32828510 DOI: 10.3168/jds.2020-18618] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
The objective of this study was to investigate the effects of heat treatment on colostral low-abundant proteins, IgG and IgA, insulin, and insulin-like growth factor I (IGF-I), as well as bacteria and somatic cells. First-milking colostrum samples >8 L and Brix % > 22.0 were harvested from 11 Holstein cows on a commercial dairy in New York State and split into 2 aliquots using single-use colostrum bags. One aliquot of each pair was cooled on ice immediately after harvest (raw, R; n = 11), and the other was heat-treated for 60 min at 60°C (heat, H; n = 11). All samples were analyzed for IgG and IgA via radial immunodiffusion assay and insulin and IGF-I concentrations by radioimmunoassay. Total bacterial counts and somatic cell counts (SCC) were determined using standard plate culture techniques and flow cytometry, respectively. Samples from a subset of 5 pairs (n = 10) were further analyzed by nano liquid chromatography-tandem mass spectroscopy, after ultracentrifugation at 100,000 × g for 60 min at 4°C to enrich the low-abundant protein whey fraction. Data were analyzed using either paired t-test or Wilcoxon signed-rank test or using an online software package to analyze proteomics data. Outcomes of proteomics analysis were fold change ≥1.5 between pairs, and paired t-tests with false discovery rate-adjusted P-value < 0.05. The median reduction of IgA concentrations was 8.5% (range: 0-38.0%) due to heat treatment, whereas IgG concentrations did not change due to treatment. Insulin concentrations decreased by a median of 22% (7-45%), and IGF-I decreased by 10% (0-18%) in H samples. Heat treatment was associated with a median reduction of SCC of 36% (0-90%) in paired samples, as well as a median reduction in total bacterial count of 93% (45-100%) in H versus R samples. Proteomics analysis identified a total of 328 unique proteins that were present in all 10 samples. Nine of the 25 proteins that decreased by at least 1.5-fold in H compared with R were identified as complement proteins. We conclude that heat treatment of colostrum is associated with a reduction in the concentration of bacterial counts and SCC, IgA, insulin, and IGF-I. In addition, proteomics analysis of colostral whey identified several complement components and other proteins that decreased in abundance due to heat treatment. Although IgG concentrations were unaffected and a reduction in bacterial counts was achieved, the change in several immunologically active proteins and growth factors may have biologically important effects on the developing immune system of the neonate fed heat-treated colostrum.
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Affiliation(s)
- S Mann
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
| | - G Curone
- Department of Veterinary Medicine, University of Milano, 26900, Lodi, Italy
| | - T L Chandler
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - P Moroni
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853; Department of Veterinary Medicine, University of Milano, 26900, Lodi, Italy
| | - J Cha
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY 14853
| | - R Bhawal
- Proteomics and Metabolomics Facility, Institute of Biotechnology, Cornell University, Ithaca, NY 14853
| | - S Zhang
- Proteomics and Metabolomics Facility, Institute of Biotechnology, Cornell University, Ithaca, NY 14853
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22
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Piñeiro-Ramos JD, Parra-Llorca A, Ten-Doménech I, Gormaz M, Ramón-Beltrán A, Cernada M, Quintás G, Collado MC, Kuligowski J, Vento M. Effect of donor human milk on host-gut microbiota and metabolic interactions in preterm infants. Clin Nutr 2020; 40:1296-1309. [PMID: 32863061 DOI: 10.1016/j.clnu.2020.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Human milk is the gold standard for infant nutrition. Preterm infants whose mothers are unable to provide sufficient own mother's milk (OMM), receive pasteurized donor human milk (DHM). We studied metabolic signatures of OMM and DHM and their effect on the interplay of the developing microbiota and infant's metabolism. METHODS Metabolic fingerprinting of OMM and DHM as well as infant's urine was performed using liquid chromatography-mass spectrometry and the infant's stool microbiota was analyzed by 16S rRNA sequencing. RESULTS Significant differences in the galactose and starch and sucrose metabolism pathways when comparing OMM and DHM, and alterations of the steroid hormone synthesis and pyrimidine metabolism pathways in urine were observed depending on the type of feeding. Differences in the gut-microbiota composition were also identified. CONCLUSION The composition of DHM differs from OMM and feeding of DHM has a significant impact on the metabolic phenotype and microbiota of preterm infants. Our data help to understand the origin of the observed changes generating new hypothesis: i) steroid hormones present in HM have a significant influence in the activity of the steroid hormone biosynthesis pathway in preterm infants; ii) the pyrimidine metabolism is modulated in preterm infants by the activity of gut-microbiota. Short- and long-term implications of the observed changes for preterm infants need to be assessed in further studies.
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Affiliation(s)
- José David Piñeiro-Ramos
- Neonatal Research Unit, Health Research Institute Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Anna Parra-Llorca
- Neonatal Research Unit, Health Research Institute Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Isabel Ten-Doménech
- Neonatal Research Unit, Health Research Institute Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - María Gormaz
- Neonatal Research Unit, Health Research Institute Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain; Division of Neonatology, University & Polytechnic Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Amparo Ramón-Beltrán
- Division of Neonatology, University & Polytechnic Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - María Cernada
- Division of Neonatology, University & Polytechnic Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Guillermo Quintás
- Health and Biomedicine, Leitat Technological Center, Carrer de la Innovació, 2, 08225 Terrassa, Spain; Analytical Unit, Health Research Institute La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - María Carmen Collado
- Instituto de Agroquímica y Tecnología de Alimentos (IATA-CSIC), Av. Agustin Escardino 7, 46980, Paterna, Spain
| | - Julia Kuligowski
- Neonatal Research Unit, Health Research Institute Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain.
| | - Máximo Vento
- Neonatal Research Unit, Health Research Institute Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain; Division of Neonatology, University & Polytechnic Hospital La Fe, Avda Fernando Abril Martorell 106, 46026 Valencia, Spain.
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23
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Breast Milk Supply of MicroRNA Associated with Leptin and Adiponectin Is Affected by Maternal Overweight/Obesity and Influences Infancy BMI. Nutrients 2019; 11:nu11112589. [PMID: 31661820 PMCID: PMC6893542 DOI: 10.3390/nu11112589] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022] Open
Abstract
Breast milk constitutes a dietary source of leptin, adiponectin and microRNAs (miRNAs) for newborns. Expression of miRNAs previously associated with maternal obesity, leptin or adiponectin function were assessed and their impact on infant weight analyzed. Milk samples were collected (at month 1, 2, and 3) from a cohort of 59 healthy lactating mothers (38 normal-weight and 21 overweight/obese (BMI ≥ 25)), and infant growth was followed up to 2 years of age. Thirteen miRNAs, leptin and adiponectin were determined in milk. Leptin, adiponectin and miRNA showed a decrease over time of lactation in normal-weight mothers that was altered in overweight/obesity. Furthermore, negative correlations were observed in normal-weight mothers between the expression of miRNAs in milk and the concentration of leptin or adiponectin, but were absent in overweight/obesity. Moreover, miRNAs negatively correlated with infant BMI only in normal-weight mothers (miR-103, miR-17, miR-181a, miR-222, miR-let7c and miR-146b). Interestingly, target genes of milk miRNAs differently regulated in overweight/obesity could be related to neurodevelopmental processes. In conclusion, a set of miRNAs present in breast milk, in close conjunction with leptin and adiponectin, are natural bioactive compounds with the potential to modulate infant growth and brain development, an interplay that is disturbed in the case of maternal overweight/obesity.
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Wesolowska A, Sinkiewicz-Darol E, Barbarska O, Bernatowicz-Lojko U, Borszewska-Kornacka MK, van Goudoever JB. Innovative Techniques of Processing Human Milk to Preserve Key Components. Nutrients 2019; 11:E1169. [PMID: 31137691 PMCID: PMC6566440 DOI: 10.3390/nu11051169] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022] Open
Abstract
Human milk not only contains all nutritional elements that an infant requires, but is also the source of components whose regulatory role was confirmed by demonstrating health-related deficiencies in formula-fed children. A human milk diet is especially important for premature babies in the neonatal intensive care unit (NICU). In cases where breastfeeding is not possible and the mother's own milk is insufficient in volume, the most preferred food is pasteurized donor milk. The number of human milk banks has increased recently but their technical infrastructure is continuously developing. Heat treatment at a low temperature and long time, also known as holder pasteurization (62.5 °C, 30 min), is the most widespread method of human milk processing, whose effects on the quality of donor milk is well documented. Holder pasteurization destroys vegetative forms of bacteria and most viruses including human immunodeficiency virus (HIV) herpes and cytomegalovirus (CMV). The macronutrients remain relatively intact but various beneficial components are destroyed completely or compromised. Enzymes and immune cells are the most heat sensitive elements. The bactericidal capacity of heat-pasteurized milk is lower than that of untreated milk. The aim of the study was for a comprehensive comparison of currently tested methods of improving the preservation stage. Innovative techniques of milk processing should minimize the risk of milk-borne infections and preserve the bioactivity of this complex biological fluid better than the holder method. In the present paper, the most promising thermal pasteurization condition (72 °C-75 °C,) and a few non-thermal processes were discussed (high pressure processing, microwave irradiation). This narrative review presents an overview of methods of human milk preservation that have been explored to improve the safety and quality of donor milk.
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Affiliation(s)
- Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Hospital, Medical University of Warsaw, Department of Neonatology, 63A Zwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Elena Sinkiewicz-Darol
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, 53-59 St. Jozef St., 87-100 Torun, Poland.
| | - Olga Barbarska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Hospital, Medical University of Warsaw, Department of Neonatology, 63A Zwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Urszula Bernatowicz-Lojko
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, 53-59 St. Jozef St., 87-100 Torun, Poland.
| | | | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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25
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Capriati T, Goffredo BM, Argentieri M, De Vivo L, Bernaschi P, Cairoli S, Laureti F, Reposi MP, Marino D, Benedetti S, Diamanti A. A Modified Holder Pasteurization Method for Donor Human Milk: Preliminary Data. Nutrients 2019; 11:nu11051139. [PMID: 31121859 PMCID: PMC6566761 DOI: 10.3390/nu11051139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Holder pasteurization (HoP) is the recommended method of pasteurization for donor human milk (DHM). The aim of the present study was to compare nutritional and microbiological impact on DHM of a new technique of pasteurization based on technical changes of HoP. Methods: We analyzed milk samples from 25 donors. Each sample, derived from one breast milk expression, was subdivided into three aliquots according to pasteurization: The first was not pasteurized, the second pasteurized by HoP, and the third was pasteurized by modified HoP (MHoP). Each aliquot was assessed as to its microbiological and nutritional profile. Nutritional profile included calcium and triglycerides concentrations detected by spectrophotometry and amino acid levels assessed by high-performance liquid chromatography (HPLC). Results: Triglycerides were significantly lower in pasteurized, by both methods, than in not pasteurized aliquots, while calcium and amino acids concentration were similar. Microbiological profile did not differ between HoP and MHoP aliquots. Conclusions: HoP and MHoP seem to have similar efficacy in preserving some nutritional characteristics of DHM and to confer similar microbiological safety. MHoP is time-saving and potentially costs-effective when compared to HoP, and it is; therefore, potentially of more interest from a practical point of view. Further studies are needed to confirm these findings.
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Affiliation(s)
- Teresa Capriati
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Marta Argentieri
- Unit of Microbiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Liliana De Vivo
- Clinical Engineering Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Paola Bernaschi
- Unit of Microbiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Sara Cairoli
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Francesca Laureti
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Maria Paola Reposi
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Daniela Marino
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Sabina Benedetti
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Antonella Diamanti
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Hoban R, Schoeny ME, Esquerra-Zwiers A, Kaenkumchorn TK, Casini G, Tobin G, Siegel AH, Patra K, Hamilton M, Wicks J, Meier P, Patel AL. Impact of Donor Milk on Short- and Long-Term Growth of Very Low Birth Weight Infants. Nutrients 2019; 11:nu11020241. [PMID: 30678256 PMCID: PMC6412258 DOI: 10.3390/nu11020241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 01/14/2023] Open
Abstract
Mother’s own milk (MOM) reduces the risk of morbidities in very low birth weight (VLBW) infants. When MOM is unavailable, donor breastmilk (DM) is used, with unclear impact on short- and long-term growth. This retrospective analysis compared anthropometric data at six time points from birth to 20–24 months corrected age in VLBW infants who received MOM supplements of preterm formula (n = 160) versus fortified DM (n = 161) during neonatal intensive care unit (NICU) hospitalization. The cohort was 46% female; mean birth weight and gestational age (GA) were 998 g and 27.3 weeks. Multilevel linear growth models assessed changes in growth z-scores short-term (to NICU discharge) and long-term (post-discharge), controlling for amount of DM or formula received in first 28 days of life, NICU length of stay (LOS), birth GA, and sex. Z-scores for weight and length decreased during hospitalization but increased for all parameters including head circumference post-discharge. Short-term growth was positively associated with LOS and birth GA. A higher preterm formula proportion, but not DM proportion, was associated with slower rates of decline in short-term growth trajectories, but feeding type was unrelated to long-term growth. In conclusion, controlling for total human milk fed, DM did not affect short- or long-term growth.
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Affiliation(s)
- Rebecca Hoban
- Department of Paediatrics, Division of Neonatology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Michael E Schoeny
- College of Nursing, Rush University Medical Center, Chicago, IL 60612, USA.
| | | | | | - Gina Casini
- Rush Medical College, Rush University, Chicago, IL 60612, USA.
| | - Grace Tobin
- Rush Medical College, Rush University, Chicago, IL 60612, USA.
| | - Alan H Siegel
- Rush Medical College, Rush University, Chicago, IL 60612, USA.
| | - Kousiki Patra
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Matthew Hamilton
- Department of Pediatrics, Division of Neonatology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Jennifer Wicks
- Department of Pediatrics, Division of Hospital-Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Paula Meier
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL 60612, USA.
- College of Nursing, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Aloka L Patel
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL 60612, USA.
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27
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Wesolowska A, Sinkiewicz-Darol E, Barbarska O, Strom K, Rutkowska M, Karzel K, Rosiak E, Oledzka G, Orczyk-Pawiłowicz M, Rzoska S, Borszewska-Kornacka MK. New Achievements in High-Pressure Processing to Preserve Human Milk Bioactivity. Front Pediatr 2018; 6:323. [PMID: 30519550 PMCID: PMC6250976 DOI: 10.3389/fped.2018.00323] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/10/2018] [Indexed: 11/13/2022] Open
Abstract
High-pressure processing (HPP) is a non-thermal technology that is being increasingly applied in food industries worldwide. It was proposed that this method could be used as an alternative to holder pasteurization (HoP; 62.5°C, 30 min) in milk banks but its impact on the immunologic, enzymatic and hormonal components of human milk has not yet been evaluated in detail. The aim of our study was to compare the effects of HPP in variants: (1) 600 MPa, 10 min (2) 100 MPa, 10 min, interval 10 min, 600 MPa, 10 min (3) 200 MPa, 10 min, interval 10 min, 400 MPa, 10 min (4) 200 MPa, 10 min, interval 10 min, 600 MPa, 10 min in temperature range 19-21°C and HoP on the leptin, adiponectin, insulin, hepatocyte growth factor (HGF), lactoferrin and IgG contents in human milk. HoP was done at the Regional Human Milk Bank in Warsaw at the Holy Family Hospital on S90 Eco pasteurizer (Sterifeed, Medicare Colgate Ltd). Apparatus U4000/65 (Unipress Equipment, Poland) was used for pascalization. Milk samples were obtained from women during 2-6 weeks of lactation. Post-treatment culture showed no endogenous bacterial contamination in any tested option. Concentrations of selected components were determined using ELISA tests. The level of all analyzed components were significantly decreased by HoP: leptin 77.86%, adiponectin 32.79%, insulin 32.40%, HGF 88.72%, lactoferrin 60.31@.%, IgG 49.04%. All HPP variants caused an increase in leptin concentration, respectively (1) 81.79% (2) 90.01% (3) 86.12% (4) 47.96%. Retention of insulin after HPP was (1) 88.20% (2) 81.98% (3) 94.76% (4) 90.31% HGF (1) 36.15% (2) 38.81% 97.15% (3) 97.15% (4) 43.02%, lactoferrin (1) 55.78% (2) 57.63% (3) 78.77% (4) 64.75%. Moreover, HPP variant as 200 + 400 MPa preserved IgG (82.24%) better than HoP and resulted not statistically significant change of adiponectin level (38.55%) compare to raw milk. Our results showed that HPP leads to preservation of adipokines, growth factor, and lactoferrin, IgG much better or comparable with HoP.
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Affiliation(s)
- Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Neonatology, Medical University of Warsaw, Warsaw, Poland
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, Poland
| | - Elena Sinkiewicz-Darol
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Neonatology, Medical University of Warsaw, Warsaw, Poland
- Human Milk Bank, Ludwik Rydygier' Provincial Polyclinical Hospital in Torun, Torun, Poland
| | - Olga Barbarska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Neonatology, Medical University of Warsaw, Warsaw, Poland
- Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Strom
- Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Elzbieta Rosiak
- Department of Food Hygiene and Quality Management, Faculty of Human Nutrition and Consumer Science, Warsaw University of Life Sciences, Warsaw, Poland
| | - Gabriela Oledzka
- Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sylwester Rzoska
- High Pressure Physics, Polish Academy of Science, Warsaw, Poland
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28
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Sparks H, Linley L, Beaumont JL, Robinson DT. Donor milk intake and infant growth in a South African neonatal unit: a cohort study. Int Breastfeed J 2018; 13:41. [PMID: 30202424 PMCID: PMC6124008 DOI: 10.1186/s13006-018-0183-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/22/2018] [Indexed: 05/29/2023] Open
Abstract
Background Implications of donor milk feedings on infant growth in resource limited settings remain uncertain. This knowledge gap includes the impact of donor milk availability on infant intake of mother’s own milk. Therefore, this investigation aimed to measure intake and growth in infants receiving donor milk when born to women from resource limited backgrounds with high rates of human immunodeficiency virus (HIV). Methods A retrospective cohort study enrolled eligible infants admitted to a South African combined neonatal intensive and secondary high care unit, within a one year admission period during 2015, with signed consent for donor milk feedings. A certified milk bank provided donor milk. Daily nutritional intake during the first month was recorded. Details included proportional intake of donor milk, mother’s own milk and infant formula. The primary outcome of infant growth velocity from day back to birth weight to discharge was calculated when length of stay was ≥14 days. Analyses primarily used T-tests; mixed effects models compared weekly calorie intake. Results One hundred five infants with donor milk consent were born at 30.9 ± 3.6 weeks of gestation, weighing 1389 ± 708 g. Forty percent of mothers had HIV. Infant growth velocity did not differ based on percent of feedings as donor milk (≥ 50%: 11.8 ± 4.9 g/kg/d; < 50%: 13.5 ± 5.3 g/kg/d; p = 0.3). Percent of feedings from donor milk was similar based on maternal HIV status (positive: 31 ± 25%; negative: 36 ± 29%; p = 0.4), as was percent of feedings as mother’s milk (positive: 53 ± 35%; negative: 58 ± 30%; p = 0.4). Calorie intake increased markedly during the first two weeks and then plateaued (p < 0.0001). Conclusions Donor milk feedings in higher proportions did not further impair growth of infants managed in a South African combined neonatal intensive and secondary high care unit with growth rates already below reference ranges. The provision of donor milk contributed to feedings being composed of primarily human milk during the first month. Increasing early calorie intake may improve infant growth in this center.
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Affiliation(s)
- Hayley Sparks
- 1Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Lucy Linley
- 2Division of Neonatology, School of Child and Adolescent Health, University of Cape Town and Mowbray Maternity Hospital, Cape Town, South Africa
| | - Jennifer L Beaumont
- 3Terasaki Research Institute, Los Angeles, CA USA.,4Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Daniel T Robinson
- 5Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA.,6Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
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Kanaprach P, Pongsakul N, Apiwattanakul N, Muanprasat C, Supapannachart S, Nuntnarumit P, Chutipongtanate S. Evaluation of Fetal Intestinal Cell Growth and Antimicrobial Biofunctionalities of Donor Human Milk After Preparative Processes. Breastfeed Med 2018; 13:215-220. [PMID: 29451823 DOI: 10.1089/bfm.2017.0208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Donor human milk is considered the next best nutrition following mother's own milk to prevent neonatal infection and necrotizing enterocolitis in preterm infants who are admitted at neonatal intensive care unit. However, donor milk biofunctionalities after preparative processes have rarely been documented. OBJECTIVE To evaluate biofunctionalities preserved in donor milk after preparative processes by cell-based assays. MATERIALS AND METHODS Ten pools of donor milk were produced from 40 independent specimens. After preparative processes, including bacterial elimination methods (holder pasteurization and cold-sterilization microfiltration) and storage conditions (-20°C freezing storage and lyophilization) with varied duration of storage (0, 3, and 6, months), donor milk biofunctionalities were examined by fetal intestinal cell growth and antimicrobial assays. RESULTS At baseline, raw donor milk exhibited 193.1% ± 12.3% of fetal intestinal cell growth and 42.4% ± 11.8% of antimicrobial activities against Escherichia coli. After bacteria eliminating processes, growth promoting activity was better preserved in pasteurized donor milk than microfiltrated donor milk (169.5% ± 14.3% versus 146.0% ± 11.8%, respectively; p < 0.005), whereas antimicrobial activity showed no difference between groups (38.3% ± 14.1% versus 53.7% ± 17.3%, respectively; p = 0.499). The pasteurized donor milk was further examined for the effects of storage conditions at 3 and 6 months. Freezing storage, but not lyophilization, could preserve higher growth-promoting activity during 6 months of storage (163.0% ± 9.4% versus 72.8% ± 6.2%, respectively; p < 0.005). Nonetheless, antimicrobial activity was lost at 6 months, regardless of the storage methods. CONCLUSIONS This study revealed that fetal intestinal cell growth and antimicrobial assays could be applied to measure donor milk biofunctionalities and support the utilization of donor milk within 3 months after preparative processes.
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Affiliation(s)
- Pasinee Kanaprach
- 1 Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Nutkridta Pongsakul
- 2 Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Nopporn Apiwattanakul
- 3 Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Chatchai Muanprasat
- 4 Department of Physiology, Faculty of Science, Mahidol University , Bangkok, Thailand
| | - Sarayut Supapannachart
- 5 Division of Neonatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Pracha Nuntnarumit
- 5 Division of Neonatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
| | - Somchai Chutipongtanate
- 2 Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok, Thailand
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Abstract
NEC is a multifactorial disease that occurs when multiple risk factors and/or stressors overlap, leading to profound inflammation and intestinal injury. Human milk feedings, both from the infant's mother and donor human milk, have been associated with reductions in NEC in preterm infants. This article will review the protective factors in human milk, clinical studies of human milk and NEC, and practices to enhance human milk use in neonatal intensive care units.
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Affiliation(s)
- Aloka L Patel
- Section of Neonatology, Rush University Children's Hospital, 1653 W. Congress Pkwy, Pavilion 353, Chicago, Illinois 60612.
| | - Jae H Kim
- Divisions of Neonatology & Pediatric Gastroenterology, Hepatology and Nutrition, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, California
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31
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Abstract
The review describes the molecular characteristics of so far detected breast milk adipokines and ranks their breast milk level compared to the respective levels in maternal and infant blood. Moreover, analytical knowledge for measurements of breast milk adipokines will be delineated. Next, we summarized data about two main potential influencing factors on adipokine concentration in breast milk, maternal weight and pasteurization of milk. Finally, associations between adipokines in breast milk and weight gain in infants as well as the putative mechanisms for effects of breast milk adipokines on food intake and weight gain in later life will debated. Our findings suggest that a source of adipokines in human breast milk cannot be uniformly defined. In dependence on the ratio between serum and breast milk levels the major quantity of these proteins may be derived from peripheral tissues, from the breast tissue itself or from both. Thus, leptin and in part adiponectin levels in breast milk are dependent on a plenty of influencing factors with an important relevance of maternal anthropometric characteristics There is some evidence that leptin, adiponectin and ghrelin levels in breast milk may be associated with growth gain of infants and even with increased risk for being overweight during infancy or childhood. We hypothesize that a dysregulation in adipokine homeostasis in early life could promote obesity and metabolic disturbance in later life.
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Affiliation(s)
- Juergen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany.
| | - Yoon Ju Bae
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Center of Paediatric Research, University of Leipzig, Leipzig, Germany
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Escuder-Vieco D, Espinosa-Martos I, Rodríguez JM, Fernández L, Pallás-Alonso CR. Effect of HTST and Holder Pasteurization on the Concentration of Immunoglobulins, Growth Factors, and Hormones in Donor Human Milk. Front Immunol 2018; 9:2222. [PMID: 30319659 PMCID: PMC6170621 DOI: 10.3389/fimmu.2018.02222] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023] Open
Abstract
Donor human milk (DHM) is submitted to Holder pasteurization (HoP) to ensure its microbiological safety in human milk banks but this treatment affects some of its bioactive compounds. The objective of this work was to compare the effects of HoP and high temperature short time (HTST) treatments on some bioactive compounds found in DHM. A total of 24 DHM batches were processed in a continuous HTST system (70, 72, and 75°C for 5-25 s) and by HoP (62.5°C for 30 min). The concentrations of immunoglobulins (Igs) A, G, and M, transforming growth factor-beta 2 (TGF-β2), adiponectine, ghrelin, and leptin were measured using a multiplex system, whereas the concentration of epidermal growth factor (EGF) was determined by ELISA. In relation to Igs, IgG showed the highest preservation rates (87-101%) after HTST treatments, followed by IgA (54-88%) and IgM (25-73%). Ig retention after any of the HTST treatments was higher than after HoP (p < 0.001). Treatment times required to reduce the concentration of IgM by 90% (D-value) were 130, 88, and 49 s at 70, 72, and 75°C, while the number of degrees Celsius required to change the D-value by one factor of 10 (z-value) was 11.79°C. None of the heat treatments had a significant effect on the concentrations of TGF-β2, EGF, adiponectin, and ghrelin. In contrast, leptin was detected only in 4 of the samples submitted to HoP, whereas it was present in all samples after the different HTST treatments, with retention rates ranging between 34 and 68%. Globally, the concentration of IgA, IgG, IgM, and leptin in DHM was significantly higher after HTST pasteurization performed in a continuous system designed to be used in human milk banks than after the HoP procedure that is routinely applied at present.
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Affiliation(s)
- Diana Escuder-Vieco
- Banco Regional de Leche Materna, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
- *Correspondence: Diana Escuder-Vieco
| | | | - Juan M. Rodríguez
- Sección Departamental de Nutrición y Ciencia de los Alimentos (Veterinaria), Universidad Complutense de Madrid, Madrid, Spain
| | - Leónides Fernández
- Sección Departamental de Farmacia Galénica y Tecnología Alimentaria (Veterinaria), Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Rosa Pallás-Alonso
- Banco Regional de Leche Materna, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, Madrid, Spain
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Meyer DM, Brei C, Stecher L, Much D, Brunner S, Hauner H. The relationship between breast milk leptin and adiponectin with child body composition from 3 to 5 years: a follow-up study. Pediatr Obes 2017; 12 Suppl 1:125-129. [PMID: 27863153 DOI: 10.1111/ijpo.12192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Research indicates that breast milk contains bioactive components that influence metabolism in infancy and may play a role in the prevention of obesity in early childhood. In our initial study, 147 breastfeeding mother/child pairs were followed from birth to 2 years of age to examine the relationship between breast milk leptin and total adiponectin (collected at 6 weeks and 4 months postpartum) and infant body composition. Higher breast milk total adiponectin was related to greater fat mass and weight gain in children at 1 and 2 years of age, whereas leptin showed no association. OBJECTIVES/METHODS In this follow-up, we examined the relationship between both adipokines and children's body weight, body mass index percentiles, sum of four skin-folds, percentage of body fat, fat mass and lean body mass at 3, 4 and 5 years of age. RESULTS Breast milk adipokines were largely unrelated to child anthropometric measures. CONCLUSION Our results do not provide significant evidence that breast milk adipokines can predict adiposity in preschool children.
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Affiliation(s)
- D M Meyer
- From the Else Kröner-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - C Brei
- From the Else Kröner-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - L Stecher
- From the Else Kröner-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - D Much
- Institute of Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Brunner
- From the Else Kröner-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H Hauner
- From the Else Kröner-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,ZIEL - Institute for Food and Health, Nutritional Medicine Unit, Technische Universität München, Freising, Germany
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Abstract
The aim of human milk banks is to deliver safe and high quality donor human milk. Treatment of human milk has to destroy most microorganisms while preserving immunological and nutrient components, which is obtained when using low time low temperature pasteurization. However it destroys bile-simulated lipase, reduces lactoferrin, lysozyme, immunoglobulins, and bactericidal capacity of human milk. New methods are under investigation such as high temperature short time pasteurization, high pressure processing, or ultraviolet irradiation. They have been tested in experimental conditions and there are promising results, but they have to be tested in real conditions in human milk bank.
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Affiliation(s)
- Jean-Charles Picaud
- Neonatal Unit, Hôpital de la Croix-Rousse, Lyon F-69004, France; Rhone-Alpes Auvergneregional Human Milk Bank, Hôpital de la Croix-Rousse, Lyon F-69004, France; Lyon Sud Charles Merieux School of Medicine, Université Claude Bernard Lyon 1, Pierre-Bénite F-69310, France; Rhone-Alpes Human Nutrition Research Center, Hôpital Lyon Sud, Pierre-Bénite F-69310, France; European Milk Bank Association (EMBA), Milano, Italy.
| | - Rachel Buffin
- Neonatal Unit, Hôpital de la Croix-Rousse, Lyon F-69004, France; Rhone-Alpes Auvergneregional Human Milk Bank, Hôpital de la Croix-Rousse, Lyon F-69004, France
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Peila C, Coscia A, Bertino E, Li Volti G, Galvano F, Visser GHA, Gazzolo D. Holder pasteurization affects S100B concentrations in human milk. J Matern Fetal Neonatal Med 2017; 31:513-517. [PMID: 28162020 DOI: 10.1080/14767058.2017.1291618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chiara Peila
- Neonatology Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Alessandra Coscia
- Neonatology Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Enrico Bertino
- Neonatology Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Giovanni Li Volti
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, Catania, Italy
| | - Fabio Galvano
- Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania, Catania, Italy
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - Diego Gazzolo
- Department of Maternal, Fetal and Neonatal Health, C Arrigo Children’s Hospital, Alessandria, Italy
- Neonatal Intensive Care Unit, University G. d’Annunzio, Chieti, Italy
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Donor Human Milk Update: Evidence, Mechanisms, and Priorities for Research and Practice. J Pediatr 2017; 180:15-21. [PMID: 27773337 PMCID: PMC5183469 DOI: 10.1016/j.jpeds.2016.09.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/29/2016] [Accepted: 09/09/2016] [Indexed: 12/19/2022]
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The effect of pasteurization on trace elements in donor breast milk. J Perinatol 2016; 36:897-900. [PMID: 27253894 DOI: 10.1038/jp.2016.88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Premature infants often receive pasteurized donor human milk when mothers are unable to provide their own milk. This study aims to establish the effect of the pasteurization process on a range of trace elements in donor milk. STUDY DESIGN Breast milk was collected from 16 mothers donating to the milk bank at the Royal Brisbane and Women's Hospital. Samples were divided into pre- and post-pasteurization aliquots and were Holder pasteurized. Inductively coupled plasma mass spectrometry was used to analyze the trace elements zinc (Zn), copper (Cu), selenium (Se), manganese (Mn), iodine (I), iron (Fe), molybdenum (Mo) and bromine (Br). Differences in trace elements pre- and post-pasteurization were analyzed. RESULTS No significant differences were found between the trace elements tested pre- and post-pasteurization, except for Fe (P<0.05). The median (interquartile range, 25 to 75%; μg l(-1)) of trace elements for pre- and post- pasteurization aliquots were-Zn: 1639 (888-4508), 1743 (878-4143), Cu: 360 (258-571), 367 (253-531), Se: 12.34 (11.73-17.60), 12.62 (11.94-16.64), Mn: (1.48 (1.01-1.75), 1.49 (1.11-1.75), I (153 (94-189), 158 (93-183), Fe (211 (171-277), 194 (153-253), Mo (1.46 (0.37-2.99), 1.42 (0.29-3.73) and Br (1066 (834-1443), 989 (902-1396). CONCLUSIONS Pasteurization had minimal effect on several trace elements in donor breast milk but high levels of inter-donor variability of trace elements were observed. The observed decrease in the iron content of pasteurized donor milk is, however, unlikely to be clinically relevant.
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Peila C, Moro GE, Bertino E, Cavallarin L, Giribaldi M, Giuliani F, Cresi F, Coscia A. The Effect of Holder Pasteurization on Nutrients and Biologically-Active Components in Donor Human Milk: A Review. Nutrients 2016; 8:E477. [PMID: 27490567 PMCID: PMC4997390 DOI: 10.3390/nu8080477] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 12/18/2022] Open
Abstract
When a mother's milk is unavailable, the best alternative is donor milk (DM). Milk delivered to Human Milk Banks should be pasteurized in order to inactivate the microbial agents that may be present. Currently, pasteurization, performed at 62.5 °C for 30 min (Holder Pasteurization, HoP), is recommended for this purpose in international guidelines. Several studies have been performed to investigate the effects of HoP on the properties of DM. The present paper has the aim of reviewing the published papers on this topic, and to provide a comparison of the reported variations of biologically-active DM components before and after HoP. This review was performed by searching the MEDLINE, EMBASE, CINHAL and Cochrane Library databases. Studies that clearly identified the HoP parameters and compared the same DM samples, before and after pasteurization, were focused on. A total of 44 articles satisfied the above criteria, and were therefore selected. The findings from the literature report variable results. A possible explanation for this may be the heterogeneity of the test protocols that were applied. Moreover, the present review spans more than five decades, and modern pasteurizers may be able to modify the degradation kinetics for heat-sensitive substances, compared to older ones. Overall, the data indicate that HoP affects several milk components, although it is difficult to quantify the degradation degree. However, clinical practices demonstrate that many beneficial properties of DM still persist after HoP.
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Affiliation(s)
- Chiara Peila
- Complex Structure Neonatology Unit, Department of Public Health and Pediatric, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | - Guido E Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, Milan 20126, Italy.
| | - Enrico Bertino
- Complex Structure Neonatology Unit, Department of Public Health and Pediatric, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Concil, largo Braccini 2, Grugliasco 10095, Italy.
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Concil, largo Braccini 2, Grugliasco 10095, Italy.
- Food & Nutrition Research Center, Council for Agricultural Research and Economics, via Ardeatina 546, Roma 00178, Italy.
| | - Francesca Giuliani
- Complex Structure Neonatology Unit, Department of Public Health and Pediatric, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | - Francesco Cresi
- Complex Structure Neonatology Unit, Department of Public Health and Pediatric, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | - Alessandra Coscia
- Complex Structure Neonatology Unit, Department of Public Health and Pediatric, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
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Hansen-Pupp I, Hellgren G, Hård AL, Smith L, Hellström A, Löfqvist C. Early Surge in Circulatory Adiponectin Is Associated With Improved Growth at Near Term in Very Preterm Infants. J Clin Endocrinol Metab 2015; 100:2380-7. [PMID: 25825949 DOI: 10.1210/jc.2015-1081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Adiponectin enhances insulin sensitivity and may play a role in fetal and postnatal growth. OBJECTIVE This study aimed to determine whether early postnatal adiponectin concentration change is related to postnatal growth in very preterm infants. SETTING, DESIGN, AND PATIENTS This was an in-hospital, prospective, longitudinal cohort study of 52 preterm infants with a gestational age (GA) of 26.0 ± 1.9 (SD) weeks and birth weight (BW) of 889 ± 284 g. INTERVENTIONS An analysis of adiponectin was performed on cord blood at birth and peripheral blood at 72 hours, day 7, and then weekly until postmenstrual age (PMA) 40 weeks. Weight, length, and head circumference (HC) measurement was performed weekly and SD scores (SDS) calculated. Energy and protein intake was calculated daily from birth until PMA 35 weeks. RESULTS Mean adiponectin concentration increased from 6.8 ± 4.4 μg/mL at 72 hours to 37.4 ± 22.2 μg/mL at 3 weeks; during days 3-21, it was 21.4 ± 12 μg/mL and correlated with GA at birth (r = 0.46, P = .001; BW: r = 0.71, P < .001; BW(SDS): r = 0.42, P = .003). Furthermore, mean adiponectin during days 3-21 correlated with weight(SDS), length(SDS), and HC(SDS) (r = 0.62, 0.65, and 0.62, respectively; all P < .001) at PMA 35 wk). Energy intake (kcal/kg/d) correlated with mean adiponectin during days 3-21 (r = 0.35, P < .013). CONCLUSIONS In very preterm infants, adiponectin concentrations increased markedly in the first 3 weeks, and a greater increase was associated with improved postnatal growth.
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Affiliation(s)
- Ingrid Hansen-Pupp
- Department of Pediatrics (I.H.P.), Institute of Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85 Lund, Sweden; Department of Pediatrics, Institute of Clinical Sciences (G.H.), and Department of Ophthalmology, Institute of Neuroscience and Physiology (A.L.H., A.H., C.L.), The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden; and Department of Ophthalmology (L.S.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Gunnel Hellgren
- Department of Pediatrics (I.H.P.), Institute of Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85 Lund, Sweden; Department of Pediatrics, Institute of Clinical Sciences (G.H.), and Department of Ophthalmology, Institute of Neuroscience and Physiology (A.L.H., A.H., C.L.), The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden; and Department of Ophthalmology (L.S.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Anna-Lena Hård
- Department of Pediatrics (I.H.P.), Institute of Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85 Lund, Sweden; Department of Pediatrics, Institute of Clinical Sciences (G.H.), and Department of Ophthalmology, Institute of Neuroscience and Physiology (A.L.H., A.H., C.L.), The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden; and Department of Ophthalmology (L.S.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Lois Smith
- Department of Pediatrics (I.H.P.), Institute of Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85 Lund, Sweden; Department of Pediatrics, Institute of Clinical Sciences (G.H.), and Department of Ophthalmology, Institute of Neuroscience and Physiology (A.L.H., A.H., C.L.), The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden; and Department of Ophthalmology (L.S.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Ann Hellström
- Department of Pediatrics (I.H.P.), Institute of Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85 Lund, Sweden; Department of Pediatrics, Institute of Clinical Sciences (G.H.), and Department of Ophthalmology, Institute of Neuroscience and Physiology (A.L.H., A.H., C.L.), The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden; and Department of Ophthalmology (L.S.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Chatarina Löfqvist
- Department of Pediatrics (I.H.P.), Institute of Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85 Lund, Sweden; Department of Pediatrics, Institute of Clinical Sciences (G.H.), and Department of Ophthalmology, Institute of Neuroscience and Physiology (A.L.H., A.H., C.L.), The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden; and Department of Ophthalmology (L.S.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Bioactive peptides released from in vitro digestion of human milk with or without pasteurization. Pediatr Res 2015; 77:546-53. [PMID: 25580741 DOI: 10.1038/pr.2015.10] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/08/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pasteurized donor human milk (HM) serves as the best alternative for breast-feeding when availability of mother's milk is limited. Pasteurization is also applied to mother's own milk for very low birth weight infants, who are vulnerable to microbial infection. Whether pasteurization affects protein digestibility and therefore modulates the profile of bioactive peptides released from HM proteins by gastrointestinal digestion, has not been examined to date. METHODS HM with and without pasteurization (62.5 °C for 30 min) were subjected to in vitro gastrointestinal digestion, followed by peptidomic analysis to compare the formation of bioactive peptides. RESULTS Some of the bioactive peptides, such as caseinophosphopeptide homologues, a possible opioid peptide (or propeptide), and an antibacterial peptide, were present in undigested HM and showed resistance to in vitro digestion, suggesting that these peptides are likely to exert their bioactivities in the gastrointestinal lumen, or be stably transported to target organs. In vitro digestion of HM released a large variety of bioactive peptides such as angiotensin I-converting enzyme-inhibitory, antioxidative, and immunomodulatory peptides. Bioactive peptides were released largely in the same manner with and without pasteurization. CONCLUSION Provision of pasteurized HM may be as beneficial as breast-feeding in terms of milk protein-derived bioactive peptides.
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Unger S, Gibbins S, Zupancic J, O’Connor DL. DoMINO: Donor milk for improved neurodevelopmental outcomes. BMC Pediatr 2014; 14:123. [PMID: 24884424 PMCID: PMC4032387 DOI: 10.1186/1471-2431-14-123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Provision of mother's own milk is the optimal way to feed infants, including very low birth weight infants (VLBW, <1500 g). Importantly for VLBW infants, who are at elevated risk of neurologic sequelae, mother's own milk has been shown to enhance neurocognitive development. Unfortunately, the majority of mothers of VLBW infants are unable to provide an adequate supply of milk and thus supplementation with formula or donor milk is necessary. Given the association between mother's own milk and neurodevelopment, it is important to ascertain whether provision of human donor milk as a supplement may yield superior neurodevelopmental outcomes compared to formula.Our primary hypothesis is that VLBW infants fed pasteurized donor milk compared to preterm formula as a supplement to mother's own milk for 90 days or until hospital discharge, whichever comes first, will have an improved cognitive outcome as measured at 18 months corrected age on the Bayley Scales of Infant Development, 3(rd) ed. Secondary hypotheses are that the use of pasteurized donor milk will: (1) reduce a composite of death and serious morbidity; (2) support growth; and (3) improve language and motor development. Exploratory research questions include: Will use of pasteurized donor milk: (1) influence feeding tolerance and nutrient intake (2) have an acceptable cost effectiveness from a comprehensive societal perspective? METHODS/DESIGN DoMINO is a multi-centre, intent-to-treat, double blinded, randomized control trial. VLBW infants (n = 363) were randomized within four days of birth to either (1) pasteurized donor milk or (2) preterm formula whenever mother's own milk was unavailable. Study recruitment began in October 2010 and was completed in December 2012. The 90 day feeding intervention is complete and long-term follow-up is underway. DISCUSSION Preterm birth and its complications are a leading cause long-term morbidity among Canadian children. Strategies to mitigate this risk are urgently required. As mother's own milk has been shown to improve neurodevelopment, it is essential to ascertain whether pasteurized donor milk will confer the same advantage over formula without undue risks and at acceptable costs. Knowledge translation from this trial will be pivotal in setting donor milk policy in Canada and beyond. TRIAL REGISTRATION ISRCTN35317141; Registered 10 August 2010.
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Affiliation(s)
- Sharon Unger
- Mount Sinai Hospital and the University of Toronto, 600 University Avenue, 19-231, Toronto, Ontario, M5G 1X5, Canada
| | - Sharyn Gibbins
- Trillium Health Partners, 2200 Eglinton Ave West, Mississauga, Ontario, L5M 2 N1, Canada
| | - John Zupancic
- Beth Israel Deaconess Med Center, Neonatology, Rose 318 330 Brookline Ave, Boston, MA 02215, USA
| | - Deborah L O’Connor
- University of Toronto and The Hospital for Sick Children, 327 Fitzgerald Building, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
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Marx C, Bridge R, Wolf AK, Rich W, Kim JH, Bode L. Human milk oligosaccharide composition differs between donor milk and mother's own milk in the NICU. J Hum Lact 2014; 30:54-61. [PMID: 24282194 DOI: 10.1177/0890334413513923] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human milk oligosaccharides (HMO) represent the third most abundant component of human breast milk. More than a hundred structurally distinct HMO have been identified, and the HMO composition varies between mothers as well as over the course of lactation. Some newborn infants receive donor milk (DM) when their mother's own milk (MOM) volume is inadequate or unavailable. OBJECTIVE This study aimed to compare HMO content between DM and MOM. METHODS We used high performance liquid chromatography analysis of fluorescently labeled HMO to analyze the variation in HMO amount and composition of 31 different batches of DM (each pooled from 3 individual donors) provided by the Mothers' Milk Bank in San Jose, California, and compared it to 26 different MOM samples donated by mothers with infants in our neonatal intensive care unit (NICU). RESULTS Total HMO amount as well as concentrations of lacto-N-tetraose, lacto-N-neotetraose, lacto-N-fucopentaose 1, and disialyllacto-N-tetraose were significantly lower in DM than in MOM, whereas the concentrations of 3'-sialyllactose and 3-fucosyllactose were significantly higher in DM. CONCLUSION Our data show that infants in our NICU who receive DM are likely to ingest HMO at different total amounts and relative composition from what they would receive with their MOM. Recent in vitro and animal studies have started to link individual HMO to infant health and disease. Future studies are needed to assess the importance of a mother-infant match with regard to HMO composition.
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Affiliation(s)
- Carolin Marx
- 1Division of Neonatology, Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
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Abstract
The Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition aims to document the existing evidence of the benefits and common concerns deriving from the use of donor human milk (DHM) in preterm infants. The comment also outlines gaps in knowledge and gives recommendations for practice and suggestions for future research directions. Protection against necrotizing enterocolitis is the major clinical benefit deriving from the use of DHM when compared with formula. Limited data also suggest unfortified DHM to be associated with improved feeding tolerance and with reduced cardiovascular risk factors during adolescence. Presence of a human milk bank (HMB) does not decrease breast-feeding rates at discharge, but decreases the use of formula during the first weeks of life. This commentary emphasizes that fresh own mother's milk (OMM) is the first choice in preterm infant feeding and strong efforts should be made to promote lactation. When OMM is not available, DHM is the recommended alternative. When neither OMM nor DHM is available, preterm formula should be used. DHM should be provided from an established HMB, which follows specific safety guidelines. Storage and processing of human milk reduces some biological components, which may diminish its health benefits. From a nutritional point of view, DHM, like HM, does not meet the requirements of preterm infants, necessitating a specific fortification regimen to optimize growth. Future research should focus on the improvement of milk processing in HMB, particularly of heat treatment; on the optimization of HM fortification; and on further evaluation of the potential clinical benefits of processed and fortified DHM.
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Gibbins S, Wong SE, Unger S, O'Connor D. Donor human milk for preterm infants: Practice considerations. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2013.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
This article provides an overview of the composition of human milk, its variation, and its clinical relevance. The composition of human milk is the biological norm for infant nutrition. Human milk also contains many hundreds to thousands of distinct bioactive molecules that protect against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonization. Some of these molecules (eg, lactoferrin) are being investigated as novel therapeutic agents. Human milk changes in composition from colostrum to late lactation, within feeds, by gestational age, diurnally, and between mothers. Feeding infants with expressed human milk is increasing.
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Affiliation(s)
- Olivia Ballard
- Center for Interdisciplinary Research in Human Milk and Lactation & Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7009, Cincinnati, OH 45229.
| | - Ardythe L. Morrow
- Center for Interdisciplinary Research in Human Milk and Lactation, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7009, Cincinnati, OH 45229.
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Ley SH, Hanley AJ, Sermer M, Zinman B, O'Connor DL. Associations of prenatal metabolic abnormalities with insulin and adiponectin concentrations in human milk. Am J Clin Nutr 2012; 95:867-74. [PMID: 22378730 DOI: 10.3945/ajcn.111.028431] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Emerging evidence indicates that metabolic hormones are present in human milk, but, to our knowledge, no studies have investigated the impact of maternal metabolic status assessed during pregnancy on insulin and adiponectin concentrations in milk. OBJECTIVES We aimed to investigate the associations of prenatal metabolic abnormalities with insulin and adiponectin in human milk and to compare the concentrations of these hormones in early and mature milk. DESIGN Pregnant women aged ≥20 y with intention to breastfeed and without preexisting type 1 or 2 diabetes were recruited. Participants (n = 170) underwent a 3-h oral-glucose-tolerance test at 30 wk (95% CI: 25, 33 wk) gestation and donated early (the first week postpartum) and mature (3 mo postpartum) milk. RESULTS Adiponectin and insulin concentrations in early milk were higher than those in mature milk (both P < 0.0001). Prenatal metabolic abnormalities, including higher pregravid BMI (β ± SEE: 0.053 ± 0.014; P = 0.0003) and gravid hyperglycemia (0.218 ± 0.087; P = 0.01), insulin resistance (0.255 ± 0.047; P < 0.0001), lower insulin sensitivity (-0.521 ± 0.108; P < 0.0001), and higher serum adiponectin (0.116 ± 0.029; P < 0.0001), were associated with higher insulin in mature milk after covariate adjustment. Prenatal metabolic measures were not associated with milk adiponectin, but obstetrical measures that included nulliparity (0.171 ± 0.058; P = 0.004), longer duration of gestation (0.546 ± 0.146; P = 0.0002), and unscheduled cesarean delivery (0.387 ± 0.162; P = 0.02) were associated with higher adiponectin in early milk after covariate adjustment, including the time elapsed from delivery to milk collection. CONCLUSION Maternal prenatal metabolic abnormalities are associated with high insulin concentrations in mature milk, whereas only obstetrical variables are associated with adiponectin concentrations in early milk.
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Affiliation(s)
- Sylvia H Ley
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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