Healthy Breastfeeding Infants Consume Different Quantities of Milk Fat Globule Membrane Lipids

The human milk fat globule membrane (MFGM) contains important lipids for growing infants. Anthropometric measurements, milk samples, and infant milk intake were collected in a cohort of eleven healthy mother–infant dyads during exclusive breastfeeding from birth to six months. One hundred and sixty-six MFGM lipids were analysed using liquid chromatography-mass spectrometry, and the infant intake was calculated. The concentrations and intake were compared and associations between infant intake and growth characteristics explored. The lipid concentrations and infant intake varied widely between mother–infant dyads and between months one and three. The infant intake for many species displayed positive correlations with infant growth, particularly phospholipid species. The high variation in lipid intake is likely an important factor in infant growth, with strong correlations identified between the intake of many MFGM lipids and infant head circumference and weight. This study highlights the need for intake measurements and inclusion in cohort studies to elucidate the role of the human milk lipidome in infant growth and development.     

Century Wide Changes in Macronutrient Levels in Indian Mothers’ Milk: A Systematic Review

The purpose of this systematic review was to understand Indian mothers’ milk composition and report changes in it over the past 100 years. A review was conducted in accordance with PRISMA and registered with PROSPERO (CRD42022299224). All records published between 1921 and 2021 were identified by searching databases Google Scholar, ResearchGate, PubMed, and the Cochrane Database of Systematic Reviews. All observational, interventional, or supplementation studies reporting macronutrients (protein, fat, lactose) in milk of Indian mothers, delivering term infants, were included. Publications on micronutrients, preterm, and methods were excluded. Milk was categorized into colostrum, transitional, and mature. In all, 111 records were identified, of which 34 were included in the final review. Fat ranged from 1.83 to 4.49 g/100 mL, 2.6 to 5.59 g/100 mL, and 2.77 to 4.78 g/100 mL in colostrum, transitional, and mature milk, respectively. The protein was higher in colostrum (1.54 to 8.36 g/100mL) as compared to transitional (1.08 to 2.38 g/100 mL) and mature milk (0.87 to 2.33 g/100 mL). Lactose was lower in colostrum (4.5–6.47 g/100 mL) as compared to transitional (4.8–7.37 g/100 mL) and mature milk ranges (6.78–7.7 g/100 mL). The older studies (1950–1980) reported higher fat and protein in colostrum as compared to subsequent time points. There were variations in maternal nutritional status, diet, socioeconomic status, and regions along with study design specific differences of time or methods of milk sampling and analysis. Additionally, advancements in methods over time make it challenging to interpret time trends. The need for conducting well-designed, multicentric studies on nutrient composition of Indian mother’s milk using standardized methods of sampling and estimation for understanding the role of various associated factors cannot be undermined.     

Comparative Proteomic Analysis of Proteins in Breast Milk during Different Lactation Periods

Breast milk is an unparalleled food for infants, as it can meet almost all of their nutritional needs. Breast milk in the first month is an important source of acquired immunity. However, breast milk protein may vary with the stage of lactation. Therefore, the aim of this study was to use a data-independent acquisition approach to determine the differences in the proteins of breast milk during different lactation periods. The study samples were colostrum (3–6 days), transitional milk (7–14 days), and mature milk (15–29 days). The results identified a total of 2085 different proteins, and colostrum contained the most characteristic proteins. Protein expression was affected by the lactation stage. The proteins expressed in breast milk changed greatly between day 3 and day 14 and gradually stabilized after 14 days. The expression levels of lactoferrin, immunoglobulin, and clusterin were the highest in colostrum. CTP synthase 1, C-type lectin domain family 19 member A, secretoglobin family 3A member 2, trefoil factor 3 (TFF3), and tenascin were also the highest in colostrum. This study provides further insights into the protein composition of breast milk and the necessary support for the design and production of infant formula.     

Endocrine-Disrupting Organochlorine Pesticides in Human Breast Milk: Changes during Lactation

The aim of the present study was to assess infant safety associated with the occurrence of endocrine-disrupting organochlorine pesticides (OCP) in breast milk. Moreover, the association between pregnant mothers’ dietary habits and these compounds levels in breast milk was investigated. Breast milk was collected at various stages of lactation. The samples were analyzed by the GC-MS method. The OCP concentrations ranged from < limit of detection (LOD) to 6.81 ng/g lipids. The highest OCP concentrations in breast milk occurred primarily within the first month of lactation, and decreased over the lactation period. It was found that the maternal consumption of certain food products—in particular pork, beef, poultry, eggs, and dairy products—could have affected the content of 1,1’-(2,2,2-Trichloroethane-1,1-diyl)bis(4-chlorobenzene), called DDT and its metabolites in the breast milk. The levels of beta-endosulfan were positively correlated with fish and poultry consumption. The redundancy analysis indicated that the diets of the pregnant women had an important impact on pesticide residues in the breast milk. There is a potential possibility of lowering the content of organochlorine compounds in breast milk by adhering to nutritional recommendations, e.g., avoiding the excessive consumption of fish and other raw food materials of unknown origin.     

哺乳期农村乳母乳汁无机元素含量的变化

目的了解哺乳期人乳无机元素含量的变化及其与乳母膳食的关联。方法采用横断面调查方法,收集55名陕西省澄城县农村健康乳母清晨乳样,利用原子吸收分光光度法测定乳汁钙、镁、铁、锰、锌和铜的浓度。采用24小时回顾法进行连续3天膳食调查,计算膳食营养素的摄入量。结果农村乳母乳汁中镁、锌、铜浓度随哺乳期延长明显降低,铁浓度随哺乳期延长而上升。乳母膳食钙摄入量约为钙膳食参考摄入量(DRI)1/3,膳食无机元素的摄入量与人乳相应元素之间无明显相关性。多因素分析表明,乳汁中钙与镁、铁与铜、锰与锌均呈正相关,钙分别与乳脂、铁、锌呈负相关。结论随哺乳期时间延长,成熟乳中镁、锌、铜浓度降低而铁浓度增加,乳母膳食钙的摄入严重不足,乳汁各元素与膳食相应元素之间无关联。     

Factors Influencing Breast Milk Fat Loss during Administration in the Neonatal Intensive Care Unit

The objective of this study was to investigate factors influencing fat loss during tube feeding of breast milk to preterm infants. An experimental study with 81 feeding simulations was performed, with nine continuous infusions in each of six modalities: Horizontal Higher, Horizontal Matched, Horizontal Lower, Tilted Higher, Tilted Matched, and Tilted Lower, and for comparison, 27 bolus feedings: nine flushed with air, nine with water, and nine that were not flushed, done at matched height. Each simulation utilized 16 mL of breast milk given over four hours. Continuous infusions were given with a flow rate of 4 mL/h. Bolus was given as 8 mL over the course of 15–20 min every other hour. Analysis for fat, true protein, carbohydrate, total solids, and energy was performed before and after each simulation. The percent of macronutrient loss was compared between all simulations. Continuous infusion resulted in an average fat loss of 40%. Bolus feedings resulted in an average fat loss of 11% (p ≤ 0.001). Considerable fat loss is seen during continuous tube feeding. Neither height in relation to the infant nor tilting of the pump reduce fat loss. To limit fat loss, the bolus feeding method should be utilized.     

Whole Goat Milk as a Source of Fat and Milk Fat Globule Membrane in Infant Formula

Cow milk is the most common dairy milk and has been extensively researched for its functional, technological and nutritional properties for a wide range of products. One such product category is infant formula, which is the most suitable alternative to feed infants, when breastfeeding is not possible. Most infant formulas are based on cow milk protein ingredients. For several reasons, consumers now seek alternatives such as goat milk, which has increasingly been used to manufacture infant, follow-on and young child formulas over the last 30 years. While similar in many aspects, compositional and functional differences exist between cow and goat milk. This offers the opportunity to explore different formulations or manufacturing options for formulas based on goat milk. The use of whole goat milk as the only source of proteins in formulas allows levels of milk fat, short and medium chain fatty acids, sn-2 palmitic acid, and milk fat globule membrane (MFGM) to be maximised. These features improve the composition and microstructure of whole goat milk-based infant formula, providing similarities to the complex human milk fat globules, and have been shown to benefit digestion, and cognitive and immune development. Recent research indicates a role for milk fat and MFGM on digestive health, the gut–brain axis and the gut–skin axis. This review highlights the lipid composition of whole goat milk-based infant formula and its potential for infant nutrition to support healthy digestion, brain development and immunity. Further work is warranted on the role of these components in allergy development and the advantages of goat milk fat and MFGM for infant nutrition and health.     

Nutritional Composition Of Breast Milk Produced By Mothers Of Preterm Infants

Milk obtained from mothers delivering preterm infants contains significantly higher amounts of non-protein nitrogen. This and other less consistent differences between milk produced by mothers of preterm and term infants may be related to the nutritional needs of the two groups of neonates.     

饮食脂肪与乳腺癌危险性META分析

应用ＭＥＴＡ分析方法综合２４篇有关乳腺癌的流行病学研究结果，对饮食脂肪及与乳腺癌危险性的关系进行分析。结果显示最高饮食脂脂摄入量组与最低组相比．总比数比值为１．４９，９５％可信区间为１．３２～１．６８，说明高饮食脂肪是乳腺癌危险因素。队列研究组高饮食脂肪摄入的乳腺癌危险性为１．０１（９５％可信区间：０．７７～１．３３），而在病例对照组则为１．６７（９５％可信区间：１．４７～１．８９），两类设计研究结果差异有统计学意义。本次分析中队列研究的对象多为特殊人群，存在影响研究结果的干扰因素，提示目前需要一般人群的队例研究结果支持高饮食脂肪摄入与乳腺癌的关系。     

Breast Milk Iodine Concentration (BMIC) as a Biomarker of Iodine Status in Lactating Women and Children <2 Years of Age: A Systematic Review

Background: Iodine is needed for the production of thyroid hormones, which are essential for infant growth and development. Given that there are wide variations in breast milk iodine concentration (BMIC) and urinary iodine concentration (UIC), it is unclear if BMIC is associated with UIC in populations residing in iodine sufficient or deficient areas. Aim: To investigate if BMIC can be used as a biomarker for iodine status in lactating women and children <2 years of age. Methods: Electronic databases; PubMed, Web of Science and Scopus were searched until year 2021, for studies investigating the relationship between BMIC and UIC. Studies were reviewed for eligibility, according to inclusion and exclusion criteria, followed by data extraction, according to the PRISMA guidelines. Results: Overall, 51 studies met the criteria for inclusion in the systematic review. BMIC ranged from 18 to 1153 µg/L. In iodine-deficient and iodine-sufficient lactating women, BMIC ranged from 26 to 185 µg/L and 15 to 1006 µg/L, respectively. In most studies, the categorisation of iodine status assessed by median UIC was consistent with the categorisation of iodine status assessed by median BMIC cut off of ≥100 µg/L, to determine iodine sufficiency in lactating women and children <2 years of age. Conclusions: The systematic review indicated that BMIC is a promising biomarker of iodine status in lactating women and children <2 years of age. However, these data need to be interpreted cautiously, given the study limitations in the included studies. Future studies should consider investigating the optimal median BMIC, as there is a lack of high-quality observational and intervention studies in lactating women and infants.     

Reduction in Maternal Energy Intake during Lactation Decreased Maternal Body Weight and Concentrations of Leptin,Insulin and Adiponectin in Human Milk without Affecting Milk Production,Milk Macronutrient Composition or Infant Growth

Maternal diet has the potential to affect human milk (HM) composition, but very few studies have directly assessed the effect of maternal diets on HM composition. The primary aim of this study was to assess the effect of improving dietary quality in lactating women over 2 weeks on the concentrations of macronutrients and metabolic hormones in HM. The secondary aims were to assess the impact of the dietary intervention on 24 h milk production, maternal body composition and infant growth. Fifteen women completed a 1-week baseline period followed by a 2-week dietary intervention phase targeted towards reducing fat and sugar intake. Maternal anthropometric and body composition and infant growth measurements were performed weekly. Total 24 h milk production was measured before and after the dietary intervention, and HM samples were collected daily. Maternal intakes of energy (−33%), carbohydrate (−22%), sugar (−29%), fat (−54%) and saturated fat (−63%) were significantly reduced during the dietary intervention. HM insulin, leptin and adiponectin concentrations were 10–25% lower at the end of the dietary intervention, but HM concentrations of macronutrients were unaffected. Maternal body weight (−1.8%) and fat mass (−6.3%) were significantly reduced at the end of the dietary intervention, but there were no effects on 24 h milk production or infant growth. These results suggest that reducing maternal energy, carbohydrate, fat and sugar intake over a 2-week period is associated with significant reductions in HM insulin, leptin and adiponectin concentrations. These changes may be secondary to decreases in maternal weight and fat mass. The limited studies to date that have investigated the association between metabolic hormone concentrations in HM and infant growth raise the possibility that the changes in HM composition observed in the current study could impact infant growth and adiposity, but further studies are required to confirm this hypothesis.     

Predictors of Dietary Milk Fat Intake by Preschool Children

BACKGROUND: High-fat whole milk is the major dietary source of total and saturated fat for young children. Children from low-income families have higher total and saturated fat intakes and their parents have higher rates of cardiovascular disease compared with children from higher income families. We identified factors that predict the use of either high-fat whole milk or low-fat (1% and/or skim) milk by children to facilitate the development of targeted intervention strategies to reduce their dietary fat intakes. METHODS: Adults (91% mothers) with children > or =1 through <5 years of age, participating in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) at 50 agencies throughout New York State, completed questionnaires. RESULTS: Most (75%) of the 1,938 children drank whole milk, while only 6.9% consumed exclusively 1% and/or skim milk. The children tended to drink the same type of milk as other family members. In multivariate logistic regression, use of whole milk was associated with younger child age, black race or Hispanic ethnicity, parent/guardian belief that whole milk was healthier for children over 2, and parent/guardian having never tried reduced-fat milks (all P < 0.0001). In contrast, use of 1% and/or skim milk was associated with older child age, female gender, nonblack race, older parent/guardian age, parent/guardian belief that reduced-fat milks were healthier for children over 2, and parent/guardian having tried 1%-fat milk (all P < 0.01). CONCLUSIONS: Individualized family-based strategies are needed to target specific behaviors and/or health beliefs held by different parent groups. For example, taste testing might be an effective strategy for parents who have never tasted reduced-fat milk. Interventions to overcome cultural barriers to the use of low-fat milk may require changing parental health beliefs, in addition to providing education about the health benefits of low-fat milk.     

Artificial Sweeteners in Breast Milk: A Clinical Investigation with a Kinetic Perspective

Artificial sweeteners (ASs) are calorie-free chemical substances used instead of sugar to sweeten foods and drinks. Pregnant women with obesity or diabetes are often recommended to substitute sugary products with ASs to prevent an increase in body weight. However, some recent controversy surrounding ASs relates to concerns about the risk of obesity caused by a variety of metabolic changes, both in the mother and the offspring. This study addressed these concerns and investigated the biodistribution of ASs in plasma and breast milk of lactating women to clarify whether ASs can transfer from mother to offspring through breast milk. We recruited 49 lactating women who were provided with a beverage containing four different ASs (acesulfame-potassium, saccharin, cyclamate, and sucralose). Blood and breast milk samples were collected before and up to six hours after consumption. The women were categorized: BMI < 25 (n = 20), BMI > 27 (n = 21) and type 1 diabetes (n = 8). We found that all four ASs were present in maternal plasma and breast milk. The time-to-peak was 30–120 min in plasma and 240–300 min in breast milk. Area under the curve (AUC) ratios in breast milk were 88.9% for acesulfame-potassium, 38.9% for saccharin, and 1.9% for cyclamate. We observed no differences in ASs distributions between the groups.     

上海和宜兴地区食品和人乳腺组织中有机氯农药污染现状

[目的]了解上海和宜兴地区环境和人体中有机氯农药的污染现状。[方法]分别在上海和宜兴两城市采集20种食物样品及5份人乳腺组织，采用GC-ECD方法对样品中有机氯含量进行测定。[结果]滴滴涕及其代谢物(DDTs)是此次检测到的主要有机氯农药污染物，DDTs、六六六(HCHs)、六氯苯及其代谢物(HCB)、氯丹(CHLs)在食品中的检出率分别为85％、64％、59％和53％，食品中HCHs，HCB，CHLs含量较低；而人乳腺组织中DDTs和HCHs的含量很高，可分别达19000ng／g脂肪和17000ng／g脂肪。[结论]上海及宜兴地区食物和人乳腺组织中普遍还能检测到有机氯农药的残留，但较前期监测数据已有明显下降。     

Fortifier and Cream Improve Fat Delivery in Continuous Enteral Infant Feeding of Breast Milk

Premature and high-risk infants require accurate delivery of nutrients to promote appropriate growth. Continuous enteral feeding methods may result in significant fat and micronutrient loss. This study evaluated fat loss in enteral nutrition using current strategies for providing high-risk infants fortified human milk (HM). The fat content of HM was measured by IR analyzer in a simulated feeding system using the Kangaroo ePump™ and the MedFusion™ 2010 pump. Comparisons in fat loss were made between HM, HM supplemented with donor HM-derived fortifier Prolacta + H²MF™ (H²MF), and HM supplemented with H²MF and donor HM-derived cream ProlactCR™ (cream). When using the Kangaroo ePump™, the addition of H²MF and cream to HM increased fat delivery efficiency from 75.0% ± 1.2% to 83.7% ± 1.0% (p < 0.0001). When using the MedFusion™ 2010 pump, the addition of H²MF to HM increased fat delivery efficiency from 83.2% ± 2.8% to 88.8% ± 0.8% (p < 0.05), and the addition of H²MF and cream increased fat delivery efficiency to 92.0% ± 0.3% (p < 0.01). The addition of H²MF and cream to HM provides both the benefits of bioactive elements from mother’s milk and increased fat delivery, making the addition of H²MF and cream an appropriate method to improve infant weight gain.     

Six Oligosaccharides’ Variation in Breast Milk: A Study in South China from 0 to 400 Days Postpartum

This study investigated the variation in oligosaccharide levels in the breast milk of south Chinese mothers in a prolonged breastfeeding period of up to 400 days postpartum. A total of 488 breast milk samples were collected from 335 healthy mothers at five different time points: 0–5 days, 10–15 days, 40–45 days, 200–240 days, and 300–400 days postpartum. A high-performance anion-exchange chromatography-pulsed amperometric detector (HPAEC-PAD) was used to quantify 2′-fucosyllactose (2′-FL), 3-fucosyllactose (3-FL), lacto-N-tetraose (LNT), lacto-N-neotetraose (LNnT), 3′-sialyllactose (3′-SL) and 6′-sialyllactose (6′-SL). In this study, we found six oligosaccharides that were present in breast milk from 0 to 400 days postpartum. The median value ranges of individual oligosaccharide components in this study were 1013–2891 mg/L 2′-FL, 193–1421 mg/L 3-FL, 314–1478 mg/L LNT, 44–255 mg/L LNnT, 111–241 mg/L 3′-SL, and 23–602 mg/L6′-SL. HMO levels decreased over the lactation periods, except for 3-FL, which increased throughout lactation. The predominant fucosylated and sialylated HMOs were 2′-FL and 6′-SL at 40–45 days postpartum and changed to 3-FL and 3′-SL at 200–240 days postpartum. Results from this study showed that lactating women continue to provide their offspring with a high level of 2′-FL one year after delivery, suggesting that 2′-FL may play an important role for infants in early life. Our findings also provide further evidence in support of breastfeeding after one-year postpartum.     

Protein Enrichment of Donor Breast Milk and Impact on Growth in Very Low Birth Weight Infants

Protein content is often inadequate in donor breast milk (DBM), resulting in poor growth. The use of protein-enriched target-pooled DBM (DBM+) has not been examined. We compared three cohorts of very low birth weight (VLBW) infants, born ≤ 1500 g: DBM cohort receiving > 1-week target-pooled DBM (20 kcal/oz), MBM cohort receiving ≤ 1-week DBM, and DBM+ cohort receiving > 1-week DBM+. Infants followed a standardized feeding regimen with additional fortification per clinical discretion. Growth velocities and z-scores were calculated for the first 4 weeks (n = 69 for DBM, 71 for MBM, 70 for DBM+) and at 36 weeks post-menstrual age (n = 58, 64, 59, respectively). In total, 60.8% MBM infants received fortification >24 kcal/oz in the first 30 days vs. 78.3% DBM and 77.1% DBM+. Adjusting for SGA, length velocity was greater with DBM+ than DBM in week 1. Average weight velocity and z-score change were improved with MBM compared to DBM and DBM+, but length z-score decreased similarly across all groups. Incidences of NEC and feeding intolerance were unchanged between eras. Thus, baseline protein enrichment appears safe in stable VLBW infants. Weight gain is greatest with MBM. Linear growth comparable to MBM is achievable with DBM+, though the overall length trajectory remains suboptimal.     

Milk folate binding protein (FBP): A secretory protein for folate?

Analyses of human milk samples reveal that although folate binding protein (FBP) concentration varies considerably among individuals, a positive correlation with milk folate concentrations exists. The equation expressing this relationship is Y=29.2+0.78 X, where Y and X represent FBP and folate concentrations, respectively. Since folylpolglutamates comprise at least half of total milk folate and are known not to cross biological membranes, these data suggest that folate is likely to be secreted from the lactating cell as a complex with FBP. This complex could exit from the lactating cell by a route which is common to other milk proteins.     

Arsenic in breast milk during the first 3 months of lactation

Increased concentrations of arsenic were found in soil and ground water from a military training area in Munster, Lower Saxony, Germany, where chemical weapons were dumped after World War II. In order to assess the possible impact of this contamination for nursing new-borns and infants, samples from breast milk of 36 women were analysed with respect to arsenic content. Study participants came from three different regions: the city of Hamburg, the rural area of Soltau, Lower Saxony, and from Munster, the potentially contaminated area. Breast milk samples were collected immediately before and after nursing on days 2, 5, 15, 30, 45, 60, 75, and 90 post partum. At least 10 ml were required for measurements of arsenic, and 187 samples were of that volume. Samples were analysed with a Perkin-Elmer Type 403 hydride-generation atomic absorption spectrometer, equipped with an arsenic EDL-lamp. Arsenic was not detectable, i.e. below 0.3 microgram/l, in 154 of 187 samples. The highest concentration of 2.8 micrograms/l was measured in a sample from the rural area of Soltau. Geometric means of arsenic concentrations were comparable in the three regions. Concentrations did neither differ in samples obtained before and after nursing nor with respect to age of the infant. The calculated daily intake of arsenic was in the range of 0.02 to 0.06 microgram per kg body weight, which is far below the lower limit of daily permissible intake for adults (WHO/JECFA recommendation 1993) of 15 micrograms/kg/wk. In conclusion, we found concentrations of arsenic in breast milk within the reported safety limits. This was also true for samples from women living in a region which has previously been shown to be contaminated with arsenic from chemical weapons.     

Exposure to 3′Sialyllactose-Poor Milk during Lactation Impairs Cognitive Capabilities in Adulthood

Breast milk exerts pivotal regulatory functions early in development whereby it contributes to the maturation of brain and associated cognitive functions. However, the specific components of maternal milk mediating this process have remained elusive. Sialylated human milk oligosaccharides (HMOs) represent likely candidates since they constitute the principal neonatal dietary source of sialic acid, which is crucial for brain development and neuronal patterning. We hypothesize that the selective neonatal lactational deprivation of a specific sialylated HMOs, sialyl(alpha2,3)lactose (3′SL), may impair cognitive capabilities (attention, cognitive flexibility, and memory) in adulthood in a preclinical model. To operationalize this hypothesis, we cross-fostered wild-type (WT) mouse pups to B6.129-St3gal4^tm1.1Jxm/J dams, knock-out (KO) for the gene synthesizing 3′SL, thereby providing milk with approximately 80% 3′SL content reduction. We thus exposed lactating WT pups to a selective reduction of 3′SL and investigated multiple cognitive domains (including memory and attention) in adulthood. Furthermore, to account for the underlying electrophysiological correlates, we investigated hippocampal long-term potentiation (LTP). Neonatal access to 3′SL-poor milk resulted in decreased attention, spatial and working memory, and altered LTP compared to the control group. These results support the hypothesis that early-life dietary sialylated HMOs exert a long-lasting role in the development of cognitive functions.