Nutrients

Editorial

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4 pages, 212 KiB

Open AccessEditorial

Human Milk and Lactation

by Maria Lorella Gianni, Daniela Morniroli, Maria Enrica Bettinelli and Fabio Mosca

Nutrients 2020, 12(4), 899; https://doi.org/10.3390/nu12040899 - 26 Mar 2020

Cited by 2 | Viewed by 3364

Abstract

Human milk is uniquely tailored to meet infants’ specific nutritional requirements [...] Full article

(This article belongs to the Special Issue Human Milk and Lactation)

Research

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11 pages, 676 KiB

Open AccessArticle

Variability of Water-Soluble Forms of Choline Concentrations in Human Milk during Storage, after Pasteurization, and among Women

by Sara Moukarzel, Alejandra M. Wiedeman, Lynda S. Soberanes, Roger A. Dyer, Sheila M. Innis and Yvonne Lamers

Nutrients 2019, 11(12), 3024; https://doi.org/10.3390/nu11123024 - 11 Dec 2019

Cited by 10 | Viewed by 3568

Abstract

Choline is critical for infant development and mother’s milk is the sole source of choline for fully breastfed infants until six months of age. Human milk choline consists to 85% of water-soluble forms of choline including free choline (FC), phosphocholine (PhosC), and glycerophosphocholine [...] Read more.

Choline is critical for infant development and mother’s milk is the sole source of choline for fully breastfed infants until six months of age. Human milk choline consists to 85% of water-soluble forms of choline including free choline (FC), phosphocholine (PhosC), and glycerophosphocholine (GPC). Donor milk requires safe handling procedures such as cold storage and pasteurization. However, the stability of water-soluble forms of choline during these processes is not known. The objectives of this research were to determine the effect of storage and pasteurization on milk choline concentration, and the diurnal intra- and inter-individual variability of water-soluble choline forms. Milk samples were collected from healthy women who were fully breastfeeding a full-term, singleton infant <6 months. Milk total water-soluble forms of choline, PhosC, and GPC concentrations did not change during storage at room temperature for up to 4 h. Individual and total water-soluble forms of choline concentrations did not change after storage for 24 h in the refrigerator or for up to one week in the household freezer. Holder pasteurization decreased PhosC and GPC, and thereby total water-soluble choline form concentrations by <5%. We did not observe diurnal variations in PhosC and total water-soluble forms of choline concentrations, but significant differences in FC and GPC concentrations across five sampling time points throughout one day. In conclusion, these outcomes contribute new knowledge for the derivation of evidence-informed guidelines for the handling and storage of expressed human milk as well as the development of optimized milk collection and storage protocols for research studies. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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10 pages, 264 KiB

Open AccessArticle

Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation

by Maria Lorella Gianni, Maria Enrica Bettinelli, Priscilla Manfra, Gabriele Sorrentino, Elena Bezze, Laura Plevani, Giacomo Cavallaro, Genny Raffaeli, Beatrice Letizia Crippa, Lorenzo Colombo, Daniela Morniroli, Nadia Liotto, Paola Roggero, Eduardo Villamor, Paola Marchisio and Fabio Mosca

Nutrients 2019, 11(10), 2266; https://doi.org/10.3390/nu11102266 - 20 Sep 2019

Cited by 192 | Viewed by 24907

Abstract

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding [...] Read more.

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt well-supported by health professionals. Maternal perception of not having a sufficient amount of milk, infant’s failure to thrive, mastitis, and the return to work were associated with a higher risk of non-exclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

19 pages, 1413 KiB

Open AccessArticle

Variation and Interdependencies of Human Milk Macronutrients, Fatty Acids, Adiponectin, Insulin, and IGF-II in the European PreventCD Cohort

by Maria Grunewald, Christian Hellmuth, Franca F. Kirchberg, Maria Luisa Mearin, Renata Auricchio, Gemma Castillejo, Ilma R. Korponay-Szabo, Isabel Polanco, Maria Roca, Sabine L. Vriezinga, Katharina Werkstetter, Berthold Koletzko and Hans Demmelmair

Nutrients 2019, 11(9), 2034; https://doi.org/10.3390/nu11092034 - 30 Aug 2019

Cited by 20 | Viewed by 4358

Abstract

Human milk composition is variable. The identification of influencing factors and interdependencies of components may help to understand the physiology of lactation. In this study, we analyzed linear trends in human milk composition over time, the variation across different European countries and the [...] Read more.

Human milk composition is variable. The identification of influencing factors and interdependencies of components may help to understand the physiology of lactation. In this study, we analyzed linear trends in human milk composition over time, the variation across different European countries and the influence of maternal celiac disease. Within a multicenter European study exploring potential prevention of celiac disease in a high-risk population (PreventCD), 569 human milk samples were donated by women from five European countries between 16 and 163 days postpartum. Some 202 mothers provided two samples at different time points. Protein, carbohydrates, fat and fatty acids, insulin, adiponectin, and insulin-like growth factor II (IGF-II) were analyzed. Milk protein and n-6 long chain polyunsaturated fatty acids decreased during the first three months of lactation. Fatty acid composition was significantly influenced by the country of residence. IGF-II and adiponectin concentrations correlated with protein content (r = 0.24 and r = 0.35), and IGF-II also correlated with fat content (r = 0.36), suggesting a possible regulatory role of IGF in milk macronutrient synthesis. Regarding the impact of celiac disease, only the level in palmitic acid was influenced by this disease, suggesting that breastfeeding by celiac disease mothers should not be discouraged. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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13 pages, 647 KiB

Open AccessArticle

Breast Milk Content of Vitamin A and E from Early- to Mid-Lactation Is Affected by Inadequate Dietary Intake in Brazilian Adult Women

by Michele R. Machado, Fernanda Kamp, Juliana C. Nunes, Tatiana El-Bacha and Alexandre G. Torres

Nutrients 2019, 11(9), 2025; https://doi.org/10.3390/nu11092025 - 29 Aug 2019

Cited by 26 | Viewed by 5412

Abstract

Our aims were to investigate vitamin A and E status during lactation and the determinants of breast milk content for the appropriate nutrition of the infant in a study with nursing Brazilian women. We hypothesized that both inadequate intake and the lipoprotein distribution [...] Read more.

Our aims were to investigate vitamin A and E status during lactation and the determinants of breast milk content for the appropriate nutrition of the infant in a study with nursing Brazilian women. We hypothesized that both inadequate intake and the lipoprotein distribution of vitamin A and E during lactation could have an impact on their breast milk levels from early- to mid-lactation. Nineteen adult lactating women participated in this longitudinal observational study, in which dietary records, blood and mature breast milk samples were collected for the analysis of vitamin A and E, and carotenoids in early- (2nd to 4th week) and mid-lactation (12th to 14th week). Nutrient intake was balanced by the Multiple Source Method (MSM), and the intake of vitamin A and E was inadequate in 74 and 100% of the women, respectively. However, these results were not reflected in low serum concentrations of retinol and only 37% of the volunteers were vitamin E deficient according to the blood biomarker. As lactation progressed, vitamin A and E status worsened, and this was clearly observed by the decrease in their content in breast milk. The reduced content of vitamin A and E in the breast milk was not related to their distribution in lipoproteins. Taken together, the contents of vitamin A and E in breast milk seemed to be more sensitive markers of maternal nutrition status than respective blood concentrations, and dietary assessment by the MSM in early lactation was sensitive to indicate later risks of deficiency and should support maternal dietary guidance to improve the infant’s nutrition. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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15 pages, 2771 KiB

Open AccessArticle

Lipid Profile, Lipase Bioactivity, and Lipophilic Antioxidant Content in High Pressure Processed Donor Human Milk

by Aleksandra Wesolowska, Joanna Brys, Olga Barbarska, Kamila Strom, Jolanta Szymanska-Majchrzak, Katarzyna Karzel, Emilia Pawlikowska, Monika A. Zielinska, Jadwiga Hamulka and Gabriela Oledzka

Nutrients 2019, 11(9), 1972; https://doi.org/10.3390/nu11091972 - 21 Aug 2019

Cited by 28 | Viewed by 5150

Abstract

Human milk fat plays an essential role as the source of energy and cell function regulator; therefore, the preservation of unique human milk donors’ lipid composition is of fundamental importance. To compare the effects of high pressure processing (HPP) and holder pasteurization on [...] Read more.

Human milk fat plays an essential role as the source of energy and cell function regulator; therefore, the preservation of unique human milk donors’ lipid composition is of fundamental importance. To compare the effects of high pressure processing (HPP) and holder pasteurization on lipidome, human milk was processed at 62.5 °C for 30 min and at five variants of HPP from 450 MPa to 600 MPa, respectively. Lipase activity was estimated with QuantiChrom™ assay. Fatty acid composition was determined with the gas chromatographic technique, and free fatty acids content by titration with 0.1 M KOH. The positional distribution of fatty acid in triacylglycerols was performed. The oxidative induction time was obtained from the pressure differential scanning calorimetry. Carotenoids in human milk were measured by liquid chromatography. Bile salt stimulated lipase was completely eliminated by holder pasteurization, decreased at 600 MPa, and remained intact at 200 + 400 MPa; 450 MPa. The fatty acid composition and structure of human milk fat triacylglycerols were unchanged. The lipids of human milk after holder pasteurization had the lowest content of free fatty acids and the shortest induction time compared with samples after HPP. HPP slightly changed the β-carotene and lycopene levels, whereas the lutein level was decreased by 40.0% up to 60.2%, compared with 15.8% after the holder pasteurization. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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14 pages, 1444 KiB

Open AccessArticle

Quantification of Nervonic Acid in Human Milk in the First 30 Days of Lactation: Influence of Lactation Stages and Comparison with Infant Formulae

by Jiahui Yu, Tinglan Yuan, Xinghe Zhang, Qingzhe Jin, Wei Wei and Xingguo Wang

Nutrients 2019, 11(8), 1892; https://doi.org/10.3390/nu11081892 - 14 Aug 2019

Cited by 26 | Viewed by 4755

Abstract

Nervonic acid (24:1 n-9, NA) plays a crucial role in the development of white matter, and it occurs naturally in human milk. This study aims to quantify NA in human milk at different lactation stages and compare it with the NA measured in [...] Read more.

Nervonic acid (24:1 n-9, NA) plays a crucial role in the development of white matter, and it occurs naturally in human milk. This study aims to quantify NA in human milk at different lactation stages and compare it with the NA measured in infant formulae. With this information, optimal nutritional interventions for infants, especially newborns, can be determined. In this study, an absolute detection method that uses experimentally derived standard curves and methyl tricosanoate as the internal standard was developed to quantitively analyze NA concentration. The method was applied to the analysis of 224 human milk samples, which were collected over a period of 3–30 days postpartum from eight healthy Chinese mothers. The results show that the NA concentration was highest in colostrum (0.76 ± 0.23 mg/g fat) and significantly decreased (p < 0.001) in mature milk (0.20 ± 0.03 mg/g fat). During the first 10 days of lactation, the change in NA concentration was the most pronounced, decreasing by about 65%. Next, the NA contents in 181 commercial infant formulae from the Chinese market were compared. The NA content in most formulae was <16% of that found in colostrum and less than that found in mature human milk (p < 0.05). No significant difference (p > 0.05) was observed among NA content in formulae with different fat sources. Special attention was given to the variety of n-9 fatty acids in human milk during lactation, and the results indicated that interindividual variation in NA content may be primarily due to endogenous factors, with less influence from the maternal diet. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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13 pages, 2385 KiB

Open AccessArticle

Longitudinal Changes of Mineral Concentrations in Preterm and Term Human Milk from Lactating Swiss Women

by Magalie Sabatier, Clara L. Garcia-Rodenas, Carlos A. De Castro, Peter Kastenmayer, Mario Vigo, Stéphane Dubascoux, Daniel Andrey, Marine Nicolas, Janique Richoz Payot, Valentine Bordier, Sagar K. Thakkar, Lydie Beauport, Jean-François Tolsa, Céline J. Fischer Fumeaux and Michael Affolter

Nutrients 2019, 11(8), 1855; https://doi.org/10.3390/nu11081855 - 9 Aug 2019

Cited by 35 | Viewed by 4558

Abstract

An adequate mineral supply to preterm infants is essential for normal growth and development. This study aimed to compare the mineral contents of human milk (HM) from healthy mothers of preterm (28–32 weeks) and full term (>37 weeks) infants. Samples were collected weekly [...] Read more.

An adequate mineral supply to preterm infants is essential for normal growth and development. This study aimed to compare the mineral contents of human milk (HM) from healthy mothers of preterm (28–32 weeks) and full term (>37 weeks) infants. Samples were collected weekly for eight weeks for the term group (n = 34) and, biweekly up to 16 weeks for the preterm group (n = 27). Iron, zinc, selenium, copper, iodine, calcium, magnesium, phosphorus, potassium, and sodium were quantitatively analyzed by Inductively Coupled Plasma-Mass Spectrometry. The mineral contents of both HM showed parallel compositional changes over the period of lactation, with occasional significant differences when compared at the same postpartum age. However, when the comparisons were performed at an equivalent postmenstrual age, preterm HM contained less zinc and copper from week 39 to 48 (p < 0.002) and less selenium from week 39 to 44 (p < 0.002) than term HM. This translates into ranges of differences (min–max) of 53% to 78%, 30% to 72%, and 11% to 33% lower for zinc, copper, and selenium, respectively. These data provide comprehensive information on the temporal changes of ten minerals in preterm HM and may help to increase the accuracy of the mineral fortification of milk for preterm consumption. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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11 pages, 539 KiB

Open AccessCommunication

Hormones in Breast Milk and Effect on Infants’ Growth: A Systematic Review

by Alessandra Mazzocchi, Maria Lorella Giannì, Daniela Morniroli, Ludovica Leone, Paola Roggero, Carlo Agostoni, Valentina De Cosmi and Fabio Mosca

Nutrients 2019, 11(8), 1845; https://doi.org/10.3390/nu11081845 - 9 Aug 2019

Cited by 47 | Viewed by 8066

Abstract

Breast milk is characterized by a dynamic and complex composition which includes hormones and other bioactive components that could influence infant growth, development, and optimize health. Among the several beneficial effects associated with prolonged breastfeeding, a 13% decrease in the risk of overweight [...] Read more.

Breast milk is characterized by a dynamic and complex composition which includes hormones and other bioactive components that could influence infant growth, development, and optimize health. Among the several beneficial effects associated with prolonged breastfeeding, a 13% decrease in the risk of overweight and obesity has been reported. Recent research has focused on breast milk hormones contributing to the appetite and energy balance regulation and adiposity. Accordingly, we conducted a literature systematic review with the aim to provide an update on the effect of leptin, ghrelin, Insulin Growth Factor 1, adiponectin, and insulin on infants’ and children’s growth and body composition. The revised literature reveals contrasting findings concerning the potential role of all these hormones on modeling growth and fat mass apposition and health outcomes later in life. Further studies are needed to gain further insight into the specific role of these bioactive components in metabolic pathways related to body composition. This could help gain a further insight on infants’ growth, both in physiological and pathological settings. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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10 pages, 862 KiB

Open AccessArticle

Validation and Application of Biocrates AbsoluteIDQ^® p180 Targeted Metabolomics Kit Using Human Milk

by Daniela Hampel, Setareh Shahab-Ferdows, Muttaquina Hossain, M. Munirul Islam, Tahmeed Ahmed and Lindsay H. Allen

Nutrients 2019, 11(8), 1733; https://doi.org/10.3390/nu11081733 - 26 Jul 2019

Cited by 16 | Viewed by 6432

Abstract

Human-milk-targeted metabolomics analysis offers novel insights into milk composition and relationships with maternal and infant phenotypes and nutritional status. The Biocrates AbsoluteIDQ^® p180 kit, targeting 40 acylcarnitines, 42 amino acids/biogenic amines, 91 phospholipids, 15 sphingolipids, and sum of hexoses, was evaluated [...] Read more.

Human-milk-targeted metabolomics analysis offers novel insights into milk composition and relationships with maternal and infant phenotypes and nutritional status. The Biocrates AbsoluteIDQ^® p180 kit, targeting 40 acylcarnitines, 42 amino acids/biogenic amines, 91 phospholipids, 15 sphingolipids, and sum of hexoses, was evaluated for human milk using the AB Sciex 5500 QTRAP mass-spectrometer in liquid chromatography-tandem mass-spectrometry (LC-MS/MS) and flow-injection analysis (FIA) mode. Milk (<6 months lactation) from (A) Bangladeshi apparently healthy mothers (body mass index (BMI) > 18.5; n = 12) and (B) Bangladeshi mothers of stunted infants (height-for-age Z (HAZ)-score <−2; n = 13) was analyzed. Overall, 123 of the possible 188 metabolites were detected in milk. New internal standards and adjusted calibrator levels were used for improved precision and concentration ranges for milk metabolites. Recoveries ranged between 43% and 120% (coefficient of variation (CV): 2.4%–24.1%, 6 replicates). Milk consumed by stunted infants vs. that from mothers with BMI > 18.5 was lower in 6 amino acids/biogenic amines but higher in isovalerylcarnitine, two phospholipids, and one sphingomyelin (p < 0.05 for all). Associations between milk metabolites differed between groups. The AbsoluteIDQ^® p180 kit is a rapid analysis tool suitable for human milk analysis and reduces analytical bias by allowing the same technique for different specimens. More research is needed to examine milk metabolite relationships with maternal and infant phenotypes. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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17 pages, 625 KiB

Open AccessArticle

The Effect of High-Dose Postpartum Maternal Vitamin D Supplementation Alone Compared with Maternal Plus Infant Vitamin D Supplementation in Breastfeeding Infants in a High-Risk Population. A Randomized Controlled Trial

by Adekunle Dawodu, Khalil M. Salameh, Najah S. Al-Janahi, Abdulbari Bener and Naser Elkum

Nutrients 2019, 11(7), 1632; https://doi.org/10.3390/nu11071632 - 17 Jul 2019

Cited by 39 | Viewed by 7688

Abstract

In view of continuing reports of high prevalence of severe vitamin D deficiency and low rate of infant vitamin D supplementation, an alternative strategy for prevention of vitamin D deficiency in infants warrants further study. The aim of this randomized controlled trial among [...] Read more.

In view of continuing reports of high prevalence of severe vitamin D deficiency and low rate of infant vitamin D supplementation, an alternative strategy for prevention of vitamin D deficiency in infants warrants further study. The aim of this randomized controlled trial among 95 exclusively breastfeeding mother–infant pairs with high prevalence of vitamin D deficiency was to compare the effect of six-month post-partum vitamin D₃ maternal supplementation of 6000 IU/day alone with maternal supplementation of 600 IU/day plus infant supplementation of 400 IU/day on the vitamin D status of breastfeeding infants in Doha, Qatar. Serum calcium, parathyroid hormone, maternal urine calcium/creatinine ratio and breast milk vitamin D content were measured. At baseline, the mean serum 25-hydroxyvitamin D (25(OH)D) of mothers on 6000 IU and 600 IU (35.1 vs. 35.7 nmol/L) and in their infants (31.9 vs. 29.6) respectively were low but similar. At the end of the six month supplementation, mothers on 6000 IU achieved higher serum 25(OH)D mean ± SD of 98 ± 35 nmol/L than 52 ± 20 nmol/L in mothers on 600 IU (p < 0.0001). Of mothers on 6000 IU, 96% achieved adequate serum 25(OH)D (≥50 nmol/L) compared with 52%in mothers on 600 IU (p < 0.0001). Infants of mothers on 600 IU and also supplemented with 400 IU vitamin D₃ had slightly higher serum 25(OH)D than infants of mothers on 6000 IU alone (109 vs. 92 nmol/L, p = 0.03); however, similar percentage of infants in both groups achieved adequate serum 25(OH)D ≥50 nmol/L (91% vs. 89%, p = 0.75). Mothers on 6000 IU vitamin D₃/day also had higher human milk vitamin D content. Safety measurements, including serum calcium and urine calcium/creatinine ratios in the mother and serum calcium levels in the infants were similar in both groups. Maternal 6000 IU/day vitamin D₃ supplementation alone safely optimizes maternal vitamin D status, improves milk vitamin D to maintain adequate infant serum 25(OH)D. It thus provides an alternative option to prevent the burden of vitamin D deficiency in exclusively breastfeeding infants in high-risk populations and warrants further study of the effective dose. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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16 pages, 825 KiB

Open AccessArticle

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

by Agnieszka Bzikowska-Jura, Aneta Czerwonogrodzka-Senczyna, Edyta Jasińska-Melon, Hanna Mojska, Gabriela Olędzka, Aleksandra Wesołowska and Dorota Szostak-Węgierek

Nutrients 2019, 11(7), 1585; https://doi.org/10.3390/nu11071585 - 12 Jul 2019

Cited by 36 | Viewed by 6424

Abstract

This study determined fatty acid (FA) concentrations in maternal milk and investigated the association between omega-3 fatty acid levels and their maternal current dietary intake (based on three-day dietary records) and habitual dietary intake (based on intake frequency of food products). Tested material [...] Read more.

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

(This article belongs to the Special Issue Human Milk and Lactation)

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11 pages, 4235 KiB

Open AccessArticle

Antenatal Influenza A-Specific IgA, IgM, and IgG Antibodies in Mother’s Own Breast Milk and Donor Breast Milk, and Gastric Contents and Stools from Preterm Infants

by Veronique Demers-Mathieu, Robert K. Huston, Andi M. Markell, Elizabeth A. McCulley, Rachel L. Martin and David C. Dallas

Nutrients 2019, 11(7), 1567; https://doi.org/10.3390/nu11071567 - 11 Jul 2019

Cited by 26 | Viewed by 4632

Abstract

Antenatal milk anti-influenza antibodies may provide additional protection to newborns until they are able to produce their own antibodies. To evaluate the relative abundance of milk, we studied the antibodies specific to influenza A in feeds and gastric contents and stools from preterm [...] Read more.

Antenatal milk anti-influenza antibodies may provide additional protection to newborns until they are able to produce their own antibodies. To evaluate the relative abundance of milk, we studied the antibodies specific to influenza A in feeds and gastric contents and stools from preterm infants fed mother’s own breast milk (MBM) and donor breast milk (DBM). Feed (MBM or DBM) and gastric contents (MBM or DBM at 1 h post-ingestion) and stool samples (MBM/DBM at 24 h post-ingestion) were collected, respectively, from 20 preterm (26–36 weeks gestational age) mother-infant pairs at 8–9 days and 21–22 days of postnatal age. Samples were analyzed via ELISA for anti-H1N1 hemagglutinin (anti-H1N1 HA) and anti-H3N2 neuraminidase (anti-H3N2 NA) specificity across immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) isotypes. The relative abundance of influenza A-specific IgA in feeds and gastric contents were higher in MBM than DBM at 8–9 days of postnatal age but did not differ at 21–22 days. Anti-influenza A-specific IgM was higher in MBM than in DBM at both postnatal times in feed and gastric samples. At both postnatal times, anti-influenza A-specific IgG was higher in MBM than DBM but did not differ in gastric contents. Gastric digestion reduced anti-H3N2 NA IgG from MBM at 21–22 days and from DBM at 8–9 days of lactation, whereas other anti-influenza A antibodies were not digested at either postnatal times. Supplementation of anti-influenza A-specific antibodies in DBM may help reduce the risk of influenza virus infection. However, the effective antibody dose required to induce a significant protective effect remains unknown. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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12 pages, 1663 KiB

Open AccessArticle

Longitudinal Analysis of Macronutrient Composition in Preterm and Term Human Milk: A Prospective Cohort Study

by Céline J. Fischer Fumeaux, Clara L. Garcia-Rodenas, Carlos A. De Castro, Marie-Claude Courtet-Compondu, Sagar K. Thakkar, Lydie Beauport, Jean-François Tolsa and Michael Affolter

Nutrients 2019, 11(7), 1525; https://doi.org/10.3390/nu11071525 - 4 Jul 2019

Cited by 48 | Viewed by 5416

Abstract

Background: Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants. As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM). Addressing HM composition and variations is essential to [...] Read more.

Background: Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants. As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM). Addressing HM composition and variations is essential to optimize HM fortification strategies for these vulnerable infants. Aims: To analyze and compare macronutrient composition in HM of mothers lactating very preterm (PT) (28 0/7 to 32 6/7 weeks of gestational age, GA) and term (T) infants (37 0/7 to 41 6/7 weeks of GA) over time, both at similar postnatal and postmenstrual ages, and to investigate other potential factors of variations. Methods: Milk samples from 27 mothers of the PT infants and 34 mothers of the T infants were collected longitudinally at 12 points in time during four months for the PT HM and eight points in time during two months for the T HM. Macronutrient composition (proteins, fat, and lactose) and energy were measured using a mid-infrared milk analyzer, corrected by bicinchoninic acid (BCA) assay for total protein content. Results: Analysis of 500 HM samples revealed large inter- and intra-subject variations in both groups. Proteins decreased from birth to four months in the PT and the T HM without significant differences at any postnatal time point, while it was lower around term equivalent age in PT HM. Lactose content remained stable and comparable over time. The PT HM contained significantly more fat and tended to be more caloric in the first two weeks of lactation, while the T HM revealed higher fat and higher energy content later during lactation (three to eight weeks). In both groups, male gender was associated with more fat and energy content. The gender association was stronger in the PT group, and it remained significant after adjustments. Conclusion: Longitudinal measurements of macronutrients compositions of the PT and the T HM showed only small differences at similar postnatal stages in our population. However, numerous differences exist at similar postmenstrual ages. Male gender seems to be associated with a higher content in fat, especially in the PT HM. This study provides original information on macronutrient composition and variations of HM, which is important to consider for the optimization of nutrition and growth of PT infants. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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16 pages, 4672 KiB

Open AccessArticle

Human Milk Oligosaccharides in the Milk of Mothers Delivering Term versus Preterm Infants

by Sean Austin, Carlos A. De Castro, Norbert Sprenger, Aristea Binia, Michael Affolter, Clara L. Garcia-Rodenas, Lydie Beauport, Jean-François Tolsa and Céline J. Fischer Fumeaux

Nutrients 2019, 11(6), 1282; https://doi.org/10.3390/nu11061282 - 5 Jun 2019

Cited by 100 | Viewed by 8902

Abstract

Human milk oligosaccharides (HMOs) are a major component of human milk, and play an important role in protecting the infant from infections. Preterm infants are particularly vulnerable, but have improved outcomes if fed with human milk. This study aimed to determine if the [...] Read more.

Human milk oligosaccharides (HMOs) are a major component of human milk, and play an important role in protecting the infant from infections. Preterm infants are particularly vulnerable, but have improved outcomes if fed with human milk. This study aimed to determine if the HMO composition of preterm milk differed from that of term milk at equivalent stage of lactation and equivalent postmenstrual age. In all, 22 HMOs were analyzed in 500 samples of milk from 25 mothers breastfeeding very preterm infants (< 32 weeks of gestational age, < 1500 g of birthweight) and 28 mothers breastfeeding term infants. The concentrations of most HMOs were comparable at equivalent postpartum age. However, HMOs containing α-1,2-linked fucose were reduced in concentration in preterm milk during the first month of lactation. The concentrations of a number of sialylated oligosaccharides were also different in preterm milk, in particular 3′-sialyllactose concentrations were elevated. At equivalent postmenstrual age, the concentrations of a number of HMOs were significantly different in preterm compared to term milk. The largest differences manifest around 40 weeks of postmenstrual age, when the milk of term infants contains the highest concentrations of HMOs. The observed differences warrant further investigation in view of their potential clinical impact. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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12 pages, 396 KiB

Open AccessCommunication

Milk Therapy: Unexpected Uses for Human Breast Milk

by Malgorzata Witkowska-Zimny, Ewa Kamińska-El-Hassan and Edyta Wróbel

Nutrients 2019, 11(5), 944; https://doi.org/10.3390/nu11050944 - 26 Apr 2019

Cited by 20 | Viewed by 14347

Abstract

Background: Human breast milk provides a child with complete nutrition but is also a popular therapeutic remedy that has been used in traditional, natural pharmacopeia, and ethnomedicine for many years. The aim of this current review is to summarize studies of non-nutritional uses [...] Read more.

Background: Human breast milk provides a child with complete nutrition but is also a popular therapeutic remedy that has been used in traditional, natural pharmacopeia, and ethnomedicine for many years. The aim of this current review is to summarize studies of non-nutritional uses of mothers’ milk. Methods: Two databases (PubMed and Google Scholar) were searched with a combination of twelve search terms. We selected articles that were published between 1 January 2010, and 1 January 2019. The language of publication was limited to English. Results: Fifteen studies were included in the systematic review. Ten of these were randomized controlled trials, one was a quasi-experimental study, two were in vitro studies, and four employed an animal research model. Conclusions: Many human milk components have shown promise in preclinical studies and are undergoing active clinical evaluation. The protective and treatment role of fresh breast milk is particularly important in areas where mothers and infants do not have ready access to medicine. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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14 pages, 1064 KiB

Open AccessArticle

Factors Associated with Increased Alpha-Tocopherol Content in Milk in Response to Maternal Supplementation with 800 IU of Vitamin E

by Amanda de Sousa Rebouças, Ana Gabriella Costa Lemos da Silva, Amanda Freitas de Oliveira, Lorena Thalia Pereira da Silva, Vanessa de Freitas Felgueiras, Marina Sampaio Cruz, Vivian Nogueira Silbiger, Karla Danielly da Silva Ribeiro and Roberto Dimenstein

Nutrients 2019, 11(4), 900; https://doi.org/10.3390/nu11040900 - 22 Apr 2019

Cited by 10 | Viewed by 4067

Abstract

Background: Vitamin E supplementation might represent an efficient strategy to increase the vitamin E content in milk. The present study aimed to evaluate the impact of supplementation with 800 IU RRR-alpha-tocopherol on the alpha-tocopherol content of milk and the factors associated with the [...] Read more.

Background: Vitamin E supplementation might represent an efficient strategy to increase the vitamin E content in milk. The present study aimed to evaluate the impact of supplementation with 800 IU RRR-alpha-tocopherol on the alpha-tocopherol content of milk and the factors associated with the increase in vitamin E. Methods: Randomized clinical trial with 79 lactating women from Brazil, who were assigned to the control group, or to the supplemented group (800 IU of RRR-alpha-tocopherol). Milk and serum were collected between 30 and 90 days after delivery (collection 1), and on the next day (collection 2). Alpha-tocopherol was analyzed using high-performance liquid chromatography. Results: In the supplemented group, the alpha-tocopherol content in serum and milk increased after supplementation (p < 0.001). In the multivariate analysis, only alpha-tocopherol in milk (collection 1) was associated with the level of this vitamin in milk after supplementation (β = 0.927, p < 0.001), and binary logistic regression showed that the dietary intake was the only determinant for the greater effect of supplementation in milk. Conclusion: The pre-existing vitamin level in milk and diet are determinants for the efficacy of supplementation in milk, suggesting that in populations with vitamin E deficiency, high-dose supplementation can be used to restore its level in milk. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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11 pages, 2021 KiB

Open AccessArticle

Online Video Instruction on Hand Expression of Colostrum in Pregnancy is an Effective Educational Tool

by Therese A. O’Sullivan, Joy Cooke, Chris McCafferty and Roslyn Giglia

Nutrients 2019, 11(4), 883; https://doi.org/10.3390/nu11040883 - 19 Apr 2019

Cited by 21 | Viewed by 7902

Abstract

The use of antenatal colostrum expression in the weeks prior to birth may help improve long-term breastfeeding, but few large-scale studies exist. Typically, antenatal colostrum expression instruction relies on face-to-face education, making large interventions costly. We aimed to determine whether an expert online [...] Read more.

The use of antenatal colostrum expression in the weeks prior to birth may help improve long-term breastfeeding, but few large-scale studies exist. Typically, antenatal colostrum expression instruction relies on face-to-face education, making large interventions costly. We aimed to determine whether an expert online instructional video can improve knowledge and confidence around antenatal colostrum expressing. Pregnant women were asked to complete a questionnaire pre- and post-watching the instructional video online. Ninety five pregnant women completed both pre- and post-questionnaires. Total antenatal colostrum expression knowledge scores improved after watching the video, from a mean of 3.05 ± 1.70 correct out of a maximum of 7, to 6.32 ± 0.76 (p < 0.001). Self-reported confidence around hand expressing in pregnancy also improved from an average ranking of not confident (2.56 ± 1.17, out of a possible 5) to confident (4.32 ± 0.80, p < 0.001). Almost all women (98%) reported that they would recommend the video to a friend or family member if antenatal colostrum expression was suggested by their healthcare provider. Findings suggest that the use of an online expert video is an acceptable and effective way to educate pregnant women in antenatal colostrum expression. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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14 pages, 2215 KiB

Open AccessArticle

Variability of Serum Proteins in Chinese and Dutch Human Milk during Lactation

by Mohèb Elwakiel, Sjef Boeren, Jos A. Hageman, Ignatius M. Szeto, Henk A. Schols and Kasper A. Hettinga

Nutrients 2019, 11(3), 499; https://doi.org/10.3390/nu11030499 - 27 Feb 2019

Cited by 26 | Viewed by 6048

Abstract

To better understand the variability of the type and level of serum proteins in human milk, the milk serum proteome of Chinese mothers during lactation was investigated using proteomic techniques and compared to the milk serum proteome of Dutch mothers. This showed that [...] Read more.

To better understand the variability of the type and level of serum proteins in human milk, the milk serum proteome of Chinese mothers during lactation was investigated using proteomic techniques and compared to the milk serum proteome of Dutch mothers. This showed that total milk serum protein concentrations in Chinese human milk decreased over a 20-week lactation period, although with variation between mothers in the rate of decrease. Variation was also found in the composition of serum proteins in both colostrum and mature milk, although immune-active proteins, enzymes, and transport proteins were the most abundant for all mothers. These three protein groups account for many of the 15 most abundant proteins, with these 15 proteins covering more than 95% of the total protein concentrations, in both the Chinese and Dutch milk serum proteome. The Dutch and Chinese milk serum proteome were also compared based on 166 common milk serum proteins, which showed that 22% of the 166 serum proteins differed in level. These differences were observed mainly in colostrum and concern several highly abundant proteins. This study also showed that protease inhibitors, which are highly correlated to immune-active proteins, are present in variable amounts in human milk and could be relevant during digestion. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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9 pages, 263 KiB

Open AccessArticle

Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues

by Beatrice Letizia Crippa, Lorenzo Colombo, Daniela Morniroli, Dario Consonni, Maria Enrica Bettinelli, Irene Spreafico, Giulia Vercesi, Patrizio Sannino, Paola Agnese Mauri, Lidia Zanotta, Annalisa Canziani, Paola Roggero, Laura Plevani, Donatella Bertoli, Stefania Zorzan, Maria Lorella Giannì and Fabio Mosca

Nutrients 2019, 11(2), 312; https://doi.org/10.3390/nu11020312 - 1 Feb 2019

Cited by 32 | Viewed by 6446

Abstract

The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that [...] Read more.

The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

14 pages, 1270 KiB

Open AccessArticle

Quantification of Human Milk Phospholipids: the Effect of Gestational and Lactational Age on Phospholipid Composition

by Ida Emilie Ingvordsen Lindahl, Virginia M. Artegoitia, Eimear Downey, James A. O’Mahony, Carol-Anne O’Shea, C. Anthony Ryan, Alan L. Kelly, Hanne C. Bertram and Ulrik K. Sundekilde

Nutrients 2019, 11(2), 222; https://doi.org/10.3390/nu11020222 - 22 Jan 2019

Cited by 48 | Viewed by 6591

Abstract

Human milk (HM) provides infants with macro- and micronutrients needed for growth and development. Milk phospholipids are important sources of bioactive components, such as long-chain polyunsaturated fatty acids (LC-PUFA) and choline, crucial for neural and visual development. Milk from mothers who have delivered [...] Read more.

Human milk (HM) provides infants with macro- and micronutrients needed for growth and development. Milk phospholipids are important sources of bioactive components, such as long-chain polyunsaturated fatty acids (LC-PUFA) and choline, crucial for neural and visual development. Milk from mothers who have delivered prematurely (<37 weeks) might not meet the nutritional requirements for optimal development and growth. Using liquid chromatography tandem-mass spectrometry, 31 phospholipid (PL) species were quantified for colostrum (<5 days postpartum), transitional (≥5 days and ≤2 weeks) and mature milk (>2 weeks and ≤15 weeks) samples from mothers who had delivered preterm (n = 57) and term infants (n = 22), respectively. Both gestational age and age postpartum affected the PL composition of HM. Significantly higher concentrations (p < 0.05) of phosphatidylcholine (PC), sphingomyelin (SM) and total PL were found in preterm milk throughout lactation, as well as significantly higher concentrations (p < 0.002) of several phosphatidylethanolamine (PE), PC and SM species. Multivariate analysis revealed that PLs containing LC-PUFA contributed highly to the differences in the PL composition of preterm and term colostrum. Differences related to gestation decreased as the milk matured. Thus, gestational age may impact the PL content of colostrum, however this effect of gestation might subside in mature milk. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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16 pages, 417 KiB

Open AccessArticle

Carotenoid Content in Breastmilk in the 3rd and 6th Month of Lactation and Its Associations with Maternal Dietary Intake and Anthropometric Characteristics

by Monika A. Zielinska, Jadwiga Hamulka and Aleksandra Wesolowska

Nutrients 2019, 11(1), 193; https://doi.org/10.3390/nu11010193 - 18 Jan 2019

Cited by 39 | Viewed by 6216

Abstract

Carotenoids are diet-dependent milk components that are important for the visual and cognitive development of an infant. This study determined β-carotene, lycopene and lutein + zeaxanthin in breastmilk and its associations with dietary intake from healthy Polish mothers in the first six months [...] Read more.

Carotenoids are diet-dependent milk components that are important for the visual and cognitive development of an infant. This study determined β-carotene, lycopene and lutein + zeaxanthin in breastmilk and its associations with dietary intake from healthy Polish mothers in the first six months of lactation. Concentrations of carotenoids in breastmilk were measured by HPLC (high-performance liquid chromatography) (first, third, sixth month of lactation) and dietary intake was assessed based on a three-day dietary record (third and sixth month of lactation). The average age of participants (n = 53) was 31.4 ± 3.8 years. The breastmilk concentrations of carotenoids were not changed over the progress of lactation. Lycopene was a carotenoid with the highest content in breastmilk (first month 112.2 (95% CI 106.1–118.3)—sixth month 110.1 (103.9–116.3) nmol/L) and maternal diet (third month 7897.3 (5465.2–10329.5) and sixth month 7255.8 (5037.5–9474.1) µg/day). There was a positive correlation between carotenoids in breastmilk and dietary intake (lycopene r = 0.374, r = 0.338; lutein + zeaxanthin r = 0.711, r = 0.726, 3rd and 6th month, respectively) and an inverse correlation with maternal BMI in the third month of lactation (β-carotene: r = −0.248, lycopene: r = −0.286, lutein + zeaxanthin: r = −0.355). Adjusted multivariate regression models confirmed an association between lutein + zeaxanthin intake and its concentration in breastmilk (third month: β = 0.730 (0.516–0.943); 6th: β = 0.644 (0.448–0.840)). Due to the positive associations between dietary intake and breastmilk concentrations, breastfeeding mothers should have a diet that is abundant in carotenoids. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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12 pages, 1531 KiB

Open AccessArticle

Temporal Progression of Fatty Acids in Preterm and Term Human Milk of Mothers from Switzerland

by Sagar K. Thakkar, Carlos Antonio De Castro, Lydie Beauport, Jean-François Tolsa, Céline J. Fischer Fumeaux, Michael Affolter and Francesca Giuffrida

Nutrients 2019, 11(1), 112; https://doi.org/10.3390/nu11010112 - 8 Jan 2019

Cited by 36 | Viewed by 4904

Abstract

We longitudinally compared fatty acids (FA) from human milk (HM) of mothers delivering term and preterm infants. HM was collected for 4 months postpartum at 12 time points for preterm and for 2 months postpartum at 8 time points for term group. Samples [...] Read more.

We longitudinally compared fatty acids (FA) from human milk (HM) of mothers delivering term and preterm infants. HM was collected for 4 months postpartum at 12 time points for preterm and for 2 months postpartum at 8 time points for term group. Samples were collected from the first feed of the morning, and single breast was fully expressed. FA were analyzed by gas chromatography coupled with flame ionization detector. Oleic, palmitic and linoleic acids were the most abundant FA across lactation and in both groups. Preterm colostrum contained significantly (p < 0.05) higher 8:0, 10:0, 12:0, sum medium chain fatty acids (MCFA), 18:3 n-3 FA compared to term counterparts. Preterm mature milk contained significantly higher 12:0, 14:0, 18:2 n-6, sum saturated fatty acids (SFA), and sum MCFA. We did not observe any significant differences between the preterm and term groups for docosahexaenoic acid, arachidonic acid and eicosapentaenoic acid at any stage of lactation. Overall, preterm milk was higher for SFA with a major contribution from MCFA and higher in 18:2 n-6. These observational differences needs to be studied further for their implications on preterm developmental outcomes and on fortification strategies of either mothers’ own milk or donor human milk. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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Review

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27 pages, 953 KiB

Open AccessReview

The Functional Power of the Human Milk Proteome

by Jing Zhu and Kelly A. Dingess

Nutrients 2019, 11(8), 1834; https://doi.org/10.3390/nu11081834 - 8 Aug 2019

Cited by 81 | Viewed by 13592

Abstract

Human milk is the most complete and ideal form of nutrition for the developing infant. The composition of human milk consistently changes throughout lactation to meet the changing functional needs of the infant. The human milk proteome is an essential milk component consisting [...] Read more.

Human milk is the most complete and ideal form of nutrition for the developing infant. The composition of human milk consistently changes throughout lactation to meet the changing functional needs of the infant. The human milk proteome is an essential milk component consisting of proteins, including enzymes/proteases, glycoproteins, and endogenous peptides. These compounds may contribute to the healthy development in a synergistic way by affecting growth, maturation of the immune system, from innate to adaptive immunity, and the gut. A comprehensive overview of the human milk proteome, covering all of its components, is lacking, even though numerous analyses of human milk proteins have been reported. Such data could substantially aid in our understanding of the functionality of each constituent of the proteome. This review will highlight each of the aforementioned components of human milk and emphasize the functionality of the proteome throughout lactation, including nutrient delivery and enhanced bioavailability of nutrients for growth, cognitive development, immune defense, and gut maturation. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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23 pages, 957 KiB

Open AccessReview

A Review of Bioactive Factors in Human Breastmilk: A Focus on Prematurity

by Andrea Gila-Diaz, Silvia M. Arribas, Alba Algara, María A. Martín-Cabrejas, Ángel Luis López de Pablo, Miguel Sáenz de Pipaón and David Ramiro-Cortijo

Nutrients 2019, 11(6), 1307; https://doi.org/10.3390/nu11061307 - 10 Jun 2019

Cited by 152 | Viewed by 14701

Abstract

Preterm birth is an increasing worldwide problem. Prematurity is the second most common cause of death in children under 5 years of age. It is associated with a higher risk of several pathologies in the perinatal period and adulthood. Maternal milk, a complex [...] Read more.

Preterm birth is an increasing worldwide problem. Prematurity is the second most common cause of death in children under 5 years of age. It is associated with a higher risk of several pathologies in the perinatal period and adulthood. Maternal milk, a complex fluid with several bioactive factors, is the best option for the newborn. Its dynamic composition is influenced by diverse factors such as maternal age, lactation period, and health status. The aim of the present review is to summarize the current knowledge regarding some bioactive factors present in breastmilk, namely antioxidants, growth factors, adipokines, and cytokines, paying specific attention to prematurity. The revised literature reveals that the highest levels of these bioactive factors are found in the colostrum and they decrease along the lactation period; bioactive factors are found in higher levels in preterm as compared to full-term milk, they are lacking in formula milk, and decreased in donated milk. However, there are still some gaps and inconclusive data, and further research in this field is needed. Given the fact that many preterm mothers are unable to complete breastfeeding, new information could be important to develop infant supplements that best match preterm human milk. Full article

(This article belongs to the Special Issue Human Milk and Lactation)

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