Preterm Human Milk Macronutrient and Energy Composition

Mimouni, Francis; Lubetzky, Ronit; Yochpaz, Sivan; Mandel, Dror

doi:10.1016/j.clp.2016.11.010

Cited by 35 publications

(44 citation statements)

References 36 publications

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“…As with these previous studies, fat was the most variable macronutrient and carbohydrate the least (see online Supplementary Table S2). Systematic reviews of term (21) and preterm (19)(20)(21) MOM macronutrient content show a steep decline in protein over the first few days and a more gradual decline thereafter in the first 3 months of lactation; increasing lactose concentration in the first 3-5 weeks before a levelling off and a gradual increase in fat content in the first 10-12 weeks. This is consistent with our findings of highest protein content in the first month of lactation with a gradual decline over the next few months and likely represents higher protein content in the colostrum and transitional milk in the first few days after birth.…”

Section: Discussionmentioning

confidence: 99%

“…A key challenge to this understanding is the relative variation attributed to between-subject differences (random effects) and that to within-subject differences (fixed effects), such as lactation stage. Nevertheless, accurate reference ranges of macronutrient content of preterm MOM over lactation stage have recently been described (19)(20)(21) , and a recent systematic review of studies analysing 24-h collections of MOM shows clear differences in macronutrient content between MOM of term and preterm infants (21) . Translation to HDM macronutrient content is however limited as donations typically represent surplus volumes of expressed milk after feeding, rather than 24-h collections.…”

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confidence: 99%

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Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Mills

Coulter²,

Savage³

et al. 2019

Br J Nutr

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Better understanding of the variation in macronutrient content of human donor milk (HDM) potentiates targeted nutrition for preterm babies. The present study describes the relationship of maternal age, parity, monthly lactation stage estimate (LSEm), daily volume of milk expressed (Vd), sex, gestation and birth weight z scores with macronutrient content of HDM. Multilevel mother–infant pair ID random intercept models were performed using the predictor variables above on the outcome HDM macronutrient content determined using mid-IR spectroscopy. Mean macronutrient content was also compared by gestational age and small for gestational age (SGA) (z score < –1·28) or appropriate for gestational age (AGA) (z score ≥ –1·28) categories. A total of 2966 samples of donations from 1175 mother–infant pairs to the UK Northwest Human Milk Bank between 2011 and 2017 were analysed. Mean protein, fat, carbohydrate and calculated energy were 0·89 (SD 0·24) g/dl, 2·99 (SD 0·96) g/dl, 7·09 (SD 0·44) g/dl, and 60·37 (SD 8·41) kcal/dl (252·59 (SD 35·19) kJ/dl), respectively. Preterm SGA HDM was significantly higher in protein, fat and energy content than term AGA HDM and significantly lower in carbohydrate content than term AGA HDM after controlling for LSEm, Vd and between-subject effects. Degree of prematurity did not influence macronutrient content. Between-subject effects accounted for more of the variance in macronutrient content than the fixed effects in the model. Despite this, SGA status, as well as prematurity, may be an important determinant of macronutrient content in human milk. As bioavailability of macronutrients from HDM is uncertain, studies evaluating growth and body composition in preterm and SGA babies fed HDM are warranted.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Mills

Coulter²,

Savage³

et al. 2019

Br J Nutr

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“…In our unit, logistical constraints related with reduction of health personnel precluded targeted fortification during a certain period of time, but samples of HM delivered to infants were stored frozen for later composition analysis. An alternative method of fortification was used, based on the assumed variable HM composition [ 3 , 15 ]. Specifically, modular protein and fat supplements were added to standard fortified HM [ 11 ] to achieve recommended intakes [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The fortification method relying on assumed human milk composition overestimates the actual energy and macronutrient intakes in very preterm infants

Macedo

Pereira‐da‐Silva

Cardoso

2018

matern health, neonatol and perinatol

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BackgroundTo achieve recommended nutrient intakes in preterm infants, the target fortification method of human milk (HM) was proposed as an alternative to standard fortification method. We aimed to compare assumed energy and macronutrient intakes based on standard fortified HM with actual intakes relying on measured composition of human milk (HM), in a cohort of HM-fed very preterm infants.MethodsThis study is a secondary retrospective analysis, in which assumed energy and macronutrient contents of daily pools of own mother’s milk (OMM) from 33 mothers and donated HM (DHM) delivered to infants were compared with the measured values using a mid-infrared HM analyzer. A fortification method consisting of modular protein and/or fat supplements added to standard fortified HM was used to provide the minimum recommended daily intakes of energy 110 Kcal/kg and protein up to 4.0 g/kg. Assumed nutrient intakes were compared with actual nutrient intakes from full enteral feeding to 35 weeks plus 6 days postmenstrual age, using the Wilcoxon matched-pairs signed ranks test.ResultsThe composition of 1181 samples of daily pools of HM were measured. For 90.2% of study days, infants were exclusively fed OMM and in remaining days fed OMM plus DHM. Comparing with reported preterm OMM composition, measured protein concentration was significantly lower, and energy and other macronutrient concentrations were lower only from the second to third postnatal week. Using fortified HM, the actual median daily intakes of energy, protein, and fat were significantly lower (113.3 vs. 120.7 Kcal/kg, 4.45 vs. 4.73 g/kg, and 4.96 vs. 5.35 g/kg, respectively) and the actual protein-to-energy ratio (PER) significantly higher than what was assumed (4.2 vs. 4.0), without differences in carbohydrate intake.ConclusionsWhen fortifying the HM, we used conservative target intakes trying not to exceed the osmolarity recommended for infant feeds. Actual energy, protein and fat intakes in OMM were significantly lower than assumed. This resulted in inadequate intake using our fortification method, that did not compensate the suboptimal measured energy and macronutrient contents of OMM delivered. Further studies comparing assumed with the gold standard target fortification are needed to determine safe upper limits of assumed fortification.

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“…The Ts content of the ferrous gluconate-milk system was slightly higher than that for ferrous chloride, but with the increase of temperature, the difference between them decreased. For both iron sources, the freezing point of milk fluctuated within the recommended range (508-546 m ∘ C) [15].…”

Section: Effect Of Different Forms Of Iron On the Composition Of Milkmentioning

confidence: 99%

“…Prot., %), true protein content (Tru. Prot., %), lactose content (Lactose, %), non-fat solids content (SnF, %), total solids content (Ts, %), and freezing point (FPT, ∘ C) [14,15]. [16].…”

Section: Milk Composition Analysismentioning

confidence: 99%

Effect of Microwave Heating on the Dielectric Properties and Components of Iron-Fortified Milk

Tang¹,

Fan²,

Feng³

et al. 2017

Journal of Food Quality

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With the iron-fortified milk as research object, this paper makes a research on the influence of iron on the dielectric properties and wave absorption properties and effect of nutritional components, such as casein and whey protein in milk, and thermostability in the process of microwave heating, and rapid heat transfer method in ferrous gluconate-milk and ferrous chloride-milk, respectively. The results show that the iron of ionic form has greater influence to convert microwave to heat energy and the effect of microwave absorption properties was greater for ferrous chloride than for ferrous gluconate at high concentration. The effect of different forms of iron on the composition of milk was different, and the composition of milk systems was more stable by microwave heating, but the rapid heat transfer method is superior in the aim of increasing the nutritional value of milk. The ferrous gluconate-milk system has a better thermal stability than ferrous chloride-milk system. From the aspect of dielectric induction, the paper discovers the response rules of iron and evaluates the microwave thermal safety of the traditional and the iron-fortified products by microwave heating.

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Preterm Human Milk Macronutrient and Energy Composition

Cited by 35 publications

References 36 publications

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

The fortification method relying on assumed human milk composition overestimates the actual energy and macronutrient intakes in very preterm infants

Effect of Microwave Heating on the Dielectric Properties and Components of Iron-Fortified Milk

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