Human Milk Sampling Protocols Affect Estimation of Infant Lipid Intake

George, Alexandra D.; Murray, Kevin; Mühlhäusler, Beverly S.; Wlodek, Mary E.; Geddes, Donna T.

doi:10.1093/jn/nxaa246

Cited by 17 publications

(10 citation statements)

References 17 publications

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“…Total fat increases across a breastfeed and changes throughout the day due to the relationship between fat content and the fullness of the breast [63,252]. As such sampling is problematic with one sample not being representative of either fat content or infant fat intake as illustrated by George et al [253]. Further, analysis differs according to analytical technique, with the creamatocrit method offering an attractive alternative to more complex biochemical assays [254,255] such that it could be integrated into the clinical practice, particularly in the area of preterm nutrition, to increase the energy content of milk [256].…”

Section: Lipidsmentioning

confidence: 99%

“…This is consistent with our previous study that showed reductions in the proportion of capric (C10:0) and lauric acids and increases in palmitoleic and stearic acid [ 260 ] in unwell mothers and infants. Indeed it also highlights both the importance of measuring component intake [ 261 ] and with respect to total lipid employing extensive sampling [ 253 ].…”

Section: Infant Healthmentioning

confidence: 99%

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25 Years of Research in Human Lactation: From Discovery to Translation

et al. 2021

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Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.

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Section: Lipidsmentioning

confidence: 99%

Section: Infant Healthmentioning

confidence: 99%

25 Years of Research in Human Lactation: From Discovery to Translation

et al. 2021

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“…The sum of all feeds gave the fat intake for the 24 h period on the day that milk production was assessed. Separate milk samples were collected before and after every feed for the purpose of calculating total fat intake (more accurate than using only a prefeed sample) [25].…”

Section: Calculated Intake Of Human Milk Macronutrientsmentioning

confidence: 99%

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

et al. 2021

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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.

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“…However, the influence of HM sample collection on macronutrient composition must be considered when utilizing HMA for clinical nutrition decisionmaking. The fat content of HM is known to vary most significantly throughout the day and within a single feed (47)(48)(49). Protein content is known to decrease over multiple weeks and has also been reported to vary throughout 24 h (11,15,50).…”

Section: Barrier 2: Collecting a Representative Samplementioning

confidence: 99%

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

et al. 2021

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Introduction: Human milk (HM) is the ideal enteral feeding for nearly all infants and offers unique benefits to the very low birthweight (VLBW) infant population. It is a challenge to meet the high nutrient requirements of VLBW infants due to the known variability of HM composition. Human milk analysis (HMA) assesses the composition of HM and allows for individualized fortification. Due to recent U.S. Food and Drug Administration (FDA) approval, it has relatively recent availability for clinical use in the US.Aim: To identify current practices of HMA and individualized fortification in neonatal intensive care units (NICUs) across the United States (US) and to inform future translational research efforts implementing this nutrition management method.Methods: An institutional review board (IRB) approved survey was created and collected data on the following subjects such as NICU demographics, feeding practices, HM usage, HM fortification practices, and HMA practices. It was distributed from 10/30–12/21/2020 via online pediatric nutrition groups and listservs selected to reach the intended audience of NICU dietitians and other clinical staff. Each response was assessed prior to inclusion, and descriptive analysis was performed.Results: About 225 survey responses were recorded during the survey period with 119 entries included in the analysis. This represented 36 states and Washington D.C., primarily from level III and IV NICUs. HMA was reported in 11.8% of responding NICUs. The most commonly owned technology for HMA is the Creamatocrit Plus TM (EKF Diagnostics), followed by the HM Analyzer by Miris (Uppsala, Sweden). In NICUs practicing HMA, 84.6% are doing so clinically.Discussion: Feeding guidelines and fortification of HM remain standard of care, and interest in HMA was common in this survey. Despite the interest, very few NICUs are performing HMA and individualized fortification. Barriers identified include determining who should receive individualized fortification and how often, collecting a representative sample, and the cost and personnel required.Conclusions: Human milk analysis and individualized fortification are emerging practices within NICUs in the US. Few are using it in the clinical setting with large variation in execution among respondents and many logistical concerns regarding implementation. Future research may be beneficial to evaluate how practices change as HMA and individualized fortification gain popularity and become more commonly used in the clinical setting.

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Human Milk Sampling Protocols Affect Estimation of Infant Lipid Intake

Cited by 17 publications

References 17 publications

25 Years of Research in Human Lactation: From Discovery to Translation

25 Years of Research in Human Lactation: From Discovery to Translation

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

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

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