Lipid-Based Nutrient Supplements During Pregnancy and Lactation Did Not Affect Human Milk Oligosaccharides and Bioactive Proteins in a Randomized Trial

Abstract

Background: Human milk oligosaccharides (HMOs) and bioactive proteins are beneficial to infant health. Recent evidence suggests that maternal nutrition may affect the amount of HMOs and proteins in breast milk; however, the effect of nutrient supplementation on HMOs and bioactive proteins has not yet been well studied.Objective: We aimed to determine whether lipid-based nutrient supplements (LNSs) affect milk bioactive protein and HMO concentrations at 6 mo postpartum in women in rural Malawi. These are secondary outcomes of a previously published randomized controlled trial.Methods: Women were randomly assigned to consume either an iron and folic acid capsule (IFA) daily from ≤20 wk gestation until delivery, followed by placebo daily from delivery to 6 mo postpartum, or a multiple micronutrient (MMN) capsule or LNS daily from ≤20 wk gestation to 6 mo postpartum. Breast milk concentrations of total HMOs, sialylated HMOs, fucosylated HMOs, lactoferrin, lactalbumin, lysozymes, antitrypsin, immunoglobulin A, and osteopontin were analyzed at 6 mo postpartum (n = 647). Between-group differences in concentrations and in proportions of women classified as having low concentrations were tested.Results: HMO and bioactive protein concentrations did not differ between groups (P > 0.10 for all comparisons). At 6 mo postpartum, the proportions of women with low HMOs or bioactive proteins were not different between groups except for osteopontin. A lower proportion of women in the IFA group had low osteopontin compared with the LNS group after adjusting for covariates (OR: 0.5; 95% CI: 0.3, 0.9; P = 0.016).Conclusion: The study findings do not support the hypothesis that supplementation with an LNS or MMN capsule during pregnancy and postpartum would increase HMO or bioactive milk proteins at 6 mo postpartum among Malawian women. This trial was registered at clinicaltrials.gov as NCT01239693.

Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months?

“…fucosyltransferase-2 secretor status); and is a strong determinant of the microbiome. Findings on the relation between maternal diet and HMO composition are inconsistent (66), however, and further research is warranted to better understand these relations.…”

Infant gut microbiota characteristics generally do not modify effects of lipid-based nutrient supplementation on growth or inflammation: secondary analysis of a randomized controlled trial in Malawi

“…In the two control groups, women received iron and folic acid (IFA) during pregnancy only or multiple micronutrients (MMN) during pregnancy and the first six months postpartum, but their infants did not receive any supplement. The effects of the intervention on infant growth 20 , characteristics of the child’s gut microbiome 59 , and maternal breast milk composition 60 have been published previously, as well as analyses that relate aspects of gut microbiome composition to infant growth and inflammation 61 , morbidity 62 , and environmental factors 63 . This analysis examines whether variability in infant gut microbiota composition, such as the ratios of taxa described above, may contribute to variability in response to the intervention.…”

Human Milk Oligosaccharide Profiles and Associations with Maternal Nutritional Factors: A Scoping Review

“…The articles reflect a quite recent interest in the link between maternal factors and HMO composition, being published between 2013 and 2020. Four studies were conducted North America [ 12 , 27 , 28 , 29 ], two in South America [ 15 , 30 ], three in Europe [ 8 , 19 , 22 ], two in Africa [ 14 , 18 ], one in Australia [ 16 ], and one in Asia [ 21 ]. One large multisite study with 11 international cohorts was also included [ 20 ].…”

“…Changes in HMO profiles over time could therefore be reported upon [ 8 , 15 , 16 ]. Two studies were controlled experiments: a single (assessor)-blind, parallel group controlled multi-nutrient supplementation trial [ 18 ], and a double-blind, placebo-controlled study with two parallel groups investigating maternal probiotic supplementation [ 22 ]. Seven of the studies (50%) were deemed to be of good quality [ 12 , 18 , 19 , 20 , 22 , 28 , 30 ] and half received a “fair” rating [ 8 , 14 , 15 , 16 , 21 , 29 , 30 ].…”

“…Lactating women are often classified as Secretors or non-secretors based upon the presence or absence of the fucosyltransferase 2 (‘FUT2′) gene, with Secretor mothers producing more neutral α1-2-fucosylated HMOs in their milk [ 9 ]. Emerging research indicates that other interrelated and somewhat complex factors may influence the composition of HMOs [ 12 ], including parity and mode of delivery, environment influences such as geographic location and seasonality, and maternal influences such as age and nutritional status [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. There is limited information and no synthesis on the effect of maternal nutritional intake, diet quality, and body composition on HMO composition during lactation [ 23 ].…”