Target fortification of breast milk: levels of fat, protein or lactose are not related

Fusch, Gerhard; Mitra, Souvik; Rochow, Niels; Fusch, Christoph

doi:10.1111/apa.12804

Cited by 17 publications

(13 citation statements)

References 31 publications

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“…Moreover, different factors (such as breast squeezing, milk collection at the beginning or the end of the feeding, circadian fluctuations) as well as maternal hormonal changes can affect lipid and lactose composition of BM (Fusch et al, 2015). During BM collection, as per the recommendation of Polberger (2009), we tried to make the samples as homogeneous as possible regarding the collection technique and conditions of sample storage, even if individual maternal variables could have interfered with the analysis.…”

Section: Discussionmentioning

confidence: 99%

Breast Milk for Preterm Multiples: More Proteins, Less Lactose

Congiu

Reali

Deidda³

et al. 2019

Twin Res Hum Genet

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Exclusive breastfeeding is currently recommended until at least 6 months of postnatal age, due to maternal breast milk (BM) unique composition and beneficial properties. In fact, BM modifies itself according to gestational age (GA) at birth, adapting its composition to neonatal requests during lactation. Multiple births represent about 3% of the whole pregnancies; such neonates result more vulnerable than full-term newborns, due to lower GA and birth weight (BW) and the higher incidence of perinatal complications. Although an adequate nutrition is fundamental for twins and other multiples, studies on this topic are lacking. We collected and analyzed BM from mothers of 19 twins and 5 triplets showing GA < 33 weeks and BW < 1500 g, comparing it to a control group of 28 preterm singletons. As a result, at GA ≤ 28 weeks, we observed that protein content is higher in BM for multiples (1.53 vs. 1.29 g per 100 ml), lactose concentration is greater in BM for singletons (6.72 vs. 6.34 g per 100 ml) and GA results the most relevant factor influencing BM protein composition. BM for multiples results higher in proteins and lower in lactose, if compared with singleton’s samples; this could promote and sustain growth and organ development in this vulnerable category. BM from multiples shows a trophic and immunologic role, since these neonates often show lower GA and BW instead of singletons. These findings could help in optimizing nutritional strategies and improving BM individualized fortification.

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Section: Discussionmentioning

confidence: 99%

Breast Milk for Preterm Multiples: More Proteins, Less Lactose

Congiu

Reali

Deidda³

et al. 2019

Twin Res Hum Genet

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“…Standard fortification is based on the assumption that the macronutrient content of human milk is constant 74 . However, there is substantial interindividual and intraindividual variation in the macronutrient composition of human milk 14 , 74 . ‐ 78 Factors that contribute to this variability include gestational age at delivery and at collection, stage of lactation, maternal nutrition status, time of day, volume, and the method of milk expression 78 .…”

Section: Methods Of Modifying Human Milk To Support Ill or Medically mentioning

confidence: 99%

“…Although the use of target fortification has been shown to be effective in the literature, its implementation is limited due to logistical and financial constraints 76 , 77 . Infrared spectroscopy equipment, which provides a simple and quick analysis technique, offers promising opportunity, but these analyzers are expensive and may require approval from regulatory bodies (eg, the U.S. Food and Drug Administration [FDA]) prior to use in clinical practice.…”

Section: Methods Of Modifying Human Milk To Support Ill or Medically mentioning

confidence: 99%

Human Milk for Ill and Medically Compromised Infants

DiLauro

Unger

Stone

et al. 2016

J Parenter Enteral Nutr

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The use of human milk (mother's own milk and/or donor milk) in ill or medically compromised infants frequently requires some adaptation to address medical diagnoses and/or altered nutrition requirements. This tutorial describes the nutrition and immunological benefits of breast milk as well as provides evidence for the use of donor milk when mother's own milk is unavailable. Several strategies used to modify human milk to meet the medical and nutrition needs of an ill or medically compromised infant are reviewed. These strategies include (1) the standard fortification of human milk to support adequate growth, (2) the novel concept of target fortification in preterm infants, (3) instructions on how to alter maternal diet to address cow's milk protein intolerance and/or allergy in breast milk-fed infants, and (4) the removal and modification of the fat in breast milk used in infants diagnosed with chylothorax.

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“…Human milk undoubtedly provides the best basis for enteral nutrition of newborn infants. However, for preterm infants, the variable composition of human milk is a risk factor for extrauterine growth retardation . Currently, infrared‐based dairy milk analyzers are increasingly used to analyse human milk .…”

mentioning

confidence: 99%

“…It is important to use daily QC samples to minimise the biological variation in human milk and help detect such systematic error. These values represent the real life variability in protein in human milk .…”

mentioning

confidence: 99%