Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Azad, Meghan B.; Nickel, Nathan; Bode, Lars; Brockway, Meredith; Brown, Amy; Chambers, Christina D.; Goldhammer, Camie; Hinde, Katie; McGuire, Michelle K.; Munblit, Daniel; Patel, Aloka L.; Pérez‐Escamilla, Rafael; Rasmussen, Kathleen M.; Shenker, Natalie; Young, Bridget E.; Zuccolo, Luisa

doi:10.1111/mcn.13109

Cited by 48 publications

(44 citation statements)

References 108 publications

(155 reference statements)

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“…Furthermore, heterogeneity, lack of standardisation of sample collection and processing within and between studies is a known challenge in breast milk research (64)(65)(66). The studies included in this review were no exception and, like others before us, we identified a need for greater standardisation and clearer reporting of sample collection and processing methods which we discuss below (64,66). Looking beyond the methodological limitations and challenges, we first discuss the current state of knowledge regarding the general miRNA profile in human milk, their stability and function and factors which affect them.…”

Section: Discussionmentioning

confidence: 99%

“…Heterogeneity, lack of standardisation of sample collection and processing within and between studies is a common challenge in breast milk research (64)(65)(66). The studies included in this review were no exception and, like others before us, we identified a need for greater standardisation and clearer reporting of sample collection and processing methods (64,66). There is currently insufficient evidence to determine if it is particularly important to standardise certain aspects of the collection and processing procedures when analysing ncRNAs, such as the time of day for collection, volume of milk, or the speed and duration of centrifugation.…”

Section: Methodological Considerations Within Studiesmentioning

confidence: 99%

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Non-Coding RNAs in Human Breast Milk: A Systematic Review

et al. 2021

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Breast milk is the primary source of nutrition and hydration for the newborn infant but also plays an important role in the child’s first immune defense. Additionally, several breast milk factors have been implicated in immune-related health outcomes later in life, including immunoglobulins, cytokines, chemokines, growth factors and, more recently, non-coding RNA (ncRNA) species. In this systematic review, we provide a comprehensive summary of the current literature on endogenous ncRNAs found in human breast milk. Thirty (30) relevant studies were identified and, whilst the majority studies focused on microRNAs (miRNAs), there is evidence that breast milk contains high quantities of RNA which also include long-coding RNAs, circular RNAs, as well as other short RNAs and fragmented tRNA and rRNAs. Among studies investigating miRNAs, miR-148a-3p, miR-30a/d-5p, miR-22-3p, miR-146b-5p, miR-200a/c-3p, and the 5p end of the let-7 miRNAs were commonly reported among the top 10 miRNAs in the cell, lipid, and skim milk fractions of breast milk. Methodological difference and small sample sizes limit the possibility of conclusively identifying which maternal and infant characteristics affect the miRNA profile. The highly expressed miRNAs were generally reported to be similar across lactational stage, milk fraction, maternal and infant characteristics, or infant growth and health. All the same, individual studies identify potential differences in miRNA expression levels which should be confirmed by future studies. Stability, uptake, and physiological functions of miRNAs were also considered in several studies. Breast milk miRNAs are relatively resistant to a range of harsh conditions and uptake experiments suggest that extracellular vesicles containing miRNAs and circular RNAs can be taken up by intestinal epithelial cells. Although the evidence regarding the functional effect of breast milk miRNAs is limited, the predicted functions range from metabolic and biosynthetic processes to signaling pathways, cellular adhesion, communication, growth, and differentiation. Finally, this systematic review highlights some of the methodological challenges and knowledge gaps which can help direct future research in this field. In particular, it is important to further investigate the bioavailability of miRNAs in different milk fractions, and to characterize other ncRNAs which are largely unstudied.Systematic Review RegistrationPROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138989, identifier CRD42020138989.

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Section: Discussionmentioning

confidence: 99%

Section: Methodological Considerations Within Studiesmentioning

confidence: 99%

Non-Coding RNAs in Human Breast Milk: A Systematic Review

et al. 2021

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“…Targeted validation and absolute quantification, however, are warranted to test ’omics-derived hypotheses to generate biologically robust evidence. Well-designed studies and experiments (e.g., longitudinal sampling and a randomized controlled dose–response trial), along with a well-characterized population (e.g., metadata on maternal and infant nutrition and health and other key factors that influence milk composition) ( 94 ) and focused hypotheses to address key biological questions, are important next steps. In addition, the use of standard operating procedures as well as cross-laboratory and cross-platform validations would enhance reproducibility.…”

Section: Advances and Technologies For Human-milk Analysismentioning

confidence: 99%

The need to study human milk as a biological system

Christian

Smith

Lee

et al. 2021

The American Journal of Clinical Nutrition

141

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Critical advancement is needed in the study of human milk as a biological system that intersects and interacts with myriad internal (maternal biology) and external (diet, environment, infections) factors and its plethora of influences on the developing infant. Human-milk composition and its resulting biological function is more than the sum of its parts. Our failure to fully understand this biology in a large part contributes to why the duration of exclusive breastfeeding remains an unsettled science (if not policy). Our current understanding of human-milk composition and its individual components and their functions fails to fully recognize the importance of the chronobiology and systems biology of human milk in the context of milk synthesis, optimal timing and duration of feeding, and period of lactation. The overly simplistic, but common, approach to analyzing single, mostly nutritive components of human milk is insufficient to understand the contribution of either individual components or the matrix within which they exist to both maternal and child health. There is a need for a shift in the conceptual approach to studying human milk to improve strategies and interventions to support better lactation, breastfeeding, and the full range of infant feeding practices, particularly for women and infants living in undernourished and infectious environments. Recent technological advances have led to a rising movement towards advancing the science of human-milk biology. Herein, we describe the rationale and critical need for unveiling the multifunctionality of the various nutritional, nonnutritional, immune, and biological signaling pathways of the components in human milk that drive system development and maturation, growth, and development in the very early postnatal period of life. We provide a vision and conceptual framework for a research strategy and agenda to change the field of human-milk biology with implications for global policy, innovation, and interventions.

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“…Together, the data from our current study and our qualitative work suggest that a demand exists for skilled breastfeeding support among vulnerable women and that such services can be delivered through a CPNP site. Further research using implementation science approaches is needed to understand the feasibility and appropriateness of the integration of postnatal lactation support within CPNP sites [46]. The current context of the CPNP creates a foundation for supporting breastfeeding initiation among vulnerable women by providing an established social support structure, links to multiple community services to reduce life stresses and strong prenatal breastfeeding promotion.…”

Section: Discussionmentioning

confidence: 99%

Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study

Francis

Mildon

Stewart

et al. 2021

Int J Equity Health

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Background In Canada, 91% of all mothers initiate breastfeeding, but 40–50% stop by 6 months and only 34% breastfeed exclusively for 6 months, with lower rates among socially and/or economically vulnerable women. The Canada Prenatal Nutrition Program (CPNP) aims to support breastfeeding among vulnerable women, but there is no formal framework or funding for sites to integrate proactive postnatal breastfeeding support. This research aimed to i) describe infant feeding practices among clients of one Toronto CPNP site using charitable funds to offer a lactation support program (in-home lactation consultant visits, breast pumps); ii) determine whether breastfeeding outcomes at 6 months differ based on maternal sociodemographics and food insecurity; and iii) assess utilization of the lactation support program. Methods Infant feeding practices were collected prospectively at 2 weeks, 2, 4 and 6 months postpartum via telephone questionnaires (n = 199). Maternal sociodemographics were collected at 2 weeks and food insecurity data at 6 months postpartum. Program monitoring records were used to determine utilization of the lactation support program. Results Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump. Conclusions This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women. Study registered at clinicaltrials.gov as NCT03400605.

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Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Cited by 48 publications

References 108 publications

Non-Coding RNAs in Human Breast Milk: A Systematic Review

Non-Coding RNAs in Human Breast Milk: A Systematic Review

The need to study human milk as a biological system

Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study

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