Macronutrient Analysis of Modified‐Fat Breast Milk Produced by 3 Methods of Fat Removal

Abstract

BackgroundInfants with chylothorax after congenital heart disease surgery are commonly treated using modified‐fat breast milk. The effect of fat removal on breast milk macronutrients remains unclear. We compared macronutrient content of breast milk with breast milk skimmed using 3 methods, including a novel device, a cream separator.MethodsThawed frozen breast milk samples from 30 women were defatted using refrigerated centrifuge, cream separator, and manual separation after refrigeration. We used standard assays to measure energy, protein, and fat content of breast milk samples.ResultsAll fat removal methods yielded skimmed breast milk with substantially lower fat and energy content. Mean energy content in breast milk skimmed by centrifuge (36.7 [SD 3.6] kcal/100 mL) was similar to that from cream separator (38.8 [3.5] kcal/100 mL). Both centrifuge and cream separator methods removed almost all fat and substantially more fat than the manual fat removal method. For unprocessed milk, energy and fat content estimated by creamatocrit was similar to reference method measurements; in skimmed milk, the creamatocrit significantly overestimated fat content. Mean protein content of skimmed breast milk was similar to unprocessed breast milk (mean 1.25 [0.31] g/100 mL).ConclusionBreast milk fat removal did not significantly alter protein levels. In skimmed breast milk, the overestimation of fat content using creamatocrit method suggests a need for more accurate bedside methods to assess macronutrient content. The similar macronutrient composition of breast milk skimmed by cream separator and centrifuge suggests the potential for cream separator use as a new, portable defatting method for hospitals and families.

Use of skimmed breast milk for an infant with a long‐chain fatty acid oxidation disorder: A novel therapeutic intervention

“…With support from the lactation team, JM's mother used techniques to optimize her use of the pump and increase pumping frequency, and at discharge, she was producing 1200 mL daily. The macronutrient composition of the skimmed breast milk obtained by a cream separator in this case was similar to samples from the refrigerated centrifuge used in the hospital as measured by CRCT and was comparable to prior published data 17 …”

“…The macronutrient composition of the skimmed breast milk obtained by a cream separator in this case was similar to samples from the refrigerated centrifuge used in the hospital and comparable to prior published data. 17 This family purchased a cream separator with 120 V motor and capacity to process up to 100 L/h (Figure 3). The pooled breast milk is poured into the collecting bowl and flows to separation channels between 12 layers of disks through vertically aligned distribution holes in the stack.…”

“…An acceptable level of residual fat at our institution was determined to be 10 to 12 g/L by CRCT, with energy content of skimmed milk ranging from 43 to 50 kcal/100 mL. 17 This translates into 20% to 25% of calories in the skimmed breast milk coming from residual long-chain fat. With a goal of less than 10% of calories from long-chain fat for patients with severe LC-FAOD, the use of skimmed breast milk had never previously been considered.…”

“…The amount of residual fat can be assessed using a Creamatocrit (CRCT) method or a Human Milk Analyzer. An acceptable level of residual fat at our institution was determined to be 10 to 12 g/L by CRCT, with energy content of skimmed milk ranging from 43 to 50 kcal/100 mL 17 . This translates into 20% to 25% of calories in the skimmed breast milk coming from residual long‐chain fat.…”

Qualitative and quantitative vibrational spectroscopic analysis of macronutrients in breast milk

“…Considering the large number of breast milk samples, we elected to use fast and user-friendly gravimetric fat analysis method to allow for at least an explicit comparison with the spectroscopic results. However, it also must be justly noted that while generally accurate, it can sometimes provide overestimated results when compared to the AOAC or ISO/IDF standard reference methods [ 33 , 34 ]. Using the milk sample aliquoted for the study, glass capillary tubes were filled with gentle shaking between each filling to ensure that the milk fat was well mixed.…”