Wide Variability in Caloric Density of Expressed Human Milk Can Lead to Major Underestimation or Overestimation of Nutrient Content

Sauer, Charles W.; Boutin, Mallory A.; Kim, Jae

doi:10.1177/0890334416672200

Cited by 23 publications

(21 citation statements)

References 41 publications

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“…However, in longitudinal analysis, we found that greater household food insecurity was significantly associated with reduced breast milk intake across this critical period of infant feeding (Table ). The quantities are biologically significant: a 20‐point increase in food insecurity would be associated with infants consuming 79.0 kcal fewer from breast milk (assuming 20 kcal/ounce [Sauer, Boutin, & Kim, ]). Further, a reduction in human milk intake could lead to micronutrient deficiencies.…”

Section: Discussionmentioning

confidence: 99%

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

Miller

Young

Boateng

et al. 2019

Maternal & Child Nutrition

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Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food‐insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother–infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose‐to‐the‐mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide‐measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed‐effects model of quantity of breast milk intake across time, deuterium oxide‐measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one‐point increase in food insecurity score was associated with a 5.6 (±2.2)‐g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake.

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Section: Discussionmentioning

confidence: 99%

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

Miller

Young

Boateng

et al. 2019

Maternal & Child Nutrition

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“…Other measurable conditions like maternal BMI, age, financial status, and parity may also influence milk macronutrient composition. Sauer (34) observed high variability in macronutrient composition of expressed human milk, even when standardized samples that were not exclusively foremilk or hindmilk were used.…”

Section: Discussionmentioning

confidence: 99%

Influence of refrigeration or freezing on human milk macronutrients and energy content in early lactation: Results from a tertiary centre survey

Păduraru

Zonda

Avasiloaiei

et al. 2018

Paediatrics &Amp; Child Health

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Background: Neonates with severe conditions that cannot be breastfed should receive fresh or preserved expressed human milk in addition to parenteral nutrition. Objective: To identify the time during lactation when the macronutrients provide maximum energy and evaluate the effect of refrigeration and freezing. Methods: We analyzed the composition of fresh milk, refrigerated at +4°C and frozen at −20°C, expressed by mothers of 60 preterm and 30 term infants from a level III maternity, in colostrum, transitional, and mature milk. Results: In fresh milk, the protein level constantly decreases during lactation, with a significant difference after 3 weeks of lactation. Preterm milk of day 21 and day 30 had significantly lower protein than term milk (1.27 versus 1.43 g/dL, P=0.015 and 1.13 versus 1.28 g/dL, P=0.001). Refrigeration for 72 hours of term milk decreased protein content less than freezing. Preterm colostrum has significantly less protein after 48 hours of refrigeration or freezing. Preterm milk from day 60 lost carbohydrates if refrigerated 72 hours or frozen for 2 months. Lipids in preterm colostrum decrease after 8 weeks of freezing. Refrigeration for up to 72 hours did not change significantly the energy value of colostrum or transitional milk. Freezing preterm milk more than 2 weeks leads to significant loss of energy. Conclusions: Milk frozen for more than 2 weeks contains less protein and energy than milk refrigerated for up to 72 hours. In the absence of milk bank access, in common settings, short-term refrigeration is preferable to long-term freezing.

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“…Human milk composition varies considerably within and between mothers and even within a single milk expression. This multidimensional variation in composition is believed to be an adaptation to the infants’ changing needs [ 8 , 9 , 10 ], and geographical region and food supply [ 11 , 12 ]. The variations in human milk composition between individual women and populations have been reported to be in response to cultural differences such as diet and other lifestyle factors [ 13 , 14 ], environmental factors, such as mineral content of the soil that is then reflected in the mineral density of the foods grown there [ 15 ], and human genetic differences [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Human Milk Composition and Dietary Intakes of Breastfeeding Women of Different Ethnicity from the Manawatu-Wanganui Region of New Zealand

et al. 2018

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Human milk is nutrient rich, complex in its composition, and is key to a baby’s health through its role in nutrition, gastrointestinal tract and immune development. Seventy-eight mothers (19–42 years of age) of Asian, Māori, Pacific Island, or of European ethnicity living in Manawatu-Wanganui, New Zealand (NZ) completed the study. The women provided three breast milk samples over a one-week period (6–8 weeks postpartum), completed a three-day food diary and provided information regarding their pregnancy and lactation experiences. The breast milk samples were analyzed for protein, fat, fatty acid profile, ash, selected minerals (calcium, magnesium, selenium, zinc), and carbohydrates. Breast milk nutrient profiles showed no significant differences between the mothers of different ethnicities in their macronutrient (protein, fat, carbohydrate, and moisture) content. The breast milk of Asian mothers contained significantly higher levels of polyunsaturated fatty acids (PUFAs), omega-3 (n-3) and omega-6 (n-6) fatty acids, docosahexaenoic acid (DHA), and linoleic acids. Arachidonic acid was significantly lower in the breast milk of Māori and Pacific Island women. Dietary intakes of protein, total energy, saturated and polyunsaturated fat, calcium, phosphorus, zinc, iodine, vitamin A equivalents, and folate differed between the ethnic groups, as well as the number of serves of dairy foods, chicken, and legumes. No strong correlations between dietary nutrients and breast milk components were found.

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Wide Variability in Caloric Density of Expressed Human Milk Can Lead to Major Underestimation or Overestimation of Nutrient Content

Abstract: The assumption that human milk contains 20 kcal/ounce is no longer supported based on this study. This supports promoting an individualized nutrition strategy as a crucial aspect to optimal nutrition.

Cited by 23 publications

References 41 publications

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

Influence of refrigeration or freezing on human milk macronutrients and energy content in early lactation: Results from a tertiary centre survey

Human Milk Composition and Dietary Intakes of Breastfeeding Women of Different Ethnicity from the Manawatu-Wanganui Region of New Zealand

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