Scanning for New Evidence on the Nutrient Content of Human Milk A Process Model for Determining Age-Specific Nutrient Requirements (2020) / Chapter Skim
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3 Results
3 Results
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Department of Agriculture's National Nutrient Database for Standard Reference (USDA SR Database) and support future comprehensive systematic reviews to update specific Dietary Reference Intake (DRI)
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18 SCANNING FOR NEW EVIDENCE ON THE NUTRIENT CONTENT OF HUMAN MILK FIGURE 3-1 Evidence-scan flow diagram.
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This is a result of both the small number of participants studied in any category of infant age as well as the need to use newer methods to analyze milk composition for DRI nutrients. Figure 3-2 compares the number of studies identified by nutrient, and Figure 3-3 shows the number of dyads for each nutrient in the combined results.
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From the initial list, 94 articles relevant to the nutrient content in human milk, 24 relevant to milk volume, and 8 articles relevant to both nutrient content and milk volume combined were determined to be relevant to the committee's criteria. A description of the selected articles is provided in Tables 3-1, 3-2, and 3-3.
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additional nutrients (total pp lipids) that did not meet Women age < 35 years the inclusion criteria 0.46 ± 0.11 μg/mL (1 mo pp)
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This article reported 10.19 ± 6.20 mg/100 g (New additional nutrients Zealand European) (selenium, zinc, fatty acids, total lipid, total protein, carbohydrate)
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This article reported 2017 cohort 12 mo pp 6.0 ± 0.8 g/dL (12 mo pp) additional nutrients (total lipid, total protein, iron, Calcium ICP-OES 200 ± 29 μg/mL (11 mo pp)
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al., 2016 d pp 55.2 ± 15.7 mg/L (90 d pp) Panagos et Case-control 21 dyads, 4– Vitamin A HPLC 4.6 ± 1.7 μg/dL Study also reported data al., 2016 10 wk pp for obese women Vitamin E HPLC 378 ± 171.7 μg/dL This article reported Vitamin D Extraction by 1.3 ± 0.6 ng/mL additional nutrients (total radio- fat, total protein, lactose, immunoassay vitamin B12)
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16.22 ± 0.71 mg/L (postintervention) Calcium Flame AAS 195 ± 17.4 mg/L (preintervention)
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the inclusion criteria Zhao et al., Cross- 444 Chinese Sodium ICP-MS 25.9 ± 26.2 mg/100 g (12–30 d This article reported 2014 sectional dyads pp) additional nutrients 14.3 ± 6.8 mg/100 g (31–60 d (copper, iodine, iron, zinc, pp)
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vitamin supplements at al., 2013 2.13 ± 0.67 TE mg/L (d 90 pp) time of sampling; milk vitamin E concentrations Total lipid Solvent 3.23 ± 0.44% (d 14 pp)
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mg/L (d 30–32 authors reported no pp) significant difference in mean breast milk concentrations between supplemented and nonsupplemented women Values are expressed as: median (IQR)
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mg/dL (group 1) additional nutrients (total 1.9 (1.7, 2.1)
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additional nutrients participants) , (selenium, iodine)
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that did not meet the inclusion criteria Shehadeh et Cross- 41 Israeli Calcium AAS 25.8 ± 3.9 mg/dL This article reported al., 2006 sectional dyads, 3 mo additional nutrients (total pp Sodium AAS 16.2 ± 3.9 mEq/dL fat, total protein, carbohydrates) that did not meet the inclusion criteria Hunt et al., Prospective 45 dyads, 1–4 Calcium ICAP-ES 281 ± 11.5 mg/L (1 mo pp)
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Carratu et al., Cross- 195 Italian Total Kjeldahl with 12.6 ± 2.0 g/L This paper also reported 2003 sectional dyads, 1 mo protein correction for milk volume, but methods pp NPN by acid did not meet the inclusion precipitation criteria Gossage et Randomized, 21 dyads, 4– Vitamin A HPLC 2079 ± 207 μmol/L (d 32 pp) Study reported no al., 2002 placebo 32 d pp significant effect of B controlled carotene supplementation trial on milk retinol values; so placebo and supplement group values were combined Kantola and Cross- 256 Finnish Selenium ETA-AAS 16.4 ± 3.2 μg/L (1987)
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This article reported al., 2001 sectional dyads, 1–30 d additional nutrients pp Copper ICP-AES 0.27 ± 0.9 mg/L (10–30 d pp) (selenium)
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1.54 ± 0.068 mmol/L (d of This article reported exercise test) additional nutrients (phosphorus)
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with zinc intakes ≥ 50% of d pp recommended intakes Wack et al., Prospective 30 dyads, 0– Sodium ICAP-ES 129 ± 61 mg/L (61–120 d pp) 1997 cohort 360+ d pp 136 ± 76 mg/L (121–180 d pp)
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0.19 ± 0.08 μg/mL (85–201 d pp) Dagnelie et Case-control 10 Dutch Calcium AAS 29.80 ± 3.87 mg/100 g This article reported al., 1992 dyads, 2–3 mo Magnesium AAS 3.58 ± 0.50 mg/100 g additional nutrients pp Zinc AAS 0.19 ± 0.10 mg/100 g (lactose, total protein, total lipid, vitamin B12)
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and milk 37.2 ± 11.3 g/L (12 mo pp) volume that did not meet the inclusion criteria Andon et al., Cross- 30 healthy, Vitamin B6 Saccharomyces 733 ± 195 nmol/L Women were not 1989 sectional lactating uvarum method consuming vitamin dyads, supplements measured at 60 d pp Foremilk samples Casey et al., Prospective 13 dyads, 0– Zinc Flame AAS 59.8 ± 14.3 μmol/L (d 14 pp)
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Clark et al., Cross- 25 milk Total lipid Solvent 4.3 ± 1.6 g/dL Study did not report the 1989 sectional samples from extraction by number of dyads dyads 2–32 modified Folch wk pp method This article reported additional nutrients (fatty acids) that did not meet the inclusion criteria Deelstra et Prospective 10 Belgian Chromium AAS 0.14 ± 0.05 ng/mL (30–60 d pp)
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milk volume that was 34 ± 6 μg/g (4 mo pp) originally reported in Butte et al.
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volume that did not meet 34 ± 4 μg/L (1800–2000 hr) the inclusion criteria 45 ± 9 μg/L (2200–2400 hr)
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RESULTS 41 4 mo pp 22 ± 2 μg/L (0400–0600 hr)
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This article reported al., 1985 cohort dyads, 1–5 wk additional nutrients pp (vitamin E) that did not meet the inclusion criteria Krebs et al., Prospective 16 dyads, 1– Zinc Flame AAS All mo pp 1985a cohort 12 mo pp 1.59 ± 1.17 μg/mL (foremilk)
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This article reported 1984c cohort 12 wk pp 184.0 ± 54 mg/L (4 wk pp) additional nutrients (total 173.0 ± 65 mg/L (6 wk pp)
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and milk volume that did not meet the inclusion criteria Song et al., Prospective 26 dyads, 2– Pantothenic Radio- 2.73 ± 0.61 μg/mL foremilk (2 1984 cohort 12 wk pp acid immunoassay wk pp) 2.40 ± 0.58 μg/mL hindmilk (2 wk pp)
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that did not 10.7 ± 0.4 mg/dL (26 wk pp) meet the inclusion criteria Keenan et al., Prospective 28 dyads, 3.5– Sodium Flame 7.9 ± 3.0 mEq/L (3.5–6 wk pp)
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AAS = atomic absorption spectrometry; B-carotene = beta-carotene; BMI = body mass index; CI = confidence interval; d = day; DHA = docosahexaenoic acid; dL = deciliter; EPA = eicosapentaenoic acid; ETA-AAS = electro thermal atomization-atomic absorption spectroscopy; g = gram; GC = gas chromatography; HPLC = high-performance liquid chromatography; HPLC-EC = high-performance liquid chromatographyelectrochemical detection; HPLC-FLD = high-performance liquid chromatography with fluorescence detection; hr = hour; HRGC = high resolution gas chromatography; ICAP-ES = inductively coupled argon plasma emission spectrometry; ICP-AES = inductively coupled plasma atomic emission spectrometry; ICP-MS = inductively coupled plasma-mass spectrometry; ICP-OES = inductively coupled plasma-optical emission spectrometry; IQR = interquartile range; kg = kilogram; L = liter; LC-MS/MS = liquid chromatography tandem mass spectrometry; MCICP-MS = multicollector inductively coupled plasma mass spectrometry; mEq = milliequivalent; mg = milligram; mL = milliliter; mmol = millimole; mo = month; mol = mole; ng = nanogram; NP-HPLC = normal-phase high-performance liquid chromatography; NPN = nonprotein nitrogen; pmol = picomole; pp = postpartum; RCT = randomized, double-blind, placebo-controlled trial; SD = standard deviation; SE = standard error; SEM = standard error of the mean; TE = alpha-tocopherol equivalent; UN-ICP-AES = ultrasonic nebulization-inductively coupled plasma atomic emission spectrometry; UV = ultraviolet; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; wk = week; wt/wt = weight/weight. a Study was done in the United States, unless noted otherwise.
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c Additional Comments Mohd RCT 11 Malaysian Deuterium dilution 534.1 ± 169 g/d (2 wk pp) Shukri et dyads, 2–18 wk pp al., 2019 Buntuchai Cross- 36 Thai dyads, 1–3 24-hr test weighing 598.7 ± 182.4 mL/d et al., 2017 sectional mo pp Bandara et Cross- 48 Sri Lankan Deuterium oxide to 773 ± 219 g/d (2 to < 4 mo pp)
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Butte et al., Prospective 45 dyads, 0–4 mo 24-hr test weighing Feeding Pattern A Feeding pattern A = 1985 cohort pp 798.2 ± 159.0 g/24 hr (1 mo feedings distributed pp) throughout the 24-hr day
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1980 cohort pp NOTE: d = day; g = gram; hr = hour; mL = milliliter; mo = month; pp = postpartum; RCT = randomized controlled trial; SD = standard deviation; wk = week. a To measure milk volume, infant intake is assessed (not maternal weight change or total production, which can be higher as infants leave milk in the breast)
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Methodology (mean ±SD) c Additional Comments McCrory Randomized 23 dyads, 8– Volume Test weighing 801 ± 115 g/d et al., intervention 16 wk pp 1999 Total lipid Folch extraction 34.1 ± 6.0 g/L Total Micro Kjeldahl 9.10 ± 1.36 g/L protein Dewey et Case-control 33 dyads, 6–8 Total Kjeldahl with 9.1 ± 1.0 g/L This article reported al., 1994 wk pp protein correction for additional nutrients (lactose)
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al., 1985 cohort 31 d pp AAS Zinc Flame AAS 4.74 ± 1.02 μg/mL (8 d pp)
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This article reported al., 1983 cohort mo pp 477 ± 79 μg/mL (2 mo pp) additional nutrients (lactose, 470 ± 81 μg/mL (3 mo pp)
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0.21 ± 0.10 μg/mL (6 mo pp) Zinc Flame AAS 2.71 ± 0.36 μg/mL (1 mo pp)
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a To measure milk volume, infant intake is assessed (not maternal weight change or total production, which can be higher as infants leave milk in the breast)
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b Study was done in the United States, unless noted otherwise. c Values are presented as the mean ± standard deviation unless noted otherwise.
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2000. Determination of the total content and binding pattern of elements in human milk by high performance liquid chromatography-inductively coupled plasma atomic emission spectrometry.
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2015. Maternal zinc status is associated with breast milk zinc concentration and zinc status in breastfed infants aged 4-6 months.
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American Journal of Clinical Nutrition 76(1)
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American Journal of Clinical Nutrition 41(3)
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2019. Maternal undernutrition and breast milk macronutrient content are not associated with weight in breastfed infants at 1 and 3 months after delivery.
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American Journal of Clinical Nutrition 33(2)
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2014. Mineral compositions in breast milk of healthy Chinese lactating women in urban areas and its associated factors.
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