Human milk-based fortifier is associated with less alteration of milk fat globule size than cow milk-based fortifier.

Yurika Yoshida,Tokuo Miyazawa,Masahiko Izumizaki,Yuya Nakano,Minami Azuma,Keli M Hawthorne,Mari Sakaue,Kazuna Furukawa,Katsumi Mizuno,Takashi Takaki,Haruhiro Kuwabara,Juan J Loor

doi:10.1371/journal.pone.0257491

Yurika Yoshida, Tokuo Miyazawa + Show 10 more

Open Access

https://doi.org/10.1371/journal.pone.0257491

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Abstract

We aimed to evaluate if human milk-based fortifier (HMBF) affects human milk fat globule (MFG) size less than cow milk-based fortifier (CMBF), which may impact overall infant feeding tolerance. Measurements of donated human milk were performed before fortification as well as at 1 hour, 24 hours, and 48 hours after fortification with CMBF or HMBF. MFG size in each sample of fortified milk was measured by laser light scattering. MFG size in the fortified milks increased gradually over time. At 24 and 48 hours after fortification, MFG size in the milk with CMBF was larger than that in the milk with HMBF (4.8 ± 0.5 vs 4.3 ± 0.3 μm, p<0.01, 5.1 ± 0.7 vs 4.5 ± 0.4 μm, p = 0.03, respectively). HMBF is associated with less alteration of MFG size than CMBF. This may have an impact on feeding tolerance of very preterm infants.

Highlights

Mother’s own milk (MOM) is the best nutrition for very preterm infants
At 24 hours after fortification, milk fat globule (MFG) particle size in the milk with cow milk-based fortifier (CMBF) was larger than MFG size in the milk with human milk-based fortifier (HMBF) (4.8 ± 0.5 vs 4.3 ± 0.3 μm, p
At 48 hours after fortification, MFG size remained larger in the milk with CMBF compared to the milk with HMBF (5.1 ± 0.7 vs 4.5 ± 0.4 μm, p = 0.03)

Summary

Introduction

Mother’s own milk (MOM) is the best nutrition for very preterm infants. There are many advantages, such as decreased rates of infection, necrotizing enterocolitis (NEC), retinopathy of prematurity, and better cognitive development [1]. The amount of protein, calcium, and phosphorus in MOM is inadequate for the appropriate growth of preterm infants. A human milk fortifier (HMF) is necessary. In Japan, the only HMF available for preterm infants is derived from cow’s milk and is in a powder form, known as cow milk-based fortifier (CMBF, Morinaga Co. Ltd., Tokyo, Japan). Fortification of human milk with CMBF may result in variable degrees of gastrointestinal (GI) symptoms, CMBF in powder form is widely used all over the world. Severe GI symptom is the formation of fatty acid calcium stones.

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