Abstract
The role of breastfeeding in improving allergy outcomes in early childhood is still unclear. Evidence suggests that immune mediators in human milk (HM) play a critical role in infant immune maturation as well as protection against atopy/allergy development. We investigated relationships between levels of immune mediators in colostrum and mature milk and infant outcomes in the first year of life. In a large prospective study of 398 pregnant/lactating women in the United Kingdom, Russia and Italy, colostrum and mature human milk (HM) samples were analysed for immune active molecules. Statistical analyses used models adjusting for the site of collection, colostrum collection time, parity and maternal atopic status. Preliminary univariate analysis showed detectable interleukin (IL) 2 and IL13 in HM to be associated with less eczema. This finding was further confirmed in multivariate analysis, with detectable HM IL13 showing protective effect OR 0.18 (95% CI 0.04–0.92). In contrast, a higher risk of eczema was associated with higher HM concentrations of transforming growth factor β (TGFβ) 2 OR 1.04 (95% CI 1.01–1.06) per ng/mL. Parental-reported food allergy was reported less often when IL13 was detectable in colostrum OR 0.10 (95% CI 0.01–0.83). HM hepatocyte growth factor (HGF) was protective for common cold incidence at 12 months OR 0.19 (95% CI 0.04–0.92) per ng/mL. Data from this study suggests that differences in the individual immune composition of HM may have an influence on early life infant health outcomes. Increased TGFβ2 levels in HM are associated with a higher incidence of reported eczema, with detectable IL13 in colostrum showing protective effects for food allergy and sensitization. HGF shows some protective effect on common cold incidence at one year of age. Future studies should be focused on maternal genotype, human milk microbiome and diet influence on human milk immune composition and both short- and long-term health outcomes in the infant.
Highlights
Increasing rates of allergy/atopy are of great concern with children bearing the greatest burden of this increase [1]
The results support the concept that IL13 and hepatocyte growth factor (HGF) have protective effects and TGFβ2 may act as a risk factor, which may explain the diversity of results from epidemiological studies on the health-promoting effects of breastfeeding with regards to allergic diseases
Our findings suggest that higher concentrations of TGFβ2 in mature human milk are associated with significantly increased risk of eczema reported by the age of 12 months
Summary
Increasing rates of allergy/atopy are of great concern with children bearing the greatest burden of this increase [1]. Long-term disease and health outcomes have been associated with multiple factors but, in particular, maturation of the immune system and immune-mediated diseases have been linked to later metabolic disorders such as cardiovascular disease [2]. Whilst there is evidence to suggest that the maternal environment in pregnancy has an impact on subsequent development of immune system in their offspring [3], early nutrition in the first two years of life, a rapid period of infant growth and development, is believed to impact short- and long-term health. Human milk (HM) contains a large variety of active immune components [4], which are present in differing concentrations [5], yet no comprehensive study has delved into the influences of maternal characteristics on immune composition of HM. We may expect HM to contain all necessary immunological components in the amounts needed for an appropriate infant immune development
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