Abstract
Background: Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants. As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM). Addressing HM composition and variations is essential to optimize HM fortification strategies for these vulnerable infants. Aims: To analyze and compare macronutrient composition in HM of mothers lactating very preterm (PT) (28 0/7 to 32 6/7 weeks of gestational age, GA) and term (T) infants (37 0/7 to 41 6/7 weeks of GA) over time, both at similar postnatal and postmenstrual ages, and to investigate other potential factors of variations. Methods: Milk samples from 27 mothers of the PT infants and 34 mothers of the T infants were collected longitudinally at 12 points in time during four months for the PT HM and eight points in time during two months for the T HM. Macronutrient composition (proteins, fat, and lactose) and energy were measured using a mid-infrared milk analyzer, corrected by bicinchoninic acid (BCA) assay for total protein content. Results: Analysis of 500 HM samples revealed large inter- and intra-subject variations in both groups. Proteins decreased from birth to four months in the PT and the T HM without significant differences at any postnatal time point, while it was lower around term equivalent age in PT HM. Lactose content remained stable and comparable over time. The PT HM contained significantly more fat and tended to be more caloric in the first two weeks of lactation, while the T HM revealed higher fat and higher energy content later during lactation (three to eight weeks). In both groups, male gender was associated with more fat and energy content. The gender association was stronger in the PT group, and it remained significant after adjustments. Conclusion: Longitudinal measurements of macronutrients compositions of the PT and the T HM showed only small differences at similar postnatal stages in our population. However, numerous differences exist at similar postmenstrual ages. Male gender seems to be associated with a higher content in fat, especially in the PT HM. This study provides original information on macronutrient composition and variations of HM, which is important to consider for the optimization of nutrition and growth of PT infants.
Highlights
Human milk (HM) is a highly complex, dynamic and species-specific system that incorporates numerous nutritional and bioactive elements
This study provides original information on macronutrient composition and variations of human milk (HM), which is important to consider for the optimization of nutrition and growth of PT infants
Temporal changes of HM composition before and after term equivalent time are of particular interest considering the critical challenges of preterm (PT) infants’ nutrition and the critical importance of HM for this vulnerable population [10,11]
Summary
Human milk (HM) is a highly complex, dynamic and species-specific system that incorporates numerous nutritional and bioactive elements. Recent studies revealed countless inter- and intra-individual factors influencing HM composition, such as maternal, circadian, pregnancy, delivery, infantile, chronological and environmental variables [5,6,7,8,9] Among these factors, temporal changes of HM composition before and after term equivalent time are of particular interest considering the critical challenges of preterm (PT) infants’ nutrition and the critical importance of HM for this vulnerable population [10,11]. Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM).
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