Milk Docosahexaenoic Acid Content Research Articles

DHA-Rich Aurantiochytrium Biomass, a Novel Dietary Supplement, Resists Degradation by Rumen Microbiota without Disrupting Microbial Activity

We first sought to evaluate the effect of dietary supplementation with the docosahexaenoic acid (DHA)-rich microalgae, Aurantiochytrium limacinum (AURA), on rumen fermentation and the resistance of DHA to degradation and biohydrogenation by rumen microbes through ex vivo fermentation experiments. Subsequently, we sought to quantify the diet-derived DHA content of milk and the impact of AURA on microbial composition and metabolism in a pilot feeding trial with rumen-cannulated dairy cows. To achieve our aims, rumen fluid from cannulated cows was used as inoculum, and the effect of AURA inclusion on fermentation ex vivo was examined. At doses corresponding to the amount of AURA recommended for commercial production animals, only ~10% of DHA was degraded or biohydrogenated by rumen microorganisms. The results show that feeding with AURA had no effect on either total bacterial density or short-chain fatty acid production. Real-time quantitative PCR analysis of the rumen fluid samples collected during a seven-week in vivo trial revealed that microbes related to lactic acid metabolism and methanogenesis were significantly suppressed by the AURA-supplemented diet. The DHA concentration in milk increased over 25-fold with the AURA-supplemented diet and dropped by 30–40% within one week of washout. The addition of A. limacinum biomass to dairy cow diets resulted in positive effects on rumen microbial composition with no adverse effect on fermentation activity. AURA-derived DHA was stable, with only modest degradation in the rumen, and was successfully deposited in milk. This is the first study to investigate the effect of supplementing the diet of dairy cows with a protist-based biomass, namely, on important rumen fermentation parameters and on DHA deposition in milk, using a combination of ex vivo and in vivo approaches.

Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes.

DHA content in milk and biohydrogenation pathway in rumen: a review.

Docosahexaenoic acid (DHA) is an essential human nutrient that may promote neural health and development. DHA occurs naturally in milk in concentrations that are influenced by many factors, including the dietary intake of the cow and the rumen microbiome. We reviewed the literature of milk DHA content and the biohydrogenation pathway in rumen of dairy cows aim to enhance the DHA content. DHA in milk is mainly derived from two sources: α-linolenic acid (ALA) occurring in the liver and consumed as part of the diet, and overall dietary intake. Rumen biohydrogenation, the lymphatic system, and blood circulation influence the movement of dietary intake of DHA into the milk supply. Rumen biohydrogenation reduces DHA in ruminal environmental and limits DHA incorporation into milk. The fat-1 gene may increase DHA uptake into the body but this lacks experimental confirmation. Additional studies are needed to define the mechanisms by which different dietary sources of DHA are associated with variations of DHA in milk, the pathway of DHA biohydrogenation in the rumen, and the function of the fat-1 gene on DHA supply in dairy cows.

Multiple Micronutrients, Lutein, and Docosahexaenoic Acid Supplementation during Lactation: A Randomized Controlled Trial.

Breastfed infants require an adequate supply of critical nutrients for growth, tissue functions, and health. Recommended intakes for several nutrients are considerably higher in lactating than non-lactating women but are not always met with habitual diets. We report a randomized, double-blind clinical trial in 70 healthy lactating women in Germany evaluating the effects of supplementation with multiple micronutrients, lutein, and docosahexaenoic acid (DHA) compared to placebo on maternal nutrient status and milk composition. The primary endpoint was the effect on the change of human milk DHA content (as a proportion of total milk fatty acids) during 12 weeks of supplementation. Maternal blood and milk biomarkers were measured as secondary endpoints. Supplementation increased maternal milk DHA by 30% compared to a decline in the placebo group. Supplementation also increased maternal blood DHA (17%), eicosapentaenoic acid (4%), 25-OH-vitamin D (24%), vitamin B12 (12%), lutein (4%), and beta carotene (49%), while homocysteine decreased. No significant difference in the number of adverse events was observed between supplementation and placebo groups. In conclusion, multi-micronutrient supplementation was safe and increased maternal blood and milk concentrations of selected nutrients in healthy women.

Correlation Between Docosahexaenoic Acid Intake and It’s Content in Breast Milk of Lactating Mothers in Jakarta

Objective: Docosahexaenoic acid (DHA) is the predominant structural fatty acid in the brain and one of the most important nutrient for cognitive development in early life. During early life, there is very limited metabolic capability to convert omega-3 fatty acids to DHA. Therefore, newborn intake of DHA completely depends on preformed DHA in mother’s breast milk. This study aims to determine DHA intake among lactating mothers and their association with breast milk’s DHA.Method: This cross-sectional study was conducted in Grogol Petamburan and Cilincing Public Health Centre in Jakarta. Eighty healthy lactating mothers aged 20–35 years old in 1–6 months postpartum was taken using consecutive sampling method. Mother’s DHA intake was assessed with a semiquantitative food frequency questionnaire. Post-feed breast milk specimens were collected in the morning, transported with cool boxes, and stored in the laboratory at -70° C before the analyses. Breast milk DHA content was analysed using Gas Chromatography with Mass Spectrometry. Descriptive analyses and Spearman rho test was used with a 95% confidence level.Result: This study showed the median of subjects’ DHA intake was 158.5(13.9–719.7) mg/day, i.e. 67.5% of the subjects was below Food and Agriculture Organization (FAO) recommendation (200 mg/day). The median of breast milk DHA was 51.7(19–184.7) mg/day, only 42.5 % of the subjects had breast milk DHA to meet the minimal requirement of their infant based on FAO recommendation (0.1% of total energy requirement). There was a moderate correlation between subject DHA intake with breast milk’s DHA content (r = 0.478, p &lt; 0.001). Conclusion: More than half of the subjects had DHA intake below FAO recommendation. Our finding showed a positive moderate correlation between DHA intake and breast milk DHA among lactating mothers.

N-docosahexaenoylethanolamine detected in human breast milk

Purpose: Measure concentrations of the neurogenic, pro-neurogenic, pro-synaptogenic and anti-inflammatory mediator N-docosahexaenoylethanolamine (synaptamide) in relation to its precursor docosahexaenoic acid (DHA) in breast milk. Design and methods: Postpartum women were recruited prior to discharge. We supplemented half the subjects with omega-3 fatty acids. Breast milk samples were collected at 1, 4 and 8 weeks. Synaptamide and DHA concentrations were determined by liquidchromatography/tandem mass spectrometry (LC-MS/MS) and gas chromatography, respectively. Results: Synaptamide was detected in all breast milk samples. The concentration ranged from 44 to 257 fmol/mL. Omega-3 fatty acid supplementation did not affect DHA or synaptamide concentration in breast milk due to a high-DHA-containing diet self-selected by control mothers. Nevertheless, synaptamide levels significantly correlated with DHA concentration in breast milk (r = 0.624, P < 0.001). Conclusion: This is the first demonstration of detectable concentrations of synaptamide in human breast milk. Although the attempt to raise the milk DHA content by omega-3 fatty acid supplementation was not successful in the current study, the positive correlation observed between synaptamide and DHA concentration suggests that synaptamide levels in human milk can be raised by proper omega-3 fatty acid supplementation that is known to increase DHA.

Breast milk DHA levels may increase after informing women: a community-based cohort study from South Dakota USA.

BackgroundDocosahexaenoic acid (DHA), an omega-3 fatty acid found in breast milk, has many health benefits for both mother and baby. A 2007 meta-analysis found U.S. women had breast milk DHA levels (0.20% of total fatty acids) below the worldwide mean (0.32%). In 2008, international dietary recommendations were made for pregnant and lactating women to consume 200 mg of DHA per day. This community-based study aimed to define current milk DHA levels from upper Midwest USA lactating mothers and to determine if providing information about their own level along with dietary recommendations would incite changes to increase breast milk DHA content.MethodsNew mothers attending lactation classes or using hospital pumping rooms in Sioux Falls, South Dakota, USA participated by providing one drop of breast milk on a card for fatty acid analysis at baseline and 1 month after initial reporting. DHA levels were analyzed by gas chromatography. Mothers received a report of their own breast milk level along with dietary recommendations on DHA intake for lactating women. Median baseline and follow-up DHA levels were determined and differences were compared by Wilcoxon signed-rank test.ResultsAt baseline, breast milk DHA content (n = 84) was highly variable (range 0.05 to 0.73%) with a median of 0.18% (IQR, 0.13, 0.28; mean ± SD, 0.22 ± 0.13%), well below the worldwide average (0.32%). Women who reported taking DHA supplements (n = 43) had higher levels than those who did not (0.23% vs. 0.15%, P < 0.0001). In a subset of 60 mothers who submitted a second sample, median breast milk DHA content increased from 0.19 to 0.22% (P < 0.01).ConclusionsFindings suggest that providing nursing mothers with their breast milk DHA level and education about DHA intake while breastfeeding motivates change to increase DHA levels.Electronic supplementary materialThe online version of this article (doi:10.1186/s13006-016-0099-0) contains supplementary material, which is available to authorized users.

Does providing lactating women with their individual breast milk DHA level promote an increase in DHA intake?

BACKGROUNDEssential long‐chain polyunsaturated fatty acids including docosahexaenoic acid (DHA) and arachidonic acid (AA) are especially important for normal infant growth and neurodevelopment. Breast milk DHA levels are highly variable and are dramatically affected by maternal intake, whereas AA levels are more stable. Recent recommendations for fish and DHA intake during pregnancy and lactation may be confusing for lactating women and their healthcare providers limiting anticipated improvements in milk DHA levels and provision for breastfeeding infants.OBJECTIVEThe purpose of this study was to determine 1) current milk DHA content in Midwestern US women, 2) factors that influence milk DHA levels, and 3) the effect of feedback regarding milk DHA levels on dietary intake of DHA as it relates to milk DHA content.METHODSLactating women were invited to participate by answering a survey about DHA intake and providing a milk sample (1 drop on an antioxidant‐treated card) for analysis by gas chromatography at baseline and again in 4 weeks. Individual levels were reported to participants. Women with baseline milk DHA higher than the worldwide average (WWA, 0.32%) were advised to make no changes, whereas women with lower levels were advised to increase DHA intake.RESULTSMilk from 81 women was available at baseline. DHA content was highly variable (0.05–0.73%) with a median 0.18%. Baseline milk DHA levels were inversely associated with weeks of lactation (R= −0.23, P=0.04) and parity (R= −0.25, P=0.03), but not with pre‐pregnancy BMI, age, or length of gestation. Women who reported taking DHA supplements at baseline (n=41) had higher levels than those who did not (n=40; 0.23% vs. 0.15%, P&lt;0.0001), but fish intake was unrelated to milk DHA levels. Median milk DHA content increased significantly from baseline to 4 week follow‐up. (n=64; 0.18% to 0.23%, P&lt;0.01). Those who reported changing their diet (n=43) had significantly greater change in their milk DHA compared to those who did not (40% vs. −9%, P&lt;0.01). There was no interaction between group (above‐ or below‐WWA milk DHA level) and their reported change in DHA intake.CONCLUSIONSMedian milk DHA levels in Midwestern US women were lower than previously reported levels for non‐supplementing US women from 10 years ago (~0.20%), hence dietary guidelines to avoid fish during pregnancy/lactation may be reducing DHA intakes as reflected by milk DHA levels. DHA supplementation (but not higher fish intake) was associated with higher milk DHA levels. Offering women information on their own milk's DHA level and providing them with international recommendations for DHA intake motivated dietary changes as quickly reflected in their milk DHA content.Support or Funding InformationThis study was internally funded by OmegaQuant Analytics, LLC. Dr. Baack receives funding support from the Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development of the National Institutes of Health (K08HD078504) and an NIH Center of Biomedical Research Excellence (COBRE) grant (P20 GM103620‐01A1).

Maternal milk DHA content predicts cognitive performance in a sample of 28 nations

Convergent evidence from neuronal biology and hominin brain hypertrophy suggests that omega-3 fatty acids are a limiting resource for neural and cognitive development in Homo sapiens, and therefore that children from populations with higher omega-3 availability should display superior cognitive performance. Using multiple regression, we tested this prediction in a sample of 28 countries, with Programme for International Student Assessment (PISA) math scores in 2009 as an index of cognitive performance, and country-specific breast milk levels of omega-3 docosahexaenoic acid (DHA) as an index of omega-3 availability. Breast milk DHA makes a highly significant contribution to math scores (β = 0.462, P = 0.006), greater in magnitude than the control variables of per capita Gross Domestic Product (PCGDP) and educational expenditures per pupil. Together, dietary fish (positively) and total fat (negatively) explain 61% of the variance in maternal milk DHA in a larger sample of 39 countries.

FADS genotype and diet are important determinants of DHA status: a cross-sectional study in Danish infants

Infant docosahexaenoic acid (DHA) status is supported by the DHA content of breast milk and thus can decrease once complementary feeding begins. Furthermore, it is unclear to what extent endogenous DHA synthesis contributes to status. We investigated several determinants, including FADS genotypes on DHA status at 9 mo and 3 y. This was a cross-sectional study with Danish infants from 2 prospective studies [Essentielle Fedtsyrer i OvergangskosteN (EFiON) and the Småbørns Kost Og Trivsel (SKOT) cohort] in which we measured red blood cell (RBC) DHA status at 9 mo (n = 409) and 3 y (n = 176) and genotyped 4 FADS tag single nucleotide polymorphisms (SNPs): rs3834458, rs1535, rs174575, and rs174448 (n = 401). Information about breastfeeding was obtained by using questionnaires, and fish intake was assessed by using 7-d precoded food diaries. FADS genotype, breastfeeding, and fish intake explained 25% of the variation in infant RBC DHA status [mean ± SD: 6.6 ± 1.9% of fatty acids (FA%)]. Breastfeeding explained most of the variation (∼20%), and still being breastfed at 9 mo was associated with a 0.7 FA% higher DHA compared with no longer being breastfed (P < 0.001). The FADS SNPs rs1535 and rs3834458 were highly correlated (r = 0.98). Homozygous carriers of the minor allele of rs1535 had a DHA increase of 1.8 FA% (P = 0.001) relative to those with the wild-type allele, whereas minor allele carriers of rs174448 and rs174575 had a decrease of 1.1 FA% (P = 0.005) and 2.0 FA% (P = 0.001), respectively. Each 10-g increment in fish intake was associated with an increased DHA status of 0.3 FA%. At 3 y, fish intake was the only significant determinant of DHA status (0.2 FA%/10 g). Breastfeeding, FADS genotype, and fish intake are important determinants of DHA status in late infancy. The EFiON study was registered at clinicaltrials.gov as NCT 00631046.

Docosahexaenoic acid in maternal and neonatal plasma phospholipids and milk lipids of Taiwanese women in Kinmen: fatty acid composition of maternal blood, neonatal blood and breast milk

BackgroundDocosahexaenoic acid (DHA) is a long-chain omega-3 polyunsaturated fatty acid (LCPUFA) that is critically important for the structure, development and function of the retina and central nervous system (CNS), ultimately contributing to improved cognition. It is known that the DHA content of breast milk is positively correlated with maternal DHA intake. Since there is a lack of information about the DHA status of pregnant and lactating women in rural Taiwan. The aims of the present study were to: 1) assess the DHA status of mothers and babies in urban setting, and 2) determine the content of DHA in the milk of nursing mothers.MethodsAll pregnant women who attended the Obstetrics and Gynecology Outpatient Clinic of Kinmen Hospital on Kinmen Island in Taiwan between May 1 and May 30, 2011 were invited by research nurses to enroll in the study. The maternal blood sample was obtained on the day of their delivery. Cord blood was collected by the obstetrician following delivery. Participants were asked to visit the doctor forty-two days after the delivery, at which time a nurse collected breast milk on the day mothers were visiting the doctor for post-natal well-baby check-up.ResultsThe DHA percentages of maternal and neonatal plasma phospholipids were 5.16% and 6.36%, respectively, which are higher than values reported for most populations elsewhere in the world. The DHA percentage for the breast milk of Kinmen mothers was also high (0.98%) relation to international norms. The DHA proportions in maternal and neonatal plasma phospholipids were positively correlated (r = 0.46, p = 0.01).ConclusionsWe show that the DHA status of mothers and newborns on Kinmen Island is satisfactory, thereby providing an evidence-based argument for promoting breastfeeding in Taiwan.

A dose–response relationship between fish consumption and human milk DHA content among Filipino women in Cebu City, Philippines

Human milk is the primary source of docosahexaenoic acid (DHA) for most infants, an important fatty acid for neurological development. Milk DHA is largely incorporated from the maternal diet. Little is known about whether milk DHA varies within populations with differences in maternal fish consumption. Here, we investigate this association in a sample of marginally nourished Filipino women. Milk samples were collected during in-home interviews with 117 lactating Filipino mothers from Cebu City, Philippines, nursing infants <24 months of age. Anthropometric data and dietary recalls were also collected. Samples were analysed for total fatty acid composition using gas chromatography. Multivariate regression was used to test the association between fish consumption and milk DHA. Milk DHA showed a positive, dose-response relationship with maternal fish consumption (p < 0.011, r(2 ) =( ) 0.21). Milk DHA was also positively related to protein intake, likely reflecting the association between fish and protein intake (p < 0.009). Unlike prior studies, parity predicted increased milk DHA (p = 0.03). Increasing fish consumption during lactation may be a cost-effective means of maximizing DHA delivery to infants particularly in populations with marginal energy intakes during lactation. However, this must be weighed against the potential dangers of increasing exposure to fish-based pollutants.

Effect of feeding fresh forage and marine algae on the fatty acid composition and oxidation of milk and butter

This study evaluated the effects of feeding fresh forage either as pasture plus a concentrate (PAS) or as a silage-based total mixed ration (TMR), combined with either a ruminally inert lipid supplement high in saturated fatty acids (−) or a ruminally protected microalgae containing 22g of docosahexaenoic acid (DHA)/100g of fatty acids (+) on the fatty acid (FA) composition and oxidation of milk and butter. For the 8 mid-lactation Holstein cows in this study, milk yield was not significantly affected by treatment, averaging 32.3±1.28kg/d. Milk fat content was higher for PAS−, averaging 5.05 compared with 4.10±0.17% for the mean of other treatments, and was significantly depressed with microalgae supplementation (3.97 vs. 4.69±0.17%). The saturated fatty acid level in the milk of cows fed TMR− was significantly higher than that of the other treatments (66.9 vs. 61.2g/100g of FA). The level of monounsaturated FA was lowered by feeding TMR− (27.4 vs. 32.0g/100g of FA), whereas levels of polyunsaturated FA were elevated by feeding PAS+ compared with the mean of the other treatments (6.54 vs. 5.07g/100g of FA). Feeding the rumen-protected microalgae increased the DHA content of milk more than 4-fold (0.06 to 0.26g/100g of FA) with the PAS treatment. The conjugated linoleic acid content of milk was highest for PAS+ compared with the other treatments (4.18 vs. 3.41g/100g of FA). In general, the fatty acid composition of butter followed that of milk. Overall, feeding the TMR supplemented with the rumen-protected microalgae increased the levels of volatile products of oxidation in milk and butter. No effect of forage type or microalgae supplementation was observed on the oxidative stability or antioxidant capacity of milk, although the oxidative stability of butter exposed to UV was reduced with microalgae supplementation, particularly with TMR, as assessed by using the ferric reducing ability of plasma assay.

Randomized Controlled Trial of Docosahexaenoic Acid Supplementation in Midwestern U.S. Human Milk Donors

Docosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid important for neonatal neurodevelopment and immune homeostasis. Preterm infants fed donor milk from a Midwestern source receive only 20% of the intrauterine accretion of DHA. We tested the hypothesis that DHA supplementation of donor mothers would provide preterm infants with DHA intake equivalent to fetal accretion. After Institutional Review Board approval and informed consent, human milk donors to the Mother's Milk Bank of Ohio were randomized to receive 1 g of DHA (Martek(®) [now DSM Nutritional Lipids, Columbia, MD]) or placebo soy oil. Dietary intake data were collected and analyzed by a registered dietitian. Fatty acids were measured by gas chromatography/flame ionization detection. Statistical analysis used linear mixed models. Twenty-one mothers were randomly assigned to either the DHA group (n=10) or the placebo group (n=11). Donor age was a median of 31 years in both groups with a mean lactational stage of 19 weeks. Dietary intake of DHA at baseline in both groups was a median of 23 mg/day (range, 0-194 mg), significantly (p<0.0001) less than the minimum recommended intake of 200 mg/day. The DHA content of milk increased in the DHA-supplemented group (p<0.05). The women enrolled in this study had low dietary DHA intake. Supplementation with preformed DHA at 1 g/day resulted in increased DHA concentrations in the donor milk with no adverse outcomes. Infants fed donor milk from supplemented women receive dietary DHA levels that closely mimic normal intrauterine accretion during the third trimester.

Impact of Maternal Nutritional Status on Human Milk Quality and Infant Outcomes: An Update on Key Nutrients

The profound importance of human milk in optimizing neonatal health and improving child survival is becoming increasingly more apparent, both domestically (1–5) and internationally (6). Human milk is recommended as the sole source of nutrition for the first 6 mo of life (7–10) and is an important food source for the first 1 (7) to 2 y (11). Therefore, promoting and protecting human milk nutrient quality are of great public health concern. Until recently, it was widely believed that nutritional deficiencies in breast-fed infants were relatively rare. Routine supplementation of breast-fed infants is not recommended in the United States, with the exception of vitamin K in the newly delivered neonate (12) and—since 2005—vitamin D supplementation throughout infancy (13). However, WHO expert consultation on the optimal duration of exclusive breastfeeding (10) did acknowledge that data are insufficient to exclude the possibility of micronutrient deficiencies in some infants exclusively breastfed for 6 mo. Thus, there has been a renewed effort to better understand the relationship between maternal micronutrient status and human milk quality, particularly in regions of the world where diet quality is poor (14). However, even for women in resource-rich settings, modern trends in diet and lifestyle may compromise human milk nutrient levels. For example, it was previously believed that only strict vegans were at risk of vitamin B-12 deficiency. However, recent studies have revealed that even lacto-ovo vegetarians and individuals who consume low amounts of meat (15) are at greater risk of vitamin B-12 deficiency compared with those consuming larger amounts of meat. Furthermore, current public health recommendations advise pregnant and lactating women to limit their consumption of seafood with high methylmercury levels (16) and for all individuals to minimize sun exposure, practices that may compromise the levels of (n-3) fatty acids (17) and vitamin D (18) in human milk, respectively. These contemporary issues highlight the need to better understand the impact of maternal dietary intake on human milk nutrient levels and the resultant infant functional outcomes. For some nutrients, the answers to these relationships are relatively well established; however, important knowledge gaps remain in our understanding of these relationships for select nutrients. Our expert panel was invited to address the current evidence and summarize emerging research with regard to human milk quality, focusing on the B vitamins, vitamin D, and docosahexaenoic acid (DHA). Dr. Lindsay Allen (19) presents a global overview of B vitamin levels in human milk, how these levels are influenced by maternal diet and supplementation patterns, and the B vitamin status of infants breast-fed by mothers with inadequate B vitamin intake. Drs. Adekunle Dawodu and Reginald Tsang (20) provide an overview of the interplay between the vitamin D status of the mother, her milk, and her infant in a contemporary, cross-national context. Their paper also highlights intriguing recent research evaluating maternal vitamin D supplementation as a means to improve the vitamin D status of infants in settings with very low maternal vitamin D levels. Dr. Christina Valentine (21) presents a critical review of the literature addressing the relationship between maternal DHA intake and DHA levels in human milk, including the donor milk supply in the United States and the potential impact of human milk DHA content on functional outcomes in the preterm infant. Although each of these authors has focused on addressing suboptimal human milk levels of select nutrients, these symposium proceedings should not be interpreted as reasons to disregard current recommendations to provide human milk as the sole source of nutrition for the first 6 mo of life. On the contrary, all 4 authors acknowledge the vitally important nutritional and immunological advantages of exclusive breastfeeding. In the instances in which human milk nutrient levels have been shown to be suboptimal, each author has highlighted emerging research on interventions designed to address the problem, primarily by improving maternal intake. It would be misguided to “solve” the problem of a nutrient deficiency in human milk by recommending human milk substitutes because this ignores the importance of exclusive breastfeeding in maximizing protection from infectious disease and improving child survival. By tackling the issue of human milk quality for select nutrients, this symposium provides a road map for future research focused on protecting and promoting human milk quality. Clearly, more research is needed to determine the safety and effectiveness of approaches used to address this challenging public health issue.

SURVEY OF HUMAN MILK FATTY ACID LEVELS OF U.S. WOMEN WHO PROVIDE EXPRESSED MILK FOR FEEDING THEIR PRETERM INFANTS

BackgroundPreterm infants have reduced in utero accretion of docosahexaenoic acid (DHA) and arachidonic acid (ARA) due to early birth. Their postnatal DHA status is in part dependent upon the DHA content of their mother's milk, but DHA content of US human milk is among the lowest in the world, typically ≤0.2% of total fatty acids.ObjectiveTo characterize DHA, ARA, and eicosapentaenoic acid (EPA) levels in milk expressed by mothers of preterm infants.MethodsMothers of infants with a gestational age ≤30 3/7 weeks provided single milk samples during the first or second postnatal month. Fatty acids were determined by capillary column gas chromatography. Maternal consumption of fish and/or DHA supplements during the last 12 weeks of pregnancy was recorded.ResultsSixteen mothers consumed fish, 25 consumed a DHA supplement, 11 consumed both supplement and fish, and 76 did not consume either. DHA was higher among mothers consuming fish or supplement, and greatest for those consuming both (Table). Milk DHA trended higher than previously seen for U.S. mothers. There was little difference in ARA among the groups; EPA was highest among those using supplements and surprisingly, lowest for those consuming fish.ConclusionMilk levels of DHA are lowest among those mothers who did not consume fish or DHA supplements during pregnancy. Dietary counseling for mothers providing milk for their preterm infants may increase their infant's DHA intake.

Low Docosahexaenoic Acid in the Diet and Milk of American Indian Women in New Mexico

A recent finding of low levels of docosahexaenoic acid (DHA) in the milk of lactating Hispanic and non-Hispanic white women in New Mexico prompted a study of the DHA content of the breast milk and diets of American Indian women in the state. Nineteen urban American Indian women (18 to 40 years) who had been lactating for 1 to 6 months and who were attending clinics at the University of New Mexico Hospital were enrolled in a cross-sectional study that was conducted between June 2005 and February 2009. Descriptive statistics and correlations were performed. The mean fat content of the breast milk was 4.67±1.9 g/dL and the mean DHA proportion of the milk fat was 0.097%±0.035%, which is a low value relative to international norms. The low DHA content of the milk could be accounted for by the women's low dietary intake of DHA (median=30 mg). The DHA percentage in the women's milk fat was positively correlated with dietary intake of DHA ( r=0.67; P<0.001). This study shows that the DHA content of the breast milk of urban American Indian women attending clinics at a university hospital in New Mexico is well below levels widely acknowledged as being healthful for infants who rely mainly on breast milk for their supply of DHA.

Docosahexaenoic acid level of breast milk of iranian women in low fish – consuming and high fish – consuming regions

Objective: Sufficient intakes of docosahexaenoic acid (DHA) via breast milk are required for optimizing visual and neural development at early stages of life. Little or no information is available on DHA intakes and levels found in breast milk in Iranian women and surrounding regions. In this study we measure the DHA in the breast milk of lactating Iranian women from low and high – fish-eating regions and estimate their DHA intakes. Methods: This is a cross-sectional and prospective study done in two cities of Iran (Mashhad and Amol); 10 ml of mature breast milk were obtained from 40 healthy lactating women (selected randomly) at Imam Reza Hospital of Mashhad (a low fish-consuming area) and Amir Kola Children Hospital of Amol city (a high fish-consuming area). The data were analyzed in two samples by using t- independent test and Mann-Whitney test via SPSS version 11.5 software. Results: The breast milk DHA levels of mothers living in the high fish-consuming area (Amol) were significantly higher than mothers living in the low fish-consuming area (Mashhad, p< 0.01). It can be estimated that the average DHA intake of lactating Iranian women is approximately 184 mg/dl in Mashhad and 307 mg/dl in Amol. Conclusion: The DHA content of breast milk was higher in high-fish consuming area in comparison to the low-fish consuming area in Iran indicating that the DHA levels of breast milk are influenced by fish consumption.

Docosahexaenoic acid and lactation

Docosahexaenoic acid (DHA) is an important component of membrane phospholipids in the retina and brain and accumulates rapidly in these tissues during early infancy. DHA is present in human milk, but the amount varies considerably and is largely dependent on maternal diet. This article reviews data addressing the impact of different DHA intakes by lactating women on infant and maternal outcomes to determine if available data are sufficient to estimate optimal breast milk DHA content and estimate dietary reference intakes (DRIs) for DHA by breast-feeding mothers. Results of published observational studies and interventional trials assessing the impact of maternal DHA intake (or breast milk DHA content) on infant visual function, neurodevelopment, and immunologic status were reviewed. Studies related to the potential impact of DHA intake on depression or cognitive function of lactating women also were reviewed. Although only a limited number of studies are available in the current medical literature, and study results have not been consistent, better infant neurodevelopment and/or visual function have been reported with higher vs. lower levels of breast milk DHA. The effect of DHA intake on the incidence or severity of depression in lactating women is not clear. Increasing breast milk DHA content above that typically found in the US, by increasing maternal DHA intake, may confer neurodevelopmental benefits to the recipient breast-fed infant. However, current data are insufficient to permit determination of specific DRIs during this period.

Evidence of inadequate docosahexaenoic acid status in Brazilian pregnant and lactating women

Recently published data concerning dietary intake of fat and food sources of (n-3) long-chain polyunsaturated fatty acids (LCPUFA) in Brazil are reviewed together with data on biochemical indices of PUFA status during pregnancy and lactation and PUFA composition of breast milk in Brazilian adolescents and adults. Potential inadequacies of docosahexaenoic acid (DHA) status among Brazilian pregnant and lactating women have not yet been thoroughly evaluated. The data reviewed show that dietary intake of food sources of n-3 LCPUFA is low and possibly deficient in Brazil, and that biochemical indices of maternal DHA status and breast milk DHA content are low compared to the international literature. These data indicate inadequate DHA status among Brazilian women during pregnancy and lactation, but this evidence needs confirmation through comprehensive and specific population-based studies.