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Background Although donor milk is increasingly fed to preterm infants, the resultant quality of growth and body composition is unknown. The aim of this pilot study was to describe the body composition of very low-birth-weight infants fed human milk in the neonatal intensive care unit and explore the association between the proportion of donor human milk intake and fat-free and fat mass deposition. Methods Body composition of 30 preterm infants fed maternal and donor human milk was measured by air displacement plethysmography. Regression models were developed to associate each parameter of body composition with the proportion of donor milk intake and other explanatory variables. Results The proportion of donor milk intake was negatively associated with body fat percentage (P = .01). Fat-free mass z-scores ranged from -4.6 to 1.11 (mean z-score of -0.95, 17th percentile). Conclusion Donor human milk intake is negatively associated with body fat percentage in this pilot study of very low-birth-weight preterm infants.

Background Evidence of interventions that are effective in improving exclusive breastfeeding (EBF) practices is needed to help countries revise their strategies. To assess whether mothers who had participated in the Nutrition at the Centre (N@C) project effectively demonstrated better EBF practices than did those who did not participate, we documented the processes of this nutritional intervention in Benin. Methods This study was a cross-sectional design comparing the intervention group, namely, the Village Saving and Loan Association (VSLA-N@C), to the control group. The N@C project was an educational intervention based on behavioural and social changes related to nutrition. Through VSLA groups installed in communities, mothers were connected to the project; had weekly discussions around the process, benefits and challenges linked to EBF, and advocated during Breastfeeding Week celebrations. The study participants were mothers with children aged 4–5.5 months from the VSLA-N@C group (n = 53) and mothers (n = 50) from non-intervention areas who served as controls. With the deuterium oxide dose-to-mother technique, we quantified human milk intake (HMI) and non-milk oral intake (NMOI) and compared both groups using Student’s t-test. A child is considered to be exclusively breastfed if the NMOI is less than 86.6 g/day. Multivariate regression logistics adjusted for VSLA membership, mothers’ body mass index, and children’s age, weight-for-age and weight-for-length, thus enabling us to measure differences in EBF rates. Results Children of mothers from the VSLA-N@C group consumed significantly more human milk than those of mothers in the control group (900.2 ± 152.5 g/day vs 842.2 ± 188.6 g/day, P = 0.044). Children in the VSLA-N@C group had significantly less non-milk oral intake than did those in the control group (difference: 148.2 g/day, P = 0.000). Therefore, the EBF rate was significantly higher in the VSLA group (38% vs 8%, P P = 0.015). Conclusion The EBF rate was significantly higher in the group of mothers who participated in the VSLA-N@C project than in those who did not receive the intervention. The N@C model could be promoted as a strategy for increasing EBF practices in poor and rural contexts, where it is possible to organize mothers into VSLA groups to discuss the process, benefits and challenges of EBF.

Indonesia government has done the WHO recomendation that the infants should be exclusively breastfed for the first six months of life to achieve optimum growth, development and health. Nevertheless, the percentage of exclusive breastfed infants have not achieved the target yet and has not been scientifically quantified. The objective of the study i s to measure the intake of human milk of Indonesian infants during first 6 months and to record the breastfeeding practices of mothers. Thirty healthy mother-infant pairs were recruited randomly for the cross-sectional study at “ Tumbuh Kembang Anak ” cohort in Bogor. Milk intake to the infant was measured using the deuterium oxide technique over 14 days. The interviews were done by members of team using the questionnaire to get the information on breastfeeding practice of respondents. The results showed that i ntake of human milk was 784 ± 117g.d -1 (mean ± SD), 787 ± 180 g.d -1 for infants 3 and 6 moths of age. It showed that the milk intake were not different between 3 and 6 months. The body composition of mothers, age, or parityhad no effects on milk intake of infants, education of mothers (3 months aged, P = 0.061, r = -0.097 and 6 months, P = 0.616, r = -0.095), infants of 3 months aged, P = 0.200, r = -0.290 and 6 months, P = -0.078, r = 0.684). Body mass index of mother (P < 0.05, r = 0.963) were correlated with the milk intake. About 53 % of the lactating mothers started breastfeeding within less than one hour of delivery. Breast-milk intake of the Indonesian infants were documented using deuterium oxide-to-the-mother technique. In the current study concluded that the exclusive breastfeeding practices with 30 pairs of mother-infant still shows that the conditions of exclusive breastfeeding practices have not been properly adhered to by mothers who deliver babies. It is recommended that "mother and baby health officer" in Indonesia are increasingly promoting in order mothers in urban and rural areas to breastfeed exclusively for up to 6 months

Nutrition continues to play an increasingly important role in neonatal health. Provision of optimal nutrients in the most vulnerable infants to preserve their neurodevelopmental potential must be balanced with the risk of pushing gastrointestinal tolerance and risk for necrotizing enterocolitis. Maximizing human milk intake now plays a key role in attenuating much of this risk. As more complex fortification for human milk starts being adopted, attention on adding back risk will need monitoring.

Background: Data on infant human milk intakes in low- and middle-income countries are limited, although the deuterium oxide dose-to-mother method (DTM) is an accurate tool for its estimation. Objective: We assessed human milk intakes of Thai infants during the first 6 months comparing exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and partial breastfeeding (PartBF). Methods: One hundred and ten healthy Thai lactating mother–infant pairs were followed from birth. Human milk intakes were determined at 6 weeks, 3 months, and 6 months using the DTM method. Daily energy and protein intakes were assessed using 3-day nonconsecutive 24-hour recalls. Sociodemographic characteristics were collected using a questionnaire. To compare breastfeeding practices, one-way analysis of variance with Tukey post hoc test assessed normally distributed data, while the Kruskal-Wallis test with Mann-Whitney U test was used for not normally distributed data. Results: No difference existed in human milk intakes during the first 6 months between EBF (743-776 g/d) and PBF (748-862 g/d). Human milk intakes of PartBF infants were significantly lower compared to other infants. Human milk intake was sufficient to meet infant energy and protein requirements during the first 3 months for EBF and PBF groups. Infant formula largely replaced human milk during the first 3 months; other solid foods were also introduced among the PartBF infants. Conclusions: Human milk intakes were comparable between EBF and PBF infants during the first 6 months and provided adequate energy and protein to meet requirements. Infant formula largely replaced breast milk among PartBF infants, although other foods were also given early. This study was registered at clinicaltrials.gov as NCT04020640.

L'allaitement exclusif augmente la survie des nourrissons. L'évaluation de son taux est surévaluée par la méthode auto-déclarative du questionnaire adressé aux mères. La technique alternative de l'oxyde de deutérium "Dose à la mère " plus précise, simple et non invasive permet de déterminer la quantité d'eau provenant d'aliments autres que le lait maternel consommé par les nourrissons. Dans la présente étude longitudinale, cette méthode a été appliquée pour la première fois au Mali pour déterminer le taux d'allaitement exclusif et la quantité de lait maternel consommée par les bébés de moins de 6 mois. L'étude s'est déroulée entre 2011 et 2014 à Bamako. Le suivi a concerné 71 couples mère-enfants du 3ème au 6ème mois post-partum pour 1750 échantillons de salives analysés par un FTIR. Les résultats ont montré que le taux d'allaitement exclusif par la " dose à la mère " était de 42,3% et 16,66% respectivement au 3ème et 6ème mois contre 74,6% et 65,5% par la déclaration des mères. La différence était significative entre les deux méthodes. Les quantités de lait consommées étaient de 1,063 kg/j et 1,233 kg/j. En conclusion, malgré le counseling sur l'alimentation du nourrisson, les mères ont accordé très peu d'importance à la pratique de l'allaitement exclusif.

Given the valuable health, development, and economic benefits of human milk Exclusive Breastfeeding (EBF) is recommended by the World Health Organisation for the first six months of an infant’s life. Many resource-limited regions in Africa do not line-up with these recommendations, therefore EBF promotion efforts on the continent need to be scaled up and monitored. This study explores the human milk intake volumes of 5 countries (Benin, Central African Republic, Morocco, South Africa and Tanzania) both at country level and in a pooled sample of children at 3 months (n= 355) and at 6 months (n=193). Mean human milk intake volumes in the pooled samples were 697.6 g/day at 3 months and 714.9 g/day at 6 months. EBF was determined both by maternal recall as well as using the deuterium oxide dose-to-mother technique, using two different cut-offs of non-milk oral intake. Comparison of these results showed substantial over-reporting of EBF by maternal recall, which suggests that actual rates of EBF are even lower than reported, thus highlighting the importance of scaling-up EBF promotion strategies.

This review highlights clinical outcomes of human milk from infancy through adulthood. Human milk outcomes of both preterm and term infants, including critically ill term infants (such as infants with congenital heart disease and those requiring therapeutic hypothermia) are summarized. Several human milk diets are identified to reduce the risk of specific diseases. Emerging research of newly discovered components of human milk are also reviewed. Human milk has significant effects on the gut microbiome, somatic growth, and neurocognitive outcomes. Continued research promises to improve donor human milk and donor milk derived products to achieve better outcomes for infants who do not receive their own mother's milk. The promotion of human milk is well-founded on evidence from the previous half century.

The effect of human milk intake on neurodevelopment in preterm infants is uncertain. We analyzed data from 611 participants in the DHA for Improvement of Neurodevelopmental Outcomes study, enrolled at ≤33 wk gestation from five Australian perinatal centers. The main exposures were (i) average daily human milk intake during the neonatal hospitalization and (ii) total duration of human milk intake before and after discharge. Outcomes were Bayley Scales of Infant Development, 2nd Edition Mental (MDI), and Psychomotor (PDI) Development Indexes. Adjusting for confounders in linear regression, human milk intake was not associated with higher MDI (0.2 points per 25 ml/kg/d; 95% confidence interval (CI): −0.6, 1.0) or PDI (−0.3 points; 95% CI: −1.1, 0.4). Longer duration of human milk intake was also not associated with MDI (0.1 points per month; 95% CI: −0.2, 0.3) or PDI (−0.2 points per month; 95% CI: −0.5, 0.01) scores, except in infants born 29–33 wk gestation (n = 364, MDI 0.3 points higher per additional month, 95% CI: 0.1, 0.6). We found no associations of human milk intake during the neonatal hospitalization with neurodevelopment at 18 mo corrected age.

Background: Exclusive breastfeeding during the first six months of an infant&rsquo, s life is an important factor for their optimal growth and health. Breastfeeding also has maternal benefits and can assist with postpartum weight loss. As shown by previous studies, postpartum weight retention can contribute to obesity. Objective: To quantify the human milk and evaluate the effect of breastfeeding on maternal weight loss during the 12 months postpartum. Method: This study included 70-mother&ndash, baby pairs. Infants&rsquo, intake of human milk and water from other sources, as well as the body composition of the mothers, were measured at the 1st, 3rd, 6th, 9th and 12th month postpartum by using the deuterium oxide dose-to-mother technique. Results: There was a significant change in the mothers&rsquo, body composition between the first and twelfth months in exclusive breastfeeding women compared to not-exclusive ones. Similarly, the difference between the quantities of human milk intake was highly significant in exclusive breastfeeding women compared to women who were not exclusively breastfeeding. Conclusion: Our results showed that exclusive breastfeeding for twelve months has a significant effect on postpartum weight loss among Moroccan women and that it is an effective way to control overweight and obesity among lactating women.

Introduction: Human milk is the optimal nutrition for preterm infants. When the mother's own milk is unavailable, donor human milk is recommended as an alternative for preterm infants. The association among early nutrition, body composition and the future risk of disease has recently attracted much interest. The aim of this study was to investigate the effect of human milk on the body composition of preterm infants.Materials and Methods: Very low birth weight infants (VLBW: birth weight

Some infants experience excessive weight gain (EWG) during exclusive breastfeeding, but causes and consequences are unknown. The objective was to identify factors associated with early EWG. Infants with EWG (HW-group) were examined at 5, 9 and 18 mo and compared to a breastfed group with normal weight gain (NW-group). Anthropometry, body composition, milk and blood samples, and milk intake were measured. Mean body-mass-index-for-age z-scores (BAZ) increased 1.93 from birth to 5 mo in the HW-group (n = 13) while the NW-group (n = 17) was unchanged (&minus, 0.01). The HW-group had 70% more fat mass at 5 mo, and then showed marked catch-down in BAZ from 5 to 18 mo (&minus, 0.84). Milk intake at 5&ndash, 6 mo did not differ between the groups. In the HW-group milk-leptin was lower at 5 mo and serum-leptin was considerably higher at 5 and 9 mo compared to the NW-group. Serum-leptin at 5 mo was positively associated with weight-for-age z-score (WAZ) and fat mass and negatively with WAZ change from 5 to 9 mo. In conclusion, breastfed infants with EWG had catch-down growth when other foods were introduced. Low milk-leptin in the HW-group may have stimulated appetite and milk intake when weight gain was high. High serum-leptin in the HW-group suggests early leptin resistance, which could impact cerebral regulation of energy intake. Larger studies are needed to confirm these results.

Breast-feeding habits are related to the nutritional status and the risk of illness and death in children under 2 years of age. For the first 6 months, infants should be exclusively breast-fed. This study aimed to evaluate the relationship between the infant’s nutritional status and human milk intake by breast-fed infants at high altitude. A quantitative, descriptive, correlational study was conducted including mother/baby pairs of infants aged 2–6 months. The amount of human milk consumed by the infants was assessed by the deuterium oxide dose-to-mother technique. The lipid content of human milk was measured by creamatocrit, and anthropometric measurements were performed. A total of eighteen mother/baby pairs were assessed. The mean human milk intake was 888 (sd 149) g/d, and the intake of water from other sources was 24·3 (sd 29·8) g/d. The lipid content in human milk was 41 (sd 12) g/l. The infant’s nutritional indicators were normal in all cases. A moderate positive correlation was found between milk volume and z scores weight-for-length r 0·58 (P=0·01), BMI-for-age r 0·56 (P=0·01) and weight-for-age r 0·45 (P=0·05). There was no correlation with length-for-age z score. The mean of breast milk intake in this study was similar to that found in other studies in the world. The lipid content is comparable to similar studies and was within the normal range. Children older than 3 months showed signs of stunting despite adequate volume and lipid content of breast milk.

The WHO recommends that exclusive breastfeeding should last up to 6 mo. However, human milk intake of Sri Lankan infants has not been quantified scientifically.The objectives of this study were to measure the human milk intake of Sri Lankan infants during the first 6 mo of age and to document the breastfeeding practices of their mothers.Forty-eight healthy mother-infant dyads were randomly recruited for this cross-sectional study at well-baby clinics. Milk intake was measured using the deuterium oxide-to-the-mother technique over a period of 2 wk. Information on breastfeeding practice and living standards of the participants were gathered using an interviewer-administered questionnaire.Human milk intake was 672 ± 123 g ⋅ d(-1) (mean ± SD), 776 ± 212 g ⋅ d(-1), and 801 ± 51 g ⋅ d(-1) for infants2 mo, 2 to4 mo, and 4-6 mo of age, respectively. The milk intakes were not different among the age groups. Maternal body composition, age, or parity had no effects on milk intake of the infants. However, mother's education : P0.05, r = 0.35), infant's age (P0.05, r = 0.30), and body mass index (P0.05, r = 0.41 : positively correlated with the milk intake. Over 63% of mothers had commenced breastfeeding within 30 min of delivery. About 60% of the mothers were feeding the baby 6-10 times during the daytime and81% intended to continue exclusive breastfeeding until 6 mo of age.This study, for the first time, documented the adequacy of breast-milk intake among Sri Lankan infants and the nutrition status of the mothers.

OBJECTIVE: To test whether and how human lactation and breastfeeding practices can adapt to fulfill infant energy requirements during exclusive breastfeeding for 6 months. METHODS: The First-Feed study was a longitudinal, observational field study to measure milk intake, energy intake (from the doubly labeled water method), anthropometry, and breastfeeding practices at 2 time points around 15 and 25 weeks of age. Fifty healthy exclusively breastfeeding mother-infant dyads were included from breastfeeding support groups in greater Glasgow, Scotland. Forty-seven completed (23 boys), and 41 were exclusively breastfed to 25 weeks of age. RESULTS: Milk intakes were higher than literature values (923 [SD: 122] g/day, n = 36; and 999 [SD: 146] g/day, n = 33) at both 15 and 25 weeks of age (both P < .001) and increased significantly between time points (mean increase: 61 g/day [95% confidence interval: 23–99]; P = .003). Infant growth was normal compared with World Health Organization Child Growth Standards, and energy intakes were adequate compared with references for energy requirements. Behavioral data indicated no evidence of strain on breastfeeding practices. CONCLUSIONS: Results of this prospective study reveal that when mothers are well supported and follow the World Health Organization recommendation on breastfeeding, milk intakes are high and increase over time, and there is adequate energy intake, normal infant growth, and no marked changes in breastfeeding practices. This new empirical evidence on adaptations during exclusive breastfeeding should help health professionals promote the initiation, duration, and exclusivity of breastfeeding.

Significant benefits to infant host defense, sensory-neural development, gastrointestinal maturation, and some aspects of nutritional status are observed when premature infants are fed their mothers' own milk. A reduction in infection-related morbidity in human milk-fed premature infants has been reported in nearly a dozen descriptive, and a few quasi-randomized, studies in the past 25 years. Studies on neurodevelopmental outcomes have reported significantly positive effects for human milk intake on mental and motor development, intelligence quotient, and visual acuity compared with the feeding of formula. Human milk-fed infants also have decreased rates of re-hospitalization after discharge. It is unclear how much human milk is needed to provide protection or at what postnatal age the protective effects maximize. More data are warranted to elucidate these questions. Despite the significant benefits of mothers' own milk, nutritional adequacy may be a limiting factor in the infant weighing less than 1500 g at birth. The overall nutritional needs of these infants can be supported with a nutrient supplement, or fortifier, added to the milk.

The application of nuclear techniques in the area of nutrition is safe because they use stable isotopes. The deuterium dilution method is used in body composition and human milk intake analysis. It is a reference method for body fat and validates inexpensive tools because of its accuracy, simplicity of application in individuals and population and the background of its usefulness in adults and children as an evaluation tool in clinical and health programs. It is a non-invasive technique as it uses saliva, which facilitates the assessment in pediatric populations. Changes in body fat are associated with non-communicable diseases; moreover, normal weight individuals with high fat deposition were reported. Furthermore, this technique is the only accurate way to determine whether infants are exclusively breast-fed and validate conventional methods based on surveys to mothers., Facultad de Humanidades y Ciencias de la Educación

To determine whether growth faltering during early infancy was attributable to inadequate intake of human milk, the nutrient intakes and growth of 30 Otomi infants from Capulhuac, Mexico, were studied at 4 or 6 mo of age. Growth was monitored monthly from 1 through 6 mo of age. The 2H dose-to-the-mother method was used to measure human milk intake. Energy, protein, lactose, and fat concentrations in milk were analyzed by standard techniques. Mean (+/- SD) human milk intakes were 885 +/- 145 and 869 +/- 150 g/d at 4 and 6 mo, respectively. Protein and lactose concentrations in milk were normal but fat and consequently energy concentrations were abnormally low. Energy intakes averaged 81 +/- 14 kcal.kg-1.d-1 at 4 mo and 72 +/- 14 kcal.kg-1.d-1 at 6 mo. Growth faltering by 6 mo was evidenced by the significant decline in growth velocities and National Center for Health Statistics Z scores. Weight gain at 6 mo was 8.1 +/- 3.5 g/d and length gain was 1.0 +/- 0.34 cm/mo. Weight-for-age and length-for-age Z scores were -0.81 +/- 0.94 and -1.51 +/- 0.83, respectively. Growth velocities were not significantly correlated with nutrient intakes. Growth faltering among the Otomi infants despite energy intakes comparable to those of breast-fed infants in more protected environments may have resulted from an increase in the need for nutrients or from a growth-limiting nutrient, other than energy, in their diet.

Background and Aims Mother’s own breast milk (MBM) is the most advantageous enteral food for extremely preterm infants (EPIs). Mothers of EPIs are at risk for inadequate expression of breast milk but determinants of MBM production are not well identified. The aim of the study was to investigate maternal predictors for MBM intake in EPIs during the neonatal period and at discharge. Methods The sample consisted of 109 mothers and their 117 EPIs born at Karolinska University Hospital from 2005–2009. Maternal data was retrieved from prenatal and obstetrical medical charts. In infants, birth data and information on enteral intake was collected from neonatal charts during the first 6 weeks of life and at discharge. Results Mean maternal age was 31.3 years. Mean infant gestational age and birth weight were 26+0 weeks and 850 grams. Only mothers with high MBM production at 3 weeks (MBM >90% of total enteral food intake) maintained their lactation over time. Predictors of low neonatal MBM production were unemployment, use of nicotine, low educational level, non-Swedish origin, non-cohabiting status and prenatal steroids (p Conclusions Special efforts should be made in young mothers of low socioeconomic status and foreign origin as well as mothers receiving prenatal steroids to help them sustain adequate breast milk production for their EPIs.

Milk intake and feeding patterns of 45 exclusively breast-fed infants were documented longitudinally over the first four months of life. Two prevailing feeding patterns were identified: one in which feedings were distributed throughout the 24-h day and one in which feedings were excluded from the early 12:00 a.m. to 6:00 a.m. period. No significant differences in total milk intake (g/24 h) were detected between months or feeding patterns. Milk intake per feeding decreased throughout the day irrespective of feeding pattern. Feeding frequency and duration declined in successive months of lactation. Total milk intake was not significantly correlated to feeding frequency or duration.

The deuterium dilution and test-weighing techniques to determine human milk intake were compared in 5 exclusively breast-fed infants, mean age 93 days, and in 4 supplemented infants, mean age 112 days. Deuterium oxide was administered orally to the mothers at 100 mg/kg body weight. The monoexponential decay curve of 2H from the mother’s milk was defined from milk sampled on days 1, 2, 6, 10, 13, 14 of the experiment. Milk samples were defatted by centrifugation and the milk water was reduced to hydrogen gas for hydrogen isotope ratio measurements by gas-isotope ratio mass spectrometry (GIRMS). Total body water (TBW) of the infants was determined by dilution after the administration of 60 mg 18O/kg body weight. Infant urine was sampled on days 1, 2, 4, 6, 8, 10, 12, 14 of the experiment and analyzed for 2H and 18O enrichment by GIRMS. The SAAM27 computer program for compartmental analysis was used to estimate fractional rate constants and predict the average human milk intake over the 14 days of the experiment. The test-weighing procedure was conducted for 5 consecutive days. All supplemental formula and solid foods consumed during the 14 days were measured.

Milk intake and growth in 45 exclusively breast-fed infants were documented during the first 4 months of life. Energy and protein intakes were substantially less than current nutrient allowances. Energy intake declined significantly from 110 +/- 24 kcal/kg/day at 1 month to 71 +/- 17 kcal/kg/day at 4 months. Protein intake decreased from 1.6 +/- 0.3 gm/kg/day at 1 month to 0.9 +/- 0.2 gm/kg/day at 4 months. Infant growth progressed satisfactorily, compared with National Center for Health Statistics standards. A reevaluation of energy and protein intakes and allowances during infancy is merited.

A comparison was made between the dose-to-the-mother deuterium-dilution method and the conventional test-weighing technique for determining human-milk intake in five exclusively breast-fed infants and in four breast-fed infants who received supplemental foods. After administration of 2H to the mothers human milk and infant urine were sampled over 14 d and analyzed for 2H:1H ratios by gas-isotope-ratio mass spectrometry. Infant total body water was determined by 18O dilution. The test-weighing procedure was conducted for 5 d consecutively. The intake of human milk (mean +/- SD) estimated by 2H dilution was 648 +/- 63 g/d and estimated by test-weighing was 636 +/- 84 g/d. The mean difference between the two methods was not significantly different from 0. The 2H-dilution and test-weighing techniques provide similar estimates of human-milk intake.