Macronutrient analysis of human milk and factors associated with its composition in mothers of preterm infants ≤ 32 weeks

Abstract

We conducted an exploratory longitudinal study to evaluate the macronutrient composition of human milk in mothers delivering very preterm infants ≤ 32 weeks over the first 4 weeks of lactation and the association of human milk composition with maternal and neonatal factors A total of 213 human milk samples collected in the morning between 8 am and 12 pm from 60 eligible mothers were analyzed on 7 (n = 60), 14 (n = 60), 21 (n = 52), and 28 (n = 41) days of lactation by infrared transmission spectroscopy. The true protein content decreased significantly over 4 weeks (mean difference (95% confidence interval)) (MD (95% CI)) week 1 and week 4 = 0.2 g (0.037 to 0.363, P = 0.009)). On the contrary, the mean fat and calorie content showed significant increase over time (MD (95% CI)) = − 1.03 g (− 1.719 to − 0.343, P = 0.001) and − 9.0 kcal/dl (− 15.170 to − 2.830, P = 0.001), respectively). There was no difference in the carbohydrate content of human milk over 4 weeks. Macronutrient composition was independent of maternal parity, mode of delivery, pre-pregnancy body mass index, umbilical artery Doppler flows, previous breast feeding experience, neonatal centile status, gestation, and infant’s weight at birth. Multiple regression analysis of human milk composition with mother’s dietary components showed no significant association.

Conclusion

We conclude that in mothers who deliver very preterm infants ≤ 32 weeks, true protein content decreased, fat and calorie content increased, and carbohydrate content remained stable in human milk during first 4 weeks of lactation. Human milk macronutrient composition was independent of various maternal and neonatal factors including maternal body mass index and dietary intake.

Trial registration

CTRI/2017/02/007895

What is Known:
• Preterm human milk has high temporal and inter-individual variation in the macronutrient composition.
What is New:
• In mothers who deliver very preterm infants < 32 weeks, true protein content decreases, fat and calorie content increases, and carbohydrate content remains stable in human milk during first 4 weeks of lactation.
• Human milk macronutrient composition is independent of various maternal and neonatal factors including maternal body mass index and dietary intake.

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Abbreviations

HM:

Human milk

VLBW:

Very low birth weight

EHM:

Expressed human milk

BMI:

Body mass index

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Acknowledgements

We would like to thank Nutricia International Private Limited for providing the Milk Analyzer to Sir Ganga Ram Hospital for the purpose of this research.

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Authors

Contributions

AT and NK conceptualized the project and wrote the protocol. P Gandhi and SG had primary responsibility on patient screening, enrolment, and data collection. AT performed the statistical analysis and wrote the manuscript. NK and PG supervised during enrolment, outcome assessment, and manuscript writing. All authors approved the final manuscript.

Corresponding author

Correspondence to Neelam Kler.

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Ethics approval

This study was ethically approved on 28th November 2015, Ethics committee, Sir Ganga Ram Hospital (EC/11/15/919)

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Consent for participation was obtained from the mothers.

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Not applicable

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Thakur, A., Kler, N., Garg, P. et al. Macronutrient analysis of human milk and factors associated with its composition in mothers of preterm infants ≤ 32 weeks. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-04158-0

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Keywords

  • Human milk analysis
  • Macronutrient
  • Very preterm infants