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Objective: The first three months after birth is a critical time interval for growth and development. Breastmilk is a natural nutrition source for infants. However, studies on the practice of exclusive breastfeeding and infant growth tend to result in contradictions. The objective of this study was to investigate the correlation between breastmilk macronutrient levels and infant growth during the first three months.
Methods: We conducted an observational cohort study at Universitas Airlangga Hospital from June-October 2018. Subjects were enrolled using total sampling. Infant anthropometry, as defined by body weight, body length, and head circumference, were measured. Breastmilk specimens were collected using a breast pump and then sent directly for analysis. Lactose, protein, fat, and total calorie levels were obtained using a human milk analyzer. Procedures were repeated three times, once per month. The Pearson correlation coefficient was used for statistical analysis.
Results: Forty participants were enrolled in this study. There was a positive correlation between breastmilk total calories and head circumference growth during the first (p = 0.039), second (p = 0.020), and third month (p = 0.020). Breastmilk protein level was positively correlated with body length (p < 0.05) and head circumference (p < 0.05) during the first month. There was no correlation between body weight and breastmilk macronutrients or total calories (p > 0.05).
Conclusion: Breastmilk macronutrient levels correlate to infant growth in a unique pattern. Total calories and first month protein correlated positively with infant head circumference. However, calorie source, e.g., lactose or fat, did not correlate with infant body weight and length.
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2 Koletzko B, Chourdakis M, Grote V, Hellmuth C, Prell C, Rzehak P, et al. Regulation of early human growth: impact on long-term health. Ann Nutr Metab 2014;65:101-9.
3 American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG). Breastfeeding Handbook for Physicians. 2nd ed. Washington, DC: AAP; 2014.
4 Schwarzenberg SJ, Georgieff MK, Committee on nutrition. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics 2018;141:e20173716.
5 Prentice P, Ong KK, Schoemaker MH, van Tol EAF, Vervoort J, Hughes IA, et al. Breast milk nutrient content and infancy growth. Acta Paediatr 2016;105:641-7.
6 Kim J, Donovan SM. Human milk: composition and nutritional value. In: Caballero PM, Finglas PM, Toldrá, editors. Encyclopedia of Food and Health. Amsterdam: Elsevier; 2016. p. 357-62.
7 Ballard O, Morrow AL. Human milk composition. Pediatr Clin North Am 2013;60:49-74.
8 Gruca MA. Breast milk macronutrient composition and infant growth in rural west Africa. [dissertation on the internet]. Boulder, CO, USA: University of Colorado; 2017. [cited 18 July 2019]. Availble from: https://scholar.colorado.edu/anth_gradetds/66/
9 Rudolph MC, Young BE, Lemas DJ, Palmer CE, Hernandez TL, Barbour LA, et al. Early infant adipose deposition is positively associated with the n-6 to n-3 fatty acid ratio in human milk independent of maternal BMI. Int J Obes 2017;41:510-7.
10 Haider R, Saha KK. Breastfeeding and infant growth outcomes in the context of intensive peer counselling support in two communities in Bangladesh. Int Breastfeed J 2016;11:1-10.
11 Saure C, Armeno M, Barcala C, Giudici V, Mazza CS. Excessive weight gain in exclusively breast-fed infants. J Pediatr Endocrinol Metab 2017;30:719-24.
12 Geddes D, Hassiotou F, Wise M, Hartmann P. Human milk composition and function in the infant. In: Polin RA, Abman SH, Rowitch DH, Benitz WE, Fox WW, editors. Fetal and Neonatal Physiology. 5th ed. Amsterdam: Elsevier; 2017.p.273-80.e3. https://doi.org/10.1016/B978-0-323-35214-7.00026-3.
13 Bartholomeusz HH, Courchesne E, Karns CM. Relationship between head circumference and brain volume in healthy normal toddlers, children, and adults. Neuropediatrics 2002;33:239-41.
14 Baker J, Workman M, Bedrick E, Frey MA, Hurtado M, Pearson O. Brains versus brawn: an empirical test of barkers brain sparing model. Am J Hum Biol 2010;22:206-15.
15 Aumeistere L, Ciprovica I, Zavadska D, Celmalniece K. Lactose content of breast milk among lactating women in Latvia. Foodbalt 2017.p.169-73. https://doi.org/10.22616/foodbalt.2017.023.
16 Chang N, Jung JA, Kim H, Jo A, Kang S, Lee SW, et al. Macronutrient composition of human milk from Korean mothers of full term infants born at 37-42 gestational weeks. Nutr Res Pract 2015;9:433-8.
17 Quinn EA, Largado F, Power M, Kuzawa CW. Predictors of breast milk macronutrient composition in Filipino mothers. Am J Hum Biol 2012;24:533-40.
18 Huynh DTT, Tran NT, Nguyen LT, Berde Y, Low YL. Impact of maternal nutritional supplementation in conjunction with a breastfeeding support program on breastfeeding performance, birth, and growth outcomes in a Vietnamese population. J Matern Fetal Neonatal Med 2018;31:1586-94.
19 Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr 2014;14:216.
20 Sever O, Mandel D, Mimouni FB, Marom R, Cohen S, Lubetzky R. Macronutrients in human milk: colostrum lactose but not fat or protein predicts mature human milk content. ICAN Infant, Child, Adolesc Nutr 2015;7:162-5.
21 Kurniati AM, Sunardi D, Sungkar A, Bardosono S, Kartinah NT. Associations of maternal body composition and nutritional intake with fat content of Indonesian mothers’ breast milk. Paediatr Indones 2016;56:298-304.
22 Yang T, Zhang L, Bao W, Rong, S. Nutritional composition of breast milk in Chinese women: a systematic review. Asia Pac J Clin Nutr 2018;27:491-502.
23 Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr 2014;14:216.
24 García-Lara NR, Escuder-Vieco D, García-Algar O, De la Cruz J, Lora D, Pallás-Alonso C. Effect of freezing time on macronutrients and energy content of breastmilk. Breastfeed Med 2012;7:295-301.
25 Lubetzky R, Sever O, Mimouni FB, Mandel D. Human milk macronutrients content: effect of advanced maternal age. Breastfeed Med 2015;10:433-6.
26 Coviello C, Keunen K, Kersbergen KJ, Groenendaal F, Leemans A, Peels B, et al. Effects of early nutrition and growth on brain volumes, white matter microstructure, and neurodevelopmental outcome in preterm newborns. Pediatr Res 2018;83:102-10.
27 Stam J, Sauer PJ, Boehm G. Can we define an infant’s need from the composition of human milk? Am J Clin Nutr 2013;98:521S-8S.
28 Martin CR, Ling PR, Blackburn GL. Review of infant feeding: key features of breast milk and infant formula. Nutrients 2016;8: 279.
29 Koletzko B, von Kries R, Closa R, Escribano J, Scaglioni S, Giovannini M, et al. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr 2009;89:1836-45.
30 Ziegler EE. Growth of breast-fed and formula-fed infants. Nestle Nutr Workshop Ser Pediatr Program 2006;58:51-63.