Relationship Between Maternal Age and Macronutrient Content of Colostrum.

BACKGROUND: Little is known about the relationship between maternal age and the macronutrient content of colostrum. RESEARCH AIMS: This study aimed to evaluate the relationship between maternal age and human milk macronutrient content by comparing the concentrations of lactose, proteins, and lipids in the colostrum of women with younger, moderate, and advanced maternal age. METHODS: An observational, cross-sectional study was designed to compare the macronutrient concentrations in the colostrum of women aged < 20 years, 20 to 34 years, and > 34 years (younger, moderate, and advanced maternal age, respectively; n = 33 per group). For each participant, 3 ml of colostrum was collected by manual extraction from the right breast at 10 am, 39-48 hr after delivery, and analyzed using a Miris Human Milk Analyzer. Macronutrient concentrations were compared between the groups using analysis of variance. P < 0.05 was considered significant. RESULTS: Mothers with moderate maternal age had a higher colostrum lipid concentration than those with younger or advanced maternal age (2.3 mg, SD = 1.4 mg vs. 1.5 mg, SD = 1.0 mg vs. 1.6 mg, SD = 0.9 mg, respectively; p = 0.007). Lactose and protein contents in the analyzed samples did not differ among the three study groups. CONCLUSION: This study lends support to the potential variation of lipids in colostrum by maternal age and suggests individual adaptation to the nutritional components of milk to the needs of the infant may be beneficial.

Nutritional composition of human milk and its association with maternal and perinatal factors / Composição nutricional do leite humano e sua associação com fatores maternos e perinatais

ABSTRACT Objective: The objective of this study was to evaluate the influence of maternal and perinatal factors on the nutritional composition of human milk. Methods: A cross-sectional study was conducted between November 2018 and January 2020, with 181 donors selected in Tertiary Health Units of the Unified Health System — from one collection station and five Human Milk Banks. Data were collected through a standardized questionnaire. To be fit to be a donor in a Human Milk Banks and produce mature milk were the eligibility criteria to participate in the study. We excluded milk samples with Dornic acidity above 8° D. The dependent variables were the macronutrients of human milk (i.e., carbohydrates, proteins, lipids, and total energy), that were analyzed using spectroscopy with the Miris Human Milk Analyzer™. The maternal and perinatal factors were the independent variables. Results: Women with pre-gestational obesity and gestational weight gain above the recommendation showed a lower protein concentration compared to eutrophic women (median=0.8, interquartile range (IQR): 0.7-0.9 vs. median=0.8, and IQR: 0.8-1.0) and those with adequate gestational weight gain (median=0.8, IQR: 0.7-0.9 vs. median=0.9, and IQR: 0.8-1.0), respectively. The other analyzed factors (i.e., maternal habits, comorbidities, and perinatal factors) were not associated with the nutritional composition of human milk. Conclusions: The assessment of factors associated with the nutritional composition of human milk is extremely important to assist postpartum care. Pre-gestational obesity and inadequate gestational weight gain were the only factors statistically associated with the nutritional composition of human milk as they impacted its protein content.

RESUMO Objetivo: Avaliar a influência de fatores maternos e perinatais na composição nutricional do leite humano. Métodos: Estudo transversal, realizado entre novembro de 2018 e janeiro de 2020, com 181 doadoras selecionadas em Unidades Terciárias de Saúde do Sistema Único de Saúde de um Posto de Coleta e cinco Bancos de Leite Humano. Foram coletados dados das variáveis maternas e dos recém-nascidos por meio de questionário padronizado. Estar apta para ser doadora em um Banco de Leite Humano e produzir leite maduro foram os critérios de elegibilidade para participar do estudo. As amostras de leite com acidez Dornic acima de 8° D foram excluídas. Os macronutrientes do leite humano, variáveis dependentes (carboidratos, proteínas, lipídeos, energia total) foram analisados pela técnica de espectroscopia de transmissão no infravermelho médio com o Miris Human Milk Analyzer™. Os fatores maternos e perinatais foram as variáveis independentes. Resultados: Mulheres com obesidade pré-gestacional e ganho de peso gestacional acima do recomendado apresentaram menor concentração proteica em relação às eutróficas (mediana=0,8, intervalo interquartil [IQR]: 0,7-0,9 vs. mediana=0,8, IQR: 0,8-1,0) e aquelas com ganho de peso gestacional adequado (mediana=0,8, IQR: 0,7-0,9 vs. mediana=0,9, IQR: 0,8-1,0), respectivamente. Os demais fatores analisados (hábitos maternos, comorbidades, fatores perinatais) não se associaram com a composição nutricional do leite humano. Conclusões: A avaliação dos fatores associados à composição nutricional do leite humano é de extrema importância para auxiliar os cuidados pós-parto. A obesidade pré-gestacional e o ganho de peso gestacional inadequado foram os únicos fatores estatisticamente associados com a composição nutricional do leite humano por terem impactado o seu teor de proteína.

Nutritional composition of human milk and its association with maternal and perinatal factors.

OBJECTIVE: The objective of this study was to evaluate the influence of maternal and perinatal factors on the nutritional composition of human milk. METHODS: A cross-sectional study was conducted between November 2018 and January 2020, with 181 donors selected in Tertiary Health Units of the Unified Health System - from one collection station and five Human Milk Banks. Data were collected through a standardized questionnaire. To be fit to be a donor in a Human Milk Banks and produce mature milk were the eligibility criteria to participate in the study. We excluded milk samples with Dornic acidity above 8° D. The dependent variables were the macronutrients of human milk (i.e., carbohydrates, proteins, lipids, and total energy), that were analyzed using spectroscopy with the Miris Human Milk Analyzer™. The maternal and perinatal factors were the independent variables. RESULTS: Women with pre-gestational obesity and gestational weight gain above the recommendation showed a lower protein concentration compared to eutrophic women (median=0.8, interquartile range (IQR): 0.7-0.9 vs. median=0.8, and IQR: 0.8-1.0) and those with adequate gestational weight gain (median=0.8, IQR: 0.7-0.9 vs. median=0.9, and IQR: 0.8-1.0), respectively. The other analyzed factors (i.e., maternal habits, comorbidities, and perinatal factors) were not associated with the nutritional composition of human milk. CONCLUSIONS: The assessment of factors associated with the nutritional composition of human milk is extremely important to assist postpartum care. Pre-gestational obesity and inadequate gestational weight gain were the only factors statistically associated with the nutritional composition of human milk as they impacted its protein content.

Fatores maternos e perinatais associados à composição nutricional do leite humano de doadoras de Banco de Leite Humano / Maternal and perinatal factors associated with the nutritional composition of human milk from Human Milk Bank donors

Objetivo: Avaliar a associação do sexo do neonato e a composição nutricional do leite humano e os principais fatores maternos e perinatais associados a composição nutricional do leite humano de doadoras de Bancos de Leite Humano. Métodos: O presente estudo foi realizado em duas fases. Para avaliar a associação entre o sexo do neonato e a composição nutricional do leite humano foi realizada uma revisão sistemática da literatura expressa na forma de um relatório breve e para os fatores peri e neonatais foi realizado um estudo transversal, entre Novembro de 2018 e Janeiro de 2020, com 181 doadoras de um Posto de Coleta, de quatro Bancos de Leite Humano do município do Rio de Janeiro e um de Duque de Caxias. Para a coleta de dados foi aplicado um questionário padronizado que continha questões maternas e do recém-nascido. A variável dependente do estudo foi a composição nutricional do leite humano (proteína, lipídio, carboidrato e energia). As variáveis independentes do estudo foram a idade, o uso de álcool, o fumo, a presença de morbidades maternas (hipertensão arterial e diabetes mellitus), o estado nutricional pré-gestacional, o ganho de peso gestacional, o sexo do neonato, o tipo de parto e a idade gestacional no parto. Para análise da composição nutricional do leite maduro, as amostras classificadas com acidez igual ou inferior a 8º D pelo método de Dornic, tiveram a sua composição nutricional analisada pelo aparelho Miris™ Human Milk Analyzer que utiliza tecnologia baseada na transmissão de espectroscopia no infravermelho médio. Resultados: Sobre a influência do sexo do neonato na composição nutricional do leite humano, quatro dos cinco estudos selecionados observaram que o leite de mães de meninos possuíram maiores teores de lipídios e/ou de energia em relação ao das mães de meninas. Quando observada a composição nutricional em relação aos fatores maternos e perinatais, a obesidade pré-gestacional e o ganho de peso gestacional acima do recomendado foram associados à redução da quantidade proteica no leite humano das doadoras de Banco de Leite Humano. Conclusão: Foi possível observar que importantes fatores maternos e perinatais reduziram a quantidade de proteinas do leite humano. Recomenda-se que esse conhecimento seja incorporado no manejo clínico dos profissionais de saúde, sobretudo, os que exercem suas atividades nos Bancos de leite humano, a fim de auxiliar no manejo do leite para os recém-nascidos internados. Outrossim, é de extrema importância que a avaliação nutricional das mulheres seja uma atividade incorporada rotineiramente nas consultas periconcepcionais e no pré-natal.

To avaluate the association of newborn gender and nutritional composition of human milk and the main maternal and perinatal factors associated with the nutritional composition of human milk from human milk banks. Methods: The present study was carried out in two phases. To assess the role of the neonate gender on a nutritional composition of human milk, a systematic review of the literature was carried out, showing a brief report and for the peri and neonatal factors carried out in a cross-sectional study between November 2018 and January 2020, with 181 donors from a Collection Station, four human milk banks in the city of Rio de Janeiro and one from Duque de Caxias. For data collection, a standardized questionnaire was applied that contains maternal and newborn questions. A dependent variable of the study was a nutritional composition of human milk (protein, lipid, carbohydrate and energy). As independent variables in the study were: age, alcohol use, smoking, presence of maternal morbidities (hypertension and diabetes mellitus), pre-gestational nutritional status, gestational weight gain, gender of the newborn, type of delivery and age gestational childbirth. For analysis of the nutritional composition of mature milk, as samples classified with acidity equal to or less than 8º D by the Dornic method, their nutritional composition was analyzed by the Miris™ Human Milk Analyzer device that uses the technology used in mid-infrared spectroscopy. Results: About the influence of the gender of neonate on the nutritional composition of human milk, four of the five selected studies observed that the milk of mothers of boys had higher levels of lipids and / or energy in relation to that of mothers of girls. When observing the nutritional composition in relation to maternal and perinatal factors, pre-gestational obesity and higher than recommended gestational weight gain were associated with a reduction in the amount of protein in human milk from Human Milk Bank donors. Conclusion: It was possible to observe that important maternal and perinatal factors reduced the amount of proteins in human milk. It is recommended that this knowledge be incorporated into the clinical management of health professionals, especially those who work in human milk banks, in order to assist in the management of milk for hospitalized newborns. Furthermore, it is extremely important that the nutritional assessment of women is an activity incorporated routinely in periconceptional consultations and in prenatal care.