Urinary Metabolomic Differentiation of Infants Fed on Human Breastmilk and Formulated Milk.

Human breastmilk is an invaluable nutritional and pharmacological resource with a highly diverse metabolite profile, which can directly affect the metabolism of infants. Application of metabolomics can discriminate the complex relationship between such nutrients and infant health. As the most common biological fluid in metabolomic study, infant urinary metabolomics may provide the physiological impacts of different nutritional resources, namely human breastmilk and formulated milk. In this study, we aimed to identify possible differences in the urine metabolome of 30 infants (1-14 days after birth) fed with breast milk (n = 15) or formulated milk (n = 15). From metabolomic analysis with gas chromatography-mass spectrometry, 163 metabolites from single mass spectrometry (GC-MS), and 383 metabolites from tandem mass spectrometry (GC-MS/MS) were confirmed in urinary samples. Various multivariate statistical analysis were performed to discriminate the differences originating from physiological/nutritional variables, including human breastmilk/formulate milk feeding, sex, and duration of feeding. Both unsupervised and supervised discriminant analyses indicated that feeding resources (human breastmilk/formulated milk) gave marginal but significant differences in urinary metabolomes, while other factors (sex, duration of feeding) did not show notable discrimination between groups. According to the biomarker analyses, several organic acid and amino acids showed statistically significant differences between different feeding resources, such as 2-hydroxyhippurate.

Biochemical Profiling of Urine Metabolome in Premature Infants Based on LC-MS Considering Maternal Influence.

In this study, Liquid Chromatography-Mass Spectrometry (LC-MS)-based metabolomics profiling was conducted to elucidate the urinary profiles of premature infants during early and late postnatal stages. As a result, we discovered significant excretion of maternal drugs in early-stage infants and identified crucial metabolites like hormones and amino acids. These findings shed light on the maternal impact on neonatal metabolism and underscore the beneficial effects of breastfeeding on the metabolism of essential amino acids in infants. This research not only enhances our understanding of maternal-infant nutritional interactions and their long-term implications for preterm infants but also offers critical insights into the biochemical characteristics and physiological mechanisms of preterm infants, laying a groundwork for future clinical studies focused on neonatal development and health.

Maternal Factors Affecting the Macronutrient Composition of Transitional Human Milk.

This study investigated the influence of selected maternal factors on the macronutrient composition and energy of human milk (HM). The study enrolled 159 breastfeeding mothers from five postpartum care centers in Seoul, Korea. Their gestational weeks were 37−42 weeks, they had no complications before and after childbirth, and were at 7−14 days postpartum. They provided data using structured questionnaires on general characteristics, stress, sleep quality, spousal support, and dietary intake. Breastfeeding assessment (LATCH) was investigated by qualified nurses, and each mother provided one sample of HM. The HM composition was analyzed using the Miris® HM analyzer. The relationships between variables were analyzed using Pearson's correlation analysis, and a linear regression analysis was performed to verify the main variables. It was found that maternal dietary intake was related to HM composition as the %energy from carbohydrates (ß = 0.86, p < 0.01) and %energy from fat (ß = 0.77, p < 0.05) showed positive relationships with HM energy. The LATCH score was positively related to HM energy (ß = 0.17, p < 0.05). In contrast, postpartum stress, sleep quality, and spousal support were not associated with HM macronutrient composition. In conclusion, HM macronutrients and energy content were associated with maternal dietary intake and LATCH scores, but not with postpartum stress, sleep quality, and spousal support.

The freeze-drying does not influence the proteomic profiles of human milk.

Purpose: Human milk (HM) proteins are known as important factors in growing and development of neonates. For longer and easier storage of HM, freeze-drying is suggested as one of the promising methods for HM banks. However, the effects of freeze-drying on HM proteins were not evaluated yet. The purpose of this study is to analyze and compare proteomic data before and after the freeze-drying.Material and methods: Totally nine fresh HM samples were collected from three healthy mothers at 15 and 60 days of lactation period. The samples were freeze-dried and the proteomic analysis was performed by shotgun proteomic method with mass spectrometry. The results were compared between samples of different lactation periods, and before and after the freeze-drying using Wilcoxon signed-rank test for paired comparisons. Moreover, the functional grouping and analysis were performed for the detected proteins by bioinformatics analysis.Results: Totally, 245 proteins were detected in the HM samples. The expression of proteins was not affected by both of the different lactation periods and the freeze-drying status (P>.050). Moreover, the functional analysis of proteomic data revealed no significant difference between both groups as well.Conclusion: HM proteins were found not to be significantly affected by the lactation periods (15 and 60 days) and freeze-drying status. As significant changes of HM proteins were not found after the freeze-drying, we hope that the present study would support introducing freeze-drying in the HM banks. However, the number of samples was quite small to provide strong evidence. Moreover, the evaluation of the safe storage length in the view of infectious agents and the composition changes after freeze-drying is warranted in the further study.

Mediating and Moderating Factors of Adherence to Nutrition and Physical Activity Guidelines, Breastfeeding Experience, and Spousal Support on the Relationship between Stress and Quality of Life in Breast Cancer Survivors.

Spousal support may attenuate stress in breast cancer survivors and improve their health-related quality of life (HRQoL). However, there is limited evidence of a relationship between spousal support, stress, and HRQoL in Asian populations. The current study examined whether spousal support, adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Survivors, and breastfeeding experience mediated or moderated the relationship between stress and HRQoL in Korean breast-cancer survivors. Between June 2016 and May 2018, 144 Korean women who survived breast cancer were recruited for the current cross-sectional study. Structured questionnaires and medical records were used to collect data. Structural equation modeling was used to examine mediating and moderating factors. Spousal support buffered the adverse effect of stress on HRQoL (ß= -0.22 for stress→spousal support; ß = 0.27 for spousal support→physical HRQoL; ß = 0.40 for spousal support→mental HRQoL). We found that adherence to ACS guidelines moderated the association between stress and HRQoL (ß = -0.14 for stress→mental HRQoL in high ACS adherence; ß = -0.79 for stress→mental HRQoL in low ACS adherence). Moreover, beta coefficients were -0.22 for stress→mental HRQoL in women with breastfeeding experience, and -0.71 in those without breastfeeding experience. In conclusion, spousal support mediated the association between stress and HRQoL and this association was moderated by both adherence to ACS guidelines and breastfeeding experience.

The human milk oligosaccharides are not affected by pasteurization and freeze-drying.

OBJECTIVES: Human milk oligosaccharides (HMOs) are known as important factors in neurologic and immunologic development of neonates. Moreover, freeze-drying seems to be a promising storage method to improve the processes of human milk banks. However, the effects of pasteurization and freeze-drying on HMOs were not evaluated yet. The purpose of this study is to analyze and compare the HMOs profiles of human milk collected before and after the pasteurization and freeze-drying. METHODS: Totally nine fresh human milk samples were collected from three healthy mothers at the first, second, and third week after delivery. The samples were treated with Holder pasteurization and freeze-drying. HMOs profiles were analyzed by matrix-assisted laser desorption/ionization (MALDI) time-of-flight/time-of-flight (TOF/TOF) mass spectrometry and compared between samples collected before and after the treatments. RESULTS: Human milk samples showed significantly different HMO patterns between mothers. However, HMOs were not affected by lactation periods within 3 weeks after delivery (r2 = 0.972-0.999, p < .001). Moreover, both of pasteurization and freeze-drying were found not to affect HMO patterns in a correlation analysis (r2 = 0.989-0.999, p < .001). CONCLUSION: HMO patterns were found not to be affected by pasteurization and freeze-drying of donor milks. We hope that introducing freeze-drying to the human milk banks would be encouraged by the present study. However, the storage length without composition changes of HMOs after freeze-drying needs to be evaluated in the further studies.

Content fat and calorie of human milk is affected by interactions between maternal age and body mass index.

PURPOSE: We evaluated the association between macronutrients of human milk (HM), and interactions between maternal age and body mass index(BMI) in matched conditions. MATERIAL AND METHODS: Totally, 80 HM samples were collected from healthy breast-feeding mothers at fourth week of lactation. HM macronutrients and maternal data were analyzed. Mothers were subgrouped into four groups by maternal age (20 s/30 s) and BMI (overweight/normal). RESULTS: Two-way ANOVA revealed significant interactions between age and BMI to affect macronutrients; fat, carbohydrate, and calories. Moreover, different responses of fat and calorie to BMI were found in different age groups. CONCLUSIONS: The evaluation of over- or under-weighted infants warrants considering both of maternal age and BMI.

Development of Korean Menstrual Symptom Scale for University Students.

PURPOSE: To develop Korean Menstrual Symptom Scale (KMSS) for university students and test its reliability and validity. METHODS: The scale was developed by intensive literature review, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of final items. Thirty-nine items were constructed. Data for validity and reliability testing were collected with a questionnaire survey from 391 university students. Data were analyzed with descriptive statistics, factor analysis, and reliability coefficients (Cronbach's α) with the SPSS program. RESULTS: There were 37 final items which were sorted into six factors: 'negative affection (8 items)', 'change of activity level (7 items)', 'physical symptom (9 items)', 'mood change (9 items)', 'change in concentration level (4 items)', and 'body water retention (5 items)'. The cumulative percent of variance was 63.3%. Regarding the reliability of the scale, its Cronbach's α was 0.96. Cronbach's α values for these factors ranged from 0.75 to 0.91. CONCLUSION: The KMSS demonstrated acceptable validity and reliability. Repeated research is needed to measure menstrual symptom experienced by women of variable ages.

Comparisons of proteomic profiles of whey protein between donor human milk collected earlier than 3 months and 6 months after delivery.

BACKGROUND AND OBJECTIVES: Human milk has nutritional, protective, and developmental advantages for premature infants. However, proteomic information of low abundant protein of donor milk is insufficient. The purpose of this study is to analyze and compare the proteome of low abundant protein of donor milk obtained at different postpartum ages other than the colostrum. METHODS AND STUDY DESIGN: Donor breast milk from 12 healthy mothers was collected 15 days, 2 months and 6 months after delivery and stored by medically approved methods. The whey milk proteomes were analyzed by mass spectrometry and classified using bioinformatics analysis. RESULTS: Human milk obtained 15 days and 2 months after delivery showed more abundant expression of whey proteins related to the generation of precursor metabolites and energy, metabolism, and catalytic activity, compared with milk collected at 3 months. Immune and transport-related proteins were abundant at all time points. Proteins involved in cellular movement, immune cell trafficking, and the carbohydrate metabolism network was more abundant in whey milk collected at 15 day and 2 months using a network analysis. CONCLUSIONS: We report proteomic information for human donor whey protein. As significant changes were found in whey proteome collected earlier than 2 months and 6 months after delivery, selecting human donor milk earlier than 2 months might be more helpful for early postnatal recipients.

Do gender and birth height of infant affect calorie of human milk? An association study between human milk macronutrient and various birth factors.

OBJECTIVE: The purpose of this study is to analyze the macronutrient of human milk (HM) and to find out the various maternal-infantile factors that can affect HM composition. METHODS: 478 HM samples were collected from healthy and exclusively breast-feeding mothers who delivered healthy term neonates within 3 months. Macronutrient of the samples was analyzed and the birth data were collected. RESULTS: In multivariate logistic regression analysis, various maternal-infantile factors were found to be associated with HM composition changes; higher fat: cesarean section (OR = 2.47, p < 0.001) and birth height (OR = 0.84, p = 0.004); higher protein: postpartum age (OR = 0.89, p < 0.001); higher carbohydrate: vaginal delivery (OR = 0.50, p = 0.005) and female infant (OR = 0.56, p = 0.012); higher calorie: postpartum age (OR = 0.95, p = 0.003), female infant (OR = 0.33, p = 0.017), and birth height (OR = 0.74, p < 0.001). Female infant (OR = 0.36, p = 0.029), birth height (OR = 0.73, p = 0.001), and postpartum age (OR = 0.95, p = 0.005) were found as independent risk factors for higher HM calorie. CONCLUSION: Various maternal-infantile factors were found to affect HM composition. Interestingly, delivery mode, gender of infant, and birth height were associated with changes in HM macronutrient as well as postpartum age.

Determination of Trace Metal Levels in the General Population of Korea.

The purpose of this study was to determine the levels of trace metals in the blood of the general Korean population. A total of 258 healthy individuals, according to their regular medical check-ups, (119 males and 139 females, age ranging from 12 to 78 years old) were enrolled from December 2014 to December 2016. Levels of 10 trace elements were determined using inductively coupled plasma mass spectrometry (ICP-MS). The geometric mean (GM) levels for lead, arsenic, cesium, mercury, aluminum, cadmium, copper, manganese, selenium, and zinc were 15.97 µg/L, 7.19 µg/L, 2.39 µg/L, 3.41 µg/L, 10.57 µg/L, 0.78 µg/L, 979.8 µg/L, 11.06 µg/L, 111.37 µg/L, and 872.7 µg/L, respectively. There were significant gender-related differences in the levels of several metals; male individuals had higher Pb, As, Cs, Hg, and Se than females, while females had higher Cd, Cu, and Mn than males. We noticed remarkably high blood levels of Hg, As and Al in the Korean population. The element concentrations reported represent a new contribution to the knowledge of the blood chemistry for the Korea population. The data can be used to assess the clinical health of this population.

Evaluation of sexuality education information for Korean adolescents.

The Internet has become clearly a powerful resource for sexual health information, especially among Korean adolescents. The purpose of this study was to explore the Korean adolescents' use and needs assessment for the information of sexuality education on Internet, and to investigate Korean university students' attitudes and knowledge toward sexuality, and the factors that influence sexuality attitudes and knowledge, and to evaluate for Internet sites related to sexuality education in Korean adolescents.

The evaluation criteria of internet health information.

The Internet has great powerful forces for health information and education. This describes the development of a web-based evaluation criteria for internet health information. The purpose of this study was to explore the evaluation criteria (tool) of internet health information for Korean. This utilized a cross-sectional design with four sections: (1) CAHPS (Consumer assessment of health plans studies); (2) Health consumer terminology and understanding review; (3) web based interactive tool construction; (4) semantic web technology application. The findings showed follows; (1) literature review related quality evaluation tool for internet health information; (2) case study; (3) development of evaluation prototype; (4) validity assessment of tool; (5) Evaluation system information strategic planning.

Korean university students' knowledge and attitudes toward breastfeeding: a questionnaire survey.

Infant feeding decisions depend on knowledge and attitudes toward breastfeeding. The purpose of this study was to explore Korean university students' knowledge and attitudes toward breastfeeding by gender and major. This was a cross-sectional comparative study among 341 university students. The instrument was a modified self-administered breastfeeding knowledge and attitudes questionnaire. Female students were slightly more knowledgeable and had somewhat more positive attitudes compared to male students. Students in health-related fields showed more knowledge than students in other disciplines, but their attitudes did not differ in majority. A significant correlation was found between the students' knowledge and their attitudes.

Evaluation of the breastfeeding intervention program in a Korean community health center.

A new model for the breastfeeding intervention program was implemented in a Korean community health center and the effectiveness of the program was evaluated. Thirty health care personnel from 29 smaller community health centers and 23 breastfeeding helpers were trained in four workshops. They then gave information on breastfeeding to pregnant and lactating women, living in each community in groups or individually. The breastfeeding rate after intervention has significantly increased at 1 week and 9 months of age. These results indicate that the community-based breastfeeding intervention program by training both the health care professionals and peer helpers is effective in promoting breastfeeding.

Associations of Breastfeeding Knowledge, Attitude and Interest with Breastfeeding Duration: A Cross-sectional Web-based Study.

PURPOSE: Maternal knowledge, positive attitudes and interest toward breastfeeding may improve the sustainability of breastfeeding. This study examined the associations of knowledge, attitudes, and interest toward breastfeeding with the duration of breastfeeding in Korean mothers who used the internet. METHODS: We conducted a cross-sectional study of 604 Korean mothers who breastfed their babies. Mothers were recruited through the internet and their knowledge, attitudes and interest toward breastfeeding were assessed using a web-based self-administered questionnaire. Geometric means and odds ratio (OR) with 95% confidence intervals were calculated. RESULTS: Higher knowledge, attitudes, and interest toward breastfeeding were associated with longer duration of breastfeeding in Korean mothers. In particular, mothers who had optimal breastfeeding duration were more likely to be aware of the easiness of breast milk stimulation and breastfeeding, the development of attachment between mother and child, and pleasure from breastfeeding compared to those mothers with shorter duration. The association with optimal breastfeeding duration was more pronounced among mothers who graduated from high school for total attitude scores and total interest scores, compared to mothers who graduated from college or above. CONCLUSION: The results of this study suggest that it is important to improve maternal knowledge, attitudes, and interest toward breastfeeding in Korean mothers who use the internet as a source of knowledge. Also, the study results imply that the development of strategies to target mothers with relatively low education levels may improve breastfeeding rates.

Breastfeeding Initiation and Continuation by Employment Status among Korean Women.

PURPOSE: The objective of this study was to examine the factors associated with initiation and continuation of breastfeeding among Korean women in relation to their employment status. METHODS: Data were collected using a web-based self-administered questionnaire from 1,031 Korean mothers living in Seoul with babies younger than 24 months. Demographic characteristics, education on breastfeeding, rooming in, breastfeeding during hospital stay, and breastfeeding knowledge were examined. Multivariate logistic regression analyses were performed to identify factors associated with initiation and continuation at 1, 6 and 12 months according to mothers' employment status. RESULTS: Breastfeeding initiation rates were similar regardless of mothers' employment status. Continuation rates decreased for both groups of mothers, but were significantly lower among employed mothers at all duration points. Unemployed mothers who were able to keep their babies in the same room during the hospital stay were more likely to initiate breastfeeding. The factor that was consistently associated with breastfeeding continuation for all duration points among unemployed mothers was whether the mother breastfed during the hospital stay. Higher knowledge scores and having an infant with atopic dermatitis were also associated with breastfeeding continuation at 6 months and 12 months, respectively for unemployed mothers, and receiving education on breastfeeding was associated with 12-month continuation for employed mothers. CONCLUSION: These results emphasize the significant roles of hospitals for breastfeeding initiation and continuation, with rooming-in, initial breastfeeding practice and education during hospital stay as important practices. In addition, for working mothers to continue their breastfeeding, significant support from the workplace is crucial.

Menopause Knowledge, Attitude, Symptom and Management among Midlife Employed Women.

OBJECTIVES: Midlife women's knowledge, positive attitudes and management toward menopause may improve the quality of peri and post-menopause life. This study was to identify correlations of the knowledge, attitude, symptoms and management toward menopause in middle-aged women. METHODS: We used a cross-sectional questionnaire study applying to 231 perimenopausal and menopausal women aged from 40 to 59 years old. The completed data of 189 perimenopausal and menopausal women were analyzed through t-test, ANOVA and pearson's correlation coefficient using the SPSS statistical programme. RESULTS: The menopausal women showed significantly higher physical symptoms than perimenopausal women. The menopausal women showed significantly higher psychosomatic symptom than perimenopausal women. There was a significant correlation between the menopausal attitude and management. CONCLUSION: This study suggests that the fundamental data of developing midlife women's symptom index (MSI) and providing menopause management could be a strategy to encourage successful menopausal transition in middle-aged women.

Student Experience and Satisfaction with Clinical Nursing Practice in Women's Health Nursing.

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.