Human Milk: Composition, Clinical Benefits and Future Opportunities

Description

Human milk contains all of the essential nutrients and other functional components thought to have short- and long-term neonatal health benefits, such as positive biological effects on growth, metabolism, cognition, and immunity. This publication brings together the world’s experts who touch on the spectrum of current knowledge, from the history and mechanics of breastfeeding, its physiological and clinical effects, to the new surprises revealed by metabolomics and comparative biology. One of the key points made is that human milk is not only a source of essential nutrients, but also contains a variety of bioactive substances. These include essential microbes, long-chain fatty acids, complex oligosaccharides, nucleotides, and bioactive signaling proteins and hormones. This book provides clinicians and researchers with useful insights from multiple perspectives on the various aspects of human milk and lactation.

Cover 2
Front Matter 5
Contents 7
Preface 9
Foreword 12
Contributors 14
State of Breastfeeding in the World 19
- Scientific Evidence for Breastfeeding 19
  - Abstract 19
  - Breastfeeding and Mammalian Evolution 20
  - Introduction 20
  - Breast Milk Composition as the Gold Standard for Infant Nutritional Needs 21
  - The Benefits of Breastfeeding Revisited 24
  - Overview 29
  - Disclosure Statement 29

Cover 2
Front Matter 5
Contents 7
Preface 9
Foreword 12
Contributors 14
State of Breastfeeding in the World 19
- Scientific Evidence for Breastfeeding 19
  - Abstract 19
  - Breastfeeding and Mammalian Evolution 20
  - Introduction 20
  - Breast Milk Composition as the Gold Standard for Infant Nutritional Needs 21
  - The Benefits of Breastfeeding Revisited 24
  - Overview 29
  - Disclosure Statement 29
  - References 29
- The Biomechanics of Breastfeeding: Bridging the Gap between Engineering-Based Studies and Clinical Practice 31
  - Abstract 31
  - Introduction 32
  - What We Already Know 32
  - Engineering-Based Approaches to Modelling Milk Removal from the Breast 35
  - Validity of the Engineering-Based Mathematical Models 44
  - Key Physiological Features Not Included in Models 45
  - Which Force Is Primary in Causing Milk Removal from the Breast? 46
  - A Final Piece of Evidence 47
  - Clinical Implications of the “Revised Suckling Physiology” 48
  - Disclosure Statement 49
  - References 49
- Summary on State of Breastfeeding in the World 51
Human Milk Composition and Physiological Benefits 53
- Physiological Effects of Feeding Infants and Young Children Formula Supplemented with Milk Fat Globule Membranes 53
  - Abstract 53
  - Introduction 54
  - Physiological Effects of Single Components of the Milk Fat Globule Membrane 54
  - Clinical Studies on Milk Fat Globule Membrane Concentrates Fed to Infants and Children 55
  - Conclusions 58
  - References 59
  - Disclosure Statement 59
- Human Milk Oligosaccharides: Factors Affecting Their Composition and Their Physiological Significance 61
  - Introduction 61
  - Abstract 61
  - Maternal Glycosyltransferase Polymorphisms Affect HMO Composition 62
  - HMO Composition and Maternal Diet, Gestational Age, and Physiological State of the Infant 65
  - Disclosure Statement 71
  - Conclusion 71
  - Acknowledgment 71
  - References 72
- Fatty Acids and Fat-Soluble Vitamins in Breast Milk: Physiological Significance and Factors Affecting Their Concentrations 75
  - Abstract 75
  - Introduction 75
  - Human Milk Fatty Acids 76
  - Fat-Soluble Vitamins of Human Milk 80
  - Conclusion 83
  - Acknowledgment 84
  - Disclosure Statement 84
  - References 84
- Water-Soluble Vitamins in Human Milk: Factors Affecting Their Concentration and Their Physiological Significance 87
  - Abstract 87
  - Introduction 88
  - Forms in Human Milk, Effects of Maternal Status, and Relationship to Infant Function 88
  - Concentration Changes during Lactation 93
  - Effects of Maternal Supplementation or Food Fortification 94
  - Conclusions 96
  - References 97
  - Disclosure Statement 97
  - Funding Sources 97
  - Acknowledgments 97
- Human Milk MicroRNAs/Exosomes: Composition and Biological Effects 101
  - Introduction 101
  - Abstract 101
  - MicroRNAs 102
  - Exosomes in Milk 102
  - Origin of Milk MicroRNAs and Variation during Lactation 104
  - Effect of Digestion on Milk Exosomes 105
  - Cellular Uptake of Exosomes/MicroRNAs 106
  - Functions of Breast Milk MicroRNAs 107
  - Disclosure Statement 109
  - References 109
  - Conclusions 109
- Human Milk Proteins: Composition and Physiological Significance 111
  - Abstract 111
  - Introduction 111
  - Human Milk Protein Composition 112
  - Biological Activities of HM Proteins 114
  - Disclosure Statement 118
  - References 118
  - Future Directions 118
- Summary on Human Milk Composition and Physiological Benefits 121
Clinical Aspects of Human Milk on Infant Health Outcomes 125
- Early-Life Nutrition, Growth Trajectories, and Long-Term Outcome 125
  - Abstract 125
  - Introduction 126
  - Very-Low-Birth-Weight Infants 127
  - Breastfed Infants from Developing Countries – Stunting 130
  - Is Low Protein Intake during the Breastfeeding Period and Beyond a Factor That Contributes to Obesity Prevention? 133
  - Disclosure Statement 136
  - References 136
  - Conclusions 136
- Early-Life Nutrition and Cognitive Development: Imaging Approaches 139
  - Abstract 139
  - Introduction 140
  - Nutrition in Early Brain Development 141
  - Noninvasive Imaging Approaches 144
  - Gut-Brain Axis 150
  - Disclosure Statement 151
  - References 151
  - Conclusions 151
- Early-Life Nutrition and Gut Immune Development 155
  - Introduction 155
  - Abstract 155
  - Gut Immune Ontogeny 156
  - Impact of Nutrition on Gut Mucosal Immune Ontogeny through Microbiota Shaping 158
  - Direct Impact of Nutrition on Gut Mucosal Immune Ontogeny 162
  - Acknowledgments 165
  - Disclosure Statement 165
  - Conclusion 165
  - Funding Sources 165
  - References 166
- Early-Life Nutrition and Microbiome Development 169
  - Abstract 169
  - The Gut Barrier and the Healthy Microbiota 170
  - Gut Microbiota: A Target for Preventive and Therapeutic Measures? 170
  - Infant Gut Microbiota: Origin and Determinants of the Composition 171
  - Optimal Nutrition for the Healthy Microbiome 174
  - References 178
  - Disclosure Statement 178
- Human Milk and Clinical Outcomes in Preterm Infants 181
  - Introduction 181
  - Abstract 181
  - LOVE MOM Cohort 182
  - Results 187
  - Discussion 187
  - Disclosure Statement 191
  - References 191
  - Conclusion 191
- Summary on Clinical Aspects of Human Milk on Infant Health Outcomes 193
  - References 196
- Research Gap and Opportunities 197
  - Metabolomics in Human Milk Research 197
    - Abstract 197
    - Introduction 197
    - Conclusions 206
    - Acknowledgment 206
    - Disclosure Statement 206
    - References 207
  - Human Milk Oligosaccharides: Next-Generation Functions and Questions 209
    - Abstract 209
    - What Are Human Milk Oligosaccharides? 209
    - What Drives the Variation in HMO Composition? 212
    - What Happens to HMOs after Ingestion? 213
    - What Are Potential HMO Functions? 213
    - How Do We Interrogate the Effects of HMOs? 215
    - Disclosure Statement 218
    - References 218
  - Guiding Development of the Neonate: Lessons from Mammalia 221
    - Abstract 221
    - Introduction 222
    - Regulation of the Tammar Lactation Cycle 225
    - The Role of Milk Bioactives in Development of Specific Tissues in the Suckled Tammar Neonate 226
    - Human Milk Bioactivity: Acute Response to Challenge and Potential for Breast-Programmed Development 229
    - Mechanisms for Delivery of Bioactivity in Milk 229
    - Conclusion 231
    - A Comparison of Tammar and Human Databases to Identify Human Colostrum, Milk, Placental, and Amniotic Fluid Bioactives 231
    - Disclosure Statement 232
    - References 232
  - Milk Lipids: A Complex Nutrient Delivery System 235
    - Abstract 235
    - Assembling Lipid Particles in the Mammary Epithelia 236
    - Introduction 236
    - Milk Fat Globule Disassembly 238
    - Lipids as Metabolic Signals 240
    - Conclusions 241
    - Disclosure Statement 242
    - References 242
    - Acknowledgements 242
  - Summary on Research Gap and Opportunities 245
- Subject Index 247
- Cover 253

90th Nestlé Nutrition Institute Workshop, Lausanne, October-November 2017

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