Elsevier

Nutrition

Volume 62, June 2019, Pages 158-161
Nutrition

Applied nutritional investigation
Breast milk: To each his own. From metabolomic study, evidence of personalized nutrition in preterm infants

https://doi.org/10.1016/j.nut.2018.12.015Get rights and content

Highlights

  • We present major evidence for a need of personalized nutrition in preterm infants.

  • The composition of milk from mothers delivering prematurely differs from full-term mature milk and changes over time.

  • Nuclear magnetic resonance spectroscopy identifies higher levels of lactose and oligosaccharides in preterm milk samples than term.

  • The preterm milk metabolome pattern changes during the first 3 wk after birth but still does not resemble the term milk pattern.

  • Understanding the peculiar characteristics of human preterm breast milk is crucial to attain tailored, individualized enteral nutrition in preterm infants.

Abstract

Objectives

The composition of milk from mothers delivering prematurely differs from that of full-term mature milk and changes over time. The aim of this study is to test the hypothesis that changes in milk metabolomic profile from mothers delivering prematurely persist over time when compared with mothers delivering at term.

Methods

Nuclear magnetic resonance spectroscopy was used to analyze the metabolome pattern of human milk samples collected from 18 mothers. Twelve mothers collected 12 term milk samples (one for each mother) once between 4 and 7 d after delivery. Six mothers delivering prematurely (29–31 wk of gestational age) and collected three samples each, once a week after delivery until the third week after birth.

Results

Principal component analysis identified two distinct metabolite groups, one represented by the 18 preterm milk samples and the other by term milk samples. Metabolite profiling identified that lactose and oligosaccharide levels were significantly more represented in preterm than in milk term samples.

Conclusions

The preterm milk metabolome pattern undergoes maturation during the first 3 wk after birth, but at the end of the third week it still does not resemble the term milk pattern. The specific changes in mothers’ milk metabolomic profiles according to their offspring might reflect the different nutritional requirement of each preterm infant. This knowledge is crucial to move from standardized nutritional protocols to tailored, individualized nutrition in preterm infants.

Introduction

Human milk is the best nourishment for the healthy growth and development of infants [1], [2]. Milk is species specific and has a dynamic composition in terms of nutritive components and non-nutritive bioactive factors [3] that makes it uniquely suited for feeding infants [4]. The benefits of breastfeeding on children's health are numerous, but, according to European Society for Pediatric Gastroenterology Hepatology and Nutrition, the most documented effect is the reduced risk of infectious diarrhea and acute otitis media [2]. Besides these advantages, some studies have found that breastfed infants have better short- and long-term outcomes compared with those of formula-fed infants [5], [6]. Formula-fed infants have different growth patterns, nutritional status, and gut microbiota that may be associated with higher risk of obesity, diabetes, and cardiovascular diseases later in life. Even with all the current attempts to modify the composition of infant formulas to make them more similar to human milk, huge differences persist between these two kinds of milk [7], [8], [9].

Just as in the case of term infants, the first choice of nourishment for preterm newborns should be the mother's own milk, and when this is not available, either at all or in sufficient quantity, donor milk from lactating mothers represents the next best choice [10].

Recently we reported that there is a clear difference in the composition of milk collected from mothers delivering extremely preterm (23–25 wk of gestational age [GA]) compared with term births. Furthermore, we found a common temporal variation in the first 3 wk of lactation of preterm deliveries. The milks tend to have very similar properties to that collected around the 30th week of postnatal age [8]. These data suggested that, after 3 wk of lactation, the milk composition seems to be more homogeneous as its “maturation” reaches completion.

The present study aims to evaluate whether the milk of mothers who delivered at a mean GA of 30 (more mature milk) had a similar composition to that collected from mothers with term delivery. In particular, we aimed to assess whether and when the metabolic profiles of milk samples from mothers of premature infants resembled the metabolic profiles of term mature milk, sampling weekly until the third week of postnatal age.

Section snippets

Materials and methods

Using nuclear magnetic resonance (NMR) spectroscopy, we analyzed 30 milk samples, obtained from 18 mothers delivering between the 29th and 41st wk of GA and collected directly from the milk bank of Santa Maria alle Scotte Hospital in Siena, Italy, from January 2013 to August 2015. Written informed consent was obtained from all the enrolled mothers.

Mothers were Caucasian, healthy, and had a similar home environment. They did not smoke or consume alcohol or drugs. All mothers had a similar

Results

Partial least squares regression discriminant analysis performed on autoscaled data indicated a distinct grouping of milk samples and a significant difference between the metabolic profiles of milk from mothers with preterm delivery and the milk from mothers of term infants, at least until the fourth week (Fig. 3).

Profiling analysis led to the identification of the metabolite as lactose (4.46 ppm), which is present in higher concentration in preterm milk samples. Furthermore, milk samples from

Discussion

Human breast milk does not have a single composition but rather changes over time, from colostrum to transitional milk and finally to mature milk, during the course of lactation [2]. Understanding the composition of human milk therefore provides an important tool for planning infants’ feeding, particularly for fragile, high-risk infants such as those born preterm [3]. Metabolomics should be considered as a key technology for this purpose. Measuring in a quantitative manner the complete set of

Conclusions

Our results contribute to understanding the peculiar nutritional needs of breastfed preterm newborns. The high content of oligosaccharides in preterm breast milk, assessed through metabolomic investigation, provides new insights about dietary modification to attain precise and specific nutritional characteristics of preterm breast milk. From the point of view of precision medicine, to promote proper growth, it is desirable that preterm infants receive their own mother's milk or at least donor

Acknowledgments

The authors thank the EURope Against Infant Brain Injury (EURAIBI) foundation for its partial grant.

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    This work was partially funded by the EURope Against Infant Brain Injury (EURAIBI) foundation.

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