report on the composition, volume and intake of breast milk

7/26/2019 Report on the Composition, Volume and Intake of Breast Milk

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Collate and review data on thecomposition and volume and intake of

breast milk

Results from a systematic literature review

Trudy MA Wijnhoven1, Caroline Bollars1, Garden Tabacchi2, and Maria Hermoso3

1 Nutrition, Physical Activity and Obesity Programme, Division of Non-communicable

Diseases and Health Promotion, World Health Organization Regional Office for Europe,

Copenhagen, Denmark

2 Institute of Physiology and Human Nutrition, University of Palermo, Palermo, Italy

3 Division of Metabolic Diseases and Nutritional Medicine. Dr. von Hauner Childrens

Hospital, Ludwig-Maximilians-University of Munich, Germany

RA 2.1: Infant Nutrition

Task 9

Funded by an EU FP6 Network of Excellence (EURRECA, grant no. FP 6-036196-2)


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Contents

Background....................................................................................................................................3Aim..................................................................................................................................................8Methods ..........................................................................................................................................9Results ..........................................................................................................................................11Discussion.....................................................................................................................................26Annex 1. PubMed: search strategy and results on 27/10/09 ....................................................27References ....................................................................................................................................30


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Background

Clinical and dietary surveys of presumably healthy populations, functional responses, optimal

intake approaches and nutrient balance calculations are the methods commonly used to estimate

nutritional requirements.1The World Health Organization (WHO) recommends exclusive

breastfeeding for six months, and thereafter sustained breastfeeding with appropriate

complementary feeding up to two years or beyond.2This recommendation was based on the

outcomes of a WHO expert consultation in 2001.3Two systematic literature reviews served as

the basis for this consultation. The first one focused on the optimal duration of exclusive

breastfeeding4and the second one focused on the nutrient adequacy of exclusive breastfeeding

for the term infant during the first six months of life.5

The latter systematic literature review included a table on nutrient intakes of exclusively

breastfed infants. The calculated nutrient intakes derived from human (breast) milk were based

on the mean milk intakes of exclusively breastfed infants from developed countries and breast

milk composition from well-nourished women, which were the results of studies carried out in

the 1980s1990s. Table 1 presents these results as was published in the report of the review.5

This review also provided an overview of the findings on the content of various nutrients, both

macro- and micronutrient, in breast milk: protein, vitamin A, vitamin D, vitamin B6(pyridoxine),

iron, calcium and zinc. The identified studies for the review showed the following results of

nutrient concentrations in breast milk (see also results section)5:

A concentration of proteinin mature breast milk varied from 8 to 10 g per litre.

Vitamin Aconcentrations varied with the stage of lactation and were strongly influenced by

maternal nutritional (vitamin A) status. It was estimated that mature milk of well-nourishedmothers contained approximately 1.7 moles/l of vitamin A.

Vitamin Dconcentrations in breast milk depend on maternal vitamin D status and are very

low. Various concentrations were found and the range varied from 0.16 g/l to 1.56 g/l.

The concentration of vitamin B6varied with maternal B6status and intake, length of

gestation, stage of lactation and the use of B6supplements. The mean vitamin B6

concentration in breast milk of women with B6intakes below 2.5 mg/day was estimated as

0.13 mg/l (778 nmol/l). Mean B6levels in breast milk of women with B6intakes between 2.5

and 5 mg/day were substantially higher approximately 0.24 mg/l.


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The concentration of irondeclined from 0.40.8 mg/l in colostrum to 0.20.4 mg/l in mature

breast milk.

Breast milk contained 250300 mg/l of calciumwith no pronounced changes during

lactation.

The concentration of zincdeclined from 45 mg/l in early milk, to 12 mg/l at 3 months

postpartum, and to 0.5 mg/l at 6 months.

Table 1Nutrient intakes derived from human milk, based on studies carried out in the 1980s

1990s.Age

(month)

Human

milk

intake

(g/day)

Human

milk

intake,

corrected

for

IWL*

(g/day)

Energy

(kcalth/day)

Protein

(g/day)

Vitamin A

(mol/day)

Vitamin

D

(ng/day)

Vitamin

B6

(mg/day)

Calcium

(mg/day)

Iron

(mg/day)

Zinc

(mg/day)

1 699 734 492 8.1 1.25 473 0.10 195 0.37 1.54

2 731 768 514 6.9 1.30 495 0.10 199 0.31 1.543 751 803 538 7.2 1.37 518 0.10 203 0.32 1.20

4 780 819 549 6.6 1.39 528 0.11 202 0.29 0.98

5 796 836 560 6.7 1.42 539 0.11 201 0.29 0.84

6 854 897 601 7.2 1.52 578 0.12 210 0.27 0.90

7 867 910 610 7.3 1.55 587 0.12 208 0.27 0.68

8 815 856 573 6.8 1.45 552 0.11 190 0.26 0.64

9 890 935 626 7.5 1.59 603 0.12 201 0.28 0.70

10 900 945 633 7.6 1.61 610 0.12 198 0.28 0.47

11 910 956 640 7.6 1.62 616 0.12 194 0.29 0.48

* IWL = insensible water losses.

Source: Adapted from World Health Organization, 2002.5

The Scientific Committee on Food (SCF) of the European Commission (EC) published in 2003

the results of an extensive literature review with the aim to revise the essential requirements of

infant formulae and follow-on formulae.6For this revision, the Committee made use of studies

that presented the composition of breast milk of healthy, well-nourished women. Information onthe breast milk content of the following nutrients (both macro- and micronutrients) was obtained:


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lactose, fat, vitamin A, vitamin D, vitamin E, vitamin K, vitamin B1(thiamin), vitamin B2

(riboflavin), vitamin B3(niacin), vitamin B5(pantothenic acid),vitamin B6, vitamin B12

(cobalamin), folic acid, vitamin C (ascorbic acid), biotin, iron, calcium, phosphorus, magnesium,

sodium, chloride, potassium, copper, manganese, fluoride, iodine, selenium and zinc. The studies

used for the SCF review found the following results on breast milk content of these nutrients (see

also results section)6:

Breast milk contained approximately 55-70 g lactoseper litre and can be considered as an

important source of energy. Breast milk did not contain saccharose or fructose.

Breast milk contained ~35 g fatper litre, which provides about one half of the energy

content of the milk.

A range of total concentrations of preformed vitamin Ain mature breast milk between 150

g/l and 1100 g/l was observed.

The reported concentration of vitamin D varied from 4 to 110 IU/l, with up to 10-fold higher

values in the summer than in the winter.

Mature breast milk contained approximately 2-5 mg/l vitamin E.

Breast milk contained low concentrations of vitamin K; a range between 0.6 g/l and 10

g/l was reported.

The reported concentrations of vitamin B1in mature breast milk varied widely; a range

between 154 g/l and 328 g/l was reported.

The reported concentrations of vitamin B2in mature breast milk varied widely; a range

between 274 g/l and 580 g/l was reported.

The reported concentrations of vitamin B3were between 1100 g/l and 2300 g/l.

The reported mean concentration of vitamin B5was 6.7 mg/l and the reported range

concentrations varied from 2.0 mg/l to 2.5 mg/l. Reported values differed and were

influenced by maternal dietary variation, or analytical approaches.

The concentration of vitamin B6increased as the maternal intake of the vitamin increased.

Furthermore, the concentration level depended on the stage of lactation, the length of

gestation and the usage of oral contraception. In mature milk the reported concentration

varied between 70 g/l and 310 g/l and in unsupplemented mothers the mean concentration

was reported to be approximately 150 g/l.


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A mean concentration of 0.51 g/l of vitamin B12was found in various studies and a range

of 0.16-0.64 g/l was found in studies among unsupplemented mothers.

A wide range of folic acidconcentrations were reported, most likely because of the

application of uncertain breast milk storage methods, difficulties in reliably determining the

folic acid content of milk or real differences among women; it varied from 24 g/l to141

g/l.

The mean vitamin C concentration was estimated to be 55 mg/l. A wide variation, however,

was observed that ranged from 30 mg/l to 100 mg/l (4.5 to 15 mg/100 kcal), with a

progressive observed decrease during the course of lactation.

The mean biotinconcentration was estimated to be 6 g/l (24 nmol/L) and a range of 5-9

g/l (0.75-1.3 g/100 kcal) was found.

The mean concentration of ironin breast milk was estimated to be approximately 0.3 mg/l.

The calciumconcentration in breast milk decreased over the course of lactation, and a range

between 194 mg/l and 268 mg/l (29 to 40 mg/100 kcal) was observed.

A range in phosphorusconcentration between 107 mg/l and 164 mg/l was reported (16 to

24 mg/100 kcal), peaking in early lactation and decreasing as lactation progresses.

A narrow range of magnesiumconcentration was found: between 31.4 mg/l and 35.7 mg/l.

A high variation of sodiumconcentrations was observed. A mean sodium concentration of

0.870.45 standard deviation (SD) mEq/100 kcal between 60 and 240 days was reported.

The concentration of sodium in adult mothers were found to be approximately 0.500.14

mEq/100 kcal and in adolescent mothers approximately 0.800.23 (SD) mEq/100 kcal.

A mean chlorideconcentration of 1.680.69 (SD) mEq/100 kcal was reported.

A range in potassiumconcentration between 1.650.27 (SD) mEq/100 kcal and 1.920.24

(SD) mEq/100 kcal was reported.

The coppercontent is not directly influenced by maternal dietary intake of copper. No

concentrations in breast milk were reported.

A mean manganeseconcentration of 3.5 g/l was estimated, with a slight decrease over the

course of lactation. A range of 3-4 g/l (approximately 0.5 g/100 kcal) was observed.

Observed mean fluorideconcentrations ranged from 0.007 mg/l to 0.011 mg/l.


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Iodineconcentrations varied markedly as a function of the iodine intake of the population. It

ranged from 10-20 g/l to more than 300 g/l in Europe and from 30 g/l to 490 g/l in the

United States of America.

A wide range of seleniumconcentrations was observed, which depended on the selenium

consumed in natural foods. In general, the selenium concentration is highest in colostrum.

The median selenium concentrations found in colostrum (0-5 days) was 26 g/l, in

transitional milk (6-21 days) 18 g/l, in mature milk (1-3 months) 15 g/l and in late

lactation (>5 months) 17 g/l.

A large variability of zinc concentrations was observed shown during the course of lactation

and among individuals; it varied from 0.5 mg/l to 4.7 mg/l. Zinc concentrations declined

sharply over the early weeks of lactation: from 4 mg/l at 2 weeks to 3 mg/l at 1 month, 2

mg/l at 2 months, 1.5 mg/l at 3 months and 1.2 mg/l at 6 months.


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Aim

The present review was part of the research activity 2.1 (task 9) of the Network of Excellence

EURRECA (European Micronutrients Recommendations Aligned). The aim was to search the

literature for the most actual micronutrient compositional data of human breast milk as well as

for data on breast milk volume consumed by infants. Data on the following micronutrients were

considered: vitamin A, vitamin D, vitamin E, vitamin K, vitamin B1, vitamin B2, vitamin B3,

vitamin B5, vitamin B6, vitamin B12, folic acid, vitamin C, biotin, iron, calcium, phosphorus,

magnesium, sodium, chloride, potassium, copper, manganese, fluoride, iodine, selenium and

zinc.


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Methods

The electronic database PubMed (U.S. National Library of Medicine & National Institutes of

Health 2009) was searched through October 2009. The database search was restricted to human

subjects, European studies and performed on combinations of both medical subject headings and

free text keywords (see Annex 1). Keywords focused on the study population (infants and

children) and the variables of interest (breastfeeding, breast milk, micronutrient, volume). In

addition, the reference lists in the eligible publications and all reviews identified by the search

were manually checked to identify further eligible studies that might have been missed in the

electronic search. No language restrictions were applied at the search of studies in the databases.

Due to limited translation possibilities, however, the final eligibility evaluation of full-textdocuments was restricted to publications in Dutch, English, French, German, Italian and Spanish.

Because of the extensive literature review done in 2003 by the EC-SCF and in 2001 by WHO,

the present review focussed on studies that were published in 2000 and beyond and thus that

would not have been included in the two previously mentioned reviews5,6.

The first review stage involved the screening of titles, keywords and abstracts of the identified

citations to determine their appropriateness for inclusion. Citations were found ineligible, whenthe information given in the title or available abstract suggested that the:

Study outcome measure was not breast milk intake and/or breast milk content or

composition.

Study population did not include exclusively or partially breastfed infants (0-12 months).

Study population did not include healthy infants (0-12 months), e.g. normal birthweight

infants, and/or healthy mothers.

Study population did not include at term infants (0-12 months).

Nutrient composition of breast milk was not given.

Study was not carried out in one of the 53 Member States of the WHO European Region.

Study design was not cross-sectional, observational (prospective cohort and case-control) or

intervention (baseline values be considered only).

The abovementioned order of screening was followed; if the response to a criterion was no, the

study was further assessed for eligibility. For each excluded study, one reason of ineligibility

was noted.


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The full-text of the studies identified to be potentially eligible during the first stage was obtained

and further evaluated during the second stage of the review, which implicated the exclusion of

systematic reviews or meta-analyses that did not present original data, exclusion of studies that

were included in the previous reviews5,6and the exclusion of studies that did not report on data

on volume of breast milk intake or on breast milk content or composition of micronutrients.

Both screening stages of the review involved the independent assessment of eligibility by two

authors (C.B. and G.T.). Disagreements were resolved through consensus with another author

(T.W.).

All found citations were downloaded into Reference Manager Version 10.0 (ISI ResearchSoft

2002) and assigned a unique identification number and subsequently transferred into a database

created with Microsoft Office Access 2003 (Microsoft Corporation 1992-2003), which was used

for the screening and analysis.


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Results

The search in PubMed yielded 553 initial records and the manual search of reference lists did not

lead to additional potentially eligible studies (Figure 1).

Figure 1Flow diagram of the process of identifying and including references for the systematic

literature review.

A total of 443 studies did not meet the first stage inclusion criteria and thus the full-text of the

110 remaining studies only were obtained for further evaluation. Because of language criteria,

however, the full-text of two Hungarian7,8publications and of one Polish9publication was not

evaluated. Thus of the 110 studies submitted to the second review stage three studies were

excluded, leaving a total of 107 studies for inclusion in the second review stage.

During the second stage evaluation 90 studies were excluded: one study was not carried out in an

European country10, 24 studies did not report on breast milk composition or on breast milk

volume intake11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34, one study was carried o

in non-healthy mothers

ut

re35, three publications referred to a similar study36,37,38, two studies we

First review sta e: Citation screenin of title/abstract/ke words, n= 553

Second review sta e: Full-text evaluation of otentiall eli ible studies, n= 110

Total included studies in the review, n= 17

Ineligible studies excluded, n= 443

Inappropriate study outcome, n= 405Inappropriate study population, n= 18Inappropriate study location, n= 20

Other language than Dutch

English, French, German,Italian or Spanish, n= 3

Ineligible studies excluded, n= 90

Any first stage exclusion criteria, n= 39Reviews without original data, n= 16No data reported on micronutrient content oron volume intake, n = 35


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carried out during the Ramadan39,40, three intervention studies did not report on baseline values

of breast milk composition before the intervention was introduced41,42,43, 16 publications were

reviews and did not contain original data44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59, 4 studies

measured breast milk volume to estimate nutrient intake only but did not indicate the mean

volume per feed60,61,62,63, one study measured iodine content of breast milk but did not rep

these results

ort on

e

e,

admium65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99 .

agnesium, sodium, potassium, copper, manganese, iodine,

elenium and zinc. None of these studies measured the infants volume intake of breast milk.

reported on

,

breast

ried between 1day and 12 months

ostpartum (three studies did not indicate the timing).

in E

s

um and zinc and different values for manganese than thealues given in these two reviews.

64and 35 studies measured the content of other nutrients than micronutrients, lik

for example total fat, polyunsaturated fatty acids, protein, nitrogen, leptin, glucose, galactos

lactoferrin or

c

Concerning breast milk composition, 16

studies100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115were found eligible for inclusion in the

present review and they reported on the content of 12 micronutrients in human breast milk:

vitamin A, vitamin E, iron, calcium, m

s

Table 2 gives an overview of these 16 studies by micronutrient (seven studies

multiple micronutrients). Nine studies did not indicate the time period of the

survey100,101,102,103,106,111,113,114,115. The studies were carried out in Turkey (n=5)100,101,108,111,113

Spain (n=3)105,107,114, the United Kingdom (n=2)102,103, Austria106, Belgium (n=1)112, Greece

(n=1)104, Italy (n=1)109, Poland115(n=1) and Portugal (n=1)110. The total number of breast milk

samples that were taken in each study varied between 13 and 905 and the timing when the

milk samples were taken from the lactating mothers va

p

Table 3 compares the nutrient content in breast milk reported in the 16 eligible studies with the

results found in the reviews done by WHO5and by the EC-SCF6. The vitamin A and vitam

content values were reported by their components (retinol, -Carotene, -Carotene, total

carotenoid, -tocopherol and -Tocopherol) and were therefore incomparable with the value

given in the WHO and EC-SCF reviews. The present review found similar values for iron,

calcium, magnesium, iodine, seleniv


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Concerning volume intake of breast milk, one study was found eligible116. This study was

carried out in Izmir, Turkey (survey period was not indicated) and 80 breast milk samples were

taken about 55-65 days postpartum. The mean (SD) number of feeds per day were 7.8 (1.6) and

the range varied from 5 to 12 feeds per day. The mean (SD) duration of breast feeding was 1

(3.4) minutes and the range varied from 5 to 20 minutes per breast feeding. The mean

1.9

(SD) milk

olume sucked per time was 94 (39) ml and the range varied between 40 and 210 ml.v


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Table 2Micronutrient content in human breast milk in 16 studies carried out in the WHO European Region.

Reference Survey period

(year)

Survey

location

Determination

method ofconcentration in

breast milk

Time

postpartumbreast milk

sample taken

Total breast

milksamples

(n)

Re

Vitamin A RetinolOrhon FS etal100

NA Ankara, Turkey High-PerformanceLiquidChromatography(HPLC)

7 days 20 fromsmokers and20 from non-smokers

Memem

Tokusoglu O

et al

101

NA Izmir and

Manisa, Turkey

HPLC 6090 days 43 from Izmir

and 49 fromManisa

Me

81.samg/81.

Jewell VC etal102

NA Belfast, UnitedKingdom

HPLC 141 days 28 (13mothers)

Me7.9

Canfield LMet al103

NA United Kingdomand 8 othercountries outsideEurope

HPLC 112 months 50 Me0.0

Vitamin A -CaroteneJewell VC etal102



Me5.0


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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Re

Vitamin A

-CaroteneCanfield LMet al103



Vitamin A -Carotene

Orhon FS etal100

NA Ankara, Turkey HPLC 7 days 20 fromsmokers and20 from non-smokers

Memem

Jewell VC etal102



Me63.

Canfield LMet al103



Vitamin A Total carotenoidCanfield LMet al103




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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Re

Vitamin E -TocopherolOrhon FS etal100

NA Ankara, Turkey HPLC 7 days 20 fromsmokers and20 from non-smokers

Memem

Tokusoglu O

et al

101NA Izmir and

Manisa, Turkey

HPLC 6090 days 43 from Izmir

and 49 fromManisa

Me

g/9.89.8

Jewell VC etal102



Me41.

Vitamin E -TocopherolJewell VC etal102



Me2.6

Iron

LeotsinidisM et al104

20002002 Patras, Greece Flame AtomicAbsorptionSpectrophotometry(FAAS)

3 days

14 days

180

95

Meg/inte

Meg/ran


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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Res

IronRodriguezRodriguezEM et al105

19941996 Tenerife, Spain Atomic AbsorptionSpectrophotometry(AAS) Varian SpectraAA-10 Plus

2 weeks5months

56 (11mothers)

Mea

Krachler M

et al

106

NA Graz, Austria Magnetic sector field

ICP-MS

NA (transitional

and mature)

27 Med

inte

CalciumRodriguezRodriguezEM et al107

19941996 Tenerife, Spain AAS Varian SpectraAA-10 Plus

2 weeks5months

55 (11mothers)

Mea

MagnesiumRodriguezRodriguezEM et al107


2 weeks5months

55 (11mothers)

Mea

SodiumOzbek A etal108

December 2002August 2005

Izmir, Turkey Ion selective methodin Hiatchi ModularAnalytics ISE 1900module

57 days 43 Mea


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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Re

SodiumManganaro Ret al109

FebruaryMarch2004

Messina, Italy Flame photometerIL943

3 days 208 Me20.

RodriguezRodriguezEM et al107

19941996 Tenerife, Spain Flame photometer 2 weeks5months

55 (11mothers)

Me

Potassium


19941996 Tenerife, Spain Flame photometer 2 weeks5months

55 (11mothers)

Me

CopperLeotsinidisM et al104

20002002 Patras, Greece Electrothermal AASequipped with an HGA400 furnace

3 days

14 days

180

95

Meg/ran

Meg/ran



2 weeks5months

56 (11mothers)

Me


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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Re

CopperKrachler Met al106

NA Graz, Austria Magnetic sector fieldICP-MS

NA (transitionaland mature)

27 Meg/720

ManganeseLeotsinidis

M et al104

20002002 Patras, Greece Electrothermal AAS

equipped with an HGA400 furnace.

3 days

14 days

180

95

Me

g/intg/

Meg/intg/

Krachler Met al106

NA Graz, Austria Magnetic sector fieldICP-MS

NA (transitionaland mature)

27 Meint

IodineCosteira MJet al110

January 2003December 2005

Guimares andBraga, Portugal

Chloric acid digestionmethod

3 days

3 months

78

52

MeP7

MeP7


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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Re

Iodine

Kurtoglu S etal111

NA Kayseri ,Turkey HPLC 5 days 70 Meg/

Ciardelli R etal112

June 1999June2000

Brussels,Belgium

NA NA 58 Me

Selenium

zdemir HSet al113

NA Van, Turkey. NA 14 days 13 Me

Navarro-Blasco I etal114

NA Pamplona, Spain Inductively coupledplasma atomicemission spectrometrywith a hydridegenerator

NA (maturemilk)

31 Me9.4

Krachler M

et al106

NA Graz, Austria Magnetic sector field

ICP-MS

NA (transitional

and mature)

27 Me

inte

Zachara BAet al115

NA Poland Fluorometric methodof Watkinson

1275 days 905 Me3.0


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Table 2Continued.


(year)

Survey

location

Determination


breast milk

Time


sample taken

Total breast

milksamples

(n)

Re

ZincLeotsinidisM et al104

20002002 Patras, Greece FAAS 3 days

14 days

180

95

Me50integ/

Me

g/integ/



2 weeks5months

56 (11mothers)

Me

AAS, Atomic Absorption Spectrophotometry; FAAS, Flame Atomic Absorption Spectrophotometry; HPLC, High-PerfNA, not available; SD, standard deviation; SEM, standard error of the mean.


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Table 3Compositional data of micronutrient content in breast milk found in the present review

compared with values found by WHO and the EC- SCF.

Micronutrients Present review

Included studies


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Table 3Continued.


Included studies


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Table 3Continued.


Included studies5months), median: 17g/l


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Table 3Continued


Included studies


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Discussion

The latest review on nutrient content of human breast milk was done in 2003 by the EC-SCF.

The present review identified 17 eligible studies that were carried out in the WHO European

Region and were not included in the EC-SCF review. While the EC-SCF review identified

information for all minerals and vitamins that were considered in the present review but copper,

16 eligible studies only reported on the breast milk content of vitamin A, vitamin E, iron,

calcium, magnesium, sodium, potassium, copper, manganese, iodine, selenium and zinc.

Surprisingly seven studies only indicated when the survey was carried out. Three studies did not

indicate the days or months postpartum when samples were taken to estimate breast milk

concentrations of iron, copper, manganese, sodium and selenium, while it has been observed thatthe content of for instance manganese and selenium in breast milk varies during the course of

lactation.

Values were expressed as a mean, median or as a range (minimum-maximum, interquartile

range) using various parameters such as mol/l, g/l, g/ml or nmol/g fat. Due to the different

reporting, it was not possible to compare all the reported values (e.g. vitamin A, vitamin E,

sodium) with the WHO and the EC-SCF reviews. Moreover, a wide range of the number of milksamples (13-905) taken as well as a wide range of the timing (1 day-12 months) when these

samples were taken postpartum was observed.

This review was carried out within the Network of Excellence EURRECA that develops building

blocks to harmonize European micronutrient recommendations. In order to harmonize the

collection of breast milk samples and the reporting of results on their micronutrient content in

future studies, it would be recommendable that EURECCA would provide guidance on the

measurement of micronutrient content in human breast milk.


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Annex 1. PubMed: search strategy and results on 27/10/09

Search terms PubMed Results#1 breast feeding [MH] OR feeding, breast OR breastfeeding OR breast-feeding OR

breast feeding OR breast feeding, exclusive OR exclusive breast feeding ORbreastfeeding, exclusive OR exclusive breastfeeding OR breastfed OR breast fed

OR breast-fed OR milk, human [MH] OR breast milk OR breastmilk ORbreastmilks OR human milk OR milk, breast OR lactation [MH] OR milk [MH]

101772

#2 infant [MH] OR infant OR infants OR child [MH] 1750261

#3 intake OR intakes OR content OR contents OR volume OR volumes ORconcentration OR concentrations OR composition OR compositions

2360497

#4 micronutrients [MH] OR micronutrient OR micronutrients OR vitamins [MH]OR vitamin OR trace elements [MH] OR elements, trace OR biometals ORvitamin B complex [MH] OR B vitamins OR fat soluble vitamin* OR fat-soluble

vitamin* OR vitamin A [MH] OR vitamin A OR carotenoids [MH] ORcarotene* OR retinol OR beta carotene [MH] OR beta carotene OR beta-caroteneOR carotene, beta OR betacarotene OR -Carotene OR vitamin D [MH] ORvitamin D OR vitamin E [MH] OR vitamin E OR tocopherol OR tocotrienol* ORwater soluble vitamin* OR water-soluble vitamin* OR vitamin C OR ascorbicacid [MH] OR ascorbate OR acid, ascorbic OR folate OR folic acid [MH] ORfolic acid OR acid, folic OR riboflavin [MH] OR riboflavin OR vitamin B2 ORvitamin B 2 OR thiamine [MH] OR thiamine OR thiamin OR vitamin B1 ORvitamin B 1 OR niacin [MH] OR niacin OR nicotinic acid OR vitamin B 6 [MH]OR vitamin B 6 OR vitamin B6 OR pyridoxine [MH] OR vitamin B 12 [MH]OR B 12, vitamin OR vitamin B12 OR vitamin B 12 OR B12, vitamin ORcobalamins OR cobalamin OR minerals OR mineral OR sodium [MH] OR

sodium OR potassium [MH] OR potassium OR calcium [MH] OR calcium ORmagnesium [MH] OR magnesium OR iron [MH] OR iron OR zinc [MH] ORzinc OR copper [MH] OR copper OR phosphorus [MH] OR phosphorus ORselenium [MH] OR selenium OR iodine [MH] OR iodine OR fatty acids [MH]OR acids, fatty OR fatty acids, essential [MH] OR fatty acids, omega 3 [MH] ORn-3 fatty acids OR n 3 fatty acids OR acids, omega-3 fatty OR fatty acids, omega3 OR omega-3 fatty acids OR omega 3 fatty acids OR fatty acids, n-3 OR n-3

polyunsaturated fatty acid OR n 3 polyunsaturated fatty acid

1869204

#5 carbohydrate OR carbohydrates OR carbohydrates [MH] OR dietarycarbohydrates [MH] OR carbohydrates, dietary OR carbohydrate, dietary ORdietary carbohydrate OR sugars OR dietary fats [MH] OR fats, dietary OR

dietary fat OR fat, dietary OR lipids [MH] OR amino acids, peptides, andproteins [MH] OR proteins [MH] OR protein OR dietary proteins [MH] ORproteins, dietary OR dietary protein OR protein, dietary

5728233

#6 Andorra [MH] OR Andorra OR Andorran OR Armenia [MH] OR Armenia ORArmenian OR Armenian S.S.R. OR Armenian SSR OR Austria [MH] ORAustria OR Austrian OR Azerbaijan [MH] OR Azerbaijan OR Azerbaijani ORAzerbaijan S.S.R. OR Azerbaijan SSR OR Byelarus [MH] OR Belarus ORBelarusian OR Byelorussian S.S.R. OR Belorussia OR Belorussian S.S.R. ORBelorussian SSR OR Byelorussian SSR OR Belgium [MH] OR Belgium ORBelgian OR Bosnia-Herzegovina [MH] OR Bosnia-Herzegovina OR Bosnia andHerzegovina OR Bosnia OR Bosnia and Herzegovina OR Bosnian OR Bulgaria[MH] OR Bulgaria OR Bulgarian OR Croatia [MH] OR Croatia OR Croatian ORCyprus [MH] OR Cyprus OR Cypriot OR Cyprian OR Czech Republic [MH] ORCzech Republic OR Czech OR Denmark [MH] OR Denmark OR Faeroe Islands

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Search terms PubMed ResultsOR Danish OR Greenland [MH] OR Kalaallit Nunaat OR Estonia [MH] OREstonia OR Estonian OR Finland [MH] OR Finland OR Finnish OR France[MH] OR France OR French OR Corsica OR Paris [MH] OR Georgia (Republic)[MH] OR Georgian OR Georgian S.S.R. OR Georgian SSR OR Georgia

(Western Asia) OR Georgia SSR OR Republic of Georgia OR Germany [MH]OR Germany OR Germany, West [MH] OR Germany, East [MH] OR GermanOR Federal Republic of Germany OR Germany, Federal Republic of OR Berlin[MH] OR German Democratic Republic OR Democratic Republic of GermanyOR Germany, Democratic Republic of OR Greece [MH] OR Greece OR GreekOR Crete OR Macedonia (Greece) OR Hungary [MH] OR Hungary ORHungarian OR Iceland [MH] OR Iceland OR Icelandic OR Ireland [MH] ORIreland OR Irish OR Eire OR Ireland, Republic of OR Irish Free State OR Israel[MH] OR Israel OR Israeli OR Hebrew OR Italy [MH] OR Italy OR Italian ORSardinian OR Sicily [MH] OR Rome [MH] OR Vatican City [MH] ORKazakhstan [MH] OR Kazakhstan OR Kazakh OR Kazakh S.S.R. OR KazakhSSR OR Kyrgyzstan [MH] OR Kyrgyzstan OR Kyrgyz OR Kirghiz S.S.R. OR

Kirghiz SSR OR Kyrgyz Republic OR Kirgizstan OR Kirghizia OR Latvia [MH]OR Latvia OR Latvian OR Lithuania [MH] OR Lithuania OR Lithuanian ORLuxembourg [MH] OR Luxembourg OR Luxemborg OR Luxemburg ORLuxembourgish OR Malta [MH] OR Malta OR Maltese

#7 Monaco [MH] OR Monaco OR Monegasque OR Montenegro [MH] ORMontenegro OR Netherlands [MH] OR Netherlands OR Dutch OR Norway[MH] OR Norway OR Norwegian OR Spitsbergen OR Svalbard [MH] ORPoland [MH] OR Poland OR Polish OR Portugal [MH] OR Portugal OR MadeiraIsland OR Portuguese OR Moldova [MH] OR Moldova OR Moldavian S.S.R.OR Moldavia OR Moldavian SSR OR Moldovan OR Romania [MH] ORRomania OR Rumania OR Roumania OR Romanian OR Russia [MH] OR

Russian Federation OR Russia OR Russian Federation (Europe) OR RussianSFSR OR Russian S.F.S.R. OR Russian OR Bashkiria [MH] OR BashkirRepublic OR Bashkortostan OR Dagestan [MH] OR Moscow [MH] OR Siberia[MH] OR Russian Federation (Asia) OR Russian S.F.S.R., Asian OR San Marino[MH] OR San Marino OR Serbia [MH] OR Serbia OR Serbian OR VojvodinaOR Kosovo OR Slovakia [MH] OR Slovakia OR Slovak Republic OR SlovakOR Slovenia [MH] OR Slovenia OR Slovenian OR Slovene OR Spain [MH] ORSpain OR Spanish OR Sweden [MH] OR Sweden OR Swedish OR Switzerland[MH] OR Switzerland OR Swiss OR Liechtenstein [MH] OR Liechtenstein ORLiechtenstein OR Tajikistan [MH] OR Tajikistan OR Tajik OR Tadzhik S.S.R.OR Tadzhik SSR OR Tadjikistan OR Tadzhikistan OR Macedonia (Republic)[MH] OR Former Yugoslav Republic of Macedonia OR Macedonia (Yugoslavia)OR Macedonia, Former Yugoslav Republic of OR The Former YugoslavRepublic of Macedonia OR Macedonian OR Macedonia OR Turkey [MH] ORTurkey OR Turkish OR Turkmenistan [MH] OR Turkmenistan OR TurkmenS.S.R. OR Turkmen SSR OR Turkmen OR Ukraine [MH] OR Ukraine ORUkrainian OR Great Britain [MH] OR United Kingdom OR UK OR Isle Man OR

Northern Ireland [MH] OR England [MH] OR Scotland [MH] OR Wales [MH]OR London [MH] OR Hebrides [MH] OR British OR Channel Islands [MH] ORAlderney Island OR Jersey Island OR Sark OR Uzbekistan [MH] OR UzbekistanOR Uzbek S.S.R. OR Uzbek SSR OR Uzbek

967248

#8 Europe [MH] OR Europe OR European OR Northern Europe OR Southern

Europe OR Western Europe OR Europe, Eastern [MH] OR Eastern Europe ORMediterranean Islands [MH] OR Mediterranean Region [MH] OR Baltic States[MH] OR Commonwealth of Independent States [MH] OR CIS nations ORUSSR [MH] OR Soviet Union OR Union of Soviet Socialist Republics OR

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Search terms PubMed ResultsYugoslavia [MH] OR Czechoslovakia [MeSH] OR Scandinavia [MH] ORGibraltar [MH] OR Transcaucasia [MH] OR Asia, Central [MH] OR EuropeanUnion [MH] OR European Community OR Common Market OR Community,European Economic OR Economic Community, European OR EEC OR

European Common Market OR European Economic Community OR EuratomOR European Atomic Energy Community OR European Coal and SteelCommunity

#9 #4 OR #5 6425990

#10 #6 OR #7 OR #8 2549080

#11 #1 AND #2 AND #3 8654

#12 #9 AND #10 AND #11 1081

#15 #14 Limit to humans 1036

#16 #15 Limit to publication date from 2000 to 2009 553


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References

1World Health Organization, Food and Agriculture Organization of the United Nations. Vitaminand mineral requirements in human nutrition. Geneva, World Health Organization; Rome, Foodand Agriculture Organization of the United Nations, 2004(http://whqlibdoc.who.int/publications/2004/9241546123.pdf, accessed 18 October 2010).2World Health Organization, United Nations for Childrens Fund. Global Strategy for Infantand Young Child Feeding. Geneva, World Health Organization, 2003(http://whqlibdoc.who.int/publications/2003/9241562218.pdf, accessed 18 October 2010).3World Health Organization. The optimal duration of exclusive breastfeeding. Report of anexpert consultation, Geneva, Switzerland, 28-30 March 2010. Geneva, World HealthOrganization, 2002, (http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.09.pdf, accessed 18October 2010).4Kramer MA, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review.

Geneva, World Health Organization, 2001(http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.08.pdf, accessed 18 October 2010).5Butte NF, Lopez-Alarcon MG, Garza C.Nutrient adequacy of exclusive breastfeeding for theterm infant during the first six months of life.Geneva, World Health Organization, 2002(http://www.who.int/nutrition/publications/infantfeeding/9241562110/en/index.html, accessed18 October 2010).6European Commission Scientific Committee on Food.Report of the Scientific Committee onFood on the revision of essential requirements of infant formulae and follow-on formulae.Brussels, European Commission, 2003 (http://ec.europa.eu/food/fs/sc/scf/out199_en.pdf,accessed 18 October 2010).

7Griff T et al. Iodine content of mother's milk--Hungarian representative survey, 2006 (inHungarian). Orvosi Hetilap, 2009, 150(30):14071411.8Marosvolgyi T et al. Fatty acid composition of human milk in mothers of preterm and full-terminfants in the first three weeks of lactation (in Hungarian). Orvosi Hetilap, 2006, 147(31):14591463.9Ksiazyk J. Current views on requirements for vitamin D, calcium and phosphorus, particularlyin formula fed infants (in Polish).Medycyna Wieku Rozwojowego, 2000, 4(4):423430.10Bonham MP et al. Habitual fish consumption does not prevent a decrease in LCPUFA statusin pregnant women (the Seychelles Child Development Nutrition Study). Prostaglandins,

Leukotrienes and Essential Fatty Acids, 2008, 78(6):343350.11Wu TC, Chen PH. Health consequences of nutrition in childhood and early infancy. Pediatricsand Neonatology, 2009, 50(4):135142.12Meyer R. Infant feeding in the first year, 2: feeding practices from 6-12 months of life.

Journal of Family Health Care, 2009, 19(2):4750.13Baird J et al. Milk feeding and dietary patterns predict weight and fat gains in infancy.Paediatric and Perinatal Epidemiology, 2008, 22(6):575586.14Owen CG et al. Does initial breastfeeding lead to lower blood cholesterol in adult life?: aquantitative review of the evidence.American Journal of Clinical Nutrition, 2008, 88(2):305

314.15Hay G et al. Folate and cobalamin status in relation to breastfeeding and weaning in healthyinfants.American Journal of Clinical Nutrition, 2008, 88(1):105114.
http://whqlibdoc.who.int/publications/2004/9241546123.pdfhttp://whqlibdoc.who.int/publications/2003/9241562218.pdfhttp://whqlibdoc.who.int/hq/2001/WHO_NHD_01.09.pdfhttp://whqlibdoc.who.int/hq/2001/WHO_NHD_01.08.pdfhttp://www.who.int/nutrition/publications/infantfeeding/9241562110/en/index.htmlhttp://ec.europa.eu/food/fs/sc/scf/out199_en.pdfhttp://ec.europa.eu/food/fs/sc/scf/out199_en.pdfhttp://www.who.int/nutrition/publications/infantfeeding/9241562110/en/index.htmlhttp://whqlibdoc.who.int/hq/2001/WHO_NHD_01.08.pdfhttp://whqlibdoc.who.int/hq/2001/WHO_NHD_01.09.pdfhttp://whqlibdoc.who.int/publications/2003/9241562218.pdfhttp://whqlibdoc.who.int/publications/2004/9241546123.pdf


31/36

31

16Wilhelm M et al. Assessment and management of the first German case of a contaminationwith perfluorinated compounds (PFC) in the Region Sauerland, North Rhine-Westphalia.

Journal of Toxicology and Environmental Health A, 2008, 71(11-12):725733.17Dangour AD, Uauy R.N-3 long-chain polyunsaturated fatty acids for optimal function during

brain development and ageing.Asia Pacific Journal of Clinical Nutrition, 2008, 17(Suppl1):185188.18Cabezuelo HG et al. 25-Hydroxyvitamin D levels in infants. Relation with breast-feeding (inSpanish).Anales de Pediatra (Barcelona, Spain : 2003), 2007, 66(5):491495.19Savino F, Lupica MM. Breast milk: biological constituents for health and well-being ininfancy (in Italian).Recenti Progressi in Medicina, 2006, 97(10):519527.20Singhal A et al. Infant nutrition and stereoacuity at age 4-6 y.American Journal of Clinical

Nutrition, 2007, 85(1):152159.21Thorsdottir I, Gunnarsson BS. Dietary quality and adequacy of micronutrient intakes in

children. The Proceedings of the Nutrition Society, 2006, 65(4):366375.22Koletzko B. Long-term consequences of early feeding on later obesity risk.Nestl Nutrition

Institute Workshop Series: Pediatric Program, 2006, 58:118.23Agostoni C. LC-PUFA content in human milk: is it always optimal?Acta Paediatrica, 2005,94(11):15321534.24Pomeroy KM, Sawyer LJ, Evans MJ. Estimated radiation dose to breast feeding infantfollowing maternal administration of 57Co labelled to vitamin B12.Nuclear MedicineCommunications, 2005, 26(9):839841.25Riva E et al. Early protein intakes and adiposity: reloaded or downloaded?Acta Paediatrica,

2004, 93(6):725726.26Strambi M et al. Selenium status, birth weight, and breast-feeding: pattern in the first month.

Biological Trace Element Research, 2004, 99(13):7181.27Coppa GV et al. Characterization of oligosaccharides in milk and feces of breast-fed infants byhigh-performance anion-exchange chromatography.Advances in Experimental Medicine and

Biology, 2001, 501:307314.28Jewell VC et al. Nutritional factors and visual function in premature infants. The Proceedingsof the Nutrition Society, 2001, 60(2):171178.29Savino F et al. Arachidonic (AA) and docosahexaenoic (DHA) acid content in healthy infants

fed with an HA milk formula supplemented with LCPUFA and in breast fed infants.Advances inExperimental Medicine and Biology, 2000, 478:411412.30Koletzko B et al. Dietary fat intakes in infants and primary school children in Germany.

American Journal of Clinical Nutrition, 2000, 72(5 Suppl):1392S1398S.31Atladottir H, Thorsdottir I. Energy intake and growth of infants in Iceland-a population withhigh frequency of breast-feeding and high birth weight.European Journal of Clinical Nutrition,2000, 54(9):695701.32Freeman V, van't Hof M, Haschke F. Patterns of milk and food intake in infants from birth toage 36 months: the Euro-growth study.Journal of Pediatric Gastroenterology and Nutrition,

2000, 31(Suppl 1):S76S85.33Prentice A. Maternal calcium metabolism and bone mineral status.American Journal ofClinical Nutrition, 2000, 71(5 Suppl):1312S1316S.


32/36

32

34Akeson PK et al. Fat intake and metabolism in Swedish and Italian infants.Acta Paediatrica,2000, 89(1):28-33.35Lauritzen L. Fatty acid composition of human milk in atopic Danish mothers.American

Journal of Clinical Nutrition, 2006, 84(1):190196.36Agostoni C et al. Long-chain polyunsaturated fatty acid concentrations in human hindmilk areconstant throughout twelve months of lactation.Advances in Experimental Medicine and

Biology, 2001, 501:157161.37Agostoni C et al. Prolonged breast-feeding (six months or more) and milk fat content at sixmonths are associated with higher developmental scores at one year of age within a breast-fed

population.Advances in Experimental Medicine and Biology, 2001, 501:137141.38Zachara BA, Pilecki A. Daily selenium intake by breast-fed infants and the seleniumconcentration in the milk of lactating women in western Poland.Medical Science Monitor, 2001,7(5):10021004.

39Olafsdottir AS et al. Polyunsaturated fatty acids in the diet and breast milk of lactatingicelandic women with traditional fish and cod liver oil consumption.Annals of Nutrition and

Metabolism, 2006, 50(3):270276.40Rakicioglu N et al. The effect of Ramadan on maternal nutrition and composition of breastmilk. Pediatrics International: Official Journal of the Japan Pediatric Society, 2006, 48(3):278283.41Bergmann RL et al. Supplementation with 200 mg/day docosahexaenoic acid from mid-

pregnancy through lactation improves the docosahexaenoic acid status of mothers with ahabitually low fish intake and of their infants.Annals of Nutrition and Metabolism, 2008,52(2):157166.42Domellof M et al. Factors influencing concentrations of iron, zinc, and copper in human milk.

Advances in Experimental Medicine and Biology, 2004, 554:355358.43Olafsdottir AS et al. Fat-soluble vitamins in the maternal diet, influence of cod liver oilsupplementation and impact of the maternal diet on human milk composition.Annals of

Nutrition and Metabolism, 2001, 45(6):265272.44Koletzko B et al. Infant feeding and later obesity risk.Advances in Experimental Medicine and

Biology, 2009, 646:1529.45Koletzko B et al. Can infant feeding choices modulate later obesity risk?American Journal ofClinical Nutrition, 2009, 89(5):1502S1508S.46Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clinical

Endocrinology, 2009, 70(5):803809.47Agostoni C. Role of long-chain polyunsaturated fatty acids in the first year of life.Journal ofPediatric Gastroenterology and Nutrition, 2008, 47(Suppl 2):S41S44.48Bokor S, Koletzko B, Decsi T. Systematic review of fatty acid composition of human milkfrom mothers of preterm compared to full-term infants.Annals of Nutrition and Metabolism,2007, 51(6):550556.49Craig-Schmidt MC. World-wide consumption of trans fatty acids.AtherosclerosisSupplements, 2006, 7(2):14.50Agostoni C et al. How much protein is safe?International journal of obesity, 2005, 29(Suppl2):S8S13.


33/36

33

51Turck D. Breast feeding: health benefits for child and mother (in French).Archives dePdiatrie, 2005, 12(Suppl 3):S145S165.52Koletzko B et al. Protein intake in the first year of life: a risk factor for later obesity? The E.U.childhood obesity project.Advances in Experimental Medicine and Biology, 2005, 569:6979.53Decsi T, Koletzko B. N-3 fatty acids and pregnancy outcomes. Current Opinion in Clinical

Nutrition and Metabolic Care, 2005, 8(2):161166.54Innis SM. Polyunsaturated fatty acids in human milk: an essential role in infant development.

Advances in Experimental Medicine and Biology, 2004, 554:2743.55Decsi T. Nutritional relevance of trans isomeric fatty acids in human milk.Acta Paediatrica,2003, 92(12):13691371.56Faldella G et al. Iron balance and iron nutrition in infancy.Acta Paediatrica Supplement,2003, 91(441):8285.57

Bender DA. Do we really know vitamin and mineral requirements for infants and children?The Journal of the Royal Society for the Promotion of Health , 2003, 123(3):154158.58Agostoni C. Compliance of present recommendations of fatty acids in formulas for terminfants with the actual human milk fatty acid composition in different populations.ActaPaediatrica, 2003, 92(7):785787.59Agostoni C, Giovannini M. Cognitive and visual development: influence of differences in

breast and formula fed infants.Nutrition Health, 2001, 15(34):183188.60Brion MJ et al. Sodium intake in infancy and blood pressure at 7 years: findings from theAvon Longitudinal Study of Parents and Children.European Journal of Clinical Nutrition, 2008,62(10):11621169.61Ohlund I et al. Dietary fat in infancy should be more focused on quality than on quantity.

European Journal of Clinical Nutrition, 2008, 62(9):10581064.62Hopkins D et al. Infant feeding in the second 6 months of life related to iron status: anobservational study.Archives of Disease in Childhood, 2007, 92(10):850854.63Noble S, Emmett P. Food and nutrient intake in a cohort of 8-month-old infants in the south-west of England in 1993.European Journal of Clinical Nutrition, 2001, 55(8):698707.64Roth C et al. The iodine supply of newborns: comparison of iodine absorption and iodineexcretion of mother and child (in German).Deutsche Medizinische Wochenschrift, 2001,126(12):321325.65Koletzko B et al. Lower protein in infant formula is associated with lower weight up to age 2y: a randomized clinical trial.American Journal of Clinical Nutrition, 2009, 89(6):18361845.66Doneray H, Orbak Z, Yildiz L. The relationship between breast milk leptin and neonatalweight gain.Acta Paediatrica, 2009, 98(4):643647.67Corvaglia L et al. Near-infrared reflectance analysis to evaluate the nitrogen and fat content ofhuman milk in neonatal intensive care units.Archives of Disease in Childhood. Fetal and

Neonatal Edition, 2008, 93(5):F372F375.68Weyermann M, Brenner H, Rothenbacher D. Adipokines in human milk and risk ofoverweight in early childhood: a prospective cohort study.Epidemiology, 2007, 18(6):722729.


34/36

34

69Ilcol YO, Hizli ZB, Eroz E. Resistin is present in human breast milk and it correlates withmaternal hormonal status and serum level of C-reactive protein. Clinical Chemistry and

Laboratory Medicine, 2008, 46(1):118124.70Ilcol YO, Hizli B. Active and total ghrelin concentrations increase in breast milk duringlactation.Acta Paediatrica, 2007, 96(11):16321639.71Ballabio C et al. Immunoglobulin-A profile in breast milk from mothers delivering full termand preterm infants.International journal of Immunopathology and Pharmacology, 2007,20(1):119128.72Gundacker C et al. Smoking, cereal consumption, and supplementation affect cadmiumcontent in breast milk.Journal of Exposure Science and Environmental Epidemiology, 2007,17(1):3946.73Musumeci M et al. Oligosaccharides in colostrum of Italian and Burkinabe women.Journal ofPediatric Gastroenterology and Nutrition, 2006, 43(3):372378.

74Cavalli C et al. Free sugar and sugar alcohol concentrations in human breast milk.Journal ofPediatric Gastroenterology and Nutrition, 2006, 42(2):215221.75Xiang M, Harbige LS, Zetterstrom R. Long-chain polyunsaturated fatty acids in Chinese andSwedish mothers: diet, breast milk and infant growth.Acta Paediatrica, 2005, 94(11):15431549.76Kovacs A et al. Fatty acids in early human milk after preterm and full-term delivery.Journalof Pediatric Gastroenterology and Nutrition, 2005, 41(4):454459.77Saarela T, Kokkonen J, Koivisto M. Macronutrient and energy contents of human milkfractions during the first six months of lactation.Acta Paediatrica, 2005, 94(9):11761181.

78Mandel D et al. Fat and energy contents of expressed human breast milk in prolongedlactation. Pediatrics, 2005, 116(3):e432e435.79Ilcol YO et al. Choline status in newborns, infants, children, breast-feeding women, breast-fedinfants and human breast milk. The Journal of Nutritional Biochemistry, 2005, 16(8):489499.80Sala-Vila A et al. Lipid composition in human breast milk from Granada (Spain): changesduring lactation.Nutrition, 2005, 21(4):467473.81Dundar NO et al. Longitudinal investigation of the relationship between breast milk leptinlevels and growth in breast-fed infants.Journal of Pediatric Endocrinology and Metabolism,2005, 18(2):181187.

82Lien E et al. Variations in concentrations of lactoferrin in human milk: a nine country survey.Advances in Experimental Medicine and Biology, 2004, 554:423426.83Gazzolo D et al. Levels of S100B protein are higher in mature human milk than in colostrumand milk-formulae milks. Clinical Nutrition, 2004, 23(1):2326.84Boniglia C et al. Influence of maternal protein intake on nitrogen fractions of human milk.

International Journal for Vitamin and Nutrition Research, 2003, 73(6):447452.85Agostoni C et al. Earlier smoking habits are associated with higher serum lipids and lowermilk fat and polyunsaturated fatty acid content in the first 6 months of lactation.European

Journal of Clinical Nutrition, 2003, 57(11):14661472.

86Smit EN et al. Fatty acids in formulae for term infants: compliance of presentrecommendations with the actual human milk fatty acid composition of geographically different

populations.Acta Paediatrica, 2003, 92(7):790796.


35/36

35

87Ferreira IM. Quantification of non-protein nitrogen components of infant formulae and follow-up milks: comparison with cows' and human milk.British Journal of Nutrition, 2003, 90(1):127133.88Lopez-Lopez A et al. Fatty acid and sn-2 fatty acid composition in human milk from Granada(Spain) and in infant formulas.European Journal of Clinical Nutrition, 2002, 56(12):12421254.89Smit EN et al. Estimated biological variation of the mature human milk fatty acidcomposition. Prostaglandins, Leukotrienes and Essential Fatty Acids, 2002, 66(5-6):549555.90Scopesi F et al. Maternal dietary PUFAs intake and human milk content relationships duringthe first month of lactation. Clinical Nutrition, 2001, 20(5):393397.91Agostoni C et al. Breastfeeding duration, milk fat composition and developmental indices at 1year of life among breastfed infants. Prostaglandins, Leukotrienes and Essential Fatty Acids,2001, 64(2):105109.

92Agostoni C et al. Free glutamine and glutamic acid increase in human milk through a three-month lactation period.Journal of Pediatric Gastroenterology and Nutrition, 2000, 31(5):508512.93Decsi T et al. Fatty acid composition of human milk in Hungary.Acta Paediatrica, 2000,89(11):13941395.94Agostoni C et al. Dietary fats and cholesterol in italian infants and children.American Journalof Clinical Nutrition, 2000, 72(5 Suppl):1384S1391S.95Agostoni C et al. Free amino acid content in standard infant formulas: comparison with humanmilk.Journal of the American College of Nutrition, 2000, 19(4):434438.

96Marangoni F et al. Polyunsaturated fatty acid concentrations in human hindmilk are stablethroughout 12-months of lactation and provide a sustained intake to the infant during exclusive

breastfeeding: an Italian study.British Journal of Nutrition, 2000, 84(1):103109.97Ucar B et al. Breast milk leptin concentrations in initial and terminal milk samples:relationships to maternal and infant plasma leptin concentrations, adiposity, serum glucose,insulin, lipid and lipoprotein levels.Journal of Pediatric Endocrinology and Metabolism, 2000,13(2):149156.98Xiang M et al. Long-chain polyunsaturated fatty acids in human milk and brain growth duringearly infancy.Acta Paediatrica, 2000, 89(2):142147.99

Holmes HC, Snodgrass GJ, Iles RA. Changes in the choline content of human breast milk inthe first 3 weeks after birth.European Journal of Pediatrics, 2000, 159(3):198204.100Orhon FS et al. The influence of maternal smoking on maternal and newborn oxidant andantioxidant status.European Journal of Pediatrics, 2009, 168(8):975981.101Tokusoglu O et al. Retinol and alpha-tocopherol concentrations in breast milk of Turkishlactating mothers under different socio-economic status.International Journal of Food Sciencesand Nutrition, 2008, 59(2):166174.102Jewell VC et al. A comparison of lutein and zeaxanthin concentrations in formula and humanmilk samples from Northern Ireland mothers.European Journal of Clinical Nutrition, 2004,58(1):9097.103Canfield LM et al. Multinational study of major breast milk carotenoids of healthy mothers.

European Journal of Nutrition, 2003, 42(3):133141.


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104Leotsinidis M, Alexopoulos A, Kostopoulou-Farri E. Toxic and essential trace elements inhuman milk from Greek lactating women: association with dietary habits and other factors.Chemosphere, 2005, 61(2):238247.105Rodriguez Rodriguez EM, Sanz AM, Diaz RC. Concentrations of iron, copper and zinc inhuman milk and powdered infant formula.International Journal of Food Sciences and Nutrition,2000, 51(5):373380.106Krachler M et al. Concentrations of selected trace elements in human milk and in infantformulas determined by magnetic sector field inductively coupled plasma-mass spectrometry.

Biological Trace Element Research, 2000, 76(2):97112.107Rodriguez Rodriguez EM, Sanz AM, Diaz RC. Concentrations of calcium, magnesium,sodium and potassium in human milk and infant formulas (in Spanish).Archivos

Latinoamericanos de Nutricin, 2002, 52(4):406412.108Ozbek A et al. Maternal psychosocial aspects in hypernatremic dehydration with high sodium

concentrations in breast milk: a case-control study.Journal of Paediatrics and Child Health,2008, 44(12):3843.109Manganaro R et al. Breast milk sodium concentration, sodium intake and weight loss in

breast-feeding newborn infants.British Journal of Nutrition, 2007, 97(2):344348.110Costeira MJ et al. Iodine status of pregnant women and their progeny in the Minho Region ofPortugal. Thyroid, 2009, 19(2): 157163.111Kurtoglu S et al. Iodine status remains critical in mother and infant in Central Anatolia(Kayseri) of Turkey.European Journal of Nutrition, 2004, 43(5):297303.112Ciardelli R et al. The nutritional iodine supply of Belgian neonates is still insufficient.

European Journal of Pediatrics, 2002, 161(10):519523.113zdemir HS et al. The selenium levels of mothers and their neonates using hair, breast milk,meconium, and maternal and umbilical cord blood in Van Basin.Biological Trace Element

Research, 2008, 122(3):206215.114Navarro-Blasco I, Alvarez-Galindo JI. Selenium content of Spanish infant formulae andhuman milk: influence of protein matrix, interactions with other trace elements and estimation ofdietary intake by infants.Journal of Trace Elements in Medicine and Biology, 2004, 17(4):277289.115Zachara BA, Pilecki A. Selenium concentration in the milk of breast-feeding mothers and itsgeographic distribution.Environmental Health Perspectives, 2000, 108(11):10431046.116Aksit S, Ozkayin N, Caglayan S. Effect of sucking characteristics on breast milkcreamatocrit. Paediatric and Perinatal Epidemiology, 2002, 16(4):355360.

report on the composition, volume and intake of breast milk

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