Composition of Human Milk The Latest Scientific Findings The - - PDF document

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Composition of Human Milk The Latest Scientific Findings The - - PDF document

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3/23/2011 Composition of Human Milk The Latest Scientific Findings The Uniqueness of Human Milk Continually changing Living Tailor-made Overview Incredible human milk Anatomy review Continually changing living and

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Composition of Human Milk

The Latest Scientific Findings The Uniqueness of Human Milk

  • Continually changing
  • Living
  • Tailor-made

Overview

  • Incredible human milk
  • Anatomy review
  • Continually changing living and tailor made
  • Continually changing, living, and tailor-made
  • How the breast makes milk
  • A new discovery
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Incredible Human Milk

  • Until recently, research in the

field of lactation was lacking

  • Scientific studies

demonstrate human milk is best for ALL babies

  • Now we have evidence-

based guidelines for best practices

Incredible Human Milk

Peter E. Hartmann, PhD

Incredible Human Milk

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Evidence-Based Benefits for Baby

  • Less risk of respiratory illnesses,
  • titis media, diarrhea, UTIs, SIDS
  • Promotes mother-baby bonding
  • Optimal nutrition
  • Optimal nutrition
  • Provides protection from disease
  • Promotes brain development

(AAP Policy Statement, Pediatrics 2005; Horwood LJ et al. Arch Dis Child Ed 2001.)

More Benefits

  • Protective against some childhood

lymphomas and leukemias

  • Decreases risk of Type I and II

diabetes

  • Improves growth, intelligence, and

brain maturation

  • Development of immune system

(Ip S et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Tech Assess 2007.)

Extra Protection for Vulnerable Infants

  • Standard of care in NICU

(AAP, 2005)

  • Protects the gut
  • Reduces incidence of NEC
  • Protection from late-onset

sepsis

(Lucas A et al. BMJ 2001; Schanler et al. Pediatrics 2005; Sisk et al. J Perinatol 2007: Sisk et al. Pediatrics 2008.)

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  • Breastmilk improves

neuro-developmental

  • utcome

Extra Protection for Vulnerable Infants

(Cowan, W.M.: The development of the brain. Sci. Am. 241:113, Sept. 1979)

Gyral development in the human brain. LATE PRETERM POPULATION

Benefits for Mom Include…

  • Natural completion of the reproductive cycle
  • Decreased risk of cardiovascular disease, such

as hypertension, heart attack or stroke (Schwarz, EB et al. Obstetrics & Gynecology 2009.)

  • Decreased risk of developing Type II diabetes

Steube AM, et al. JAMA 2005.)

  • Decreased risk of ovarian, endometrial and

premenopausal breast cancers Steube, AM et al. Archives of Internal Medicine 2009.) The longer a woman breastfeeds throughout her lifetime, the more protection she receives.

Long-Term Protection

  • Celiac Disease
  • Ulcerative colitis
  • Diabetes – Type 1 and

T 2 Type 2

  • Obesity
  • Cholesterol metabolism
  • Other autoimmune

disorders

Ip S et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Tech Assess 2007.

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Benefits for the World

  • Decreases infant mortality
  • Improves health outcomes
  • Decreases healthcare costs
  • Child spacing
  • No waste of energy
  • No packaging – no landfill waste

New Findings in Breast Anatomy

  • Dr. Donna Geddes (on left)

Glandular Tissue Retromammary Fat Cooper‘s Ligaments

Anatomy of the Lactating Breast

Milk Duct Main Milk Duct Subcutaneous Fat Intraglandular Fat

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How is Breastmilk Made?

Alveoli - group of lactocytes

Blood supply Myoepithelial cells y p Milk duct Lactocyte

How is Breastmilk Made?

Alveoli ‐ group of lactocytes

Clinical Implications of Breast Anatomy Findings

  • Importance of proper latch
  • Importance of proper flange

size/fit A id d

  • Avoid pressure on ducts
  • Drain breasts completely to

maximize milk supply

  • Breastfeeding and pumping

may be individualized

  • Surgical implications
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Breastmilk Composition Breastmilk Composition

  • Continually changing
  • Living
  • Tailor-made

Humans are Mammals

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Tailor-made

40 50 60

Comparison of Mammalian milk

Webb et al 1974

10 20 30

Donkey Human Cow Whale % Fat % Protein % Carbohydrate

%

Breastfeeding

Not only best nutritionally, but plays an important role in p y p immune system development and neurological development

  • r “brain wiring”

Development of the Immune System

Broncho-Enteromammary Pathway

Important Immunologic Mechanism

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What is Involved in the Process?

Continually Changing: …throughout the feeding… …throughout the day… …as the baby grows…

There are over 100,000 components in human milk and we currently only know the y y function of about 1000

Charles Czank, UWA

Highlights of a Few Components

≠

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Highlights of a Few Components

  • Secretory IgA
  • Lactoferrin
  • Lysozyme

A ti t h l l

  • Immunoglobulins
  • Interferon
  • Anti-tumor cells
  • Secretory IgA
  • Lactoferrin
  • Lysozyme
  • Antistaphylococcal

and antistreptococcal factors

  • Antiparasitic factors
  • Anti-inflammatory

properties

  • Bifidus factor
  • Enhanced bioavailability
  • f nutrients such as iron

and zinc

  • New discovery???

Highlights of a Few Components

  • Secretory IgA
  • Lactoferrin
  • Lysozyme

A ti t h l l

  • Immunoglobulins
  • Interferon
  • Anti-tumor cells
  • Antistaphylococcal

and antistreptococcal factors

  • Antiparasitic factors
  • Anti-inflammatory

properties

  • Bifidus factor
  • Enhanced bioavailability
  • f nutrients such as iron

and zinc

  • Discovery of stem cells

Continually Changing

Breastmilk

Colostrum Transitional Mature

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Colostrum

  • Earliest milk produced
  • “Liquid Gold”
  • Contains antioxidants

Contains antibodies and anti

  • Contains antibodies and anti-

inflammatory properties

  • Yellow color due to beta-carotene
  • Laxative effect increases stooling

and decreases hyperbilirubinemia

Transitional Milk

500 600 700 800 900 1000

e of Milk (mL)

Milk production at Day 6 ≈

395‐868 750‐800

100 200 300 400

Volume

Milk production at Week 6

(Neville, 1991)

Day 2‐6 7‐123 Day 1 One Month

Day 1: 7‐123 mL, generally 3‐8 breastfeeds (Arthur, 1989; Saint, 1984) Day 2‐6: 395‐868 mL 5‐10 breastfeeds (Arthur, 1989; Saint 1984, Casey, 1986; Glassier, 1990) 1 Month: 750‐800 mL (Hartmann, 1995; Kent, 2006; Cox 1996)

Mature Human Milk

  • Higher in volume

than colostrum

  • Lower in caloric

Fat

  • Lower in caloric

density than colostrum

  • 2 weeks-6 months:

750-1000 mL/day

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Macronutrients (fats, lactose and proteins)

Constantly Changing

40 50 60 70 Lactose (g/L)

n (g/L)

Mitoulas et al (2002)

10 20 30 40 3 6 9 12 Lactose (g/L) Fat (g/L) Protein (g/L)

Concentratio Month

Constantly Changing

0.3 0.4 0.5 (%)

Fatty Acids

0.1 0.2 3 6 9 12 AA DHA Content (

Mitoulas et al (2002)

Month

Breastmilk Composition

Living . . . Alive . . .

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Living

Microscopic View of Breastmilk

Cregan et al 2007

Living

Microscopic View of Breastmilk

Cregan et al 2007

Living

Microscopic View of Breastmilk

Lymphocyte

Cregan et al 2007

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Microscopic View of Breastmilk

Macrophage

Living

Cregan et al 2007

Microscopic View of Breastmilk

Lactocytes

Living

Why??

Cregan et al 2007

Breastmilk Composition

  • Tailor-made to biologic

specificity of human infants infants

  • In other words,

“species-specific”

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Tailor-made

Ingredients of Breastmilk

  • Proteins
  • Fats
  • Carbohydrates
  • Others

Proteins

  • Secretory IgA
  • Lactoferrin
  • α – lactalbumin
  • Caseins
  • Lysozyme

Fats

  • Provide approximately 50% of the calories,

contains essential fatty acids, and delivers fat-soluble vitamins

  • Most variable component – changes within a

feeding, during the day, between breasts, age of

Fat

g, g y, , g baby, and among women

  • AA: Arachidonic acid plays a role in infant growth

and is especially important for brain development

  • DHA: Docosohexaenoic acid plays a central role

in cognitive development – especially vision and nerve supply

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Brain Development

Gyral development in the human brain. LATE PRETERM

(Cowan, W.M.: The development of the brain. Sci. Am. 241:113, Sept. 1979)

LATE PRETERM POPULATION

  • The major carbohydrate in human

milk

  • Supplies ~40% of infant’s energy
  • Important for brain development
  • Probiotic activities
  • Anti-infective properties
  • Act as decoys

Carbohydrates

Lactose Oligosaccharides

  • Important for brain development
  • Human milk contains one of the

highest concentrations of lactose of any mammal

  • Used by brain for energy
  • Helps develop central nervous

system

  • Improves infant’s absorption of

calcium

  • ~130 oligosaccharides in human

milk

  • Formula may contain one oligosac-

charide (plant-based)

  • May protect against urinary

pathogens

  • Play role in infant gray matter

development

Other Components

  • Nucleotides
  • Carnitine
  • Taurine
  • Enzymes
  • Growth factors
  • Hormones
  • Vitamins and minerals
  • Even more…
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How Does This Incredible Process Work? How is Human Milk Manufactured?

Lactocyte – milk making cell

Blood supply Rough endoplasmic reticulum Nucleus

(control center of the cell;

Apical Membrane Golgi

(process/dispatch proteins)

Milk Tight/gap junctions

(hold cells together) (co t o ce te o t e ce ; where proteins are made)

Basal Membrane

Pathways for Milk Synthesis and Secretion into Alveolus

Four Major Transcellular Pathways and One Paracellular Pathway

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Pathway 1:

Exocytosis

Pathway 1: Exocytosis

Lactocyte – milk making cell

Pathway 2:

Lipid Secretion

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Pathway 2: Lipid Secretion

Lactocyte – milk making cell

Pathway 3:

Transport Across Cell Membrane

Pathway 3: Simple Transfer Across Cell Membrane

Lactocyte – milk making cell

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Pathway 4:

/ f Pinocytosis/Exocytosis of Immunoglobulins

Pathway 4: Pinocytosis/Exocytosis of Immunoglobulins

Lactocyte – milk making cell

Pathway 5:

Paracellular Pathway

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Pathway 5: Paracellular

Lactocyte – milk making cell

Tailor-made

Lactocyte – milk making cell

Tailor-made

Alphalactalbumin Lactoferrin Lysozyme Oligosaccharides Urea sIgA DHA AA EGF Lactose Alphalactalbumin Casein Glucose Lactose

Immunological Developmental

sIgA EGF Lactose Sodium

Nutritional

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Clinical Implications

  • Human milk and infant formula are not equal
  • All mothers deserve to make an informed decision
  • Human milk has life-giving benefits and mothers need

support and protection of their breastfeeding support and protection of their breastfeeding

Clinical Implications

  • Importance of human milk use in the NICU
  • There is a need to participate in research
  • Staff need education to learn the value of human milk

and how to support the mother and baby and how to support the mother and baby

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New Discovery

What is New?

Cregan et al 2007

New Discovery

Stem Cells in Breastmilk

Cregan et al 2007

New Discovery

Pluripotent Add stimuli Multipotent

What is a Stem Cell?

Multipotent Lactocyte Myo‐ epithelial Ductal Breast stem cell Bone Muscle Blood Nerve

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New Discovery

Putative Stem Cells – Stained Nestin Positive

Cregan et al 2007

Commitment to Research and Education

  • Funding research to increase the body of

knowledge in the field of lactation

  • Disseminating the results of both general and

applied research to health care professionals applied research to health care professionals throughout the world

  • Striving for excellence in meeting our

responsibility to promote the health and well- being of mothers and babies by promoting breastfeeding and the use of human milk

Human Milk

  • Constantly changing
  • Living
  • Tailor-made
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Acknowledgements

Peter Hartmann Mark Cregan