MOTHERS MILK DHA TEST KRISTINA HARRIS JACKSON, PHD, RD RESEARCH - PowerPoint PPT Presentation

MOTHER’S MILK DHA TEST KRISTINA HARRIS JACKSON, PHD, RD RESEARCH ASSOCIATE, OMEGAQUANT ANALYTICS, LLC, SIOUX FALLS, SOUTH DAKOTA, USA

OUTLINE • My background • Mother’s Milk DHA (MM -DHA) test • Accuracy, Stability, Validity and Efficiency of MM-DHA test • MM-DHA Report and Recommendations • Research supporting higher breast milk DHA levels

KRISTINA HARRIS JACKSON, PHD, RD • Research Associate for OmegaQuant Analytics, LLC since 2013 with a specialty in human milk fatty acid research • PhD in Nutritional Sciences and Registered Dietitian (RD) credentials from The Pennsylvania State University in 2014 • 4 recent peer- reviewed publications on the Mother’s Milk DHA method (2 first author) since 2015 • Daughter of Bill Harris, co-creator of the Omega-3 Index and President of OmegaQuant, and currently a part-time researcher, full-time new mom of a 9-month old girl, June

WHY MEASURE DHA IN BREAST MILK? • Docosahexaenoic acid (DHA) is an important component of an infant’s developing brain and eyes. • Breast milk the best source of nutrition for an infant and always contains some level of DHA. • Breast milk DHA levels are correlated to the mother’s blood levels, which are largely dependent on mother’s intake of DHA. • Low intake of DHA-rich foods results in low levels of breast milk DHA, which is common in industrialized nations with low fish intake. • Higher breast milk DHA increases the breast- fed infant’s DHA blood levels, which is related to improved neurocognitive and vision development.

WHAT IS THE MOTHER’S MILK -DHA (MM-DHA) TEST? A measure of the amount of DHA in human milk expressed as the percent of total fatty acids There are 640 fatty displayed from milk triglycerides and 3 of which are DHA 3/640 = 0.47% MM-DHA = 0.47%

MM-DHA TARGET LEVEL: 0.32% 0.32% Worldwide Average Brenna et al. AJCN, 2007

Circulating EPA+DHA levels taken from • 24,129 individual subjects • 54 countries • 398 data sets • Converted to Omega-3 Index equivalents based on Stark et al. b GLOBAL OMEGA-3 INDEX A A Stark et al. Global survey of the omega-3 fatty acids, DHA and b Stark et al. PLEFA 2016;104:1 – 10 EPA in the blood stream of healthy adults. Prog Lipid Res. 2016;63:132-152.

MM-DHA TARGET LEVEL: 0.32% 0.32% Worldwide Average USA + China Philippines Japan UK + Canada Australia (0.35%) (0.74%) (0.99%) (0.17%) (0.24-0.25%) Brenna et al. AJCN, 2007; Yuhas R, et al. Lipids, 2006

WHY IS OUR MM-DHA TARGET 0.32%? • Corresponds to estimated milk levels from current DHA intake recommendations (200 mg/day DHA) by American Academy of Pediatrics • Worldwide average of milk DHA, as established by Brenna et al. 2007 • Formula is fortified to at least this level of DHA • Research shows neurocognitive benefits for infant at this level

MM-DHA: FROM ONE DROP OF MILK One drop of fresh or thawed milk is needed to analyze milk fatty acid content Date Collected Drop Name of Milk

DRIED MILK SPOTS VS. LIQUID MILK: SAME DHA LEVEL • DHA levels in liquid milk and dried milk spots from the R=0.99, same women were P<0.0001 compared • 55 samples in both liquid and dried milk spot form (n=5, South Dakota, USA and n=50, Malawi, Africa) Jackson K et al. 2016 Int Breastfeeding Journal

DHA IS STABLE WHEN STORED AT ROOM TEMPERATURE FOR 4 WEEKS • DHA values from dried milk spot samples stored at room temperature for 4 weeks • Average DHA level of 5 milk samples per time point from women in South Dakota, DHA USA • DHA levels stayed within 15% of the baseline value Jackson K et al. 2016 Int Breastfeeding Journal

OMEGAQUANT VS. RESEARCH METHOD: SAME DHA LEVEL • DHA levels from liquid milk analyzed by a research method from the University of Colorado were compared to DHA values derived from dried milk spots • 35 women from Colorado, USA R=0.92, P<0.0001 provided milk samples Rudolph MR et al. J Mammary Glad Neoplasia 2016 (epub)

MILK DHA LEVELS DO NOT CHANGE BETWEEN FORE AND HIND MILK Milk DHA (% Composition) Early in Feed Late in Feed (Fore) (Hind) Colostrum 0.53 ± 0.11% 0.52 ± 0.13% Mature Milk 0.08 ± 0.02% 0.09 ± 0.01% N=19 Australian mums (colostrum), first feed of the day; N=6 English mums (mature milk) Hall, B. AJCN 1979; Gibson R. and Kneebone G. AJCN,1980

RESULTS AND RECOMMENDATIONS FROM THE MM-DHA REPORT

“First, congratulations on breastfeeding your baby! Below the 0.32% Target: There are many benefits to “ Your MM-DHA level is below breastfeeding for you and the worldwide average. We your baby, both physical and recommend that you emotional. You’ve made the increase your intake of DHA right choice!” to at least 200 mg per day. ” “There are very simple dietary changes you can make to increase your “Your Mother’s Milk -AA breast milk DHA levels. First level was XX% and the you can eat two servings of worldwide range is 0.2% - low-mercury, high-DHA fish 1.0%.” per week (see attached list).”

“First, congratulations on Above the 0.32% Target: breastfeeding your baby! “ Congratulations! Your MM- There are many benefits to DHA level is above the breastfeeding for you and worldwide average. We your baby, both physical and recommend you continue emotional. You’ve made the your current diet and/or right choice!” supplementation routine.” “If you eat fish, it is important that you choose a low- mercury, high DHA fish (see attached list).”

GUIDELINES FOR PREGNANT AND LACTATING WOMEN HAVE BECOME MORE “FISH FRIENDLY” • Fish intake decreased (and milk DHA levels) after advisories for pregnant women to avoid fish due to mercury concerns. • The British Nutrition Foundation recommends “2 portions of fish per week, one of which should be oily fish” for the general population and pregnant women (no mention of lactating women). • US FDA recommends 2 servings per week of low-mercury fish and the American Academy of Pediatrics recommends 200-300 mg DHA per day for pregnant and lactating women (primarily from low-mercury fish). Johnston M, et al. Pediatrics, 2012; Papanikolaou Y, et al. Nutrition Journal, 2015.; American Academy of Pediatrics, 2012

Low Mercury – Eat 2 servings per week Fish DHA Fish DHA Walleye/Pike 245 Atlantic Salmon (farmed) 1238 Oysters (farmed, raw) 173 Atlantic Salmon (wild) 1215 Clams 124 Atlantic Herring 939 Mixed Shrimp 120 Pacific Herring 751 Catfish (wild) 116 Coho Salmon (farmed) 740 Flat Fish (Flounder/Sole) 112 Coho Salmon (wild) 706 Tilapia 110 Sockeye Salmon (wild) 690 King Crab 100 Pink Salmon (wild) 638 Dungeness Crab 96 Rainbow Trout (farmed) 524 Scallops 88 Sardines (canned) 433 Catfish (farmed) 59 Atlantic Pollock 383 Blue Crab 57

Moderate Mercury – Eat 1 serving per week Fish DHA Bluefin Tuna 970 Mackerel (canned) 677 Albacore (or White) Tuna 535 (canned) Sea Bass 473 Skipjack Tuna 201 Light Chunk Tuna 190 Halibut 132 Cod 131 Mahi-Mahi (Dolphin Fish) 96 Yellowfin Tuna 89

Excess Mercury – Avoid Fish DHA Swordfish 656 Shark (raw) 448 King Mackerel 193 Supplements – Up to 1000 mg DHA per day Supplements DHA Standard Drug Store Fish Oil Capsules 120 Fish Oil Concentrate (many varieties) 100-400 Cod Liver Oil (teaspoon) 500 Standard Vegan DHA Capsule 100-200

“Taking flaxseed oil supplements that are rich in the plant omega-3 fatty acid, alpha-linolenic acid [ALA], will not affect your MM-DHA level.”

SUPPLEMENTING WITH ALA, THE PLANT- BASED OMEGA-3, DOES NOT IMPACT BREAST MILK DHA LEVELS 0.5 DHA (% Composition) 0.4 0.32% 0.3 OQ Target 0.2 0.1 0 Baseline 2 weeks 4 weeks N=7, mothers of breastfed infants (for at least 8 weeks); supplementing with 20 g/day Francois et al. AJCN 2003 flaxseed oil (10.7 g/day ALA); P=NS

Omega-6 Fatty Acids Omega-3 Fatty Acids LA ALA (18:2n6) (18:3n3) Δ 6-desaturase GLA SDA (18:3n6) (18:4n3) Δ 5-desaturase DGLA EPA (20:3n6) (20:5n3) (22:5n3) DHA AA (22:6n3) (20:4n6) Both found in mother’s milk

RESEARCH SUPPORTING HIGHER DHA LEVELS IN PREGNANT AND LACTATING WOMEN

DHA SUPPLEMENTATION DURING PREGNANCY IS GOOD FOR MOM AND BABY • Carlson et al. 2013 - DHA supplementation (600 mg/day) during pregnancy resulted in longer gestational duration (2.9 days), greater birth weight, length and head size as well as fewer pre-term births • Helland et al. 2003 - Maternal supplementation with DHA (~1 g/day) during pregnancy and lactation resulted in higher IQ scores in the children at 4 years old compared to the placebo group Helland et al. Pediatrics 2003;111(1) Carlson et al. AJCN 2013; 97(4):808-15.

COST:BENEFIT RATIO FOR DHA SUPPLEMENTATION IS VERY FAVORABLE • Estimated at least £8.9 million in savings per year in hospital bills if all women took DHA during pregnancy • Most savings from uncomplicated pregnancies and decreasing early pre-term birth rates • Testing the Omega-3 Index levels (DHA+EPA) in pregnant women could help identify those who are reaching beneficial levels (or not) Ahmed S et al. PLEFA 2015;102:5-11.