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
• f 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%

Brenna et al. AJCN, 2007

0.32% Worldwide Average

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

b Stark et al. PLEFA 2016;104:1–10 A Stark et al. Global survey of the omega-3 fatty acids, DHA and

EPA in the blood stream of healthy adults. Prog Lipid Res. 2016;63:132-152.

GLOBAL OMEGA-3 INDEXA

MM-DHA TARGET LEVEL: 0.32%

Brenna et al. AJCN, 2007; Yuhas R, et al. Lipids, 2006

Japan

(0.99%)

UK + Australia

(0.24-0.25%)

Philippines

(0.74%)

USA + Canada

(0.17%)

China

(0.35%)

0.32% Worldwide Average

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

• f

Milk

Name

DRIED MILK SPOTS VS. LIQUID MILK: SAME DHA LEVEL

Jackson K et al. 2016 Int Breastfeeding Journal

• DHA levels in liquid milk and

dried milk spots from the same women were compared

• 55 samples in both liquid and

dried milk spot form (n=5, South Dakota, USA and n=50, Malawi, Africa)

R=0.99, P<0.0001

DHA IS STABLE WHEN STORED AT ROOM TEMPERATURE FOR 4 WEEKS

Jackson K et al. 2016 Int Breastfeeding Journal

• 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, USA

• DHA levels stayed within

15% of the baseline value DHA

OMEGAQUANT VS. RESEARCH METHOD: SAME DHA LEVEL

Rudolph MR et al. J Mammary Glad Neoplasia 2016 (epub)

• 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

provided milk samples

R=0.92, P<0.0001

MILK DHA LEVELS DO NOT CHANGE BETWEEN FORE AND HIND MILK

Hall, B. AJCN 1979; Gibson R. and Kneebone G. AJCN,1980

Early in Feed (Fore) Late in Feed (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)

Milk DHA (% Composition)

RESULTS AND RECOMMENDATIONS FROM THE MM-DHA REPORT

Below the 0.32% Target: “Your MM-DHA level is below the worldwide average. We recommend that you increase your intake of DHA to at least 200 mg per day.” “First, congratulations on breastfeeding your baby! There are many benefits to breastfeeding for you and your baby, both physical and

• emotional. You’ve made the

right choice!” “There are very simple dietary changes you can make to increase your breast milk DHA levels. First you can eat two servings of low-mercury, high-DHA fish per week (see attached list).” “Your Mother’s Milk-AA level was XX% and the worldwide range is 0.2% - 1.0%.”

Above the 0.32% Target: “Congratulations! Your MM- DHA level is above the worldwide average. We recommend you continue your current diet and/or supplementation routine.” “First, congratulations on breastfeeding your baby! There are many benefits to breastfeeding for you and your baby, both physical and

• emotional. You’ve made the

right choice!” “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

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

Low Mercury – Eat 2 servings per week

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

Moderate Mercury – Eat 1 serving per week

Fish DHA Swordfish 656 Shark (raw) 448 King Mackerel 193 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

Excess Mercury – Avoid Supplements – Up to 1000 mg DHA per day

“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

0.1 0.2 0.3 0.4 0.5

Baseline 2 weeks 4 weeks DHA (% Composition)

Francois et al. AJCN 2003

N=7, mothers of breastfed infants (for at least 8 weeks); supplementing with 20 g/day flaxseed oil (10.7 g/day ALA); P=NS 0.32% OQ Target

LA

(18:2n6)

GLA

(18:3n6)

DGLA

(20:3n6)

Omega-6 Fatty Acids Omega-3 Fatty Acids ALA

(18:3n3)

SDA

(18:4n3)

EPA

(20:5n3) (22:5n3)

Δ6-desaturase Δ5-desaturase

AA

(20:4n6)

DHA

(22:6n3)

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.

FORMULA STUDIES PROVIDE CLEAR EVIDENCE FOR THE ROLE OF DHA IN INFANT DEVELOPMENT

• Compared to formula with 0% DHA:
• Colombo et al. 2011 (US) – Infants fed 0.32% DHA (0.64% AA)

formula had lower heart rates and improved active stimulus processing time during the first year

• Willatts et al. 2013 (UK) – 6-year old children who were fed 0.21%

DHA (0.35% AA) formula as infants were more efficient in processing information

Colombo J et al. Pediatric Res 2011;70(4):406-410; Willatts P et al. AJCN 2013;98:536S-542S

“DHA accretion in utero occurs primarily in the last trimester of pregnancy to support rapid growth and brain development. Premature infants, born before this process is complete, are relatively deficient in this essential fatty acid.”

Baack M and Harris WS. 2015, J Perinatology

DIETARY DHA IS CRITICAL FOR PREMATURE INFANTS

• 800 mg DHA/day and milk DHA level
• f 0.8-1.0% for mothers of premature

infants has been suggested

• DHA may be beneficial for premature

babies for these reasons:

• Proper development
• Decrease inflammatory diseases of

prematurity

Baack M and Harris WS, 2015 J Perinatolo

Bronchopulmonary Dysplasia (BPD) Retinopathy of Prematurity (ROP) Necrotizing Enterocolitis (NEC)

0.21 5.8 0.35 7.2 0.46 7.7 0.86 9 1.13 9.8 1 2 3 4 5 6 7 8 9 10 Mom DHA (Milk) Infant DHA (RBC) DHA (% Composition) 200 400 900 1300

INCREASING MILK DHA CORRESPONDED TO AN INCREASE IN INFANT RBC DHA

Gibson R et al. 1997 EJCN

DHA Dose for Mom (mg/day DHA) n=52 breastfeeding mothers and their infants (for at least 12 weeks) R=0.88, P<0.0001

0.32 %

INFANT DHA LEVELS HAVE BEEN DIRECTLY ASSOCIATED WITH COGNITIVE AND VISUAL OUTCOMES

• Gibson et al. 1997 - Infant RBC-DHA levels in 52 infants were

correlated with a neurodevelopmental test score at 1 year but not at 2 years

• Lauritzen et al. 2004 - Infant RBC-DHA was a significant determinant of

visual acuity in 97 infants

Gibson RA et al. EJCN 1997;51:578-584 Lauritzen L et al. Lipids 2004;39:195-206

CHILDREN FROM DHA-SUPPLEMENTED MOMS HAD IMPROVED COGNITIVE OUTCOMES AT 5 YEARS

• Jensen et al. 2005, 2010
• 200 mg DHA/day versus a vegetable oil placebo for 16

weeks post-partum in 227 breastfeeding mother-infant pairs (USA)

• No group differences in neurodevelopmental outcomes at

12 and 30 months; no visual acuity outcomes at 4 and 8 months

• At 30 months, infants of DHA supplemented mothers

performed better on the Bayley’s Psychomotor Development Index

• At 5 years, children of DHA supplemented mothers

performed better on Sustained Attention Tasks

Jensen CL et al. AJCN 2005;82:125-32; Jensen CL et al. J Peds 2010;157:900-905.

0.2 3.57 0.35 4.81 1 2 3 4 5 6 Milk Infant Plasma DHA (% Composition) Placebo 200 mg DHA/day

“Although research in both humans and animal models has shown that some level of DHA is needed in the infant’s diet for normal development when compared with the complete elimination of DHA, it is less clear at what DHA level maximal benefit is achieved.”

Jackson KH and Harris WS. Curr Op Clin Nut Metab Care 2016;19:92-96.

SUMMARY

• DHA is a natural and essential component of human milk.
• DHA is a major component of the brain and eyes.
• DHA levels vary world wide from <0.2% to >1%, with an average of

0.32% (recommended level).

• Measuring breast milk DHA levels (MM-DHA) is the only way to

know how much DHA a baby is consuming from breast milk.

• The MM-DHA test is safe, accurate, effective and inexpensive.

QUESTIONS?

KRISTINA@OMEGAQUANT.COM

Laboratory Diagnostics

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