Yun Kyung Choi; Nayoung Kim; Ji-Myung Kim; Mi Sook Cho; Bong Soo Kang; Yuri Kim

doi:10.4163/jnh.2015.48.6.476

Journal List > J Nutr Health > v.48(6) > 1081419

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Kim, Kim, Cho, Kang, and Kim: Studies of nutrient composition of transitional human milk and estimated intake of nutrients by breastfed infants in Korean mothers∗

Research Article

J Nutr Health 2015;48(6):476-487.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.6.476

Studies of nutrient composition of transitional human milk and estimated intake of nutrients by breastfed infants in Korean mothers^∗

Yun Kyung Choi¹, Nayoung Kim¹, Ji-Myung Kim², Mi Sook Cho^1,³, Bong Soo Kang⁴, Yuri Kim^1,^3,^†

¹Dept. of Clinical Nutrition, The Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 03760, Korea

²Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University, Uijeongbu 11644, Korea

³Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea

⁴U2 Bio Co. Ltd., 68, Geoma-ro, Songpa-gu, Seoul 05755, Korea

^†To whom correspondence should be addressed. tel: +82-2-3277-4485, e-mail: yuri.kim@ewha.ac.kr

^∗ This research was supported by U2 Bio Co. Ltd.

Received 10 September 2015 Revised 21 October 2015 Accepted 3 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was conducted to examine the concentration of nutrients in transitional breast milk from Korean lactating mothers and to evaluate daily intakes of their infants based on the Dietary Reference Intakes for Koreans 2010 (KDRIs 2010).

Methods:

Breast milk samples were collected at 5~15 days postpartum from 100 healthy lactating Korean mothers. Macro- and micro-nutrients, and immunoglobulin (Igs) concentrations in breast milk were analyzed.

Results:

The mean energy, protein, fat, and carbohydrate concentrations in breast milk were 59.99 ± 8.01 kcal/dL, 1.47 ± 0.27 g/dL, 2.88 ± 0.89 g/dL, and 6.72 ± 0.22 g/dL. The mean linoleic acid (LA), a-linolenic acid (ALA), arachidonic acid (AA), and docosahexaenoic acid (DHA) concentrations were 181.44 ± 96.41 mg/dL, 28.15 ± 8.89 mg/dL, 5.67 ± 1.86 mg/dL, and 5.74 ± 2.57 mg/dL. The mean vitamin A, vitamin D, vitamin E, vitamin B₁, vitamin B₂, vitamin B₁₂, and folate concentrations were 2.75 ± 1.75 µg/dL, 2.31 ± 1.12 ng/dL, 0.74 ± 1.54 mg/dL, 3.02 ± 1.84 mg/dL, 7.51 ± 20.96 µg/dL, 61.78 ± 26.78 µg/dL, 63.71 ± 27.19 ng/dL, and 0.52 ± 0.26 µg/dL. The mean concentrations of calcium, iron, potassium, sodium, zinc, and copper were 20.71 ± 3.34 mg/dL, 0.59 ± 0.86 mg/dL, 66.71 ± 10.35 mg/dL, 27.72 ± 10.16 mg/dL, 0.44 ± 0.41 mg/ dL, and 70.48 ± 30.41 µg/dL. The mean IgA and total IgE concentrations were 61.85 ± 31.97 mg/dL and 235.00 ± 93.00 IU/dL. The estimated daily intakes of infants for protein, vitamin D, vitamin E, vitamin B₂, vitamin B₁₂, iron, potassium, sodium, zinc, and copper were sufficient compared to KDRIs 2010 adjusted by transitory milk intakes. The estimated infants' intakes of energy, fat, carbohydrate, vitamin A, vitamin C, vitamin B₁, folate, and calcium did not meet KDRIs 2010 adjusted by transitory milk intakes.

Conclusion:

In general most estimated nutrient intakes of Korean breastfed infants in transitory breast milk were sufficient, however some nutrient intakes were not sufficient based on KDRIs 2010. These results warrant conduct of future studies for investigation of important dietary factors associated with nutrients in breast milk to improve the quality of breast milk, which may contribute to understanding nutrition in early life and promoting growth and development of breastfed infants.

Keywords: breast milk, concentration, intakes, infants

REFERENCES

1.Worthington-Roberts BS., Williams SR. Nutrition in pregnancy and lactation. St. Louis, MO: Mosby;1993.

2.Besculides M., Grigoryan K., Laraque F. Increasing breastfeeding rates in New York City, 1980-2000. J Urban Health. 2005. 82(2):198–206.

3.Newburg DS. Innate immunity and human milk. J Nutr. 2005. 135(5):1308–1312.

4.Oddy WH. The impact of breastmilk on infant and child health. Breastfeed Rev. 2002. 10(3):5–18.

5.Min KB., Lee SM., Eun HS., Park MS., Park KI., Namgung R., Lee C. Analysis of the macronutrient composition of breast milk from Korean women and growth of infants. Korean J Perinatol. 2012. 23(4):259–265.

6.Lee SW., In YM., Ham JS., Choi JC. Studies on the composition of Korean human milk during lactation period. Korean J Dairy Sci. 1997. 19(2):123–130.

7.Adamson ED., Deller MJ., Warshaw JB. Functional EGF receptors are present on mouse embryo tissues. Nature. 1981. 291(5817):656–659.

8.Jensen RG., Clark RM., Ferris AM. Composition of the lipids in human milk: a review. Lipids. 1980. 15(5):345–355.

9.Isaacs EB., Fischl BR., Quinn BT., Chong WK., Gadian DG., Lucas A. Impact of breast milk on intelligence quotient, brain size, and white matter development. Pediatr Res. 2010. 67(4):357–362.

10.Auestad N., Scott DT., Janowsky JS., Jacobsen C., Carroll RE., Mon-talto MB., Halter R., Qiu W., Jacobs JR., Connor WE., Connor SL., Taylor JA., Neuringer M., Fitzgerald KM., Hall RT. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics. 2003. 112(3 Pt 1):e177–e183.

11.Lee JS., Lee YN., Kim ES. Study on zinc and copper intakes of breastfed infants. Korean J Nutr. 2000. 33(8):857–863.

12.Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatr Clin North Am. 2001. 48(1):125–141.

13.van Odijk J., Kull I., Borres MP., Brandtzaeg P., Edberg U., Hanson LA., Høst A., Kuitunen M., Olsen SF., Skerfving S., Sundell J., Wille S. Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy. 2003. 58(9):833–843.

14.Sobti J., Mathur GP., Gupta A. WHO. WHO's proposed global strategy for infant and young child feeding: a viewpoint. J Indian Med Assoc. 2002. 100(8):502–504.

15.Neville MC. Measurement of milk transfer from mother to breastfed infant. J Pediatr Gastroenterol Nutr. 1987. 6(5):659–662.

16.Kim ES., Cho KH. Iron, copper and zinc levels in human milk and estimated intake of the minerals by breastfed infants during the early lactation. J East Asian Soc Diet Life. 2004. 14(1):27–33.

17.Lee MJ. A study on the influencing factors of macronutrient concentrations in human milk. Korean J Nutr. 1997. 30(6):715–726.

18.Lee JS., Kim ES., Kim BN. Changes in transitional milk intakes and body weight of breastfed infants. Korean J Nutr. 1994. 27(6):591–598.

19.Seol MY., Kim ES., Keum HK. A longitudinal study on human milk intake in exclusively breastfed infants. Korean J Nutr. 1993. 26(4):414–422.

20.Lee JS., Kim ES. A longitudinal study on human milk volume and lactational pattern. Korean J Nutr. 1991. 24(1):48–57.

21.Choi KS., Kim ES. A longitudinal study on human milk volume and lactational performance of Korean lacto-ovo-vegetarians. Korean J Nutr. 1991. 24(3):219–229.

22.The Korean Nutrition Society. Dietary reference intakes for Koreans. 1st revision. Seoul: The Korean Nutrition Society;2010.

23.Seol MY., Kim ES., Keum HK. A longitudinal study on human milk volume in lactating women during the first 6 months of lactation. Korean J Nutr. 1993. 26(4):405–413.

24.Lee JS., Choi KS., Kim ES. Changes on milk production of lactating women in Kwangwon province during lactation. Korean J Nutr. 1996. 29(10):1105–1111.

25.Kim ES., Lee JS. A longitudinal study on energy, protein, fat and lactose intakes of breastfed infants. Korean J Nutr. 2002. 35(7):771–778.

26.Bae YJ., Leem EJ., Kim SY., Chang MJ., Lee DT. Influence of exercise participation on changes of body composition, physical fitness and breast milk composition in milk feeding women. J Exerc Nutr Biochem. 2004. 8(1):17–22.

27.Moon SJ., Ahn HS., Lee MJ., Kim JH., Kim CJ., Kim SY. A longitudinal study of the total lipid, total cholesterol, and vitamin E contents and fatty acids composition of human milk. Korean J Nutr. 1993. 26(6):758–771.

28.Trumbo P., Schlicker S., Yates AA., Poos M. Food and Nutrition Board of the Institute of Medicine, The National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc. 2002. 102(11):1621–1630.

29.Chun YM., Kim YJ., Chang N. Effects of maternal dietary intakes and health-related behaviors on vitamin B concentrations in human milk. Korean J Nutr. 2005. 38(4):313–319.

30.Butte NF., Calloway DH. Evaluation of lactational performance of Navajo women. Am J Clin Nutr. 1981. 34(10):2210–2215.

31.Kim ES. Vitamin A intake of exclusively breastfed infants in Cheongju and Anseong areas. Korean J Nutr. 2003. 36(7):743–748.

32.Na B., No S., Kim MJ., Han HS., Jeong EH., Han Y., Hyeun T. Nutritional status of vitamin D in Korean mothers and their newborn infants: Vitamin D status of Korean mothers and newborns. Korean J Perinatol. 2007. 18(4):399–406.

33.Farrell PM. Vitamin E deficiency in premature infants. J Pediatr. 1979. 95(5 Pt 2):869–872.

34.Rönnholm KA., Dostálová L., Siimes MA. Vitamin E supplementation in very-low-birth-weight infants: long-term follow-up at two different levels of vitamin E supplementation. Am J Clin Nutr. 1989. 49(1):121–126.

35.Oski FA., Barness LA. Vitamin E deficiency: a previously unrecognized cause of hemolytic anemia in the premature infant. J Pediatr. 1967. 70(2):211–220.

36.Lee JS., Kim ES. Study on vitamin E intake of exclusively breastfed infants. Korean J Nutr. 1998. 31(9):1440–1445.

37.Machlin LJ. Handbook of vitamins. New York, NY: M. Dekker;1991.

38.Lim HS., Lee JI., Lee JA. Folate status of Korean pregnant women and their pregnancy outcomes-across-sectional study. Korean J Nutr. 1999. 32(5):592–597.

39.Feeley RM., Eitenmiller RR., Jones JB Jr., Barnhart H. Calcium, phosphorus, and magnesium contents of human milk during early lactation. J Pediatr Gastroenterol Nutr. 1983. 2(2):262–267.

40.Pizarro F., Olivares M., Gidi V., Araya M. The gastrointestinal tract and acute effects of copper in drinking water and beverages. Rev Environ Health. 1999. 14(4):231–238.

41.Lönnerdal B. Nutritional and physiologic significance of human milk proteins. Am J Clin Nutr. 2003. 77(6):1537S–1543S.

42.Kwon MS., Yun IS., Cho MS., Lee HS., Kim WY. Effect of maternal factors on the concentrations of minerals and immunological substance in breast milk. Korean J Nutr. 2004. 37(9):809–816.

Table 1.

General characteristics of the subjects and their baby (n= 100)

Mothers
Age (years)	32.01 ± 4.08¹⁾
Height (cm)	161.93 ± 4.79
Present weight (kg)	60.34 ± 8.17
Prepregnancy weight (kg)	52.64 ± 8.75
Parturiency weight (kg)	65.92 ± 8.17
BMI²⁾ (kg/m²)	23.00 ± 2.80
Weight gain in pregnancy (kg)	13.28 ± 50.29
Weight loss after delivery (kg)	5.57 ± 2.26
Education level
High school or less	2 (2.0)³⁾
College or more	98 (98.0)
Employed status
Employed	37 (37.0)
Unemployed	63 (63.0)
Income level (won)
Under 3,000,000	46 (46.0)
3,000,000 ~ 5,000,000	31 (31.0)
Over 5,000,000 won	23 (23.0)
Supplement⁴⁾ in pregnancy
Yes	83 (83.0)
No	17 (17.0)
Smoking before pregnancy
Yes	11 (11.0)
No	89 (89.0)
Drinking in pregnancy
Yes	14 (14.0)
No	86 (86.0)
Newborn infants
Age (days)	11.19 ± 2.85
Sex
Male	51 (51.0)
Female	49 (49.0)
Birth weight (kg)	3.17 ± 0.43
Parity parous
Prime	81 (81.0)
Multi	19 (19.0)
Parturition
Natural	74 (74.0)
Cesarean	26 (26.0)

¹⁾ Values are Mean ± SD.

²⁾ BMI: Body Mass Index

³⁾ Value are N (%).

⁴⁾ Supplement: mineral supplement

Table 2.

Instrumental conditions and parameters for vitamin analysis in human milk

Subject	Vitamin A & E	Vitamin C	Vitamin B₁	Vitamin B₂
Analyzer
Model		1260 series
Company		Agilent
Manufacturing country		Germany
Parameters
Method	HPLC	HPLC	HPLC	HPLC
Injection Volume	50 µL	20 µL	50 µL	50 µL
Flow rate	1.5 mL/min	1.0 mL/min	1.5 mL/min	1.5 mL/min
Detector	UV Detector	UV Detector	Fluorescence	Fluorescence
Wavelength	325 nm after 3.5 min 295 nm	UV 254 nm	EX 367 nm, EM 435 nm	E 465 nm, EM 525 nm

Table 3.

Instrumental conditions parameters for copper and zinc analysis in human milk

Subject	Cu	Zn
Analyzer
Model	NexION 350D
Company	Perkin Elmer
Manufacturing country	USA
Parameters & condition
Method	ICP-mass	ICP-mass
Preprocessing	Microwave	Microwave
Mass	Deflect voltage	-12 V
	R.f.power	Forward: 1.1
	R.f.power	Reflected: < 3 W
Inductively coupled plasma		Plasma argon: 15 L/min
	Gas Flow rates	Nebulizer argon: 0.87 L/min
	Gas Flow rates	Auxiliary argon: 0.9 L/min
Interface	Sampling cone	Nikel 1.0 mm
	Skimmer cone	Nikel 0.9 mm
	Hyper Skimmer cone	Nikel 1.0 mm
	Ion sampling depth	8 mm
Spectrometer	Sccanning mode	Auto
	Dwell time	330 msec
	Number of replicates	3
	30 sec	30 sec
	10.3 sec	10.3 sec
	150 sec	150 sec

Table 4.

Concentration of nutrients in human milk (n=100)

Nutrient	Mean ± SD	Range
Energy (kcal/dL)	59.99 ± 8.01¹⁾	42.00 ~ 89.00²⁾
Protein (g/dL)	1.47 ± 0.27	0.80 ~ 2.20
Carbohydrate (g/dL)	6.72 ± 0.22	5.90 ~ 7.10
Fat (g/dL)	2.88 ± 0.89	1.00 ~ 6.20
LA³⁾ (mg/dL)	181.44 ± 96.41	72.50 ~ 643.50
ALA⁴⁾ (mg/dL)	28.15 ± 8.89	4.80 ~ 63.20
AA⁵⁾ (mg/dL)	5.67 ± 1.86	2.80 ~ 11.60
DHA⁶⁾ (mg/dL)	5.74 ± 2.57	1.70 ~ 18.10
Vitamin A (µg/dL)	2.75 ± 1.75	0.002 ~ 8.42
Vitamin D (µg/dL)	2.31 ± 1.12	0.88 ~ 8.20
Vitamin E (mg/dL)	0.74 ± 1.54	0.05 ~ 10.80
Vitamin C (mg/dL)	3.02 ± 1.84	0.03 ~ 9.10
Vitamin B₁ (µg/dL)	7.51 ± 20.96	0.05 ~ 85.74
Vitamin B₂ (µg/dL)	61.78 ± 26.78	0.05 ~ 135.44
Vitamin B₁₂ (ng/dL)	63.71 ± 27.19	0.21 ~ 1.94
Folate (µg/dL)	0.52 ± 0.26	0.03 ~ 1.46
Calcium (mg/dL)	20.71 ± 3.34	9.60 ~ 25.80
Iron (mg/dL)	0.59 ± 0.86	0.005 ~ 3.4
Potassium (mg/dL)	66.71 ± 10.35	19.40 ~ 98.50
Sodium (mg/dL)	27.72 ± 10.16	3.00 ~ 71.30
Zinc (mg/dL)	0.44 ± 0.41	0.08 ~ 3.11
Copper (µg/dL)	70.48 ± 30.41	0.50 ~ 233.40
IgA⁷⁾ (mg/dL)	61.85 ± 31.97	17.50 ~ 262.60
Total IgE⁸⁾ (IU/dL)	235 ± 93	140 ~ 600

¹⁾ Values are Mean ± SD.

²⁾ Min ~ Max

³⁾ LA: Linoleic acid

⁴⁾ ALA: a-Linolenic acid

⁵⁾ AA: Arachidonic acid

⁶⁾ DHA: Do cosahexaenoic acid

⁷⁾ IgA: immunoglobulin A

⁸⁾ IgE: immu noglobulin E

Table 5.

Daily human milk intakes estimation of infant and comparison with KDRI¹⁾ (n = 100)

Nutrient	Daily intake estimation²⁾	AI³⁾ in KDRI	%AI in KDRI	Adjusted %AI in KDRI⁴⁾
Energy (g/day)	309.0 ~ 319.2	550^∗	56.2^∗ ~ 58.0	81.8
Protein (g/day)	7.6 ~ 7.8	9.5	79.7 ~ 82.4	116.1
Carbohydrate (g/day)	34.6 ~ 35.7	55	62.9 ~ 64.9	91.6
Fat (g/day)	14.9 ~ 15.3	25	59.4 ~ 61.4	85.6
Vitamin A (µg/day)	141.7 ~ 146.3	300	47.2 ~ 48.8	68.8
Vitamin D (µg/day)	11.9 ~ 12.3	5	237.9 ~ 245.7	346.4
Vitamin E (mg/day)	3.8 ~ 3.9	3	126.6 ~ 130.8	184.3
Vitamin C (mg/day)	15.6 ~ 16.1	35	44.5 ~ 45.9	64.8
Vitamin B₁ (µg/day)	38.7 ~ 40.0	200	19.4 ~ 20.0	28.2
Vitamin B₂ (µg/day)	318.2 ~ 328.7	300	106.1 ~ 109.6	154.5
Vitamin B₁₂ (ng/day)	328.4 ~ 339.3	300	109.5 ~ 113.1	159.4
Folate (ng/day)	26.6 ~ 27.5	65	40.9 ~ 42.3	59.6
Calcium (mg/day)	106.6 ~ 110.2	200	53.3 ~ 55.1	77.7
Iron (mg/day)	0.3 ~ 0.3	0.3	100.7 ~ 104.0	146.7
Potassium (mg/day)	343.6 ~ 354.9	400	85.9 ~ 88.7	125.1
Sodium (mg/day)	142.8 ~ 147.5	120	119.0 ~ 122.9	173.3
Zinc (mg/day)	2.3 ~ 2.4	1.7	134.5 ~ 138.9	195.9
Copper (µg/day)	362.8 ~ 374.7	230	157.7 ~ 162.9	229.7

¹⁾ KDRI: Korean Dietary Reference Intakes 2010 for 0~5 month infants regarding 750 mL as daily milk intake

²⁾ Daily intake of transitory milk was estimated based on transitional milk intake of 515~532 mL/day.

³⁾ AI: Adequate Intake by KDRIs 2010

⁴⁾ Adjusted %AI in KDRI: considered 515 mL daily tansitional milk intake

∗EER: Estimated Energy Requirements by KDRIs 2010

Table 6.

Comparison of nutrients levels in human milk during transitory (5 ~ 15 days after parturition) in referred similar Korean study

Reference	Number of subjects	Stage of lactation		Nutrients
Energy & Macro nutrients			Energy (kcal/dL)	Protein (g/dL)	Fat (g/dL)	Carbohydrate (g/dL)
Bae et al., 2004	6	7 ~ 10 day		0.7	2.00
Kim and Lee, 2002	16	15 day	64.2	1.48	3.46	6.6∗
Lee et al., 1997	42	7 day			2.52
	38	14 day			2.87
Lee et al., 1997		6 ~ 10 day	65.26
Choi and Kim, 1997	23	15 days		1.31	3.29	6.46∗
Moon et al.,1993		7 day	59.10	1.95	2.89	6.51∗
		14 day	68.59	1.79	2.93	7.14∗
Choi et al., 1991	12	7 day			1.99
	17	14 day			3.27
Choue et al., 1980	14	7 ~ 28 day			4.91
Present study	100	5 ~ 15 day	59.99	1.47	2.88	6.72
Vitamins			Vitamin A (µg/dL)	Vitamin E (mg/dL)
Kim et al., 2004	20	5 ~ 10 day	7.83
Kim et al., 2003	27	5 ~ 10 day	6.57
Lee and Kim, 1995	25	7 day	9.49
	31	10 day	8.05
	31	15 day	6.73
Lee and Kim 1998	33	15 day		0.54
	26	7 day		0.65
Moon et al., 1993	26	14 day		0.42
Present study	100	5 ~ 15 day	2.75	0.74
Minerals			Calcium (mg/dL)	Iron (mg/dL)	Zinc (mg/dL)	Copper (mg/dL)
Kwon et al., 2004	33	6 ~ 10 day	24.52	0.87	0.29
Kim et al., 2004	12	7 ~ 15 day		0.48	0.37	0.43
Lee et al., 2000	33	15 day			0.39	0.61
Yang et al., 1995	15	7 day			0.42
Yoon et al., 1991	13	6 ~ 10 day	23.67
Choi et al., 1991	11	7 day		0.31	0.35	0.34
	17	14 day		0.28	0.34	0.32
Present study	100	5 ~ 15 day	20.71	0.59	0.44	0.71
Immunoglobulins			IgA¹⁾ (mg/dL)
Kwon et al., 2004	33	6 ~ 10 day	87
Bae et al., 2004	6	7 ~ 10 day	17∗
Kim et al., 1994	72	7 ~ 14 day	17∗
Present study	100	5 ~ 15 day	62

¹⁾ IgA: immunoglobulin A

∗lactose concentration in breast milk

TOOLS

Similar articles