The document summarizes the composition of breast milk over time from colostrum to transitional milk to mature milk. It discusses the high levels of proteins, immunoglobulins, vitamins, and minerals in colostrum that provide local immunity and are well-adapted to the newborn's needs. Mature breast milk contains proteins, carbohydrates like lactose, lipids, minerals, vitamins, and enzymes that support infant growth, immunity, and development. The composition of breast milk differs from cow's milk in beneficial ways such as higher antibody levels, easier digestibility of proteins, and appropriate mineral ratios.

1. Composition of breast
milk
Presenter: Dr. Pugazhenthi

2. HUMAN MILK COMPOSITION
Mammary gland secretion:
- colostrum
- transitional milk,
- mature milk.
Colostrum:
- lactation within 5 days after birth
- opaque yellow liquid,
- Ig richer in protein than transitional and mature
human milk.

3. Colostrum
Protein
- varies between 27-41 g / l
- diminishes as soon as the milk flow.
Immunoglobulins:
- initially very high, which decrease during the first day
after birth.
- 90% of total Ig are IgA (Anti polio Anticoli,
antistaphylococcal, anticoxakie).
→ high degree of local immunity.

4. Colostrum
Colostrum is adapted to the needs of the newborn in the
first days of life, with increased quantities of:
- lactoferrin
- secretory IgA,
- protein bound vitamin B12
- zinc
- lipase, alpha-amylase, phosphatase, protease
inhibitors
- taurine

5. Colostrum
Carbohydrates:
- total of 55-60 g / l
- proportion of lactose is small (37 g / l)
- oligosaccharides (23g / l), promotes implantation of
the newborn intestine of the Bacillus bifidus.

6. Colostrum
Total lipids:
- initial 30g / l, in conjunction with low activity of
intestinal lipase.
- unsaturated fatty acids are essential especially those in
large quantities and have a role in nervous system
development.

7. Colostrum
Mineral salts:
- the amount of 3.9 g / l
- the Na, P, Ca, Fe, Zn, Cu more in line with that of
protein.
Vitamins A, E, C, B12 are well represented in colostrum
compared with mature milk.
Caloric value = 58 kcal/100ml.

8. Transitional milk
 on the 6th and 10th postpartum, although biochemical
and immunological changes continue until one month;
- decreases the protein, mineral salts, pH,
- increase the level of lipids and lactose.

9. Mature human milk (h.m.)
Water - 87%.
Total Protein - 10g / l:
4g / l casein
6g / l of whey protein (lactalbumin and lactoglobulin)
Human milk is a milk type albumin.

10. Mature human milk
Human casein:
- mammary gland synthesis of amino acids in the blood
three fractions (alpha, beta and kappa)
- kappa - casein has a role in colonization of the
intestinal bifidus Bacilus in breastfed infant.

11. Mature human milk
Proteins in whey:
Alfalactalbumin - contains Lactose synthase, an
enzyme involved in lactose synthesis;
Lactoferrin - glycoprotein capable of reversibly bind
iron in milk → Fe absorption in the intestines and
stomach.
- iron chelator → bacteriostatic action.
- additional factor of protection against intestinal
pathogens, with IgAs, Lactobacilus lysozyme and
bifidus.

12. Mature human milk
Proteins in whey:
- Betalactoglobulin is absent In Human milk
- serum albumin → ligand role for folate, vit. B12,
tyrosine, zinc.
Immunoglobulins: IgAs
- agglutinate of food antigens, bacterial enterotoxins
and viruses, blocking their adhesion to epithelial
surfaces,
- IgAS containing anti E. coli, Shigella, Salmonella,
Klebsiella, Coxackie, polio virus, hepatitis B and
measles virus.

13. Mature human milk
Ig G and Ig M:
- small quantities in milk,
- serum Ig does not differ structurally.
Enzymes in human milk - a role in:
- digestion of milk components
- antibiotic protection.
Lysozyme:
- contribute to lysis of intestinal bacteria,
- enhances antibody formation.

14. Mature human milk - Enzymes
Lipases have a role in digestion of human milk
triglycerides.
Alpha amylase:
- catalyzes the hydrolysis of starch into maltose
- pancreatic and intestinal amylase often deficit in the
infant.
Proteases and protease inhibitors:
- greater amount compared with cow's milk
- catalyzes the hydrolysis of proteins.

15. Mature human milk
Amino acids:
taurine - a role in absorption of lipids and brain
development.
Human milk proteins are absorbed and used by the
infant with optimal efficiency.

16. Mature human milk
Carbohydrates - 70 g / l:
- lactose (beta-lactose - 60 g / l) - a source of galactose
(cerebroside composition of the brain);
- oligosaccharides (10 g / l) - role in the defense of non-
specific antibiotic (promotes intestinal colonization with
Lactobacilus bifidus).

17. Mature human milk
Lactobacilus bifidus - roles:
- causes acidification of the intestinal environment →
inhibits the growth of pathogens
-Anti anemic and antirickets (promotes absorption of
Fe, Ca, vit. D and lipid)
- synthesis of vitamins B and K.

18. Mature human milk
Lipids: 36 - 40 g / l
fatty acids (FA), mono and polyunsaturated fats (oleic
acid, palmitic and linoleic)
-over half of the total FA h.m.
- role in CNS maturation in the newborn
period
triglycerides - report equally between unsaturated and
saturated FA.

19. Mature human milk
Cholesterol and lecithin:
large quantities h.m. than c.m.
The presence of lipase in human milk:
- facilitates lipid hydrolysis
- FA promote rapid release of usable energy
metabolism.

20. Mature human milk
Mineral salts and trace elements:
- content four times lower than c.m., less influenced by
maternal dietary intake, being provided by maternal
stores.
- thus, if sufficient phosphorus and calcium are the
mother's diet, they are obtained through its mobilization
from bone deposits.

21. Mature human milk
Sodium: → low amount - renal function overloading is
avoided.
Calcium four times and phosphorus 6-7 times less than
the c.m., but the Ca : P = 2 : 1 is favorable for their
proper absorption.
Iron:
- amount of two times higher in h.m.
- intestinal absorption and incorporation into the
hemoglobin molecule is much higher in infants
breastfed.

22. Mature human milk
Vitamins:
soluble (A, D, E, K)
soluble (C, folic acid, vitamin complex. B)
- varying proportions, in relation to food intake.
- a balanced diet of the mother provides adequate
intake of these vitamins, except vitamin D.

23. Mature human milk
The amount of vitamin D in human milk does not
provide even if your baby needs a proper sun exposure,
but is higher than that of cow's milk, which explains the
lower incidence of rickets in infants breastfed.
The energy value of h.m. mature = 65-68 kcal/100ml.

24. Factors of human milk
1. Antiinfectious protection factors:
- immunological
- biological
- provide protection against infectious agents from the
environment until the baby develops its own immunity.
breastfed infants versus artificially fed infants:
-low rate of hospitalization
-low incidence of respiratory infections, diarrhea, a
rash, etc.

25. Factors of human milk
Antiinfectious protection factors
Cellular factors (macrophages, neutrophils, Lyzozyme :
anti-infective role in maternal mammary gland and
infant's digestive tract (protects against enterocolitis
ulceronecrosis).
Immunoglobulins - IgAs:
- opsonizant role,
- mobilize and agglutinate bacteria, viruses and antigens
of food,
Ly stimulates the formation of intestinal mucosal IgA
in the infant.

26. Factors of human milk
Antiinfectious protection factors
Lactoferrin - bacteriostatic role.
Lysozyme - a role in combination with complement
and antimicrobial IgAs, which potentiates the action.
Lactoperoxidase - bactericidal action against germs
like Pseudomonas, E. coli, Salmonella, Streptococcus.

27. Factors of human milk
Antiinfectious protection factors
Mucin - prevent adhesion of germs and rotaviruses to
the surface of intestine.
C3 and C4 fractions of complement - role in
chemoattraction of phagocytes and intracellular
incorporation of particles.
Bifidogens factors (glycoproteins and
oligosaccharides) - role in promoting growth of
Lactobacilus bifidus in the intestine of breastfed infant.

28. Factors of human milk
2. Modulators of growth factors:
- stimulates growth of mammary gland
- acting on the baby's organs.
Epidermal growth factor (epidermal Growth
Factor - EGF) and insulin-like growth factor (Insulin-
like growth factor: IGF-1) - role in the maturation of the
gastrointestinal tract.

29. Factors of human milk
Modulators of growth factors
Nervous growth factor - essential for the
development of sympathetic neurons and sensory
cells.
B-cell stimulating factor - role in the proliferation of
B cells and production of immunoglobulins.
Taurine - improves fat absorption and promotes
intestinal colonization of Lactobacilus bifidus.

30. The composition of cow's milk (c.m)
Protein: 32-34 g / l
casein - 28 g
whey protein (lactalbumin and lactoglobulin): 4-6 g.
β-lactglobulin is highly antigenic / allergy.
Casein c.m precipitates in the stomach of infants in
large clots, difficult digestible → longer intervals of
time between lunches.

31. The composition of cow's milk
Carbohydrates: 48-50 g / l (vs. 68-70 g / l h.m)
represented only lactose → low intake of galactose →
slow myelination of CNS.
oligosaccharides missing → absence of bowel
colonization with bacillus bifidus in bottle fed infant

32. The composition of cow's milk
Lipids: 36 g / l
- saturated, indigestible, deficient in essential fatty
acids
- five times lower amount of linoleic acid
- cholesterol in amounts less than h.m

33. The composition of cow's milk
Mineral salts:
- amount of four times higher than in h.m.
with high protein content → metabolites and
osmolarity ↑ ↑ → ↑ baby's water needs.
- amounts of phosphate and citrate ↑ → ↑ pH gastric →
prevents absorption and promotes Calcium elimination

34. The composition of cow's milk
Mineral salts
The ratio Ca / P ~ 1:
- inappropriate for absorption
- rickety
- putrefaction (intestinal flora - E. coli)
↑ effort to remove the liver and kidney metabolites.

35. The composition of cow's milk
Iron:
Fe deficiency . This explains its poor absorption
frequency and iron deficiency anemia in infants fed
cow's milk.
Vitamins:
- smaller quantities than in human milk and by boiling
the milk a good part of them are destroyed.

36. Disadvantages administration of cow milk
- iron deficiency, the intake / absorption + low intestinal
absorption (occult bleeding) due allergenicity of cow's
milk;
- various nutritional deficiencies (rickets, etc.);
- dehydration through increased renal load;
- increased risk to allergy.

39. Patient’s Attenders the very next Day

41. Thank you