Human milk provides optimal nutrition and bioactive factors that promote infant health and development. It contains macro and micronutrients that vary depending on the mother's diet and lactation stage. Beyond nutrients, human milk contains growth factors, immunologic components, and prebiotics that support tissue growth, intestinal and immune system development. Storage and pasteurization can reduce certain bioactive components in milk. Further large-scale studies are still needed to establish comprehensive reference values for human milk composition.

1. Journal club
Human milk composition-
Nutrient and bioactive factors

2. • Authors: Olivia Ballard,Ardythe L Morrow
• Journal:Pediatric clinics of North America:
Breast feeding Updates for the
Pediatricaian.
Morrow and Chantry
February 2013,Volume 60,Number 1

3. Introduction:
• EBF for 6 months with continued breastfeeding for 1-
2yrs of life is normative standard for infant feeding.`
• Human milk is uniquely suited to human infant in
nutritional and bioactive factors that promote
survival and healthy infant.
• Human milk composition is dynamic.
`WHO.infant and young children nutrition.Geneva:WHO;2003

4. • Briefly reviews nutritional a components of
human milk and provides overview of varied
bioactive factors .
• Discuss impact on human milk with storage
and pasteurization .

5. Stages of lactation:
• Colostrum
• Transitional milk
• Mature milk

7. Studies on human milk composition:
• Gold standard for milk collection involves
sampling of all milk expressed over 24 hrs,with
collection over time multiple times from same
individual`
`Bauerj,Gerss.Longitudinal aanalysis of macro and mineral in human milk.Clin Nutr
2011;30(2)215-20

8. Nutritional components
Nutritional components derived from 3 sources
• Synthesis in lactocyte.
• Dietary in origin
• Maternal stores

9. Macronutrients:
• Varies with mothers and across lactation
• Macronutrient composition is conserved across
population despite variation in maternal status.
• After 4 months of postpartum associated with
:maternal wt for ht,protein intake ,parity and
nursing frequency and return of mensturation.`
• Higher quantity of milk lower conc. of fat and
protein but higher concentration of lactose `
`Nommsen LA et al.Determinants of energy,protein,lipid in humam milk in first 12 months of
lactation:the DARLING Study.Am J Nutr 1991;53(2):457-65

11. Proteins:
• Term mature milk:0.9-1.2g/dl
• Predominantly whey and casein.
• Most abundant proteins are- casein,a-
lactoalbumin,lactoferrin,sIgA,lysozyme and serum
albumin.
• Non protein nitrogen compounds-urea,uric acid
,creatinine,aa,nucleotides(25% of human milk
nitrogen)
• Concentration is not affected by maternal
diet,but increases with weight for height and
decreases in mother producing more milk.

13. Changes in casein content as a percentage of total protein (ie,
ratio of whey protein to casein) in 2 mothers during lactation
Bo Lönnerdal Am J Clin Nutr 2003;77:1537S-1543S

14. Fat:
• Term mature milk:3.2- 3.6gm/dl.
• High conc of palmitic and oleic acid
• Highly variable macronutrient-foremilk and hindmilk
• Significantly lower in night and morning compared to
afternoon and evening`
• 25% variation in lipid concentration between mothers can be
explained by maternal protein intake.
` Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and
frequency of breastfeedings and fat content of breast milk throughout the
day. Pediatrics. 2006;117(3):e387–395.

15. • Fatty acid profile varies in relation to maternal
diet particularly LCPUFA.
• LCPUFA intake in western is predominantly
w-6,sup optimal w-3 fatty acids.
• DHA composition in human milk is low in N
American population,supplementation to be
considered for breast feeding women .

16. Carbhoydrate:
• Predominant sugar lactose 6.7-7.8gm/dl
• Least variable of macro nutrients
• Higher quantity in mothers producing more
milk
• Oligosaccharide 1gm/dl bioactive factor

17. Micronutrients:
• Vary depending on maternal diet and body stores
including Vit A,B1,B6,B2,B12,D and iodine.
• Maternal diet is not always optimal so continuing
multivitamins during lactation is recommended.`
• Vit K and Vit D low quantity in human milk.
`Greer FR. Do breastfed infants need supplemental vitamins? Pediatric clinics of North
America.2001;48(2):415–423.

18. Bioactive components:
• Elements that affect biologic processes or
substrates and hence have an impact on body
function or condition.
• Secreted by mammary epithelium,produced
by cells in milk,drawn from maternal blood.
• 1.Growth factors .
• 2.Immunologic factors.

19. Growth factors
• Epidermal growth factor:intestinal maturation
and repair.
• Neuronal growth factors:BDNF,GDNF:growth
and development of the enteral nervous
system.
• Insulin like growth factor superfamily:tissue
growth

20. • VEGF:regulation of vascular system
• Erythropoetin:Intestinal development and
prevention of anaemia.
• Calcitonin and somatostatin:growth regulating
hormones.
• Adiponectin:regulating metabolism and body
composition.

21. Immunologic factors
• Cells of human milk:Macrophages,T cells,stem
cells and lymphocytes
• Cytokines and chemokines:TGF superfamily,G-
CSF,IL 7,IL 10/pro infalmmotory-TNF-a,IL-6,IL-8
and interferons.
• Acquired and innate factors:sIgA,defensins-
lactoferrin,lactoadherin,BSSL,MFG.
• HOMS:prebiotics

22. Storage and pasteurization:
• HTST ,Holder pasteurization(LTLT),Flash method.
• Heat treatment reduces bioactive components.
• Reduction in sIgA,lyzozyme,cytokines,lipases,TGF-
B,adiponectin.
• More damage with multiple freeze thaw cycle
• LTLT method more damaging than HTST method

23. Conclusion:
• Many studies of human milk composition have
been conducted ,components of human milk
are still being identified.
• Standardised multipopulation studies of
human milk composition are needed to create
rigorous comprehnsive reference values.

24. THANK YOU