Collate and review data on the

composition and volume and intake of

breast milk
Results from a systematic literature review

Trudy MA Wijnhoven1, Caroline Bollars1, Garden Tabacchi2, and Maria Hermoso3

Nutrition, Physical Activity and Obesity Programme, Division of Non-communicable

Diseases and Health Promotion, World Health Organization Regional Office for Europe,
Copenhagen, Denmark
2

Institute of Physiology and Human Nutrition, University of Palermo, Palermo, Italy

Division of Metabolic Diseases and Nutritional Medicine. Dr. von Hauner Childrens

Hospital, Ludwig-Maximilians-University of Munich, Germany

RA 2.1: Infant Nutrition

Task 9
Funded by an EU FP6 Network of Excellence (EURRECA, grant no. FP 6-036196-2)

Contents
Background....................................................................................................................................3
Aim..................................................................................................................................................8
Methods ..........................................................................................................................................9
Results ..........................................................................................................................................11
Discussion.....................................................................................................................................26
Annex 1. PubMed: search strategy and results on 27/10/09....................................................27
References ....................................................................................................................................30

Background
Clinical and dietary surveys of presumably healthy populations, functional responses, optimal
intake approaches and nutrient balance calculations are the methods commonly used to estimate
nutritional requirements. 1 The World Health Organization (WHO) recommends exclusive
breastfeeding for six months, and thereafter sustained breastfeeding with appropriate
complementary feeding up to two years or beyond. 2 This recommendation was based on the
outcomes of a WHO expert consultation in 2001. 3 Two systematic literature reviews served as
the basis for this consultation. The first one focused on the optimal duration of exclusive
breastfeeding 4 and the second one focused on the nutrient adequacy of exclusive breastfeeding
for the term infant during the first six months of life. 5
The latter systematic literature review included a table on nutrient intakes of exclusively
breastfed infants. The calculated nutrient intakes derived from human (breast) milk were based
on the mean milk intakes of exclusively breastfed infants from developed countries and breast
milk composition from well-nourished women, which were the results of studies carried out in
the 1980s1990s. Table 1 presents these results as was published in the report of the review.5
This review also provided an overview of the findings on the content of various nutrients, both
macro- and micronutrient, in breast milk: protein, vitamin A, vitamin D, vitamin B6 (pyridoxine),
iron, calcium and zinc. The identified studies for the review showed the following results of
nutrient concentrations in breast milk (see also results section)5:
A concentration of protein in mature breast milk varied from 8 to 10 g per litre.
Vitamin A concentrations varied with the stage of lactation and were strongly influenced by
maternal nutritional (vitamin A) status. It was estimated that mature milk of well-nourished
mothers contained approximately 1.7 moles/l of vitamin A.
Vitamin D concentrations in breast milk depend on maternal vitamin D status and are very
low. Various concentrations were found and the range varied from 0.16 g/l to 1.56 g/l.
The concentration of vitamin B6 varied with maternal B6 status and intake, length of
gestation, stage of lactation and the use of B6 supplements. The mean vitamin B6
concentration in breast milk of women with B6 intakes below 2.5 mg/day was estimated as
0.13 mg/l (778 nmol/l). Mean B6 levels in breast milk of women with B6 intakes between 2.5
and 5 mg/day were substantially higher approximately 0.24 mg/l.
3

 The concentration of iron declined from 0.40.8 mg/l in colostrum to 0.20.4 mg/l in mature
breast milk.
Breast milk contained 250300 mg/l of calcium with no pronounced changes during
lactation.
The concentration of zinc declined from 45 mg/l in early milk, to 12 mg/l at 3 months
postpartum, and to 0.5 mg/l at 6 months.

Table 1 Nutrient intakes derived from human milk, based on studies carried out in the 1980s
1990s.
Age

Human

Human

Energy

Protein

Vitamin A

Vitamin

Vitamin

Calcium

Iron

Zinc

(month)

milk

milk

(kcalth/day)

(g/day)

(mol/day)

B6

(mg/day)

(mg/day)

(mg/day)

intake

intake,

(g/day)

corrected

(ng/day)

(mg/day)

for
IWL*
(g/day)

699

734

492

8.1

1.25

473

0.10

195

0.37

1.54

731

768

514

6.9

1.30

495

0.10

199

0.31

1.54

751

803

538

7.2

1.37

518

0.10

203

0.32

1.20

780

819

549

6.6

1.39

528

0.11

202

0.29

0.98

796

836

560

6.7

1.42

539

0.11

201

0.29

0.84

854

897

601

7.2

1.52

578

0.12

210

0.27

0.90

867

910

610

7.3

1.55

587

0.12

208

0.27

0.68

815

856

573

6.8

1.45

552

0.11

190

0.26

0.64

890

935

626

7.5

1.59

603

0.12

201

0.28

0.70

10

900

945

633

7.6

1.61

610

0.12

198

0.28

0.47

11

910

956

640

7.6

1.62

616

0.12

194

0.29

0.48

* IWL = insensible water losses.

Source: Adapted from World Health Organization, 2002.5
The Scientific Committee on Food (SCF) of the European Commission (EC) published in 2003
the results of an extensive literature review with the aim to revise the essential requirements of
infant formulae and follow-on formulae. 6 For this revision, the Committee made use of studies
that presented the composition of breast milk of healthy, well-nourished women. Information on
the breast milk content of the following nutrients (both macro- and micronutrients) was obtained:
4

lactose, fat, vitamin A, vitamin D, vitamin E, vitamin K, vitamin B1 (thiamin), vitamin B2

(riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid),vitamin B6, vitamin B12
(cobalamin), folic acid, vitamin C (ascorbic acid), biotin, iron, calcium, phosphorus, magnesium,
sodium, chloride, potassium, copper, manganese, fluoride, iodine, selenium and zinc. The studies
used for the SCF review found the following results on breast milk content of these nutrients (see
also results section)6:
Breast milk contained approximately 55-70 g lactose per litre and can be considered as an
important source of energy. Breast milk did not contain saccharose or fructose.
Breast milk contained ~35 g fat per litre, which provides about one half of the energy
content of the milk.
A range of total concentrations of preformed vitamin A in mature breast milk between 150
g/l and 1100 g/l was observed.
The reported concentration of vitamin D varied from 4 to 110 IU/l, with up to 10-fold higher
values in the summer than in the winter.
Mature breast milk contained approximately 2-5 mg/l vitamin E.
Breast milk contained low concentrations of vitamin K; a range between 0.6 g/l and 10
g/l was reported.
The reported concentrations of vitamin B1 in mature breast milk varied widely; a range
between 154 g/l and 328 g/l was reported.
The reported concentrations of vitamin B2 in mature breast milk varied widely; a range
between 274 g/l and 580 g/l was reported.
The reported concentrations of vitamin B3 were between 1100 g/l and 2300 g/l.
The reported mean concentration of vitamin B5 was 6.7 mg/l and the reported range
concentrations varied from 2.0 mg/l to 2.5 mg/l. Reported values differed and were
influenced by maternal dietary variation, or analytical approaches.
The concentration of vitamin B6 increased as the maternal intake of the vitamin increased.
Furthermore, the concentration level depended on the stage of lactation, the length of
gestation and the usage of oral contraception. In mature milk the reported concentration
varied between 70 g/l and 310 g/l and in unsupplemented mothers the mean concentration
was reported to be approximately 150 g/l.
5

 A mean concentration of 0.51 g/l of vitamin B12 was found in various studies and a range
of 0.16-0.64 g/l was found in studies among unsupplemented mothers.
A wide range of folic acid concentrations were reported, most likely because of the
application of uncertain breast milk storage methods, difficulties in reliably determining the
folic acid content of milk or real differences among women; it varied from 24 g/l to141
g/l.
The mean vitamin C concentration was estimated to be 55 mg/l. A wide variation, however,
was observed that ranged from 30 mg/l to 100 mg/l (4.5 to 15 mg/100 kcal), with a
progressive observed decrease during the course of lactation.
The mean biotin concentration was estimated to be 6 g/l (24 nmol/L) and a range of 5-9
g/l (0.75-1.3 g/100 kcal) was found.
The mean concentration of iron in breast milk was estimated to be approximately 0.3 mg/l.
The calcium concentration in breast milk decreased over the course of lactation, and a range
between 194 mg/l and 268 mg/l (29 to 40 mg/100 kcal) was observed.
A range in phosphorus concentration between 107 mg/l and 164 mg/l was reported (16 to
24 mg/100 kcal), peaking in early lactation and decreasing as lactation progresses.
A narrow range of magnesium concentration was found: between 31.4 mg/l and 35.7 mg/l.
A high variation of sodium concentrations was observed. A mean sodium concentration of
0.870.45 standard deviation (SD) mEq/100 kcal between 60 and 240 days was reported.
The concentration of sodium in adult mothers were found to be approximately 0.500.14
mEq/100 kcal and in adolescent mothers approximately 0.800.23 (SD) mEq/100 kcal.
A mean chloride concentration of 1.680.69 (SD) mEq/100 kcal was reported.
A range in potassium concentration between 1.650.27 (SD) mEq/100 kcal and 1.920.24
(SD) mEq/100 kcal was reported.
The copper content is not directly influenced by maternal dietary intake of copper. No
concentrations in breast milk were reported.
A mean manganese concentration of 3.5 g/l was estimated, with a slight decrease over the
course of lactation. A range of 3-4 g/l (approximately 0.5 g/100 kcal) was observed.
Observed mean fluoride concentrations ranged from 0.007 mg/l to 0.011 mg/l.
6

 Iodine concentrations varied markedly as a function of the iodine intake of the population. It
ranged from 10-20 g/l to more than 300 g/l in Europe and from 30 g/l to 490 g/l in the
United States of America.
A wide range of selenium concentrations was observed, which depended on the selenium
consumed in natural foods. In general, the selenium concentration is highest in colostrum.
The median selenium concentrations found in colostrum (0-5 days) was 26 g/l, in
transitional milk (6-21 days) 18 g/l, in mature milk (1-3 months) 15 g/l and in late
lactation (>5 months) 17 g/l.
A large variability of zinc concentrations was observed shown during the course of lactation
and among individuals; it varied from 0.5 mg/l to 4.7 mg/l. Zinc concentrations declined
sharply over the early weeks of lactation: from 4 mg/l at 2 weeks to 3 mg/l at 1 month, 2
mg/l at 2 months, 1.5 mg/l at 3 months and 1.2 mg/l at 6 months.

Aim
The present review was part of the research activity 2.1 (task 9) of the Network of Excellence
EURRECA (European Micronutrients Recommendations Aligned). The aim was to search the
literature for the most actual micronutrient compositional data of human breast milk as well as
for data on breast milk volume consumed by infants. Data on the following micronutrients were
considered: vitamin A, vitamin D, vitamin E, vitamin K, vitamin B1, vitamin B2, vitamin B3,
vitamin B5, vitamin B6, vitamin B12, folic acid, vitamin C, biotin, iron, calcium, phosphorus,
magnesium, sodium, chloride, potassium, copper, manganese, fluoride, iodine, selenium and
zinc.

Methods
The electronic database PubMed (U.S. National Library of Medicine & National Institutes of
Health 2009) was searched through October 2009. The database search was restricted to human
subjects, European studies and performed on combinations of both medical subject headings and
free text keywords (see Annex 1). Keywords focused on the study population (infants and
children) and the variables of interest (breastfeeding, breast milk, micronutrient, volume). In
addition, the reference lists in the eligible publications and all reviews identified by the search
were manually checked to identify further eligible studies that might have been missed in the
electronic search. No language restrictions were applied at the search of studies in the databases.
Due to limited translation possibilities, however, the final eligibility evaluation of full-text
documents was restricted to publications in Dutch, English, French, German, Italian and Spanish.
Because of the extensive literature review done in 2003 by the EC-SCF and in 2001 by WHO,
the present review focussed on studies that were published in 2000 and beyond and thus that
would not have been included in the two previously mentioned reviews5,6.
The first review stage involved the screening of titles, keywords and abstracts of the identified
citations to determine their appropriateness for inclusion. Citations were found ineligible, when
the information given in the title or available abstract suggested that the:
Study outcome measure was not breast milk intake and/or breast milk content or
composition.
Study population did not include exclusively or partially breastfed infants (0-12 months).
Study population did not include healthy infants (0-12 months), e.g. normal birthweight
infants, and/or healthy mothers.
Study population did not include at term infants (0-12 months).
Nutrient composition of breast milk was not given.
Study was not carried out in one of the 53 Member States of the WHO European Region.
Study design was not cross-sectional, observational (prospective cohort and case-control) or
intervention (baseline values be considered only).
The abovementioned order of screening was followed; if the response to a criterion was no, the
study was further assessed for eligibility. For each excluded study, one reason of ineligibility
was noted.

The full-text of the studies identified to be potentially eligible during the first stage was obtained
and further evaluated during the second stage of the review, which implicated the exclusion of
systematic reviews or meta-analyses that did not present original data, exclusion of studies that
were included in the previous reviews5,6 and the exclusion of studies that did not report on data
on volume of breast milk intake or on breast milk content or composition of micronutrients.
Both screening stages of the review involved the independent assessment of eligibility by two
authors (C.B. and G.T.). Disagreements were resolved through consensus with another author
(T.W.).
All found citations were downloaded into Reference Manager Version 10.0 (ISI ResearchSoft
2002) and assigned a unique identification number and subsequently transferred into a database
created with Microsoft Office Access 2003 (Microsoft Corporation 1992-2003), which was used
for the screening and analysis.

10

Results
The search in PubMed yielded 553 initial records and the manual search of reference lists did not
lead to additional potentially eligible studies (Figure 1).
Figure 1 Flow diagram of the process of identifying and including references for the systematic
literature review.
First review stage: Citation screening of title/abstract/keywords, n= 553
Ineligible studies excluded, n= 443
Inappropriate study outcome, n= 405
Inappropriate study population, n= 18
Inappropriate study location, n= 20

Second review stage: Full-text evaluation of potentially eligible studies, n= 110

Other language than Dutch

English, French, German,
Italian or Spanish, n= 3

Ineligible studies excluded, n= 90

Any first stage exclusion criteria, n= 39
Reviews without original data, n= 16
No data reported on micronutrient content or
on volume intake, n = 35

Total included studies in the review, n= 17

A total of 443 studies did not meet the first stage inclusion criteria and thus the full-text of the
110 remaining studies only were obtained for further evaluation. Because of language criteria,
however, the full-text of two Hungarian 7,8 publications and of one Polish 9 publication was not
evaluated. Thus of the 110 studies submitted to the second review stage three studies were
excluded, leaving a total of 107 studies for inclusion in the second review stage.
During the second stage evaluation 90 studies were excluded: one study was not carried out in an
European country 10 , 24 studies did not report on breast milk composition or on breast milk
volume intake 11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34 , one study was carried out
in non-healthy mothers 35 , three publications referred to a similar study 36,37,38 , two studies were
11

carried out during the Ramadan 39,40 , three intervention studies did not report on baseline values
of breast milk composition before the intervention was introduced 41,42,43 , 16 publications were
reviews and did not contain original data 44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59 , 4 studies
measured breast milk volume to estimate nutrient intake only but did not indicate the mean
volume per feed 60,61,62,63 , one study measured iodine content of breast milk but did not report on
these results 64 and 35 studies measured the content of other nutrients than micronutrients, like
for example total fat, polyunsaturated fatty acids, protein, nitrogen, leptin, glucose, galactose,
lactoferrin or
cadmium 65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99 .

Concerning breast milk composition, 16

studies 100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115 were found eligible for inclusion in the
present review and they reported on the content of 12 micronutrients in human breast milk:
vitamin A, vitamin E, iron, calcium, magnesium, sodium, potassium, copper, manganese, iodine,
selenium and zinc. None of these studies measured the infants volume intake of breast milk.
Table 2 gives an overview of these 16 studies by micronutrient (seven studies reported on
multiple micronutrients). Nine studies did not indicate the time period of the
survey100,101,102,103,106,111,113,114,115. The studies were carried out in Turkey (n=5)100,101,108,111,113,
Spain (n=3)105,107,114, the United Kingdom (n=2)102,103, Austria106, Belgium (n=1)112, Greece
(n=1)104, Italy (n=1)109, Poland115 (n=1) and Portugal (n=1)110. The total number of breast milk
samples that were taken in each study varied between 13 and 905 and the timing when the breast
milk samples were taken from the lactating mothers varied between 1day and 12 months
postpartum (three studies did not indicate the timing).
Table 3 compares the nutrient content in breast milk reported in the 16 eligible studies with the
results found in the reviews done by WHO5 and by the EC-SCF6. The vitamin A and vitamin E
content values were reported by their components (retinol, -Carotene, -Carotene, total
carotenoid, -tocopherol and -Tocopherol) and were therefore incomparable with the values
given in the WHO and EC-SCF reviews. The present review found similar values for iron,
calcium, magnesium, iodine, selenium and zinc and different values for manganese than the
values given in these two reviews.
12

Concerning volume intake of breast milk, one study was found eligible 116 . This study was
carried out in Izmir, Turkey (survey period was not indicated) and 80 breast milk samples were
taken about 55-65 days postpartum. The mean (SD) number of feeds per day were 7.8 (1.6) and
the range varied from 5 to 12 feeds per day. The mean (SD) duration of breast feeding was 11.9
(3.4) minutes and the range varied from 5 to 20 minutes per breast feeding. The mean (SD) milk
volume sucked per time was 94 (39) ml and the range varied between 40 and 210 ml.

13

Table 2 Micronutrient content in human breast milk in 16 studies carried out in the WHO European Region.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Orhon FS et
al100

NA

Ankara, Turkey

High-Performance
Liquid
Chromatography
(HPLC)

Tokusoglu O
et al101

NA

Izmir and
Manisa, Turkey

Jewell VC et
al102

NA

Canfield LM
et al103

NA

Time
postpartum
breast milk
sample taken

Total breast
milk
samples
(n)

Results micronutrient content

7 days

20 from
smokers and
20 from nonsmokers

MeanSEM in smokers: 8.10.6 mol/l;

meanSEM in non-smokers: 8.60.7
mol/l.

HPLC

6090 days

43 from Izmir
and 49 from
Manisa

Mean? in sample from Izmir:

81.3515.67 g/100 ml; mean? in
sample from Manisa: 81.1419.84
g/100ml; mean? total group:
81.512.06 g/100ml

Belfast, United
Kingdom

HPLC

141 days

28 (13
mothers)

Median: 1.49 nmol/g fat; min-max: 0.28

7.96 nmol/g fat

United Kingdom
and 8 other
countries outside
Europe

HPLC

112 months

50

MeanSEM: 1.0520.0500 mol/l,

0.0290.001 nmol/g fat

28 (13
mothers)

Median: 1.70 nmol/g fat; min-max: 0.0

5.07 nmol/g fat

Vitamin A Retinol

Vitamin A -Carotene
Jewell VC et
al102

NA

Belfast, United
Kingdom

HPLC

141 days

14

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Time
postpartum
breast milk
sample taken

Total breast
milk
samples
(n)

Results micronutrient content

49

MeanSEM: 0.0310.003 mol/l,

0.9370.098 nmol/g fat

Vitamin A -Carotene
Canfield LM
et al103

NA

United Kingdom
and 8 other
countries outside
Europe

HPLC

Orhon FS et
al100

NA

Ankara, Turkey

HPLC

7 days

20 from
smokers and
20 from nonsmokers

MeanSEM in smokers: 0.90.12 mol/l;

meanSEM in non-smokers: 1.00.15
mol/l

Jewell VC et
al102

NA

Belfast, United
Kingdom

HPLC

141 days

28 (13
mothers)

Median: 12.77 nmol/g fat; min-max: 0.0

63.14 nmol/g fat

Canfield LM
et al103

NA

United Kingdom
and 8 other
countries outside
Europe

HPLC

112 months

49

MeanSEM: 0.0480.003 mol/l,

1.4070.135 nmol/g fat

Canfield LM
et al103

NA

United Kingdom
and 8 other
countries outside
Europe

HPLC

48

MeanSEM: 0.1590.007 mol/l,

4.5830.283 nmol/g fat

112 months

Vitamin A -Carotene

Vitamin A Total carotenoid

112 months

15

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Orhon FS et
al100

NA

Ankara, Turkey

HPLC

Tokusoglu O
et al101

NA

Izmir and
Manisa, Turkey

Jewell VC et
al102

NA

Jewell VC et
al102

NA

Time
postpartum
breast milk
sample taken

Total breast
milk
samples
(n)

Results micronutrient content

7 days

20 from
smokers and
20 from nonsmokers

Mean SEM smokers: 23.22.5 mol/l;

meanSEM non-smokers: 30.81.6
mol/l

HPLC

6090 days

43 from Izmir
and 49 from
Manisa

Mean? in sample from Izmir: 10.102.47

g/ml; mean? in sample from Manisa:
9.852.58 g/ml; mean? total group:
9.842.13 g/ml

Belfast, United
Kingdom

HPLC

141 days

28 (13
mothers)

Median: 6.04 nmol/g fat; min-max: 1.2

41.5 nmol/g fat

Belfast, United
Kingdom

HPLC

28 (13
mothers)

Median: 0.52 nmol/g fat; min-max: 0.0

2.61 nmol/g fat

3 days

180

Mean (SD): 544 (348) g/l; median: 431

g/l; min-max: 1401670 g/l;
interquartile range P25-P75: 299691 g/l

14 days

95

Mean (SD): 458 (311) g/l; median: 369

g/l; min-max: 961544 g/l; interquartile
range P25-P75: 259571 g/l

Vitamin E -Tocopherol

Vitamin E -Tocopherol
141 days

Iron
Leotsinidis
M et al104

20002002

Patras, Greece

Flame Atomic
Absorption
Spectrophotometry
(FAAS)

16

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Time
postpartum
breast milk
sample taken

Rodriguez
Rodriguez
EM et al105

19941996

Tenerife, Spain

Atomic Absorption
Spectrophotometry
(AAS) Varian Spectra
AA-10 Plus

Krachler M
et al106

NA

Graz, Austria

Magnetic sector field

ICP-MS

Total breast
milk
samples
(n)

Results micronutrient content

2 weeks5
months

56 (11
mothers)

Mean (SD): 0.465 (0.191) mg/l

NA (transitional
and mature)

27

Median: 380 g/l; min-max: 1501570 g/l;

interquartile range P25-P75: 310670 g/l

55 (11
mothers)

Mean (SD): 313.3 (52.9) mg/l

55 (11
mothers)

Mean (SD): 40.11 (9.75) mg/l

43

Mean (SD): 12.2 (4.0) mmol/l

Iron

Calcium
Rodriguez
Rodriguez
EM et al107

19941996

Tenerife, Spain

AAS Varian Spectra

AA-10 Plus

Rodriguez
Rodriguez
EM et al107

19941996

Tenerife, Spain

AAS Varian Spectra

AA-10 Plus

Ozbek A et
al108

December 2002
August 2005

Izmir, Turkey

Ion selective method

in Hiatchi Modular
Analytics ISE 1900
module

2 weeks5
months

Magnesium
2 weeks5
months

Sodium
57 days

17

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Time
postpartum
breast milk
sample taken

Manganaro R
et al109

FebruaryMarch
2004

Messina, Italy

Flame photometer
IL943

Rodriguez
Rodriguez
EM et al107

19941996

Tenerife, Spain

Flame photometer

Rodriguez
Rodriguez
EM et al107

19941996

Tenerife, Spain

Flame photometer

Leotsinidis
M et al104

20002002

Patras, Greece

Electrothermal AAS
equipped with an HGA
400 furnace

Total breast
milk
samples
(n)

Results micronutrient content

3 days

208

Mean (SD): 23.05 (1.10) mmol/l; 95% CI:

20.8725.24 mmol/l

2 weeks5
months

55 (11
mothers)

Mean (SD): 162.8 (90.1) mg/l

55 (11
mothers)

Mean (SD): 602.7 (118.5) mg/l

3 days

180

Mean (SD): 381 (132) g/l; median: 368

g/l; min-max: 97690 g/l; interquartile
range P25-P75: 274469 g/l

14 days

95

Mean (SD): 390 (108) g/l; median: 408

g/l; min-max: 120614 g/l; interquartile
range P25-P75: 313478 g/l

2 weeks5
months

56 (11
mothers)

Mean (SD): 0.329 (0.140) mg/l

Sodium

Potassium
2 weeks5
months
Copper

Rodriguez
Rodriguez
EM et al105

19941996

Tenerife, Spain

AAS Varian Spectra

AA-10 Plus

18

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Time
postpartum
breast milk
sample taken

Krachler M
et al106

NA

Graz, Austria

Magnetic sector field

ICP-MS

Total breast
milk
samples
(n)

Results micronutrient content

27

Median: 400 g/l; min-max: 1201400

g/l; interquartile range P25-P75: 180
720 g/l

3 days

180

Mean (SD): 4.79 (3.23) g/l; median: 3.58

g/l; min-max: 1.0115.70 g/l;
interquartile range P25-P75: 2.336.58
g/l

14 days

95

Mean (SD): 3.13 (2.00) g/l; median: 2.56

g/l; min-max: 0.179.89 g/l;
interquartile range P25-P75: 1.924.40
g/l

NA (transitional
and mature)

27

Median: 6.3 g/l; min-max: 1.822.3 g/l;

interquartile range P25-P75: 3.87.5 g/l

3 days

78

Median: 95 g/l; interquartile range P25P75: 68143 g/l

3 months

52

Median: 70 g/l; interquartile range P25P75: 50102 g/l

Copper
NA (transitional
and mature)

Manganese
Leotsinidis
M et al104

Krachler M
et al106

20002002

NA

Patras, Greece

Graz, Austria

Electrothermal AAS
equipped with an HGA
400 furnace.

Magnetic sector field

ICP-MS

Iodine
Costeira MJ
et al110

January 2003
December 2005

Guimares and
Braga, Portugal

Chloric acid digestion

method

19

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Time
postpartum
breast milk
sample taken

Total breast
milk
samples
(n)

Results micronutrient content

Iodine
Kurtoglu S et
al111

NA

Kayseri ,Turkey

HPLC

5 days

70

Median: 73 g/l; min-max: 9.50355.60

g/l

Ciardelli R et
al112

June 1999June
2000

Brussels,
Belgium

NA

NA

58

MeanSEM: 985 g/l; median: 78 g/l

Selenium
zdemir HS
et al113

NA

Van, Turkey.

NA

14 days

13

Mean?: 68.67.8 ng/g

NavarroBlasco I et
al114

NA

Pamplona, Spain

Inductively coupled
plasma atomic
emission spectrometry
with a hydride
generator

NA (mature
milk)

31

Mean (SD): 16.3 (4.7) g/l; min-max:

9.429.0 g/l

Krachler M
et al106

NA

Graz, Austria

Magnetic sector field

ICP-MS

NA (transitional
and mature)

27

Median 17 g/l; min-max <4.787 g/l;

interquartile range P25-P75 <4.754 g/l

Zachara BA
et al115

NA

Poland

Fluorometric method
of Watkinson

1275 days

905

Mean (SD): 10.24 (2.82) ng/l; min-max:

3.023.4 ng/l

20

Table 2 Continued.
Reference

Survey period
(year)

Survey
location

Determination
method of
concentration in
breast milk

Leotsinidis
M et al104

20002002

Patras, Greece

FAAS

Time
postpartum
breast milk
sample taken

Total breast
milk
samples
(n)

Results micronutrient content

3 days

180

Mean (SD): 4905 (1725) g/l; median:

5010 g/l; min-max: 13219123 g/l;
interquartile range P25-P75: 36906000
g/l

14 days

95

Mean (SD): 2990 (920)g/l; median: 2969

g/l; min-max: 8646550 g/l;
interquartile range P25-P75: 25903546
g/l

2 weeks5
months

56 (11
mothers)

Mean (SD): 2.10 (1.10) mg/l

Zinc

Rodriguez
Rodriguez
EM et al105

19941996

Tenerife, Spain

AAS Varian Spectra

AA-10 Plus

AAS, Atomic Absorption Spectrophotometry; FAAS, Flame Atomic Absorption Spectrophotometry; HPLC, High-Performance Liquid Chromatography;
NA, not available; SD, standard deviation; SEM, standard error of the mean.

21

Table 3 Compositional data of micronutrient content in breast milk found in the present review
compared with values found by WHO and the EC- SCF.
Micronutrients

Present review
Included studies
<2009

WHO review5
Included studies
1980s-1990s

SCF review6
Included studies up
to early 2000s

Vitamin A

Retinol, mean: 815 g/l

-Carotene,
meanSEM:
0.0310.003 mol/l
-Carotene,
meanSEM:
0.0480.003 mol/l
Total carotenoid,
meanSEM: 30.81.6
mol/l

Mean: 1.7 moles/l

(equivalent to 510 g/l)

Min-max: 1501100
g/l (equivalent to 0.5
3.8 moles/l)

Vitamin D

NA

Min-max: 0.161.56
g/l

Min-max: 4110 IU/l

(equivalent to 0.12.8
g/l)

Vitamin E

-Tocopherol, mean:
9.84 mg/l

NA

Min-max: 25 mg/l

Vitamin K

NA

NA

Min-max: 0.610 g/l

Vitamin B1

NA

NA

Vitamin B2

NA

NA

Min-max: 154328
g/l
Min-max: 274580
g/l

Vitamin B3

NA

NA

Vitamin B5

NA

NA

Vitamin B6

NA

Min-max: 0.130.24
mg/l

Mean: 150 g/l

Min-max: 70310 g/l

Vitamin B12

NA

NA

Mean: 0.51 g/l

Min-max: 0.160.64
g/l

Folic acid

NA

NA

Min-max: 24141 g/l

Vitamin C

NA

NA

Mean: 55 mg/l
Min-max: 30100 mg/l

Biotin

NA

NA

Mean: 6 g/l
Min-max: 59 g/l

22

Min-max: 11002300
g/l
Mean: 6.7 mg/l
Min-max: 2.02.5 mg/l

Table 3 Continued.
Micronutrients

Present review
Included studies
<2009

WHO review5
Included studies
1980s-1990s

SCF review6
Included studies up
to early 2000s

Iron

Colostrum, mean: 0.5

mg/l
Colostrum, min-max:
0.11.7 mg/l
Transitional, mean: 0.5
mg/l
Transitional, min-max:
0.11.5 mg/l
Transitional-mature,
mean (SD): 0.5 (0.2)
mg/l

Colostrum, min-max:
0.40.8 mg/l
Mature, min-max: 0.2
0.4 mg/l

Mean: 0.3 mg/l

Calcium

Transitional-mature,
mean (SD): 313.3
(52.9) mg/l

Min-max: 250300
mg/l

Min-max: 194268
mg/l

Phosphorus

NA

NA

Min-max: 107164
mg/l

Magnesium

Transitional-mature,
mean (SD): 40.1 (9.8)
mg/l

NA

Min-max: 31.435.7
mg/l

Sodium

Min-max, mean (SD):

12.2 (4.0)23.1 (1.1)
mmol/l
Transitional-mature,
mean (SD): 162.8
(90.1) mg/l

NA

MeanSD: 870.45
mEq/100 kcal

Chloride

NA

NA

MeanSD: 1.680.69
mEq/100 kcal

Potassium

Transitional-mature,
mean (SD): 602.7
(118.5) mg/l

NA

Min-max meanSD:
1.650.271.920.24
mEq/100 kcal

23

Table 3 Continued.
Micronutrients

Present review
Included studies
<2009

WHO review5
Included studies
1980s-1990s

SCF review6
Included studies up
to early 2000s

Copper

Colostrum, mean (SD):

381 (132) g/l
Colostrum, min-max:
97690 g/l
Transitional, mean
(SD): 390 (108) g/l
Transitional, min-max:
120-614 g/l
Transitional-mature,
mean (SD): 329 (140)
g/l
Transitional-mature,
median: 400 g/l
Transitional-mature,
min-max: 1201400
g/l

NA

NA

Manganese

Colostrum, mean (SD):

4.79 (3.23) g/l
Colostrum, min-max:
1.0115.70 g/l
Transitional, mean
(SD): 3.13 (2.00) g/l
Transitional, min-max:
0.179.89 g/l

NA

Mean: 3.5 g/l

Min-max: 34 g/l

Fluoride

NA

NA

Min-max: 0.0070.011
mg/l

Iodine

Colostrum, min-max:
9.50355.60 g/l
Transitional, median: 70
g/l

NA

Min-max: 10300 g/l

Selenium

Transitional, mean:
68.67.8 ng/g
Mature, mean (SD): 16.3
(4.7) g/l
Mature, min-max: 9.4
29.0 g/l

NA

Colostrum (0-5 days),

median: 26 g/l
Transitional milk (621
days), median: 18 g/l
Mature milk (13
months), median: 15
g/l
Late lactation (>5
months), median: 17
g/l

24

Table 3 Continued
Micronutrients

Present review
Included studies
<2009

WHO review5
Included studies
1980s-1990s

SCF review6
Included studies up
to early 2000s

Zinc

Colostrum, mean (SD):

4.95 (1.73) mg/l
Colostrum, min-max:
1.329.12 g/l
2 weeks, mean (SD):
2.99 (0.92) mg/l
2 weeks, min-max:
0.866.55 g/l
Transitional-mature,
mean (SD): 2.1 (1.1)
mg/l

Early milk, min-max:

45 mg/l
3 months postpartum,
min-max: 12 mg/l
6 months postpartum,
mean: 0.5 mg/l

Min-max: 0.54.7 mg/l

2 weeks, mean: 4 mg/l
1 month, mean: 3 mg/l
2 months, mean: 2 mg/l
3 months, mean: 1.5
mg/l
6 months, mean: 1.2
mg/l

NA, not available.

25

Discussion
The latest review on nutrient content of human breast milk was done in 2003 by the EC-SCF.
The present review identified 17 eligible studies that were carried out in the WHO European
Region and were not included in the EC-SCF review. While the EC-SCF review identified
information for all minerals and vitamins that were considered in the present review but copper,
16 eligible studies only reported on the breast milk content of vitamin A, vitamin E, iron,
calcium, magnesium, sodium, potassium, copper, manganese, iodine, selenium and zinc.
Surprisingly seven studies only indicated when the survey was carried out. Three studies did not
indicate the days or months postpartum when samples were taken to estimate breast milk
concentrations of iron, copper, manganese, sodium and selenium, while it has been observed that
the content of for instance manganese and selenium in breast milk varies during the course of
lactation.
Values were expressed as a mean, median or as a range (minimum-maximum, interquartile
range) using various parameters such as mol/l, g/l, g/ml or nmol/g fat. Due to the different
reporting, it was not possible to compare all the reported values (e.g. vitamin A, vitamin E,
sodium) with the WHO and the EC-SCF reviews. Moreover, a wide range of the number of milk
samples (13-905) taken as well as a wide range of the timing (1 day-12 months) when these
samples were taken postpartum was observed.
This review was carried out within the Network of Excellence EURRECA that develops building
blocks to harmonize European micronutrient recommendations. In order to harmonize the
collection of breast milk samples and the reporting of results on their micronutrient content in
future studies, it would be recommendable that EURECCA would provide guidance on the
measurement of micronutrient content in human breast milk.

26

Annex 1. PubMed: search strategy and results on 27/10/09

Search terms PubMed

Results

#1

breast feeding [MH] OR feeding, breast OR breastfeeding OR breast-feeding OR

breast feeding OR breast feeding, exclusive OR exclusive breast feeding OR
breastfeeding, exclusive OR exclusive breastfeeding OR breastfed OR breast fed
OR breast-fed OR milk, human [MH] OR breast milk OR breastmilk OR
breastmilks OR human milk OR milk, breast OR lactation [MH] OR milk [MH]

101772

#2

infant [MH] OR infant OR infants OR child [MH]

1750261

#3

intake OR intakes OR content OR contents OR volume OR volumes OR

concentration OR concentrations OR composition OR compositions

2360497

#4

1869204
micronutrients [MH] OR micronutrient OR micronutrients OR vitamins [MH]
OR vitamin OR trace elements [MH] OR elements, trace OR biometals OR
vitamin B complex [MH] OR B vitamins OR fat soluble vitamin* OR fat-soluble
vitamin* OR vitamin A [MH] OR vitamin A OR carotenoids [MH] OR
carotene* OR retinol OR beta carotene [MH] OR beta carotene OR beta-carotene
OR carotene, beta OR betacarotene OR -Carotene OR vitamin D [MH] OR
vitamin D OR vitamin E [MH] OR vitamin E OR tocopherol OR tocotrienol* OR
water soluble vitamin* OR water-soluble vitamin* OR vitamin C OR ascorbic
acid [MH] OR ascorbate OR acid, ascorbic OR folate OR folic acid [MH] OR
folic acid OR acid, folic OR riboflavin [MH] OR riboflavin OR vitamin B2 OR
vitamin B 2 OR thiamine [MH] OR thiamine OR thiamin OR vitamin B1 OR
vitamin B 1 OR niacin [MH] OR niacin OR nicotinic acid OR vitamin B 6 [MH]
OR vitamin B 6 OR vitamin B6 OR pyridoxine [MH] OR vitamin B 12 [MH]
OR B 12, vitamin OR vitamin B12 OR vitamin B 12 OR B12, vitamin OR
cobalamins OR cobalamin OR minerals OR mineral OR sodium [MH] OR
sodium OR potassium [MH] OR potassium OR calcium [MH] OR calcium OR
magnesium [MH] OR magnesium OR iron [MH] OR iron OR zinc [MH] OR
zinc OR copper [MH] OR copper OR phosphorus [MH] OR phosphorus OR
selenium [MH] OR selenium OR iodine [MH] OR iodine OR fatty acids [MH]
OR acids, fatty OR fatty acids, essential [MH] OR fatty acids, omega 3 [MH] OR
n-3 fatty acids OR n 3 fatty acids OR acids, omega-3 fatty OR fatty acids, omega
3 OR omega-3 fatty acids OR omega 3 fatty acids OR fatty acids, n-3 OR n-3
polyunsaturated fatty acid OR n 3 polyunsaturated fatty acid

#5

carbohydrate OR carbohydrates OR carbohydrates [MH] OR dietary

carbohydrates [MH] OR carbohydrates, dietary OR carbohydrate, dietary OR
dietary carbohydrate OR sugars OR dietary fats [MH] OR fats, dietary OR
dietary fat OR fat, dietary OR lipids [MH] OR amino acids, peptides, and
proteins [MH] OR proteins [MH] OR protein OR dietary proteins [MH] OR
proteins, dietary OR dietary protein OR protein, dietary

5728233

#6

Andorra [MH] OR Andorra OR Andorran OR Armenia [MH] OR Armenia OR

Armenian OR Armenian S.S.R. OR Armenian SSR OR Austria [MH] OR
Austria OR Austrian OR Azerbaijan [MH] OR Azerbaijan OR Azerbaijani OR
Azerbaijan S.S.R. OR Azerbaijan SSR OR Byelarus [MH] OR Belarus OR
Belarusian OR Byelorussian S.S.R. OR Belorussia OR Belorussian S.S.R. OR
Belorussian SSR OR Byelorussian SSR OR Belgium [MH] OR Belgium OR
Belgian OR Bosnia-Herzegovina [MH] OR Bosnia-Herzegovina OR Bosnia and
Herzegovina OR Bosnia OR Bosnia and Herzegovina OR Bosnian OR Bulgaria
[MH] OR Bulgaria OR Bulgarian OR Croatia [MH] OR Croatia OR Croatian OR
Cyprus [MH] OR Cyprus OR Cypriot OR Cyprian OR Czech Republic [MH] OR
Czech Republic OR Czech OR Denmark [MH] OR Denmark OR Faeroe Islands

934758

27

Search terms PubMed

Results

OR Danish OR Greenland [MH] OR Kalaallit Nunaat OR Estonia [MH] OR

Estonia OR Estonian OR Finland [MH] OR Finland OR Finnish OR France
[MH] OR France OR French OR Corsica OR Paris [MH] OR Georgia (Republic)
[MH] OR Georgian OR Georgian S.S.R. OR Georgian SSR OR Georgia
(Western Asia) OR Georgia SSR OR Republic of Georgia OR Germany [MH]
OR Germany OR Germany, West [MH] OR Germany, East [MH] OR German
OR Federal Republic of Germany OR Germany, Federal Republic of OR Berlin
[MH] OR German Democratic Republic OR Democratic Republic of Germany
OR Germany, Democratic Republic of OR Greece [MH] OR Greece OR Greek
OR Crete OR Macedonia (Greece) OR Hungary [MH] OR Hungary OR
Hungarian OR Iceland [MH] OR Iceland OR Icelandic OR Ireland [MH] OR
Ireland OR Irish OR Eire OR Ireland, Republic of OR Irish Free State OR Israel
[MH] OR Israel OR Israeli OR Hebrew OR Italy [MH] OR Italy OR Italian OR
Sardinian OR Sicily [MH] OR Rome [MH] OR Vatican City [MH] OR
Kazakhstan [MH] OR Kazakhstan OR Kazakh OR Kazakh S.S.R. OR Kazakh
SSR OR Kyrgyzstan [MH] OR Kyrgyzstan OR Kyrgyz OR Kirghiz S.S.R. OR
Kirghiz SSR OR Kyrgyz Republic OR Kirgizstan OR Kirghizia OR Latvia [MH]
OR Latvia OR Latvian OR Lithuania [MH] OR Lithuania OR Lithuanian OR
Luxembourg [MH] OR Luxembourg OR Luxemborg OR Luxemburg OR
Luxembourgish OR Malta [MH] OR Malta OR Maltese
#7

967248
Monaco [MH] OR Monaco OR Monegasque OR Montenegro [MH] OR
Montenegro OR Netherlands [MH] OR Netherlands OR Dutch OR Norway
[MH] OR Norway OR Norwegian OR Spitsbergen OR Svalbard [MH] OR
Poland [MH] OR Poland OR Polish OR Portugal [MH] OR Portugal OR Madeira
Island OR Portuguese OR Moldova [MH] OR Moldova OR Moldavian S.S.R.
OR Moldavia OR Moldavian SSR OR Moldovan OR Romania [MH] OR
Romania OR Rumania OR Roumania OR Romanian OR Russia [MH] OR
Russian Federation OR Russia OR Russian Federation (Europe) OR Russian
SFSR OR Russian S.F.S.R. OR Russian OR Bashkiria [MH] OR Bashkir
Republic OR Bashkortostan OR Dagestan [MH] OR Moscow [MH] OR Siberia
[MH] OR Russian Federation (Asia) OR Russian S.F.S.R., Asian OR San Marino
[MH] OR San Marino OR Serbia [MH] OR Serbia OR Serbian OR Vojvodina
OR Kosovo OR Slovakia [MH] OR Slovakia OR Slovak Republic OR Slovak
OR Slovenia [MH] OR Slovenia OR Slovenian OR Slovene OR Spain [MH] OR
Spain OR Spanish OR Sweden [MH] OR Sweden OR Swedish OR Switzerland
[MH] OR Switzerland OR Swiss OR Liechtenstein [MH] OR Liechtenstein OR
Liechtenstein OR Tajikistan [MH] OR Tajikistan OR Tajik OR Tadzhik S.S.R.
OR Tadzhik SSR OR Tadjikistan OR Tadzhikistan OR Macedonia (Republic)
[MH] OR Former Yugoslav Republic of Macedonia OR Macedonia (Yugoslavia)
OR Macedonia, Former Yugoslav Republic of OR The Former Yugoslav
Republic of Macedonia OR Macedonian OR Macedonia OR Turkey [MH] OR
Turkey OR Turkish OR Turkmenistan [MH] OR Turkmenistan OR Turkmen
S.S.R. OR Turkmen SSR OR Turkmen OR Ukraine [MH] OR Ukraine OR
Ukrainian OR Great Britain [MH] OR United Kingdom OR UK OR Isle Man OR
Northern Ireland [MH] OR England [MH] OR Scotland [MH] OR Wales [MH]
OR London [MH] OR Hebrides [MH] OR British OR Channel Islands [MH] OR
Alderney Island OR Jersey Island OR Sark OR Uzbekistan [MH] OR Uzbekistan
OR Uzbek S.S.R. OR Uzbek SSR OR Uzbek

#8

Europe [MH] OR Europe OR European OR Northern Europe OR Southern

Europe OR Western Europe OR Europe, Eastern [MH] OR Eastern Europe OR
Mediterranean Islands [MH] OR Mediterranean Region [MH] OR Baltic States
[MH] OR Commonwealth of Independent States [MH] OR CIS nations OR
USSR [MH] OR Soviet Union OR Union of Soviet Socialist Republics OR
28

1062986

Search terms PubMed

Results

Yugoslavia [MH] OR Czechoslovakia [MeSH] OR Scandinavia [MH] OR

Gibraltar [MH] OR Transcaucasia [MH] OR Asia, Central [MH] OR European
Union [MH] OR European Community OR Common Market OR Community,
European Economic OR Economic Community, European OR EEC OR
European Common Market OR European Economic Community OR Euratom
OR European Atomic Energy Community OR European Coal and Steel
Community
#9

#4 OR #5

6425990

#10

#6 OR #7 OR #8

2549080

#11

#1 AND #2 AND #3

8654

#12

#9 AND #10 AND #11

1081

#15

#14 Limit to humans

1036

#16

#15 Limit to publication date from 2000 to 2009

553

29

References
1

World Health Organization, Food and Agriculture Organization of the United Nations. Vitamin
and mineral requirements in human nutrition. Geneva, World Health Organization; Rome, Food
and Agriculture Organization of the United Nations, 2004
(http://whqlibdoc.who.int/publications/2004/9241546123.pdf, accessed 18 October 2010).
2

World Health Organization, United Nations for Childrens Fund. Global Strategy for Infant
and Young Child Feeding. Geneva, World Health Organization, 2003
(http://whqlibdoc.who.int/publications/2003/9241562218.pdf, accessed 18 October 2010).

World Health Organization. The optimal duration of exclusive breastfeeding. Report of an

expert consultation, Geneva, Switzerland, 28-30 March 2010. Geneva, World Health
Organization, 2002, (http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.09.pdf, accessed 18
October 2010).

Kramer MA, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review.
Geneva, World Health Organization, 2001
(http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.08.pdf, accessed 18 October 2010).

Butte NF, Lopez-Alarcon MG, Garza C. Nutrient adequacy of exclusive breastfeeding for the
term infant during the first six months of life. Geneva, World Health Organization, 2002
(http://www.who.int/nutrition/publications/infantfeeding/9241562110/en/index.html, accessed
18 October 2010).
6

European Commission Scientific Committee on Food. Report of the Scientific Committee on

Food on the revision of essential requirements of infant formulae and follow-on formulae.
Brussels, European Commission, 2003 (http://ec.europa.eu/food/fs/sc/scf/out199_en.pdf,
accessed 18 October 2010).
7

Griff T et al. Iodine content of mother's milk--Hungarian representative survey, 2006 (in
Hungarian). Orvosi Hetilap, 2009, 150(30):14071411.
8

Marosvolgyi T et al. Fatty acid composition of human milk in mothers of preterm and full-term
infants in the first three weeks of lactation (in Hungarian). Orvosi Hetilap, 2006, 147(31):1459
1463.
9

Ksiazyk J. Current views on requirements for vitamin D, calcium and phosphorus, particularly
in formula fed infants (in Polish). Medycyna Wieku Rozwojowego, 2000, 4(4):423430.
10

Bonham MP et al. Habitual fish consumption does not prevent a decrease in LCPUFA status
in pregnant women (the Seychelles Child Development Nutrition Study). Prostaglandins,
Leukotrienes and Essential Fatty Acids, 2008, 78(6):343350.
11

Wu TC, Chen PH. Health consequences of nutrition in childhood and early infancy. Pediatrics
and Neonatology, 2009, 50(4):135142.
12

Meyer R. Infant feeding in the first year, 2: feeding practices from 6-12 months of life.
Journal of Family Health Care, 2009, 19(2):4750.

13

Baird J et al. Milk feeding and dietary patterns predict weight and fat gains in infancy.
Paediatric and Perinatal Epidemiology, 2008, 22(6):575586.
14

Owen CG et al. Does initial breastfeeding lead to lower blood cholesterol in adult life?: a
quantitative review of the evidence. American Journal of Clinical Nutrition, 2008, 88(2):305
314.

15

Hay G et al. Folate and cobalamin status in relation to breastfeeding and weaning in healthy
infants. American Journal of Clinical Nutrition, 2008, 88(1):105114.
30

16

Wilhelm M et al. Assessment and management of the first German case of a contamination
with perfluorinated compounds (PFC) in the Region Sauerland, North Rhine-Westphalia.
Journal of Toxicology and Environmental Health A, 2008, 71(11-12):725733.

17

Dangour AD, Uauy R.N-3 long-chain polyunsaturated fatty acids for optimal function during
brain development and ageing. Asia Pacific Journal of Clinical Nutrition, 2008, 17(Suppl
1):185188.
18

Cabezuelo HG et al. 25-Hydroxyvitamin D levels in infants. Relation with breast-feeding (in

Spanish). Anales de Pediatra (Barcelona, Spain : 2003), 2007, 66(5):491495.

19

Savino F, Lupica MM. Breast milk: biological constituents for health and well-being in
infancy (in Italian). Recenti Progressi in Medicina, 2006, 97(10):519527.
20

Singhal A et al. Infant nutrition and stereoacuity at age 4-6 y. American Journal of Clinical
Nutrition, 2007, 85(1):152159.

21

Thorsdottir I, Gunnarsson BS. Dietary quality and adequacy of micronutrient intakes in

children. The Proceedings of the Nutrition Society, 2006, 65(4):366375.
22

Koletzko B. Long-term consequences of early feeding on later obesity risk. Nestl Nutrition
Institute Workshop Series: Pediatric Program, 2006, 58:118.

23

Agostoni C. LC-PUFA content in human milk: is it always optimal? Acta Paediatrica, 2005,
94(11):15321534.
24

Pomeroy KM, Sawyer LJ, Evans MJ. Estimated radiation dose to breast feeding infant
following maternal administration of 57Co labelled to vitamin B12. Nuclear Medicine
Communications, 2005, 26(9):839841.
25

Riva E et al. Early protein intakes and adiposity: reloaded or downloaded? Acta Paediatrica,
2004, 93(6):725726.
26

Strambi M et al. Selenium status, birth weight, and breast-feeding: pattern in the first month.
Biological Trace Element Research, 2004, 99(13):7181.

27

Coppa GV et al. Characterization of oligosaccharides in milk and feces of breast-fed infants by

high-performance anion-exchange chromatography. Advances in Experimental Medicine and
Biology, 2001, 501:307314.

28

Jewell VC et al. Nutritional factors and visual function in premature infants. The Proceedings
of the Nutrition Society, 2001, 60(2):171178.
29

Savino F et al. Arachidonic (AA) and docosahexaenoic (DHA) acid content in healthy infants
fed with an HA milk formula supplemented with LCPUFA and in breast fed infants. Advances in
Experimental Medicine and Biology, 2000, 478:411412.
30

Koletzko B et al. Dietary fat intakes in infants and primary school children in Germany.
American Journal of Clinical Nutrition, 2000, 72(5 Suppl):1392S1398S.

31

Atladottir H, Thorsdottir I. Energy intake and growth of infants in Iceland-a population with
high frequency of breast-feeding and high birth weight. European Journal of Clinical Nutrition,
2000, 54(9):695701.
32

Freeman V, van't Hof M, Haschke F. Patterns of milk and food intake in infants from birth to
age 36 months: the Euro-growth study. Journal of Pediatric Gastroenterology and Nutrition,
2000, 31(Suppl 1):S76S85.

33

Prentice A. Maternal calcium metabolism and bone mineral status. American Journal of
Clinical Nutrition, 2000, 71(5 Suppl):1312S1316S.
31

34

Akeson PK et al. Fat intake and metabolism in Swedish and Italian infants. Acta Paediatrica,
2000, 89(1):28-33.
35

Lauritzen L. Fatty acid composition of human milk in atopic Danish mothers. American
Journal of Clinical Nutrition, 2006, 84(1):190196.
36

Agostoni C et al. Long-chain polyunsaturated fatty acid concentrations in human hindmilk are
constant throughout twelve months of lactation. Advances in Experimental Medicine and
Biology, 2001, 501:157161.
Agostoni C et al. Prolonged breast-feeding (six months or more) and milk fat content at six
months are associated with higher developmental scores at one year of age within a breast-fed
population. Advances in Experimental Medicine and Biology, 2001, 501:137141.

37

38

Zachara BA, Pilecki A. Daily selenium intake by breast-fed infants and the selenium
concentration in the milk of lactating women in western Poland. Medical Science Monitor, 2001,
7(5):10021004.
39

Olafsdottir AS et al. Polyunsaturated fatty acids in the diet and breast milk of lactating
icelandic women with traditional fish and cod liver oil consumption. Annals of Nutrition and
Metabolism, 2006, 50(3):270276.
40

Rakicioglu N et al. The effect of Ramadan on maternal nutrition and composition of breast
milk. Pediatrics International: Official Journal of the Japan Pediatric Society, 2006, 48(3):278
283.

41

Bergmann RL et al. Supplementation with 200 mg/day docosahexaenoic acid from midpregnancy through lactation improves the docosahexaenoic acid status of mothers with a
habitually low fish intake and of their infants. Annals of Nutrition and Metabolism, 2008,
52(2):157166.
42

Domellof M et al. Factors influencing concentrations of iron, zinc, and copper in human milk.
Advances in Experimental Medicine and Biology, 2004, 554:355358.
43

Olafsdottir AS et al. Fat-soluble vitamins in the maternal diet, influence of cod liver oil
supplementation and impact of the maternal diet on human milk composition. Annals of
Nutrition and Metabolism, 2001, 45(6):265272.
44

Koletzko B et al. Infant feeding and later obesity risk. Advances in Experimental Medicine and
Biology, 2009, 646:1529.

45

Koletzko B et al. Can infant feeding choices modulate later obesity risk? American Journal of
Clinical Nutrition, 2009, 89(5):1502S1508S.
46

Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clinical
Endocrinology, 2009, 70(5):803809.

47

Agostoni C. Role of long-chain polyunsaturated fatty acids in the first year of life. Journal of
Pediatric Gastroenterology and Nutrition, 2008, 47(Suppl 2):S41S44.

48

Bokor S, Koletzko B, Decsi T. Systematic review of fatty acid composition of human milk
from mothers of preterm compared to full-term infants. Annals of Nutrition and Metabolism,
2007, 51(6):550556.
49

Craig-Schmidt MC. World-wide consumption of trans fatty acids. Atherosclerosis

Supplements, 2006, 7(2):14.

50

Agostoni C et al. How much protein is safe? International journal of obesity, 2005, 29(Suppl
2):S8S13.
32

51

Turck D. Breast feeding: health benefits for child and mother (in French). Archives de
Pdiatrie, 2005, 12(Suppl 3):S145S165.
52

Koletzko B et al. Protein intake in the first year of life: a risk factor for later obesity? The E.U.
childhood obesity project. Advances in Experimental Medicine and Biology, 2005, 569:6979.

53

Decsi T, Koletzko B. N-3 fatty acids and pregnancy outcomes. Current Opinion in Clinical
Nutrition and Metabolic Care, 2005, 8(2):161166.

54

Innis SM. Polyunsaturated fatty acids in human milk: an essential role in infant development.
Advances in Experimental Medicine and Biology, 2004, 554:2743.

55

Decsi T. Nutritional relevance of trans isomeric fatty acids in human milk. Acta Paediatrica,
2003, 92(12):13691371.
56

Faldella G et al. Iron balance and iron nutrition in infancy. Acta Paediatrica Supplement,
2003, 91(441):8285.
57

Bender DA. Do we really know vitamin and mineral requirements for infants and children?
The Journal of the Royal Society for the Promotion of Health, 2003, 123(3):154158.
58

Agostoni C. Compliance of present recommendations of fatty acids in formulas for term

infants with the actual human milk fatty acid composition in different populations. Acta
Paediatrica, 2003, 92(7):785787.
59

Agostoni C, Giovannini M. Cognitive and visual development: influence of differences in

breast and formula fed infants. Nutrition Health, 2001, 15(34):183188.

60

Brion MJ et al. Sodium intake in infancy and blood pressure at 7 years: findings from the
Avon Longitudinal Study of Parents and Children. European Journal of Clinical Nutrition, 2008,
62(10):11621169.
61

Ohlund I et al. Dietary fat in infancy should be more focused on quality than on quantity.
European Journal of Clinical Nutrition, 2008, 62(9):10581064.
62

Hopkins D et al. Infant feeding in the second 6 months of life related to iron status: an
observational study. Archives of Disease in Childhood, 2007, 92(10):850854.
63

Noble S, Emmett P. Food and nutrient intake in a cohort of 8-month-old infants in the southwest of England in 1993. European Journal of Clinical Nutrition, 2001, 55(8):698707.

64

Roth C et al. The iodine supply of newborns: comparison of iodine absorption and iodine
excretion of mother and child (in German). Deutsche Medizinische Wochenschrift, 2001,
126(12):321325.

65

Koletzko B et al. Lower protein in infant formula is associated with lower weight up to age 2
y: a randomized clinical trial. American Journal of Clinical Nutrition, 2009, 89(6):18361845.
66

Doneray H, Orbak Z, Yildiz L. The relationship between breast milk leptin and neonatal
weight gain. Acta Paediatrica, 2009, 98(4):643647.
67

Corvaglia L et al. Near-infrared reflectance analysis to evaluate the nitrogen and fat content of
human milk in neonatal intensive care units. Archives of Disease in Childhood. Fetal and
Neonatal Edition, 2008, 93(5):F372F375.

68

Weyermann M, Brenner H, Rothenbacher D. Adipokines in human milk and risk of

overweight in early childhood: a prospective cohort study. Epidemiology, 2007, 18(6):722729.

33

69

Ilcol YO, Hizli ZB, Eroz E. Resistin is present in human breast milk and it correlates with
maternal hormonal status and serum level of C-reactive protein. Clinical Chemistry and
Laboratory Medicine, 2008, 46(1):118124.

70

Ilcol YO, Hizli B. Active and total ghrelin concentrations increase in breast milk during
lactation. Acta Paediatrica, 2007, 96(11):16321639.
71

Ballabio C et al. Immunoglobulin-A profile in breast milk from mothers delivering full term
and preterm infants. International journal of Immunopathology and Pharmacology, 2007,
20(1):119128.
72

Gundacker C et al. Smoking, cereal consumption, and supplementation affect cadmium

content in breast milk. Journal of Exposure Science and Environmental Epidemiology, 2007,
17(1):3946.

73

Musumeci M et al. Oligosaccharides in colostrum of Italian and Burkinabe women. Journal of

Pediatric Gastroenterology and Nutrition, 2006, 43(3):372378.
74

Cavalli C et al. Free sugar and sugar alcohol concentrations in human breast milk. Journal of
Pediatric Gastroenterology and Nutrition, 2006, 42(2):215221.

75

Xiang M, Harbige LS, Zetterstrom R. Long-chain polyunsaturated fatty acids in Chinese and
Swedish mothers: diet, breast milk and infant growth. Acta Paediatrica, 2005, 94(11):1543
1549.
76

Kovacs A et al. Fatty acids in early human milk after preterm and full-term delivery. Journal
of Pediatric Gastroenterology and Nutrition, 2005, 41(4):454459.
77

Saarela T, Kokkonen J, Koivisto M. Macronutrient and energy contents of human milk

fractions during the first six months of lactation. Acta Paediatrica, 2005, 94(9):11761181.

78

Mandel D et al. Fat and energy contents of expressed human breast milk in prolonged
lactation. Pediatrics, 2005, 116(3):e432e435.

79

Ilcol YO et al. Choline status in newborns, infants, children, breast-feeding women, breast-fed
infants and human breast milk. The Journal of Nutritional Biochemistry, 2005, 16(8):489499.
80

Sala-Vila A et al. Lipid composition in human breast milk from Granada (Spain): changes
during lactation. Nutrition, 2005, 21(4):467473.

81

Dundar NO et al. Longitudinal investigation of the relationship between breast milk leptin
levels and growth in breast-fed infants. Journal of Pediatric Endocrinology and Metabolism,
2005, 18(2):181187.

82

Lien E et al. Variations in concentrations of lactoferrin in human milk: a nine country survey.
Advances in Experimental Medicine and Biology, 2004, 554:423426.

83

Gazzolo D et al. Levels of S100B protein are higher in mature human milk than in colostrum
and milk-formulae milks. Clinical Nutrition, 2004, 23(1):2326.

84

Boniglia C et al. Influence of maternal protein intake on nitrogen fractions of human milk.
International Journal for Vitamin and Nutrition Research, 2003, 73(6):447452.

85

Agostoni C et al. Earlier smoking habits are associated with higher serum lipids and lower
milk fat and polyunsaturated fatty acid content in the first 6 months of lactation. European
Journal of Clinical Nutrition, 2003, 57(11):14661472.
86

Smit EN et al. Fatty acids in formulae for term infants: compliance of present
recommendations with the actual human milk fatty acid composition of geographically different
populations. Acta Paediatrica, 2003, 92(7):790796.
34

87

Ferreira IM. Quantification of non-protein nitrogen components of infant formulae and followup milks: comparison with cows' and human milk. British Journal of Nutrition, 2003, 90(1):127
133.

88

Lopez-Lopez A et al. Fatty acid and sn-2 fatty acid composition in human milk from Granada
(Spain) and in infant formulas. European Journal of Clinical Nutrition, 2002, 56(12):1242
1254.
89

Smit EN et al. Estimated biological variation of the mature human milk fatty acid
composition. Prostaglandins, Leukotrienes and Essential Fatty Acids, 2002, 66(5-6):549555.
90

Scopesi F et al. Maternal dietary PUFAs intake and human milk content relationships during
the first month of lactation. Clinical Nutrition, 2001, 20(5):393397.

91

Agostoni C et al. Breastfeeding duration, milk fat composition and developmental indices at 1
year of life among breastfed infants. Prostaglandins, Leukotrienes and Essential Fatty Acids,
2001, 64(2):105109.
92

Agostoni C et al. Free glutamine and glutamic acid increase in human milk through a threemonth lactation period. Journal of Pediatric Gastroenterology and Nutrition, 2000, 31(5):508
512.
93

Decsi T et al. Fatty acid composition of human milk in Hungary. Acta Paediatrica, 2000,
89(11):13941395.

94

Agostoni C et al. Dietary fats and cholesterol in italian infants and children. American Journal
of Clinical Nutrition, 2000, 72(5 Suppl):1384S1391S.

95

Agostoni C et al. Free amino acid content in standard infant formulas: comparison with human
milk. Journal of the American College of Nutrition, 2000, 19(4):434438.
96

Marangoni F et al. Polyunsaturated fatty acid concentrations in human hindmilk are stable
throughout 12-months of lactation and provide a sustained intake to the infant during exclusive
breastfeeding: an Italian study. British Journal of Nutrition, 2000, 84(1):103109.
97

Ucar B et al. Breast milk leptin concentrations in initial and terminal milk samples:
relationships to maternal and infant plasma leptin concentrations, adiposity, serum glucose,
insulin, lipid and lipoprotein levels. Journal of Pediatric Endocrinology and Metabolism, 2000,
13(2):149156.
98

Xiang M et al. Long-chain polyunsaturated fatty acids in human milk and brain growth during
early infancy. Acta Paediatrica, 2000, 89(2):142147.

99

Holmes HC, Snodgrass GJ, Iles RA. Changes in the choline content of human breast milk in
the first 3 weeks after birth. European Journal of Pediatrics, 2000, 159(3):198204.
100

Orhon FS et al. The influence of maternal smoking on maternal and newborn oxidant and
antioxidant status. European Journal of Pediatrics, 2009, 168(8):975981.

101

Tokusoglu O et al. Retinol and alpha-tocopherol concentrations in breast milk of Turkish

lactating mothers under different socio-economic status. International Journal of Food Sciences
and Nutrition, 2008, 59(2):166174.

102

Jewell VC et al. A comparison of lutein and zeaxanthin concentrations in formula and human
milk samples from Northern Ireland mothers. European Journal of Clinical Nutrition, 2004,
58(1):9097.
103

Canfield LM et al. Multinational study of major breast milk carotenoids of healthy mothers.
European Journal of Nutrition, 2003, 42(3):133141.
35

104

Leotsinidis M, Alexopoulos A, Kostopoulou-Farri E. Toxic and essential trace elements in

human milk from Greek lactating women: association with dietary habits and other factors.
Chemosphere, 2005, 61(2):238247.

105

Rodriguez Rodriguez EM, Sanz AM, Diaz RC. Concentrations of iron, copper and zinc in
human milk and powdered infant formula. International Journal of Food Sciences and Nutrition,
2000, 51(5):373380.

106

Krachler M et al. Concentrations of selected trace elements in human milk and in infant
formulas determined by magnetic sector field inductively coupled plasma-mass spectrometry.
Biological Trace Element Research, 2000, 76(2):97112.

107

Rodriguez Rodriguez EM, Sanz AM, Diaz RC. Concentrations of calcium, magnesium,
sodium and potassium in human milk and infant formulas (in Spanish). Archivos
Latinoamericanos de Nutricin, 2002, 52(4):406412.
108

Ozbek A et al. Maternal psychosocial aspects in hypernatremic dehydration with high sodium
concentrations in breast milk: a case-control study. Journal of Paediatrics and Child Health,
2008, 44(12):3843.
109

Manganaro R et al. Breast milk sodium concentration, sodium intake and weight loss in
breast-feeding newborn infants. British Journal of Nutrition, 2007, 97(2):344348.

110

Costeira MJ et al. Iodine status of pregnant women and their progeny in the Minho Region of
Portugal. Thyroid, 2009, 19(2): 157163.

111

Kurtoglu S et al. Iodine status remains critical in mother and infant in Central Anatolia
(Kayseri) of Turkey. European Journal of Nutrition, 2004, 43(5):297303.

112

Ciardelli R et al. The nutritional iodine supply of Belgian neonates is still insufficient.
European Journal of Pediatrics, 2002, 161(10):519523.

113

zdemir HS et al. The selenium levels of mothers and their neonates using hair, breast milk,
meconium, and maternal and umbilical cord blood in Van Basin. Biological Trace Element
Research, 2008, 122(3):206215.

114

Navarro-Blasco I, Alvarez-Galindo JI. Selenium content of Spanish infant formulae and

human milk: influence of protein matrix, interactions with other trace elements and estimation of
dietary intake by infants. Journal of Trace Elements in Medicine and Biology, 2004, 17(4):277
289.
115

Zachara BA, Pilecki A. Selenium concentration in the milk of breast-feeding mothers and its
geographic distribution. Environmental Health Perspectives, 2000, 108(11):10431046.

116

Aksit S, Ozkayin N, Caglayan S. Effect of sucking characteristics on breast milk

creamatocrit. Paediatric and Perinatal Epidemiology, 2002, 16(4):355360.

36