Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu
Original Article
Department of Nutrition and Food Science, Faculty of Pharmacy, University of Barcelona. Avda. Joan XXIII s/n CE-08028, Barcelona, Spain
CIBER of Epidemiology and Public Health, Spain
Hospital Clnic, Institut de Ginecologia, Obstetrcia i Neonatologia, Agrupaci Sanitria Hospital Clnic e Hospital Sant Joan de Du. IDIBAPS (Institut dInvestigacions Biomdiques
August Pi i Sunyer), University of Barcelona, Barcelona, Spain
b
c
a r t i c l e i n f o
s u m m a r y
Article history:
Received 22 December 2009
Accepted 18 July 2010
Background & aims: Human milk composition changes according to gestational age and stage of lactation,
but infants fed banked human milk often receive pooled milk. We studied the changes in fat content and
fatty acid proportions throughout lactation in very preterm, preterm, and full term milk, and the
differences among gestational age groups.
Methods: Samples from women delivering before 30 (n 10), between 30 and 37 (n 10), and between
38 and 42 (n 23) weeks of gestation were analyzed.
Results: Fat content was higher in very preterm than in preterm and full term samples (p < 0.05).
Medium-chain saturated fatty acids, alpha-linolenic acid, and rumenic acid proportions increased
(p < 0.05) during lactation, while those of most long-chain saturated fatty acids and most long-chain
polyunsaturated fatty acids from the n-3 and n-6 families decreased (p < 0.05). In colostrum and
transitional milk, medium-chain saturated fatty acid proportions were highest in the very preterm group,
and decreased with gestational age (p < 0.05).
Conclusions: The differences in fat and fatty acids of human milk obtained at different gestational ages
and stages of lactation may impact preterm infants health. Therefore they could be taken into account
when feeding newborns banked human milk and when designing infant formulas or human milk
fortiers.
2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Keywords:
Conjugated linoleic acid
DHA
Human milk
Milk banking
Preterm infants
Creamatocrit
1. Introduction
Mothers own milk (MOM), with appropriate fortication for
some premature or very-low birth weight (VLBW) infants, is the
best food for newborns.1e3 However, breastfeeding premature or
Abbreviations: VLBW, very-low birth weight; FT, full term; PT, preterm; VPT,
very preterm; SFAs, saturated fatty acids; MCSFAs, medium-chain saturated fatty
acids; LCSFAs, long-chain saturated fatty acids; MUFAs, monounsaturated fatty
acids; PUFAs, polyunsaturated fatty acids; LCPUFAs, long-chain polyunsaturated
fatty acids; LA, linoleic acid; CLA, conjugated linoleic acid; AA, arachidonic acid;
ALA, alpha-linolenic acid; EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid.
* Corresponding author. Department of Nutrition and Food Science, Faculty of
Pharmacy, University of Barcelona. Avda. Joan XXIII s/n CE-08028, Barcelona, Spain.
Tel.: 34 93 402 45 12; fax: 34 93 403 59 31.
E-mail addresses: carolinamolto@ub.edu (C. Molt-Puigmart), aicastellote@ub.
edu (A.I. Castellote), XCARBO@clinic.ub.es (X. Carbonell-Estrany), mclopez@ub.
edu, mclopez@ub.edu (M.C. Lpez-Sabater).
0261-5614/$ e see front matter 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
doi:10.1016/j.clnu.2010.07.013
117
118
Table 1
Characteristics of women and infants included in the study.
Characteristicsc
Very preterm
(n 10)
33.10
65.90
1.67
23.75
8.4
1.40
1.10
1.33
25.25
0.97
a
b
c
d
3.56
6.85
0.05
1.97
3.75
0.67
0.30
0.96
21.64
0.25
Preterm
(n 10)
32.80
64.15
1.60
25.09
13.55
1.60
1.20
1.25
68.50
2.21
5.33
11.76
0.06
5.25
3.48
0.49
0.40
0.44
53.79
0.58
30.83
55.91
1.60
21.97
11.92
1.61
1.00
1.75
11.05
3.67
4.88
6.48
0.07
2.49
5.04
0.86
0.00
1.73
8.30
0.71
p valued
0.327a
0.004a
0.025a
0.050a
0.050a
0.607b
0.103b
0.795a
0.354a
0.000a
Fig. 1. Creamatocrit values (%) in colostrum (black bars), transitional (white bars), and
mature milk (striped bars), from women delivering very preterm (VPT), preterm (PT),
and full term (FT) infants. Lower case letters indicate differences among colostrum,
transitional, and mature milk in each gestational age group (same letters indicate
signicant differences, according to GLM and LSD post-hoc test). Symbols indicate
differences among gestational age groups at each stage of lactation (same symbols
indicate signicant differences, according to ANOVA and Bonferroni post-hoc test).
Signicance: p < 0.05. Error bars represent SD.
C10:0
C12:0
C14:0
C15:0
C16:0
C17:0
C18:0
C20:0
C22:0
C24:0
SFAs
MCSFAs
LCSFAs
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
0.03
0.02
0.02
0.39
0.16
0.13
3.38
1.81
1.33
5.93
4.19
3.69
0.22
0.22
0.23
21.08
23.68
22.71
0.29
0.29
0.29
5.85
6.68
6.21
0.19
0.25
0.24
0.07
0.10
0.10
0.11
0.15
0.18
37.54
37.57
35.13
3.77
1.97
1.46
33.74
35.57
33.65
0.01a,b
0.01a
0.02a
0.18a,#,
0.07a,b,#
0.08a,b,
1.61a,#,
0.59a,#
0.46a,b,
2.60a,#,
0.45a,#
0.84a,b,
0.05a,b
0.05
0.05a
2.71a,b,#,
2.25a,b,#
2.08a,b,
0.07
0.05a
0.04
1.42
2.20a
1.24
0.04#,
0.09a,b,#
0.06a,
0.02a,#,
0.04a,#
0.04a,
0.05a,#
0.09a
0.10a,#
4.87
4.44a
3.30a,b
1.78a,#,
0.64a,#
0.53a,b,
4.30a
4.25a,b
3.41
Transitional
0.08
0.07
0.08
0.98
0.91
0.80
6.00
5.95
4.28
6.94
7.02
5.28
0.19
0.19
0.26
16.84
19.83
21.70
0.26
0.25
0.30
6.00
5.68
6.45
0.18
0.19
0.20
0.06
0.07
0.07
0.07
0.08
0.07
37.60
40.24
39.48
6.99
6.87
5.09
30.53
33.31
34.32
0.02a
0.03a
0.02a
0.25a,#
0.19a
0.25a,#
2.04a,#
1.84a,
1.58a,#,
2.79a,b,#
2.16a,
1.96a,#,
0.05a,#
0.06
0.07a,#,
6.06a,#,
2.65a,#
1.66a,
0.04#
0.05a,b,
0.05a,#,
0.96
1.25a,#
0.98#
0.02#
0.05a
0.04a,#
0.01a
0.02a
0.02a
0.04a
0.05a
0.03a
9.64
6.19a
4.56a
2.26a,#
2.01a,
1.80a,#,
7.53#
4.92a
3.24#
Mature
0.08
0.09
0.09
0.86
0.88
0.83
4.41
4.74
4.15
4.95
5.65
4.98
0.19
0.23
0.25
18.64
20.65
21.26
0.25
0.29
0.28
6.15
6.06
6.39
0.18
0.18
0.19
0.04
0.05
0.05
0.05
0.04
0.05
35.79
38.83
38.52
5.28
5.62
4.98
30.44
33.12
33.45
119
Table 3
Monounsaturated fatty acid proportions according to the stage of lactation and
gestational age groups.
Fatty acid G. age group Colostrum
0.02b
0.03a
0.04a
0.25a
0.22b
0.20b
1.56a
1.19a
1.10b
1.69b
1.58a
1.74b
0.03b,#
0.07
0.11#
1.23b,#,
2.43b,#
2.79b,
0.02
0.06b
0.06a
0.80
0.83
0.93
0.04
0.03b
0.03a
0.02a
0.03a
0.02a
0.02a
0.03a
0.03a
4.71
5.25
5.44b
1.74a
1.40a
1.28b
3.20a,#
4.25b
4.57#
Results expressed as mean SD. G. age group refers to the three gestational age
groups: very preterm (VPT), preterm (PT), and full term (FT). Lower case letters
indicate differences among colostrum, transitional, and mature milk in each
gestational age group (same letters indicate signicant differences, according to
GLM and LSD post-hoc test). Symbols indicate differences among gestational age
groups, for each stage of lactation (same symbols indicate signicant differences,
according to ANOVA and Bonferroni post-hoc test). Signicance: p < 0.05. MCSFA
refers to the sum of C10:0 and C12:0 and LCSFA to the sum of saturated fatty acids
with 14 carbon atoms or more.
C14:1
C16:1 n-9
C16:1 n-7
C17:1
t-C18:1
C18:1 n-9
C18:1 n-7
C20:1 n-9
C22:1 n-9
C24:1
MUFAs
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
0.11
0.12
0.12
0.54
0.57
0.56
1.54
1.78
1.48
0.16
0.16
0.14
0.32
0.40
0.45
37.76
36.84
37.11
1.91
2.25
1.95
0.79
0.96
0.96
0.21
0.28
0.27
0.21
0.30
0.32
43.53
43.65
43.37
Transitional
0.04
0.03a
0.05a,b
0.08a
0.11a,b
0.08a
0.50
0.53a,#
0.38a,b,#
0.04
0.03a
0.02a,b
0.14a,#
0.07a
0.22#
4.52a
3.88
3.51
0.36a,#
0.31a,b,#,
0.48a,b,
0.16a,#,
0.11a,#
0.15a,
0.04a,#,
0.03a,#
0.06a,
0.06a,#,
0.09a,#
0.12a,
4.91
4.37a
3.80a
0.12
0.14
0.18
0.45
0.45
0.43
1.62
1.78
1.82
0.15
0.15
0.17
0.22
0.29
0.51
40.46
35.49
36.12
1.78
1.78
1.72
0.66
0.58
0.52
0.15
0.14
0.12
0.10
0.11
0.08
45.72
40.91
41.68
0.05#
0.06
0.08a,#
0.07a
0.10a
0.06a
0.46
0.58b
0.49a
0.03#
0.03b,
0.03a,#,
0.09a,#
0.16a,b,
0.37#,
9.78#
5.61a
4.88#
0.35
0.37a
0.27a
0.13a,#,
0.07a,#
0.09a,
0.02a,#
0.02a,
0.02a,#,
0.03a,#
0.04a,
0.02a,#,
9.84
5.97a,b
5.21a
Mature
0.13
0.18
0.21
0.38
0.44
0.39
1.60
2.06
1.99
0.15
0.19
0.18
0.23
0.39
0.43
41.11
39.00
37.45
1.62
1.75
1.66
0.52
0.48
0.47
0.10
0.10
0.10
0.06
0.05
0.05
45.90
44.64
42.92
0.03#
0.09a
0.13b,#
0.13a
0.06b
0.06a
0.53
0.56a,b
0.64b
0.02#,
0.04a,b,#
0.05b,
0.12#
0.20b
0.30#
5.07a,#
6.47a
5.11#
0.28a
0.17b
0.28b
0.04a
0.10a
0.11a
0.02a
0.01a
0.03a
0.02a
0.01a
0.02a
4.38
6.47b
5.34
Results expressed as mean SD. G. age group refers to the three gestational age
groups: very preterm (VPT), preterm (PT), and full term (FT). Lower case letters
indicate differences among colostrum, transitional, and mature milk in each
gestational age group (same letters indicate signicant differences, according to
GLM and LSD post-hoc test). Symbols indicate differences among gestational age
groups, for each stage of lactation (same symbols indicate signicant differences,
according to ANOVA and Bonferroni post-hoc test). Signicance: p < 0.05.
VPT
PT
FT
c9t12, t9c12- VPT
PT
C18:2
FT
C18:2 n-6
VPT
PT
FT
0.06
0.07
0.07
0.13
0.15
0.18
14.42
12.99
15.95
0.02#
0.01
0.03#
0.02a,#
0.04a
0.07#
6.13
3.41a,#
4.07#
Transitional
0.05
0.06
0.08
0.12
0.13
0.16
13.08
14.79
15.17
Mature
0.02#
0.06 0.02
0.08 0.03a
0.02a,
#,
0.03
0.08 0.05
0.02a,#
0.13 0.03#
0.02a,b, 0.16 0.05b
0.03#,
0.16 0.04#
2.49
15.00 2.35
4.27a,b 13.23 3.51b
4.03
15.24 5.22
(continued on next page)
120
Table 4 (continued)
Fatty acid
C18:3 n-6
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
VPT
PT
FT
c9t11-CLA
t10c12-CLA
C20:2 n-6
C20:3 n-6
C20:4 n-6
C22:2 n-6
C22:4 n-6
C22:5 n-6
PUFAs n-6
LCPUFA n-6
C18:3 n-3
C20:5 n-3
C22:5 n-3
C22:6 n-3
PUFA n-3
LCPUFA n-3
PUFA
n-6/n-3
LA/ALA
AA/DHA
EPA/DHA
0.09
0.05
0.05
0.12
0.13
0.14
0.010
0.009
0.010
0.76
0.98
1.09
0.82
0.89
0.75
0.78
1.02
0.92
0.15
0.19
0.20
0.31
0.61
0.55
0.12
0.20
0.17
17.61
17.10
19.88
2.78
3.70
3.49
0.33
0.35
0.38
0.06
0.06
0.07
0.24
0.37
0.36
0.51
0.66
0.55
1.13
1.44
1.37
0.80
1.09
0.99
18.91
18.75
21.47
16.18
12.47
15.37
44.61
38.40
45.17
1.61
1.71
1.79
0.11
0.10
0.12
0.04a,#,
0.02a,#
0.02a,
0.03
0.03a
0.06a,b
0.001a,b
0.001
0.001
0.22a,#,
0.23a,#
0.23a,
0.25a,b
0.16a,#
0.21a,#
0.14a,#,
0.015a,#
0.19a,
0.04a,#,
0.05a,#
0.04a,
0.10a,#,
0.14a,#
0.24a,
0.09a,#
0.11a,#
0.11a,b
6.12
3.74a
4.10a,b
0.48a,#,
0.60a,#
0.81a,
0.05a
0.09a,b
0.17a,b
0.02
0.01
0.03
0.07a,b,#,
0.10a,#
0.13a,b,
0.14a,#
0.24a,#
0.18a,b
0.21#,
0.33a,#
0.36a,b,
0.21a,#
0.31a,#
0.32a,b
6.13
3.80a
4.22a,b
7.09
4.13a,b
4.59
20.48a,b
9.08a,b
13.12a
0.43
0.57a
0.57
0.02a
0.04a,b,#
0.04a,#
Transitional
0.08
0.08
0.09
0.12
0.14
0.18
0.008
0.007
0.010
0.55
0.59
0.50
0.57
0.60
0.50
0.61
0.72
0.62
0.10
0.11
0.08
0.16
0.22
0.17
0.07
0.10
0.08
15.41
17.44
17.56
1.95
2.23
1.86
0.44
0.50
0.53
0.07
0.06
0.06
0.16
0.19
0.16
0.47
0.48
0.41
1.14
1.24
1.16
0.70
0.74
0.63
16.66
18.82
18.82
14.97
15.04
16.13
32.36
31.66
30.72
1.43
1.65
1.71
0.13
0.15
0.15
0.03b
0.03a
0.04a
0.04#
0.06b,
0.06a,#,
0.001a
0.001#
0.000#
0.13a
0.12a,#
0.12a,#
0.15a
0.10a,#
0.13a,#
0.10a,#
0.08a,#,
0.11a,
0.03a
0.03a,#
0.02a,#
0.03a,#
0.06a,#,
0.06a,
0.04a,#
0.03a,#
0.03a
2.58
4.39b
4.16a
0.22a,#
0.28a,#,
0.27a,
0.12a
0.16a
0.18a
0.05
0.05
0.04
0.05a
0.07a
0.05a
0.17b
0.15a
0.15a
0.33
0.36a
0.29a
0.26
0.25a
0.22a
2.50
4.47b
4.22a
5.97
5.87a
5.40
11.68a
13.15a
10.49a
0.50
0.54b
0.59
0.04b
0.07a
0.06a
Mature
0.11
0.12
0.12
0.13
0.17
0.18
0.007
0.009
0.009
0.43
0.40
0.38
0.52
0.53
0.43
0.52
0.54
0.49
0.06
0.06
0.05
0.11
0.13
0.11
0.05
0.06
0.06
17.06
15.42
17.28
1.63
1.65
1.48
0.59
0.52
0.60
0.06
0.05
0.08
0.14
0.13
0.15
0.36
0.29
0.35
1.14
1.00
1.18
0.55
0.47
0.58
18.29
16.50
18.53
15.60
16.39
16.50
28.89
28.55
27.00
1.59
2.02
1.81
0.16
0.19
0.20
0.04a,b
0.05a
0.03a
0.03
0.06a,b
0.10b
0.001b
0.001
0.001
0.13a
0.09a
0.10a
0.23b
0.17a
0.08a
0.12a
0.07a
0.08a
0.03a
0.02a
0.02a
0.04a
0.02a
0.03a
0.02a
0.01a
0.07b
2.64
3.69a,b
5.31b
0.52a
0.27a
0.22a
0.27a
0.19b
0.25b
0.02
0.02
0.02
0.03b
0.03a
0.07b
0.15a,b
0.08a
0.27b
0.30
0.25a
0.57b
0.20a
0.12a
0.46b
2.80
3.72a,b
5.49b
3.37
6.21b
6.00
10.04b
14.43b
8.71a
0.48
0.77a,b
0.70
0.03a,b
0.09b
0.09a
Results expressed as mean SD. G. age group refers to the three gestational age
groups: very preterm (VPT), preterm (PT), and full term (FT). Lower case letters
indicate differences among colostrum, transitional, and mature milk in each gestational age group (same letters indicate signicant differences, according to GLM and
LSD post-hoc test). Symbols indicate differences among gestational age groups, for
each stage of lactation (same symbols indicate signicant differences, according to
ANOVA and Bonferroni post-hoc test). Signicance: p < 0.05. LCPUFA (n-3 or n-6)
refers to the sum of polyunsaturated fatty acids with 20 or more carbon atoms.
121
A 1.20
a,#
1.00
AA (%)
0.80
a,
a,#,
a,#,
a,
0.60
a,#
0.40
a
a
a
0.20
0.00
Colostrum
Mature milk
0.70
a,#
0.60
0.50
DHA(%)
Transitional milk
a,b
a
a,#
0.40
0.30
a,b
b
a
0.20
0.10
0.00
Colostrum
Fig. 2. Evolution of medium-chain saturated fatty acids (A) and long-chain saturated
fatty acids (B) throughout lactation according to the gestational age group. Solid,
broken, and dotted lines correspond to very preterm, preterm, and full term samples,
respectively. Lower case letters indicate differences among colostrum, transitional, and
mature milk in each gestational age group (same letters indicate signicant differences, according to GLM and LSD post-hoc test). Symbols indicate differences among
gestational age groups at each stage of lactation (same symbols indicate signicant
differences, according to ANOVA and Bonferroni post-hoc test). Signicance: p < 0.05.
MCSFA refers to the sum of C10:0 and C12:0 and LCSFA to the sum of saturated fatty
acids with 14 carbon atoms or more.
Transitional milk
Mature milk
Fig. 3. Evolution of arachidonic (A) and docosahexaenoic (B) acids throughout lactation according to the gestational age group. Solid, broken, and dotted lines correspond
to very preterm, preterm, and full term samples, respectively. Lower case letters
indicate differences among colostrum, transitional, and mature milk in each gestational age group (same letters indicate signicant differences, according to GLM and
LSD post-hoc test). Symbols indicate differences among gestational age groups at each
stage of lactation (same symbols indicate signicant differences, according to ANOVA
and Bonferroni post-hoc test). Signicance: p < 0.05.
Regarding variations among gestational age groups, most differences in the fatty acid composition were found between VPT and FT
groups, while the PT group had a fatty acid composition in between
that of the other two groups. Of note, most differences were found
among colostrums and transitional milks of the three gestational
age groups, while very few differences were observed among
mature milks. This is, at one month post-partum, milks from
women delivering at different gestational ages basically differed in
their fat content (higher in VPT milk) but their fatty acid composition was almost identical. The higher fat content in VPT than in PT
and FT milk, not only in mature milk but also in the other two
stages of lactation is worth mentioning: if considering that milk
intake by VPT infants is very low, the supply of more concentrated
milk (in terms of lipids) may be physiologically important.
For PUFAs and LCPUFAs, we found minimal changes in LA, ALA,
and EPA proportions according to gestational age, which agrees
with the studies from Kovcs et al., Genzel-Boroviczny et al.,
Luukkainen et al., Bitman et al., and Rueda et al.,9,12,16,23,29 all of
them reviewed in Bokor et al.39 According to this same review,
results for other LCPUFAs were more variable among studies: one
study16 could nd higher proportions of DHA, C20:3 n-6, and AA in
PT than in FT colostrum; later in lactation, two out of the ve
studies found higher proportions of C22:5 n-3, DHA, and AA16,29 in
PT than in FT milk, while one of these two also found higher
122
123
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