NUTRITIONAL COMPOSITION OF BREAST MILK.pptx

nutrition

1. NUTRITIONAL COMPOSITION OF BREAST MILK By Bhuvana Parasuraman I M.Sc. Food Science & Nutrition 20PFN006

2. INTRODUCTION The Nutritional composition of breast milk  is complex. It consists of over 200 different substances , including  protein ,  fat ,  carbohydrates ,  vitamins , minerals, other nutrients,  enzymes , and  hormones . This composition isn't constant. It's different from mother to mother. It even varies within the same mother, depending on the baby's needs. The nutritional components of human milk derive from three sources: Some of the nutrients of milk originate by synthesis in the lactocyte. some are dietary in origin. some originate from maternal stores. Overall, the nutritional quality of human milk is highly conserved.

3. The composition of human milk is dynamic and variable Within a Feeding Diurnally Between mothers Maternal diet and body stores Over the Stage of Lactation Variation with length of Gestation (Preterm & Term delivery) Treatment of expressed milk

4. Within a Feed Diurnally Between mothers Maternal diet Treatment of Expressed milk Changes in Composition of Breast milk The fat concentration is consistently higher in hind milk and lower in foremilk Fat concentration is significantly lower in night and morning feedings compared with afternoon or evening feedings. The lipid concentration has also been shown to increase with the increase in the mother’s parity. Overweight mothers have a lower milk protein concentration and the milk of smokers has been reported to contain lower levels of lipids and proteins and sIgA The diet of the mother also effects the composition of her milk. For example, maternal protein intake may affect the lipid concentration. Many other micronutrients including vitamins and trace elements vary in human milk depending on the maternal diet and body stores. supplementation of multivitamins to mothers during lactation is highly recommended. The treatment of expressed milk also affects the composition of human milk. The fat content decreases significantly following storage, freezing, and thawing processes; however, the protein and carbohydrate concentrations increase significantly in all containers. In addition, lactoferrin and sIgA have both been reported to be significantly reduced in pasteurized milk. Heat treatment of human milk also reduces the concentration and functionality of its bioactive components, particularly in protein composition and function. Significant reductions have been demonstrated after pasteurization in sIgA , lysozyme , BSSL, cytokines, lipases, TGF-β, and adiponectin , among other proteins.

5. Breast milk stages and Composition F irst breast milk , At the end of pregnancy and during the first few days after birth Milk changes to mature breast milk by the time a baby is about two weeks old C ombination of colostrum and mature milk. After 3-5 days of breastfeeding. Foremilk (Watery) Hindmilk (Creamy) COLOSTRUM TRANSITIONAL MILK MATURE MILK

6. Composition of Preterm & Term milk Higher levels of Lactoferrin Carbohydrate, fat, protein, and energy concentrations were significantly higher in preterm milk Protein levels were significantly higher in extremely preterm milk (<28weeks). Preterm milk is characterized by higher concentrations of immune proteins and lower concentrations of nutritive proteins. Calcium, magnesium, and phosphorus concentrations are similar in preterm and full-term milk Carbohydrate, fat, protein, and energy concentrations were significantly lower in term milk compared to Preterm milk. Protein level is found to be decreased in Term milk. PRETERM MILK TERM MILK

7. MACRONUTRIENTS M acronutrient composition varies within mothers and across lactation, but is remarkably Conserved. Macronutrient composition differs between preterm and term milk, with preterm milk tending to be higher in protein and fat. T he macronutrient concentrations of human milk are associated with one or more of the following factors: Maternal body weight for height, P rotein intake, Mother’s parity, Return of menstruation and N ursing frequency.

8. PROTEIN D ivided into the W hey(60%) and C asein fractions(40%) or complexes. The most abundant proteins are C asein, α- lactalbumin L actoferrin S ecretory immunoglobulin sIgA L ysozyme and Serum albumin. Non-protein nitrogen-containing compounds, including urea, uric acid, creatine, creatinine, amino acids, and nucleotides, comprise ~25% of human milk nitrogen. Protein levels decrease in human milk over the first 4 to 6 weeks or more of life regardless of timing of delivery. Human milk protein concentration is not affected by maternal diet, but increases with maternal body weight for height, and decreases in mothers producing higher amounts of milk.

9. Milk protein

10. Lactoferrin Secretory IgA   Lysozyme   Bifidus factor   One of the whey protein which i nhibits the growth of siderophilic (iron-absorbing) bacteria in the gastrointestinal tract.  This inhibits certain organisms, such as coliforms and yeast, that require iron. W orks to protect the infant from viruses and bacteria.  It also helps to protect against E. Coli and possibly allergies.  Other immunoglobulins, including IgG and IgM, in breast milk also help protect against bacterial and viral infections.  It is an enzyme that protects the infant against E. Coli and  Salmonella . It also promotes the growth of healthy intestinal flora and has anti-inflammatory functions It supports the growth of lactobacillus. Lactobacillus is a beneficial bacteria that protect the baby against harmful bacteria by creating an acidic environment where it cannot survive Benefits of Breast milk Protein

11. carbohydrates The principal sugar of human milk is the disaccharide lactose. It accounts for approximately 40% of the total calories provided by breast milk. The concentration of lactose in human milk is the least variable of the macronutrients, but higher concentrations of lactose are found in the milk of mothers producing higher quantities of milk. Lactose helps to decrease a large number of unhealthy bacteria in the stomach, and promotes the growth of healthy bacteria which also improves the absorption of calcium, phosphorus, and magnesium.  Compared with glucose, lactose provides nearly twice the energy value per molecule (per unit of osmotic pressure). The concentrations of lactose in human milk are remarkably similar among women. L actose concentration in human milk decreased from 78 to 60 g/liter both 5 to 6 days before and 6 to 7 days after ovulation

12. Non Lactose Carbohydrates There is an array of moderate-chain-length carbohydrates (oligosaccharides and glycoconjugates) in human milk They comprise approximately 1g/dL in human milk, depending on stage of lactation and maternal genetic factors. some of these appear to be protective even though they are present in low concentrations. Nitrogen-containing sugars promote the growth of lactobacilli, the dominant bacteria in the lower intestinal tract of breastfed infants. These lactobacilli appear to protect against the colonization of bacterial pathogens by secreting inhibitory organic compounds such as acetic acid.  Specialized oligosaccharides, including monosialogangliosides and glycoconjugates, inhibit the binding of selected bacterial pathogens or their toxins to epithelial cells by acting as receptor analogs

13. FAT Fat is the most highly variable macronutrient of milk. The fascinating fact that milk composition changes constantly during periods as short as a breastfeed and as long as the entire lactation period . This gives rise to speculation of whether these changes benefit the infant or simply reflect physiological changes associated with the synthesis of milk. T he hydrolysis of fats in human milk appears to generate fatty acids and monoglycerides with antiviral properties Human milk fat is characterized by high contents of palmitic and oleic acids, the former heavily concentrated in the 2-position and the latter in the 1- and 3-positions of the triglycerides. Hindmilk, defined as the last milk of a feed, may contain two to three times the concentration of milk fat found in foremilk, defined as the initial milk of a feed. A study found that ~25% of the variation in lipid concentration between mothers’ milk may be explained by maternal protein intake. Another study found that the milk fat content was significantly lower in night and morning feedings compared to afternoon or evening feedings. When a low-fat, calorie-restricted diet was fed, C 16 or longer-chain saturated fatty acids predominated in the milk, indicating that stored body fat was utilized for milk fat synthesis.

14. T he lipid and cell contents immediately after the feed were higher compared to pre-feeding, but the highest lipid content of breastmilk was seen 30 minutes post-feed, after which it gradually dropped as the breast synthesized milk and refilled. Exactly the same response was seen for breastmilk cell content. This very close association between the cell and lipid content of milk and the corresponding changes in response to breast emptying was indeed remarkable LIPID CONTENT WITH RESPECT TO FEEDING

15. MICRONUTRIENTS Human milk provides the normative standard for infant nutrition. Nevertheless, many micronutrients vary in human milk depending on Maternal diet Body stores The maternal diet is not always optimal, thus, continuing multi-vitamins during lactation is recommended.  Regardless of maternal diet, Vitamin K and D is extremely low in human milk and thus, the recommendation of an injection of this vitamin K is needed to avoid hemorrhagic disease of the newborn .

16. VITAMIN - A Forms of vitamin A in human milk include retinol , retinyl esters(96%) , and β-carotene(4%). The concentration of this vitamin in human milk decreases over the course of lactation from approximately 2,000 to 600 µg/liter and  0 to 320 µg/liter Vitamin A is necessary for healthy vision and breast milk contains plenty of vitamin A. Colostrum has twice as much vitamin A as transitional or mature milk. These higher levels of vitamin A, especially beta-carotene gives colostrum it's yellow-orange color.  β-Carotene is stored in the mammary gland during pregnancy and is rapidly secreted into milk during the first few days of lactation  Several reports indicate that the amount of vitamin A in human milk decreases with maternal deficiency of the vitamin and increases with excessive intake

17. VITAMIN - D Vitamin D in human milk is mostly present as vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D helps to build strong bones and teeth. There is vitamin D in breast milk, but the levels vary from woman to woman depending on how much vitamin D she gets.  Human milk normally contains 0.5 to 1.5 µg (20 to 60 IU) of vitamin D per liter. the vitamin D activity of human milk is directly related to maternal vitamin D status. vitamin D concentrations in human milk drop to undetectable levels during maternal deficiency and increase following supplementation and exposure to ultraviolet light.

18. VITAMIN - E Vitamin E refers to the 8 chemically related α-, β-, γ - and δ tocopherols and α-, β-, γ -, and δ-tocotrienols, which differ in structure and bioavailability . α-Tocopherol is the only biologically active form of vitamin E, the other vitamers do not convert into the active form. Approximately 83% of the total vitamin E content of human milk is α-Tocopherol . Concentrations of tocopherols are high in colostrum (8 mg/liter) and decline and stabilize to 2 to 3 mg/liter in mature human milk.  Vitamin E protects the cell membranes in the eyes and the lungs. There is more than enough vitamin E in breast milk to fulfill the recommended daily requirements. Approximately 83% of the total vitamin E content of human milk is         -tocopherol.

19. VITAMIN - K Vitamin K in human milk consists mainly of phylloquinone (vitamin K-1) and menaquinone-4 (vitamin K – 2). Menaquinone-6 has been found in trace amounts . Vitamin K is involved in the production of blood clotting factors that help to stop bleeding. The vitamin K content of mature human milk is typically 2 µg/liter It's given to all infants when they're born . The amount of this vitamin obtained by the breastfed neonate in the first few days after birth may be insufficient to meet the infant's needs So dietary intake or Supplementation of this vitamin is suggested.

20. Ascorbic acid (AA), as the principal form of vitamin C, and dehydroascorbic acid (DHAA) represent the biologically relevant forms of vitamin C in human milk. Breast milk contains plenty of vitamin C. There is no need to take extra vitamin C supplement. T he vitamin C content of mature human milk levels off at 50 to 60 mg/liter if daily maternal intakes are equal to or exceed 100 mg (approximately the mother's Recommended Dietary Allowance [RDA] for this vitamin). Even if you don't take any additional vitamin C, your breast milk will still have two times more than the recommended amount for formula. VITAMIN - C

21. VITAMIN – B Complex

22. Page 07 Page 06 Page 05 Page 04 Page 03 Page 02 Page 01 “B" VITAMINS

23. 7. Biotin B7 6. Pyridoxine B6 5.Pantothenic acid 4. Choline B4 3. Niacin B3 2. Riboflavin B12 1. Thiamin B1

24. b Thiamin B1 2. Riboflavin B12 3. Niacin B3 4. Choline B4 5.Pantothenic acid 6. Pyridoxine B6 7. Biotin B7 Thiamin in breast milk exists in its free form as well as in 2 of its phosphorylated forms: Thiamin monophosphate (TMP) Thiamin pyrophosphate. Free thiamin and TMP are the main forms of vitamin B-1 in human milk. There are large variations in the thiamin content of human milk between individuals and over the course of lactation. Thiamin concentrations are low in colostrum (10 µg/liter) and increase 7-to 10-fold in mature milk. Vitamin B1

25. Page 01 7. Biotin B7 6. Pyridoxine B6 5.Pantothenic acid 4. Choline B4 3. Niacin B3 Riboflavin B2 Riboflavin (7,8-dimethyl-10-ribityl-isoalloxazine) and its coenzymatic form FAD are the prevalent forms of vitamin B-2 in human milk.  Riboflavin content is high in early lactation and declines thereafter. The milk of well-nourished women contains riboflavin concentrations of approximately 350 µg/liter  Vitamin B2

26. Page 01 Page 02 Niacin B3 4. Choline B4 5.Pantothenic acid 6. Pyridoxine B6 7. Biotin B7 Vitamin B3 Niacin refers to nicotinic acid (pyridine-3-carboxylic acid) and nicotinamide (pyridine-3-carboxylic acid amide). Nicotinamide and its coenzymatic forms nicotinamide mononucleotide (NMN), NAD, NAD(P), and nicotinamide riboside have been reported to be present in human milk. The average niacin concentration in human milk increases from 0.75 mg/liter in colostrum to approximately 1 mg/liter in mature human milk. Actual niacin levels are largely dependent on maternal intake.

27. Page 01 Page 02 Page 03 5.Pantothenic acid Choline B4 6. Pyridoxine B6 7. Biotin B7 Vitamin B4 Forms of choline (N- trimethylethanolamine ) in human milk include mainly free choline and its metabolites phosphocholine and glycerophosphocholine , with minor contributions of lipophilic phosphatidylcholine (lecithin) and sphingomyelin . Its concentration doubles 6–7 d after birth due to increasing amounts of phosphocholine and glycerophosphocholine .

28. Page 01 Page 02 Page 03 Page 04 Pantothenic acid 6. Pyridoxine B6 7. Biotin B7 Vitamin B5 Pantothenic consists of pantoic acid bound to βalanine. The pantothenic acid content of human milk averages about 2.6 µg/liter Approximately 85–90% of pantothenic acid in human milk is available in its free form. Although it is a key factor in lipid metabolism, this vitamin does not occur in the lipid fraction in substantial amounts

29. Page 01 Page 02 Page 03 Page 04 Page 05 7. Biotin B7 Pyridoxine B6 Vitamin B6 Vitamin B-6 (2-methyl-3-hydroxy-5-hydroxy methyl pyridine derivatives) refers to the biologically active equivalent and metabolically interconvertible pyridoxine, pyridoxal, and pyridoxamine and their phosphorylated forms. Pyridoxal represents the principal form of vitamin B-6 in human milk, with possible contributions of pyridoxal-5 -phosphate (7–64%), pyridoxamine-5 -phosphate, pyridoxine, and pyridoxamine. The vitamin B 6  content is low in colostrum and varies between 50 and 250 µg/liter in mature milk. Deficiency of this vitamin leads to neurologic disorders.

30. 9. Cobalamin (Vitamin B-12) 8. Folate (Vitamin B-9) Biotin B7 Biotin (cis-hexahydro-2-oxo-1H-thieno [3,4-d]imidazole-4- pentanoic acid) in human milk accumulates to >95% in the skimmed-milk fraction. The biotin content in human milk is exceedingly variable: values were reported to range from 0 to 27 µg/liter when maternal plasma concentrations varied from 142 to 1,090 ng/liter The biotin content of human milk increases with the progression of lactation, is directly related to maternal plasma biotin concentration . Vitamin B7

31. Folate 9. Cobalamin (Vitamin B-12) Folate is the collective term for the large group of heterocyclic compounds that all possess the biological activity of folic acid (pteroylglutamic acid). Milk folate is covalently bound to whey- binding proteins and predominantly present as pteroylpolyglutamates and as N-5 methyltetrahydrofolate . Folate in human milk are bound to whey proteins; therefore, maternal factors regulating protein secretion are more likely to affect milk levels of these vitamins over the short term than are fluctuations in maternal vitamin intake. The folate content of breast milk is about 2.5 µg vitamin B9

32. Page 01 Cobalamin vitamin B12 Vitamin B-12 is the collective term for cobalt-containing corrinoids. Only the biologically active cobalamins are selectively transported into human milk. Methyl cobalamin represents the dominant form of vitamin B-12 in human milk followed by 5 - deoxyadenosylcobalamin and small amounts of hydroxocobalamin and cyanocobalamin, all bound to haptocorrin

33. MINERALS Iron in human milk is found in the lipid as well as in the low-molecular-weight compound fraction; only small amounts are bound to lactoferrin . Little is known about the mechanisms that regulate iron concentrations in human milk. Copper is mostly found in the skim-milk fraction of human milk, but substantial amounts are also present in milk fat. Copper-binding proteins in milk include casein, serum albumin, and ceruplasmin . Over the first 4 months of lactation, the concentration of copper in human milk gradually declines and then remains stable up to month 12 More than 75% of the iodine content in human milk is present as ionic iodide. Iodine is concentrated by the lactating breast due to increased expression of the main iodine transporter during lactation. However, maternal intake also influences the iodine concentration in milk. Iodine is unique among the trace elements because the mammary gland avidly accumulates it. Its level in human milk correlates directly with maternal intake Like iron and copper, zinc can be found in both the whey and fat fractions of human milk. A substantial amount of zinc is associated with citrate, a low-molecular-weight binding ligand as well as with casein and serum albumin as zinc-binding proteins. Zinc concentrations in human milk decrease over the course of lactation. In colostrum, the zinc content is quite high The majority of selenium in human milk is bound to proteins, whereas only a minor faction is associated with the milk fat. Selenium concentrations in milk are high at the initiation of lactation (41 µg/liter) and decrease as lactation progresses Iron Copper Iodine Zinc Selenium Mothers milk contains 30-40 mg of calcium per 100 ml. Since about 850ml of milk is produced, around 300mg of calcium is secreted through milk per day. Therefore the additional intake of calcium is essential to enable the retention of 300mg of extra calcium daily. Since the dietary calcium retention in lactating women is 60 percent, ICMR has recommend 1000 mg of calcium per day for a lactating mother. Calcium

34. BIOACTIVE COMPONENTS OF BREAST MILK Bioactive components of food are defined as Elements that “affect biological processes or substrates and hence have an impact on body function or condition and ultimately health”. Bioactive components in human milk come from a variety of sources; some are Produced and secreted by the mammary epithelium, Produced by cells carried within the milk,  D rawn from maternal serum and carried across the mammary epithelium by receptor-mediated transport

35. MAJOR BIOACTIVE FACTORS IN HUMAN MILK Cells Immunoglobulins Cytokines Chemokines Cytokine Inhibitors Growth Factors Hormones Anti-microbial factors Metabolic hormones Oligosaccharides and Glycans Mucins

36. No. COMPONENTS FUNCTIONS 1. Cells Macrophages Protection against infection, T-cell activation Stem cells Regeneration and repair 2. Immunoglobulins IgA/sIgA Pathogen binding inhibition IgG Anti-microbial, activation of phagocytosis (IgG1, IgG2, IgG3); anti-inflammatory, response to allergens (IgG4) IgS Agglutination, complement activation 3. Cytokines Interleukin (IL – 6) Stimulation of the acute phase response, B cell activation, pro-inflammatory IL – 7 Increased thymic size and output IL – 8 Recruitment of neutrophils, pro-inflammatory IL – 10 Repressing Th1-type inflammation, induction of antibody production, facilitation of tolerance (Interferon) IFN γ Pro-inflammatory, stimulates Th1 response TGF β (Transforming Growth factor) Anti-inflammatory, stimulation of T cell phenotype switch TNF α (Tumor Necrosis factor) Stimulates inflammatory immune activation

37. No. COMPONENTS FUNCTIONS 4. Chemokines G-CSF( Granulocyte-colony stimulating factor) Trophic factor in intestines MIF Macrophage Migratory Inhibitory Factor: Prevents macrophage movement, increases anti-pathogen activity of macrophages 5. Cytokine Inhibitors  TNFR I and II Inhibition of TNF α, anti-inflammatory 6 Growth Factors EGF ( Epidermal growth factor) Stimulation of cell proliferation and maturation HB-EGF ( Heparin-binding growth factor) Protective against damage from hypoxia and ischemia VEGF( Vascular endothelial growth factor) Promotion of angiogenesis and tissue repair NGF ( Neuronal growth factors) Promotion of neuron growth and maturation IGF ( insulin-like growth factor) Stimulation of growth and development, increased RBCs and hemoglobin Erythropoietin Erythropoiesis, intestinal development

38. No. COMPONENTS FUNCTIONS 7 Hormones Calcitonin Development of enteric neurons Somatostatin Regulation of gastric epithelial growth 8 Anti-microbial Lactoferrin Acute phase protein, chelates iron , anti-bacterial , anti-oxidant Lactadherin/ MFG E8 Anti-viral, prevents inflammation by enhancing phagocytosis of apoptotic cells 9 Metabolic Hormones Adiponectin Reduction of infant BMI and weight, anti-inflammatory Leptin Reduction of infant BMI and weight, anti-inflammatory Ghrelin Regulation of energy conversion and infant BMI 10 Oligosaccharides & glycans HMOS Prebiotic, stimulating beneficial colonization and reducing colonization with pathogens; reduced inflammation Gangliosides Brain development; anti-infectious Glycosaminoglycans Anti-infectious 11 Mucins MUC1 Block infection by viruses and bacteria MUC4 Block infection by viruses and bacteria

39. References https://www.ncbi.nlm.nih.gov/books/NBK235590/ . http://www.pediatr-neonatol.com https://academic.oup.com/advances/article/9/suppl_1/313S/5017779 by guest on 13 December 2020 Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013;60(1):49-74 American Academy of Pediatrics. New Mother’s Guide To Breastfeeding. Bantam Books, 2011. Australian breastfeeding association( https://www.breastfeeding.asn.au/ ) https://milkgenomics.org/article/breastmilk-composition-dynamic-infant-feeds-mother-responds/ https://main.icmr.nic.in/icmr-bulletin https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/whats-in-breastmilk-71018/ https://wcd.nic.in/sites/default/files/nationalguidelines_1.pdf Indian Council of Medical Research: Nutrient Requirements and Recommended Dietary Allowances for Indians. A Report of the Expert Group of the Indian Council of Medical Research, ICMR, New Delhi , 2010.

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