The Latest In Breastmilk Science

A. Singhal, Childhood Nutrition Centre, UCL GOS Institute of Child Health, 30 Guilford Street, London.

Whilst human milk is without doubt the best source of nutrition for the newborn, there is now increasing evidence supporting its additional long-term benefits for health^1,2. Breast feeding has been shown to have major advantages for long-term cognitive function^1-4, atopic disease, bone health, and risk of obesityand cardiovascular disease^5,6. There is particularly strong evidence that breast-feeding can improve later cognitive development, a hypothesis supported by: several systematic reviews¹, evidence of a dose-response association⁴, data from a cluster randomised trial³, as well as evidence of benefits of breast-feeding on visual developmentand structure of the brain⁴.

The mechanisms underlying the long-term advantages of breast-feeding are uncertain, but most research has focused on important differences between human milk and formula in concentrations of biologically active nutrients such as carbohydrates (e.g. human milk oligosaccharides^7,8), lipids (including differences in concentrations of long-chain⁹ and other fatty acids¹⁰), and protein quality and quantity. For example, there is increasing evidence for an impact of breastmilk nutrients (e.g. tryptophan¹¹) on sleep modulation and early brain development in infancy¹¹, and for protein intake and patterns of infant weight gain on long-term risk of obesity¹².

This presentation gave an update on the latest research in breastmilk science including an overview of the role of human milk intake on long-term cognitive function and the possible mechanisms involved. It will highlight the key role of promoting exclusive breast-feeding¹, the potential impact of specific breastmilk nutrients, and the importance of experimental (randomised) studies in interpreting the effects of early nutrition on later health. Finally, it considered the implications of breastmilk science for nutritional, clinical and public health practice.

References

Scientific Advisory Committee on Nutrition 2018. Feeding in the first year of life. https://www.gov.uk/government/publications/feeding-in-the-first-year-of-life-sacn-report
Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 30: 387: 475-490. doi: 10.1016/S0140-6736(15)01024-7.
Kramer MS, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 2008; 65: 578-584.
Deoni S, et al. Early nutrition influences developmental myelination and cognition in infants and young children. Neuroimage 2018; 178: 649-659.
Patro-Gołąb B, et al. Nutritional interventions or exposures in infants and children aged up to 3 years and their effects on subsequent risk of overweight, obesity and body fat: a systematic review of systematic reviews. Obes Rev 2016; 17: 1245-1257.
Woo Baidal JA, et al. Risk factors for childhood obesity in the first 1,000 days; a systematic review. Am J Prev Med 2016; 50: 761–779.
Vandenplas Y, et al. Human Milk Oligosaccharides: 2'-Fucosyllactose (2'-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula. Nutrients 2018; 10. pii: E1161. doi: 10.3390/nu10091161.
Reverri EJ,et al. Review of the Clinical Experiences of Feeding Infants Formula Containing the Human Milk Oligosaccharide 2'-Fucosyllactose.Nutrients 2018; 10: E1346. doi: 10.3390/nu10101346.
Lien EL, et al.DHA and ARA addition to infant formula: Current status and future research directions. Prostaglandins Leukot Essent Fatty Acids 2018; 128: 26-40. doi: 10.1016/j.plefa.2017.09.005.
Bronsky J, et al.Palm Oil and Beta-palmitate in Infant Formula: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019: 68: 742-760. doi: 10.1097/MPG.0000000000002307.
Schneider N, et al. Diet and nutrients in the modulation of infant sleep: A review of the literature. Nutr Neurosci 2016 ;21: 1-11.
Singhal A. Early Life Origins of Obesity and Related Complications. Indian J Pediatr 2018; 85: 472-477.