Reference Values for Macronutrients in Human Milk: the Mothers, Infants and Lactation Quality (MILQ) Study
Jack Windsor Lewis, Daphna K Dror, Daniela Hampel, Gilberto Kac, Christian Mølgaard, Sophie E. Moore, Janet M Peerson, Sophie Hilario Christensen, M Munirul Islam, Daniela de Barros Mucci, Amanda C. Cunha Figueiredo, Adriana Divina de Souza Campos, Mehedi Hasan, Lindsay H. Allen, Lindsay H. Allen, Sophie E. Moore, Gilberto Kac, Kim F. Michaelsen, Christian Mølgaard, M Munirul Islam, Maria Andersson, Setareh Shahab‐Ferdows, Sophie Hilario Christensen, Jack Windsor Lewis, Janet M Peerson, Xiuping Tan, Daphna K Dror, Andrew M. Doel, Daniela de Barros Mucci, Bruna Celestino Schneider, Farhana Khanam, Adriana Divina de Souza Campos, Gabriela Torres Silva, Fanta Nije, Mehedi Hassan, Amanda C. Cunha Figueiredo, Daniela Hampel
Abstract
This second article in the series establishing reference values (RVs) for nutrients in human milk describes RVs for protein, carbohydrate, fat, and energy. To establish RVs, the mothers, infants, and lactation quality (MILQ) and early-MILQ studies collected human milk samples throughout the first 8.5 mo of lactation in 1242 well-nourished women in Bangladesh, Brazil, Denmark, and The Gambia. Macronutrients were measured by near-infrared spectroscopy. Protein concentrations decreased from 12.4 g/L at 4-17 d to a 7.7-7.9 g/L plateau by 4-5 mo. Carbohydrate concentrations were stable throughout lactation, ranging from 68.2 to 70.1 g/L. Fat concentrations decreased from 37.0 g/L at 4-17 d to 31.2-32.8 g/L after 2-3 mo. Energy density mirrored fat trends, decreasing from 665 kcal/L at 4-17 d to 597-602 kcal/L by 3-4 mo. Compared with estimates used by the Institute of Medicine (IOM)--renamed the National Academy of Medicine (NAM) in 2015--to set nutrient intake recommendations for infants, MILQ values were ∼90% of concentrations used for carbohydrate and energy, and 70%-80% for protein and fat. Total daily median intakes (concentrations × milk volumes) from 1 to 6 mo were on par with IOM adequate intakes (AIs) for carbohydrate and energy, 65% of the AI for protein, and 84% of the AI for fat. These RVs offer a critical resource for understanding the nutritional contributions of human milk and informing public health practices to support infant growth and development.