A cross-sectional study of macronutrients, vitamins, minerals, and bioactive components in human milk of approved milk bank donors from low-, middle-, and high-income countries
Maryanne T. Perrin, Kimberly Mansen, Kiersten Israel‐Ballard, Lars Bode, Daniela Hampel, Setareh Shahab‐Ferdows, Lindsay H. Allen, Francisca Cofré Maggio, Emily Mbaire Njuguna, Hoang Thi Tran, Aleksandra Wesołowska
Abstract
BACKGROUND: Currently, clinical care of preterm infants is limited by a dearth of information on the nutritional and bioactive composition of donor human milk (DHM). OBJECTIVES: The primary objective is to assess and compare the macronutrients, vitamins, minerals, human milk oligosaccharides (HMOs), and antimicrobial proteins in human milk from approved milk banks in a variety of low-, middle-, and high-income settings. The secondary objective is to explore factors that influence composition, including gestational stage (preterm compared with term), lactation stage, maternal age, lifetime donation volume, and storage duration. METHODS: We conducted a cross-sectional study of human milk collected systematically from unique, approved milk bank donors (n = 600) in Chile, Kenya, Poland, the United States, and Vietnam. True protein, total fat, lactose, HMOs, vitamins, minerals, and antimicrobial proteins were assessed. Analysis of variance and Tukey's tests were used to evaluate normally distributed data; Kruskal-Wallis and Dunn's tests were used for nonparametric data. Multiple regression was used to explore factors associated with milk composition. RESULTS: The only site with predominantly preterm donors was Kenya (26/50). Kenya also had an early donation model (mean lactation stage 1.6 ± 1.1 wk), whereas the remaining sites had a mature donation model (mean lactation stage ranged 14.2-21.4 wk). Most nutrients differed significantly (P < 0.05) between geographies. For instance, true protein in Kenya was 1.3 ± 0.3 g/dL compared with 0.8 ± 0.2 at all United States banks. Many minerals were higher in the early donation model whereas lactose and several water-soluble vitamins were higher in the mature donation model. Although the lactation stage typically had the most predictive value, most nutrient variation (>60%) remained unexplained. CONCLUSIONS: Clinical protocols for feeding DHM to preterm infants, including setting-specific fortifier products, may need to take into consideration the local donor milk banking model. Multidonor pooling warrants further investigation as a tool for milk banks to ensure minimum nutrient standards for DHM.