Human breast milk (BM) is the best source of nutrition in early life, particularly during the first 6 months. Nevertheless, human BM composition is variable, and more insight in the exact factors contributing to this variability is warranted. In this review, we explored the impact of maternal dietary intake and nutritional status (e.g. anthropometric measures, BMI, bioimpedance) on human milk macronutrient composition. PubMed, Scopus and Cochrane were systematically searched till November 2019. In total, 4946 publications underwent title–abstract screening; 101 publications underwent full-text screening. Eventually, fifty publications were included in this review, investigating either associations between maternal dietary intake (n 29) and/or maternal nutritional status (n 29), and macronutrient composition of human BM. Reported energy composition ranged from 213 to 301 kJ/100 ml, and 67 % and 54 % of the studies reported associations between with maternal nutritional intake and status, respectively. Protein content ranged from 0·8 to 3·3 g/100 ml, and four studies suggested a negative association with nutritional status. Fat content ranged from 2·1 to 9·8 g/100 ml, and 68 % of the studies reported positive associations with nutritional status. Carbohydrate content ranged from 5·8 to 7·5 g/100 ml, and 67 % of the included studies did not report an association between intake and status. Literature investigating associations of maternal dietary intake and nutrition status with BM composition of macronutrients and energy content is diversified, both in terms of used methodology and results. Further studies using well-defined and standard parameters are essential to aid the formulation of scientific recommendations.

This study quantified the fatty acid profile with emphasis on the stereo-specifically numbered (sn) 2 positional distribution in TAG and the composition of main phospholipids at different lactation stages. Colostrum milk (n 70), transitional milk (n 96) and mature milk (n 82) were obtained longitudinally from healthy lactating women in Shanghai. During lactation, total fatty acid content increased, with SFA dominating in fatty acid profile. A high ratio of n-6:n-3 PUFA was observed as 11:1 over lactation due to the abundance of linoleic acid in Chinese human milk. As the main SFA, palmitic acid showed absolute sn-2 selectivity, while oleic acid, linoleic acid and α-linolenic acid, the main unsaturated fatty acids, were primarily esterified at the sn-1 and sn-3 positions. Nervonic acid and C22 PUFA including DHA were more enriched in colostrum with an sn-2 positional preference. A total of three dominant phospholipids (phosphatidylethanolamine (PE), phosphatidylcholine (PC) and sphingomyelin (SM)) were analysed in the collected samples, and each showed a decline in amount over lactation. PC was the dominant compound followed by SM and PE. With prolonged breast-feeding time, percentage of PE in total phospholipids remained constant, but PC decreased, and SM increased. Results from this study indicated a lipid profile different from Western reports and may aid the development of future infant formula more suitable for Chinese babies.

Human milk provides infants with various immune molecules. The objective of the present study was to measure human β-defensin-1 (hBD-1) and human β-defensin-2 (hBD-2) levels in the colostrum and mature milk of healthy Han Chinese, to identify factors regulating milk hBD-1 and hBD-2 expression and to explore the potential protective effect of milk hBD-1 and hBD-2 on infants. A total of 100 mothers and their babies were recruited into the study. Sociodemographic characteristics and other factors were obtained by a questionnaire. Babies were followed up for a period of 6 months. Colostrum samples (n 100) and mature milk samples (n 82) were collected by hand expression. The hBD-1 and hBD-2 concentrations were measured by ELISA. The hBD-1 and hBD-2 levels differed in the colostrum and mature milk. In the colostrum, the concentration ranges of hBD-1 and hBD-2 were 1·04–12·81 μg/ml and 0·31–19·12 ng/ml, respectively. In mature milk, the hBD-1 and hBD-2 levels were 1·03–31·76 ng/ml and 52·65–182·29 pg/ml, respectively. Several independent factors influence their production. The multivariable analysis showed a strong association between pre-pregnancy BMI and hBD-1 levels in the colostrum (P= 0·001), mode of delivery was significantly associated with hBD-2 levels in the colostrum (P= 0·006) and gestational age was significantly associated with hBD-1 levels in mature milk (P= 0·010). During the first 6 months of life, the incidence rate of upper respiratory infection was found to be less in the high-colostrum hBD-1 group than in the low-colostrum hBD-1 group (χ2= 4·995, P= 0·025). The present study suggested that the abundance of hBD-1 in the colostrum may have a protective function against upper respiratory infection for infants younger than 6 months.