The impact of human breast milk components on the infant metabolism

Abstract

Background & aims: Breastfeeding is beneficial for mothers and infants. Underlying mechanisms and biochemical mediators thus need to be investigated to develop and support improved infant nutrition practices promoting the child health. We analysed the relation between maternal breast milk composition and infant metabolism.

Methods: 196 pairs of mothers and infants from a European research project (PreventCD) were studied. Maternal milk samples collected at month 1 and month 4 after birth were analysed for macronutrient classes, hormone, and fatty acid (FA) content. Phospholipids, acylcarnitines, and amino acids were measured in serum samples of 4-month old infants. Associations between milk components and infant metabolites were analysed with spearman correlation and linear mixed effect models (LME). P-values were corrected for multiple testing (PLME).

Results: Month 1 milk protein content was strongly associated with infant serum lyso-phosphatidylcholine (LPC) 14:0 (PLME = 0.009). Month 1 milk insulin was associated to infant acetylcarnitine (PLME = 0.01). There were no associations between milk protein content and serum amino acids and milk total fat content and serum polar lipids. Middle- and odd-chain FA% in breast milk at both ages were significantly related to serum LPC and sphingomyelins (SM) species in infant serum (all PLME<0.05), while FA% 20:5n-3 and 22:6n-3 percentages were significantly associated to serum LPC 22:6 (PLME = 1.91×10-4/7.93×10-5) in milk only at month 4. Other polyunsaturated fatty acids and hormones in milk showed only weak associations with infant serum metabolites.

Conclusions: Infant serum LPC are influenced by breast milk FA composition and, intriguingly, milk protein content in early but not late lactation. LPC 14:0, previously found positively associated with obesity risk, was the serum metabolite which was the most strongly associated to milk protein content. Thus, LPC 14:0 might be a key metabolite not only reflecting milk protein intake in infants, but also relating high protein content in milk or infant formula to childhood obesity risk.

Fig 1. CONSORT flow diagram.

Of 944 children in the PreventCD-cohort, 196 complete mother/infant pairs with complete sample sets were analysed. 136 pairs were studied for the associations between month 1 breast milk composition and infant serum metabolites at age of 4 months and 137 were studied for the associations between month 4 breast milk composition and infant serum metabolites at age of 4 months. 87 were studied at both time points.

Fig 2. Associations between breast milk macronutrient classes and hormones to infant serum metabolites at 4 months of age.

Breast milk components were measured at month 1 (a) or month 4 (b). Negative log-transformed P-values are plotted for each metabolite arranged by metabolite group and species. Higher values represented in the outer circles present a higher association between metabolite and predictor. P-values were calculated by linear regression models with the milk compound as independent variable, adjusted for infant sex, breastfeeding status at 4-month blood withdrawal (exclusively BF yes/no), and the infant’s age at blood withdrawal. Random intercepts were modelled for batch number and study centre. P-values were corrected (PLME) for multiple testing using Bonferroni’s methods, this is by dividing the p-value with number of metabolites (n = 184).

Fig 3. Correlations between breast milk fatty acids percentages to infant serum metabolites at 4 months of age.

Breast milk components were measured at month 1 (a) or month 4 (b). Spearman correlation coefficients are plotted for each metabolite arranged by metabolite group. AA, amino acids; Carn, acylcarnitines; LPC, lysophosphatidylcholines; PC aa, diacyl-phosphatidylcholines; PC ae, acyl-alkyl-phosphatidylcholines SM, sphingomyelins.