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. 2021 Dec;16(12):978-986.
doi: 10.1089/bfm.2021.0131. Epub 2021 Aug 3.

Human Milk Glucose, Leptin, and Insulin Predict Cessation of Full Breastfeeding and Initiation of Formula Use

Emily M Nagel  1 , Leslie Kummer  2 , David R Jacobs Jr.,  1 , Laurie Foster  1 , Katy Duncan  3 , Kelsey Johnson  4 , Lisa Harnack  1 , Jacob Haapala  5 , Harmeet Kharoud  1 , Tiffany Gallagher  1 , Elyse O Kharbanda  5 , Stephanie Pierce  6 , David A Fields  3 , Ellen W Demerath  1
Affiliations

Human Milk Glucose, Leptin, and Insulin Predict Cessation of Full Breastfeeding and Initiation of Formula Use

Emily M Nagel et al. Breastfeed Med. 2021 Dec.

Abstract

Objective: We aimed to investigate prospective associations between milk bioactives related to metabolic health (glucose, insulin, leptin, C reactive protein [CRP], and interleukin 6 [IL-6]) and incident formula initiation at 3 and 6 months postpartum. Design: This study included 363 mother-infant dyads who were fully breastfed at 1 month and participated in the prospective Mothers and Infants Linked for Healthy Growth study from pregnancy to 6 months postpartum. Associations between milk glucose, leptin, insulin, CRP, and IL-6 at 1 and 3 months and incident formula feeding (FF) at 3 and 6 months, respectively, were tested using multiple logistic regression, adjusting for numerous potential confounders such as maternal age and prepregnancy body mass index. Results: At 3 months postpartum, 1-month glucose (odds ratio [OR] 0.45 [95% confidence interval (CI): 0.27-0.75], p ≤ 0.01) and smaller decreases in glucose from 1 to 3 months (OR 0.51 [95% CI: 0.28-0.92], p = 0.03) were associated with lower odds of FF, whereas 1-month leptin (OR 2.30 [95% CI: 1.30-4.07], p < 0.01) and larger increase in insulin (OR 1.86 [95% CI: 1.23-2.81], p < 0.01) and leptin (OR 2.17 [95% CI: 1.29-3.68], p < 0.01) from 1 to 3 months were associated with increased odds of FF. At 6 months, insulin increases (OR 2.08 [95% CI: 1.03-4.17], p = 0.04) were associated with higher odds of FF. Conclusions: In a cohort of women with established lactation, 1-month milk glucose, insulin, and leptin predicted initiation of FF at 3 months. Early milk composition may provide a window into mammary gland function, allowing identification of women at risk of not meeting their breastfeeding goals.

Keywords: bioactives; breastfeeding; formula; human milk; infants; lactation; metabolic health.

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Conflict of interest statement

D.R.J., D.A.F., L.H., E.O.K., and E.W.D. report grant funding from the National Institute of Child Health and Human Development (NICHD) during the conduct of this study. National Institute of Dental and Craniofacial Research (NIDCR). E.M.N. reports funding on a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). No other conflicts of interest or financial disclosures were reported.

Figures

FIG. 1.
FIG. 1.
Milk bioactive concentrations at 1 month (A through E) and change in bioactive concentrations from 1 to 3 months (F through J) by feeding outcome at 3 months. ns = p > 0.05; *p < 0.05; **p < 0.01. FBF, fully breastfeeding; FF, formula feeding.
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