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Collate and review data on thecomposition and volume and intake of
breast milk
Results from a systematic literature review
Trudy MA Wijnhoven1, Caroline Bollars1, Garden Tabacchi2, and Maria Hermoso3
1 Nutrition, Physical Activity and Obesity Programme, Division of Non-communicable
Diseases and Health Promotion, World Health Organization Regional Office for Europe,
Copenhagen, Denmark
2 Institute of Physiology and Human Nutrition, University of Palermo, Palermo, Italy
3 Division of Metabolic Diseases and Nutritional Medicine. Dr. von Hauner Childrens
Hospital, Ludwig-Maximilians-University of Munich, Germany
RA 2.1: Infant Nutrition
Task 9
Funded by an EU FP6 Network of Excellence (EURRECA, grant no. FP 6-036196-2)
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Contents
Background....................................................................................................................................3Aim..................................................................................................................................................8Methods ..........................................................................................................................................9Results ..........................................................................................................................................11Discussion.....................................................................................................................................26Annex 1. PubMed: search strategy and results on 27/10/09 ....................................................27References ....................................................................................................................................30
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Background
Clinical and dietary surveys of presumably healthy populations, functional responses, optimal
intake approaches and nutrient balance calculations are the methods commonly used to estimate
nutritional requirements.1The World Health Organization (WHO) recommends exclusive
breastfeeding for six months, and thereafter sustained breastfeeding with appropriate
complementary feeding up to two years or beyond.2This recommendation was based on the
outcomes of a WHO expert consultation in 2001.3Two systematic literature reviews served as
the basis for this consultation. The first one focused on the optimal duration of exclusive
breastfeeding4and the second one focused on the nutrient adequacy of exclusive breastfeeding
for the term infant during the first six months of life.5
The latter systematic literature review included a table on nutrient intakes of exclusively
breastfed infants. The calculated nutrient intakes derived from human (breast) milk were based
on the mean milk intakes of exclusively breastfed infants from developed countries and breast
milk composition from well-nourished women, which were the results of studies carried out in
the 1980s1990s. Table 1 presents these results as was published in the report of the review.5
This review also provided an overview of the findings on the content of various nutrients, both
macro- and micronutrient, in breast milk: protein, vitamin A, vitamin D, vitamin B6(pyridoxine),
iron, calcium and zinc. The identified studies for the review showed the following results of
nutrient concentrations in breast milk (see also results section)5:
A concentration of proteinin mature breast milk varied from 8 to 10 g per litre.
Vitamin Aconcentrations varied with the stage of lactation and were strongly influenced by
maternal nutritional (vitamin A) status. It was estimated that mature milk of well-nourishedmothers contained approximately 1.7 moles/l of vitamin A.
Vitamin Dconcentrations in breast milk depend on maternal vitamin D status and are very
low. Various concentrations were found and the range varied from 0.16 g/l to 1.56 g/l.
The concentration of vitamin B6varied with maternal B6status and intake, length of
gestation, stage of lactation and the use of B6supplements. The mean vitamin B6
concentration in breast milk of women with B6intakes below 2.5 mg/day was estimated as
0.13 mg/l (778 nmol/l). Mean B6levels in breast milk of women with B6intakes between 2.5
and 5 mg/day were substantially higher approximately 0.24 mg/l.
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The concentration of irondeclined from 0.40.8 mg/l in colostrum to 0.20.4 mg/l in mature
breast milk.
Breast milk contained 250300 mg/l of calciumwith no pronounced changes during
lactation.
The concentration of zincdeclined from 45 mg/l in early milk, to 12 mg/l at 3 months
postpartum, and to 0.5 mg/l at 6 months.
Table 1Nutrient intakes derived from human milk, based on studies carried out in the 1980s
1990s.Age
(month)
Human
milk
intake
(g/day)
Human
milk
intake,
corrected
for
IWL*
(g/day)
Energy
(kcalth/day)
Protein
(g/day)
Vitamin A
(mol/day)
Vitamin
D
(ng/day)
Vitamin
B6
(mg/day)
Calcium
(mg/day)
Iron
(mg/day)
Zinc
(mg/day)
1 699 734 492 8.1 1.25 473 0.10 195 0.37 1.54
2 731 768 514 6.9 1.30 495 0.10 199 0.31 1.543 751 803 538 7.2 1.37 518 0.10 203 0.32 1.20
4 780 819 549 6.6 1.39 528 0.11 202 0.29 0.98
5 796 836 560 6.7 1.42 539 0.11 201 0.29 0.84
6 854 897 601 7.2 1.52 578 0.12 210 0.27 0.90
7 867 910 610 7.3 1.55 587 0.12 208 0.27 0.68
8 815 856 573 6.8 1.45 552 0.11 190 0.26 0.64
9 890 935 626 7.5 1.59 603 0.12 201 0.28 0.70
10 900 945 633 7.6 1.61 610 0.12 198 0.28 0.47
11 910 956 640 7.6 1.62 616 0.12 194 0.29 0.48
* IWL = insensible water losses.
Source: Adapted from World Health Organization, 2002.5
The Scientific Committee on Food (SCF) of the European Commission (EC) published in 2003
the results of an extensive literature review with the aim to revise the essential requirements of
infant formulae and follow-on formulae.6For this revision, the Committee made use of studies
that presented the composition of breast milk of healthy, well-nourished women. Information onthe breast milk content of the following nutrients (both macro- and micronutrients) was obtained:
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lactose, fat, vitamin A, vitamin D, vitamin E, vitamin K, vitamin B1(thiamin), vitamin B2
(riboflavin), vitamin B3(niacin), vitamin B5(pantothenic acid),vitamin B6, vitamin B12
(cobalamin), folic acid, vitamin C (ascorbic acid), biotin, iron, calcium, phosphorus, magnesium,
sodium, chloride, potassium, copper, manganese, fluoride, iodine, selenium and zinc. The studies
used for the SCF review found the following results on breast milk content of these nutrients (see
also results section)6:
Breast milk contained approximately 55-70 g lactoseper litre and can be considered as an
important source of energy. Breast milk did not contain saccharose or fructose.
Breast milk contained ~35 g fatper litre, which provides about one half of the energy
content of the milk.
A range of total concentrations of preformed vitamin Ain mature breast milk between 150
g/l and 1100 g/l was observed.
The reported concentration of vitamin D varied from 4 to 110 IU/l, with up to 10-fold higher
values in the summer than in the winter.
Mature breast milk contained approximately 2-5 mg/l vitamin E.
Breast milk contained low concentrations of vitamin K; a range between 0.6 g/l and 10
g/l was reported.
The reported concentrations of vitamin B1in mature breast milk varied widely; a range
between 154 g/l and 328 g/l was reported.
The reported concentrations of vitamin B2in mature breast milk varied widely; a range
between 274 g/l and 580 g/l was reported.
The reported concentrations of vitamin B3were between 1100 g/l and 2300 g/l.
The reported mean concentration of vitamin B5was 6.7 mg/l and the reported range
concentrations varied from 2.0 mg/l to 2.5 mg/l. Reported values differed and were
influenced by maternal dietary variation, or analytical approaches.
The concentration of vitamin B6increased as the maternal intake of the vitamin increased.
Furthermore, the concentration level depended on the stage of lactation, the length of
gestation and the usage of oral contraception. In mature milk the reported concentration
varied between 70 g/l and 310 g/l and in unsupplemented mothers the mean concentration
was reported to be approximately 150 g/l.
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A mean concentration of 0.51 g/l of vitamin B12was found in various studies and a range
of 0.16-0.64 g/l was found in studies among unsupplemented mothers.
A wide range of folic acidconcentrations were reported, most likely because of the
application of uncertain breast milk storage methods, difficulties in reliably determining the
folic acid content of milk or real differences among women; it varied from 24 g/l to141
g/l.
The mean vitamin C concentration was estimated to be 55 mg/l. A wide variation, however,
was observed that ranged from 30 mg/l to 100 mg/l (4.5 to 15 mg/100 kcal), with a
progressive observed decrease during the course of lactation.
The mean biotinconcentration was estimated to be 6 g/l (24 nmol/L) and a range of 5-9
g/l (0.75-1.3 g/100 kcal) was found.
The mean concentration of ironin breast milk was estimated to be approximately 0.3 mg/l.
The calciumconcentration in breast milk decreased over the course of lactation, and a range
between 194 mg/l and 268 mg/l (29 to 40 mg/100 kcal) was observed.
A range in phosphorusconcentration between 107 mg/l and 164 mg/l was reported (16 to
24 mg/100 kcal), peaking in early lactation and decreasing as lactation progresses.
A narrow range of magnesiumconcentration was found: between 31.4 mg/l and 35.7 mg/l.
A high variation of sodiumconcentrations was observed. A mean sodium concentration of
0.870.45 standard deviation (SD) mEq/100 kcal between 60 and 240 days was reported.
The concentration of sodium in adult mothers were found to be approximately 0.500.14
mEq/100 kcal and in adolescent mothers approximately 0.800.23 (SD) mEq/100 kcal.
A mean chlorideconcentration of 1.680.69 (SD) mEq/100 kcal was reported.
A range in potassiumconcentration between 1.650.27 (SD) mEq/100 kcal and 1.920.24
(SD) mEq/100 kcal was reported.
The coppercontent is not directly influenced by maternal dietary intake of copper. No
concentrations in breast milk were reported.
A mean manganeseconcentration of 3.5 g/l was estimated, with a slight decrease over the
course of lactation. A range of 3-4 g/l (approximately 0.5 g/100 kcal) was observed.
Observed mean fluorideconcentrations ranged from 0.007 mg/l to 0.011 mg/l.
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Iodineconcentrations varied markedly as a function of the iodine intake of the population. It
ranged from 10-20 g/l to more than 300 g/l in Europe and from 30 g/l to 490 g/l in the
United States of America.
A wide range of seleniumconcentrations was observed, which depended on the selenium
consumed in natural foods. In general, the selenium concentration is highest in colostrum.
The median selenium concentrations found in colostrum (0-5 days) was 26 g/l, in
transitional milk (6-21 days) 18 g/l, in mature milk (1-3 months) 15 g/l and in late
lactation (>5 months) 17 g/l.
A large variability of zinc concentrations was observed shown during the course of lactation
and among individuals; it varied from 0.5 mg/l to 4.7 mg/l. Zinc concentrations declined
sharply over the early weeks of lactation: from 4 mg/l at 2 weeks to 3 mg/l at 1 month, 2
mg/l at 2 months, 1.5 mg/l at 3 months and 1.2 mg/l at 6 months.
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Aim
The present review was part of the research activity 2.1 (task 9) of the Network of Excellence
EURRECA (European Micronutrients Recommendations Aligned). The aim was to search the
literature for the most actual micronutrient compositional data of human breast milk as well as
for data on breast milk volume consumed by infants. Data on the following micronutrients were
considered: vitamin A, vitamin D, vitamin E, vitamin K, vitamin B1, vitamin B2, vitamin B3,
vitamin B5, vitamin B6, vitamin B12, folic acid, vitamin C, biotin, iron, calcium, phosphorus,
magnesium, sodium, chloride, potassium, copper, manganese, fluoride, iodine, selenium and
zinc.
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Methods
The electronic database PubMed (U.S. National Library of Medicine & National Institutes of
Health 2009) was searched through October 2009. The database search was restricted to human
subjects, European studies and performed on combinations of both medical subject headings and
free text keywords (see Annex 1). Keywords focused on the study population (infants and
children) and the variables of interest (breastfeeding, breast milk, micronutrient, volume). In
addition, the reference lists in the eligible publications and all reviews identified by the search
were manually checked to identify further eligible studies that might have been missed in the
electronic search. No language restrictions were applied at the search of studies in the databases.
Due to limited translation possibilities, however, the final eligibility evaluation of full-textdocuments was restricted to publications in Dutch, English, French, German, Italian and Spanish.
Because of the extensive literature review done in 2003 by the EC-SCF and in 2001 by WHO,
the present review focussed on studies that were published in 2000 and beyond and thus that
would not have been included in the two previously mentioned reviews5,6.
The first review stage involved the screening of titles, keywords and abstracts of the identified
citations to determine their appropriateness for inclusion. Citations were found ineligible, whenthe information given in the title or available abstract suggested that the:
Study outcome measure was not breast milk intake and/or breast milk content or
composition.
Study population did not include exclusively or partially breastfed infants (0-12 months).
Study population did not include healthy infants (0-12 months), e.g. normal birthweight
infants, and/or healthy mothers.
Study population did not include at term infants (0-12 months).
Nutrient composition of breast milk was not given.
Study was not carried out in one of the 53 Member States of the WHO European Region.
Study design was not cross-sectional, observational (prospective cohort and case-control) or
intervention (baseline values be considered only).
The abovementioned order of screening was followed; if the response to a criterion was no, the
study was further assessed for eligibility. For each excluded study, one reason of ineligibility
was noted.
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The full-text of the studies identified to be potentially eligible during the first stage was obtained
and further evaluated during the second stage of the review, which implicated the exclusion of
systematic reviews or meta-analyses that did not present original data, exclusion of studies that
were included in the previous reviews5,6and the exclusion of studies that did not report on data
on volume of breast milk intake or on breast milk content or composition of micronutrients.
Both screening stages of the review involved the independent assessment of eligibility by two
authors (C.B. and G.T.). Disagreements were resolved through consensus with another author
(T.W.).
All found citations were downloaded into Reference Manager Version 10.0 (ISI ResearchSoft
2002) and assigned a unique identification number and subsequently transferred into a database
created with Microsoft Office Access 2003 (Microsoft Corporation 1992-2003), which was used
for the screening and analysis.
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Results
The search in PubMed yielded 553 initial records and the manual search of reference lists did not
lead to additional potentially eligible studies (Figure 1).
Figure 1Flow diagram of the process of identifying and including references for the systematic
literature review.
A total of 443 studies did not meet the first stage inclusion criteria and thus the full-text of the
110 remaining studies only were obtained for further evaluation. Because of language criteria,
however, the full-text of two Hungarian7,8publications and of one Polish9publication was not
evaluated. Thus of the 110 studies submitted to the second review stage three studies were
excluded, leaving a total of 107 studies for inclusion in the second review stage.
During the second stage evaluation 90 studies were excluded: one study was not carried out in an
European country10, 24 studies did not report on breast milk composition or on breast milk
volume intake11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34, one study was carried o
in non-healthy mothers
ut
re35, three publications referred to a similar study36,37,38, two studies we
First review sta e: Citation screenin of title/abstract/ke words, n= 553
Second review sta e: Full-text evaluation of otentiall eli ible studies, n= 110
Total included studies in the review, n= 17
Ineligible studies excluded, n= 443
Inappropriate study outcome, n= 405Inappropriate study population, n= 18Inappropriate study location, n= 20
Other language than Dutch
English, French, German,Italian or Spanish, n= 3
Ineligible studies excluded, n= 90
Any first stage exclusion criteria, n= 39Reviews without original data, n= 16No data reported on micronutrient content oron volume intake, n = 35
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carried out during the Ramadan39,40, three intervention studies did not report on baseline values
of breast milk composition before the intervention was introduced41,42,43, 16 publications were
reviews and did not contain original data44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59, 4 studies
measured breast milk volume to estimate nutrient intake only but did not indicate the mean
volume per feed60,61,62,63, one study measured iodine content of breast milk but did not rep
these results
ort on
e
e,
admium65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99 .
agnesium, sodium, potassium, copper, manganese, iodine,
elenium and zinc. None of these studies measured the infants volume intake of breast milk.
reported on
,
breast
ried between 1day and 12 months
ostpartum (three studies did not indicate the timing).
in E
s
um and zinc and different values for manganese than thealues given in these two reviews.
64and 35 studies measured the content of other nutrients than micronutrients, lik
for example total fat, polyunsaturated fatty acids, protein, nitrogen, leptin, glucose, galactos
lactoferrin or
c
Concerning breast milk composition, 16
studies100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115were found eligible for inclusion in the
present review and they reported on the content of 12 micronutrients in human breast milk:
vitamin A, vitamin E, iron, calcium, m
s
Table 2 gives an overview of these 16 studies by micronutrient (seven studies
multiple micronutrients). Nine studies did not indicate the time period of the
survey100,101,102,103,106,111,113,114,115. The studies were carried out in Turkey (n=5)100,101,108,111,113
Spain (n=3)105,107,114, the United Kingdom (n=2)102,103, Austria106, Belgium (n=1)112, Greece
(n=1)104, Italy (n=1)109, Poland115(n=1) and Portugal (n=1)110. The total number of breast milk
samples that were taken in each study varied between 13 and 905 and the timing when the
milk samples were taken from the lactating mothers va
p
Table 3 compares the nutrient content in breast milk reported in the 16 eligible studies with the
results found in the reviews done by WHO5and by the EC-SCF6. The vitamin A and vitam
content values were reported by their components (retinol, -Carotene, -Carotene, total
carotenoid, -tocopherol and -Tocopherol) and were therefore incomparable with the value
given in the WHO and EC-SCF reviews. The present review found similar values for iron,
calcium, magnesium, iodine, seleniv
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Concerning volume intake of breast milk, one study was found eligible116. This study was
carried out in Izmir, Turkey (survey period was not indicated) and 80 breast milk samples were
taken about 55-65 days postpartum. The mean (SD) number of feeds per day were 7.8 (1.6) and
the range varied from 5 to 12 feeds per day. The mean (SD) duration of breast feeding was 1
(3.4) minutes and the range varied from 5 to 20 minutes per breast feeding. The mean
1.9
(SD) milk
olume sucked per time was 94 (39) ml and the range varied between 40 and 210 ml.v
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Table 2Micronutrient content in human breast milk in 16 studies carried out in the WHO European Region.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
Vitamin A RetinolOrhon FS etal100
NA Ankara, Turkey High-PerformanceLiquidChromatography(HPLC)
7 days 20 fromsmokers and20 from non-smokers
Memem
Tokusoglu O
et al
101
NA Izmir and
Manisa, Turkey
HPLC 6090 days 43 from Izmir
and 49 fromManisa
Me
81.samg/81.
Jewell VC etal102
NA Belfast, UnitedKingdom
HPLC 141 days 28 (13mothers)
Me7.9
Canfield LMet al103
NA United Kingdomand 8 othercountries outsideEurope
HPLC 112 months 50 Me0.0
Vitamin A -CaroteneJewell VC etal102
NA Belfast, UnitedKingdom
HPLC 141 days 28 (13mothers)
Me5.0
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
Vitamin A
-CaroteneCanfield LMet al103
NA United Kingdomand 8 othercountries outsideEurope
HPLC 112 months 49 Me0.9
Vitamin A -Carotene
Orhon FS etal100
NA Ankara, Turkey HPLC 7 days 20 fromsmokers and20 from non-smokers
Memem
Jewell VC etal102
NA Belfast, UnitedKingdom
HPLC 141 days 28 (13mothers)
Me63.
Canfield LMet al103
NA United Kingdomand 8 othercountries outsideEurope
HPLC 112 months 49 Me1.4
Vitamin A Total carotenoidCanfield LMet al103
NA United Kingdomand 8 othercountries outsideEurope
HPLC 112 months 48 Me4.5
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
Vitamin E -TocopherolOrhon FS etal100
NA Ankara, Turkey HPLC 7 days 20 fromsmokers and20 from non-smokers
Memem
Tokusoglu O
et al
101NA Izmir and
Manisa, Turkey
HPLC 6090 days 43 from Izmir
and 49 fromManisa
Me
g/9.89.8
Jewell VC etal102
NA Belfast, UnitedKingdom
HPLC 141 days 28 (13mothers)
Me41.
Vitamin E -TocopherolJewell VC etal102
NA Belfast, UnitedKingdom
HPLC 141 days 28 (13mothers)
Me2.6
Iron
LeotsinidisM et al104
20002002 Patras, Greece Flame AtomicAbsorptionSpectrophotometry(FAAS)
3 days
14 days
180
95
Meg/inte
Meg/ran
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Res
IronRodriguezRodriguezEM et al105
19941996 Tenerife, Spain Atomic AbsorptionSpectrophotometry(AAS) Varian SpectraAA-10 Plus
2 weeks5months
56 (11mothers)
Mea
Krachler M
et al
106
NA Graz, Austria Magnetic sector field
ICP-MS
NA (transitional
and mature)
27 Med
inte
CalciumRodriguezRodriguezEM et al107
19941996 Tenerife, Spain AAS Varian SpectraAA-10 Plus
2 weeks5months
55 (11mothers)
Mea
MagnesiumRodriguezRodriguezEM et al107
19941996 Tenerife, Spain AAS Varian SpectraAA-10 Plus
2 weeks5months
55 (11mothers)
Mea
SodiumOzbek A etal108
December 2002August 2005
Izmir, Turkey Ion selective methodin Hiatchi ModularAnalytics ISE 1900module
57 days 43 Mea
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
SodiumManganaro Ret al109
FebruaryMarch2004
Messina, Italy Flame photometerIL943
3 days 208 Me20.
RodriguezRodriguezEM et al107
19941996 Tenerife, Spain Flame photometer 2 weeks5months
55 (11mothers)
Me
Potassium
RodriguezRodriguezEM et al107
19941996 Tenerife, Spain Flame photometer 2 weeks5months
55 (11mothers)
Me
CopperLeotsinidisM et al104
20002002 Patras, Greece Electrothermal AASequipped with an HGA400 furnace
3 days
14 days
180
95
Meg/ran
Meg/ran
RodriguezRodriguezEM et al105
19941996 Tenerife, Spain AAS Varian SpectraAA-10 Plus
2 weeks5months
56 (11mothers)
Me
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
CopperKrachler Met al106
NA Graz, Austria Magnetic sector fieldICP-MS
NA (transitionaland mature)
27 Meg/720
ManganeseLeotsinidis
M et al104
20002002 Patras, Greece Electrothermal AAS
equipped with an HGA400 furnace.
3 days
14 days
180
95
Me
g/intg/
Meg/intg/
Krachler Met al106
NA Graz, Austria Magnetic sector fieldICP-MS
NA (transitionaland mature)
27 Meint
IodineCosteira MJet al110
January 2003December 2005
Guimares andBraga, Portugal
Chloric acid digestionmethod
3 days
3 months
78
52
MeP7
MeP7
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
Iodine
Kurtoglu S etal111
NA Kayseri ,Turkey HPLC 5 days 70 Meg/
Ciardelli R etal112
June 1999June2000
Brussels,Belgium
NA NA 58 Me
Selenium
zdemir HSet al113
NA Van, Turkey. NA 14 days 13 Me
Navarro-Blasco I etal114
NA Pamplona, Spain Inductively coupledplasma atomicemission spectrometrywith a hydridegenerator
NA (maturemilk)
31 Me9.4
Krachler M
et al106
NA Graz, Austria Magnetic sector field
ICP-MS
NA (transitional
and mature)
27 Me
inte
Zachara BAet al115
NA Poland Fluorometric methodof Watkinson
1275 days 905 Me3.0
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Table 2Continued.
Reference Survey period
(year)
Survey
location
Determination
method ofconcentration in
breast milk
Time
postpartumbreast milk
sample taken
Total breast
milksamples
(n)
Re
ZincLeotsinidisM et al104
20002002 Patras, Greece FAAS 3 days
14 days
180
95
Me50integ/
Me
g/integ/
RodriguezRodriguezEM et al105
19941996 Tenerife, Spain AAS Varian SpectraAA-10 Plus
2 weeks5months
56 (11mothers)
Me
AAS, Atomic Absorption Spectrophotometry; FAAS, Flame Atomic Absorption Spectrophotometry; HPLC, High-PerfNA, not available; SD, standard deviation; SEM, standard error of the mean.
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Table 3Compositional data of micronutrient content in breast milk found in the present review
compared with values found by WHO and the EC- SCF.
Micronutrients Present review
Included studies
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Table 3Continued.
Micronutrients Present review
Included studies
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Table 3Continued.
Micronutrients Present review
Included studies5months), median: 17g/l
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Table 3Continued
Micronutrients Present review
Included studies
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Discussion
The latest review on nutrient content of human breast milk was done in 2003 by the EC-SCF.
The present review identified 17 eligible studies that were carried out in the WHO European
Region and were not included in the EC-SCF review. While the EC-SCF review identified
information for all minerals and vitamins that were considered in the present review but copper,
16 eligible studies only reported on the breast milk content of vitamin A, vitamin E, iron,
calcium, magnesium, sodium, potassium, copper, manganese, iodine, selenium and zinc.
Surprisingly seven studies only indicated when the survey was carried out. Three studies did not
indicate the days or months postpartum when samples were taken to estimate breast milk
concentrations of iron, copper, manganese, sodium and selenium, while it has been observed thatthe content of for instance manganese and selenium in breast milk varies during the course of
lactation.
Values were expressed as a mean, median or as a range (minimum-maximum, interquartile
range) using various parameters such as mol/l, g/l, g/ml or nmol/g fat. Due to the different
reporting, it was not possible to compare all the reported values (e.g. vitamin A, vitamin E,
sodium) with the WHO and the EC-SCF reviews. Moreover, a wide range of the number of milksamples (13-905) taken as well as a wide range of the timing (1 day-12 months) when these
samples were taken postpartum was observed.
This review was carried out within the Network of Excellence EURRECA that develops building
blocks to harmonize European micronutrient recommendations. In order to harmonize the
collection of breast milk samples and the reporting of results on their micronutrient content in
future studies, it would be recommendable that EURECCA would provide guidance on the
measurement of micronutrient content in human breast milk.
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Annex 1. PubMed: search strategy and results on 27/10/09
Search terms PubMed Results#1 breast feeding [MH] OR feeding, breast OR breastfeeding OR breast-feeding OR
breast feeding OR breast feeding, exclusive OR exclusive breast feeding ORbreastfeeding, exclusive OR exclusive breastfeeding OR breastfed OR breast fed
OR breast-fed OR milk, human [MH] OR breast milk OR breastmilk ORbreastmilks OR human milk OR milk, breast OR lactation [MH] OR milk [MH]
101772
#2 infant [MH] OR infant OR infants OR child [MH] 1750261
#3 intake OR intakes OR content OR contents OR volume OR volumes ORconcentration OR concentrations OR composition OR compositions
2360497
#4 micronutrients [MH] OR micronutrient OR micronutrients OR vitamins [MH]OR vitamin OR trace elements [MH] OR elements, trace OR biometals ORvitamin B complex [MH] OR B vitamins OR fat soluble vitamin* OR fat-soluble
vitamin* OR vitamin A [MH] OR vitamin A OR carotenoids [MH] ORcarotene* OR retinol OR beta carotene [MH] OR beta carotene OR beta-caroteneOR carotene, beta OR betacarotene OR -Carotene OR vitamin D [MH] ORvitamin D OR vitamin E [MH] OR vitamin E OR tocopherol OR tocotrienol* ORwater soluble vitamin* OR water-soluble vitamin* OR vitamin C OR ascorbicacid [MH] OR ascorbate OR acid, ascorbic OR folate OR folic acid [MH] ORfolic acid OR acid, folic OR riboflavin [MH] OR riboflavin OR vitamin B2 ORvitamin B 2 OR thiamine [MH] OR thiamine OR thiamin OR vitamin B1 ORvitamin B 1 OR niacin [MH] OR niacin OR nicotinic acid OR vitamin B 6 [MH]OR vitamin B 6 OR vitamin B6 OR pyridoxine [MH] OR vitamin B 12 [MH]OR B 12, vitamin OR vitamin B12 OR vitamin B 12 OR B12, vitamin ORcobalamins OR cobalamin OR minerals OR mineral OR sodium [MH] OR
sodium OR potassium [MH] OR potassium OR calcium [MH] OR calcium ORmagnesium [MH] OR magnesium OR iron [MH] OR iron OR zinc [MH] ORzinc OR copper [MH] OR copper OR phosphorus [MH] OR phosphorus ORselenium [MH] OR selenium OR iodine [MH] OR iodine OR fatty acids [MH]OR acids, fatty OR fatty acids, essential [MH] OR fatty acids, omega 3 [MH] ORn-3 fatty acids OR n 3 fatty acids OR acids, omega-3 fatty OR fatty acids, omega3 OR omega-3 fatty acids OR omega 3 fatty acids OR fatty acids, n-3 OR n-3
polyunsaturated fatty acid OR n 3 polyunsaturated fatty acid
1869204
#5 carbohydrate OR carbohydrates OR carbohydrates [MH] OR dietarycarbohydrates [MH] OR carbohydrates, dietary OR carbohydrate, dietary ORdietary carbohydrate OR sugars OR dietary fats [MH] OR fats, dietary OR
dietary fat OR fat, dietary OR lipids [MH] OR amino acids, peptides, andproteins [MH] OR proteins [MH] OR protein OR dietary proteins [MH] ORproteins, dietary OR dietary protein OR protein, dietary
5728233
#6 Andorra [MH] OR Andorra OR Andorran OR Armenia [MH] OR Armenia ORArmenian OR Armenian S.S.R. OR Armenian SSR OR Austria [MH] ORAustria OR Austrian OR Azerbaijan [MH] OR Azerbaijan OR Azerbaijani ORAzerbaijan S.S.R. OR Azerbaijan SSR OR Byelarus [MH] OR Belarus ORBelarusian OR Byelorussian S.S.R. OR Belorussia OR Belorussian S.S.R. ORBelorussian SSR OR Byelorussian SSR OR Belgium [MH] OR Belgium ORBelgian OR Bosnia-Herzegovina [MH] OR Bosnia-Herzegovina OR Bosnia andHerzegovina OR Bosnia OR Bosnia and Herzegovina OR Bosnian OR Bulgaria[MH] OR Bulgaria OR Bulgarian OR Croatia [MH] OR Croatia OR Croatian ORCyprus [MH] OR Cyprus OR Cypriot OR Cyprian OR Czech Republic [MH] ORCzech Republic OR Czech OR Denmark [MH] OR Denmark OR Faeroe Islands
934758
27
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Search terms PubMed ResultsOR Danish OR Greenland [MH] OR Kalaallit Nunaat OR Estonia [MH] OREstonia OR Estonian OR Finland [MH] OR Finland OR Finnish OR France[MH] OR France OR French OR Corsica OR Paris [MH] OR Georgia (Republic)[MH] OR Georgian OR Georgian S.S.R. OR Georgian SSR OR Georgia
(Western Asia) OR Georgia SSR OR Republic of Georgia OR Germany [MH]OR Germany OR Germany, West [MH] OR Germany, East [MH] OR GermanOR Federal Republic of Germany OR Germany, Federal Republic of OR Berlin[MH] OR German Democratic Republic OR Democratic Republic of GermanyOR Germany, Democratic Republic of OR Greece [MH] OR Greece OR GreekOR Crete OR Macedonia (Greece) OR Hungary [MH] OR Hungary ORHungarian OR Iceland [MH] OR Iceland OR Icelandic OR Ireland [MH] ORIreland OR Irish OR Eire OR Ireland, Republic of OR Irish Free State OR Israel[MH] OR Israel OR Israeli OR Hebrew OR Italy [MH] OR Italy OR Italian ORSardinian OR Sicily [MH] OR Rome [MH] OR Vatican City [MH] ORKazakhstan [MH] OR Kazakhstan OR Kazakh OR Kazakh S.S.R. OR KazakhSSR OR Kyrgyzstan [MH] OR Kyrgyzstan OR Kyrgyz OR Kirghiz S.S.R. OR
Kirghiz SSR OR Kyrgyz Republic OR Kirgizstan OR Kirghizia OR Latvia [MH]OR Latvia OR Latvian OR Lithuania [MH] OR Lithuania OR Lithuanian ORLuxembourg [MH] OR Luxembourg OR Luxemborg OR Luxemburg ORLuxembourgish OR Malta [MH] OR Malta OR Maltese
#7 Monaco [MH] OR Monaco OR Monegasque OR Montenegro [MH] ORMontenegro OR Netherlands [MH] OR Netherlands OR Dutch OR Norway[MH] OR Norway OR Norwegian OR Spitsbergen OR Svalbard [MH] ORPoland [MH] OR Poland OR Polish OR Portugal [MH] OR Portugal OR MadeiraIsland OR Portuguese OR Moldova [MH] OR Moldova OR Moldavian S.S.R.OR Moldavia OR Moldavian SSR OR Moldovan OR Romania [MH] ORRomania OR Rumania OR Roumania OR Romanian OR Russia [MH] OR
Russian Federation OR Russia OR Russian Federation (Europe) OR RussianSFSR OR Russian S.F.S.R. OR Russian OR Bashkiria [MH] OR BashkirRepublic OR Bashkortostan OR Dagestan [MH] OR Moscow [MH] OR Siberia[MH] OR Russian Federation (Asia) OR Russian S.F.S.R., Asian OR San Marino[MH] OR San Marino OR Serbia [MH] OR Serbia OR Serbian OR VojvodinaOR Kosovo OR Slovakia [MH] OR Slovakia OR Slovak Republic OR SlovakOR Slovenia [MH] OR Slovenia OR Slovenian OR Slovene OR Spain [MH] ORSpain OR Spanish OR Sweden [MH] OR Sweden OR Swedish OR Switzerland[MH] OR Switzerland OR Swiss OR Liechtenstein [MH] OR Liechtenstein ORLiechtenstein OR Tajikistan [MH] OR Tajikistan OR Tajik OR Tadzhik S.S.R.OR Tadzhik SSR OR Tadjikistan OR Tadzhikistan OR Macedonia (Republic)[MH] OR Former Yugoslav Republic of Macedonia OR Macedonia (Yugoslavia)OR Macedonia, Former Yugoslav Republic of OR The Former YugoslavRepublic of Macedonia OR Macedonian OR Macedonia OR Turkey [MH] ORTurkey OR Turkish OR Turkmenistan [MH] OR Turkmenistan OR TurkmenS.S.R. OR Turkmen SSR OR Turkmen OR Ukraine [MH] OR Ukraine ORUkrainian OR Great Britain [MH] OR United Kingdom OR UK OR Isle Man OR
Northern Ireland [MH] OR England [MH] OR Scotland [MH] OR Wales [MH]OR London [MH] OR Hebrides [MH] OR British OR Channel Islands [MH] ORAlderney Island OR Jersey Island OR Sark OR Uzbekistan [MH] OR UzbekistanOR Uzbek S.S.R. OR Uzbek SSR OR Uzbek
967248
#8 Europe [MH] OR Europe OR European OR Northern Europe OR Southern
Europe OR Western Europe OR Europe, Eastern [MH] OR Eastern Europe ORMediterranean Islands [MH] OR Mediterranean Region [MH] OR Baltic States[MH] OR Commonwealth of Independent States [MH] OR CIS nations ORUSSR [MH] OR Soviet Union OR Union of Soviet Socialist Republics OR
1062986
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Search terms PubMed ResultsYugoslavia [MH] OR Czechoslovakia [MeSH] OR Scandinavia [MH] ORGibraltar [MH] OR Transcaucasia [MH] OR Asia, Central [MH] OR EuropeanUnion [MH] OR European Community OR Common Market OR Community,European Economic OR Economic Community, European OR EEC OR
European Common Market OR European Economic Community OR EuratomOR European Atomic Energy Community OR European Coal and SteelCommunity
#9 #4 OR #5 6425990
#10 #6 OR #7 OR #8 2549080
#11 #1 AND #2 AND #3 8654
#12 #9 AND #10 AND #11 1081
#15 #14 Limit to humans 1036
#16 #15 Limit to publication date from 2000 to 2009 553
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