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Cover of Dietary Patterns during Lactation and Human Milk Composition and Quantity: A Systematic Review

Dietary Patterns during Lactation and Human Milk Composition and Quantity: A Systematic Review

, PhD, RD, , PhD, , PhD, RDN, LD, , PhD, MPH, RD, , MD, MPH, , MD, , DrPH, MPH, MSc, , PhD, , MS, , PhD, MPH, RD, , MS, MLS, , MLIS, MEd, and , PhD, RD.

Author Information and Affiliations
Alexandria (VA): USDA Nutrition Evidence Systematic Review; .

TECHNICAL ABSTRACT

Background

  • This important public health question was identified by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) to be examined by the 2020 Dietary Guidelines Advisory Committee.
  • The 2020 Dietary Guidelines Advisory Committee, Pregnancy and Lactation Subcommittee conducted a systematic review to answer this question with support from the Nutrition Evidence Systematic Review (NESR) team.
  • The goal of this systematic review was to examine the following question: What is the relationship between dietary patterns consumed during lactation and human milk composition and quantity?

Conclusion statements and grades

  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and human milk quantity. (Grade: Grade not assignable)
  • Insufficient evidence is available to determine the relationship between maternal diets differing in macronutrient distributions during lactation and human milk quantity. (Grade: Grade not assignable)
  • Insufficient evidence is available to determine the relationship between dietary patterns during lactation and total fat in human milk. (Grade: Grade not assignable)
  • Limited evidence suggests that maternal consumption of diets higher in fat (>35 percent fat) and lower in carbohydrate during lactation is related to higher total fat in human milk collected in the maternal postprandial period. (Grade: Limited)
  • Limited evidence suggests that certain maternal dietary patterns during lactation, including diets based on macronutrient distributions, are related to the relative proportions of saturated fat and monounsaturated fatty acids in human milk, and of polyunsaturated fatty acids in human milk collected in the maternal postprandial period. (Grade: Limited)
  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and total protein concentration in human milk. (Grade: Grade not assignable)
  • Insufficient evidence is available to determine the relationship between maternal diets differing in macronutrient distribution during lactation and total protein concentration in human milk. (Grade: Grade not assignable)
  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and bioactive proteins including alpha-lactalbumin, lactoferrin, casein, alpha (1) antitrypsin, osteopontin, secretory immunoglobulin A, lysozyme in human milk. (Grade: Grade not assignable)
  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and human milk oligosaccharides. (Grade: Grade not assignable)
  • Insufficient evidence is available to determine the relationship between maternal dietary patterns during lactation and vitamin B12 concentration in human milk. (Grade: Grade not assignable)
  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and vitamin C, choline and B vitamins (other than vitamin B12) in human milk. (Grade: Grade not assignable)
  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and vitamins A, D, E and K in human milk. (Grade: Grade not assignable)
  • No evidence is available to determine the relationship between maternal dietary patterns during lactation and iodine and selenium in human milk. (Grade: Grade not assignable)

Methods

  • A literature search was conducted using four databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that evaluated the intervention or exposure of dietary patterns during lactation and the outcomes of human milk composition and quantity. A manual search was conducted to identify articles that may not have been included in the electronic databases searched. Articles were screened by two NESR analysts independently for inclusion based on pre-determined criteria.
  • Data extraction and risk of bias assessment were conducted for each included study, and both were checked for accuracy. The Committee qualitatively synthesized the body of evidence to inform development of conclusion statements, and graded the strength of evidence using pre-established criteria for risk of bias, consistency, directness, precision, and generalizability.

Summary of the evidence

  • This systematic review includes three randomized controlled trials (RCTs) (four articles) and two cross-sectional studies (three articles) published between 2009 and 2019.
  • Studies included in this review assessed one of the following maternal interventions or exposures during lactation:
    • Dietary patterns (2 studies)
    • Diets based on macronutrient distributions outside of the acceptable macronutrient distribution range (AMDR) (3 studies)
  • Two of the three RCTs reported that a maternal diet higher in fat during lactation (i.e., >35 percent of total energy from fat, which is greater than the AMDR) resulted in higher total fat in human milk.
  • Some, but not all studies showed that maternal dietary patterns during lactation were related to the relative proportions of saturated fat (SAT), monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) in human milk, which differed depending on whether milk samples were collected in a fed or fasted state.
  • This body of evidence had notable limitations:
    • All RCTs had a small sample size (<20 participants) and none reported power analyses.
    • The cross-sectional studies did not account for most of the confounders.
    • One cross-sectional study reported that the participants differed on supplement intake during lactation, in addition to differing on dietary patterns. However, this was not controlled for in the statistical analysis or accounted for in the interpretation of the study findings.
    • The timing and methods of human milk collection were heterogeneous.
    • The study populations did not represent the racial/ethnic or socioeconomic diversity of the U.S. population.
  • Insufficient or no evidence was available to assess the association between dietary patterns and several other outcomes, including human milk quantity and human milk composition of total protein, water soluble vitamins (B, C, and choline), fat soluble vitamins (A, D, E, and K), minerals (iodine and selenium), human milk oligosaccharides, and bioactive proteins (alpha-lactalbumin, lactoferrin, casein, alpha (1) antitrypsin, osteopontin, secretory immunoglobulin A (sIgA), and lysozyme).
FUNDING SOURCE: United States Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA

Suggested citation:

Donovan S, Dewey K, Novotny R, Stang J, Taveras E, Kleinman R, Raghavan R, Nevins J, Scinto-Madonich S, Kim JH, Terry N, Butera G, Obbagy J. Dietary Patterns during Lactation and Human Milk Composition and Quantity: A Systematic Review. July 2020. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.DGAC2020.SR0203

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Related citation: Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. July 2020. U.S. Department of Agriculture, Agricultural Research Service. Available at: https://doi.org/10.52570/DGAC2020

Copyright Notice

The contents of this document may be used and reprinted without permission. Endorsements by NESR, NGAD, CNPP, FNS, or USDA of derivative products developed from this work may not be stated or implied.

Bookshelf ID: NBK578493PMID: 35258873DOI: 10.52570/NESR.DGAC2020.SR0203

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