Water-soluble vitamins in human milk: factors affecting their concentration and their physiological significance

Authors: Allen, Lindsay - A; Hampel, Daniela

Submitted to: Nestle Nutrition Workshop
Publication Type: Book / Chapter
Publication Acceptance Date: 6/12/2018
Publication Date: 3/13/2019
Citation: Allen, L.H., Hampel, D. 2019. Water-soluble vitamins in human milk: factors affecting their concentration and their physiological significance. In: Donovan,S.M., German, J.B., Lönnerdal, B, Lucas, A., editors. Human Milk: Composition, Clinical Benefits and Future Opportunities. Lausanne, Switzerland. Nestle Nutrition Workshop. 90:69-81. https://doi.org/10.1159/000490296.
DOI: https://doi.org/10.1159/000490296

Interpretive Summary: Most B-vitamins and vitamin C are some of the nutrients in milk most strongly affected by maternal status and/or dietary intake of those nutrients. Recent methods for analyzing water soluble vitamins in human milk are more efficient and valid, revealing major differences in water soluble vitamins across population groups. An inadequate supply in milk can be detrimental to the breast-fed infant’s health and development although cut-points for the concentrations in milk below which risk of infant deficiency is increased are often uncertain and little attention has been paid to adverse effects of low milk water soluble vitamins on infant health and function. Concentrations of vitamins in milk change during lactation: thiamin, niacin and pantothenic acid increase; B6, B12, and ascorbic acid gradually decrease; while riboflavin concentrations are stable, as is choline after an initial increase. Folate fluctuates until stabilizing in late lactation. Water soluble vitamin concentrations in milk are also influenced by maternal supplementation, and for some, by how many births the mother has had, premature delivery, smoking, and maternal illness. However there is relatively little change in concentrations during a feed, nor is day-night variation a major influence. Milk vitamin concentrations I the literature are used to set recommendations for Adequate Intakes for infants, and the mother’s additional requirements for lactation. However the status of available data is poor due to the small number of participants in most studies, uncertainties about maternal nutritional status, and variable times of milk collection postpartum.

Technical Abstract: Most B-vitamins and vitamin C are among the nutrients in milk most strongly affected by maternal status and/or dietary intake. Recent analytical methods are more efficient and valid, revealing major differences in water soluble vitamins across population groups. An inadequate supply in milk can be detrimental to the breast-fed infant’s health and development although cut-points below which risk is increased are often uncertain and little attention has been paid to adverse effects of low milk water soluble vitamins on infant health and function. Concentrations change during lactation: thiamin, niacin and pantothenic acid increase; B6, B12, and ascorbic acid gradually decrease; while riboflavin concentrations are stable, as is choline after an initial increase. Folate fluctuates until stabilizing in late lactation. Water soluble vitamin concentrations in milk are also influenced by maternal supplementation, and for some, by parity, preterm delivery, smoking, and maternal illness. However there is relatively little change in concentrations during a feed, nor is diurnal variation a major influence. Reported concentrations are used to set Adequate Intakes for infants, and incremental requirements for lactation. However the status of available data is poor due to the small number of participants in most studies, uncertainties about maternal nutritional status, and variable times of milk collection postpartum.