Human milk composition and related data for national health and nutrition monitoring and related research

Authors: Ahuja, Jaspreet; LI, YING - University Of Maryland; Wu, Xianli; Pehrsson, Pamela; CHAKRABARTI, SUBHADEEP - Health Canada; BROOKS, STEPHEN - Health Canada; BONDY, GENEVIEVE - Health Canada; MACFARLANE, AMANDA - Health Canada; WEILER, HOPE - Health Canada; CHEUNG, WINNIE - Health Canada; VERREAULT, MARIE-FRANCE - Health Canada; HAYWARD, DEBORAH - Health Canada; FISHER, MANDY - Health Canada; BORGHESE, MICHAE - Health Canada; HINES, ERIN - Us Environmental Protection Agency (EPA); AHLUWALIA, NAMAN - National Center For Health Statistics; VARGAS, ASHLEY - National Institute Of Health (INSA); ARTEAGA, SONIA - National Institute Of Health (INSA); LOMBO, TANIA - National Institute Of Health (INSA)

Submitted to: Advances in Nutrition
Publication Type: Review Article
Publication Acceptance Date: 9/2/2022
Publication Date: 9/9/2022
Citation: Ahuja, J.K., Li, Y., Wu, X., Pehrsson, P.R., Chakrabarti, S., Brooks, S.P., Bondy, G.S., MacFarlane, A.J., Weiler, H.A., Cheung, W., Verreault, M., Hayward, D., Fisher, M.M., Borghese, M.M., Hines, E., Ahluwalia, N., Vargas, A.J., Arteaga, S., Lombo, T. 2022. Human milk composition and related data for national health and nutrition monitoring and related research. Advances in Nutrition. 13(6):2098-2114. https://doi.org/10.1093/advances/nmac099.
DOI: https://doi.org/10.1093/advances/nmac099

Interpretive Summary: Our understanding of exposures through human milk (HM) is lacking. The 2020-2025 Dietary Guidelines Advisory Committee recommended updating human milk composition (HMC) data in USDA databases used for dietary assessment in national surveys. This paper provides an overview of national monitoring activities for HM-fed children, including human milk composition data and includes a framework for collection and reporting of data. Several hundreds of potential measurements in over 40 categories - macronutrients, micronutrients, bioactives, microbiota, environmental chemicals - are included. We delineated maternal, infant, and temporal factors, feeding practices, and factors for compositional analyses (sample handling, storage, analytical methods) that potentially impact HMC variability. We articulate a vision for a publicly available Human Milk Composition Data Repository (HMCD-R), which can provide a central platform for researchers and public health officials for using HMC data. The compiled compositional and metadata in HMCD-R will provide pertinent measures of central tendency and variability and enable more accurate exposure assessments for surveillance and inform dietary guidance and nutrition programs.

Technical Abstract: National health and nutrition monitoring is an important federal effort in both United States and Canada, and the basis for many national and state nutrition and health policies. Our understanding of exposures through human milk (HM) remains out of reach due to lack of representative data on its composition and intake volume. The purpose of this paper is to provide an overview of the current national monitoring activities for HM-fed children, including human milk composition (HMC) data. Furthermore, we provide a framework for collection and reporting of data on HMC for national health and nutrition monitoring. HM contains myriad of components. Several hundreds of potential measurements in over 40 categories were elucidated including - macronutrients, micronutrients, bioactives, microbiota, environmental chemicals. We delineated maternal, infant, and temporal factors, feeding practices, and factors for compositional analyses, such as sample handling, storage, and analytical methods that can potentially impact variability in HMC and intake volume. Furthermore, we articulate a vision for a publicly available HMC Data Repository (HMCD-R), which can provide a central platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R will provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for sub-groups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadatacould facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines.