Table 2.
Effect of maternal obesity on human milk macronutrient composition: key findings 1,2.
| Gestational Age | HM Method of Collection | Milk Type | Collection Time | Analytical Method | Outcomes/Effect | |
|---|---|---|---|---|---|---|
| Comparison of Macronutrients between OW/OB and NW Women | ||||||
| Aleali, 2018 [23] | Preterm | NS | Transitional and mature | 14:00–16:00 | MIRIS analyzer, Sweden | No difference in HM fat, protein or lactose between groups |
| Brown, 1986 [27] | NS | Full expression | Mature | 24 h | Gravimetric method, Kjeldahl method and colorimetry | HM fat was higher in women with higher AC and TCSF. No difference in HM protein or lactose between groups |
| DeLuca, 2016 [29] | Term | Full expression | Mature | 9:00–11:00 | MIRIS analyzer, Sweden | No difference in HM fat, protein or lactose between groups |
| Dritsakou, 2017 * [30] | Preterm and term | Full expression | Colostrum, transitional and mature | 24 h | MIRIS analyzer, Sweden | HM fat (colostrum, transitional and mature) was higher in OW/OB women. No difference in HM protein and lactose between groups |
| Fujimori, 2015 [32] | Term | NS | Colostrum | NS | Creamatocrit, Biuret colorimetric | HM fat was higher in OB women. No difference in HM protein between groups |
| Jans, 2015* [34] | Term | Mid-feed | Colostrum | NS | MIRIS analyzer, Sweden | HM fat was higher in OB women. No difference in HM protein or lactose |
| Jans, 2018* [35] | Term | Mid-feed | Colostrum, transitional and mature | NS | MIRIS analyzer, Sweden | No difference in HM fat, protein or lactose between groups |
| Kwon, 2017* [38] | NS | NS | Mature | NS | Lipid extraction, Kjeldahl method | No difference in HM fat or protein between groups |
| Lemas, 2016* [39] | Term | Mid-feed | Transitional | Morning | Creamatocrit, Bradford protein assay, colorimetric assay | No difference in HM fat, protein or lactose between groups |
| Makela, 2013* [41] | NS | Pre-feed | Mature | Morning | Lipid extraction | No difference in HM fat content between groups |
| Mangel, 2017* [42] | Term | Pre-feed | Colostrum | 8am–3pm | MIRIS analyzer, Sweden | No difference in HM fat, protein or lactose between groups |
| Panagos, 2016* [9] | Term | Full expression | Mature | Morning | Julie Z7 Automatic MilkoScope, Germany | No difference in HM fat, protein or lactose between groups |
| Rudolph, 2017 [45] | Term | Mid-feed | Transitional and mature | Morning | Creamatocrit | HM fat was higher in OW women |
| Villalpando, 2001 [48] | NS | Full expression | Mature | 10:00, 12:00 and 18:00 | Gravimetric method | No difference in HM fat between groups |
| Young, 2017 * [50] | Term | Full expression | Transitional and mature | 10:00-13:00 | Creamatocrit, Bradford assay, enzymatic method | HM protein (transitional) and lactose (mature) were lower in OW/OB women. No difference in HM fat between groups |
| Correlation between maternal measures of maternal obesity and HM macronutrient concentrations | ||||||
| Antonakou, 2013 [24] | Term | Pre-feed | Mature | Morning | Creamatocrit | No correlation between HM fat and BMI |
| Aumeistere, 2017 [25] | NS | NS | Mature | 24 h | HPLC | No correlation between HM lactose and BMI |
| Bzikowska-Jura, 2018 [28] | Term | Pre- and post-feed | Mature | 24 h | MIRIS analyzer, Sweden | HM fat (1 and 6 mo) and protein (3 mo) positively correlated with BMI, and HM protein (3 mo) with % body fat. No correlation of HM lactose with either BMI or %body fat |
| Chang, 2015 [8] | Term | Full expression | Colostrum, transitional and mature | NS | MilkoScan FT2 Foss Analytical, Denmark | HM protein at 0-1 wk, 3–4, and 4–5 mo, and HM fat at 1–2 wk, 2–3, and 7–8 mo positively correlated with BMI. HM lactose at 4–5 and 6–7 mo was negatively correlated with BMI |
| Eilers, 2011 [31] | Preterm and term | Pre- and post-feed | Colostrum and mature | 16:00–20:00 | Creamatocrit, BCA protein assay | No correlation between BMI and HM fat or protein |
| Gridneva, 2018 [33] | Term | Pre- and post-feed | Mature | NS | Bradford protein assay | No correlation between BMI and HM total protein; whey protein was positively correlated to BMI, fat-free mass, fat-free mass index, and fat mass index |
| Kierson, 2006 [36] | Preterm and term | Full expression | Transitional and mature | NS | Creamatocrit | HM fat was positively correlated to maternal BMI |
| Kugananthan, 2017 [16] | Term | Pre- and post-feed | Mature | 9:30–11:30 | Bradford assay, Enzymatic spectrophotometric method | HM protein positively correlated with %body fat, but not BMI. No correlation of either %body fat or BMI with HM lactose. |
| Kurniati, 2016 [37] | Term | Mid-feed | Mature | 6:00–8:00 | Creamatocrit | No correlation between %body fat and HM fat |
| Ley, 2012 [40] | Term | early milk Full expression | Colostrum/Transitional and mature | NS | Creamatocrit, BCA protein assay | No correlation between BMI and HM fat or protein |
| Nommsen, 1991 [43] | NS | Full expression | Mature | 24 h | Folch extraction, Lowry assay, colorimetric assay | HM fat (6, 9, and 12 mo) and protein (9 mo) positively correlated with %IBM. No correlations with HM lactose |
| Quinn, 2012 [44] | NS | Mid-feed | Colostrum, transitional and mature | 6:00–10:30 | Rose-Gottlieb extraction, automated analyzer, phenol- sulfuric acid method | HM lactose was inversely correlated with BMI. No relationship between %body fat and HM fat, protein, or lactose |
| Schueler, 2013 [46] | NS | Pre- and post-feed | Mature | 7:00-10:00 | Creamatocrit | HM fat positively correlated with total fat mass, BMI, body weight, and %body fat |
| Villalpando, 1992 [47] | Term | Full expression | Mature | 10:00, 12:00, and 18:00 | Jeejeebhoy method, Kjeldahl method, automated enzymatic method | HM fat positively correlated with body weight, BMI, and %body fat. No associations between these measures and HM protein or lactose |
| Yang, 2014 [49] | Term | Full expression | Transitional and mature | 9:00–11:00 | MIRIS analyzer, Sweden | HM protein and fat were positively correlated, and HM lactose negatively correlated, with BMI |
| Both comparison and correlation | ||||||
| Barbosa, 1997 [26] | Term | Full expression | Mature | 10:00, 14:00, and 18:00 | Gravimetric method, Kjeldahl method, automatic enzyme method | HM fat was positively correlated with BMI and %body fat, and was lower in the lower BMI group (<23 kg/m2) compared to the higher (≥23 kg/m2). HM protein and lactose were not correlated with BMI or %body fat and no different between these BMI groups |
1 Analytical methods are reported based on the sequence noted on outcomes, otherwise reporting follows the “fat, protein and lactose” sequence. Maternal obesity values are reported as mean ± SD or mean (range) when SD is not available. Studies included in the meta-analysis are indicated with *. 2 Symbol—was used to represent information not stated or unclear. AC, Arm circumference; BCA, Bicinchoninic acid method; BMI, body mass index; HM, human milk; HPLC, high-performance liquid chromatography; % IBM, pre-pregnancy percent ideal body weight; h, hour; MIRIS, Mid-infrared milk analyzer; mo, month (s); NS, not stated; NW, normal weight; OB, obese; OW, overweight; PT, preterm; T, term; TCSF, triceps skinfold thickness; wk, week (s).