产后前 9 个月，母乳成分随母体 BMI 不同而变化。
Human milk composition differs by maternal BMI in the first 9 months postpartum.
机构信息
Arkansas Children's Nutrition Center, Little Rock, AR, USA.
Edward Via College of Osteopathic Medicine-Louisiana Campus, Monroe, LA, USA.
出版信息
Am J Clin Nutr. 2020 Sep 1;112(3):548-557. doi: 10.1093/ajcn/nqaa098.
BACKGROUND
Studies indicate that maternal weight status modulates human milk composition; however, results are conflicting.
OBJECTIVES
Our objective was to examine the relation between maternal body composition and human milk macronutrients and bioactive components and also their association with infant daily intakes and body composition.
METHODS
Human milk samples were obtained from a longitudinal study (NCT01131117) in normal weight (NW: 18.5-24.9 kg/m2, n = 88) and overweight/obese (OW: 25-35 kg/m2, n = 86) women between 0.5 and 9 mo postpartum. Macronutrient content was estimated using mid-infrared spectroscopy. Leptin, insulin, and C-reactive protein (CRP) were measured using electrochemiluminescence immunoassays. Infant body composition was obtained using quantitative MRI. Linear mixed models were adjusted for postpartum age and infant sex.
RESULTS
Human milk in OW mothers was higher in fat and protein and lower in carbohydrate content at some time points compared with that in NW mothers. Human milk leptin, insulin, and CRP concentrations were higher in OW mothers compared with NW mothers, with infants of OW mothers exposed to 1.5-2.5 times higher concentrations of leptin and insulin compared with infants of NW mothers. Similar results were observed when concentrations were normalized to infant daily intake and body weight. The effect sizes of infant daily intakes associated with infant growth parameters were small for macronutrients [0.005-0.05 z-score units and 0.02-0.45 fat mass index (FMI) or fat-free mass index units per unit of change in composition, P < 0.05]. Larger effect sizes were seen with human milk insulin and leptin (0.24 z-score units and 0.37-1.15 FMI units per unit of change in composition, P < 0.05).
CONCLUSIONS
These findings demonstrate that infants of OW mothers are exposed to higher concentrations of insulin, leptin, and, to a lesser extent, CRP. The bioavailability of these 3 human milk bioactives and their mechanisms of action in the infant are unclear.This trial was registered at clinicaltrials.gov as NCT01131117.
背景
研究表明，产妇体重状况会调节人乳成分；然而，结果存在矛盾。
目的
我们的目的是检验产妇身体成分与人乳宏量营养素和生物活性成分之间的关系，以及它们与婴儿每日摄入量和身体成分的关系。
方法
从一项正常体重（NW：18.5-24.9 kg/m2，n=88）和超重/肥胖（OW：25-35 kg/m2，n=86）女性的纵向研究（NCT01131117）中获得人乳样本。使用中红外光谱法估计宏量营养素含量。使用电化学发光免疫分析法测量瘦素、胰岛素和 C 反应蛋白（CRP）。使用定量 MRI 获得婴儿身体成分。线性混合模型根据产后年龄和婴儿性别进行调整。
结果
在某些时间点，OW 母亲的人乳脂肪和蛋白质含量较高，而碳水化合物含量较低。OW 母亲的人乳瘦素、胰岛素和 CRP 浓度高于 NW 母亲，OW 母亲的婴儿暴露于 1.5-2.5 倍于 NW 母亲婴儿的瘦素和胰岛素浓度。当浓度按婴儿每日摄入量和体重进行标准化时，也观察到了类似的结果。与婴儿生长参数相关的婴儿每日摄入量的效应大小对于宏量营养素较小[0.005-0.05 个 z 评分单位和 0.02-0.45 脂肪质量指数（FMI）或无脂肪质量指数单位/组成变化单位，P<0.05]。人乳胰岛素和瘦素的效应大小较大（0.24 z 评分单位和 0.37-1.15 FMI 单位/组成变化单位，P<0.05）。
结论
这些发现表明，OW 母亲的婴儿暴露于更高浓度的胰岛素、瘦素和在较小程度上暴露于 CRP。这些 3 种人乳生物活性物质的生物利用度及其在婴儿中的作用机制尚不清楚。本试验在 clinicaltrials.gov 上注册为 NCT01131117。
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