Christian Parul, Smith Emily R, Lee Sun Eun, Vargas Ashley J, Bremer Andrew A, Raiten Daniel J
Johns Hopkins Bloomberg School of Public Health, Program in Human Nutrition, Department of International Health, Baltimore, MD, USA.
Milken Institute School of Public Health, The George Washington University, Departments of Global Health and Exercise and Nutrition Sciences, Washington, DC, USA.
Am J Clin Nutr. 2021 May 8;113(5):1063-1072. doi: 10.1093/ajcn/nqab075.
Critical advancement is needed in the study of human milk as a biological system that intersects and interacts with myriad internal (maternal biology) and external (diet, environment, infections) factors and its plethora of influences on the developing infant. Human-milk composition and its resulting biological function is more than the sum of its parts. Our failure to fully understand this biology in a large part contributes to why the duration of exclusive breastfeeding remains an unsettled science (if not policy). Our current understanding of human-milk composition and its individual components and their functions fails to fully recognize the importance of the chronobiology and systems biology of human milk in the context of milk synthesis, optimal timing and duration of feeding, and period of lactation. The overly simplistic, but common, approach to analyzing single, mostly nutritive components of human milk is insufficient to understand the contribution of either individual components or the matrix within which they exist to both maternal and child health. There is a need for a shift in the conceptual approach to studying human milk to improve strategies and interventions to support better lactation, breastfeeding, and the full range of infant feeding practices, particularly for women and infants living in undernourished and infectious environments. Recent technological advances have led to a rising movement towards advancing the science of human-milk biology. Herein, we describe the rationale and critical need for unveiling the multifunctionality of the various nutritional, nonnutritional, immune, and biological signaling pathways of the components in human milk that drive system development and maturation, growth, and development in the very early postnatal period of life. We provide a vision and conceptual framework for a research strategy and agenda to change the field of human-milk biology with implications for global policy, innovation, and interventions.
将母乳作为一个与众多内部（母体生物学）和外部（饮食、环境、感染）因素相互交叉和作用的生物系统进行研究，以及研究其对发育中婴儿的诸多影响，都需要取得重大进展。母乳的成分及其产生的生物学功能并非各部分的简单相加。我们未能充分理解这一生物学原理，在很大程度上导致了为什么纯母乳喂养的持续时间仍然是一门尚未定论的科学（甚至在政策方面也是如此）。我们目前对母乳成分及其单个成分和功能的理解，未能充分认识到母乳在乳汁合成、最佳喂养时间和持续时间以及哺乳期等方面的生物钟学和系统生物学的重要性。过于简单化但常见的分析母乳单一成分（主要是营养成分）的方法，不足以理解单个成分或其所处基质对母婴健康的贡献。需要转变研究母乳的概念方法，以改进支持更好的泌乳、母乳喂养以及全面婴儿喂养实践的策略和干预措施，特别是对于生活在营养不良和感染环境中的妇女和婴儿。最近的技术进步推动了母乳生物学科学的发展。在此，我们描述了揭示母乳中各种营养、非营养、免疫和生物信号通路的多功能性的基本原理和迫切需求，这些通路驱动着生命早期产后阶段的系统发育和成熟、生长与发育。我们为一项研究策略和议程提供了愿景和概念框架，以改变母乳生物学领域，并对全球政策、创新和干预措施产生影响。
