母乳中母体肥胖与食欲调节激素之间的关联是通过母体循环浓度介导的，可能会影响婴儿的发育结果。
Associations between maternal adiposity and appetite-regulating hormones in human milk are mediated through maternal circulating concentrations and might affect infant outcomes.
作者信息
Christensen Sophie Hilario, Lewis Jack Ivor, Larnkjær Anni, Frøkiær Hanne, Allen Lindsay H, Mølgaard Christian, Michaelsen Kim F
机构信息
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark.
Department of Veterinary and Animal Science, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
出版信息
Front Nutr. 2022 Nov 4;9:1025439. doi: 10.3389/fnut.2022.1025439. eCollection 2022.
BACKGROUND
Appetite-regulating hormones (ARH) in human milk (HM) are suggested to affect infants' milk intake and possibly infant growth. Maternal adiposity might contribute to higher levels of ARH in HM, either from the mammary gland or from raised circulating levels due to higher adiposity. Counterfactual-based mediation analysis can define indirect and direct effects between HM ARH and maternal and infant factors, and might be an important tool when investigating the mother-milk-infant triad.
OBJECTIVE
We aim to investigate whether potential associations between (1) maternal adiposity and HM ARH and (2) HM ARH and infant milk intake and growth are mediated through maternal and infant plasma ARH, respectively.
MATERIALS AND METHODS
Maternal and infant anthropometry and body composition, HM and blood samples were collected from 223 mother-infant dyads participating in the Mother, Infant and Lactation Quality study at three postpartum visits from 1 to 8.49 months. Leptin, insulin and adiponectin were analyzed using immunoassays. Mediation analyses using linear mixed-effect models were applied to investigate the direct and indirect effects through maternal and infant plasma hormone concentrations.
RESULTS
A positive association between maternal body-mass-index (BMI) and HM leptin was mediated by maternal plasma leptin by 29% when fixing BMI to < 25 kg/m, and through 51% when fixing BMI to ≥ 25 kg/m ( < 0.01). There was no mediated effect through plasma insulin in the association between BMI and HM insulin ( = 0.068). We found negative and positive associations between HM insulin and total milk intake and infant weight, respectively, however, these diminished in mediation analyses with reduced sample sizes.
CONCLUSION
Our main results suggest that the association between maternal adiposity and HM leptin was mediated through circulating leptin to a stronger degree for mothers with overweight compared to mothers with normal-weight. This indicates that excess maternal adiposity, and the resulting rise of circulating leptin and possible concomitant low-grade inflammation, may be reflected in HM composition.
CLINICAL TRIALS REGISTRY NUMBER
NCT03254329.
背景
人乳（HM）中的食欲调节激素（ARH）被认为会影响婴儿的奶量摄入，并可能影响婴儿生长。母体肥胖可能导致HM中ARH水平升高，这可能源于乳腺，也可能是由于肥胖导致循环水平升高。基于反事实的中介分析可以确定HM ARH与母体和婴儿因素之间的间接和直接影响，在研究母婴三联体时可能是一个重要工具。
目的
我们旨在分别研究（1）母体肥胖与HM ARH之间以及（2）HM ARH与婴儿奶量摄入和生长之间的潜在关联是否通过母体和婴儿血浆ARH介导。
材料与方法
从223对母婴中收集母体和婴儿的人体测量数据、身体成分、HM和血液样本，这些母婴参与了母婴和哺乳期质量研究，在产后1至8.49个月的三次访视中进行采集。使用免疫分析法分析瘦素、胰岛素和脂联素。应用线性混合效应模型进行中介分析，以研究通过母体和婴儿血浆激素浓度的直接和间接影响。
结果
当将母体体重指数（BMI）固定为<25 kg/m²时，母体血浆瘦素介导了母体BMI与HM瘦素之间29%的正相关，当将BMI固定为≥25 kg/m²时，介导比例为51%（P<0.01）。在BMI与HM胰岛素的关联中，血浆胰岛素没有介导作用（P = 0.068）。我们分别发现HM胰岛素与总奶量摄入和婴儿体重之间存在负相关和正相关，然而，在样本量减少的中介分析中，这些相关性减弱。
结论
我们的主要结果表明，与体重正常的母亲相比，超重母亲中母体肥胖与HM瘦素之间的关联通过循环瘦素介导的程度更强。这表明母体肥胖过多，以及由此导致的循环瘦素升高和可能伴随的低度炎症，可能反映在HM成分中。
临床试验注册号
NCT03254329。
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