Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
Adv Nutr. 2024 Jan;15(1):100127. doi: 10.1016/j.advnut.2023.09.015. Epub 2023 Oct 4.
Human milk (HM) contains macronutrients, micronutrients, and a multitude of other bioactive factors, which can have a long-term impact on infant growth and development. We systematically searched MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born infants. From 9992 abstracts screened, 141 articles were included and categorized based on their reporting of HM micronutrients, macronutrients, or bioactive components. Bioactives including hormones, HM oligosaccharides (HMOs), and immunomodulatory components are reported here, based on 75 articles from 69 unique studies reporting observations from 9980 dyads. Research designs, milk collection strategies, sampling times, geographic and socioeconomic settings, reporting practices, and outcomes varied considerably. Meta-analyses were not possible because data collection times and reporting were inconsistent among the studies included. Few measured infant HM intake, adjusted for confounders, precisely captured breastfeeding exclusivity, or adequately described HM collection protocols. Only 5 studies (6%) had high overall quality scores. Hormones were the most extensively examined bioactive with 46 articles (n = 6773 dyads), compared with 13 (n = 2640 dyads) for HMOs and 12 (n = 1422 dyads) for immunomodulatory components. Two studies conducted untargeted metabolomics. Leptin and adiponectin demonstrated inverse associations with infant growth, although several studies found no associations. No consistent associations were found between individual HMOs and infant growth outcomes. Among immunomodulatory components in HM, IL-6 demonstrated inverse relationships with infant growth. Current research on HM bioactives is largely inconclusive and is insufficient to address the complex composition of HM. Future research should ideally capture HM intake, use biologically relevant anthropometrics, and integrate components across categories, embracing a systems biology approach to better understand how HM components work independently and synergistically to influence infant growth.
母乳（HM）含有宏量营养素、微量营养素和多种其他生物活性因子，这些因子可能对婴儿的生长发育产生长期影响。我们系统地检索了 MEDLINE、EMBASE、Cochrane 图书馆、Scopus 和 Web of Science，以综合 1980 年至 2022 年间关于足月出生婴儿在 2 岁之前母乳成分与人体测量学的研究证据。从筛选出的 9992 篇摘要中，纳入了 141 篇文章，并根据其对母乳微量营养素、宏量营养素或生物活性成分的报告进行分类。这里报告了包括激素、母乳低聚糖（HMOs）和免疫调节成分在内的生物活性物质，这些物质基于 75 篇文章和 69 项独特研究的观察结果，这些研究共涉及 9980 对母婴。研究设计、母乳采集策略、采样时间、地理和社会经济环境、报告实践和结果差异很大。由于纳入研究的数据收集时间和报告不一致，因此无法进行荟萃分析。很少有研究精确测量婴儿的母乳摄入量，调整混杂因素，准确记录母乳喂养的排他性，或充分描述母乳采集方案。只有 5 项研究（6%）的整体质量评分较高。激素是研究最多的生物活性物质，有 46 篇文章（n = 6773 对母婴），其次是 HMOs，有 13 篇文章（n = 2640 对母婴），免疫调节成分有 12 篇文章（n = 1422 对母婴）。有两项研究进行了非靶向代谢组学研究。瘦素和脂联素与婴儿生长呈负相关，但也有几项研究未发现相关性。个别 HMOs 与婴儿生长结果之间没有一致的关联。在母乳中的免疫调节成分中，IL-6 与婴儿生长呈负相关。目前关于母乳生物活性物质的研究结果尚无定论，不足以解决母乳复杂的组成问题。未来的研究理想情况下应捕捉母乳摄入量，使用具有生物学意义的人体测量学，并整合各分类中的成分，采用系统生物学方法更好地理解母乳成分如何独立和协同地发挥作用，从而影响婴儿的生长。
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