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Nutrients Apr 2023Goat-milk-based infant formulas (GMFs) are now available in several countries, having been approved by authorities. We systematically evaluated the effects of GMF... (Meta-Analysis)
Meta-Analysis Review
Goat-milk-based infant formulas (GMFs) are now available in several countries, having been approved by authorities. We systematically evaluated the effects of GMF compared with cow-milk-based formula (CMF) on infant growth and safety parameters. The MEDLINE, EMBASE, and Cochrane Library databases were searched (December 2022) for randomized controlled trials (RCTs). The risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool (ROB-2). Heterogeneity was quantified by . Four RCTs involving a total of 670 infants were identified. All trials revealed some concern in ROB-2. Furthermore, all of the included studies were funded by the industry. Compared with infants fed CMF, those fed GMF showed similar growth in sex- and age-adjusted -scores for weight (mean difference, MD, 0.21 [95% confidence interval, CI, -0.16 to 0.58], = 56%), length (MD 0.02, [95% CI -0.29 to 0.33], = 24%), and head circumference (MD 0.12, 95% [CI -0.19 to 0.43], = 2%). Stool frequency was similar among the groups. Due to differences in the reporting of stool consistency, no firm conclusion can be drawn. Adverse effects (serious or any) were similar in both groups. These findings provide reassurance that GMFs compared with CMFs are safe and well tolerated.
Topics: Animals; Cattle; Female; Milk; Infant Formula; Glia Maturation Factor; Databases, Factual; Goats
PubMed: 37432055
DOI: 10.3390/nu15092110 -
The British Journal of Nutrition Sep 2016There are wide variations in the macronutrient values adopted by neonatal intensive care units and industry to fortify milk in efforts to achieve recommended intakes for... (Review)
Review
There are wide variations in the macronutrient values adopted by neonatal intensive care units and industry to fortify milk in efforts to achieve recommended intakes for preterm infants. Contributing to this is the variation in macronutrient composition of preterm milk between and within mothers and the variable quality of milk analyses used to determine the macronutrient content of milk. We conducted a systematic review of the literature using articles published in English between 1959 and 2013 that reported the concentrations of one or more macronutrients or energy content in human preterm milk, sampled over a representative 24-h period. Searched medical databases included Ovid Medline, Scopus, CINAHL and the Cochrane Library. Results are presented as mean values and ranges for each macronutrient during weeks 1-8 of lactation, and preferred mean values (g/100 ml) for colostrum (week 1) and mature milk (weeks 2-8; protein: 1·27, fat: 3·46, lactose: 6·15 and carbohydrate: 7·34), using data from studies employing the highest-quality analyses. Industry-directed fortification practices using these mean values fail to meet protein targets for infants weighing <1000 g when the fortified milk is fed <170-190 ml/kg per d, and the protein:energy ratio of the fortified milk is inadequate. This study aimed to provide additional information to industry in order to guide their future formulation of breast milk fortifiers. Quality macronutrient analyses of adequately sampled preterm breast milk would improve our understanding of the level of fortification needed to meet recommended protein and energy intakes and growth targets, as well as support standardised reporting of nutritional outcomes.
Topics: Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Milk, Human; Nutritional Requirements
PubMed: 27522863
DOI: 10.1017/S0007114516003007 -
Environmental Monitoring and Assessment Jun 2023In this study, the average level of aflatoxin M1 in various types of milk from 107 articles (297 studies with 16,274 milk samples) were meta-analyzed using random-effect... (Meta-Analysis)
Meta-Analysis Review
In this study, the average level of aflatoxin M1 in various types of milk from 107 articles (297 studies with 16,274 milk samples) were meta-analyzed using random-effect model based on the milk varieties (animal species and heating processes), geographical regions, seasons, detection techniques and dairy farming subgroups. Studies on milk contamination with aflatoxin M1 in Iran were collected using universal and Persian databanks from January 1974 to the end of November 2021. The overall aflatoxin M1 mean concentration and prevalence in milk samples of Iran were 39.65 ng/l (95% CI: 36.00-43.30) and 80% (95% CI: 76-85%), respectively. The rank order of importance of various variables in mean levels of aflatoxin M1 in milk samples included milk type (animal species) > geographical regions > detection techniques > dairy farming types > milk types (heating processes) > seasons. Findings revealed that the overall content of aflatoxin M1 in milk samples of Iran was lower than that allowed by the European Union, Institute of Standards and Industrial Research of Iran, and the USA, possibly due to the milk monitoring by the Iranian regulatory systems.
Topics: Animals; Iran; Milk; Aflatoxin M1; Food Contamination; Environmental Monitoring
PubMed: 37261597
DOI: 10.1007/s10661-023-11373-9 -
The Cochrane Database of Systematic... May 2020Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination of breastfeeding. When addressing this concern, it is important first to consider the influence of maternal and neonatal health, infant suck, proper latch, and feeding frequency on milk production, and that steps be taken to correct or compensate for any contributing issues. Oral galactagogues are substances that stimulate milk production. They may be pharmacological or non-pharmacological (natural). Natural galactagogues are usually botanical or other food agents. The choice between pharmacological or natural galactagogues is often influenced by familiarity and local customs. Evidence for the possible benefits and harms of galactagogues is important for making an informed decision on their use.
OBJECTIVES
To assess the effect of oral galactagogues for increasing milk production in non-hospitalised breastfeeding mother-term infant pairs.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Health Research and Development Network - Phillippines (HERDIN), Natural Products Alert (Napralert), the personal reference collection of author LM, and reference lists of retrieved studies (4 November 2019).
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs (including published abstracts) comparing oral galactagogues with placebo, no treatment, or another oral galactagogue in mothers breastfeeding healthy term infants. We also included cluster-randomised trials but excluded cross-over trials.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. Two to four review authors independently selected the studies, assessed the risk of bias, extracted data for analysis and checked accuracy. Where necessary, we contacted the study authors for clarification.
MAIN RESULTS
Forty-one RCTs involving 3005 mothers and 3006 infants from at least 17 countries met the inclusion criteria. Studies were conducted either in hospitals immediately postpartum or in the community. There was considerable variation in mothers, particularly in parity and whether or not they had lactation insufficiency. Infants' ages at commencement of the studies ranged from newborn to 6 months. The overall certainty of evidence was low to very low because of high risk of biases (mainly due to lack of blinding), substantial clinical and statistical heterogeneity, and imprecision of measurements. Pharmacological galactagogues Nine studies compared a pharmacological galactagogue (domperidone, metoclopramide, sulpiride, thyrotropin-releasing hormone) with placebo or no treatment. The primary outcome of proportion of mothers who continued breastfeeding at 3, 4 and 6 months was not reported. Only one study (metoclopramide) reported on the outcome of infant weight, finding little or no difference (mean difference (MD) 23.0 grams, 95% confidence interval (CI) -47.71 to 93.71; 1 study, 20 participants; low-certainty evidence). Three studies (metoclopramide, domperidone, sulpiride) reported on milk volume, finding pharmacological galactagogues may increase milk volume (MD 63.82 mL, 95% CI 25.91 to 101.72; I² = 34%; 3 studies, 151 participants; low-certainty evidence). Subgroup analysis indicates there may be increased milk volume with each drug, but with varying CIs. There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints, such as tiredness, nausea, headache and dry mouth (very low-certainty evidence). No adverse effects were reported for infants. Natural galactagogues Twenty-seven studies compared natural oral galactagogues (banana flower, fennel, fenugreek, ginger, ixbut, levant cotton, moringa, palm dates, pork knuckle, shatavari, silymarin, torbangun leaves or other natural mixtures) with placebo or no treatment. One study (Mother's Milk Tea) reported breastfeeding rates at six months with a concluding statement of "no significant difference" (no data and no measure of significance provided, 60 participants, very low-certainty evidence). Three studies (fennel, fenugreek, moringa, mixed botanical tea) reported infant weight but could not be meta-analysed due to substantial clinical and statistical heterogeneity (I = 60%, 275 participants, very low-certainty evidence). Subgroup analysis shows we are very uncertain whether fennel or fenugreek improves infant weight, whereas moringa and mixed botanical tea may increase infant weight compared to placebo. Thirteen studies (Bu Xue Sheng Ru, Chanbao, Cui Ru, banana flower, fenugreek, ginger, moringa, fenugreek, ginger and turmeric mix, ixbut, mixed botanical tea, Sheng Ru He Ji, silymarin, Xian Tong Ru, palm dates; 962 participants) reported on milk volume, but meta-analysis was not possible due to substantial heterogeneity (I = 99%). The subgroup analysis for each intervention suggested either benefit or little or no difference (very low-certainty evidence). There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints such as mothers with urine that smelled like maple syrup and urticaria in infants (very low-certainty evidence). Galactagogue versus galactagogue Eight studies (Chanbao; Bue Xue Sheng Ru, domperidone, moringa, fenugreek, palm dates, torbangun, moloco, Mu Er Wu You, Kun Yuan Tong Ru) compared one oral galactagogue with another. We were unable to perform meta-analysis because there was only one small study for each match-up, so we do not know if one galactagogue is better than another for any outcome.
AUTHORS' CONCLUSIONS
Due to extremely limited, very low certainty evidence, we do not know whether galactagogues have any effect on proportion of mothers who continued breastfeeding at 3, 4 and 6 months. There is low-certainty evidence that pharmacological galactagogues may increase milk volume. There is some evidence from subgroup analyses that natural galactagogues may benefit infant weight and milk volume in mothers with healthy, term infants, but due to substantial heterogeneity of the studies, imprecision of measurements and incomplete reporting, we are very uncertain about the magnitude of the effect. We are also uncertain if one galactagogue performs better than another. With limited data on adverse effects, we are uncertain if there are any concerning adverse effects with any particular galactagogue; those reported were minor complaints. High-quality RCTs on the efficacy and safety of galactagogues are urgently needed. A set of core outcomes to standardise infant weight and milk volume measurement is also needed, as well as a strong basis for the dose and dosage form used.
Topics: Administration, Oral; Body Weight; Breast Feeding; Domperidone; Female; Galactogogues; Humans; Infant; Infant, Newborn; Lactation; Metoclopramide; Milk, Human; Mothers; Phytotherapy; Plant Extracts; Randomized Controlled Trials as Topic; Sulpiride; Thyrotropin-Releasing Hormone
PubMed: 32421208
DOI: 10.1002/14651858.CD011505.pub2 -
Advances in Nutrition (Bethesda, Md.) Jan 2024Human milk (HM) contains macronutrients, micronutrients, and a multitude of other bioactive factors, which can have a long-term impact on infant growth and development.... (Review)
Review
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.
Topics: Infant; Female; Child; Humans; Milk, Human; Breast Feeding; Body Composition; Anthropometry; Micronutrients
PubMed: 37802214
DOI: 10.1016/j.advnut.2023.09.015 -
Maternal & Child Nutrition Jan 2022Perceived insufficient milk supply (PIMS) is one of the major reasons for discontinued breastfeeding. We aimed to estimate the rates and evaluate related factors of... (Meta-Analysis)
Meta-Analysis Review
Perceived insufficient milk supply (PIMS) is one of the major reasons for discontinued breastfeeding. We aimed to estimate the rates and evaluate related factors of PIMS. We searched four databases for relevant articles published from January 2000 to March 2021. We then performed a meta-analysis of the pooled data to estimate the rates and related factors of PIMS using Stata 15.0. Descriptive analyses of textual data were performed to summarise the related factors of PIMS if data could not be synthesised quantitatively. The quality of included studies was assessed using Newcastle-Ottawa scale (NOS), AHRQ checklist or Consolidated Criteria for Reporting Qualitative Research (COREQ). Overall, 27 studies were included in this review. At different periods after delivery, approximately 50% of mothers reported PIMS as the reason for stopping breastfeeding, while for breastfeeding mothers, the incidence of PIMS ranged from 10% to 25%. Breastfeeding initiation (OR 4.22, 95%CI 1.57-11.34) and breastfeeding knowledge (OR 7.10, 95%CI 2.00-25.26) were two factors influencing PIMS. Besides, PIMS had a strong negative relationship with breastfeeding self-efficacy (r = -0.57); moderate negative association with infant suck ability (r = -0.46) and planned breastfeeding duration (r = -0.45); and a moderate positive correlation with formula supplementation (r = 0.42). Descriptive analyses revealed that infant crying was reported to be a sign of PIMS, and inadequate intake of energy/liquids was a reported cause of it. This review identified a high proportion of women reporting PIMS, particularly among those who stopped breastfeeding. Deliberate interventions were needed to improve breastfeeding for mothers at risk.
Topics: Breast Feeding; Female; Humans; Infant; Milk, Human; Mothers; Self Efficacy
PubMed: 34382733
DOI: 10.1111/mcn.13255 -
Environmental Science and Pollution... Nov 2023Although veterinary antibiotics are essential in preventing and treating clinical diseases in cattle, the frequent use of antibiotics leads to antibiotic residues in... (Review)
Review
Although veterinary antibiotics are essential in preventing and treating clinical diseases in cattle, the frequent use of antibiotics leads to antibiotic residues in milk and dairy products, consequently threatening human health. The massive milk consumption makes it necessary to assess antibiotic pollution and health impact comprehensively. Hence, we conducted a systematic review to evaluate antibiotics in milk and dairy products and their potential health risk. We searched four databases using multiple keyword combinations to retrieve 1582 pieces of literature and finally included eighteen articles to analyze antibiotic residues in milk and dairy products. These studies detected seven antibiotics in different regions of China. Quinolones and β-lactam antibiotics exceeded the MRL for raw and commercial milk. The maximum levels of sulfonamides and tetracyclines were detected in the same raw milk sample, exceeding the MRL. The estimated THQ and HI values in milk and dairy products are less than 1 for adults, indicating negligible noncarcinogenic health risk of antibiotics through consuming milk and dairy products. Children face higher health risks than adults, with the HI and THQ of quinolones exceeding 1. It is worth noting that quinolones accounted for nearly 89% of health risks associated with all antibiotics. Finally, we put forward possible research directions in the future, such as specific health effects of total dietary exposure to low levels of antibiotics. In addition, policymakers should effectively improve this problem from the perspectives of antibiotic use supervision, antibiotic residue analysis in food, and continuous environmental monitoring and control.
Topics: Adult; Child; Humans; Animals; Cattle; Milk; Anti-Bacterial Agents; Dairy Products; Sulfanilamide; Quinolones; China; Drug Residues
PubMed: 37851252
DOI: 10.1007/s11356-023-30312-2 -
PloS One Dec 2009An association between insufficient milk supply, the inability of a mother's breast milk to provide sufficiently for her infant, and breast cancer has been suggested by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
An association between insufficient milk supply, the inability of a mother's breast milk to provide sufficiently for her infant, and breast cancer has been suggested by observations in animal models. To determine if an association has been reported in epidemiological studies of human breast cancer, a systematic review of the literature has been conducted. We also sought to identify the methodological limitations of existing studies to guide the design of any future prospective studies in this field.
METHODOLOGY/PRINCIPAL FINDINGS
PubMed, EMBASE, Web of Science, BIOSIS, and CAB abstracts were searched. We selected any study that (1) assessed breast cancer in association with breastfeeding history and (2) examined the relationship between insufficient milk supply with breast cancer. Seven relevant studies were identified that met both criteria. There was statistically significant heterogeneity among the results which likely reflects clinically significant differences in definitions of insufficient milk supply and reference groups that were used. Among premenopausal women who had experienced insufficient milk supply, odds ratios (ORs) for breast cancer risk ranged from 0.9 to 16.3. Among postmenopausal women, ORs ranged from 0.6 to 6.7. Based on the range of odds ratios obtained in the studies reported in this review, it remains unclear if there is a true association between insufficient milk supply and breast cancer.
CONCLUSIONS/SIGNIFICANCE
Although some studies have shown a strong positive association, there is no consistent evidence for an effect of insufficient milk supply on breast cancer risk. Exposure definitions are in need of improvement in order to focus on primary insufficient milk supply. Reference groups consisting of women who have successfully breastfed may also introduce positive bias (inflation of the odds ratio) into study results because of the protective effect of prolonged breastfeeding in the control group.
Topics: Breast Neoplasms; Female; Humans; Lactation; Milk, Human; Postmenopause; Premenopause; Risk Factors
PubMed: 20011591
DOI: 10.1371/journal.pone.0008237 -
Nutrition Reviews May 2019Various epidemiological studies suggest a positive association between exposure to cow's milk A1 β-casein protein and risk for noncommunicable chronic diseases. The...
CONTEXT
Various epidemiological studies suggest a positive association between exposure to cow's milk A1 β-casein protein and risk for noncommunicable chronic diseases. The consumption of A2 cow's milk is increasing, likely because A2 milk is postulated to have positive effects on digestive health.
OBJECTIVE
A systematic review was conducted to investigate associations between A1 β-casein and health-related outcomes in humans.
DATA SOURCES
Five electronic databases, 3 clinical trial registries, and the internet were searched systematically.
STUDY SELECTION
Using predefined inclusion criteria, 2 authors independently selected studies investigating the effect of A1 β-casein or β-casomorphin-7 intake/exposure on any health-related outcome in humans. Discrepancies were resolved by consensus.
DATA EXTRACTION
Two authors independently extracted data and assessed risk of bias. The certainty of evidence per outcome was evaluated using the GRADE approach. Discrepancies were resolved by consensus.
RESULTS
Fifteen randomized controlled trials, 2 case-control studies, and 8 ecological studies were included. Most randomized controlled studies and case-control studies investigating a potential effect on various outcomes were based on intermediate markers and found no significant difference between the 2 milk types. In contrast, most ecological studies reported that population-level A1 β-casein exposure is associated with adverse health outcomes. The certainty of the evidence for the included outcomes, as assessed by the GRADE approach, was rated as moderate for digestive symptoms and as low to very low for all other outcomes.
CONCLUSIONS
Human-based evidence from clinical trials and epidemiological studies published prior to October 2017 provides moderate certainty for adverse digestive health effects of A1 β-casein compared with A2 β-casein but low or very low certainty for other health effects. These conclusions may change in the future, given the emergent nature of this topic and the ongoing research in this area.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42016043795.
Topics: Animals; Biomarkers; Case-Control Studies; Caseins; Cattle; Digestion; Endorphins; Female; Humans; Milk; Peptide Fragments; Randomized Controlled Trials as Topic
PubMed: 30722004
DOI: 10.1093/nutrit/nuy063 -
Future Microbiology May 2019Breastfeeding is a major determinant of human health. Breast milk is not sterile and ecological large-scale sequencing methods have revealed an unsuspected microbial...
Breastfeeding is a major determinant of human health. Breast milk is not sterile and ecological large-scale sequencing methods have revealed an unsuspected microbial diversity that plays an important role. However, microbiological analysis at the species level has been neglected while it is a prerequisite before understanding which microbe is associated with symbiosis or dysbiosis, and health or disease. We review the currently known bacterial repertoire from the human breast and milk microbiota using a semiautomated strategy. Total 242 articles from 38 countries, 11,124 women and 15,489 samples were included. Total 820 species were identified mainly composed of Proteobacteria and Firmicutes. We report variations according to the analytical method (culture or molecular method), the anatomical site (breast, colostrum or milk) and the infectious status (healthy control, mastitis, breast abscess, neonatal infection). In addition, we compared it with the other human repertoires. Finally, we discuss its putative origin and role in health and disease.
Topics: Abscess; Archaea; Bacteria; Breast; Breast Feeding; Colostrum; Databases, Factual; Dysbiosis; Female; Humans; Mastitis; Microbiota; Milk, Human; Symbiosis
PubMed: 31025880
DOI: 10.2217/fmb-2018-0317