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Human Breast Milk

Human Breast Milk. พญ.วรางค์ทิพย์ คูวุฒยากร หน่วยทารกแรกเกิด ภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่. Questions. Why breast milk is the best? How milk is produced ? What are human breast milk compositions? Does it different from cow’s milk?

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Human Breast Milk

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  1. Human Breast Milk พญ.วรางค์ทิพย์ คูวุฒยากร หน่วยทารกแรกเกิด ภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่

  2. Questions Why breast milk is the best? How milk is produced ? What are human breast milk compositions? Does it different from cow’s milk? What are protective components in human breast milk?

  3. Benefits of breastfeeding

  4. Effect of breastfeeding on the mothers • Decrease postpartum hemorrhage • Decrease breast , ovarian and endometrial cancer • Decrease osteoporosis • More rapid return to pre-pregnancy weight

  5. Decrease infection in children Diarrhea ถ่ายเหลว Respiratory tract infection ติดเชื้อทางเดินหายใจ Otitismedia หูชั้นกลางอักเสบ Bacteremia ติดเชื้อแบคทีเรียใน กระแสเลือด Bacterial meningitis เยื่อหุ้มสมองอักเสบจาก แบคทีเรีย Urinary tract infection ติดเชื้อทางเดินปัสสาวะ Late onset sepsis in ติดเชื้อในกระแสเลือด preterm infant ในทารกก่อนกำหนด Necrotizing Enterocolitis ลำไส้เน่าเปื่อย from American Academy of Pediatrics. Breast feeding and the use of human milk:Pediatrics.2005;115(2):506 from AAP.Breast feeding and the use of human milk:Pediatrics.2005;115(2):506

  6. Decrease non-infectious disease Asthma หอบหืด Overweight and obesity โรคอ้วน Insulin dependent DM (type I) เบาหวาน Non insulin dependent DM (type II)เบาหวาน Hypercholesterolemia ไขมันสูง Lymphoma มะเร็งต่อมน้ำเหลือง Leukemia มะเร็งเม็ดเลือดขาว Hodgkin disease มะเร็งต่อมน้ำเหลือง Sudden Infant Death Syndrome (SIDs) from American Academy of Pediatrics. Breast feeding and the use of human milk:Pediatrics.2005;115(2):506

  7. Neurodevelopment Anderson JW, Johnstone BM, Remley DT, 1999 • Meta-analysis 20 studies • Significantly higher levels of cognitive function were seenin breast-fed than in formula-fed children at 6–23 moof ages • Higher IQ 3.16 points in term (95%CI 2.15,3.17) • Higher IQ 5.18 pointsin preterm (95%CI 3.59,6.77) American Journal of Clinical Nutrition, Vol. 70, No. 4, 525-535, October 1999

  8. WHO and UNICEF • Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health • Infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. “กินนมแม่เพียงอย่างเดียวจนถึงอายุ 6 เดือน หลังจากนั้นกินนมแม่ควบคู่กับอาหาร เสริม จนถึงอายุ 2 ปีหรือมากกว่า “ http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/index.html

  9. Contraindications to breastfeeding • HIV positive mother • HTLV type I and II positive • Active tuberculosis disease • Herpes simplex infection on a breast • Drugs of abuse • Expose to radioactive materials • Receiving diagnostic or therapeutic radioactive isotropes • Receiving antimetabolites or chemotherapeutic agents AAP.Breast feeding and the use of human milk:Pediatrics.2005;115(2):506 American Academy of Pediatrics .Breast feeding and the use of human milk. Pediatrics 2005;115(2):506

  10. Exclusive breastfeeding • is defined as no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive ORS, drops and syrups (vitamins, minerals and medicines). • ให้ทารกกินนมแม่อย่างเดียวโดยไม่ให้อาหารอื่นๆแม้แต่น้ำ เป็นระยะเวลา 6 เดือน • ยกเว้นน้ำเกลือแร่ ยา หรือ วิตามินเสริม

  11. อัตราการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือน ระหว่างประเทศ ร้อยละ แหล่งที่มา : สำนักนโยบายและยุทธศาสตร์ กระทรวงสาธารณสุข

  12. เปรียบเทียบกับทั่วโลก อัตราการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือนประเทศไทยจัดอยู่ในกลุ่มที่มีอัตราน้อยกว่าร้อยละ 20 (สีแดง)

  13. แผนภูมิแสดงการกินนมแม่ของเด็กไทย ปี 2548-2549

  14. Anatomy of the breast

  15. Anatomy of the breast

  16. Mammary development Embryogenesis GH, estrogen Pubertal development progesterone Mature progesterone, prolactin, HPL The Lactation cycle Pregnancy Involution progesterone, prolactin, HPL Prolactin, oxytocin Lactation

  17. Mammary development

  18. Lactogenesis I & II

  19. Lactogenesis II- Prolactin

  20. Anatomy of the breast

  21. Lactogenesis II- Oxytocin

  22. Cellular mechanisms for milk synthesis and secretion • Exocytosis • Most of the components of the aqueous fraction eg. Protein- casein, CHO- lactose • Fat synthesis and secretion • Transport across apical membrane • Ions and water • Transcytosis of interstitial molecules • Immunoglobulin A • Paracellular pathway

  23. The pathway of milk synthesis and secretion

  24. Colostrums, transitional and mature milk • Colostrums • 1-4 day after parturition • Transitional milk • 4-10 days after parturition • Mature milk • After 10 days

  25. Colostrums, transitional and mature breast milk

  26. Colostrums ingredients

  27. Breastmilk Composition

  28. Composition of breastmilk

  29. Carbohydrate in human milk • Mainly carbohydrate is lactose • Increasing amount correlate with milk volume • Provides galactose • A sugar involved in brain and nervous system development • Low risk of causing dental caries

  30. Fat in human milk • 30-50 g/L, 97-98% is triglyceride • Major energy for a baby (45-55% of total calories) • Synthesis and development of retinal and neural tissues • Essential fatty acid (FAs) • Linoleic acid (8-17%) • α-Linolenic acid (0.5-1.0%) • Arachinodic acid (0.5-0.7%) (LC-PUFA) • Docosahexaenoic acid (0.2-0.5%) (LC-PUFA) • Fat digestion is aids by gastric lipase and bile-salt dependent lipase in human milk

  31. Factors influencing human fat content and composition

  32. Foremilk vs Hindmilk

  33. Protein in Human milk • 15.8 g/L (colostrums)  9.0 g/L (mature milk) • Whey : Casein = 60 :40 • Total protein • Protein nitrogen • Non-protein nitrogen (20-25%) • free amino acid, Carnitine, taurine, Aminosugars • Nucleic acids, nucleotides • Polyamines

  34. Human milk protein functions • Growth • Protective factors • Carries for vitamins and hormones • Enzyme activities • Biological activities

  35. Vitamins in human milk • Corresponding to maternal status • Fat soluble vitamins • Vitamin A (200-300 mg/L) • Decreases with advancing lactation • Vitamin D (0.1-1.0 ug/L) • Maternal intake, sunlight, northern latitudes • Supplement vitamin D 10 ug/L is recommended in a baby at risk

  36. Fat-Soluble vitamins • Vitamin K (1-9 ug/L) • Tran placental transfer is minor • Maternal dietary intake bears little relationship to milk vitamin K content • Maternal supplementation of 5-20 mg/day increases in milk and infant plasma levels

  37. Water-Soluble vitamins • Vitamin C (100 mg/L) • 8-10 fold higher than the maternal plasma concentration • Vitamin B6 • Low levels in mothers with a long-term history of OCT uses

  38. Water-Soluble vitamins • Vitamin B12 • Vitamin B12 deficiency was found in infants nursed by mothers who were strict vegetarians • Folate • Interfere by maternal diet and medication

  39. Minerals and trace elements in human milk • Not correlate with amounts in the maternal diet or maternal serum • Calcium, phosphorus and magnesium • Sodium, potassium and chloride • Iron (0.3mg/L), copper and zinc • Iron from HM is absorbed 5-fold more efficiently • Lactoferrin

  40. Immunomodulating agent • Affect the development of newborns’ immune system • cytokines • Enhance inflammation • TNF-α, IL-1, IL-6, IL-8, interferon-γ • Suppress inflammation • IL-10 • Soluble receptors • TNF-α1, TNF-α2

  41. Anti-inflammatory components Antioxidants: vitamins A, C, E Enzymes : catalase, glutathione peroxidase E prostaglandins Enzymes inhibitors: Platelet Activating Factor (PAF) Protease inhibitor Anti-inflammatory cytokine: IL-10

  42. Hormones and growth factors • Higher in early mammary secretion (colostrum) • Some hormones are synthesized in mammary cells, transfer from maternal circulation or modified by mammary cells • Mammary synthesis : PRL, GnRH, thyroxine(T4), Triiodothyronine(T3), PTH-rP, estrogen • Transfer from maternal circulation : TRH, progesterone • Modified by mammary cell : increase resistance to digestion in infants’ GI tract : PRL • Growth factors stimulate GI growth in the newborn

  43. Enzymes in human milk • Protective function • Lysozyme • Peroxidase • Antiprotease, catalase, glutathione peroxidase, • PAF-acetylhydrolase • Digestive function • Amylase • Bile salt-stimulate lipase

  44. Comparison of the macronutrient contents of human milk and bovine milk From Neville MC.Physiology of lactation.Clin Perinatol1999;26:257

  45. Comparison of the macronutrient contents of human milk and bovine milk From Neville MC.Physiology of lactation.Clin Perinatol1999;26:257

  46. Protective factors in human milk

  47. Protective nutrients in human milk

  48. Protective nutrients in human milk

  49. Immune protection SIgA – secretory immunoglobulin A is the main component Protects mucosal surfaces eg digestive and respiratory tract Composed of specific antibodies against bacteria that mother has encountered in the environment Includes specific antibodies against diarrhea: giardia, toxigenic E coli, Vibrios, Campylobacter

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