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A randomized controlled trial protocol comparing the feeds of fresh versus frozen mother's own milk for preterm infants in the NICU.
Sun, H, Cao, Y, Han, S, Cheng, R, Liu, L, Liu, J, Xia, S, Zhang, J, Li, Z, Cheng, X, et al
Trials. 2020;(1):170
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the leading cause of death among preterm infants born at < 30 weeks' gestation. The incidence of NEC is reduced when infants are fed human milk. However, in many neonatal intensive care units (NICUs), it is standard practice to freeze and/or pasteurize human milk, which deactivates bioactive components that may offer additional protective benefits. Indeed, our pilot study showed that one feed of fresh mother's own milk per day was safe, feasible, and can reduce morbidity in preterm infants. To further evaluate the benefits of fresh human milk in the NICU, a randomized controlled trial is needed. METHODS Our prospective multicenter, double-blinded, randomized, controlled trial will include infants born at < 30 weeks' gestation and admitted to one of 29 tertiary NICUs in China. Infants in the intervention (fresh human milk) group (n = 1549) will receive at least two feeds of fresh human milk (i.e., within 4 h of expression) per day from the time of enrollment until 32 weeks' corrected age or discharge to home. Infants in the control group (n = 1549) will receive previously frozen human milk following the current standard protocols. Following informed consent, enrolled infants will be randomly allocated to the control or fresh human milk groups. The primary outcome is the composite outcome mortality or NEC ≥ stage 2 at 32 weeks' corrected age, and the secondary outcomes are mortality, NEC ≥ stage 2, NEC needing surgery, late-onset sepsis, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), weight gain, change in weight, increase in length, increase in head circumference, time to full enteral feeds, and finally, the number and type of critical incident reports, including feeding errors. DISCUSSION Our double-blinded, randomized, controlled trial aims to examine whether fresh human milk can improve infant outcomes. The results of this study will impact both Chinese and international medical practice and feeding policy for preterm infants. In addition, data from our study will inform changes in health policy in NICUs across China, such that mothers are encouraged to enter the NICU and express fresh milk for their infants. TRIAL REGISTRATION Chinese Clinical Trial Registry; #ChiCTR1900020577; registered January 1, 2019; http://www.chictr.org.cn/showprojen.aspx?proj=34276.
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Genetic Variants in the ELOVL5 but not ELOVL2 Gene Associated with Polyunsaturated Fatty Acids in Han Chinese Breast Milk.
Li, X, Gan, ZW, Ding, Z, Wu, YX, Chen, XY, Tian, HM, Liu, GL, Yang, YT, Xie, L
Biomedical and environmental sciences : BES. 2017;(1):64-67
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Abstract
The present study was designed to examine the contributions of the fatty acid elongase (ELOVL) gene polymorphisms to the levels of polyunsaturated fatty acids (PUFAs) in breast milk. Two hundred and nine healthy Han Chinese mothers were included in the study. Carriers of minor alleles of SNPs (rs2397142 and rs9357760) in ELOVL5 were associated with higher levels of linoleic acid (LA), dihomo-γ-linolenic acid (DGLA), arachidonic acid (AA), docosatetraenoic acid (DTA), docosahexenoic acid (DHA), while in rs209512 of ELOVL5 the carriers of minor alleles had lower levels of DTA compared to major homozygote alleles (P ranged from 0.004-0.046), and genetically explained variability ranged from 3.2% for eicosapentaenoic acid (EPA) to 6.0% for LA. Our findings demonstrated that common variation in ELOVL5 gene encoding rate-limiting enzymes in the metabolism of PUFAs contribute to the PUFAs in breast milk.
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Relationship between polyunsaturated fatty acid levels in maternal diets and human milk in the first month post-partum.
Liu, G, Ding, Z, Li, X, Chen, X, Wu, Y, Xie, L
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2016;(4):405-10
Abstract
BACKGROUND The present study evaluated the relationship between dietary fatty acid (FA) intakes and human milk FA levels. METHODS Healthy lactating women (n = 514) from Northern China participated in the study. Dietary intake was assessed with a 24-h dietary recall questionnaire and evaluated using golden key maternal nutrition software (Wincome, Shanghai, China) and China Food Composition 2009. Human milk FA composition was determined by gas chromatography. RESULTS The maternal daily median intakes of linoleic acid (LA), α-linolenic acid (ALA) and arachidonic acid (AA) were 19.93 g, 3.08 g and 16.33 mg, respectively. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes were below the recommended levels. FA levels in 100 g of human milk were 0.363 g LA, 0.038 g γ-linolenic acid (GLA), 0.052 g dihomo γ-linolenic acid (DGLA), 0.144 g ALA, 0.079 g AA, 0.007 g EPA, 0.018 g docosatetraenoic acid (DTA) and 0.048 g DHA. Multiple linear regression analysis revealed that human milk DGLA levels were negatively correlated with dietary LA intake (β = -0.223, P = 0.030), and human milk GLA and DTA levels were negatively correlated with dietary ALA intake (β = -2.189, P = 0.031; β = -2.252, P = 0.027) after adjusting for possible confounding factors. CONCLUSIONS The results of the present study suggest the presence of competitive interactions between n-3 fatty acids (ALA) and n-6 fatty acids (GLA and DTA).
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Association of polyunsaturated fatty acids in breast milk with fatty acid desaturase gene polymorphisms among Chinese lactating mothers.
Ding, Z, Liu, GL, Li, X, Chen, XY, Wu, YX, Cui, CC, Zhang, X, Yang, G, Xie, L
Prostaglandins, leukotrienes, and essential fatty acids. 2016;:66-71
Abstract
BACKGROUND The fatty acid desaturase (FADS) controls polyunsaturated fatty acid (PUFA) synthesis in human tissues and breast milk. DESIGN Evaluate the influence of 10 single nucleotide polymorphisms (SNPs) and various haplotypes in the FADS gene cluster (FADS1, FADS2, FADS3) on PUFA concentration in the breast milk of 209 healthy Chinese women. PUFA concentrations were measured in breast milk using gas chromatography and genotyping was performed using the Sequenom Mass Array system. RESULTS A SNP (rs1535) and 2-locus haplotypes (rs3834458-rs1535, rs1535-rs174575) in the FADS2 gene were associated with concentrations of γ-linoleic acid (GLA) and arachidonic acid (AA) in breast milk. Likewise, in the FADS1 gene, a 2-locus constructed haplotype (rs174547-rs174553) also affected GLA and AA concentration (P<0.05 for all). Minor allele carriers of the SNP and haplotypes described above had lower concentrations of GLA and AA. In the FADS2 gene, the 3-locus haplotype rs3834458-rs1535-rs174575, significantly affected concentrations of GLA but not AA. Pairwise comparison showed that individuals major homozygous for the SNP rs1000778 in the FADS3 gene had lower concentrations of ALA and linoleic acid (LA) in their breast milk. CONCLUSION Polymorphisms in the FADS gene cluster influence PUFA concentrations in the breast milk of Chinese Han lactating women.
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Adiponectin levels in circulation and breast milk and mRNA expression in adipose tissue of preeclampsia women.
Liu, Y, Zhu, L, Pan, Y, Sun, L, Chen, D, Li, X
Hypertension in pregnancy. 2012;(1):40-9
Abstract
OBJECTIVE Physiological insulin resistance occurs in normal pregnancy and is exaggerated in women with preeclampsia (PE). Adiponectin is a hormone with insulin-sensitizing, anti-atherogenic, and anti-inflammatory properties. Reports published on association between adiponectin levels and PE risk have been conflicting. This study sought to better determine the circulating adiponectin levels and its mRNA expression in adipose tissue in women with PE. METHODS This report includes a cross-sectional study at a Chinese clinical research center and meta-analysis. The cross-sectional study included normal pregnancy women (n = 28) and PE women (n = 20) who underwent cesarean operation. Adiponectin concentrations in maternal serum, cord blood, and colostrums were determined by ELISA. Adiponectin mRNA expression levels in adipose tissue were measured by quantitative real-time PCR. Meta-analysis was done on 13 studies, including 302 PE women and 385 normal pregnancy women. RESULTS In comparison with controls, PE women had higher serum adiponectin concentrations in maternal blood and breast milk, but lower adiponectin concentration in cord blood. Adiponectin mRNA expression in the subcutaneous (Sc) and omental adipose tissues (OM) did not differ between the two groups of women. Meta-analysis confirms that the circulating adiponectin levels were elevated in PE women (p < 0.01). CONCLUSIONS PE women had a higher adiponectin concentration in the maternal blood as well as breast milk but lower adiponectin concentration in umbilical cord blood when compared to women with normal pregnancy. The elevated circulating adiponectin levels in PE women are probably because of a reduced degradation/elimination rather than an increased synthesis of this hormone.
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Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review.
Shi, Z, Yang, Y, Wang, H, Ma, L, Schreiber, A, Li, X, Sun, W, Zhao, X, Yang, X, Zhang, L, et al
Archives of pediatrics & adolescent medicine. 2011;(9):837-46
Abstract
OBJECTIVE To perform a systematic review of prospective studies to confirm the role of breastfeeding in mother-to-child transmission (MTCT) of hepatitis B virus (HBV). DATA SOURCES A database was constructed from MEDLINE, EMBASE, Cochrane Library, National Science Digital Library, and China Biological Medicine Database and through contact with experts in this field from January 1, 1990, to August 31, 2010. STUDY SELECTION All studies were peer reviewed and met the preset inclusion standards. MAIN EXPOSURE Breastfeeding. MAIN OUTCOME MEASURES Data regarding HBV intrauterine infection, MTCT, maternal blood and breast milk infectiousness, infant immunoprophylaxis methods and response, and adverse events. The Mantel-Haenszel fixed-effects model was used for all analyses using odds ratios and 95% confidence intervals. RESULTS Ten qualified studies were included. All were clinical controlled trials, involving 751 infants in the breastfeeding group and 873 infants in the nonbreastfeeding group. As indicated by infant peripheral blood hepatitis B surface antigen or HBV DNA positivity at age 6 to 12 months, the odds ratio of MTCT of HBV in the breastfeeding group compared with that in the nonbreastfeeding group was 0.86 (95% confidence interval, 0.51-1.45) (from 8 clinical controlled trials, P = .56; I(2) = 0%, P = .99). As indicated by infant peripheral blood hepatitis B surface antibody positivity at age 6 to 12 months, the odds ratio of development of hepatitis B surface antibodies in the breastfeeding group compared with that in the nonbreastfeeding group was 0.98 (95% confidence interval, 0.69-1.40) (from 8 clinical controlled trials, P = .93; I(2) = 0%, P = .99). No adverse events or complications during breastfeeding were observed. CONCLUSION Breastfeeding after proper immunoprophylaxis did not contribute to MTCT transmission of HBV.