A systematic review and meta-analysis of the nutrient content of preterm and term breast milk.
A systematic review and meta-analysis of the nutrient content of preterm and term breast milk.
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对早产儿和足月母乳营养成分的系统回顾和荟萃分析。
DOI：
10.1186/1471-2431-14-216
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发表时间：
2014-08-30
期刊：
影响因子：
2.4
通讯作者：
Fenton TR
中科院分区：
文献类型：
--
作者：
Gidrewicz DA;Fenton TR
母乳的营养成分随早产儿和产后年龄而变化。我们的目的是对早产儿和足月儿母乳营养成分（能量、蛋白质、乳糖、低聚糖、脂肪、钙和磷）进行荟萃分析，并评估胎龄和出生后年龄的影响。此外，我们通过实验室方法评估了能量（测量值与计算值）和蛋白质（真实蛋白质测量值与总氮估计值）的差异。以图形方式总结了系统性综述结果，以说明足月和早产母乳成分随时间的变化。由于母乳脂肪含量在不同饲料和每日中存在差异，为了获得准确的估计值，我们将脂肪和能量的荟萃分析限制在24小时母乳采集中。41项研究符合纳入标准：26项（843名母亲）早产研究和30项（2299名母亲）母乳成分研究。早产儿乳汁中的真蛋白质含量高于足月儿乳汁，初乳中的差异高达35%（0.7 g/dL），然而，出生后第3天后，早产儿乳汁和足月儿乳汁中的真蛋白质差异大多在0.2 g/dL范围内，第10-12周的估计值表明，到该年龄时，足月儿乳汁可能与早产儿乳汁相同。初乳中蛋白质含量高于成熟乳，能量、脂肪和乳糖含量低于成熟乳。母乳成分在2至12周之间相对稳定。随着牛奶的成熟，蛋白质的差异缩小。无论是测量还是计算，能量估计值的差异在-9%至13%之间;真实蛋白质测量值与总氮估计值的差异在1%至37%之间。尽管母乳在个体之间差异很大，但出生后年龄和妊娠阶段（早产与足月）被认为是母乳含量的重要预测因素。从常量营养素计算的母乳能量含量提供了测量能量的差估计，并且从氮估计的蛋白质高估了蛋白质乳含量。当母乳能量、常量营养素和矿物质含量不能直接测量时，这些荟萃分析的平均值可能提供母乳能量和营养素含量的有用估计。
Breast milk nutrient content varies with prematurity and postnatal age. Our aims were to conduct a meta-analysis of preterm and term breast milk nutrient content (energy, protein, lactose, oligosaccharides, fat, calcium, and phosphorus); and to assess the influence of gestational and postnatal age. Additionally we assessed for differences by laboratory methods for: energy (measured vs. calculated estimates) and protein (true protein measurement vs. the total nitrogen estimates). Systematic review results were summarized graphically to illustrate the changes in composition over time for term and preterm milk. Since breast milk fat content varies within feeds and diurnally, to obtain accurate estimates we limited the meta-analyses for fat and energy to 24-hour breast milk collections. Forty-one studies met the inclusion criteria: 26 (843 mothers) preterm studies and 30 (2299 mothers) term studies of breast milk composition. Preterm milk was higher in true protein than term milk, with differences up to 35% (0.7 g/dL) in colostrum, however, after postnatal day 3, most of the differences in true protein between preterm and term milk were within 0.2 g/dL, and the week 10–12 estimates suggested that term milk may be the same as preterm milk by that age. Colostrum was higher than mature milk for protein, and lower than mature milk for energy, fat and lactose for both preterm and term milk. Breast milk composition was relatively stable between 2 and 12 weeks. With milk maturation, there was a narrowing of the protein variance. Energy estimates differed whether measured or calculated, from −9 to 13%; true protein measurement vs. the total nitrogen estimates differed by 1 to 37%. Although breast milk is highly variable between individuals, postnatal age and gestational stage (preterm versus term) were found to be important predictors of breast milk content. Energy content of breast milk calculated from the macronutrients provides poor estimates of measured energy, and protein estimated from the nitrogen over-estimates the protein milk content. When breast milk energy, macronutrient and mineral content cannot be directly measured the average values from these meta-analyses may provide useful estimates of mother’s milk energy and nutrient content.
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