NIH workshop on human milk composition: summary and visions

Authors: CASAVALE, KELLIE - Health & Human Services; Ahuja, Jaspreet; Wu, Xianli; LI, YING - University Of Maryland; QUAM, JULIA - Health & Human Services; OLSON, RICHARD - Health & Human Services; Pehrsson, Pamela; Allen, Lindsay - A; BALENTINE, DOUGLAS - Health & Human Services; HANSPAL, MANJIT - Health & Human Services; HAYWARD, DEBORAH - Health Canada; HINES, ERIN - Environmental Protection Agency (EPA); MCCLUNG, JAMES - Department Of Defense; PERRINE, CRIA - Health & Human Services; BELFORT, MANDY - Harvard Medical School; DALLAS, DAVID - Oregon State University; GERMAN, DALLAS - University Of California, Davis; KIM, JAE - University Of California; MCGUIRE, MARK - University Of Idaho; MCGUIRE, MICHELLE - Washington State University; MORROW, ARDYTHE - Children'S Hospital - Cincinnati, Ohio; NEVILLE, MARGARET - University Of Colorado; NOMMSEN-RIVERS, LAURIE - University Of Cincinnati; RASAMUSSEN, KATHLEEN - Cornell University; ZEMPLENI, JANOS - University Of Nebraska; LYNCH, CHRISTOPHER - National Institutes Of Health (NIH)

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/15/2019
Publication Date: 7/9/2019
Citation: Casavale, K.O., Ahuja, J.K., Wu, X., Li, Y., Quam, J., Olson, R., Pehrsson, P.R., Allen, L.H., Balentine, D., Hanspal, M., Hayward, D., Hines, E.P., McClung, J., Perrine, C., Belfort, M.B., Dallas, D., German, D., Kim, J., McGuire, M., McGuire, M. Morrow, A., Nommsen-Rivers, Rasmussen, K.M., Zempleni, J., Lynch, C. 2019. NIH workshop on human milk composition: summary and visions. American Journal of Clinical Nutrition. 110(3):769-779. https://doi.org/10.1093/ajcn/nqz123.
DOI: https://doi.org/10.1093/ajcn/nqz123

Interpretive Summary: Research initiatives on human milk, the most fundamental and important biological food, have been limited in focus in the United States and Canada. Nationally representative data from mother-child dyads that capture human milk composition (HMC) and associated health outcomes are crucial to advancing the evidence to inform federal nutrition and related health programs, policies, and consumer information across the governments in the United States and Canada as well as in non-government sectors. In response to identified gaps in knowledge, the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health sponsored the “Workshop on Human Milk Composition – Biological, Environmental, Nutritional, and Methodological Considerations” held on November 16-17, 2017, in Bethesda, Maryland. The workshop identified major knowledge gaps to include lack of standardized collection, storage, and analytical methods for many components in the HM matrix, and limited understanding of changes in composition during lactation and from the impact of maternal and environmental factors, leading to lack of robust estimates of “reference” and “standard” HMC and volume in the United States and Canada. Efforts to fill these gaps are essential to provide basic foundational tools for researchers to conduct comprehensive investigations on the factors that influence HMC and their relationship to maternal and infant health. Subsequently, this work can lead to dietary guidelines to inform public health policies, programs, and regulations for HM and related products and extensions into clinical practice applications to support short- and long term goals for maternal and infant health.

Technical Abstract: Nationally representative data from mother-child dyads that capture human milk composition (HMC) and associated health outcomes are crucial to advancing the evidence to inform federal nutrition and related health programs, policies, and consumer information across the governments in the United States and Canada as well as in non-government sectors. In response to identified gaps in knowledge, the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health sponsored the “Workshop on Human Milk Composition – Biological, Environmental, Nutritional, and Methodological Considerations” held on November 16-17, 2017, in Bethesda, Maryland. Through presentations and discussions, the workshop aimed to: 1) share knowledge on the scientific need for data on HMC; 2) explore the current understanding of factors affecting HMC; 3) identify methodological challenges in human milk (HM) collection, storage, and analysis; and 4) develop a vision for a research program to develop a HMC data repository and database. The four workshop sessions included: 1) perspectives from both federal agencies and non-federal academic experts, articulating scientific needs for data on HMC that could lead to new research findings and programmatic advances to support public health; 2) information about the factors that influence lactation and/or HMC; 3) considerations for data quality including addressing sampling strategies and the complexities in standardizing collection, storage, and analyses of HM; and 4) insights on how existing research programs and databases can inform potential visions for HMC initiatives. From the general consensus of this workshop, the limited scope of HM research initiatives has led to a lack of robust estimates of the composition and volume of HM consumed, and consequently, missed opportunities to improve maternal and infant health.