Reference values for fat-soluble vitamins in human milk: The Mothers, Infants and Lactation Quality (MILQ) Study

Authors: KAC, GILBERTO - Universidade Federal Do Rio De Janeiro; JONES, KERRY - University Of Cambridge; MEADOWS, SARAH - University Of Cambridge; HAMPEL, DANIELA - University Of California, Davis; ISLAM, M. MUNIRUL - Icddr,b; MOLGAARD, CHRISTIAN - University Of Copenhagen; MOORE, SOPHIE - King'S College; Dror, Daphna; Shahab-Ferdows, Setareh; DE BARROS MUCCI, DANIELA - Universidade Federal Do Rio De Janeiro; FIGUEREDO, AMANDA - Universidade Federal Do Rio De Janeiro; PEERSON, JANET - Consultant; Allen, Lindsay

Submitted to: Advances in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/15/2025
Publication Date: 8/26/2025
Citation: Kac, G., Jones, K.S., Meadows, S.R., Hampel, D., Islam, M., Molgaard, C., Moore, S.K., Dror, D.K., Shahab-Ferdows, S., De Barros Mucci, D., Figueredo, A.C., Peerson, J.M., Allen, L.H. 2025. Reference values for fat-soluble vitamins in human milk: The Mothers, Infants and Lactation Quality (MILQ) Study. Advances in Nutrition. https://doi.org/10.1016/j.advnut.2025.100484.
DOI: https://doi.org/10.1016/j.advnut.2025.100484

Interpretive Summary: Our research has developed Reference Values (RVs) for nutrients in human milk and this sixth articles in a series describes the values for the fat soluble vitamins A, E, and D. RVs are needed to evaluate if nutrient concentrations in milk are adequate. To estimate RVs, the Mothers, Infants and Lactation Quality (MILQ) study collected breastmilk samples at four times during lactation, from 1,882 well-nourished but unsupplemented mothers in Bangladesh, Brazil, Denmark, and The Gambia. The concentrations of vitamins A, E and D from the MILQ study were compared with those used by the Institute of Medicine (IOM) for setting recommendations for nutrient requirements of infants. MILQ estimates were slightly below the IOM reference value for vitamin A (93%) and much lower for vitamin E (alpha-tocopherol, 69%). The estimate of 0.89 mg/L gamma tocopherol (another form of vitamin E) is novel, given that the IOM does not have an existing reference concentration. While it is known that human milk does not meet infant requirements for vitamin D, values from the MILQ study are even lower, by 60-80%, than those estimated by the IOM. The MILQ fat soluble vitamin estimated percentile curves are provided to enable comparison and interpretation of data from other studies.

Technical Abstract: This fifth article in the series presenting Reference Values (RVs) for nutrients in human milk describes the values for the fat soluble vitamins A, E, and D. The Mothers, Infants and Lactation Quality (MILQ) and Early-MILQ (E-MILQ) studies collected human milk samples at four times during the first 8.5 months of lactation, from 1,882 well-nourished but unsupplemented women in Bangladesh, Brazil, Denmark, and The Gambia. Vitamins A and E were measured by HPLC, while vitamin D was measured by LC-MS/MS. Milk fat soluble vitamin concentrations from the MILQ study were compared with those used by the Institute of Medicine (IOM) for setting recommendations for nutrient requirements of infants. MILQ estimates were slightly below the IOM reference value for retinol activity equivalents (RAE, 93%) and much lower for alpha-tocopherol (69%). The estimate of 0.89 mg/L gamma-tocopherol is novel, given that the IOM does not have an existing reference concentration. While it is known that human milk does not meet infant requirements for vitamin D, results of the MILQ study suggest that actual median concentrations are even lower, by 60-80% than those estimated by the IOM. The MILQ fat soluble vitamin estimated percentile curves are provided to enable comparison and interpretation of data from other studies.