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Metabolisable energy consumption in the exclusively breast-fed infant aged 3–6 months from the developed world: a systematic review

Published online by Cambridge University Press:  08 March 2007

John J. Reilly ,
Susan Ashworth  and
Jonathan C. K. Wells
John J. Reilly*
Affiliation:
University of Glasgow Division of Developmental Medicine, Yorkhill Hospitals, Glasgow G3 8SJ, UK
Susan Ashworth
Affiliation:
University of Glasgow Library, Hillhead Street, Glasgow G12 8QQ, UK
Jonathan C. K. Wells
Affiliation:
MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
*
*Corresponding author: Dr John J. Reilly, fax +44 (0) 141 201 9275, email jjr2y@clinmed.gla.ac.uk
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Abstract

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The present study aimed to evaluate evidence on metabolisable energy consumption and pattern of consumption with age in infants in the developed world who were exclusively breast-fed, at around the time of introducing complementary feeding. We carried out a systematic review aimed at answering three questions: how much milk is transferred from mother to infant?; does transfer increase with the age of the infant?; and what is the metabolisable energy content of breast milk? Thirty-three eligible studies of 1041 mother–infant pairs reported transfer at 3–4 months of age, the weighted mean transfer being 779 (SD 40) g/d. Six studies (99 pairs) measured transfer at 5 months, with a weighted mean transfer of 827 (SD 39) g/d. Five studies (72 pairs) measured milk transfer at 6 months, reporting a weighted mean transfer of 894 (SD 87) g/d. Nine longitudinal studies reported no significant increases in milk transfer after 2–4 months. Twenty-five studies on breast-milk energy content were based on 777 mother–infant pairs. The weighted mean metabolisable energy content was 2·6 (SD 0·2) kJ/g. Breast-milk metabolisable energy content is probably lower, and breast-milk transfer slightly higher, than is usually assumed. Longitudinal studies do not support the hypothesis that breast-milk transfer increases markedly with age. More research on energy intake in 5–6-month-old exclusively breast-fed infants is necessary, and information on the metabolisability of breast milk in mid-infancy is desirable. This evidence should inform future recommendations on infant feeding and help to identify research needs in infant energy balance.

Keywords

Infant nutritionBreast feedingComplementary feedingEnergy metabolism
Type
Research Article
Information
British Journal of Nutrition , Volume 94 , Issue 1 , July 2005 , pp. 56 - 63
Copyright
Copyright © The Nutrition Society 2005

References

Brown, KH, Dewey, KG & Allen, LH (1998) Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Geneva: WHO.Google Scholar
Butte, NF (1986) Breast milk consumption in infancy. In Human Lactation. II. Maternal and Environmental Factors, pp.30–41 [Hamosh, M & Goldman, AS, editor]. New York: Plenum Press.Google Scholar
Butte, NF & Garza, C (1985) Energy and protein intakes of exclusively breast fed infants in the first 4 months of life. In Nutritional Needs and Assessment of Normal Growth, pp.218–232 [Gracey, M & Falkner, F, editors]. Nestle Workshop Series vol. 7. New York: Raven Press.Google Scholar
Butte, NF, Garza, C, Smith, EO & Nichols, B (1984) Human milk intake and growth in exclusively breast-fed infants. J Pediatr 104, 187–195.CrossRefGoogle ScholarPubMed
Butte, NF, Lopez-Alarcon, MG & Garza, C (2002) Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant During the First Six Months of Life. Geneva: WHO.Google Scholar
Butte, NF, Wong, WW, Ferlic, L, Smith, EO, Klein, PD & Garza, C (1990) Energy expenditure and deposition of breast-fed and formula fed infants during early infancy. Pediatr Res 28, 631–640.CrossRefGoogle ScholarPubMed
Butte, NF, Wong, WW, Garza, C, Stuff, JE, Smith, EO, Klein, PD & Nichols, BL (1991) Energy requirements of breast-fed infants. J Am Coll Nutr 10, 190–195.CrossRefGoogle ScholarPubMed
Butte, NF, Wong, WW & Hopkinson, JM (2001) Energy requirements of lactating women derived from doubly-labelled water and milk energy output. J Nutr 131, 53–58.CrossRefGoogle Scholar
Butte, NF, Wong, WW, Hopkinson, JM, Heinz, CJ, Mehta, NR & Smith, EO (2000) Energy requirements derived from total energy expenditure and energy deposition during the first two years of life. Am J Clin Nutr 72, 1558–1569.CrossRefGoogle Scholar
Chandra, RK (1981) Breast-feeding, growth, and morbidity.Nutr Res 1, 25–31.CrossRefGoogle Scholar
de Bruin, NC, Degenhart, HJ, Gal, S, Westerterp, KR, Stijnen, T & Visser, HKA (1998) Energy utilisation and growth in breast-fed and formula-fed infants measured prospectively during the first year of life. Am J Clin Nutr 67, 885–896.CrossRefGoogle ScholarPubMed
Department of Health and Social Security (1977) The Composition of Mature Human Milk. Report on Health and Social Subjects no. 12. London: HMSO.Google Scholar
Dewey, KG (1986) Milk consumption of exclusively breast fed infants. In Human Lactation. II. Maternal and Environmental Factors, pp.47–65 [Hamosh, M & Goldman, AS, editors]. New York: Plenum Press.Google Scholar
Dewey, KG, Heinig, MJ, Nommsen, LA & Lonnerdal, B (1990) Maternal versus infant factors related to breast-milk intake and residual milk volume. Pediatrics 87, 129–137.Google Scholar
Dewey, KG & Lonnerdal, B (1983) Milk and nutrient intakes of breast-fed infants from 1–6 months. J Pediatr Gastroenterol Nutr 2, 497–506.Google Scholar
Dewey, KG & Lonnerdal, B (1986) Infant self regulation of milk intake. Acta Paediatr 75, 893–898.CrossRefGoogle ScholarPubMed
Garza, C & Butte, NF (1986) Energy concentration of human milk estimated from 24-hour pools and various abbreviated sampling schemes. J Pediatr Gastroenterol Nutr 5, 943–948.Google Scholar
Garza, C, Johnson, CA, Smith, EO & Nichols, B (1983) Changes in the nutrient composition of human milk during gradual weaning. Am J Clin Nutr 37, 61–65.Google Scholar
Goldberg, GR, Prentice, AM, Coward, WA, Davies, HL, Murgatroyd, PR, Sawyer, MB, Ashford, JB & Black, AE (1991) Longitudinal assessment of the components of energy balance in well nourished lactating women. Am J Clin Nutr 54, 788–798.Google Scholar
Heinig, MJ, Nommsen, LA, Peerson, JM, Lonnerdal, B & Dewey, KG (1993) Energy and protein intakes of breast-fed and formula-fed infants during the first year of life. Am J Clin Nutr 58, 152–161.CrossRefGoogle ScholarPubMed
Hofvander, Y, Hagman, U, Hillervik, C & Sjolin, S (1982) The amount of milk consumed by 1–3 month old breast-fed or bottle fed infants. Acta Paediatr 73, 40–48.Google Scholar
Kohler, L, Meeuwisse, G & Mortensson, W (1984) Food intake and growth of infants between 6–26 weeks of age. Acta Paediatr 73, 40–48.Google Scholar
Kramer, MS & Kakuma, R (2002) Optimal duration of exclusive breastfeeding (Cochrane Review). In The Cochrane Library, Issue 1, Oxford: Update Software.Google Scholar
Krebs, NF, Reidinger, CJ, Robertson, AD & Hambidge, KM (1994) Growth and intakes of energy and zinc in infants fed human milk. J Pediatr 124, 32–39.Google Scholar
Lanigan, JA, Bishop, JA, Kimber, AC & Morgan, J (2001) Systematic review concerning the age of introduction of complementary foods to the healthy full term infant. Eur J Clin Nutr 55, 309–320.CrossRefGoogle Scholar
Lepage, G, Collet, S, Bougle, D, Kien, LC, Lepage, D, Dallaire, L, Darling, P & Roy, CC (1984) The composition of preterm milk in relation to the degree of prematurity. Am J Clin Nutr 40, 1042–1049.Google Scholar
Lonnerdal, B, Forsum, E & Hambraeus, L (1976) A longitudinal study of the protein, nitrogen, and lactose contents of human milk from Swedish well nourished mothers. Am J Clin Nutr 29, 1127–1133.Google Scholar
Lovelady, CA, Meredith, CN, McCrory, MA, Nommsen, LA, Joseph, LJ & Dewey, KG (1993) Energy expenditure in lactating women: a comparison of doubly-labelled water and heart-rate monitoring methods. Am J Clin Nutr 57, 512–518.Google Scholar
Lucas, A, Ewing, G, Roberts, SB & Coward, WA (1987) How much energy does the breast-fed infant consume and expend?. Br Med J 295, 75–77.CrossRefGoogle ScholarPubMed
Manson, WG & Weaver, LT (1997) Fat digestion in the neonate. Arch Dis Child 76, F206–F211.CrossRefGoogle ScholarPubMed
Matheny, RJ & Picciano, MF (1985) Assessment of abbreviated techniques for determination of milk volume intake of the human milk fed infant. J Pediatr Gastroenterol Nutr 4, 808–812.Google Scholar
Michaelsen, KF, Larsen, PS, Thomsen, BL & Samuelson, G (1994) The Copenhagen Cohort Study on Infant Nutrition and Growth. Am J Clin Nutr 59, 600–611.CrossRefGoogle ScholarPubMed
Michaelsen, KFWeaver, LTBranca, F & Robertson, A (2000) Feeding and Nutrition of Infants and Young Children. WHO Regional Publications Series no. 87. Geneva: WHO.Google Scholar
Mitoulas, LR, Kent, JC, Cox, DB, Owens, RA, Sherriff, JL & Hartmann, PE (2002) Variation in fat, lactose and protein in human milk over 24 hours and throughout the first year of lactation. Br J Nutr 88, 29–37.Google Scholar
Motil, KJ, Sheng, HP, Montandon, CM & Wong, WW (1997) Human milk protein does not limit growth of exclusively breast-fed infants. J Pediatr Gastroenterol Nutr 24, 10–17.Google Scholar
Neville, MC, Keller, R, Seacat, J, Neifert, M, Casey, C, Allen, J & Archer, P (1988) Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 48, 1375–1386.CrossRefGoogle ScholarPubMed
Neville, MC & Rasbach, JO (1988) Is maternal milk production limiting for infant growth during the first year of life in breast-fed infants?. In Human Lactation. III. The Effects of Human Milk on the Recipient Infant, pp.123–133 [Goldman, AS, editor]. New York: Plenum Press.Google Scholar
Nommsen, LA, Lovelady, CA, Heinig, MJ, Lonnerdal, B & Dewey, KG (1991) Determinants of the energy, protein, lipid, and lactose concentrations in human milk during the first twelve months of lactation. Am J Clin Nutr 53, 457–465.CrossRefGoogle Scholar
Pao, EM, Himes, JM & Roche, AF (1980) Milk intakes and feeding patterns of breast-fed infants. J Am Diet Assoc 77, 540–545.CrossRefGoogle ScholarPubMed
Paul, AA, Cole, TJ & Whitehead, RG (1988) Studies in lactation J Hum Nutr Diet 1, 437–450.Google Scholar
Picciano, MF, Calkins, EJ, Garrick, JR & Deering, RH (1981) Milk and mineral intakes of breast-fed infants. Acta Paediatr 70, 189–194.CrossRefGoogle Scholar
Prentice, AM, Paul, AA, Prentice, A, Black, A, Cole, TJ & Whitehead, RG (1986) Cross-cultural differences in lactational performance. In Human Lactation. II. Maternal and Environmental Factors, 121–133 [Hamosh, M & Goldman, AS, editors]. New York: Plenum Press.Google Scholar
Sadurskis, A, Kabir, N, Wager, J & Forsum, E (1988) Energy metabolism, body composition, and milk production in healthy Swedish women during lactation. Am J ClinNutr 48, 44–49.Google ScholarPubMed
Salmenpera, L, Perheentupa, J & Siimes, MA (1985) Exclusively breast-fed healthy infants grow slower than reference infants. Pediatr Res 19, 307–312.CrossRefGoogle ScholarPubMed
Scanlon, KS, Alexander, MP, Serdula, MK, Davis, MK & Bowman, BA (2002) Assessment of infant feeding: the validity of measuring milk intake. Nutrition 60, 235–251.Google ScholarPubMed
Southgate, DAT & Barrett, IM (1966) The intake and excretion of calorific constituents of milk by babies. Br J Nutr 20, 363–372.Google Scholar
Southgate, DAT & Durnin, JVGA (1970) Calorie conversion factors: an experimental reassessment of the factors used in the calculation of the energy value of human diets. Br J Nutr 24, 517–535.Google Scholar
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA & Thacker, SB (2000) Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283, 2008–2012.Google Scholar
Stuff, JE, Garza, C, Boutte, C, Fraley, JK, Smith, EO, Klein, ER & Nichols, BL (1986) Sources of variance in milk and caloric intakes in breast-fed infants. Am J Clin Nutr 43, 361–366.Google Scholar
Stuff, JE & Nichols, BL (1989) Nutrient intake and growth performance of older infants fed human milk. J Pediatr 115, 959–968.CrossRefGoogle ScholarPubMed
Van Raaij, JM, Schonk, CM, Vermat-Miedema, SH, Peek, ME & Hautvast, JG (1991) Energy cost of lactation and energy balance of well nourished lactating women. Am J Clin Nutr 53, 612–619.CrossRefGoogle Scholar
Wells, JC (1994) Energy metabolism in breast-fed and formula-fed infants. PhD Thesis, University of Cambridge.Google Scholar
Whitehead, RG & Paul, AA (1981) Infant growth and human milk requirements. Lancet i, 161–163.CrossRefGoogle Scholar
Whitehead, RG & Paul, AA (2000) Long-term adequacy of exclusive breast-feeding: how scientific research has led to revised opinions. Proc Nutr Soc 59, 17–23.Google Scholar
Whitehead, RG, Paul, AA, Black, AE & Wiles, SJ (1981) Recommended dietary amounts for pregnancy and lactation in the UK. Food Nutr Bull Suppl 5, 259–265.Google Scholar
World Health Organization (1985) The Quantity and Quality of Breastmilk. Collaborative Study on Breastfeeding. Geneva: WHO.Google Scholar
World Health Organization (1995) The World Health Organisation Infant Feeding Recommendation. WHO Weekly Epidemiological Recommendations 17, 117–120.Google Scholar
Wood, CS, Isaacs, PC, Jensen, M & Hilton, HG (1988) Exclusively breast-fed infants: growth and caloric intake. Pediatr Nurs 14, 117–124.Google ScholarPubMed
Zoppi, G, Andreotti, G, Pajno-Ferrara, FNjai, DMGarburro, D (1972) Exocrine pancreas function in premature and full-term neonates. Pediatr Res 6, 880–886.Google Scholar