Maternal diet and human milk composition: an updated systematic review

CONTEXT: Exclusive breastfeeding for 6 months after birth provides infants with the best start for life. A review by Bravi et al. summarized the importance of maternal diet as a determinant of human milk composition based on data up to 2015, but evidence on nutrient intake level was limited. OBJECTIVE: We updated the review by Bravi et al., critically assessed differences in study designs and sampling methods, and graphically visualized trends and associations. DATA SOURCES: PubMed was systematically searched for articles published between January 2015 and March 2021. DATA EXTRACTION: Article screening, selection, and data extraction was done by two independent researchers, including a risk of bias assessment based on 11 criteria. Articles were eligible when including: quantitative information, commonly used effect estimates, healthy mother-infant dyads. RESULTS: Twenty seven observational and five intervention studies were identified ( n  = 7,138) and combined with results of Bravi et al. Fatty acids were still the most studied human milk components in relation to maternal diet ( n  = 17 studies) with maternal fish intake being predominantly positively associated with milk ALA ( r  = 0.28-0.42), DHA ( r  = 0.24-0.46), and EPA ( r  = 0.25-0.28) content. PUFAs from diet were generally positively correlated with their concentrations in milk, while SFA intake was negatively associated with several fatty acids in milk. Studies on associations with maternal diet and milk carbohydrates, proteins, vitamins and minerals were limited in number and varied in methods and results. CONCLUSION: This updated review shows that evidence on the association between maternal diet and human milk fatty acids is rapidly increasing, but still diversified in methodology and results. Further studies, preferably intervention studies, assessing diet and milk carbohydrates, proteins, vitamins and minerals are needed to be able draw conclusions on the importance of maternal diet for human milk composition as a whole

Time Trends in Age at Menarche and Related Non-Communicable Disease Risk during the 20th Century in Mexico

Developed countries have shown a time trend towards a younger age at menarche (AAM), which is associated with increased risk of later obesity and non-communicable diseases. This study aimed to assess whether a time trend in AAM is associated with disease risk in Mexican women (n = 30,826), using data from the Mexican National Health Survey (2000). Linear and log binomial regression was used for nutritional and disease outcomes, while Welch⁻ANOVA was used to test for a time trend. AAM (in years) decreased over time (p < 0.001), with a maximal difference of 0.99 years between the 1920s (13.6 years) and 1980s (12.6 years ). AAM was negatively associated with weight (β = -1.01 kg; 95% CI -1.006, -1.004) and body mass index (BMI) (β = -1.01 kg/m²; -1.007, -1.006), and positively with height (β = 0.18 cm; 0.112, 0.231). AAM was associated with diabetes (RR = 0.95; 0.93, 0.98) and hypercholesterolemia (RR = 0.93; 0.90, 0.95), but not with hypertension, breast cancer or arthritis. In Mexico, AAM decreased significantly during the 20th century. AAM was inversely associated with adult weight and BMI, and positively with height. Women with a later AAM had a lower risk of diabetes and hypercholesterolemia.</p

Table_1_Maternal diet and human milk composition: an updated systematic review.DOCX

ContextExclusive breastfeeding for 6 months after birth provides infants with the best start for life. A review by Bravi et al. summarized the importance of maternal diet as a determinant of human milk composition based on data up to 2015, but evidence on nutrient intake level was limited.ObjectiveWe updated the review by Bravi et al., critically assessed differences in study designs and sampling methods, and graphically visualized trends and associations.Data sourcesPubMed was systematically searched for articles published between January 2015 and March 2021.Data extractionArticle screening, selection, and data extraction was done by two independent researchers, including a risk of bias assessment based on 11 criteria. Articles were eligible when including: quantitative information, commonly used effect estimates, healthy mother-infant dyads.ResultsTwenty seven observational and five intervention studies were identified (n = 7,138) and combined with results of Bravi et al. Fatty acids were still the most studied human milk components in relation to maternal diet (n = 17 studies) with maternal fish intake being predominantly positively associated with milk ALA (r = 0.28–0.42), DHA (r = 0.24–0.46), and EPA (r = 0.25–0.28) content. PUFAs from diet were generally positively correlated with their concentrations in milk, while SFA intake was negatively associated with several fatty acids in milk. Studies on associations with maternal diet and milk carbohydrates, proteins, vitamins and minerals were limited in number and varied in methods and results.ConclusionThis updated review shows that evidence on the association between maternal diet and human milk fatty acids is rapidly increasing, but still diversified in methodology and results. Further studies, preferably intervention studies, assessing diet and milk carbohydrates, proteins, vitamins and minerals are needed to be able draw conclusions on the importance of maternal diet for human milk composition as a whole.</p

Mortality attributable to diabetes in 20-79 years old adults, 2019 estimates: results from the International Diabetes Federation Diabetes Atlas, 9th edition

AIMS: To estimate the number of deaths attributable to diabetes in 20-79-year-old adults in 2019.METHODS: The following were used to estimate the number of deaths attributable to diabetes: all-cause mortality estimates from the World Health Organization life table, country level age- and sex-specific estimates of diabetes prevalence in 2019 and relative risks of death in people with diabetes compared to people without diabetes.RESULTS: An estimated 4.2 million deaths among 20-79-year-old adults are attributable to diabetes. Diabetes is estimated to contribute to 11.3% of deaths globally, ranging from 6.8% (lowest) in the Africa Region to 16.2% (highest) in the Middle East and North Africa. About half (46.2%) of deaths attributable to diabetes occur in people under the age of 60 years. The Africa Region has the highest (73.1%) proportion of deaths attributable to diabetes in people under the age of 60 years, while the Europe Region has the lowest (31.4%).CONCLUSIONS: Diabetes is estimated to contribute to one in nine deaths among adults aged 20-79 years. Prevention of diabetes and its complications is essential, particularly in middle-income countries, where the current impact is estimated to be the largest. Contemporary data from diverse populations are needed to validate these estimates