Dietary Sugars Found In Breast Milk
Condition: Lactation
Study type: Interventional

Summary: 
      The majority of pregnant women in the United States are either overweight or obese at
      conception with their offspring having greater adiposity at birth, a 2-fold greater risk of
      later obesity and neonatal insulin resistance.

      Conventional wisdom holds that breast-milk composition is uniform; recently our group has
      questioned this. An increase in consumption of dietary sugars including fructose over the
      past 30 years has risen, and this has been associated with chronic metabolic and endocrine
      disorders and phenotypic alterations that promote obesity and diabetes. However, no prior
      studies have examined how maternal increases of sugars/fructose during lactation affects
      breast-milk composition with potential transmission to the infant. The objective of this
      proposal is to comprehensively assess the presence and pharmacokinetics of sugars, including
      fructose in human breast-milk in response to maternal consumption. The central hypothesis is
      that a graded, dose-response relationship be-tween maternal adiposity and sugar
      concentrations in breast-milk exist and that milk fructose concentrations are associated with
      altered body composition in the first months of life. This proposal, guided by compelling
      preliminary data will examine the evidence linking high intakes of milk fructose with altered
      metabolism and early obesity by pursuing two Specific Aims: 1) Test novel relationships
      between breast-milk sugars and changes in infant fat mass and 2) Characterize the
      pharmacokinetics of milk sugars after consuming a 20 oz. cola. These aims are significant
      given the intractability of obesity/diabetes and a potentially identifiable novel target,
      making for a clear but powerful public message to reduce sugary beverage consumption during
      lactation.
    

Detailed description: 
      One of the most highly effective preventive measures a mother can make in protecting the
      health of her infant and herself is to breastfeed. Despite extensive research on breast-milk,
      limited information beyond basic micro/macronutrient composition currently exists in the
      literature. Breast-milk is a complex, non-uniform biological substance. In prior studies the
      PI has shown significant associations be-tween non-nutritive constituents in breast-milk
      (e.g. IL-6, TNF-α, insulin, leptin) and body composition in infants starting at 4wks of age.
      The putative causal influence of breastfeeding reducing obesity is mixed with no clear
      probative evidence showing causal pathways. Despite many studies in this area, there are no
      detailed studies that have examined the potential modifying role of maternal diet, especially
      one high in sugars on the compositional makeup of the three largest breast-milk sugars
      (glucose, galactose and lactose) with none to date looking at fructose. Animal models have
      demonstrated that the obesogenic effect of maternal fructose consumption is transmitted to
      offspring via breast-milk with fructose-fed lactating dams producing offspring with double
      fasting insulin levels compared to control pups. This is relevant in humans because of the
      increase in dietary sugar consumption that has occurred in the population.

      A mother/infant cohort (n=37) has been established with detailed infant phenotypic body
      composition (dual-energy X-ray absorptiometry) and detailed breast-milk analysis (insulin,
      leptin, IL-6, TNF-α but no milk sugars other than glucose) in exclusively breast feeding
      mothers varying widely in BMI (19 to 44 kg/m2). Sampling of breast-milk and infant body
      composition occurred at both 4 and 24wks. As a proof of concept, fructose was detected in
      breast-milk from 9 of these mothers which was significantly related to infant body fat, which
      is a novel finding to date and has never been reported in the literature. Building upon this
      prior work this study will determine the concentration and pharmacokinetics of breast-milk
      sugars after a test beverage is consumed.
    

Intervention name(s): Coke; Diet Rite
Intervention type(s): Other; Other
Intervention description(s): Patients were given a 20 ounce bottle of Coke Cola.; Patients were given a 12 ounce can of Diet Rite.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: breast feeding; fructose