433 - Macronutrient Analysis Revealed Higher Caloric Content in Pooled Donor Human Milk Due to Shift in Nutrient Content
Sunday, April 24, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 433 Publication Number: 433.302
Kate Beard, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Caitlin Irwin, Indiana University School of Medicine, Avon, IN, United States; Clare McLaughlin, Riley Hospital for Children, Indianapolis, IN, United States; Wendy Cruse, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Kok Lim Kua, Indiana University School of Medicine, Indianapolis, IN, United States
Registered Dietitian Riley Hospital for Children at Indiana University Health Indianapolis, Indiana, United States
Background: Pasteurized donor human milk (DHM) is the recommended alternative enteral nutrition for very low birth weight (VLBW) infants when mothers experience difficulty producing sufficient breast milk. Macronutrient content of DHM is often lower than mother’s own milk, and it is critical to provide appropriate nutritional intake to optimize growth of VLBW infants. DHM in the United States in purchased predominately from milk banks managed by the Human Milk Banking Association of North America (HMBANA). The Milk Bank of Indiana labels DHM bottles with analyzed protein concentration and presumed caloric concentration of 20kcal/oz. Caloric content, along with protein, carbohydrate (lactose), and fat concentration of DHM in Indiana has not been extensively studied.
Objective: We hypothesize that the measured caloric and macronutrient content of DHM in Indiana would be similar to milk bank labelled levels.
Design/Methods: 65 separate pools of DHM were analyzed over the course of 7 months (May 2021 – Dec 2021). The protein, fat, and lactose contents of DHM were measured using the FDA-approved Human Milk Analyzer (MIRIS AB, Uppsala, Sweden) according to manufacturer instruction. The HMA is based on semi-solid mid-infrared transmission spectroscopy with wavebands specific for (5.7 µm), protein (6.5 µm); and lactose (9.6 µm). The protein concentration (g/dL), protein calorie (g protein/100kcal), and caloric content (kcal/oz) measured using HMA were compared to levels measured by the milk bank (Lactoscope, mid-infrared spectroscopy) using paired t-test.
Results: Compared to the presumed caloric content of 20kcal/oz, DHM had higher caloric content (mean 22.7±0.3 kcal/oz, p< 0.05 vs presumed caloric content) when analyzed using the HMA. True protein content was lower than milk bank labels (8.4% lower; Lactoscope 0.85±0.012 vs. HMA 0.78± 0.013 g/dL*), leading to reduced protein calorie ratios (~18% lower; Lactoscope 1.26±0.01 vs. HMA 1.03 ±0.02 g/100kcal*). The discrepancy between protein concentration and protein calorie ratio is potentially due to higher fat concentration in DHM (4.3±0.1 g/dL, published data 2.9-3.5g/dL). *p < 0.05Conclusion(s): In summary, our preliminary study demonstrates significant differences between milk bank labelled protein concentration and subsequent protein calorie ratios, and a higher caloric concentration in Indiana DHM. Indiana DHM may be lower in protein and higher in calories than anticipated. Preterm infants receiving primarily DHM may benefit from individualized fortification strategies to meet protein and energy goals.