OBES SURG DOI 10.1007/s11695-015-1610-1
BRIEF COMMUNICATION
Breast Milk Macronutrient Composition After Bariatric Surgery Goele Jans & Christophe Matthys & Matthias Lannoo & Bart Van der Schueren & Roland Devlieger
# Springer Science+Business Media New York 2015
Abstract Breast milk samples from 12 lactating women with bariatric surgery were investigated by comparing the macronutrient and energy content with samples from 36 non-surgical controls. Samples were analyzed with the Human Milk Analyzer and the maternal diet 24 h prior to sampling with a food record. A higher fat, energy, and a slightly higher carbohydrate milk content was found in the surgical group compared to the G. Jans : R. Devlieger Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
non-surgical group (3.0 ± 0.7 versus 2.2 ± 0.9 g/100 ml, P=0.008; 61.0±7.2 versus 51.7±9 kcal/100 ml, P=0.002; and 6.6±0.6 versus 6.3±0.4 g/100 ml, P=0.045, respectively). No correlations and no strong explanatory variance were found between milk macronutrient composition and corresponding maternal dietary intake. The nutritional value of breast milk after bariatric surgery appears to be at least as high as in nonsurgical controls. Keywords Lactation . Macronutrients . Body mass index . Bariatric surgery . Maternal diet
G. Jans e-mail: [email protected] C. Matthys : M. Lannoo : B. Van der Schueren Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium C. Matthys e-mail: [email protected] M. Lannoo e-mail: [email protected] B. Van der Schueren e-mail: [email protected] C. Matthys : B. Van der Schueren Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium M. Lannoo Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium R. Devlieger (*) Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium e-mail: [email protected] R. Devlieger Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk, Belgium
Introduction Breastfeeding is generally regarded as the number one option to provide newborns with all nutrients required for a healthy growth and development. However, concerns rise whether caution is needed in lactating women with bariatric surgery. This type of abdominal surgery aims to generate significant long-term weight loss by restricting the macronutrient intake as a result of malabsorption. This malabsorption potentially results in nutrient deficiencies which are reflected in lower serum concentrations [1]. The lower serum concentrations potentially result in lower energy and macronutrient content in the breast milk. Some authors have reported negative outcomes in exclusively breastfed children of mothers with bariatric surgery. For vitamin B12, low levels in the mother and breast milk have been documented resulting in symptomatically depleted children [2, 3]. No systematic analysis of human milk macronutrients has been published in this specific population. The aim of the study was to compare the macronutrient and energy content of breast milk from lactating women with bariatric surgery with obese, overweight, and normal weight controls.
OBES SURG
Materials and Methods The study was conducted at the University Hospital Leuven, Belgium. Ethical approval has been obtained from the local ethical committee (S54464). Lactating women, who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycemic, and who were not on predefined medication, were invited. The milk sample was gathered in a standardized manner 4 days after delivery. Two trained researchers assisted with sample collection. They instructed participants to contact them before starting to breastfeed. Infants were fed for 3 min before collection of 5 ml occurred manually or by use of an electric pump. Samples were immediately frozen at −80 °C and afterwards analyzed with the Human Milk Analyzer (MIRIS®, HMA) [4]. Values were compared with the reference values for colostrum as presented in the UK Food Composition Table (Table 1). The maternal diet 24 h prior to sampling was questioned by using an estimated dietary record method, and analyzed with a self-developed software program based on the Belgian Food Composition Database (NUBEL). Baseline characteristics (maternal age, parity, pre-pregnancy body mass index (BMI), and relevant pregnancy outcomes) were retrieved from the electronic patient file. Statistical analyses were performed using the SPSS software (IBM SPSS Statistics Version 19). The normality of continuous variables was tested using the Shapiro–Wilk-test. The Student’s t test or non-parametrical Mann–Whitney U test examined differences in continuous variables between two groups. A one-way ANOVA or non-parametrical Kruskal– Wallis test examined differences in continuous variables between more than two groups. Pearson and Spearman correlation coefficients examined correlations between two continuous variables. Regression analyses evaluated causal relations. A P value
BRIEF COMMUNICATION
Breast Milk Macronutrient Composition After Bariatric Surgery Goele Jans & Christophe Matthys & Matthias Lannoo & Bart Van der Schueren & Roland Devlieger
# Springer Science+Business Media New York 2015
Abstract Breast milk samples from 12 lactating women with bariatric surgery were investigated by comparing the macronutrient and energy content with samples from 36 non-surgical controls. Samples were analyzed with the Human Milk Analyzer and the maternal diet 24 h prior to sampling with a food record. A higher fat, energy, and a slightly higher carbohydrate milk content was found in the surgical group compared to the G. Jans : R. Devlieger Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
non-surgical group (3.0 ± 0.7 versus 2.2 ± 0.9 g/100 ml, P=0.008; 61.0±7.2 versus 51.7±9 kcal/100 ml, P=0.002; and 6.6±0.6 versus 6.3±0.4 g/100 ml, P=0.045, respectively). No correlations and no strong explanatory variance were found between milk macronutrient composition and corresponding maternal dietary intake. The nutritional value of breast milk after bariatric surgery appears to be at least as high as in nonsurgical controls. Keywords Lactation . Macronutrients . Body mass index . Bariatric surgery . Maternal diet
G. Jans e-mail: [email protected] C. Matthys : M. Lannoo : B. Van der Schueren Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium C. Matthys e-mail: [email protected] M. Lannoo e-mail: [email protected] B. Van der Schueren e-mail: [email protected] C. Matthys : B. Van der Schueren Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium M. Lannoo Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium R. Devlieger (*) Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium e-mail: [email protected] R. Devlieger Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk, Belgium
Introduction Breastfeeding is generally regarded as the number one option to provide newborns with all nutrients required for a healthy growth and development. However, concerns rise whether caution is needed in lactating women with bariatric surgery. This type of abdominal surgery aims to generate significant long-term weight loss by restricting the macronutrient intake as a result of malabsorption. This malabsorption potentially results in nutrient deficiencies which are reflected in lower serum concentrations [1]. The lower serum concentrations potentially result in lower energy and macronutrient content in the breast milk. Some authors have reported negative outcomes in exclusively breastfed children of mothers with bariatric surgery. For vitamin B12, low levels in the mother and breast milk have been documented resulting in symptomatically depleted children [2, 3]. No systematic analysis of human milk macronutrients has been published in this specific population. The aim of the study was to compare the macronutrient and energy content of breast milk from lactating women with bariatric surgery with obese, overweight, and normal weight controls.
OBES SURG
Materials and Methods The study was conducted at the University Hospital Leuven, Belgium. Ethical approval has been obtained from the local ethical committee (S54464). Lactating women, who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycemic, and who were not on predefined medication, were invited. The milk sample was gathered in a standardized manner 4 days after delivery. Two trained researchers assisted with sample collection. They instructed participants to contact them before starting to breastfeed. Infants were fed for 3 min before collection of 5 ml occurred manually or by use of an electric pump. Samples were immediately frozen at −80 °C and afterwards analyzed with the Human Milk Analyzer (MIRIS®, HMA) [4]. Values were compared with the reference values for colostrum as presented in the UK Food Composition Table (Table 1). The maternal diet 24 h prior to sampling was questioned by using an estimated dietary record method, and analyzed with a self-developed software program based on the Belgian Food Composition Database (NUBEL). Baseline characteristics (maternal age, parity, pre-pregnancy body mass index (BMI), and relevant pregnancy outcomes) were retrieved from the electronic patient file. Statistical analyses were performed using the SPSS software (IBM SPSS Statistics Version 19). The normality of continuous variables was tested using the Shapiro–Wilk-test. The Student’s t test or non-parametrical Mann–Whitney U test examined differences in continuous variables between two groups. A one-way ANOVA or non-parametrical Kruskal– Wallis test examined differences in continuous variables between more than two groups. Pearson and Spearman correlation coefficients examined correlations between two continuous variables. Regression analyses evaluated causal relations. A P value
