Influence of Homogenization in the Physicochemical Quality of Human Milk and Fat Retention in Gastric Tubes

Abstract

Portuguese

Background:

The retention of human milk nutrients in gastric tubes used to feed premature infants is a challenge to be overcome.

Research Aims:

To evaluate (1) the performance of six homogenizers (mixing processor, piston valve, ultrasonic bath, ultraturrax, stirring mixer, and ultrasound probe) for the fat retention reduction in gastric tubes; (2) the influence of the best homogenization conditions on the fatty acid and protein profiles of human milk; and (3) the cost/benefit ratio for the inclusion of homogenization as a new step in human milk processing.

Methods:

The influence of different levels and times of homogenization on reducing fat retention of human milk in probes was evaluated in this comparative prospective cross-sectional study. After homogenization, human milk flowed through a gavage and infusion pump apparatus used for feeding. Fat content was quantified before and after feeding. The techniques that reduced fat globule sizes and/or promoted a lower percentage of fat holding were evaluated for efficiency, variations in the fatty acid and protein profiles, and energy density and operating costs.

Results:

Homogenization led to a reduction in fat retention in feeding probes. The mixer processor and the ultrasound probe reduced fat retention by 99.23% (SD = 0.07) and 99.95% (SD = 0.02), respectively, and did not negatively influence fatty acid and protein profiles. The mixer processor demonstrated low energy density and low cost for human milk processing.

Conclusion:

Homogenization promoted reduced fat retention in the feed probe and could help maintain fat nutrients of human milk during enteral feeding.

Keywords

breastfeeding cost benefit analysis gavage human milk milk composition milk bank nutrition

Get full access to this article

View all access options for this article.

References

Adamkin

D. H.

Radmacher

P. G.

(2014). Fortification of human milk in very low birth weight infants (VLBW <1500 g birth weight). Clinics in Perinatology, 41(2), 405–421. https://doi.org/10.1016/j.clp.2014.02.010

Adhisivam

Bhat

B. V.

Rao

Kingsley

S. M.

Plakkal

Palanivel

(2018). Effect of holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. The Journal of Maternal-Fetal & Neonatal Medicine, 32(18), 3016–3019. https://doi.org/10.1080/14767058.2018.1455089

Bligh

E. G.

Dyer

W. J.

(1959). A rapid method of total lipid extraction and purification. Canadian Journal of Biochemistry and Physiology, 37(8), 911–917. https://doi.org/10.1139/o59-099.

Borges

M. S.

Oliveira

A. M. M.

Hattori

W. T.

Abdallah

V. O. S.

(2017). Quality of human milk is expressed in a human milk bank and at home. Jornal de Pediatria, 94(4), 399–403. https://doi.org/10.1016/J.JPED.2017.07.004

Brasil

A. N.

V. S.

, (2008). Banco de leite humano: Funcionamento, prevenção e controle de riscos [Human milk bank: Operation, prevention and risk control]. Organização do Banco de Leite e do Posto de Coleta [Organization of the Milk Bank and the Collection Station]. 1st ed. Brasília, Brazil, https://www.anvisa.gov.br/servicosaude/manuais/manual_banco_leite.pdf

Brooke

O. G.

Barley

(1978). Loss of energy during continuous infusions of breast milk. Archives of Disease in Childhood, 53(4), 344–345. https://doi.org/10.1136/adc.53.4.344

Bui

A. T. H.

Cozzolino

Zisu

Chandrapala

(2021). Infrared analysis of ultrasound treated milk systems with different levels of caseins, whey proteins and fat. International Dairy Journal, 117(1), 104983. https://doi.org/10.1016/j.idairyj.2021.104983

Calvo

Lara

N. R. G.

Gormaz

Peña

Lorenzo

M. J. M.

Murillo

P. O.

Sabaté

J. M. B.

Samaniego

C. M.

Gayà

(2018). Recommendations for the creation and operation of maternal milk banks in Spain. Anales de Pediatría (English Edition), 89(1), 65.e1–6.e6. https://doi.org/10.1016/J.ANPEDE.2018.01.007

Chen

Y. J.

Zhou

X. H.

Han

S. M.

H. X.

Liu

Zhang

L.W.

Y. Y.

Jiang

S. L.

Pan

J. C.

C. H.

Wang

B. C.

(2020). Composition analysis of fatty acids and stereo-distribution of triglycerides in human milk from three regions of China. Food Research International, 133, 109196. https://doi.org/10.1016/j.foodres.2020.109196

10.

Cheng

(2018). Codex Alimentarius Commission. Encyclopedia of Food Security and Sustainability, 1, 50–55. https://doi.org/10.1016/B978-0-08-100596-5.22376-7

11.

Davidson

Elabiad

M. T.

(2019). A simple intervention to decrease nutrient losses in continuous feeds with human milk. Journal of Pediatric Gastroenterology and Nutrition, 70(4), e81–e83. https://doi.org/10.1097/MPG.0000000000002609

12.

Demmelmair

Koletzko

(2018). Lipids in human milk. Best Practice & Research Clinical Endocrinology & Metabolism, 32(1), 57–68. https://doi.org/10.1016/J.BEEM.2017.11.002

13.

Ellsworth

Sturza

Stanley

(2020). An alternative to mother’s own milk: Maternal awareness of donor human milk and milk banks. Journal of Human Lactation, 37(1), 62–70. https://doi.org/10.1177/0890334420939549

14.

Gallier

Vocking

Andries

Heijning

B. V.

Acton

Beek

E. M. V. D.

Baalen

T. Van

. (2015). A novel infant milk formula concept: Mimicking the human milk fat globule structure. Colloids and Surfaces B: Biointerfaces, 136, 329–339. https://doi.org/10.1016/j.colsurfb.2015.09.024

15.

Guerra

A. F.

Mellinger-Silva

Rosenthal

Luchese

R. H.

(2018). Hot topic: Holder pasteurization of human milk affects some bioactive proteins. Journal of Dairy Science, 101(4), 2814–2818. https://doi.org/10.3168/jds.2017-13789

16.

Gul

Saricaoglu

F. T.

Mortas

Atalar

Yazici

(2017). Effect of high-pressure homogenization (HPH) on microstructure and rheological properties of hazelnut milk. Innovative Food Science and Emerging Technologies, 41(6), 411–420. https://doi.org/10.1016/j.ifset.2017.05.002

17.

Lamb

R. L.

Haszard

J. J.

Little

H. M. J.

Franks

A. F.

Meeks

M. G.

(2021). Macronutrient composition of donated human milk in a New Zealand population. Journal of Human Lactation, 37(1), 114–121. https://doi.org/10.1177/0890334420963666

18.

Association of Official Agricultural Chemists. (2019). AOAC Official Methods of Analysis. Association of Official Agricultural Chemists. https://www.aoac.org/official-methods-of-analysis-21st-edition-2019/

19.

Lavine

Clark

R. M.

(1989). The effect of short-term refrigeration of milk and addition of breast milk fortifier on the delivery of lipids during tube feeding. Journal of Pediatric Gastroenterology and Nutrition, 8(4), 496–499. https://doi.org/10.1097/00005176-198905000-00013

20.

Lien

E. L.

Richard

Hoffman

D. R.

(2018). DHA and ARA addition to infant formula: Current status and future research directions. Prostaglandins Leukotrienes and Essential Fatty Acids, 128(1), 26–40. https://doi.org/10.1016/j.plefa.2017.09.005

21.

Lin

Pang

Wang

(2018). Simultaneous determination of galactose, glucose, lactose, and galactooligosaccharides in galactooligosaccharides raw materials by high-performance anion-exchange chromatography with pulsed amperometric detection. Food Chemistry, 263, 29–36. https://doi.org/10.1016/j.foodchem.2018.04.092

22.

Mercan

Sert

Akın

(2018). Determination of powder flow properties of skim milk powder produced from high-pressure homogenization treated milk concentrates during storage. LWT, 97, 279–288. https://doi.org/10.1016/j.lwt.2018.07.002

23.

Meredith-Dennis

Goonatilleke

Lebrilla

C. B.

Underwood

M. A.

Smilowitz

J. T.

(2017). Composition and variation of macronutrients, immune proteins, and human milk oligosaccharides in human milk from nonprofit and commercial milk banks. Journal of Human Lactation, 34(1), 120–129. https://doi.org/10.1177/0890334417710635

24.

Narayanan

Singh

Harvey

(1984). Fat loss during feeding of human milk. Archives of Disease in Childhood, 59(5), 475–477. https://doi.org/10.1136/adc.59.5.475

25.

Oliveira

S. C.

Bellanger

Ménard

Pladys

Le Gouar

Henry

Dirson

Rousseau

Carrière

Dupont

Bourlieu Deglaire

(2017). Impact of homogenization of pasteurized human milk on gastric digestion in the preterm infant: A randomized controlled trial. Clinical Nutrition ESPEN, 20(1), 1–11. https://doi.org/10.1016/j.clnesp.2017.05.001

26.

Perrella

Gridneva

Lai

C. T.

Stinson

George

Bilston-John

Geddes

(2021). Human milk composition promotes optimal infant growth, development and health. Seminars in Perinatology, 45 (2), 151380. https://doi.org/10.1016/j.semperi.2020.151380

27.

Picaud

J. C.

Buffin

(2017). Human milk-treatment and quality of banked human milk. Clinics in Perinatology, 44(1), 95–119. https://doi.org/10.1016/j.clp.2016.11.003

28.

Quan

Tao

Qie

Zeng

Qin

Chen

(2020). Effects of high-pressure homogenization, thermal processing, and milk matrix on the in vitro bioaccessibility of phenolic compounds in pomelo and kiwi juices. Journal of Functional Foods, 64(4), 103633. https://doi.org/10.1016/j.jff.2019.103633

29.

Radmacher

P. G.

Adamkin

D. H.

(2017). Fortification of human milk for preterm infants. Seminars in Fetal and Neonatal Medicine, 22(1), 30–35. https://doi.org/10.1016/j.siny.2016.08.004

30.

Silva

M. E. T.

Correa

K. P.

Martins

M. A.

Matta

S. L. P.

Martino

H. S. D.

Coimbra

J. S. R.

(2020). Food safety, hypolipidemic and hypoglycemic activities, and in vivo protein quality of microalga Scenedesmus obliquus in Wistar rats. Journal of Functional Foods, 65, 103711. https://doi.org/10.1016/j.jff.2019.103711

31.

Wang

Hussain

Liu

Zhang

(2020). Effect of lactation stages and dietary intake on the fatty acid composition of human milk (A study in northeast China). International Dairy Journal, 101, 104580. https://doi.org/10.1016/j.idairyj.2019.104580

32.

Zhang

Zhou

(2020). Food bioscience macronutrients, total aerobic bacteria counts, and serum proteome of human milk during refrigerated storage. Food Bioscience, 35, 100562. https://doi.org/10.1016/j.fbio.2020.100562