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Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds.
PLoS One. 2016; 11(2):e0148941.Plos

Abstract

For preterm infants, it is common practice to add human milk fortifiers to native breast milk to enhance protein and calorie supply because the growth rates and nutritional requirements of preterm infants are considerably higher than those of term infants. However, macronutrient intake may still be inadequate because the composition of native breast milk has individual inter- and intra-sample variation. Target fortification (TFO) of breast milk is a new nutritional regime aiming to reduce such variations by individually measuring and adding deficient macronutrients. Added TFO components contribute to the final osmolality of milk feeds. It is important to predict the final osmolality of TFO breast milk to ensure current osmolality recommendations are followed to minimize feeding intolerance and necrotizing enterocolitis. This study aims to develop and validate equations to predict the osmolality of TFO milk batches. To establish prediction models, the osmolalities of either native or supplemented breast milk with known amounts of fat, protein, and carbohydrates were analyzed. To validate prediction models, the osmolalities of each macronutrient and combinations of macronutrients were measured in an independent sample set. Additionally, osmolality was measured in TFO milk samples obtained from a previous clinical study and compared with predicted osmolality using the prediction equations. Following the addition of 1 g of carbohydrates (glucose polymer), 1 g of hydrolyzed protein, or 1 g of whey protein per 100 mL breast milk, the average increase in osmolality was 20, 38, and 4 mOsm/kg respectively. Adding fat decreased osmolality only marginally due to dilution effect. Measured and predicted osmolality of combinations of macronutrients as well as single macronutrient (R2 = 0.93) were highly correlated. Using clinical data (n = 696), the average difference between the measured and predicted osmolality was 3 ± 11 mOsm/kg and was not statistically significant. In conclusion, the prediction model can be utilized to estimate osmolality values after fortification.

Authors+Show Affiliations

Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26863130

Citation

Choi, Arum, et al. "Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds." PloS One, vol. 11, no. 2, 2016, pp. e0148941.
Choi A, Fusch G, Rochow N, et al. Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds. PLoS ONE. 2016;11(2):e0148941.
Choi, A., Fusch, G., Rochow, N., & Fusch, C. (2016). Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds. PloS One, 11(2), e0148941. https://doi.org/10.1371/journal.pone.0148941
Choi A, et al. Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds. PLoS ONE. 2016;11(2):e0148941. PubMed PMID: 26863130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds. AU - Choi,Arum, AU - Fusch,Gerhard, AU - Rochow,Niels, AU - Fusch,Christoph, Y1 - 2016/02/10/ PY - 2015/08/31/received PY - 2016/01/23/accepted PY - 2016/2/11/entrez PY - 2016/2/11/pubmed PY - 2016/7/19/medline SP - e0148941 EP - e0148941 JF - PloS one JO - PLoS ONE VL - 11 IS - 2 N2 - For preterm infants, it is common practice to add human milk fortifiers to native breast milk to enhance protein and calorie supply because the growth rates and nutritional requirements of preterm infants are considerably higher than those of term infants. However, macronutrient intake may still be inadequate because the composition of native breast milk has individual inter- and intra-sample variation. Target fortification (TFO) of breast milk is a new nutritional regime aiming to reduce such variations by individually measuring and adding deficient macronutrients. Added TFO components contribute to the final osmolality of milk feeds. It is important to predict the final osmolality of TFO breast milk to ensure current osmolality recommendations are followed to minimize feeding intolerance and necrotizing enterocolitis. This study aims to develop and validate equations to predict the osmolality of TFO milk batches. To establish prediction models, the osmolalities of either native or supplemented breast milk with known amounts of fat, protein, and carbohydrates were analyzed. To validate prediction models, the osmolalities of each macronutrient and combinations of macronutrients were measured in an independent sample set. Additionally, osmolality was measured in TFO milk samples obtained from a previous clinical study and compared with predicted osmolality using the prediction equations. Following the addition of 1 g of carbohydrates (glucose polymer), 1 g of hydrolyzed protein, or 1 g of whey protein per 100 mL breast milk, the average increase in osmolality was 20, 38, and 4 mOsm/kg respectively. Adding fat decreased osmolality only marginally due to dilution effect. Measured and predicted osmolality of combinations of macronutrients as well as single macronutrient (R2 = 0.93) were highly correlated. Using clinical data (n = 696), the average difference between the measured and predicted osmolality was 3 ± 11 mOsm/kg and was not statistically significant. In conclusion, the prediction model can be utilized to estimate osmolality values after fortification. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26863130/Target_Fortification_of_Breast_Milk:_Predicting_the_Final_Osmolality_of_the_Feeds_ L2 - http://dx.plos.org/10.1371/journal.pone.0148941 DB - PRIME DP - Unbound Medicine ER -