Premium
Human Milk Fortification for Preterm Infants: Deficiencies and Excesses in Micronutrients
Author(s) -
Koo Winston
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.958.20
Subject(s) - micronutrient , carnitine , fortification , food science , taurine , choline , multivitamin , nutrient , chemistry , vitamin , biochemistry , organic chemistry , amino acid
Background The standard of care in nutrition support for human milk fed small preterm infants especially those with birth weights <1,000g includes the use of fortifier containing multiple nutrients. Micronutrients are critical to physiological function and growth with potential adverse effects from deficient or excessive states. Objective This study aims to determine the extent to which the recommended intake of micronutrients (AAP CON 2013) are met by the use of commercial human milk fortifiers (HMF). Methods. One human milk (HM) based fortifier (liquid only) from manufacturer A was compared with two (liquid and powder) non‐HM based fortifiers from manufacturer B and C respectively, were compared at the same caloric density of the fortified human milk. Both the liquid and powder (if available) preparations were compared. Nutrient contents were provided by each manufacturer at the recommended fortification. Results. Of the 31 micronutrients recommended, manufacturer A, B, and C provided 22, 27 and 23 micronutrients respectively. The number of micronutrients provided were the same within each manufacturer except for one liquid product from manufacturer C which contained 25 micronutrients with the inclusion of choline and inositol. HMF from A and C lack choline, inositol, carnitine, taurine, molybdenum, iodine, selenium and chromium. HMF from A also lack biotin. HMF from B lack carnitine, taurine, molybdenum and chromium. At an isocaloric intake of 130 kcal/kg/d, comparing liquid HMFs, manufacturer A resulted in below the recommended range for fat soluble vitamins by 16 to 95%, water soluble vitamins by 23 to 92%, iron by 84%, and above the recommended range for potassium, copper and manganese by 30, 2 and 109% respectively. HMF B resulted in deficient intake for inositol, sodium and iron by 8, 11 and 62% resp but excessive intake of vitamin A and K by 7 and 34% resp, water soluble vitamins by 21 to 437%, phosphorus, magnesium, copper and manganese by 5 to 66%. HMF C resulted in deficient intake for magnesium by 13% and excessive intake for vitamins A, K and water soluble vitamins, manganese and potassium by 3 to 195%. Conclusions Up to 30% of the micronutrients with well‐defined actions on metabolism or growth are not provided by commercial HMF. All current commercial HMF can result in deficient and excessive intake for various micronutrients. This increases stress on homeostasis especially in patients with dysfunction of organs such as the kidney and liver. Support or Funding Information none