European Journal of Clinical Nutrition (2006) 60, 1400–1405

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ORIGINAL ARTICLE
The influence of Iraqi mothers’ socioeconomic status
on their milk-lipid content
YY Al-Tamer1 and AA Mahmood2

1
Ninevah Medical College, University of Mosul, Mosul, Iraq; 2Department of Chemistry, College of Education, University of Mosul,
Mosul, Iraq

Objective: To investigate the lipid content and fatty acid (FA) composition, especially n3 long-chain polyunsaturated fatty acids
(n3 LCPUFAs) of mature breast-milk of Iraqi mothers and their relation to the socioeconomic status of the mothers.
Design: A collection of mature breast-milk of mothers with three different socioeconomic status (lactation period 571 month).
Setting: Mosul province (in the north of Iraq).
Subjects: Mature breast-milk samples were obtained from a group of 20- to 35-year-old mothers with different socioeconomic
status: high urban (HU, n ¼ 25), low urban (LU, n ¼ 15) and typical suburban (SU, n ¼ 25).
Procedure: Mature-milk samples were collected from each lactating mother. The lipid components of each sample, namely
triglycerides (TGs), cholesterol (C) and phospholipids (PLs) were determined enzymatically. After their separation and
esterification, FAs were determined as FA methyl esters by capillary gas chromatography.
Results: The percentages of n3 LCPUFAs were 0.4870.025, 0.3770.029 and 0.3870.018% for HU, LU and SU mothers,
respectively. The amount of TGs, the major component of milk lipid, was 5.6470.24, 5.2171.61 and 3.2170.92 g/100 ml for
HU, SU and LU mothers, respectively. The milk-lipid content varied with the socioeconomic status.
Conclusion: The socioeconomic status of lactating mothers affected the lipid content and FA composition, especially the level of
n3 LCPUFAs (the very important structural constituents of the retina, brain and other nervous tissues). Mature breast-milk for the
studied groups was low in n3 LCPUFAs compared with that of mothers from developed countries and that recommended by
WHO for optimum infant nutrition.
Sponsorship: Supported by grants from Department of Chemistry, University of Mosul. The analysis of FA methyl ester samples
was performed at the National Centre for Scientific Research, France.
European Journal of Clinical Nutrition (2006) 60, 1400–1405. doi:10.1038/sj.ejcn.1602470; published online 14 June 2006

Keywords: mature breast-milk; lipid content; arachidonic acid; docosahexaenoic acid; n3 long-chain polyunsaturated fatty acids

Introduction the duration of lactation (Hawk et al., 1954; Bitman et al.,

Breast-milk is the most complete food the mother can offer
her infant, with just the right levels and quality of nutrients
to suit child food needs (Ambartsumyan, 1998). The
composition of mature breast-milk may undergo some
variation depending on the mother’s nutritional status and
Correspondence: Dr YY Al-Tamer, Ninevah Medical College, University of
Mosul, Mosul, Iraq.
E-mail: Yassar_altamer@yahoo.co.uk
Guarantor: YY Al-Tamer.
Contributors: YYA conceived and planned the study, prepared the initial
manuscript and wrote the revised version. AAM performed the sampling and
all laboratory works, participated in statistical analysis and reading the final
manuscript.
Received 23 February 2005; revised 19 May 2006; accepted 19 May 2006;
published online 14 June 2006
1983; Brown et al., 1986; Lonnerdal, 1986; Yoneyama et al.,
1994). Under mother’s optimal nutrition and living condi-
tions, breast-milk alone provides enough energy from fat and
all n6, n3 parent essential fatty acids (EFAs) as well as derived
long-chain polyunsaturated fatty acids (LCPUFAs) to meet
the infant’s requirements for normal development, at least
until 4–6 months of age (FAO/WHO, 1994). LCPUFAs are
derived from mother’s blood and greatly influenced by the
maternal diet, whereas fatty acids (FAs) up to 14 carbon
atoms are produced within the mammary gland (Beijers and
Schaafsma, 1996; Jensen, 1999).
Over the past few decades, particular attention has been
paid to the LCPUFA composition of breast-milk, especially
arachidonic acid (AA) and docosahexaenoic acid (DHA).
These LCPUFAs are found abundantly in the brain, the retina
and the nervous tissue (Koletzko and Decsi, 1997; Al-Tamer

and Mahmood, 2004). Evidence suggests that infants are
unable to meet the EFAs requirements without being
preformed in the diet (Innis, 1991; Morgan et al., 1998).
The supply of EFAs in exclusively breast-fed infants depends
on the lipid content of intake milk and the proportion of
EFAs to total FAs in the milk lipid. Conjugated linoleic acid
(CLA), the anticarcinogenic and antiatherosclerotic agent is
found in milk of mothers who consume ruminant products
(Jensen et al., 1998). Despite the difference in dietary habits
in developing countries, the amounts of EFAs in mature
human milk may be similar to those in Western countries
(Kneebone et al., 1985; Muskiet et al., 1987; Prentice et al.,
1989; Krasevec et al., 2002).
Partially breast-fed infants in developing countries are
often given high-carbohydrate, low-fat complementary
foods before 4–6 months of age. This causes breast-milk
intake to decrease causing EFAs deficiency (FAO/WHO,
1994). In Iraq, a high percentage of infants aged less than
4 months may receive biscuits, rice soup and gruel.
This work aims to investigate the lipid content and FA
composition of mature-milk of Iraqi mothers in Mosul
province with different socioeconomic status.
Materials and methods
Subjects
The study subjects were 65 healthy lactating mothers. They
were (25) suburban (SU) and (40) urban mothers (15 low
urban (LU) and 25 high urban (HU)). They were regular
visitors to the maternity centre in Mosul province (when this
work was performed): they represent most of the population
type of Mosul city (population about 1.3 millions). The mean
lactation period was 5 months and the range of mother age
was 20–35 years. Mothers were questioned on their dietary
habits to ascertain that they (socially and economically) fit
in the categories mentioned above. They were healthy at the
time of this work according to their medical consultants,
were exclusively breast-feeding and were told about the
nature and purpose of the study.
Milk sampling
At the time of sampling, mothers had been nursing for 571
months. They expressed 5–10 ml of breast-milk (from
both breasts), using a manual sterile glass sucker. Samples
were collected in the mid-morning when lipid content is
supposed to be the highest (Ferris and Jensen, 1984) before
feeding their infants. The samples were immediately trans-
ferred into a 15 ml sterile screw-capped glass vials containing
2 ml of methanol to limit lipolytic and oxidative degradation
of milk lipid before extraction (Ali et al., 1984).
Lipid analysis
Milk lipids were solvent-extracted according to de-Jong
and Bading (1990) using ethanol, H2SO4 (0.25 M) and then
Iraqi mothers’ socioeconomic status and their milk-lipid content
YY Al-Tamer and AA Mahmood
1401
a mixture of diethyl ether/hexane (1:1 (v/v)). The main lipid
class, triglycerides (TGs), was separated by thin-layer chro-
matography (Merck Silica Gel G 0.25 mm) with hexane:-
diethyl ether:formic acid (80:20:2 by vol). After drying, the
plates were sprayed with 1% alcoholic solution of 2,7-
dichlorofluorescein (a non-destructive reagent) to visualize
the bands under ultraviolet light. To avoid loss of volatile
lipid components, extraction was performed in an ice-bath,
and thin-layer chromatography in a refrigerated cabinet, and
then the separated components were stored at 201C.
The FAs moiety of separated TGs was converted to FA
methyl esters by super-dried acidified methanol at 90–951C
for 2 h (Al-Tamer, 1974). The proportional composition (%)
of methylated FAs was determined by capillary gas chroma-
tography. The samples were analysed at the National Centre
of Scientific Research, the Institute of Chemistry of Natural
Substances, France. The capillary gas chromatography was
CP-3800, Varian, Palo Alto, CA, USA. The capillary column
was CP-Sil 8 CB, 0.25 mm IDx 30 m with film thickness:
0.25 mm and helium as a carrier gas. The programme used a
temperature gradient from 80 to 2201C, 51C each minute.
The identity of 14 individual FA peaks was ascertained by
comparing each peak’s retention time to the retention times
of FAs of synthetic standards. The relative amount of each FA
(% of total FAs) was quantified by integrating the area under
the peak and dividing the result by the total area for all
FAs. To minimize transcription errors, the data from the gas
chromatogram were electronically transferred to a computer
for analysis.
The lipid components of mature-milk, TGs and cholesterol
(C) were determined enzymatically using kits obtained from
bioMeriux, France. The phospholipids (PLs) were determined
by a colourimetric method based on the formation of a
phosphomolybdate complex (Tietz, 1986).
Statistical analysis
For comparison of means between more than two groups
(lipid contents and FA composition), Duncan multiple range
test was used. All the data were expressed as mean7s.e. of
the mean. Different letters indicate a significant difference at
Pp0.05 level.
Results
Dietary habits
The main foods known to be commonly consumed in Iraq
include wheat bread (or other foods processed from wheat),
margarine or vegetable oil and, to some extent, rice. These
varieties were consumed every day by the majority of
mothers in the three groups, HU, LU and SU. Green leafy
vegetables and fruits were almost eaten daily by SU and HU
groups, but they were taken a few times a week by LU group.
Meat (beef, mutton and/or chicken) was consumed several
times a week by the HU and SU, but once a week or seldom
European Journal of Clinical Nutrition
 Iraqi mothers’ socioeconomic status and their milk-lipid content
YY Al-Tamer and AA Mahmood
1402
by the LU group. Dairy products were consumed daily by HU
and SU, but only once or twice a week by LU. Fish was
seldom consumed by the three groups in Mosul province,
especially by the LU group.
There are many other foods that have not been included
because they have not reached most of the population owing
to their high cost and money was scarce in the period of
doing this work (October 2001–March 2002) as a result of the
economic sanctions (imposed on Iraq since, 1990), therefore
the diet of Iraqi people, in general, was poor and included a
limited variety of foods.
Socioeconomic and anthropometric status
Mothers of the HU and LU groups and their families had
similar sociological status and living conditions, including
family size (which was not large), mother’s education
(ranging from secondary school to a higher level) and
mother’s occupation (public servants or housewives). The
sociological status and living conditions of the mothers of
the SU group showed noticeable differences compared to the
HU and LU mothers. Family size was larger, mothers at best
had primary school education and most of them were either
unemployed or farmers.
The economic status of the three studied groups was
different. For the LU group, the economic status was very
low, because a high percentage of the mothers were public
servants who are highly affected by the economic sanctions.
The anthropometric data of mothers of the studied groups
are shown in Table 1. The mean body mass index (BMI)
for the HU and SU groups was 26.876.4 and 27.778.2,
respectively (they were over weight), but for the LU group it
was 24.277.8 (there was almost no energy deficiency). There
was no clear relationship between the mother’s BMI and
milk-lipid content (Po0.2).
Breast-milk-lipid content
The lipid components of mature breast-milk of Iraqi mothers
with different nutritional status are presented in Table 2.
Compared to the mature breast-milk of HU mothers, SU
mothers exhibited no significant difference in the level of
TGs (the main milk-lipid component, which represents
about 98% of the milk lipid according to Jensen, 1999), C,
PLs and the percentage of PLs/TGs, but exhibited a
significant increase in the ratio of C/TGs. On the other
hand, the milk of LU mothers showed a significantly lower
level in TGs, C, PLs and a lower ratio of PLs/TGs and C/TGs
compared to HU mothers.
Breast-milk FA composition
The mature breast-milk FA composition of SU and urban
nursing 571-month-old infants is presented in Table 3.
Saturated fatty acids (SFAs) represented the major FAs of
mature-milk lipid in all studied groups and C16 had the

Table 1 Anthropometric measurement of Iraqi mothers with different socioeconomic status

HU group SU group LU group

Mean7s.d. (n ¼ 25) Range Mean7s.d. (n ¼ 25) Range Mean7s.d. (n ¼ 15) Range

Min. Max. Min. Max. Min. Max.

Age (years) 28.275.7 20 35 23.176.6 18 36 27.779.1 19 37

Weight (Kg) 69.2715.2 58 94 71.3713.3 61 101 62.177.9 54 83
Height (cm) 163.0711.1 156 177 167.1712.1 160 179 161.8713.7 154 176
BMI 26.876.4 19.7 28.1 27.778.2 21.3 29.3 24.277.8 17.3 27.6

Abbreviations: BMI: body mass index,weight in kg/(height in m)2; HU, high urban; LU, low urban; max., maximum; min., minimum; s.d., standard deviation; SU,
suburban.

Table 2 Main lipid components of maturea-milk of Iraqi mothers with different socioeconomic status

Lipid class Concentration of each lipid class (mean7s.e.)

HU group(n ¼ 25) SU group (n ¼ 25) LU group (n ¼ 15)

TGs (g/100 ml) 5.6470.24 b 5.2171.61 b 3.2170.92 a

TC (mg/100 ml) 21.6472.12 b 26.2972.02 b 13.4670.86 a
% TC/TGs 0.3970.04 a 0.5270.02 b 0.4370.02 a
PLs (mg/100 ml) 33.5971.17 b 31.1571.99 b 15.9472.29 a
%PLs/TGs 0.6070.03 ab 0.6270.05 b 0.5070.02 a

Abbreviations: HU, high urban; LU, low urban; PL, phospholipid; s.e., standard error; SU, suburban; TC, total cholesterol; TG, triglyceride.
Different letters horizontally mean a significant difference at 0.05 level according to Duncan test (ab ¼ not significant with either a or b).
a
Lactation period ¼ 571 months.

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 Iraqi mothers’ socioeconomic status and their milk-lipid content
YY Al-Tamer and AA Mahmood
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Table 3 Fatty-acid composition of mother maturea-milk (wt%) of Iraqi mothers with different socioeconomic status

FA (Mean7s.e.)

HU group (n ¼ 25) SU group (n ¼ 25) LU group (n ¼ 15)

Saturated
10:0 4.9670.36 b 3.7570.28 c 1.9170.14 a
12:0 7.6370.20 a 9.6770.23 c 8.6470.32 b
14:0 11.2170.42 a 14.9770.35 b 12.2570.45 ab
16:0 20.4170.77 a 22.0970.95 ab 24.8570.73 b
18:0 4.2670.53 a 5.2370.43 ab 6.4170.59 b
Total 48.4771.41 a 55.7171.11 b 54.0671.28 b

Monounsaturated
16:1 3.6670.17 c 3.0970.15 b 2.4770.15 a
18:1 35.8670.99 b 26.5371.09 a 28.7170.72 a
Total 39.5271.03 b 29.6271.18 a 31.1870.65 a

Polyunsaturated
18:2 n6 8.9570.43 a 11.5570.34 b 11.9170.52 b
18:3 n6 0.0970.01 b 0.0870.01 ab 0.05670.01 a
18:3 n3 0.2470.01 b 0.2070.02 ab 0.1870.01 a
20:4 n6 0.3870.03 b 0.1670.01 a 0.1270.01 a
20:5 n3 0.1070.01 b 0.0670.02 a 0.0970.03 ab
22:6 n3 0.1470.03 b 0.1270.02 ab 0.1070.01 a
18:2 ct 0.1470.03 b 0.2170.04 c 0.1070.007 a

n3 0.4870.025 b 0.3870.018 a 0.3770.029 a

n6 9.4270.43 a 11.7970.34 b 12.0870.51 b
n3/n6 0.05470.004 b 0.03370.002 a 0.0370.003 a

Abbreviations: FA, fatty acid; HU, high urban; LU, low urban; s.e., standard error; SU, suburban.
Different letters horizontally mean a significant difference at Pp0.05 level according to Duncan test (ab ¼ not significant with either a or b).
a
Lactation period ¼ 571 months.

highest level. Among the three studied groups, a signifi-
cantly greater percentage of SFAs, but a slightly lower
percentage of monounsaturated fatty acids (MUFAs) were
observed in the case of SU and LU mothers in contrast with
HU mothers. As regards polyunsaturated fatty acids (PUFAs),
there was a significant increase in C18:2 n6 (and CLA, for SU
mothers), but there was a significant decrease in all other
PUFAs, total n3 and n3/n6 ratio for both SU and LU mothers
compared to HU mothers.
The nursing age in our study was 4–6 months. Subdividing
samples into 4–5 and 5–6 nursing months showed no
statistical differences in all the studied parameters, except
PLs that were significantly lower in the 5–6 than 4–5 months.
Discussion
The amount of mature breast-milk lipid of HU and SU Mosuli
mothers was higher (5.6 and 5.2 g/100 ml) than that reported
for human milk (3.5–4 g/100 ml) in some developing coun-
tries (Brown et al., 1986; Rocquelin et al., 1998), and it was
approximately equal to the lipid content of human milk in
developed countries (Institute of Medicine, 1991). The
amount of lipid content of LU mothers was lower than that
usually reported. These results indicate that the lipid content
of human milk is influenced by variation in the mother’s
socioeconomic/nutritional status, qualitatively and quanti-
tatively (FAO/WHO, 1994).
The present study does not show any clear relationship
between the mother’s BMI and milk-lipid content, contrary
to what Van Steenbergen et al. (1983) and Rocquelin et al.
(1998) report.
Total SFAs in the mature-milk lipid of the HU, LU and SU
groups exhibited the highest level, E50% (especially C16)
compared with MUFAs and PUFAs. This result seems to be
in harmony with that reported for lactating mothers from
developing and developed countries (Guesnet et al., 1995;
Laryea et al., 1995). The higher portion of MCFAs might be
advantageous for the fat and calcium absorption and they
represent a rich source of energy (Jensen and Jensen, 1992;
Genzel-Boroviczeny et al., 1997). The highest level was for
HU mothers. This result reflects their de novo synthesis in the
mammary gland, which is enhanced in the case of high
carbohydrate and low-fat diets (Harzer et al., 1984), which is
the pattern of nutrition for Iraqi mothers.
Koletzko et al. (1991) reported that the high intake of
vegetable oil leads to a high level of MUFAs in milk lipid.
This observation confirms the result observed in the present
study when HU mothers exhibited the highest level of
MUFAs among the other studied groups.
The level of the EFAs, n6 and n3, is affected mainly by the
mothers’ nutritional status. The n6 FAs are commonly

European Journal of Clinical Nutrition

 Iraqi mothers’ socioeconomic status and their milk-lipid content
YY Al-Tamer and AA Mahmood
1404
present in vegetable oils and eggs (especially C20:4 n6 in
lecithine) and n3 FAs are commonly present in fish oil (Flayeh,
2000; Wu et al., 2002). A noticeable quantity of n6 FAs was
detected in Iraqi mothers’ breast-milk, but it was still lower
than that of most milk samples from other countries (Innis,
1991; Jorgensen et al., 1995; Jensen, 1999; Wu et al., 2002).
Iraqi breast-milk was particularly poor in n3 FAs. There is no
doubt that the low intakes of fish, the main source of n3 FAs,
by Mosuli population (according to the social habit or because
of its high price or unpleasant odour) are associated with
decreasing the level of n3 FAs in the blood and breast-milk.
AA, C20:4 n6, and DHA, C22:6 n3, are the most representa-
tive LCPUFAs as they affect infant growth and development
and they are found abundantly in the brain, the retina and
other nervous tissues (Suh et al., 1994; Ambartsumyan, 1998;
Agostoni et al., 1999). Among the three studied groups, HU
mothers showed the highest level of AA and DHA.
There is strong evidence that the level of LCPUFAs is
affected by the mother’s educational and/or socioeconomic
status, which may lead to consuming a more balanced diet.
Generally, it was observed that the level of n3 FAs/n6 FAs
for the three groups was lower than that recommended by
WHO for infant optimum nutrition (FAO/WHO, 1994).
One of the important unsaturated FAs is CLA, C18:2 ct,
which is considered to be anticarcinogenic, antiatherosclero-
tic and a potent antioxidant component (Kramer et al., 1997;
Park et al., 1997; Jensen et al., 1998; Kelly et al., 1998). The
presence of CLA in breast-milk reflects the mother’s intakes
of hydrogenated fat and ruminant products. The breast-milk
of SU mothers, who consume a large proportion of dairy
products, exhibited the highest level of CLA.
In conclusion, the lipid content seems to be affected by the
mother’s socioeconomic/nutritional status as LU mothers (who
were under some degree of nutritional stress) showed the lowest
amount, whereas HU mothers showed the highest amount.
Concerning LCPUFAs, it has been observed that HU
mothers showed the best level compared with the other
two groups, which reflects variety in diet. Although HU
mothers’ breast-milk exhibited the best level of LCPUFAs
among the studied groups, it was still low in n3 FAs/n6 FAs
(0.05) compared with that recommended for optimum
infant nutrition (0.1). Therefore, Iraqi mothers are advised
to take a suitable diet with a relatively high amount of n3
FAs (found mainly in fish) in order to obtain milk with
the recommended FA composition. Furthermore, it is also
recommended to add physiological concentrations of nu-
trient (e.g. DHA) to the milk substitute formula (in addition
to breast-feeding) and mothers are advised to feed their
infants, from the age of 6 months, foods containing
vegetable oil to enhance the level of their EFAs.
Acknowledgements
We thank the French Embassy for granting a 2-month
research fellowship without which the analysis of samples
European Journal of Clinical Nutrition
by capillary gas chromatography would never have been
carried out, as the technique is still not available in Iraq.
Also, we express our gratitude to Dr Christian Marazano,
Dr Stephane Mons, Dr Alice Olsker and Wafaa Al-Sheikh, the
staff of the laboratory of CNRS, France, who provided the
facilities for the analysis performed. The cooperation of a
large number of volunteers is sincerely acknowledged.
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