Review

Human Milk and Factors influencing its

Chemical Compositions: A Narrative Review
Cecile Leah T. Bayaga, RND, PhD1*, Marietoni B. Pico, RND1,
1 2
Jethro Ian G. Belano, RND , Karen May N. Tanguilig ,
1 2
Yasmin Janina A. Serrano, RND , Richard Paolo M. Aba ,
1 2
Demetria C. Bongga, PhD and Alonzo A. Gabriel , PhD

Human milk is considered as the most suitable food for infants because it promotes survival and healthy
development. Human milk has been established to contain proteins, fats, carbohydrates, vitamins and
minerals vital for optimal growth, development, and health of the infant. Aside from nutrients, recent
studies revealed the presence of bioactive compounds, such as human milk oligosaccharides, that play
significant roles in shaping the infant's intestinal microbiota and developing the infant's digestive tract
and immune system. In this review, the chemical composition of human milk and the influence of
maternal characteristics including diet, nutrition status, length of lactation, health status, and age on its
composition are discussed.

Keywords: human milk, breastfeeding, human milk oligosaccharides (HMOs), microbiota

1. Introduction et al., 2013; Jost et al., 2013; and Cabrera-Rubio et

Human milk is the ideal food for the first six
months of life. Exclusive breastfeeding is the
accepted standard of infant feeding from first to sixth
month (Eidelman & Schanler, 2012; WHO 2002).
Human milk is uniquely suited to the human infant to
promote survival and healthy development.
Breastfeeding protects infants from diarrhea (Turin
and Ochoa, 2014) and respiratory diseases
(Macchiavervi et al., 2014) and is associated with
reduced long-term risk for obesity (Marseglia et al.,
2015). Numerous studies and reviews have also
enumerated nutrients, both macro and micro, in
human milk (Ballard and Morrow, 2013; Bayaga and
Gavino, 2006; Jensen, 1995). Human milk likewise
contains non-nutritional components that support
healthy growth and development including
antimicrobial factors, digestive enzymes, hormones,
trophic factors, and growth modulators (Prentice
1996). Recent studies have shown that human milk
also contains communities of bacteria that may have
health implications (Fernández et al., 2013; González
al., 2012). The function of microbiota in human milk
include, among others, enhanced immune
development of the infant, nutrient metabolism and
absorption, improved intestinal barrier function, and
stimulation of the gut-brain axis which reduces the
risk to infectious diseases (LaTuga, Stuebe, & Seed,
2014).
Despite the vast knowledge established on
human milk composition and its benefits, it is difficult
to generalize its composition because human milk
composition changes. It varies with stage of
lactation, breastfeeding pattern, gestational age, and
parity. Maternal nutrition is an obvious variable that
can influence human milk composition. However, it is
difficult to pinpoint which among the multiple factors
affect maternal nutrition. These include diet, health
status, age, body mass index, educational status,
even genetics among others. Here, a brief review of
the nutritional composition of human milk and the
factors affecting its chemical composition is
presented. Understanding the composition of human

1
Breastmilk Research Laboratory, College of Home Economics,
University of the Philippines, Diliman, 1101 Quezon City, Philippines
2
Laboratory of Food Microbiology and Hygiene, College of Home Economics,
University of the Philippines, Diliman, 1101 Quezon City, Philippines

Corresponding author: Cecile Leah T. Bayaga / (ctbayaga@up.edu.ph)

JNDAP January-December 2020 Vol. 34 Nos. 1 & 2 | 1

 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
milk results in understanding the biology of the
growing infant.
Key words such as human milk composition,
breast milk, maternal diet and human milk were
entered into a search engine, specifically Google. Top
5-10 articles were scrutinized if these meet the
purpose of the review. Priority were given to articles
published in the past 10-15 years. Cross references
were also done for articles beyond the years indicated
but were cited by majority of the articles used.
2. Determinants of the chemical compositions
of human milk
Human milk is a source of nutrients and
contributes to the microflora of the infant gut.
Human milk quality, defined by its chemical
compositions, is influenced by several factors. These
include but not limited to maternal characteristics
including diet, health, antibiotic/supplement use, and
postnatal factors like mode of delivery, gestational
age, and stage of lactation (Figure 1). Factors such
as education, socio-economic status (SES), and
ethnic background can further influence maternal
dietary choices resulting in variations in the maternal
diet (Ojha et al., 2015). Latuga, Stuebe, and Seed
(2014) observed that human milk composition is
dynamic. It changes from increased diversity in
colostrum to less diversity as the milk matures.
Figure 1. Determinants of the chemical and microbiological compositions of human milk.
92 | JNDAP January-December 2020 Vol. 34 Nos. 1 & 2
3. Chemical composition of human milk
Human milk contains all the nutrients needed by
the infant for the first six months of life. These are
energy-yielding nutrients, water, minerals, vitamins,
and trace elements (Table 1).
3.1 Lipids
Lipids are the most abundant source of energy
present in breast milk wherein more than 98% of
these is in the form of triglycerides, synthesized
within the mammary epithelial cell from medium- and
long-chain fatty acids derived either from the
maternal circulation or manufactured locally (Jensen,
1995). The most abundant fatty acids in human milk
are oleic acid (18:1) and palmitic acid (16:0). High
proportions of essential fatty acids, linoleic acid (18:2
n-6) and linolenic acid (18:3 n-3), and other long-
chain fatty acids, such as arachidonic acid (20:4 n-6)
and docosahexaenoic acid (22:6 n-3), are also
present (Bayaga & Gavino, 2006; Jensen, 1995).
These long-chain fatty acids are constituents of brain
and neural tissue vital in early mental and visual
development. At least half of the triglyceride
molecules in human milk contains palmitic acid
attached to the central carbon of the glycerol
component, a property that increases digestibility,
absorption, and mineral balance (Carnielli et al, 1995;
Jensen, 1995).
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions

Table 1. Chemical composition of human milk.

References: Jensen, 1995; Peng et al., 2009; Tanaka et al, 2013; Bayaga & Gavino, 2006; Carnielli et al,
1995; Uauy et al, 1994; Singhal et al, 2008; Gutierrez et al, 2007; Lonnerdal, 1985; Rezaei et al, 2016;
Lebrilla, 2011; Andreas et al, 2015; Bode, 2015; Andersson et al, 1986; Cravioto et al, 1991; Ballard &
Morrow, 2013; Allen, 2012; Eidelman and Schanler, 2012.

Short-chain fatty acids (carbon chain length = 8)
are only present in trace amounts but these are
essential for the maturation of the gastrointestinal
tract (Peng et al., 2009). Sphingomyelins, a lipid
present in milk fat globule membrane, are specifically
important for central nervous system myelinization
and has shown beneficial effect on the improvement
of neurobehavioral development among low-birth
weight infants (Tanaka et al., 2013). The lipid
component of human milk is the transport vehicle for
fat-soluble micronutrients such as prostaglandins and
vitamins A, D, E, and K. Arachidonic acid also plays an
important role in the hormonal regulation of normal
bone formation and whole-body mineral metabolism
during infant and childhood growth (Hadley et al.,
2016).

JNDAP January-December 2020 Vol. 34 Nos. 1 & 2 | 3

 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
3.2 Protein and non-protein nitrogen sources
Proteins comprise approximately 75% of the
nitrogen-containing compounds in human milk.
These can be divided into two categories: micellar
caseins and aqueous whey proteins in the ratio of
about 40:60 (Lonnerdal, 1985). The predominant
casein is -casein, which forms micelles of relatively
small volume and produces a soft, flocculent curd in
the infant's stomach. It also supplies the infant with
essential amino acids, calcium and phosphate (Rezaei
et al., 2016). The major whey proteins are -
lactalbumin, lactoferrin, secretory IgA, and serum
albumin, with a large number of other proteins
present in smaller amounts. -lactalbumin which is
approximately 25% of total whey proteins of milk has
a high content of tryptophan and plays an important
role in lactose production and secretion (Rezaei et al,
2016). Secretory IgA is the principal immunoglobulin
of human milk. Many of the proteins in human milk
have a multitude of functions. Lactoferrin, for
example, transports and promotes the absorption of
iron, is bacteriostatic to a range of organisms, and
acts as a nutritional protein, producing amino acids
for absorption on digestion (Roseanu and Brock,
2006).
Non-protein nitrogen substances in human milk
include urea, nucleotides, peptides, free amino acids,
and DNA (Uauy et al., 1994). This understudied
fraction of human milk comprises various bioactive
molecules. Eight to twenty-two percent of the non-
nitrogen substances present in breast milk are from
the free amino acids (Chuang et al, 2005, Carratu et
al, 2003). These free amino acids are more readily
absorbed in the body compared to protein-derived
amino acid and there were increasing studies which
found free amino acids to play a beneficial role in early
postnatal development (Carratu et al, 2003, Ferreira
et al, 2003). Nucleotides perform key roles in many
cell processes, such as changing enzymatic activities,
and serving as metabolic mediators (Uauy et al,
1994). In addition, nucleotides are recognized to be
beneficial for the development of microbiota (Singhal
et al, 2008), maturation, development and repair of
the gastrointestinal tract (Uauy et al, 1994), and
immune function (Gutierrez-Castrellon et al, 2007).
04 | JNDAP January-December 2020 Vol. 34 Nos. 1 & 2
3.3 Carbohydrate
Lactose is the principal sugar of human milk
(Jensen, 1995). The amount of lactose in human milk
is the least variable of the macronutrients (Ballard
and Morrow, 2013). The other significant
carbohydrates of human milk are the
oligosaccharides (HMO), which comprise
approximately ~5 to 15g/L of human milk, depending
on maternal characteristics and stage of lactation
(Hunt et al., 2012; Kunz et al., 2000). The past 50
years of research have suggested that HMO nourishes
the infant's gut microbiota by serving as a prebiotic
which promote the presence of certain types of
gastrointestinal bacteria (Hunt et al., 2012).
3.4 Human milk oligosaccharides (HMOs)
Human milk contains significant quantities of
human milk oligosaccharide (HMOs) at a
concentration ranging 5 to 23 g/L (Lebrilla et al,
2012). It represents about 10% of the total milk
carbohydrate in human milk and is predominantly
composed of lactose-N-tetraose and its
monofucosylated derivatives. The oligosaccharide
composition reflects the Lewis blood group and
secretor status of the mother (Bode, 2015; Lebrilla,
2012; Blank 2011). It is the third largest solid
component of milk and, while their structural
complexity makes them non-digestible, they are
liable to hydrolytic enzymes of the infant colonic
microbiota (Fernández et al., 2013; Zivkovic et al.,
2011; German et al, 2008).
It must be highlighted that HMOs also play a key
role in driving the diversity of the infant gut
microbiota (Sela & Mills, 2010). It has been
previously demonstrated that selected bifidobacterial
and lactobacilli phylotypes use specific HMOs
secreted early in the lactation cycle; and more
recently, the genome sequences of two
bifidobacterial strains have revealed several
adaptations for milk utilization within the infant
microbiome (Fernández et al., 2013). It has also
been found that HMOs stimulate the growth of
probiotic bacteria by interfering with the bacteria-
host interactions which make HMO a prebiotic in
consideration of this function (Newburg et al, 2005).
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
HMOs also serve as antiadhesives at the
interface of microbe-host interactions. One proposed
mechanism by which HMOs protect against
gastrointestinal infection is by acting as receptor
decoys (Andreas et al., 2015). A crucial step in the
initiation of infection is the binding of pathogens to
carbohydrates present on intestinal epithelial cells.
HMOs inhibit this process due to their analogous
shapes to cell surface carbohydrates; pathogens
recognize and bind to HMOs anchoring the bacteria in
the mucosal layer and prevent cell adhesion to
epithelial cells. Once bound, pathogens pass
harmlessly through the gastrointestinal tract. In a
recent study, it was shown that Streptococcus
agalacticae (Group B Streptococcus; GBS) is no
longer able to proliferate when HMOs are present
(Bode, 2015). GBS is one of the leading neonatal
pathogens affecting about 1 in 2000 newborns in the
US. HMOs could also prevent the adherence of
Streptococcus pneumoniae as well as Escherichia
coli, which suggests that HMOs are able to provide
protection against many other bacterial and viral
infections (Andersson et al, 1986; Cravioto et al,
1991). Studies conducted by Hong et al (2009) and
Ruiz-Palacios et al (2003, 2005) have explored the
antiadhesive property of HMOs which mimics the
natural ligands of a bacteria thereby inhibiting the
adhesion of bacteria. The bacteria and viruses where
this property has been observed include
Streptococcus pneumonia, Listeria monocytogenes,
Vibrio cholera, Salmonella fyris, Escherichia coli and
Campylobacter jejuni.
In a study by German et al (2008), the authors
observed the activity of bacteria among the presence
of oligosaccharides and they found that the bacteria
have specificity on how they consume and approach
the oligosaccharides.
3.5 Bioactive factors
Bioactive factors are components that affect
biological processes or substrates thereby influencing
functions of the body and in the long run, health. In
human breast milk, these include immune cells,
growth factors and hormones, and metabolic
hormones (Ballard & Morrow, 2013).
JNDAP January-December 2020 Vol. 34 Nos. 1 & 2 | 5
Immunological factors such as secretory IgA,
antimicrobial proteins like CD14, cytokines, and fatty
acids provide protection against infections, and
modulate and promote development of infant
immune system. Secretory IgA is an immunoglobulin
found in the infant's gut and mother's breast milk that
plays a significant role in fighting antigens in the
mother's environment. Soluble CD14, on the other
hand, is an immunoregulatory protein that enhances
innate immunity by binding lipopolysaccharides from
Gram-negative bacteria and intestinal enterocyte.
Meanwhile, cytokines and chemokines have
protective factors against allergic diseases. Cytokines
are involved in IgE production which is also found in
high levels in milk produced by mothers with allergies
(Iyengar& Walker, 2012). In a study conducted by
Silva et al. (2013), their data supported the previously
hypothesized idea that production of hormones and
cytokines decreases as the milk matures.
Growth factors found in milk play significant roles
in the intestinal tract and nervous system. Epidermal
growth factor (EGF) is essential in healing and
maturation of infant's intestinal mucosa. Brain-
derived neurotrophic factor (BNDF) can improve
peristalsis while glial cell-line derived neurotrophic
factor (GDNF) increases survival and outgrowth of
neurons (Ballard & Morrow, 2013).
Some of the metabolic hormones found in
human breast milk include leptin, adiponectin, and
ghrelin. These components are specifically involved in
food intake regulation and energy balance hence,
plays important roles on nutritional programming of
childhood obesity. Leptin, signals satiety and
decreases sensation of hunger. Adiponectin, on the
other hand, helps in lipid and glucose metabolism
regulation. Finally, ghrelin, can influence various body
processes such as glucose metabolism, energy
balance, gastrointestinal motility, gastric acid
secretion, and cardiovascular and immune system
functions (Fei&Meng, 2017). The study of Chan et al
(2017) investigated the association between
metabolic hormones and infant body composition in
the first year of life and found that breast milk
containing higher concentrations of leptin and
intermediate concentrations of insulin were
associated with lower infant weight-for-length and
body mass index.
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
The bioactive factors mentioned above have long
been established as components of human milk. In
the last decade, however, some studies observed that
in addition to these factors, breast milk also contains
stem and progenitor cells. Additionally, the existence
of human milk microbiome was also discovered over
the last ten years. Currently, bacterial translocation to
extraintestinal tissues is suggested to be a favorable
physiological event given a healthy host. This may
also play a role in the maturation of neonatal immune
system (Witkowska-Zimny & Kaminska-El-Hassan,
2017).
3.6 Micronutrients
Micronutrients include vitamins and minerals.
These are essential nutrients needed by the body in
milligrams or micrograms. These nutrients vary in
quantity in the human breast milk depending on
maternal diet and body stores. Maternal diet is not
always adequate. Thus, consumption of multi-
vitamin supplementation during lactation has been
recommended (Allen, 2012).
Vitamin K is extremely low in human breast milk.
Thus, the American Academy of Pediatrics
recommends an injection of this vitamin to avoid
hemorrhagic disease of the newborn (Eidelman &
Schanler, 2012). Moreover, Vitamin K may be
produced by gut microbiota which are still absent in a
new born infant. Levels of Vitamin D are also low in
quantity which is primarily caused by low maternal
exposure to sunlight, now a common circumstance
worldwide (Ballard & Morrow, 2013). While the
impact of maternal Vitamin D supplementation on
milk composition is yet to be established, breastfed
infants are currently recommended to undergo
postnatal supplementation of this vitamin.
Iron, copper, calcium, magnesium, and zinc are
among the most essential minerals because
deficiency in these elements can cause various
complications such as stunted growth and cognitive
performance, poor bone development, and may
affect transmission of nerve impulses. In 2014,
Andrade et al., conducted a study on the
micronutrients found in breast milk of lactating
mothers in Brazil. Mean mineral concentration of
6 | JNDAP January-December 2020 Vol. 34 Nos. 1 & 2
iron, copper, calcium, magnesium, and zinc were
obtained and revealed that all of the said minerals
except for calcium could satisfy the daily
requirements of the newborn during the first six
months of life.
3.7 Factors affecting the chemical composition
of human milk
Human milk composition varies within and
among lactating women. Factors previously
demonstrated to influence the chemical composition
of human milk are maternal diet, stage of lactation,
maternal health status, and age.
3.7.1 Maternal diet
The influence of maternal diet on human milk
composition is complex. Depending on the nutrient,
maternal diet may have no impact on a nutrient
profile (i.e. folate, iron, zinc, calcium, magnesium,
and carbohydrates), while for other nutrients,
maternal diet can result in large variations (i.e. lipids,
thiamin, riboflavin, vitamin B-12, vitamin C, and
vitamin A) (Innis, 2014). A previous study on the
macronutrient content of human milk from mothers
of different ethnicities found little variation based on
diet (Lonnerdal et al., 1985). A study conducted by
Wojcik et al. (2009) showed the same result in which
the mother's nationality has no impact on the
macronutrient content of human milk. The milk
samples came from 273 participants. In another
study, results showed that lower maternal fluid intake
led to lower lactose concentrations in human milk
samples (Ballard & Morrow, 2013).
Variations in the amount of lipid in human milk
appear to be independent of maternal diet but certain
specific fatty acids are sensitive to maternal diet
(Ballard & Morrow, 2013). These certain fatty acids
can be synthesized endogenously by the mammary
gland, or taken up from the maternal plasma. These
fatty acid sources are influenced by the maternal diet,
whatever the source (Innis, 1992 Brenna et al.,
2007). Numerous studies examining the fatty acid
(FA) profile of human milk have noted that it can be
altered by manipulating the maternal diet especially
the omega-6 and omega-3 fatty acids (Innis, 1992;
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
Bayaga & Gavino, 2006; Brenna et al., 2007).
Dietary fatty acids are transferred to human milk, and
the milk fatty acid composition copies the
composition of dietary fat intake within 2 to 3 days
(Andreas et al., 2015). The mammary glands can
synthesize medium-chain fatty acids (MCFAs) 10:0,
12:0 and 14:0.
Another group of fatty acid essential during
infancy are the long-chain polyunsaturated fatty acids
(LC-PUFAs) which are needed for the formation of the
cell membrane particularly in the eye and brain. A
high-fat diet has shown higher LC-PUFAs
concentration in human milk (Stam et al., 2013).
However, high consumption of trans-fatty acids due
to increased consumption of foods with hydrogenated
oils lowers the amount of LC-PUFAs in the milk
produced (Innis, 2014).
For the micronutrients, levels of some vitamins
and minerals like zinc, selenium, iodine, and fluorine
are also affected by maternal diet. The
concentrations of vitamins B2 and C show dose-
related responses to maternal diet and
supplementation (Bates & Prentice, 1994; Tawfeek et
al., 2002). In the review article by Allen (2012)
studies conducted in different countries have shown
that lactating women with low concentrations of
thiamin in their diets have also lower amount of
thiamin in their milk. In the same manner, low intake
of riboflavin, vitamin B6, vitamin B12 and choline
result in low amounts of these respective vitamins in
human milk.
The fat-soluble vitamins A, D, E, and K are also
responsive to maternal diet changes and
supplementation (Lammi-Keefe and Jensen, 1984;
Olafsdottir et al., 2001; Bravi et al., 2016).
Supplementation of fat-soluble vitamins increases the
fat-soluble content of the human milk, meeting the
needs of the infants, except for vitamin D (Olafsdottir
et al., 2001). Contrariwise, the mineral content of
human milk is generally less related to the maternal
diet (Bravi et al., 2016). A study conducted among
Swedish and Honduran at 9-months postpartum
mothers have shown that the mother's intake and
mineral stores of iron, zinc and copper do not directly
affect the trace minerals component in human milk
JNDAP January-December 2020 Vol. 34 Nos. 1 & 2 | 7
(Domellof et al., 2004). This result may imply the
need to properly plan nutritious weaning food for
infants as milk cannot be an adequate source of the
mentioned minerals beyond six months.
A supplementation study which tripled the
calcium intake of Gambian women for the first year of
lactation, showed no effect on human milk calcium
concentration (Prentice et al., 1995). Similarly, a
study conducted by Laskey et al. (1998) has shown
that the dietary calcium intake of the mother has no
significant impact on the calcium content of human
milk.
3.7.2 Length of lactation
Human milk is generally classified into colostrum,
transitional, and mature. It should be noted that
these classifications suggest the steady modification
in terms of volume output and nutrient content of milk
throughout lactation (Andreas et al., 2015). During
the early stage of lactation, human milk produced has
low amount of casein and high concentration of whey
protein (Stam et al., 2013). The concentration of
whey remains always high during the course of
lactation as compared to that of casein which
increases during the process. In the review article by
Andreas et al (2015) the average protein content in
human milk slowly decreases from the second month
to the seventh month, after which the rate of
reduction of protein content wanes. Colostrum
contains low concentrations of both lactose and fat
compared to mature milk. Lactose content is highest
in the fourth to seventh month, after which it
decreases, while a gradual increase in the
concentration of lipid occurs over lactation.
Colostrum is noticeably different from mature
human milk in terms of its bioactive properties,
containing high concentrations of secretory
immunoglobulin (Castellote et al., 2011). These
qualities suggest that the primary role of colostrum is
not nutritional, but immunologic, protecting the
infant as it emerges from the relatively sterile
environment of the womb, to being exposed to many
environmental pathogens. In agreement with this,
the concentration of HMOs in colostrum is particularly
high, approximately double that of mature milk, with
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
concentrations decreasing from ~21 g/L to ~13 g/L
from day 4 to day 120 post-partum and composed
mostly of fucosylated HMO which works as protection
of infants against diarrhea and has a significant role in
building up the infant's immune system (Lebrilla et al.,
2007; Andreas et al., 2015). In the early stage of
lactation, vitamins B1, B6, and folate are present in
lower amounts, while vitamin B12 is present in higher
amounts. However, the levels of these B vitamins
relatively stabilize at around the third week of
lactation (Allen, 2012).
3.7.3 Maternal health status
A correlation between maternal weight gain
during pregnancy and human milk lipid content has
been reported. However, this was only observed to
be significant at four months post-partum. The
observed phenomenon may be due to the laying
down of fat stores during pregnancy, which are used
as energy reserves during lactation (Michaelsen et al.,
1997). Despite this finding, an earlier study was
unable to identify an association between maternal
weight gain during pregnancy and human milk lipid
content (Butte et al., 1984). A recent study has shown
that the amount of lipids in human milk, especially LC-
PUFAs increases with maternal adiposity and milk
from underweight lactating mothers have lower lipid
content compared to that of overweight or obese
lactating mothers (Innis, 2014).
3.7.4 Age
Human milk composition may be influenced by
the mother's age. From the review of Andreas et al.
(2015), protein concentration was found to be
highest in human milk of mothers aged 20–30 years
but maternal age does not seem to influence either
lipid or lactose concentrations. In another study, the
lipid content in colostrum and carbohydrate content
in mature milk were significantly higher in women
aged > 35 years old compared to those < 35 years
old. Moreover, carbohydrates in mature milk
correlated positively with maternal age (Lubetzky et
al, 2015).
08 | JNDAP January-December 2020 Vol. 34 Nos. 1 & 2
4. Summary
Human milk is the best food for the first six
months of life. As such, it's chemical composition
should be optimum and maximized. This review was
able to show aside from the usual nutrients, human
milk contain HMOs and bioactive components
responsible for establishing an infant's immune
functions. Further, the concentration of these
chemical components are affected by various factors.
These include among others maternal characteristics
(age and health status), maternal diet, and length of
lactation.
The function of human milk in the development
and improvement of an infant's overall growth and
health has been the focus of researchers for many
years. Previous studies have focused on the
nutritional aspects of the biological fluid specifically
on its chemical composition and its role on the infant.
New technologies gave rise to a whole new
perspective of analyzing and understanding the
bioactive components of human milk. The recent
discovery of human milk oligosaccharides proves that
human milk is a source of prebiotics - influencing
bacterial colonization of the infant's gut by serving as
the substrate for the bacteria.
Understanding human milk by studying the
factors affecting its composition and how these
compositions change throughout the lactation
remains to be a challenge considering the differences
in maternal diet, nutritional conditions and status,
environmental factors, and genetic backgrounds.
Furthermore, other areas of great interest such as the
influence of maternal diet and nutritional status on
the production of different profiles of HMOs and its
influence on the species of bacteria colonizing the
infant gut, and have not yet been fully examined.
Nevertheless, the numerous studies on the chemical
composition of human milk and the various factors
affecting it prove to be indispensable tools in fully
uncovering the wonders of human milk.
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
ACKNOWLEDGMENT
This work was funded by the following: (1) UP
Emerging Interdisciplinary Research (EIDR-C08-
007.1); (2) UP System Enhanced Creative Work and
Research Grant (ECWRG 2016-2-082); (3) Philippine
Council for Health Research and Development-
Department of Science and Technology; (4)
Commission on Higher Education, Republic of the
Philippines (Contract of Assistance granted to
CLTBayaga); (5) Nutritionist-Dietitian's Association of
the Philippines Foundation; and (6) University of the
Philippines-Diliman, Office of the Vice Chancellor for
research and Development Outright Research Grant
(171701 PNSE).
CONFLICT OF INTEREST
The authors whose names are listed above
certify that they have NO affiliations and relationships
with any organization or entity with any financial
interest or non-financial interest in the subject matter
or materials discussed in this manuscript.
REFERENCES
1. Allen LH. (2012). B Vitamins in Breast Milk:
Relative Importance of Maternal Status and
Intake, and Effect on Infant Status and Function.
Advances in Nutrition, 3:362-369.
2. Andersson B, Porras O, Hanson LA, Lagergard T,
Svanborg-Eden C. (1986). Inhibition of
attachment of Streptococcus pneumoniae and
Haemophilus influenzae by human milk and
receptor oligosaccharides. Journal of Infectious
Diseases, 153(2):232–7.
3. Andrade MTS, Del Ciampo LA, Ieda Regina Lopes
Del Ciampo IRL, Ferraz IS, Barbosa FJr. (2014)
Breast Milk Micronutrients in Lactating Mothers
from Ribeirão Preto (SP), Brazil. Food and
Nutrition Sciences, 5, 1196-1201.
http://dx.doi.org/10.4236/fns.2014.513130
4. Andreas NJ, Kaampmann B, Mchring Le-Doare K.
(2015). Human milk: A review on its composition
and bioactivity. Early Human Development,
91:629-635.
JNDAP January-December 2020 Vol. 34 Nos. 1 & 2 | 9
5. Ballard O, Morrow AL. (2013). Human Milk
Composition: Nutrients and Bioactive Factors.
Pediatrics Clinics of North America, 60(1):49-74.
6. Bates CJ, Prentice A. (1994). Breast milk as a
source of vitamins, essential minerals and trace
elements. Pharmacology & Therapeutics,
62:193-220.
7. Bayaga CLT, Gavino VC. (2006). Chapter IV:
Benefits and Sources of Docosahaenoic Acid
(DHA) in Human Milk. In: Landow MV, editor.
Trends in Dietary Fats Research. New York: Nova
Science Publishers, Inc., p. 69-87.
8. Bode L. (2015). The functional biology of human
milk oligosaccharides. Early Human
Development, 91:619–622.
9. Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni
C, Ferraroni M. (2016) Impact of maternal
nutrition on breast-milk composition: a
systematic review. American Journal of Clinical
Nutrition. 104(3):646-62. doi:
10.3945/ajcn.115.120881.
10. Brenna JT, Varamini B, Jensen RG, Diersen-
Schade DA, Boettcher JA, Arterburn LM. (2007).
Docosahexaenoic and arachidonic acid
concentrations in human milk worldwide.
American Journal of Clinical Nutrition, 85:1457-
1464.
11. Butte NF, Garza C, Stuff JE, Smith EO, Nichols BL.
(1984). Effect of maternal diet and body
composition on lactational performance.
American Journal of Clinical Nutrition,
39(2):296–306.
12. Cabrera-Rubio R, Mira-Pascual L, Mira A, Collado
MC. (2016). Impact of mode of delivery on the
milk microbiota composition of healthy women.
Journal of Developmental Origins of Health and
Disease, 7(1):54-60.
13. Cabrera-Rubio R, Collado MC, Laitinen K,
Salminen S, Isolauri E & Mira A. (2012). The
human milk microbiome changes over lactation
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions
and is shaped by maternal weight and mode of
delivery. American Journal of Clinical Nutrition,
96(3):544-51.
14. Carnielli VP, Luijendijk IH, van Goudoever JB,
Sulkers EJ, Boerlage AA, Degenhart HJ, Sauer PJ.
(1995). Feeding premature newborn infants
palmitic acid in amounts and stereoisomeric
position similar to that of human milk: effects on
fat and mineral balance. American Journal of
Clinical Nutrition, 61:1037-1042.
15. Castellote C, Casillas R, Ramirez-Santana C,
Perez-Cano FJ, Castell M, Moretones MG, Lopez-
Sabater MC, Franch A. (2011). Premature
delivery influences the immunological
composition of colostrum and transitional and
mature human milk. Journal of Nutrition,
141(6):1181–1187.
16. Cravioto A, Tello A, Villafan H, Ruiz J, del Vedovo
S, Neeser JR. (1991). Inhibition of localized
adhesion of enteropathogenic Escherichia coli to
HEp-2 cells by immunoglobulin and
oligosaccharide fractions of human colostrum
and breast milk. Journal of Infectious Diseases,
163(6):1247–55.
17. Domellof M, Lonnerdal B, Dewey K, Cohen R &
Hernell O. (2004). Iron, zinc and copper
concentrations are independent of maternal
mineral status. American Journal of Clinical
Nutrition, 79:111-115.
18. Eidelman AI and Schanler RJ. (2012). Policy
Statement: Breastfeeding and the Use of Human
Milk. Pediatrics, 129(3):e827-e841. Hunt KM,
Foster JA, Forney LJ, Schütte UME, Beck DL,
Abdo Z, et al. (2011). Characterization of the
Diversity and Temporal Stability of Bacterial
Communities in Human Milk. PLOS ONE, 6(6).
19. Innis SM. (1992). Human milk and formula fatty
acids. Journal of Pediatrics, 120(4 Pt 2):S56–61.
20. Innis SM. (2014). Impact of maternal diet on
human milk composition and neurological
development of infants. American Journal of
Clinical Nutrition, 99(supp):734S-741S.
10 | JNDAP January-December 2020 Vol. 34 Nos. 1 & 2
21. Jensen RG. (2002). Handbook of Milk
Composition. San Diego, California: Academic
Press Inc.
22. Jost T, Lacroix C, Braegger C, Chassard C.
(2013). Assessment of bacterial diversity in
breast milk using culture-dependent and culture-
independent approaches. British Journal of
Nutrition, 110:1253-1262.
23. Laskey MA, Prentice A, Hanratty LA, Jarjou LM,
Dibba B, Beavan SR, Cole TJ. (1998). Bone
changes after 3 mo of lactation: influence of
calcium intake, breast-milk output, and vitamin
D-receptor genotype. American Journal of
Clinical Nutrition, 67:685-692.
24. Lebrilla CB, LoCascio RG, Ninonuevo MR,
Freeman SL, Sela DA, Grimm R, Mills D & German
JB (2007). Glycoprofiling of Bifidobacterial
Consumption of Human Milk Oligosaccharides
Demonstrates Strain Specific, Preferential
Consumption of Small Chain Glycans Secreted in
Early Human Lactation. Journal of Agricultural
and Food Chemistry, 55:8914-8919.
25. Lebrilla CB, Marcobal A, Barboza M, Froehlich JW,
Block DE, German JB, Mills DA. (2010).
Consumption of Human Milk Oligosaccharides by
Gut-Related Microbes. Journal of Agricultural and
Food Chemistry, 58:5534-5340.
26. Lonnerdal B. (1985). Biochemistry and
physiological functions of human milk proteins.
American Journal of Clinical Nutrition, 42:1299-
1317.
27. Lubetzky R, Sever O, Mimouni FB, Mandel D.
(2015). Human Milk Macronutrients Content:
Effect of Advanced Maternal Age. Breastfeeding
Medicine, 10(9):433-436.
28. Marseglia L, Manti S, D'Angelo G, Cuppari C,
Salpietro V, Filippelli M, et al. (2015). Obesity and
breastfeeding: The strength of association.
Women and Birth, 28:81–86.
 Bayaga et. al. / Human Milk and Factors influencing its Chemical Compositions

29. Michaelsen KF. (1997). Nutrition and growth
during infancy. The Copenhagen Cohort Study.
Acta Paediatrica, Suppl. 420:1–36.
30. Olafsdottir AS, Wagner KH, Thorsdottir I,
Elmadfa I. (2001). Fat-soluble vitamins in the
maternal diet, influence of cod liver oil
supplementation and impact of the maternal diet
on human milk composition. Annals of Nutrition
and Metabolism, 45:265-272.
31. Peng L, Li ZR, Green RS, Holzman IR, Lin J.
(2009). Butyrate enhances the intestinal barrier
by facilitating tight junction assembly via
activation of AMP-activated protein kinase in
Caco-2 cell monolayers. Journal of Nutrition,
139:1619–1625.
38. Stam J, Sauer PJJ, Boehm G. (2013). Can we
define an infant's need from the composition of
human?. American Journal of Clinical Nutrition,
98(supp):521S-528S
39. Tanaka K, Hosozawa M, Kudo N, Yoshikawa N,
Hisata K, Shoji H, et al. (2013). The pilot study:
sphingomyelin-fortified milk has a positive
association with the neurobehavioural
development of very low birth weight infants
during infancy, randomized control trial. Brain
and Development, 35(1):45–52.
40. Uauy R, Quan R, Gil A. (1994). Role of
nucleotides in intestinal development and repair:
implications for infant nutrition. Journal of
Nutrition, 124(8 Suppl):1436S–41S.

32. Prentice A, Jarjou LM, Cole TJ, Stirling DM, Dibba
B & Fairweather-Tait S (1995). Calcium
requirements of lactating Gambian mothers:
effects of a calcium supplement on breast milk
calcium concentration maternal bone mineral
content and urinary calcium excretion.
American Journal of Clinical Nutrition, 65:58-67.
33. Prentice A. (1996). Constituents of human milk.
Food and Nutrition Bulletin, 17(4):1-10.
41. Wojcik KY, Rechtman DJ, Lee ML, Montoya A,
Medo ET. (2009). Macronutrient Analysis of a
Nationwide Sample of Donor Breast Milk. Journal
of the American Dietetic Association, 109:137-
140. World Health Organization (WHO). (2002).
Infant and young child nutrition: Global strategy
on infant and young child feeding. Proceeding of
the Fifty-Fifth World Health Assembly,
Provisional agenda item 13.10, 155/15.

34. Rezaei R, Wu Z, Hou Y, Bazer FW, Wu G. (2016).

Amino acids and mammary gland development:
nutritional implications for milk production and
neonatal growth. Journal of Animal Science and
Technology, 7:20.

35. Sela DA and Mills DA. (2010). Nursing our

microbiota: molecular linkages between
bifidobacteria and milk oligosaccharides. Trends
in Microbiology, 18:298–307.

37. Singhal A, Macfarlane G, Macfarlane S, Lanigan J,

Kennedy K, Elias-Jones A, et al. (2008). Dietary
nucleotides and fecal microbiota in formula-fed
infants: a randomized controlled trial. American
Journal of Clinical Nutrition, 87(6):1785–92.

JNDAP January-December 2020 Vol. 34 Nos. 1 & 2 | 11