BREASTFEEDING MEDICINE

Volume 18, Number 3, 2023

ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2022.0281

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The Volume of Breast Milk Intake

in Infants and Young Children:
A Systematic Review and Meta-Analysis

Magali Rios-Leyvraz1 and Qisi Yao2

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Abstract

Objective: The objective of this study was to provide global breast milk intake estimates for infants and children
from 0 to 3 years old.
Materials and Methods: A systematic search of online databases (Embase, MEDLINE, and CENTRAL) was
conducted and complemented with a manual search of additional databases (African Journals Online and
LILACS), reference lists, and unpublished data. Studies with apparently healthy mothers and their children 0–3
years old worldwide were included. Random effects meta-analyses, subgroup analyses, and meta-regressions
were conducted.
Results: A total of 167 studies on breast milk intake were identified. The mean daily breast milk intake among
all the studies included was 670 mL per day and 117 mL/kg per day. Breast milk intake was influenced by infant
age, infant body weight, and breastfeeding practices. The deuterium dilution method tended to yield higher
estimates than test-weighing methods. Breast milk intake over time was modeled with a nonlinear meta-
regression: breast milk intake (mL/day) = 51–1.4 · days +180 · log(days). When restricting to studies involv-
ing healthy term infants exclusively breastfed up to 6 months, breast milk intake was 624 mL per day and
135 mL/kg per day at 1 month, 735 mL per day and 126 mL/kg per day at 3 months, 729 mL per day and
107 mL/kg per day at 6 months, and 593 mL per day and 61 mL/kg per day at 12 months.
Conclusions: This review provides global breast milk intake estimates for infants and young children. It
demonstrates differences in intakes according to region and measurement method, as well as longitudinal
changes over the first year of life.

Keywords: breast milk, infant, child, breastfeeding, systematic review

Introduction receive nutritionally adequate and safe complementary

B reast milk is the key component of the diet and an
important source of nutrient intake in infants and
young children. It is assumed that breast milk from healthy
well-nourished women provides adequate amounts and
concentrations of nutrients required for optimal growth
of infants. Accordingly, the World Health Organization
(WHO) recommends that infants should be exclusively
breastfed for the first 6 months of life, and thereafter should
foods, while continuing to breastfeed for up to 2 years or
beyond.1,2
Data on breast milk intake can be used to assess infant
feeding and to determine nutrient requirements for infants
and young children. However, amounts of breast milk con-
sumed can vary throughout the first years of life and across
different populations. It is, therefore, important to have es-
timates of breast milk intake that are based on a wide variety
of samples collected in a systematic manner.

1
Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland.
2
Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, USA.

188
 BREAST MILK INTAKE REVIEW
In 1998, WHO published a report on complementary
feeding in young children3 with mean breast milk intakes in
developing and industrialized countries. These values have
been used widely to estimate breast milk intakes and to derive
values, such as energy intake from breast milk, in clinical and
research settings. Since then, several reviews on breast milk
intake have been published, but have either been restricted to
a limited number of studies,4 or regions,5 or focused on the
comparison of different measurement methods.6 A system-
atic review providing updated breast milk intake estimates
for infants and young children representative of different
regions across the world is needed.
This review was commissioned by the Food and Agriculture
Organization of the United Nations (FAO) and WHO, to in-
form their work on updating nutrient requirements and safe
upper levels of intake in infants and young children, originally
established in 2004.7 The objective of this systematic review
was to provide estimates of breast milk intakes in infants and
children from birth up to 3 years of age around the world.
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Materials and Methods
Eligibility criteria
We included studies with apparently healthy, free from any
clinical signs or symptoms of undernutrition or illness that
might impact milk production, lactating women, and their
offspring 0–35.9 months of age. Mothers and infants with
severe or moderate acute malnutrition, and infants with enteral
or intravenous feeding, diarrhea, Wilson’s disease, or familial
hypophosphatemia were excluded. However, women with
chronic conditions, such as obesity, diabetes, or HIV, and in-
fants with low birth weight or born prematurely were included.
We included studies that reported breast milk intake. Stu-
dies in which the breast milk intake measurement method was
not reported, in which breast milk production or expression
was measured without child intake, in which the breast milk
intake was measured for <12 hours, or in which sample size
and units were not reported, or where standard deviations (SD)
could not be derived, were excluded. Intervention studies,
cohort studies, cross-sectional studies and case–control studies
were included. Conference abstracts, posters, commentaries,
editorials, and studies for which full texts were unobtainable
were excluded. Studies from all regions of the world, in all
languages, and of any date of publication were included.
Search strategy
The online databases MEDLINE, MEDLINE In-Process
and Other Non-Indexed Citations, EMBASE, and Cochrane
Central Register of Controlled Trials (CENTRAL) were
searched up to October 1, 2020 (Supplementary Files).
Moreover, the African Journals Online (on December 11,
2020) and the LILACS database (on December 18, 2020)
were searched to improve geographical coverage of the
search. The reference lists of recent systematic reviews and
included reports were screened manually. An update of the
search was conducted in EMBASE on November 17, 2022,
to identify new articles published.
Moreover, the International Atomic Energy Agency
(IAEA) provided unpublished data from a selection of stud-
ies (IAEA, unpublished data, Country investigators: Africa:
Amoussa Hounkpatin WBA, Kenguela Wabolou P, Lartey A,
Bansa DK, Karuri EG, Nduati R, Owino V, El Kari K,
189
Coutsoudis A; Asia: Urio EM, Thomas T, Fadjarwati T,
Winarno EK, Karim N, Ahmed T, Yameen A, Hettiarachchi
M, Winishagoon P, Poncharoen T, Nga TT; Latin America:
Pallaro AN, Ramos Silva V, Weisstaub SG, Hernández Tri-
ana MT, Mieses Consepción KM, Aguilar Lema EM,
Ramı́rez-Zea M, Della Santa Méndez AP. Breastmilk intake
in infants by the dose to mother technique. 2021 Mar.).
Selection process
The identified records were imported into Covidence8 and
duplicates were merged. The records were screened for eli-
gibility first by the title and abstract, and then by the full-text,
in duplicate by two researchers. Any disagreement on the
exclusion or inclusion of a report between the two reviewers
was resolved by discussion between the two reviewers or by a
third reviewer. For the update of the review, screening was
done by one single reviewer.
Data extraction
Information on the study design, the participants, as well as
the measurement methods was extracted. Values for breast
milk intake per day and per body weight were extracted. If
data were only available from figures, they were extracted
with PlotDigitizer.9 For trials, data were extracted solely
from baseline or from the control group, except if the inter-
vention was relevant to subgroup analyses or if there were no
significant effect of the intervention. Data were extracted in
Excel by one researcher and a subset was verified by another
researcher. Whenever reported, predominantly breastfeeding
was merged together with exclusive breastfeeding.
Data analysis
Data transformations and imputations were done accord-
ing to the Cochrane Handbook for Systematic Reviews
of Interventions10 and following the recommendations of
Borenstein et al.11 If means and SD were not reported, they
were imputed from 95% confidence interval (CI), p-values,
t-values, medians, percentiles, interquartile ranges, or ran-
ges.10 If values for several groups were reported, they were
merged together.10 Breast milk intake was transformed into a
common unit (i.e., mL/day) using the conversion 1.03 g/mL.
To calculate an overall mean breast milk intake per day
and per body weight per day, random effects meta-analyses
were conducted. Outlying and influencing studies were
identified with Baujat plots. Subgroup analyses were con-
ducted to investigate differences by lactation stage (colos-
trum 1–4 days postpartum [pp], transitional milk 5–15 days
pp, and mature milk >15 days pp), health status (healthy
versus condition), maternal age (adolescents versus adults),
maternal body mass index (BMI), maternal anemia (yes
versus no), gestation duration (term versus preterm), breast-
feeding practice (exclusive/predominantly breastfeeding
versus partial/mixed breastfeeding), country income cate-
gory, continent, and measurement method.
A complementary analysis was limited to the studies that
would provide the best quality estimates of breast milk in-
take, the ‘‘key studies,’’ studies with only healthy mothers
and infants who were born at term, and, <6 months of age,
exclusively breastfed.
The evolution of breast milk over time was plotted
and fitted with a local polynomial regression. Then meta-
 190
regressions were conducted with several models (i.e.,
linear, quadratic, cubic, exponential, logarithmic, and re-
stricted cubic splines) and the model with the best fit was
selected based on Akaike information criterion. Statistical
analyses were conducted with RAnalyticFlow (version
3.1.8) with the package meta.
Results
Study characteristics
From 5,064 records identified, a total of 167 studies in-
cluding 20,857 participants were included. The flowchart of the
study selection process is shown in Figure 1. The detailed
characteristics of each included study are shown in the Sup-
plementary Files. The study designs were cohorts (N = 81),
cross-sectional studies (N = 46), trials (N = 35), and case–con-
trols studies (N = 5). The studies were conducted in all conti-
nents of the world, with 50 studies in North America, 38 studies
in Africa, 37 studies in Asia, 31 studies in Europe, 21 studies in
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Australasia/Oceania, and 20 studies in South America.
The countries with the most studies identified were the
United States (N = 39) and Australia (N = 21). The majority of
the studies included healthy populations (N = 99), many did
not specify health status (N = 61), and a few included popu-
lations with conditions (N = 7). The conditions were diabetes
type 1 (N = 1), diabetes type 1/gestational diabetes (N = 1),
diabetes type 2/hyperthyroidism/hypothyroidism/ovulatory
disturbance (N = 1), HIV (N = 1), mastitis (N = 1), persistent
nipple pain (N = 1), and ankyloglossia (N = 1). The majority
of the articles did not specify the nutritional status of their
study population (N = 145), whereas some included popu-
lation with a good nutritional status (N = 7), others with a
suboptimal nutritional status (N = 15).
The methods used to determine breast milk intake were
test-weighing (N = 113), deuterium dilution (N = 49), and
both test-weighing and deuterium dilution (N = 5). The ma-
jority of the test-weighing was done by weighing the infant,
except for two studies that used maternal test-weighing. Test-
weighing was either self-managed by the mothers (N = 61) or
conducted under observation or by a researcher (N = 34) or
RIOS-LEYVRAZ AND YAO
not reported (N = 23). The duration of test-weighing varied
between 12 and 168 hours, with the majority being 24 hours
(N = 58). Only 15 studies mentioned having corrected for
insensible water losses. The scales used were electronic (N =
65), mechanical (N = 12), electronic and mechanical (N = 1),
or unspecified (N = 39). The deuterium dilution technique
was conducted by administering deuterium to the mothers
(N = 47) and in some cases the infants (N = 7), with samples of
saliva (N = 32), urine (N = 16), saliva or urine (N = 4), or un-
specified (N = 2).
Meta-analysis
The mean intake of breast milk was 670 mL per day (95%
CI: 630–710), ranging from 84 to 992 mL per day. Six out-
liers were identified and could be explained by the extreme
ages of the infants included: Four were from studies with
infants in the first days of life and two were with children of
2 years and above. The mean intake of breast milk per body
weight was 117 mL/kg per day (95% CI: 112–122), ranging
from 50 to 191 mL/kg per day. One outlier was identified,
which was a study with infants between a large age range
(1–12.5 months old).
The breast milk intakes among different subgroups are
summarized in Table 1. Breast milk intake increased over the
different lactation stages, from colostrum to transitional and
mature milk. Breast milk intake was higher among healthy
populations, exclusively breastfed infants, and when mea-
sured with deuterium dilution than with test-weighing and
differed between continents (i.e., the lowest values were
found in Asia), but did not differ between country income
categories. Breast milk intake also did not differ between
adolescent and adult mothers (noting there was only one
study with adolescent mothers).
No studies were identified to permit the comparison of
breast milk intake from anemic versus nonanemic women
(i.e., only one study explicitly excluded women with severe
anemia,12 the other studies did not specify anemia sta-
tus). The subgroup meta-analysis by maternal BMI was not
possible because nearly all studies included several BMI
FIG. 1. Study selection
flowchart.
 BREAST MILK INTAKE REVIEW 191

Table 1. Summary of Subgroup Meta-Analyses for Breast Milk Intake Volume (mL/Day)
Group N N Mean (95% CI) pa pb
All 167 20,951 670 (630–710) — —
Lactation stage
Colostrum 14 2,846 215 (177–253) <0.001 <0.001
Colostrum/transitional milk 4 498 326 (151–500)
Transitional milk 16 1,266 489 (434–545)
Transitional/mature milk 2 28 583 (495–672)
Mature milk 153 17,310 715 (693–738)
Unspecified/mixed 2 60 690 (613–766)
Maternal/infant health
Healthy 105 13,355 682 (640–724) <0.001 <0.001
With condition 12 624 335 (264–406)
Unspecified/mixed 60 7,061 661 (598–725)
Maternal age
Adults (‡18 years) 55 4,829 696 (655–737) 0.631 0.331
Adolescents (<18 years) 1 42 714 (654–773)
Unspecified/mixed 112 16,080 657 (606–709)
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Gestation
Term 93 11,635 660 (609–711) — 0.595
Preterm 0 0 —
Unspecified/mixed 74 9,316 683 (617–748)
Breastfeeding practice
Exclusive breastfeeding 86 5,961 729 (678–779) 0.031 0.017
Mixed 59 6,523 634 (565–704)
Unspecified 57 7,577 620 (549–690)
Country income category
Low 12 1,615 723 (658–788) 0.446 0.189
Low–middle 29 4,294 653 (576–731)
Upper–middle 32 4,370 687 (609–764)
High 95 9,441 658 (600–717)
Unspecified/mixed 3 279 826 (677–975)
Continent
Africa 29 3,277 704 (650–757) 0.005 0.001
Asia 29 5,410 567 (473–661)
Australasia/Oceania 19 739 734 (704–765)
Europe 30 4,514 625 (524–725)
North America 48 3,960 691 (667–714)
South America 14 2,050 740 (668–811)
Unspecified/mixed 2 49 898 (732–1,064)
Measurement method
Deuterium dilution 54 6,103 759 (729–789) <0.001 —
Test-weighing 117 14,504 634 (586–683)
Deuterium dilution and test-weighing 1 78 877 (827–927)
a
p-Value for difference between groups without ‘‘Unspecified/Mixed’’ group.
b
p-Value for difference between groups for all groups.
CI, confidence interval.

categories, making comparisons not meaningful. However, a
meta-regression with mean BMI was conducted. The asso-
ciation between maternal BMI and breast milk intake was
nonsignificant ( p = 0.867).
The daily breast milk intakes per body weight among
different subgroups are summarized in Table 2. The dif-
ferences between healthy and unhealthy populations and
between regions became nonsignificant. The other signif-
icant and nonsignificant differences between subgroups,
respectively, remained the same as for total breast milk
intake.
The differences between the measurement methods were
further explored. Five studies compared deuterium dilution
and test-weighing with measured breast milk intake in the
same sample of infants.13–17 Four of the five studies found
significantly higher values with deuterium dilution than with
test-weighing (one was nonsignificant). When deuterium was
administered to mothers, values tended to be closer to test-
weighing results than when administered to infants. Differ-
ences between deuterium dilution and test-weighing tended
to also be smaller when test-weighing values were corrected
for insensible water losses.
When comparing all the studies that measured deute-
rium administered to mothers and all the studies that corrected
for insensible water losses in test-weighing, the differences
between methods became nonsignificant (deuterium dilution:
N = 46, estimate: 744, 95% CI: 713–776, and test-weighing
corrected for insensible water losses: N = 14, estimate: 735,
 192 RIOS-LEYVRAZ AND YAO

Table 2. Summary of Subgroup Meta-Analyses for Breast Milk Intake

Volume per Body Weight (mL/kg per Day)
Group N n Mean (95% CI) pa pb
All 93 9,941 117 (112–122) — —
Lactation stage
Colostrum 4 400 64 (59–68) <0.001 <0.001
Transitional milk 6 436 148 (122–174)
Mature milk 88 8,999 118 (113–123)
Unspecified/mixed 1 45 137 (128–147)
Maternal/infant health
Healthy 60 6,814 118 (112–125) 0.594 0.412
With condition 2 127 123 (108–138)
Unspecified/mixed 33 3,089 113 (106–121)
Maternal age
Adults 25 2,232 125 (114–136) — 0.079
Adolescents 0 0 —
Unspecified/mixed 68 7,709 114 (108–119)
Gestation
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Term 58 6,466 118 (112–124) — 0.387

Preterm 0 0 —
Unspecified/mixed 35 3,475 114 (105–122)
Breastfeeding practice
Exclusive breastfeeding 50 3,242 129 (124–134) <0.001 <0.001
Mixed 37 3,556 97 (90–104)
Unspecified 24 2,073 115 (105–126)
Country income category
Low 10 953 107 (94–120) 0.072 0.072
Low–middle 18 1,398 105 (90–120)
Upper–middle 19 2,468 121 (110–132)
High 49 3,940 120 (114–126)
Unspecified/mixed 1 230 112 (106–117)
Continent
Africa 23 2,114 104 (93–114) 0.019 —
Asia 15 2,176 114 (99–129)
Australasia/Oceania 5 233 103 (80–126)
Europe 15 1,238 128 (117–139)
North America 28 1,990 120 (113–126)
South America 11 1,238 126 (109–143)
Unspecified/mixed 0 0 —
Measurement method
Deuterium dilution 43 4,354 129 (121–136) <0.001 —
Test-weighing 55 5,587 108 (102–114)
Deuterium dilution and test-weighing 0 0 —
a
p-Value for difference between groups without ‘‘unspecified/mixed’’ group.
b
p-Value for difference between groups for all groups.
CI, confidence interval.

95% CI: 690–781, p-value: 0.749), indicating that the true provides breast milk intake estimates from key studies only
breast milk intake probably lies between the two estimates at different ages from 1 to 24 months old estimated from the
from deuterium dilution and test-weighing. meta-regression model.

Meta-regression
The evolution of breast milk intake per day and per body
weight at different ages of the infant is shown in Figures 2
and 3, respectively. The intake of breast milk increases
sharply over the first month and then reaches a plateau *3–
4 months, and starts slowly decreasing with the introduc-
tion of solid foods. The meta-regression model fitting the
data the best was the logarithmic model. The meta-
regression results are depicted in Figures 4 and 5. Table 3
Discussion
Summary of results
This systematic review included a large number of studies,
from all continents. The mean breast milk intake for chil-
dren 0–35.9 months old was 670 mL per day and 117 mL/kg
per day. Breast milk intake increased rapidly over the first
month (from 45 up to 621 mL/day), reaching a plateau *3–4
months (just below 750 mL/day), and starting a progressive
decrease *4–6 months with the introduction of solid foods.
 BREAST MILK INTAKE REVIEW
FIG. 2. Breast milk intake
(mL/day) over time (in days since
birth), with local polynomial re-
gression (dashed line: 6 months of
age).
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The evolution of breast milk intake over time was best
modeled with a logarithmic model. Breast milk intake was
influenced by infant age, infant body weight, breastfeeding
practices, and measurement methods.
Interpretation
The intakes of breast milk found in this review are
comparable with the values in the previous WHO review3
(Tables 4 and 5). The 22 studies included in the 1998 WHO
review were identified through a systematic search of
Medline and references lists. All studies included in the
WHO review used test-weighing, except for one study that
used deuterium dilution. Our review included all the studies
from the 1998 WHO review and included more and ulterior
studies. For the interpretation of the values per infant age
category, it is important to note that the age distribution
FIG. 3. Breast milk intake per
body weight (mL/kg per day) over
time (in days since birth), with lo-
cal polynomial regression (dashed
line: 6 months of age).
193
within each age category was not evenly distributed, which
could have skewed the estimates toward one end of the age
category.
For example, in the 12–35.9 months age group, most of the
studies were for children near 12 months old and few studies
were available for children >24 months old. Therefore, the
mean intake of breast milk in the 12–35.9 months would be
more confidently applied to a 12-month-old infant, but less to
a 35-month-old infant. To overcome this challenge, we
conducted a meta-regression with age as a covariate.
Our review found that breast milk intake was influenced by
infant body weight. Another review18 found that breast milk
volume was influenced by birth weight and gestational age,
through differences in suckling strength, frequency, and du-
ration. We were not able to assess differences in infants born
term and preterm. Most of the studies comparing breast milk
intake in term and preterm infants focused on milk
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FIG. 4. Breast milk intake (mL/day) over time (in days since birth) with log meta-regression with all (black) and key
(gray) studies (dashed line: 6 months of age).

*Correction added on March 1, 2023 after first online publication of February 10, 2023: The equations in Figures 4 and
5 have been corrected.

FIG. 5. Breast milk intake per body weight (mL/kg per day) over time (in days since birth) with log meta-regression with
all (black) and key (gray) studies (dashed line: 6 months of age).
194
 BREAST MILK INTAKE REVIEW 195

Table 3. Mean Breast Milk Intake (95% such as contraceptive pills and growth hormones, focused on
Confidence Interval) from 1 to 24 Months milk expression only,28–30 which was an exclusion criteria in
of Age from Meta-Regression with Key Studiesa our review. Other studies have found that maternal under-
weight does not influence breast milk production,31 but ma-
Daily breast milk
intake per body ternal obesity does.32 The absence of association between
Age Daily breast milk weight (mL/kg maternal BMI and breast milk intakes found in our review
(months) intake (mL/day) per day) could have been due to the paucity of studies with women in
the extreme BMI categories.
1 624 (605–642) 135 (129–141) Concerning breast milk measurement methods, a systematic
2 705 (690–721) 132 (127–136) review6 found that deuterium dilution and test-weighing
3 735 (719–750) 126 (122–131) methods were the best methods to measure breast milk intakes.
4 743 (728–758) 120 (116–124) Our review included only studies that used one of these two
5 740 (724–755) 114 (110–118) methods. However, both the deuterium dilution and test-
6 729 (713–745) 107 (102–111)
7 713 (697–730) 99 (95–104) weighing methods are still prone to errors resulting in possible
8 694 (676–711) 92 (87–97) over-estimation of intake with deuterium and underestimation
9 671 (652–691) 84 (79–90) with test-weighing.13–15 For example, deuterium dilution ad-
10 647 (625–668) 77 (71–83) ministered to mothers and measured in mothers and infants in
11 620 (596–645) 69 (62–76) saliva samples can provide more accurate estimates than when
12 593 (566–620) 61 (54–69) administered to infants or measured in urine samples.33–35
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13 563 (533–594) 54 (45–62) Test-weighing should be conducted by a researcher or by

14 533 (500–567) 46 (36–55) the mother under observation to avoid missing feeds, using an
15 502 (465–539) 38 (27–49) electronic scale to increase precision, and corrected for in-
16 470 (430–511) 30 (18–42) sensible water losses.6,36 In our review, the actual intakes of
17 438 (393–482) 22 (8–35)
18 404 (356–452) —b breast milk probably lie between the two estimates with the
19 370 (318–422) — two different methods. When comparing deuterium dilution
20 336 (280–392) — administered to mothers and test-weighing corrected for in-
21 301 (241–361) — sensible water losses, the gap between the two estimates was
22 266 (202–330) — narrower and became nonsignificant.
23 231 (162–299) —
24 195 (122–267) —
Strengths and limitations
a
Healthy, term children exclusive breastfeeding up to 6 months.
b
There were insufficient studies >17 months of age to provide A strength of this review is the considerate effort was made
reliable estimates. to cover as much as possible of the literature available on the
topic, in terms of dates, language, and geography. In fact, a
broad systematic search strategy was developed and com-
expression only19–21 or used enteral feeding with the preterm plemented with additional searches, including searches of Af-
infants,22–27 which were both criteria of exclusion in our rican and Latin American literature databases. Studies from all
review. the continents were identified. Another strength of this study is
The latter review also found an influence of substance use, the multiple subgroup analyses conducted to compare different
which we also could not assess, as most of the studies in- groups of populations and study influencing factors. Moreover,
vestigating the effect of the intake of different substances, a meta-regression was conducted to be able to model the effect

Table 4. Comparison of Breast Milk Intake with 1998 World Health Organization Review (mL/Day)
0–2.9 months 3–5.9 months 6–11.9 months 12–23.9 months
Age group n Mean n Mean n Mean n Mean
1999 WHO review
All 1,061 661 1,511 727 1,569 653 417 539
Exclusive breastfeeding 505 717 658 786 235 806 0 —
Mixed 556 624 853 675 1,334 613 417 539
This review, all studies
All 8,323 635 5,283 764 4,001 645 978 527
Exclusive breastfeeding 3,002 700 2,619 766 109 748 0 —
Mixed 1,350 584 1,377 746 2,361 617 397 544
Unspecified 3,971 553 1,287 774 1,531 678 581 437
This review, key studies
All 4,367 622 2,376 761 1,417 639 111 513
Exclusive breastfeeding 1,520 685 1,731 758 78 734 0 —
Mixed 996 529 424 725 1,286 604 111 513
Unspecified 1,851 528 221 811 53 802 0 —
n = Number of participants.
 196 RIOS-LEYVRAZ AND YAO

Table 5. Comparison of Breast Milk Intake with 1998 World Health Organization Review (mL/kg per Day)
0–2.9 months 3–5.9 months 6–11.9 months 12–23.9 months
Age group n Mean n Mean n Mean n Mean
1999 WHO review
All 537 140 916 116 771 91 222 59
Exclusive breastfeeding 473 153 520 123 143 103 473 153
Mixed 64 102 396 100 628 86 222 59
This review, all studies
All 2,647 143 3,364 119 2,389 80 224 59
Exclusive breastfeeding 1,292 146 1,863 120 72 94 0 —
Mixed 443 139 1,064 120 1,593 78 190 60
Unspecified 912 139 437 119 724 82 34 44
This review, key studies
All 1,579 139 1,563 119 1,088 81 106 50
Exclusive breastfeeding 835 144 1,327 118 72 94
Mixed 216 129 191 121 1,001 76 106 50
Unspecified 528 134 45 120 15 124 0 —
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n = Number of participants.

of age on breast milk intake. The analyses restricted to the key
studies give values of breast milk intakes of high quality and
can be used as a reference.
A limitation of this review is the information available from the
studies. Several studies did not provide sufficient information on
influencing factors, especially on nutrition status. The results of
the subgroup analyses should be interpreted with caution10 as the
studies were unevenly distributed between some of the subgroups
(i.e., healthy versus unhealthy, adult versus adolescent mothers).
Another limitation is that only study-level data were available. If
individual-level data had been available, a more detailed and
precise analysis could have been conducted. The Mothers, Infants
and Lactation Quality study is an ongoing study whose goal is to
establish reference values for breast milk by collecting
individual-level data from well-nourished women and infants in
four countries.37 It will be useful to compare the results of the
latter study, when available, with our review.
for all studies, except for the studies in Chinese, which were
extracted by Q.Y. Q.Y. verified a subset of the extracted data.
M.R.L. conducted the analyses. M.R.L. wrote the report and
Q.Y. provided inputs.
Disclosure Statement
No competing financial interests exist.
Funding Information
Funding for this study was provided to M.R.L. and Q.Y. by
the Food and Agriculture Organization of the United Nations
(FAO) and World Health Organization (WHO).
Supplementary Material
Supplementary Files

Conclusion
In conclusion, this study updates the 1998 WHO breast
milk estimates3 and is currently the most up-to-date and
comprehensive systematic review on the topic to our
knowledge. Results of this review can be used as an aid in
assessing infant and young child nutrition, including the es-
timation of nutrient intakes and requirements.
Acknowledgments
We thank Dr Jason Montez for conducting the database sear-
ches and for providing inputs on the analyses and the report. We
also thank the FAO/WHO expert group on nutrient requirements
for children aged 0–36 months for their inputs, the IAEA for
providing unpublished data from IAEA-supported projects and
for their comments on the report, and the WHO translation team,
Rain Yamamoto and Darius Rohani, for translating full texts.
Authors’ Contributions
M.R.L. designed the research protocol. M.R.L. and Q.Y.
screened the studies for the original review and M.R.L.
screened the studies for the update. M.R.L. extracted the data
References
1. World Health Organization. WHO Recommendations on
Maternal and Newborn Care for a Positive Postnatal Ex-
perience. World Health Organization: Geneva, Switzerland;
2022. Available from: https://apps.who.int/iris/handle/
10665/352658 [Last accessed: November 26, 2022].
2. Pan American Health Organization. Guiding Principles
for Complementary Feeding of the Breastfed Child. Pan Amer-
ican Health Organization: Washington, DC, USA; 2003; 34 p.
3. WHO Programme of Nutrition. Complementary Feeding
of Young Children in Developing Countries: A Review of
Current Scientific Knowledge. World Health Organization;
1998. Available from: https://apps.who.int/iris/handle/10665/
65932 [Last accessed: January 20, 2023].
4. da Costa THM, Haisma H, Wells JCK, et al. How much
human milk do infants consume? Data from 12 countries
using a standardized stable isotope methodology. J Nutr
2010;140(12):2227–2232.
5. National Academies of Sciences, Engineering, and Medicine.
Scanning for New Evidence on the Nutrient Content of Hu-
man Milk: A Process Model for Determining Age-Specific
Nutrient Requirements. The National Academies Press:
Washington, DC; 2020.
 BREAST MILK INTAKE REVIEW
6. Scanlon KS, Alexander MP, Serdula MK, et al. Assessment
of infant feeding: The validity of measuring milk intake.
Nutr Rev 2002;60(8):235–251.
7. World Health Organization (WHO), Food and Agricultural
Organization (FAO). Vitamin and Mineral Requirements in
Human Nutrition, Second edition. World Health Organi-
zation: Geneva; 2004; 341 p.
8. Covidence Systematic Review Software. Veritas Health
Innovation: Melbourne, Australia. Available from: www
.covidence.org [Last accessed: January 20, 2023].
9. PlotDigitizer Software. Available from: plotdigitizer.source
forge.net [Last accessed: January 20, 2023].
10. Higgins J, Green S. Cochrane Handbook for Systematic
Reviews of Interventions. The Cochrane Collaboration;
2019. Available from: www.handbook.cochrane.org [Last
accessed: January 20, 2023].
11. Borenstein M, Hedges LV, Higgins JP, et al. Introduction
to Meta-Analysis. John Wiley & Sons, Ltd: West Sussex,
United Kingdom; 2009.
12. Agne-Djigo A, Kwadjode KM, Idohou-Dossou N, et al.
Downloaded by 125.163.193.90 from www.liebertpub.com at 05/02/23. For personal use only.
Energy intake from human milk covers the requirement of
6-month-old Senegalese exclusively breast-fed infants. Br J
Nutr 2013;110(10):1849–1855.
13. Butte NF, Garza C, Smith EO, et al. Evaluation of the
deuterium dilution technique against the test-weighing pro-
cedure for the determination of breast milk intake. Am J Clin
Nutr 1983;37(6):996–1003.
14. Butte NF, Wong WW, Patterson BW, et al. Human-milk
intake measured by administration of deuterium oxide to
the mother: A comparison with the test-weighing tech-
nique. Am J Clin Nutr 1988;47(5):815–821.
15. Butte NF, Wong WW, Klein PD, et al. Measurement of
milk intake: Tracer-to-infant deuterium dilution method. Br
J Nutr 1991;65(1):3–14.
16. Coward WA, Sawyer MB, Whitehead RG, et al. New
method for measuring milk intakes in breast-fed babies.
Lancet 1979;2(8132):13–14.
17. Laskey MA, Prentice A, Hanratty LA, et al. Bone changes
after 3 mo of lactation: Influence of calcium intake, breast-
milk output, and vitamin D-receptor genotype. Am J Clin
Nutr 1998;67(4):685–692.
18. Institute of Medicine (US) Committee on Nutritional Status
During Pregnancy and Lactation. 5. Milk volume. In: Nu-
trition During Lactation. National Academies Press (US):
Washington, DC, USA; 1991. Available from: https://www
.ncbi.nlm.nih.gov/books/NBK235589/ [Last accessed: Jan-
uary 20, 2023].
19. Anderson GH, Atkinson SA, Bryan MH. Energy and
macronutrient content of human milk during early lactation
from mothers giving birth prematurely and at term. Am J
Clin Nutr 1981;34(2):258–265.
20. Anderson DM, Williams FH, Merkatz RB, et al. Length of
gestation and nutritional composition of human milk. Am J
Clin Nutr 1983;37(5):810–814.
21. Hill PD, Aldag JC, Chatterton RT, et al. Comparison of
milk output between mothers of preterm and term infants:
The first 6 weeks after birth. J Hum Lact 2005;21(1):22–
30.
22. Acuña-Muga J, Ureta-Velasco N, de la Cruz-Bértolo J,
et al. Volume of milk obtained in relation to location and
circumstances of expression in mothers of very low birth
weight infants. J Hum Lact 2014;30(1):41–46.
23. Carnielli VP, Pederzini F, Vittorangeli R, et al. Plasma and
red blood cell fatty acid of very low birth weight infants fed
197
exclusively with expressed preterm human milk. Pediatr
Res 1996;39(4):671–679.
24. Carroll K, Herrmann KR. The cost of using donor hu-
man milk in the NICU to achieve exclusively human milk
feeding through 32 weeks postmenstrual age. Breastfeed
Med 2013;8(3):286–290.
25. Feldman R, Eidelman AI. Direct and indirect effects of breast
milk on the neurobehavioral and cognitive development of
premature infants. Dev Psychobiol 2003;43(2):109–119.
26. Haase B, Barreira J, Murphy PK, et al. The development of an
accurate test weighing technique for preterm and high-risk
hospitalized infants. Breastfeeding Med 2009;4(3):151–156.
27. Lund A, Löfqvist C, Pivodic A, et al. Unpasteurised ma-
ternal breast milk is positively associated with growth
outcomes in extremely preterm infants. Acta Paediatr 2020;
109(6):1138–1147.
28. Milsom SR, Breier BH, Gallaher BW, et al. Growth hor-
mone stimulates galactopoiesis in healthy lactating women.
Acta Endocrinol (Copenh) 1992;127(4):337–343.
29. Sas M, Gellen JJ, Dusitsin N, et al. An investigation on the
influence of steroidal contraceptives on milk lipid and fatty
acids in Hungary and Thailand. Contraception 1986;33(2):
159–178.
30. Abdou RM, Fathey M. Evaluation of early postpartum
fenugreek supplementation on expressed breast milk vol-
ume and prolactin levels variation. Egypt Pediatr Assoc Gaz
2018;66(3):57–60.
31. Prentice AM, Goldberg GR, Prentice A. Body mass index
and lactation performance. Eur J Clin Nutr 1994;48 Suppl
3:S78–S86; discussion S86–S89.
32. Lovelady CA. Is maternal obesity a cause of poor lactation
performance. Nutr Rev 2005;63(10):352–355.
33. Matsiko E, Hulshof PJM, van der Velde L, et al. Com-
paring saliva and urine samples for measuring breast milk
intake with the 2H oxide dose-to-mother technique among
children 2–4 months old. Br J Nutr 2020;123(2):232–240.
34. International Atomic Energy Agency (IAEA). Stable
Isotope Technique to Assess Intake of Human Milk in
Breastfed Infants. Human Health Series: Vienna, Austria;
2010. Available from: https://www.iaea.org/publications/
8168/stable-isotope-technique-to-assess-intake-of-human-
milk-in-breastfed-infants [Last accessed: January 20, 2023].
35. Coward WA, Cole TJ, Sawyer MB, et al. Breast-milk in-
take measurement in mixed-fed infants by administration
of deuterium oxide to their mothers. Hum Nutr Clin Nutr
1982;36(2):141–148.
36. Neville MC, Keller R, Seacat J, et al. Studies in human
lactation: Milk volumes in lactating women during the
onset of lactation and full lactation. Am J Clin Nutr 1988;
48(6):1375–1386.
37. Allen LH, Hampel D, Shahab-Ferdows S, et al. The mothers,
infants, and lactation quality (MILQ) study: A multi-center
collaboration. Curr Dev Nutr 2021;5(10):nzab116.
Address correspondence to:
Magali Rios-Leyvraz, PhD
Department of Nutrition and Food Safety
World Health Organization
Avenue Appia 20
1211 Geneva
Switzerland
E-mail: magali.leyvraz@gmail.com