reastfeeding

Breastfeeding
fbm
 OBJECTIVES
 At the end of the lecture, the student should
be able to:
 Describe the physiology of lactation.

 Differentiate colostrum, transitional and

human mature milk.
 Compare the quantitative and qualitative

properties of breast milk and cow’s milk.

 Enumerate the advantages of breast milk

over cow’s milk.

 MILK
HUMAN MILK
COW’S MILK
SPECIAL MILK
FORMULAS
 MILK

FACTS
FALACIES
FIGURES
FOTOS
LET-DOWN REFLEX
 COLOSTRUM
 Physical Characteristics
 Secreted from 1st
sucking day – 5 days
 Deep yellow

 Alkaline reaction pH 7.7

 Specific gravity 1.040 –

1.060
 10 – 40 ml/day
 COLOSTRUM
 Nutrient Composition
 Lower lactose (sugar) and fat
content
 Higher protein & Ig (esp. sIgA)

content (95% of the proteins)

 Richer in Vit. A, minerals like

Na, K, and trace elements like Fe

 Increased amount of macrophages

for phagocytosis
 TRANSITIONAL MILK –
NUTRIENT COMPOSITION
 4th – 10th day of lactation
 Fats, lactose and most B vits.

gradually increase
 Phosphorus is higher than

in either colostrum or
mature human milk
HUMAN MATURE MILK
 Physical
Characteristics
 Secreted beyond

10th day of
lactation
 Bluish and watery

 pH 6.8 – 7.4, ave. 7

 Sp. gr. 1.026 –

1.036, ave. 1.031

HUMAN MATURE MILK
 Nutrient Composition
 High levels of fats, lactose

and most B vitamins

 Lower proteins, Igs, minerals

and fat soluble vitamins

“Breast milk is the
best”
“Breastmilk feeding
is the best form of
feeding”
“Natural mothering is
the best”
 MILK COMPOSITION
NUTRIENT MATURE COW’S MILK
COMPOSITION HUMAN MILK
Water (ml) 87.1 87.2
Energy (kcal/dl) 69.0 66.0
Protein (g/dl) 1.1 3.5
Fat (g/dl) 4.5 3.7
Lactose (g/dl) 6.8 4.9
Ash (g/dl) 0.2 0.7
CALORIC DISTRIBUTION
IN HUMAN MILK
NUTRIENT % OF TOTAL
CALORIES
Carbohydrates 47%

Fats 50%

Proteins 3%
 LACTOSE
6 6
HOCH2 HOCH2
 Major and dominant
O 5 O
human milk HO 5
H
H
4H
OH
1
carbohydrate 4
OH H
1 O
OH H H
 Why? H 3 2 H 3 2

 Disaccharide H OH H OH
LACTOSE
 Glucose  energy (galactose +
 Galactose  glucose)
galactolipids  CNS
development
 LACTOSE
 Small amounts of N2-
containing complex
carbohydrates
 N-acetyl glucosamine
 Sialic acid-containing
oligosaccharides and
polysaccharides
 Bifidus factor – lactobacillus
bifidus
 LACTOSE -
ADVANTAGES
 Facilitates Ca+2 and Mg+2
absorption
 Favors protein absorption

 Promotes growth of intestinal

bacteria
 LACTOSE -
ADVANTAGES
 Promotes growth of microbial
flora
 Promotes predominance of

fermentative stool flora

 Less sweet than sugar
PROTEIN NITROGEN FRACTION
HUMAN COW’S
MILK MILK
PROTEIN 1.1 3.5
(g/dl)
1. Protein 1.43 5.03
Nitrogen
a. Casein 40% 82%

b. Whey 60% 18%

COMPOSITION OF PROTEIN NITROGEN
A. PROTEIN NITROGEN HUMAN MILK COW’S MILK
Whey
α-lactalbumin 0.42 0.17
Lactoferrin 0.27 traces
β-lactoglobulin - 0.57
Lysozyme 0.08 traces
Serum albumin 0.08 0.07
IgA (sIgA) 0.16 0.005
IgG 0.005 0.096
IgM 0.003 0.005
COMPOSITION OF NON-PROTEIN NITROGEN
CONTENT HUMAN MILK COW’S MILK
B. NON-PROTEIN 0.50 0.28
NITROGEN
Urea 0.25 0.13
Creatine 0.37 0.009
Creatinine 0.035 0.003
Uric Acid 0.005 0.008
Glucosamine 0.047 -
α-amino 0.002 0.006
Nitrogen
ESSENTIAL AMINO ACIDS (mg/100ml)
CONTENT HUMAN MILK COW’S
MILK
Histidine 22 95
Isoleucine 68 228
Leucine 100 350
Lysine 73 277
Methionine 25 88
Phenylalanine 48 172
Threonine 50 164
Tryptophan 18 49
 NON-ESSENTIAL AMINO ACIDS
(mg/100ml)
CONTENT HUMAN MILK COW’S MILK
Arginine 45 129
Alanine 35 75
Cystine 22 32
Glutamic acid 320 680
Glycine 0 11
Proline 80 250
Serine 69 160
Tyrosine 61 179
 FATS
 Major energy source
 Important for CNS myelinization
 Most variable component
 Effect of Maternal Diet
 Diets high in fish (Eskimos,

Japanese)
– high PUFA
 Diets high in vegetable oil – high

PUFA
 Diets high in CHO – high SFA
 FATS
 Most variable component
 Diurnal Variation
 Higher in early AMs
 Higher at end of
breastfeeding (“hind
milk” vs. “fore milk”)
FATTY ACID PROFILE
CONTENT HUMAN COW’S
MILK MILK
Total Fat 4.5 3.7
Fat Composition (%)
Unsaturated Fatty Acids 48 33
Saturated Fatty Acids 49 67
Unclassified Fatty Acids 3
Essential Fatty Acids 7 2
 MINERALS
CONTENT HUMAN COW’S
MILK MILK
Calcium (mg/100ml) 340 1170

Phosphorus (mg/100ml) 140 920

Sodium (mEq/L) 7 22

Potassium (mEq/L) 13 35

Chloride (mEq/L) 11 29
 IRON
HUMAN COW’S
MILK MILK

Iron 0.50 0.50

% 49 10
Absorption
 FAT-SOLUBLE VITAMINS
VITAMINS HUMAN COW’S
MILK MILK
A. Fat Soluble
A (IU) 1898 1025
D (IU) 22 14
E (IU) 2 0.4
K (IU) 15 60
 H2O-SOLUBLE VITAMINS
VITAMINS HUMAN COW’S
MILK MILK
B. Water Soluble ↑ ↓
Vit. C ↑ ↓
Niacin ↓ ↑
Thiamine ↓ ↑
Riboflavin ↓ ↑
Vit. B12 ↓ ↑
Pyridoxine ↓ ↑
HUMANIZED MILKS
EVAPORATED
EVAPORATED MILK
MILK
 EVAPORATED MILK
 Cow’s milk evaporated at 55 - 60o C
 reduced to 50% of its volume
 Homogenized
 Sealed, autoclaved at 1160 C
 Sterilization causes some damage
to protein quality
 COMPOSITION OF HUMAN
MILK VS. EVAPORATED MILK
COMPOSITION HUMAN COW’S
FACTORS MILK MILK
Energy (kcal/dl) 69 152

Protein (gm/dl) 1.1 7.8

(100% casein)
Fat (gm/dl) 4.5 6.5 (coconut &
corn oil) -
filled milk
Lactose (gm/dl) 6.8 12
 COMPOSITION OF HUMAN
MILK VS. EVAPORATED MILK
MINERALS HUMAN EVAPORATED
MILK MILK
Calcium (mg/L) 340 2750
Phosphorus (mg/L) 140 2112
Sodium (mg/L) 7 55
Potassium (mg/L) 13 77
Chloride (mg/L) 11 46
Iron (mg/L) .5 2.43
 COMPOSITION OF HUMAN
MILK VS. EVAPORATED MILK

VITAMINS HUMAN EVAPORATED

MILK MILK
Fat-Soluble Vits
A E K (IU) same same
D (IU) 22 420
H2O-Soluble ↑ B1 B2 B6
↓ Vit. C
Vitamins
 SWEETENED
SWEETENED
CONDENSED
CONDENSED MILK
MILK
 COMPOSITION OF HUMAN
MILK VS. CONDENSED MILK
COMPOSITION HUMAN CONDENSED
FACTORS MILK MILK
Energy (kcal/dl) 69 67

Protein (gm/dl) 1.1 1.6

(Casein predominant)
Fat (gm/dl) 4.5 1.6 (100% veg. oil)

Carbohydrates 6.8 11.7 lactose

(gm/dl) lactose 43.7 sucrose
55.4
 SOY PROTEIN
FORMULAS
 Based on vegetable proteins (soya)
 Lactose free, “milk free”
 For children with allergy to cow’s

milk proteins or those with

lactose or galactose intolerance
SOY
SOY PROTEIN
PROTEIN FORMULAS
FORMULAS
 COMPOSITION OF HUMAN MILK
VS. MILK – FREE FORMULA
COMPOSITION HUMAN MILK MILK – FREE
FACTORS
Energy (kcal/dl) 67 67
Protein (gm/dl) 1.1 1.9 – 2.1 (soy
prot.)
Casein 40% 100%
Whey 60%
Fat (gm/dl) 4.5 (milk fat) 3.3 – 3.6 (24-100%
veg. oil)
Carbohydrate (gm/dl) 6.8 (lactose) 6.9 – 7.4 (sucrose,
maltodextrin)
Carnitine + +
Linoleic Acid (mg/L) + 500 - 2050
NON-PREMIUM
NON-PREMIUM FORMULAS
FORMULAS
 COMPOSITION OF HUMAN MILK
VS. NON-PREMIUM FORMULA
COMPOSITION HUMAN MILK NON-PREMIUM
FACTORS FORMULA
Energy (kcal/dl) 69 67
Protein (gm/dl) 1.1 1.5 – 1.7
Casein 40% 60 – 70%
Whey 60% 30 – 40%
Fat (gm/dl) 4.5 (milk fat) 3.2 – 3.5 (65 – 100%
veg. oil)
CHO (gm/dl) 6.8 (lactose) 7.1 – 7.4 (lactose &
sucrose)
Minerals slightly ↑
Vitamins
Fat Soluble slightly ↑
Water Soluble slightly ↓
PREMIUM FORMULAS
 Intended for healthy,
uncompromised and
non-problematic babies
 From birth up to 6

months of age
 Relatively expensive
PREMIUM
PREMIUM FORMULAS
FORMULAS
 COMPOSITION OF HUMAN MILK
VS. PREMIUM FORMULA
COMPOSITION HUMAN MILK PREMIUM
FACTORS FORMULAS
Energy (kcal/dl) 69 67 – 68
Protein (gm/dl) 1.1 1.5
Casein 40% 40%
Whey 60% 60%
Fat (gm/dl) 4.5 3.4 – 3.7 (100%
veg. oil)
CHO (gm/dl) 6.8 (lactose) 7 – 7. 2 (lactose)
Ash 0.2 0.4 – 2.5
Minerals ↑