Biochemistry 4.

November 15, 2011

Dr. Madarcos

Breastfeeding
OBJECTIVES
At the end of the lecture, the student should
be able to:
1. Describe the physiology of lactation.
2. Enumerate the differences among colostrum, transitional milk and
human mature milk.
3. Identify the quantitative and qualitative differences between breast
milk and cows milk.
4. Enumerate the advantages of breast milkover cows milk.

I. HUMAN MILK
Milk is produced in small sac-like glands in the breast. These sacs
develop after stimulation of hormones such as estrogen and
progesterone at the beginning of the second trimester of pregnancy.

The size of the breast does not determine the amount of milk
production.
The skin of the nipple has oil and sweat glands which protects the
babies from infection through its secretion.

III. COLOSTRUM
The first milk produced from the first sucking to 5 days of
lactation.
Deep yellow in color, alkaline reaction, pH 7.7
Specific gravity: 1.040 1.060
10 40 ml/day

NUTRIENT COMPOSITION
Note: Estrogen suppress lactation thus, there is no milk during
Pregnancy
.

II. LET-DOWN OR MILK EJECTION REFLEX

The reflex that forces milk to the front of the breast when the
infant begins to nurse. Other stimuli may include: smell, touch,
voice, cry, cuddling
It stimulates nerve endings in the nipple and areola.
The signal travels through nerve pathways to the hypothalamus.
The hypothalamus will then signal the anterior pituitary gland to
release prolactin in the blood stream.
On the other hand, signals from the hypothalamus will go to the
posterior pituitary gland to stimulate the release of oxytocin.

Lower lactose (sugar) and fat content

High protein & Immunoglobulin (esp. sIg A) content (95% of the
proteins)
Richer in Vitamin A, minerals like Na, K, and trace elements like Fe
Increased amount of macrophages for phagocytosis

IV. TRANSITIONAL MILK

Secreted from the 4th to the 10th day of lactation.
Concentration of fats, lactose, and most B-vitamins gradually
increase.
Phosphorus is the only component higher than colostrum and
mature milk.
There is decrease in the number of cells.

V. HUMAN MATURE MILK

Secreted beyond the 10th day of lactation

A. PHYSICAL CHARACTERISTICS
Bluish in color and watery in consistency
pH 6.8 7.4 (average of pH 7)
Specific gravity 1.026 1.036 (average of 1.031)

B. NUTRIENT COMPOSITION
High levels of fats, lactose, and mostly vitamin B
Caloric Distribution in human milk:
o CHO: 43%
o CHON: 7%
o Fats: 50%
Lower concentrations of vitamins, immunoglobulin, minerals and
fat-soluble vitamins

VI. MATURE HUMAN MILK VS COWS MILK

Remember:
Prolactin stimulates milk production; also causes alveoli to take
nutrients from blood to breast milk.
Oxytocin stimulates the contraction of the myoepithelial cells
thus, propelling milk into the ducts and then to nipple pores.
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Same water content

Human milk has higher caloric density (Protein:
7%,Carbohydrates: 43%, Fats: 50%), fat, and lactose content
Cows milk has higher protein and ash content

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Breastfeeding

Human milk has lower protein content offers lower renal

sodium load to the immature kidneys
Protein nitrogen factor is lower in human who was breastfed
Protein nitrogen fraction determines the digestion of milk based
on the casein and the whey fraction

VII. LACTOSE
Major and dominant carbohydrate in human milk highest in
human species (7% in human, 4.8% in cows).
A disaccharide composed of glucose and galactose.
Galactose is an essential building block of galactolipids for the
growth of CNS.
Lactase is the enzyme that is most abundant at birth.
Other nitrogen-containing complex carbohydrates are present in
human milk and labeled as N-acetylglucosamine and sialic acidcontaining oligosaccharides and polysaccharides.
Constitutes the so-called bifidus factor (Lactobacillus bifidus) that
promotes the growth of a favorable bacterium in the GIT of
infants. They help keep the intestinal content acidic that will
inhibit the growth of harmful bacteria.

ADVANTAGES OF LACTOSE
Facilitates Ca and Mg absorption
Favors protein absorption
Promotes growth of intestinal bacteria that will synthesize B
complex
Promotes growth of microbial flora for lactic acid and lower
intestinal pH
Predominant stool flora is fermentive than putrefactive
Less sweet than sugar providing little opportunity for the
development of dental cavities
In human milk, presence of nitrogen-containing complex CHO
promotes the growth of good bacteria
Lactobacilli keep intestinal content acidic and inhibit growth of
harmful bacteria
CONTENT

Nov 15, 2011

This lower protein is most suitable to the infant because it means

lesser solute load to the infants immature or growing kidney.
In the stomach of the new born, the protein nitrogen fraction
undergoes digestion and is separated into two fractions:
o Protein nitrogen fraction
o Non-protein nitrogen fraction
Casein forms a precipitate with calcium and phosphorus-> less
digestible than human milk -> less absorption -> lower rate of
utilization.

A. COMPOSITION OF PROTEIN NITROGEN

A. CONTENT
HUMAN MILK
COWS MILK
WHEY
60%
18%
-lactalbumin
0.42
0.17
Lactoferrin
0.27
TRACES
-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
Advantages:
o Lactoferrin binds iron, thus acts as a bacteriostatic agent
o Whey -> more digestible- > more utilization
Because of higher whey fraction, human milk makes the protein
curds in the stomach smaller, softer and more flocculent,
contributing to the efficient and faster digestibility and more
complete absorption and higher rate of utilization of human milk

B. COMPOSITION OF NONPROTEIN NITROGEN

CONTENT
NON-PROTEIN
CONTENT
UREA
CREATINE
CREATININE
URIC ACID
GLUCOSAMINE
-AMINO NITROGEN

HUMAN MILK

COWS MILK

0.50

0.28

0.25
0.37
0.035
0.005
0.047
0.002

0.13
0.009
0.003
0.008
0.006

HUMAN MILK

COWS MILK

Histidine

22

95

Isoleucine
Leucine

68
100

228
350

Lysine
Methionine

73
25

277
88

May play a role in metabolic acidosis if infant is over fed with nonprotein nitrogen.
Advantages: Contributes to generation of amino acids.
Content ranking: Highest in breastmilk

Phenylalanine
Threonine

48
50

172
164

IX. ESSENTIAL AMINO ACIDS

Tryptophan

18

49

VIII. PROTEIN NITROGEN FRACTION

Human milk has lower protein content than cows milk
o -lactoglobulin is lacking in breast milk.
o Composes of immunoglobulins, where secretory IgA (sIg

A) is highest in breast milk.

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Lower in human milk in comparison to cows milk.

This low level in breast milk is of physiological important again
because it offers a lesser solute load to the infants immature
kidney.
PROTEIN (g/dl)
PROTEIN NITROGEN
A. CASEIN
B. WHEY

HUMAN MILK
1.1
1.43
40%
60%

COWS MILK
3.5
5.03
82%
18%

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Breastfeeding

the infants immature kidney and therefore must be thought of as

beneficial -> no problems on H2O, electrolytes and acid-base
balance.

X. NON-ESSENTIAL AMINO ACIDS

CONTENT

HUMAN MILK

COWS MILK

Arginine

45

129

Alanine

35

75

Cystine

22

32

Glutamic acid

320

680

Glycine

11

Proline

80

250

Serine

69

160

Tyrosine

61

179

Also lower in human milk in comparison to cows milk

Same advantage as that of essential amino acids

Nov 15, 2011

XIII. IRON
Both human and cows milk have low Fe contents.
Be that as it may it is still open to question whether Fe is really
that important in a breast-fed baby because the baby has enough
opportunity to store Fe in the tissues derived from the mother
during intrauterine life.
Absorption of iron in human milk is 49% efficient in comparison to
only 10% efficient in cows milk
Infants have numerous levels of Fe-binding protein lactoferrin
whose function is to inhibit the growth of respiratory and
gastrointestinal pathogens while at the same time providing a
buffer against Fe-deficiency anemia.

XII. FAT-SOLUBLE VITAMINS

XI. FATS
Major energy source, and is affected the most by maternal

diets.
Effect of maternal diet:
o Fish leads to high PUFAs,
o High carbohydrates leads to high saturated FAs.
o Milk formulas from vegetable oil and coconut will also

1. Except for Vit K, the other fat-soluble vitamins (A, D and E) are
higher in human milk in comparison to cows milk
2. This low vitamin K, however, is compensated by the routine
administration of Vit. K at birth (to prevent hemorrhagic disease
of the newborn) and by GIT flora production as the baby grows
older.

XIV. WATER-SOLUBLE VITAMINS

contribute to high saturated FAs.

o Also affected by diurnal variation, where hind milk is

1. Human milk as higher Vit C

2. Cows milk has higher niacin, thiamine, riboflavin, Vit B12 and
pyridoxine

more fatty.
FATTY ACID PROFILE
CONTENT
Total fat
Fat composition (%)
Unsaturated fatty
acids
Saturated fatty acids
Unclassified fatty
acids
Essential fatty acids

HUMAN MILK
4.5

COWS MILK
3.7

48

33

49

67

3
7

XV. INFLUENCES OF MILK COMPOSITION

CES MILK COMPOSITION

Time of the day

Diet of mother
Emotional state
Fore or hind milk
Drugs
Smoking

EVAPORAT
Advantages:
Important for CNS myelinization and development.
PUFAs, especially MCTs (in premature formulas), are easier
to absorb, digestion and utilization.
Content ranking: (PUFAs to SFAs)
Premature formulas < Hypoallergenic formulas < Breast
milk <Soy protein formulas < others high in fat and are SFAs

XII. MINERALS
All the major minerals found in cows milk occur in human milk at
about 1/3 of the concentration observed in cows milk with the
exception of phosphorus which is 1/7 that of cows milk
This low mineral content and consequently ash content is again of
physiologic importance since it results to a lower solute load to
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XVI. HUMANIZED MILK

The market today is flooded with a lot of commercial milk formulas
all intended as substitutes for breast milk.

A. EVAPORATED MILK

Cows milk evaporated at 55-60 C

Sterilization causes some damage to protein quality
Reduced to 50% of its volume
Very high density
It is homogenized broken down into smaller components
Animal fat is replaced by coconut oil saturated fatty acid
With high levels of lactose, protein, fat
With high levels of vitamin D, B1, B2, B6
Lower levels of Vitamin C

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Breastfeeding

Same levels of vitamins A-E-K

B. SWEETENED CONDENSED MILK

When diluted at 1:4, gives caloric yield as breastmilk

Slightly higher protein content than breastmilk
It is casein predominant
100% vegetable oil
It has low vitamin content
Lactose is added with 33.7 g/dl cane sugar or sucrose giving it a
disproportionately high CHO content nutritionally out of balance
formula for infants
Not recommended for infant feeding

SO
C. SOY PROTEIN FORMULA
Based on vegetable proteins
Lactose free, milk free
Intended for children who are allergic to cows milk or with
lactose or galactose intolerance
Same caloric density as breastmilk
Slightly higher protein content and 100% casein
Lower fat content with 24-100% vegetable oil composing of
coconut, corn, and soybean
Carbohydrates utilized are either sucrose or maltodextrin from
enzymatic digestion of corn, starch
500-2050 mg/L linoleic acid is added to offset essential fatty acid
deficiency (PUFA deficiency)brought about by the presence of
increased saturated FA in vegetable oil
Since casein is low in carnitine, carnitine is an added component
to soy-protein formulas
Carnitine serves to transport FA from the cytoplasm into the
mitochondria during -oxidation process for ATP synthesis
In the absence of carnitine, many FA cannot be oxidized and
therefore accumulate within the cell and in the blood stream as
fats and triglycerols

D. NON-PREMIUM FORMULAS

Less expensive
Lower caloric density
Casein dependent
Majority with vegetable oils
CHO content is a mixture of lactose and sucrose

E. PREMIUM FORMULAS
Expensive
For healthy, uncompromised, and non-problematic babies
From birth up to 6 months of age
Whey predominant
Contains high levels of saturated FA
HIGH PROTEIN FORMULAS OR FOLLOW-UP FORMULAS

Nov 15, 2011

G. PREMATURE FORMULA

With PUFA
For low birth weight infants
For premature babies
Promote growth at intrauterine rates
Higher caloric density
Whey predominant
Fat contains corn oil, coco oil, and medium chained triacylglycerol
(MCT)
Premature babies have low bile acid pools
MCT does not require bile acid for absorption
CHO content: lactose, corn syrup, maltodextrin
Maltodextrin stimulates multipathway absorption
High in vitamins especially Vit. D
HYPOALLERGENIC FORM
AH. HYPOALLERGENIC FORMULAS
For babies born with strong family history of allergy
Whey predominant
With vegetable oil

XVII. ADVANTAGES OF BREASTMILK

ASTMILK
Can NEVER be approximated
Has living biologic fluid with hormones and antibodies like
immunoglobulins and major nutrients
Composition never subject to human errors
Large amounts of lactoferrin, preferentially binds to iron and
inhibits growth of E. Coli, staphylococci and candida
Lysozyme is bacteriostatic against enterobaceriacea and
staphylococci

Other noteworthy Comparisons:

High content of Iron in Premature formulas, while lowest in
breast milk and cows milk
Low Vit K in breast milk, requiring administration of Vit K at
birth.
High Vit E in Premature formulas
High Vit C in breast milk as compared to cows milk.
Evaporated milk contains higher Vit B1, 2, & 6
High Vit D in Evaporated milk
High CHO and CHONs in Evaporated milk may contribute to
renal and CNS problems
Cows Milk contain highest content in vitamins like: niacin,
thiamine, riboflavin, vit b12 and pyridoxine

F. HIGH PROTEIN FORMULAS OR FOLLOW-UP FORMULAS

For 6 months and above
For rapid growth and development
Whey predominant
Contains vegetable oil
CHO blend of lactose, sucrose, and maltodextrin
PREMATUR
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