Thesis (Ph.D.)--University of Western Australia, 2008.

Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

M.Tech. / Natural occurring components in human breast milk, cow milk and soy milk have shown anticarcinogenic abilities. The human breast milk protein, -lactalbumin, was found to induce apoptosis in cancer cells, embryonic cells and rapidly growing cells, when converted from its native form to a partial denatured apoptotic-inducing form. Moreover, radiation may cause irreversible changes of protein conformation at the molecular level. Native -lactalbumin is one protein that has shown a decrease in aromatic amino acid concentration and the formation of high and low molecular weight fractions when exposed to high doses of ionizing radiation. The effect of human breast milk, cow milk, soy milk and galactose (positive control) on SNO, A549 cancer cells and normal lymphocytes were investigated. Human breast milk was irradiated with low doses of Co60 ionizing radiation (0.1Gy, 1.0Gy and 5.0Gy) in order to establish the effect of these doses on the apoptotic-inducing ability of human breast milk. The techniques used included, Trypan blue dye exclusion (cell viability), haematoxylin and eosin stain (cell morphology), modified comet assay (halo) (DNA damage) and flow cytometry (apoptosis and necrosis). Findings showed that human breast milk, irradiated human breast milk and galactose induced apoptosis in the SNO, A549 cells and lymphocytes. The cell viability, cell morphology and DNA fragmentation patterns of irradiated human breast milk were similar to that of non-irradiated human breast milk, although the flow cytometry results did not correlate. Cow and soy milk did not induce apoptosis in the SNO, A549 cells and lymphocytes. The modified comet assay (halo) detected DNA damage as apoptotic or necrotic cells. A clear distinction could not be made between the two cell populations using this assay. Flow Cytometry discriminated and quantified apoptotic cells and necrotic/late apoptotic cells using Annexin V and Propidium Iodide (PI), respectively.

Background: Breast milk is an ideal source of nutrition for newborns as it provides nutrients required for growth in addition to numerous bioactive factors which help to develop an infant’s immune system. However, the macronutrient content of breast milk alone is not able to support preterm infant’s rapid growth needs and requires supplementation with fortifiers. There is strong evidence that the current practice of standard fortification (SF) may lead to nutritional deficits and consequently increases an infant’s risk of inadequate postnatal growth. Furthermore, the natural variation of breast milk composition makes it increasingly difficult to provide recommended macronutrient intakes with the SF. Individualized approaches, like adjustable fortification or target fortification (TFO), have been proposed to improve growth during hospitalization. A recent pilot trial demonstrated that TFO, which individually adjusts deficient macronutrient content after SF by analyzing the breast milk for native protein, carbohydrate and fat, is feasible in clinical practice and significantly reduces variation of macronutrient intakes. Objectives: To compare the response of preterm infants to feedings of breast milk with either SF or SF+TFO with respect to: 1) weight at 36 weeks’ post-menstrual age and growth velocity during hospitalization; 2) head circumference, length and body composition; and 3) the relationship between preterm infant’s weight or growth velocity and their macronutrient intake factors including protein intake and protein:energy (P:E) ratio. Methods: This was a single-center, double-blind randomized controlled trial completed at McMaster Children’s Hospital’s Level III NICU with a study period of at least 21 days. Preterm infants (n=103) born at <30 weeks of gestation and tolerating full enteral intakes of breast milk were enrolled and randomized to the Control (SF only) or Intervention (SF+TFO) groups. Native breast milk samples were collected for all infants on each study day and were analyzed for protein, carbohydrate and fat content. In the Control group, SF was provided using Enfamil (Mead Johnson, IL) human milk fortifier at the recommended dosage. In the Intervention group, after the addition of SF, modular macronutrient fortifiers were added based on analysis of the mother’s milk to reach target values based on ESPGHAN recommendations. Adjustment of the modular fortifiers was done three times per week. The primary outcomes were weight at 36 weeks’ PMA and growth velocity during the study period. Head circumference, length and body composition were also assessed at term-equivalent age. Subgroup analysis, stratified around the median protein levels after SF, also compared the growth outcomes between Control and Intervention groups. Multiple regression analysis models examined the effect of macronutrient intake factors and infant characteristics on weight, average growth velocity and daily weight gain. Results: Infants fed with SF+TFO had significantly higher protein (p<0.001), carbohydrate (p<0.001) and fat intakes (p<0.01) in addition to higher protein:energy and carbohydrate:non-protein energy (CHO:NPE) ratios (p<0.001) compared to those fed with SF alone. The average weight at 36 weeks’ PMA and growth velocity during the 21-day study period were higher for infants in the Intervention group (p<0.001). The Intervention group had significantly higher fat-mass (p<0.05) as well as more fat-free mass than the Control group at term-equivalent age (TEA), but were still within normal limits when compared to normative data from our NICU. At TEA, infants fed with TFO also showed significantly higher change in z-scores from birth for length when compared to infants fed SF with low-protein intakes (p<0.05). Change in head circumference z-scores were not statistically significant between groups. Higher average protein intakes and P:E ratios were each positively associated with higher weight at 36 weeks’ PMA (p<0.05). Moreover, higher daily weight gain was positively associated with higher daily protein intake from the previous study day (p<0.05). The absolute difference in day-to-day macronutrient intakes, however, were not significant predictors of daily weight gain. Conclusions: This study shows that target fortification of breast milk is promising as an individualized approach to improve the quality of nutrition for preterm infants. By addressing the variation and deficits of macronutrients that occur after standard fortification, infants were able to achieve higher body weight and faster weight gain. In the short term, target fortification may reduce the preterm infant’s risk for sub-optimal postnatal growth. These improved growth outcomes also have positive clinical implications on infant’s long-term health and development. Protein intake and the P:E ratio were identified as important factors for growth and should be considered in nutritional management and future fortification strategies for breast milk fed preterm infants. / Thesis / Master of Science (MSc)

Thesis (M.Sc.)--Memorial University of Newfoundland, 2000. / Bibliography: leaves 66-77.

No description available.

Human milk fortification is recommended to meet the nutritional requirements of preterm infants. Most human milk fortifiers (HMFs) contain non-protein energy (NPE) predominantly as carbohydrate which may lead to high fat deposition relative to lean mass accretion. We hypothesized that fortifying human milk with a HMF containing NPE predominantly as fat (fatHMF) would result in a higher (1) lean mass accretion (percent lean mass) and (2) growth (anthropometry), compared to fortifying with an isocaloric, isonitrogenous HMF containing NPE predominantly as carbohydrate (carbHMF). In a double-blind randomized trial, 29 infants (≤32 weeks and appropriate for gestational age) admitted to the Neonatal Intensive Care Unit received either mother's milk fortified with the fatHMF (n = 14) or the carbHMF (n = 15). Body composition and growth measurements were performed at Baseline (at ≤10% of goal intake 150 ml/kg), Phase 1, and Phase 2 (3 weeks and 6 weeks, respectively, from starting HMF). Although neither percent lean (fat) mass nor growth were statistically different, by Phase 2 infants receiving fatHMF showed a 63% increase in percent fat mass, gained 1194 g in weight and 8.8 cm in length, whereas the carbHMF showed a 96% increase in percent fat mass, gained 1005 g in weight and 6.9 cm in length (p = 0.3586, 0.3815, and 0.1851 respectively). By Phase 2, the fatHMF infants gained 128 g in absolute dry lean tissue, whereas the carbHMF infants gained 99 g (p = 0.0362, Post hoc analysis). Differences of this magnitude are clinically important, but a larger study is required to demonstrate statistical significance.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Biyokimya ve Klinik Biyokimya Anabilim Dalı, 2001. / Bibliyografya var.

Thesis (M.Sc. (Food and Nutrition for Development))--Mahidol University, 2007. / LICL has E-Thesis 0027 ; please contact computer services.

Maternal nutrition, breast milk micronutrients and infant growth in rural Gambia The World Health Organization recommends exclusive breastfeeding for the first six months of an infant’s life. However, the evidence base to support the adequacy of breast milk with respect to infant micronutrient status, across the duration of exclusive breastfeeding, among women who enter pregnancy and lactation with a poor nutritional status is limited. The research presented in this thesis explores the relationship between maternal nutritional status, breast milk micronutrients and infant status in a rural sub-Saharan context. Existing evidence for associations between maternal dietary intake and nutritional status and breast milk micronutrient composition were systematically reviewed. Most effected by maternal nutrition were breast milk water-soluble vitamin concentrations (except for folic acid), fat-soluble vitamin concentrations were less influenced, and mineral concentrations were generally unaffected (except for iodine and selenium). Next, the impact of feeding practice on infant growth in rural Gambia was explored. In this population, where growth faltering across the first two years of life is endemic, exclusive breastfeeding to six months of age had limited benefit on infant growth. Finally, the impact of maternal multiple micronutrient supplementation on breast milk iodine, thiamin, riboflavin, vitamin B6 and B12 was explored. Supplementation during pregnancy positively influenced maternal status for all investigated micronutrients, and modestly increased breast milk iodine and riboflavin concentrations across the first six months of lactation. No effects on breast milk concentrations of thiamin, vitamin B6 or B12, and limited effect on infant postpartum status, were observed. The research presented in this thesis suggests that concentrations of breast milk micronutrients may be insufficient in settings where maternal micronutrient status is poor, with likely consequences for infant health. This research supports the need for interventions to improve the nutritional status of pregnant and lactating women in resource-poor settings alongside the promotion of exclusive breastfeeding for optimal health outcomes for infants as well as their mothers.